Sanford Health Clinic President on The Way Forward

Luis Garcia, MD, FACS, MBA, FASMBS, shares strategies the rural health system has implemented in tackling current workforce shortages and issues.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below.

Luis Garcia, MD, FACS, MBA, FASMBS, who is a surgeon by training, serves as the president of Sanford Health Clinic, where he oversees governance, mergers and acquisitions, and overall clinical integration of the South Dakota-based health system's clinical division.

He has a passion for healthcare, which was introduced early in life by family, and has experience in the Mexico healthcare sector as well as the American healthcare sector.

This week, he will be speaking during a United Nations health forum in New York on strategies to address mental health challenges, strengthening resiliency, and improving health and wellbeing in communities worldwide.

In a recent podcast interview, Garcia shared insights into his personal and professional background and strategies that the health system has on tackling workforce issues. He also shared what he was excited to speak about during The Way Forward, a leadership summit recently hosted by HealthLeaders.

This transcript has been edited for clarity and brevity.

HealthLeaders: What does your career journey look like and how did you end up at Sanford Health?

Luis Garcia: My father is a surgeon by training; my mother was the CEO and CFO of my dad's practice. Since I can remember, I've been related to healthcare.

I grew up in a very poor community [in Mexico City], but thankfully, both my father and my mother were able to give us opportunities in life. I was able to go to a very reputable medical school in Mexico City, and as part of my training I did my last year of medical school at the University of Miami in the Latin American training program. That gave me the introduction of medicine in the United States.

Fast forward, I decided to apply for a surgical residency and ended up matching at the University of North Dakota, where I did my surgical training, and subsequently did a fellowship at the University of Pittsburgh Medical Center on advanced laparoscopic and bariatric surgery. After that I came back to the Midwest to Sanford Health to be employed.

As a native of Mexico City, people often ask me, 'Why did you choose North Dakota and South Dakota to stay working? Why did you choose Sanford Health?' To be honest, the reason why I decided to stay is because the Midwest offers a tremendous opportunity to have a good life. Our communities in general are safe communities; the people are just great. When it comes to Sanford Health, it's a phenomenal organization. The mission and the values of the organization are something that aligned with my personal values, and the relentless commitment that we have to bring the best care possible in the rural setting is something that was extremely attractive to me. As a surgeon, I lived that commitment and executed on that commitment for 20 years, and now as president of the clinic I get the privilege to lead and represent our group of clinicians in that same mission and commitment.

HL: How does your background as a surgeon help you lead as president?

Garcia: Sanford is one of the largest, if not the largest, fully integrated rural healthcare delivery systems [in the country]. The core of our clinical operations is in the states of North Dakota, South Dakota, and Minnesota. Our geographical footprint is about 250,000 square miles. We have 47 hospitals and over 300 clinics, and the medical group is a little bit short of 3,000 clinicians.

Now, I want you to think for a minute about the responsibility that takes to lead and represent 3,000 clinicians in a footprint of 250,000 square miles, with the commitment that we have to bring the best care in rural communities. Unquestionably, every day, we're dealing with situations of high stress and important decision making. As a surgeon, that's what I lived every day in the operating room; situations of high stress where you need to make decisions fast, and you need to think always about the impact that your decisions are going to have at the individual level or at the collective level.

But to be honest, in the position of leadership that I hold, titles don't matter. Whether you are a surgeon, a cardiologist, or family medicine doctor, that's not what matters. What matters is:

1. You understand the complexity of the business of medicine. The decisions that you make affect your clinicians, and they also affect the organization at large.

2. You need to understand the practice of medicine. The challenges of the different sectors of medicine are different, and you always need to take into consideration after you make a decision. How are you going to affect the workforce that you're representing?

3. The most important aspect is that you have to be empathetic and caring. Every day we make difficult decisions, but ultimately, we always need to make the right decision. And sometimes the right decision affects people. I always keep in mind that my responsibility is that commitment to our patients, to support our clinicians, and to bring the best out of the talent that we have inside Sanford.

HL: How is Sanford Health investing in clinician wellbeing programs and building recruitment pipelines?

Garcia: I would like to take this opportunity to thank everybody that has been involved in our industry, because in the last few years we have been tested to our limits and we have delivered, and that should be heavily recognized.

We have workforce challenges and shortages, just like any other industry, but it just so happens that in healthcare we cannot close doors. We cannot reduce the number of tables like a restaurant can. In healthcare we have the commitment and we have to honor that commitment of delivering care.

Our frontline workers are feeling overworked, they're feeling burnout. In the last couple of years, they've seen people dying that shouldn't have died, and they're feeling devalued. Part of what we are doing in Sanford is to engage our workforce, engage our nurses, our physicians, our APPs, and bring back that pride of being in healthcare. Our jobs in healthcare are very honorable jobs. We get to help people in the situations of greatest need for them. Our patients are trusting them with their lives and their health, which are the most valuable assets. And we get the privilege to change suffering into joy and to get them through very difficult moments. Part of what we're doing at Sanford is re-elevating the honor of being a healthcare professional.

How are we doing that? It's through internal support and looking at the future of medicine. When we talk about internal support, we are responsible for their clinical success. We look at all the aspects of running a practice and how we support them. We pay attention tremendously to treating our employees like humans and supporting them. We have developed comprehensive strategies internally to support them from the emotional standpoint, the financial standpoint, the legal standpoint, and to create a great experience to work in our facilities.

It's extremely difficult to recruit into the rural setting; we are at a disadvantage to start. One of the biggest strategies for us is to develop our own workforce, specifically physicians. Sanford Health has invested heavily in the last decade, and we will continue to invest, in graduate medical education. We're very proud of the relationships that we have with our academic organizations, the University of South Dakota and the University of North Dakota, and others. With that relationship, we've been able to develop training programs in different medical and surgical specialties that would allow us to develop our own pipeline of workforce. We know that the biggest predictor of a medical student or resident choosing a job is the place where they train, and because of that, we have invested heavily on that. Right now, Sanford has 18 residencies, some fellowships that we fund directly or indirectly. Our plan in the next decade is to develop eight to 10 more programs to satisfy that development of pipeline.

HL: You joined healthcare executives for The Way Forward, a leadership summit. What initiatives were you looking forward to sharing during the event?

Garcia: Right now in healthcare, we're being challenged to think about how we need to position ourselves in the industry, not in five or 10 [years], but in the next two or three decades, to make sure that our industry stays strong to deliver that care that we're asked to do.

Some of the topics that we're going to be engaging on is the cost of care, challenges with supply chain, how are we finding and managing operational efficiencies, workforce optimization, virtual care, and digital strategies.

We're looking forward to sharing our own experiences with other reputable organizations of things that we have done right. One of the things that Sanford Health is invested in the next two or three years is on a robust virtual health strategy and a digital strategy that would improve our patient experience, improve our workforce experience, and would allow us to continue to deliver that high quality of care in remote areas and using different tools that the traditional face to face interaction with patients.

It's a great time in healthcare where leaders are sharing opportunities of success and sharing instances in which we have failed to make sure that others capitalize on those opportunities.

Related: Healthcare Executives Discuss The Way Forward