The Health Pulse

MICHAEL SUK: It's that tension that exists between technology and humanity that has to be resolved, and we have to bridge the gap. I think that AI should amplify empathy, not automate it. And I think that's one of the things that I think is a critical pillar that needs to be enforced because the physician-patient relationship is sacred. It's not just something that should be optimized, and it shouldn't be optimized away.

SPEAKER: Dr. Michael Suk, practicing orthopedic surgeon, immediate past chair of the American Medical Association board of Trustees, and chair of the Board of Commissioners at the Joint Commission. He steps out of a health conference in Hawaii to give us his thoughts on all the latest health headlines. You have a current view of health and health through many lenses-- the American Medical Association side, Joint Commission, orthopedic surgeon. You have a legal background, supply chain executive. Has I made health better yet, or are we still a ways from feeling the future?

MICHAEL SUK: You know, Alex, thanks for that question. I believe that we are standing at the threshold but not yet at the destination. There's no question that AI has absolutely shown promise, especially in areas of medicine like radiology.

I think documentation assistance certainly is a big area that we're seeing today where it's impacting workflows, early diagnostic decision support. But at the end of the day, I think most people would agree that its potential is still very aspirational. And I think the tension that exists lies kind of in our systems, in the ecosystems in which we work.

I think AI is advancing much faster than our ability in health to safely and equitably integrate it. And so I often say that we're really good at building tools but not really great at deploying them, especially with any sense of wisdom. And until AI, I think, reduces friction at the bedside, supports better outcomes and enhances but doesn't replace the clinician patient relationship, I think we're still chasing the future. We're not quite there yet.

SPEAKER: You talked about workflows, and that makes me think workforce. There's certainly a lot of societal conversation about especially the clinician workforce. Physicians and care teams are burnt out.

You see the headlines that there's not great alignment with the incentives of modern day health care delivery and financing. Are you hearing something different on the ground? Is it better or worse than the headlines?

MICHAEL SUK: Unfortunately, in my belief, and I believe that the evidence supports it, I think it's worse. And I think what's happening now, it's not just burnout, but it's this question of moral injury, which is this idea that really puts physicians in the way of harm in the sense that they personalize many of the things that are occurring because they're trying to do the best that they can. I think a lot of physicians feel trapped in systems that don't necessarily reflect their values.

Physicians that I know and anyone who goes into medicine go into it with an idea and a purpose to heal. They aren't going into medicine, to code visits, to meet RVUs, or click through EMR screens. As I walk the halls as a surgeon and I sit in the boardrooms as a policymaker, that dichotomy gives me a real time sense of what's happening out there. And I know that physicians are still passionate about what they do, but I also know the exhaustion is very real.

SPEAKER: The tech industry, in the sort of broad sense, what can we do to make a difference in physician and nursing and administrator lives? Do you have some suggestions on a path forward? You mentioned there's a big miss in the technology that we design and the technology that we deploy.

MICHAEL SUK: Yeah, I think it's such an excellent question because in so much of what we do with the expansion of technology and its implementation in kind of the human interaction is that we tend to come up with solutions that we believe are good but in the real world circumstance sometimes miss the mark. And I would say the biggest thing we can do is start by listening. I think we have to empower clinical voices at the decision making table.

When we talk about things that would make sense in a corporate structure, it may not make sense in a health care structure. And so to redesign workflows, I think, depends on clinicians to give that input. And don't design it just for them, but allow them to have input on how they're actually being done. Fundamentally, we have to give back time. We have to give time back to the practice of the art of medicine and finally, I think, reward the really critical aspect of what it is to be a doctor, and that's the relationships, and reward relational care, not just transactional throughput.

I think that shift in incentives from volume to value, as many of us talk about now, it goes from volume to value. And then ultimately, I think the next step is to meaning. And I think that's essential.

SPEAKER: Volume to value to meaning-- I love that. You've coined a lot of terms during your time and have a few patents and things to show for it. There's a few graphs that I've seen floating on social media lately that seem consistent to pop up. The first one is the top employer in every state and how it has changed since 1990.

So it essentially shows a snapshot of 1990, then 2025. 1990, top employer was almost always hospitality, retail. 2025, almost every state, the top employer is a health care employer. The second one is the rise of administrators relative to the lack of physicians.

And so essentially, physicians per capita haven't risen since 1990, but administrators have exploded. The third one is overall health outcomes. So for the amount of employment we've put into it, the amount of investment we've put into it, we haven't got a rise in length of life, life expectancy, infant mortality, mental health rates. All are crashing a little bit.

So we haven't seen huge gains in these either. You're a pioneer in parks, nature, so the Parks Prescription Pass, nature as medicine. Does the answer to some of these solutions-- or some of the health problems that we've talked about, does it lie outside of health, or is it something that can be fixed structurally within?

MICHAEL SUK: Yeah, you know, Alex, you point out a really interesting synergy of statistics that are starting to come out, right? So we have a upcoming crisis or concern that we may not have enough physicians to take care of the population. But at the same time, you see in the dramatic rise of the number of administrators within health care. And we're talking tens of thousands of percent greater than what's happening in the physician workforce.

A lot of that has been self-designed and essentially self-driven by the quest for what I would say is standardizing, the quest for making things algorithmic in the name of value or in the name of better outcomes. And I think there's certainly a lot of room to play in that space, but I think we may have depersonalized it so much we don't know what-- the direction may be going in the wrong way. At the end of the day, I would say that we've medicalized way too much what are fundamentally social, behavioral, and environmental things.

As you know, I've long championed this idea that nature is a critical aspect of our lives. It's part of the topics that I talk about as a board-certified lifestyle medicine physician. It's a critical factor in terms of making sure that health is seen as a holistic and a humanistic thing and not just a transactional set of circumstances because at the end of the day, health begins where we live and where we work and where we play and not just where we see care. I think you and I have talked a lot about the idea that health is not something that you go and you pick up at the hospital, right?

It's not an episodic. It's a holistic. It's a lifetime. It's a health span concept.

And we can't just prescribe our way out of things like loneliness or nature deficits or poor nutrition or economic instability. Unfortunately, as much as physicians would love to do that, the health care system would try to do that, that's not the place where you seek those answers. And our clinical system is really excellent at rescue care at the end of the day.

As an orthopedic trauma surgeon, I pride myself on being able to deal and take care of patients who are at a critical point in their time, whether by injury, accident, or others. But at the end of the day, we do a great job about doing that, rescue care. But we're really poor at upstream investments. And I think that's where you're leading to. And so I think the next evolution in health is going to require us to expand our definition of health care itself.

SPEAKER: This episode is both audio and video, and I think it will be the one that people will want to watch. And so if you're listening to it, you're going to need to transfer over to the video side to see you practicing what you preach here. We really appreciate that answer.

All right, we've asked some of the tough questions about societal challenges in health care, about workforce. We'll get you to the speed round where you get a little bit of fun. So these are sort of quick, fast paced answers, first thing that comes to your mind. What's one place-- or maybe you're already there right now, but what's one place on your travel bucket list?

MICHAEL SUK: Well, that's a great question. I'd love to visit the Patagonia one day, maybe even the Antarctic. Places like that reflect kind of, in my mind, places that are raw, kind of remote and humbling at the same time.

SPEAKER: What's your favorite app on your phone?

MICHAEL SUK: On my phone? So the app that I've been playing a lot with lately is Gamma, Gamma.ai, which is a really interesting tool that can take text and concepts and turn it into really slick presentations and capture a lot of concepts and coordinate them in a way that would normally take me days or weeks. And I'm just fascinated how fast things can happen.

SPEAKER: Are you a morning or night person?

MICHAEL SUK: Definitely morning, as you can tell.

SPEAKER: It looks like--

MICHAEL SUK: I think my best ideas show up at sunrise.

SPEAKER: It looks like you've got both in this background. Mountain or beach?

MICHAEL SUK: I got a little bit of both. That's right.

SPEAKER: Which one if you have to choose?

MICHAEL SUK: Oh, I see. Whether I have to choose, I love both directly. But I think because I'm where I am, I'm going to pick beach.

SPEAKER: Books or movies?

MICHAEL SUK: Oh, I love both, actually. Books take me away. Movies are a great way to spend a couple hours outside of the day to day. But with books, at the end of the-- for me personally, I like to linger on sentences. I like to think deeply if something strikes me.

SPEAKER: These next two questions are intensely related. What's your favorite ice cream flavor?

MICHAEL SUK: I'm going to pick pistachio. Classic, but maybe a little underrated.

SPEAKER: The intensely related one is what's your go-to workout or exercise.

MICHAEL SUK: So I've really been enjoying my time playing a lot of golf. But if I'm going to do it for exercise, I really have a long time history of playing tennis. And to me, there's a mental game associated with the physical game.

SPEAKER: Wait, people can Google that and see how good you really were at tennis, right?

MICHAEL SUK: It's a decade-- decades ago. And when--

SPEAKER: The internet lives on.

MICHAEL SUK: Yeah, right.

SPEAKER: All right, two more hot seat questions. Of all the administrative fellows you trained at Guissinger, do you have a particular favorite?

MICHAEL SUK: Yes, there's one that stands out in my mind. He works at SAS in North Carolina. Oh, Alex. Hey, how are you?

SPEAKER: All right, all right. That was a paid promo.

MICHAEL SUK: Paid promo.

SPEAKER: Job you'd be doing if it wasn't the 12 jobs you already have.

MICHAEL SUK: Oh, I actually had a conversation with my daughter not long ago, and she's entering into a space that I probably would be if I wasn't doing what I'm doing, and that would be to be an architect. And I love designing systems with building, whether it's in buildings or in health.

SPEAKER: Really cool and really excited to see. I'm sure that'll come to fruition at some point here. Exciting.

So you're off the hot seat. We'll go back into societal health challenges, some of the hard ones. You were the first person to put in place a lifetime guarantee of total joint replacements.

MICHAEL SUK: Yeah.

SPEAKER: Is that somehow implied, if I went to get a knee replacement, hip replacement at some point in life, is that-- walk me through. What is the first and only of its kind warranty on health care? If it fails in me at another place, I have to go back and get it redone?

MICHAEL SUK: Yeah. So the history of the warranties, I think, started over a decade ago through some of the work that they were doing at Guissinger where I was-- where I've been proud to have been for a long time. And I will tell you that it started with the very simple question of what if we stood behind our surgical outcomes the same way other industries stood behind their products.

And we would then look at kind of the means of production and how we would find ways to tweak them in a way so that ultimately we could be very highly confident of the outcome. Underscoring all of this is the idea that the patient-physician relationship was a critical, foundational element because surgical episodes are based on partnerships. A surgeon will do the technical component of it, will provide the algorithms, conditions, and the technique in order to do it well.

The patient Bears a responsibility to be engaged, to follow up, to do their physical therapy, et cetera, et cetera. And so by establishing a compact between patient and physician, that's foundational to be able to say we can ultimately influence the outcomes that we know are positive. When we moved into the first version of this, it was a 90 day warranty. We said, hey, for 90 days if anything goes wrong, if you're in our health plan, if you are in our hospitals, and I'm the surgeon that did it, anything goes wrong, we'll take care of it.

It was Earth-shattering when we did 90 days. Shortly after that, I began to start wondering several things is we're picking on the episodes of care that tend to be fairly easy to regiment or at least put into place. And I say easy in the sense that a total knee, I think, or a total hip are procedures that have a pretty set, rigorous way to look at them, either pre-op, post-op, and interop. But then I began to ask the question.

What if we started doing things that are more difficult, right? And what if we started doing things that extended past 90 days? So we looked at a year and things. And so the big, hairy, audacious idea was, why not do it for a lifetime?

So for a lifetime, if the patients meet the conditions that they need to meet, if they enter into the compact with the physician and with the surgeon, and they agree to do the things that they need to do, for a lifetime, if they ever have a problem with that total joint, we'll take care of it because that is the guarantee that we're going to set. Now, we know that joints don't have a lifetime in terms of-- they will wear out and things.

But at the end of the day, we've now also created a brand new relationship with this patient that also lasts for a lifetime. And I think that investment is completely worth it. It brings the patient a sense that the health care team that's involved is truly invested in their care. And to date, nobody else has replicated what we've done.

And I believe that it's a bell that can't be unrung. And I would say that we've proven the results, and we have fewer complications, better outcomes with these patients, and certainly at a lower cost. So it's not just about accountability, as many people would say, as who's going to pay, but it's more about trust, and it's about faith in the people and the relationships that you have, which is, I think, underscoring many of the things I've already said is it's a fundamental belief that I have.

SPEAKER: So key to what you just said is exactly the trust and that physician-patient relationship and sort of contract that you have with each other. There's a lot of-- the other headlines are AI verse doctor, AI with doctor, AI-augmented doctors. You have big, bold predictions out there that surgery will be done by robots fairly soon and not, like, people guided robots-- by robots, robots. What's the tension in the way tech talks about health care and the physician-patient relationship.

MICHAEL SUK: Yeah, it relates back to that other conversation we had about what is it that tech companies can do to relate to the human side of medicine. I would say that the danger is believing that AI is going to replace the doctor, right? There's a lot of conversation. I saw a recent study that said that some large language model was able to diagnose things three times faster or more in-depth than a group of human doctors.

But the reality is that the best outcomes will come from AI-augmented physicians. It's not going to replace the physician. But here's the rub.

Technology companies often approach health as a data problem, and that's the approach they take, when physicians live it as a human problem. And so it's that tension that exists between technology and humanity that has to be resolved. And we have to bridge the gap.

I think that I should amplify empathy, not automate it. And I think that's one of the things that I think is a critical pillar that needs to be enforced because the physician-patient relationship is sacred. It's not just something that should be optimized, and it shouldn't be optimized away.

SPEAKER: You mentioned that you're already using AI. It's a favorite app on your phone. You're playing around with different tools and things. How much are you using it in your practice, and how, why, what excites you about it?

MICHAEL SUK: So yes, I do use in practice, I think from clinical decision support tools that are out there to help us in the workflow to determine the right code, et cetera, et cetera, with basic vernacular type of queries, to literature synthesis, platforms like Open Evidence, which is really hitting the headlines these days. So I think AI is quietly transforming how we access information for sure.

I think what excites me is the potential to curate this knowledge in real time, to personalize it to the patient that's sitting in front of me. I think that's the next step. And in the OR or in the clinic or even in the boardroom or in legal settings, AI, I think, is the silent partner that elevates our precision and hopefully our presence.

SPEAKER: You've been at the forefront your entire career. We've talked about some of the ways from parks passes to the surgical warranties. What's something that others are missing? What should we be talking about more? What's the next idea that you've got for this next decade?

MICHAEL SUK: I don't know if it's a truly Earth-shattering idea, but I think I like to articulate it in a way that hopefully resonates with people. We need to fundamentally re-imagine trust in health care. As you know, Alex, from your time we spent together, I always have two rules when I ever engage with anybody.

It's always assume good intentions, and you have to say what you want, not what you don't want. And that goes a long way in helping to establish a trusting relationship no matter what environment you're in. So I think trust is the through line, whether it's trust in artificial intelligence or augmented intelligence, trust in systems, or trust in leadership or even in the care itself.

And I believe the next decade is going to be defined by the term-- what I'll call the term radical relationality. It's a move toward personalized, maybe place-based and purpose-driven health. Think about it as a physicians guiding new partnerships.

And AI understands the values, not just vitals and systems, that reward presence and not just productivity. And so I think we're at a critical juncture right now where the economics of health drive us toward a very transactional viewpoint. And we've lost a lot over the last decades of what it means to have that human connection. And then maybe, just maybe, we'll remember that health, as we've talked about before, health is not just the absence of disease, but it's actually the presence of connection.

SPEAKER: From volume to value to meaning to advocating for physicians and the daily lives and workflows and how that can be augmented with technology, how technology can be a silent partner in those spaces, to how important the human relationship and trust is, both with each other and with technology-- what an incredible opportunity to learn from you. Dr. Suk, thank you so much for being here. And next time, we're going to be invited to where you are. So--

MICHAEL SUK: Yes, you come personally. We'll do an in-person interview next time.

SPEAKER: Yeah, next time in person. We'll choose your location.

MICHAEL SUK: All right. Thanks, Alex.

SPEAKER: If you agree that pistachio ice cream barely counts as a dessert or you'd like to leave a comment or join us as a guest, please email us, thehealthpulsepodcast@sas.com. Thanks so much for joining. See you next time.

Dr. Michael Suk, practicing orthopedic pa-- immediate past chair of the American Medical Assoc-- All right, yeah, that-- all right, I got this one.

Dr. Michael Suk, practicing orthopedic surgeon. I don't got this one. All right, you got something to play with here. Orthopedic surgeon, orthopedic physician? Is that-- that's not even a thing.