In March, Dr. Bill Vandivier was appointed chief physician executive and president of Mercy Clinics following a nationwide search. Vandivier joined Mercy in 2006 after a family practice residency at Broadlawns Medical Center. One of his first tasks at Mercy was to launch a family practice clinic at the hospital; he later helped to start Mercy Prairie Trail Clinic in Ankeny. For the past seven years he has split his time between family practice and leading the rollout of Mercy’s electronic health records system. In his new role, Vandivier will manage Mercy Clinics’ multi-specialty physician enterprise of more than 400 providers. He will provide strategic direction on physician enterprise activities, represent providers in organizational decisions, drive quality goals across the system and assist in integration with the statewide network.

What’s the role of the chief physician executive? 

Being the chief physician executive, I’m part of [Mercy President] Karl Keeler’s leadership council and I’m trying to work through some of the issues [related to] ambulatory growth versus hospital need. … The days of having the systems be completely separate are gone, because with how health care is moving forward and the challenges of Medicare reimbursement if we’re not really working together, we’re not going to be able keep providing cutting-edge care. 

I’m here to serve the community and I’m here to serve the docs. So it’s just a privilege to have the opportunity to try to design a system that will improve care across all of Iowa. That’s how I approach the job — developing the system that supports the patients; being part of the system rather than top-down. 

How did you become involved in implementing electronic health records? 

I didn’t ever have an IT degree, but I used to hack computers for fun, so I understood program logic. As we went to an electronic health record, there was a lot of pushing people over the cliff and getting things going and not really [recognizing] all the function the program could have. So I really spoke up and challenged the docs to have a voice. Because of what I did, [Mercy’s parent organization, Catholic Health Initiatives] stopped their implementation and started to do some fixes to the system. And so [former Mercy CEO] Dave Vellinga said, “The docs believe in you because of what you did; we need you to get involved in this electronic health record thing.” … During a very tumultuous time, I have now spent time with over 300 of our providers to talk about the EHR, how the system works, how we can help them, how they can set up their system so it’s more streamlined for them. 

What’s the current consensus about electronic health records? 

Most electronic systems around started out as billing systems — to capture documentation for billing. As most people [adopted] electronic health records, there were a lot of [government mandates involving “meaningful use”]. Well, it helped us to get to an electronic health record, but it stopped development because every vendor had to meet these criteria. So they didn’t pay attention to you as a user to ask, “Is this usable?” … Within the next five to seven years, I think you’ll see a very usable product, but it’s being designed off of the sweat and frustration of the docs and staff right now. 

How would you assess overall physician satisfaction currently? 

If you look nationally, the job satisfaction rate in being a physician has dropped significantly over the last seven years, which is the same time frame as electronic health records. The burnout rate is going up. We have people who are retiring earlier than they used to. Docs used to work until 70, 72 because they enjoyed the work. Now because of all the other work being added to them, they’re retiring earlier. So it creates a support issue for the system: How do we focus on delivering the best care we absolutely can, and do it efficiently so we’re not burdening the providers with tasks they really don’t need to be doing?  

How do physician shortages affect Mercy Clinics? 

It’s significant. The odd part is that specialty is sometimes easier to recruit than primary care and the nurses, because you have more and more people going into specialty [areas] after training. So primary care in general is in a shortage, and in Iowa it’s a significant shortage. Des Moines is a great place and it’s one of the best places in the country to practice medicine … but there’s a lot of folks that don’t know Iowa, so it’s hard to get them here. 

Has mental health access through the primary care clinics improved? 

There are a couple of things we’ve put in place. We have an embedded psychiatrist who works with some social workers and nurse practitioners, and we’ve created a consultative clinic for family practice. What we do with her and her team is when we have some difficult patients in family practice, we consult with them and weigh in on the meds and treatment. [The social workers also get involved.] And a fair amount of our family practice doctors have also taken the time to own a lot more of the psych stuff over time — [basic cases are] getting a lot more comfortable [for them]. 

The challenge I’ve got right now as we’re building a 100-bed psychiatric hospital, which is fantastic, but what’s our ambulatory answer to that? If 50 percent of our discharges are within the city, we don’t have enough ambulatory docs to take care of all those patients we’re going to discharge. It’s still two years out, but we’ve got to be thinking about that now because if you’re thinking about recruiting and building outpatient [clinic] services … we’ve got to make sure we’re ready to do that as well.

What are other key issues you’re focusing on? 

As I look at what we need to be in the future, [Mercy Health Network’s] vision is that we need to be radically convenient and offer world-class care. What that means is we have to change some thought processes in how medicine is practiced. As doctors, we can sometimes be over-controlling of our schedule because we want to make sure our day runs smoothly all the time. That can sometimes mean access issues getting in to see the docs. But that isn’t patient-focused; it’s doc-focused. So we have to get [doctors] comfortable and reassure them that we can do open access, so we can get patients in the same day, all the time. That comes back to getting some of those menial tasks off of docs so they can focus on care. 

What drives you as a person? 

What drives me as a person is building relationships, creating partnerships and really developing people. As a doc, I was someone who really wanted to educate and make patients understand what’s going on, because the more you do that, the more they buy in. 

How do you recharge? 

I am avid motorcyclist; I’ve been riding since I was 5. I take motorcycle trips to get away because you can’t do cellphones [on a bike] or you’re in the middle of nowhere. I’ve been teaching motorcycle safety for 24 years. My favorite ride is probably through the Big Horn Mountains in Wyoming. … There’s just something about the Big Horns that’s just kind of the perfect mix — you’ve got some fast roads, you’ve got some beautiful mountains, you’ve got some great wildlife. It’s just a great place.  

What are you reading lately? 

The un-fun part of that, I’m reading a bunch of finance books right now because I’m trying to learn all that with the new job. I’ve been a big Stephen Hunter fan for a lot of years. Just reading a lot of leadership stuff right now, trying to figure out how to reorganize and drive some meaningful change.  n