Dr. Badia is a hand and upper limb surgeon. He studied physiology and medicine at Cornell University and NYU. He completed a hand fellowship in Pittsburgh. He is the creator and founder of the Badia Hand to Shoulder Center in Miami. He is also the Founder and Chief Medical Officer of OrthoNOW in Miami.
Dr. Badia has a passion for making US healthcare more cost-effective, and raises awareness on this matter in his book: ‘Healthcare From the Trenches’ and podcast: ‘Fixing Healthcare…From the trenches.’
Could you give me a backstory on your career?
I’m an orthopaedic surgeon, next year will be 30 years since I started. I went to medical school in New York City, I trained at NYU. Before that, I spent four years at Cornell I did my undergraduate work in physiology and after my residency, I went to Pittsburgh to do a hand fellowship. At that time, it was one of only 4 fellowships that was hand to upper extremity which is now common place. Then I went to Europe and I highly recommend that to all students, to travel, because you get another perspective of the healthcare system, techniques and philosophies. I came to Miami because I am of Cuban origin. I was born in Havana. I grew up in New Jersey and I came to Miami because I wanted the Latin influence and I'm also a big water person. One of the things I've been able to do here because of the location and the culture is I have a very international practice: I've had some patients from Asia, and somebody just wrote to me from Australia.
It's all outside the hospital so for people who are reading, understand that to me healthcare doesn't mean in-hospital care we need hospitals of course but I've been a big proponent of being more cost-effective it's also more pleasant for patients. All the surgery I've been doing for the last 12 years have been in a very specialised ambulatory surgery centre. I started an orthopaedic walk-in centre network, so I think the physicians also have to be a little bit entrepreneurial to keep our place in the healthcare system because the business people will eat us up. They're much savvier at this, we're so focused on our patients - as we should be - but we also have to keep an eye on the business of medicine and making sure that you know that our patients get the best care because that's what our priority is.
What made you decide to do medicine?
I have a book and a podcast called ‘Healthcare From the Trenches’ and in the very first page, I talk about the fact that when I was 8 years old with my paternal grandmother, we went to see a hand surgeon in New York. She had crippling rheumatoid arthritis, the typical rheumatoid deformity with what we call ulnar drift fingers, she couldn’t open her hand. I was very close to her and I think really that day crystallised my decision. When I was younger, I liked dinosaurs and I realised it is hard to make money in archaeology and palaeontology. I like veterinary medicine but I really like working with people so really since I was 8 years old, I've been very focused, not just being a physician but for whatever reason, I wanted to be a surgeon.
What would you say you like most about your job and why?
I think that my specialty is very diverse and it's ironic because people particularly in Miami, with the culture here, people think 'surgeon' means cosmetic or plastic. But what I like about it actually is that it's so incredibly diverse. Every day I see different things, which is hard in a lot of specialties. We are the vascular surgeons of the upper limb, we are the orthopaedic, we are plastic surgeons, we are the neurosurgeons, peripheral nerve surgeons. We are the paediatric and congenital, we are the arthritis and reconstructive surgeons. I treat this gambit of people, males, females, kids, older people. That, to me, is what is gratifying about my specialty.
What is most challenging about being a doctor?
Finding balance in your life. I think people around you who don't understand medicine find it hard to understand the dedication to it. It’s one of the few fields where there's lifelong learning. Next week I'll be in Paris, I'm lecturing at my third meeting in a row and so people think "are you being paid for that?" Well no, you know, in fact we lose income when we go to a conference all doctors lose money, especially if they're in private practice. Doctors like me, there are still plenty of us or in traditional private practice in the US, we have bills to pay, we have staff, we have overhead, we have unfortunately medical malpractice in many cases, all those things keep going and then when you leave to attend a conference to better yourself for your patients, you lose a lot of money. I think most of us are not not driven primarily by the money I don't think you can go to college, medical school, residency, fellowship - for me, it was 14 years, you don't do it primarily for the money. You make a good living although even that's being very much challenged in today's climate, but at least you're doing something very fulfilling.
You have a book, and a podcast, where you express your opinions about the US healthcare system. For those who aren’t familiar with it, what is different about it from other countries, and what are the main issues with it?
Many countries have some type of socialised program and I travelled enough and I've also read the best books on this topic by author T.R. Reid. He wrote a book called ‘The Healing of America.’ It talks about a guy with shoulder pain which I treat and he went to a big famous hospital in New York City and he talked about doing the shoulder replacement because his shoulder was very arthritic then he went to India, France, Japan, England I believe, he went to about 8 or 9 countries and he talks about his experience in each of those.
What I will say is that the American spirit of entrepreneurism is something that would have difficulty adopting a, for example, Canadian healthcare system. There are many good doctors in Canada but you know what? If you have shoulder pain and you need an MRI, you wait on average about 10 months in Canada. In my centre, you might wait 10 minutes, and Americans are used to this. The problem is, people traditionally haven't wanted to spend money, they think that the government or the state will take care of them. To some degree, it's true, in the US we have Medicare so once you're 65, you get pretty good care. The problem is that technology has exploded so much and healthcare is more expensive and I think that at some point, people have to understand that they have to contribute a bit to those costs. I don't have the solution, I wish I had. One of the systems that I really respect is the healthcare system in France, there's a lot of positives. What we can do in the US is to take this and that from other systems. The problem here is that again because the United States is such an entrepreneurial business focused nation. There are what I call ‘opportunists.’ There is a whole chapter in my book called ‘opportunists in healthcare.’ I get emails every day from people who make money by not even doing the billing - there's other companies for that - they just help optimise the billing. I'm thinking well if I do a surgery, it's pretty straightforward. I do a surgery, here's the bill, and I am expecting the insurance company or the patient to pay. There are all these people in the middle, which I call ‘middlemen,’ and they literally suck money out of the system. They're not contributing really anything, I mean they have no medical knowledge. So the question is, in our society, how can we start to minimise these people? There's just way too many of them, and many of them make more than the doctors. There's something really really wrong about that.
Something you do on your podcast is ask your guests for initiatives and you give 3 of your own initiatives. What 3 initiatives would you take to start fixing the system?
Mine are the same every week cause I want to be consistent. The first we mentioned is to minimise the middleman. The other thing is we need oversight as physicians, not authorisation. Authorisation means that every decision I make, there's somebody at a desk in an insurance company somewhere, who has to approve or authorise it. It’s really a ridiculous concept. They don’t even understand what they are approving. It’s just set up as a barrier. What the public needs to understand is that those barriers cost money. That person sitting at the desk has a salary and ironically insurance benefits. It also slows the process. For many things in healthcare, the more efficient you can make it, usually the better outcome. If you treat things early, it’s better, and if you treat things efficiently, it’s going to be more cost effective. The last one is what we’re doing here - public education. Public education is critical. I really think the public needs to understand. When are people going to wake up and realise there is terrible injustice going on now with how healthcare is being delivered in the US. This is important because healthcare takes up 20% of our GDP. We’re 100% more expensive than the next country.
Could you explain why you started your 2 projects? What is the backstory? Why do people need to take an interest on the topics?
Healthcare affects everybody. Ultimately we all need physicians and nurses and technicians, so it is an important issue. Especially as you get older or if you happen to have a chronic illness. On top of that, it affects the economy in a big way. If we can make healthcare more cost-effective, there’s all this money left over to now put into, for example, education. People are always complaining about how the education system doesn’t get enough money, and teachers aren’t paid enough. They’re not. But that’s because there is so much money being put into healthcare. I saw how people were coming to me, and the average person for wrist pain has seen 3 or 4 doctors. None of those doctors really knew much about the wrist, but yet they took money out of the system. I think the public needs to understand that we need to deliver healthcare in a different way. The only way I can do that is try to convey this to the public through a book. After that, there was enough interest in it so I started a podcast. Podcasts are how, especially younger people, are learning a lot. Right now, my project is to get an audiobook version. Again, I realised that a lot of younger people don’t read as much but they like audiobooks. The whole goal of these things is to strictly inform the public. This is a passion I have that can help people. This is my way of giving back to society.
Learn more about Dr. Badia's 'Fixing Healthcare From The Trenches':
Do you have any advice for people in my situation? Is there anything you wish you would have known at my age?
I have one very good piece of advice that I wish I had thought about, wish I was exposed to. It is to take a basic business course. I could go into the need for research, especially if trying to get into a competitive specialty, but I think the one thing that can help everybody, is to take a business course. We as physicians get taken advantage of by business people because they know we don’t know a lot about business.
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