The Shift: Dr. Tad Jacobs
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SDPB's Kealey Bultena was in Sioux Falls with Dr. Tad Jacobs from Avera for a conversation about how healthcare systems strive to meet the increasingly specialized needs of growing populations. 

Interview Highlights:

On watching the changes in the healthcare systems of South Dakota:

I started my clinical practice in 1982 in Flandreau. In fact, I still live on the farm up there. It's been an interesting journey for me. I spent 28 years actually in family practice in Flandreau and then began a transition initially in the informatics world with electronic records. Telemedicine, we started experiments in telemedicine back in 1993, actually. It's amazing where that's gone today. We can talk about that a little later, and then eventually becoming more involved with Avera as a system and with the medical group.

It's been an interesting transition for me, being on the rural country doc side and what the needs are there and then being involved and seeing what's involved at the system level as things change across South Dakota.

What healthcare in South Dakota looks like today at Avera:

We're blessed in the state to have, I think, wonderful healthcare. I think our organization is driven by our mission. It's driven by the Sisters, so a big part of that was a commitment. That's what brought them here originally was a commitment to rural America and bringing healthcare throughout the entire state, including those smaller areas.

As time has gone on, there's continued to be that focus in those smaller towns, and we could talk a little about different things that we've done out there, but now the shift in populations that we're talking about that's happening in those rural areas, coming to Sioux Falls, the growth of Sioux Falls pretty dramatically and other regional centers, you've got to rethink some of the things that you're doing in healthcare.

I think back to when I started back in the early 80s. We had subspecialists here in Sioux Falls, but we didn't have nearly the subspecialists that we have now, so it's been the growth of those systems throughout our state that's been allowed to bring really quality people in very technical specialties. To think that we're doing transplants in our state, liver transplants now, is pretty amazing. We couldn't have said that a year ago, let alone two decades ago, so we're bringing in specialty care that probably we wouldn't be seeing in this state otherwise.


Maybe I take for granted that specialty care because I haven't been involved in medicine for decades, and I talk about it, but I don't work in it every day, so what you're saying is, when we're talking about innovation and technology, we're also talking about really bringing people here in ways that we couldn't have more recently.

On the use of telemedicine in South Dakota:

It's like Skype, except that you're really able to see detail. We have specialized cameras. We have stethoscopes. We have otoscopes. We have various technical tools that we can use. The days of not being able to connect in that fashion are gone. That allows us to bring specialists into those rural areas without necessarily traveling away from Sioux Falls, let's say for example. That's really changed the game. I'll tell you, when you're a rural family practice doc, especially in some of these isolated areas, I'll tell you, you can feel a little isolated. You can feel alone, so being able to connect with those people have really changed the game for those providers.

Sometimes, some specialists, actually we will transport here, we will fly him here or whatever in certain instances. In other instances, we can connect with them virtually, so that's kind of a virtual consult. I think it's ... One of our terms that we looked ... Everybody wants access, so a lot of what you're seeing, especially in the Sioux Falls market right now, is how do we improve access to patients?

One of our key things that we're looking at right now is that access without affordability is not very good access. I think, as the market changes and as consumers really are becoming more engaged in their healthcare, they're very savvy in terms of what things cost, so being able to do lower cost types of things like virtual medicine, I think, continues to grow in the future.

It's all about severity. If I would go online with you right now and you said, "You know, I'm having crushing chest pain," I'm not probably going to consider to continue the conversation long. I'm going to say, "Somebody call 9-1-1-." I think a lot of the success of virtual care is the comfort level of, not only who's doing it on this end, but then the comfort level of the people that are on the other end.

As we've done this over the years, that connection, whether it's a physician connecting on the other end, as it might be in the emergency room, or if it's the nurses or an aide that's actually involved, there's a lot of trust and a lot of sharing of information that occurs between those folks that make that just a lot more comfortable encounter than you might think. You're right. At times, you can't do everything there, and it's time to go to a regional center.


On how to keep healthcare personal while working within a large health system:

It's one of those things that, when you go into medicine, or healthcare in general ... I won't just say physicians because it applies to nursing, it applies to everybody who's involved in the business. You go into the business primarily because you want to take care of people, because you care about people. Even though there's all of this stuff going around, all of the governmental, the regulations, the paperwork, the EMR, all those things around, when you go in the room and you close the door, it's still just you and the patient that are there. That relationship is really what we, as caregivers, that's what drives us day in, day out.

It's not hard to really reinforce that to our medical group to say, "That's the most important thing. It's about the patients that we're seeing." We do things to try to help improve service excellence and customer service and all that type of thing, but still you're dealing with a population of people that really do care.Kealey:

On recruiting health professionals to South Dakota:

It has been amazing to me. We've got a recruitment team at Avera that's been remarkable in being able to recruit talent. One of the things that we do that might just be a little different is that, when we interview folks very early, we spend a lot of time talking to them about the mission of the organization. We want to make sure that they understand it's well beyond the walls of Avera McKennan.

Let's say it's extending out into the most remote areas of our state, so we want them to understand that mission. We often try to get them out into those locations so that they can see those pieces, and then part of the interview committee when they come in is actually a person who's a part of our mission group. They explain that to the applicant so that they understand that there's a greater purpose to what we're doing here. I think that attracts the right talent.

Listen to the entire conversation here.