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Sr. VP of Medical Education and Research, Methodist Le Bonheur Healthcare

Straight out of a Norman Rockwell painting in rural Kentucky, circa 1950’s, a country doctor takes his grandson with him on house calls. The child watches the caring, healing nature of his grandfather as he pulls out his black medicine bag to treat his patients. A seed is planted and the young boy is instilled with a yearning to study medicine, continuing the legacy of his father and his late grandfather, E. W. Miller, MD, of Hazel, Ky.

The days of the country doctor are long gone but the young boy who was influenced by his grandfather embraced his education and training to become a modern physician. Stephen Thomas Miller remembers his grandfather’s commitment and engagement with the community – the characteristics that he attributes for engendering his desire to become a physician.

While working in a research lab in college, Miller was mentored by a University of Kentucky professor, a graduate of Johns Hopkins, who encouraged him to apply to med school. With his aptitude in science, it was a natural match. Though many role models influenced him as he studied medicine, he credits John Runyan, MD, legendary leader in internal medicine, with exercising a powerful influence on his thinking in terms of designing a system that cares for patients independent of ability to pay. Complications from a chronic disease like hypertension, stroke and kidney disease are preventable and there are simple, straightforward interventions. This led Miller to Memphis to collaborate with Runyan with a focus on preventive intervention. Ultimately, Miller envisions the creation of a “medical home” environment and an interdisciplinary team that takes care of the individual as a whole, unique human being, regardless of ability to pay.

Miller is senior vice-president of medical education and research at Methodist Le Bonheur Healthcare and a professor of medicine at the UTHSC. His C.V. encompasses leadership positions in graduate medical education (GME), the ACP, the internal medicine and geriatric societies, ABIM, AMA, TMA and MMS. He has authored peer-reviewed journal publications and received many distinguished awards from various organizations, appointments at UT and Methodist Healthcare, and has had a research career and practice focused on hypertension, management of chronic diseases and geriatrics.



What were the challenges in developing the Methodist Teaching Practice (MTP) and is it a model for the future?

The MTP brings learners and teachers (faculty) together. It was designed to be a “real world model,” not an artificial clinic situation, so people feel as if they belong to a clinical unit that is focused not only on patient care but also on learning.

We did not invent the concept. But Methodist deserves great credit for funding it and it is their charitable purpose that enables us to operate. Otherwise, we could not treat a large number of uninsured or underinsured people. Bank presidents and the homeless are all treated the same.



What are the goals for the Methodist Teaching Practice? How will it change as a result of healthcare reform?

· We are embracing the concept of the team management for patients. Assigning the proper roles and making sure nothing falls through the cracks is a challenge.

· We are going to a paperless system. We want to be in the forefront on the electronic record, offering a demo for any physician interested.

· We are working with Mike Cates at the MMS and Renee Frazier at Healthy Memphis Common Table: the Aligning Forces for Quality initiative. We’ve focused on creating a “multiple payer medical home strategy.” The establishment of a functional medical home as a teaching entity is a major goal for us but the devil is in the details.

We’re a home in a clinical sense but to make it certifiable, you must be electronic. We need registries of patients, quality reporting, and electronic prescribing, all of which are part of the medical home.



Can you discuss your current research sponsored by the National Institute on Aging – CMS Non-payment for Nosocomial Injury and Risk of Falls in Hospitals?

A few years ago we began to look at why people fell, the impact of meds and the assessment of that. Falls have decreased in hospitals but it is still an important concern for elderly people both in and outside the hospital. In terms of patient and provider education, how to prevent falls is an ongoing concern.

With geriatrics you can’t “fix” things. But you can create an environment where people have physical therapy, medical alerts, and surveillance and are not placed on treatment/meds which would make things worse. Creating the right “home” environment is an increasing concern for the future as our population grows.



What initiatives have been developed to address the physician shortage in primary care?

In healthcare reform, dollars have been allocated to have more community-based education. For example, Christ Community Health Services is working on programs which will meet the needs of the populations we serve. As medical homes are established in patient care areas, they will be emulated in educational models.



How do you feel about physicians like your grandfather - will they be able to sustain a practice in the current environment?

I think that the infrastructure and the coordination required to practice medicine in the future requires you to be part of an organization. No one can keep up with the complexities of clinical medicine, the new knowledge, the need for communications and the technology, plus handling the financial aspects of practice. You must be part of a team.

I’ve witnessed major changes in medicine since my residency. I think we are having an earthquake of change. We don’t know the extent of the change but it is major.



If you could wave a magic wand, what would you change from the standpoint of the provision of quality and effective care?

To have people realize they are the real doctors of their health. Doctors often end up being “wreck repair” physicians. Accepting responsibility for one’s health needs to start in the schools and to permeate throughout the educational and public health system. Don’t neglect your health with the mindset that someone can fix it. Medications and technology can keep people alive but can’t restore the health lost because they didn’t take care of themselves.



How is healthcare reform likely to impact graduate medical education and the number of physicians in the future?

The big issue in healthcare reform is “what are we going to do about primary care?” Over the past decade, it has become less attractive, partially due to GME placing less emphasis on primary care. So much of GME is conducted in hospitals, which requires the best subspecialty care. Residents are exposed to the need for technology and subspecialty expertise; they don’t get the exposure I got from my grandfather. How to address that is a major issue in reform – moving to a more equitable distribution of needs in the community.

The other major issue is that not all primary care will be provided by physicians. We have moved from the one-on-one doctor/patient encounter to the medical home/team concept. The focus of medical education should be “How do you teach people to work in this type of environment?”



Are you concerned at the prospect of fewer patients seeing a primary care physician with the new medical home model? What does this mean from a risk management perspective?

The medical home will substitute great quality of patient care services, including telephone and e-mails, for quantity of visits to the office. The challenge for medical education is to make certain that the correct professionals, doctors and others are prepared to advance these new services.



What pearls of wisdom do you have for prospective physicians/residents in training about the practice of medicine?

Do what you enjoy. Don’t try to guess what the future holds with respect to healthcare reform and financing – do what is professionally fulfilling.



What achievements or accomplishments are you most proud of in your career and personally?

My family has been supportive. My wife, Wendy, has permitted me to work long hours and to pursue my interests. I brought her to Memphis from the D.C. area. I have two career minded children. My son is an internist in Wilmington, N.C., and my daughter is regional manager of Chanel, New York. My Mom still lives in her Kentucky home at the age of 91.

The other thing that has been unexpected – but wonderful – is the recognition by my peers. Last year I received the Leadership Award of the Society of General Internal Medicine and the ACP Laureate Award. And I have been notified that I will receive the Master of the American College of Physicians designation in April this spring.



What do you do for fun?

I’m part of a physicians’ book club. We read literature and reflect on what it means to us as clinicians. The subject of our last book was what it means to be an immigrant - the impact it has on one’s thinking and behavior in society.

And now, thanks to the new Greenway and the bridge across the Wolf River, I can ride my bicycle from my house to Shelby Farms!



What are your reflections on your career?

I wouldn’t be able to do anything educationally and clinically without the support of Methodist Healthcare. Their willingness to provide us with resources for education is much appreciated with special thanks to Gary Shorb and Kevin Spiegel and Maurice Elliott, CEO Emeritus. That support is essential – nothing can happen at the clinical level without visionary leadership.

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MD Methodist Teaching Practice Methodist Healthcare University of Tenne, MD Stephen Miller, MD Steve Miller, Stephen T. Miller

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