In this conversation, Josh and I discuss how an interest in healthcare that peaked at an early age led him to a successful career. We also discuss the importance of communication in the OR and how some difficult conversations are necessary when you’re focused on the best patient outcomes.

Todd Schlosser: Thank you for joining me here on Scrubbing In. I’m Todd Schlosser and joining me today is neurophysiologist Josh Van Beverhoudt.

Van Beverhoudt: Van Beverhoudt, yup.

Todd Schlosser: Awesome. I like to start out all the podcast interviews with sort of a similar question just so we can gauge what brought everyone into health care, and we get a lot of different answers out of this question. It sorts of helps us find out how people derive their passion for what they do, so I’d like to start there. So what is it, if anything in your childhood or young adult life, that inspired you to move into the health care field?

Van Beverhoudt: I’ve always been interested in science and I guess, really, the first time I really found some type of passion for health care, or a health related type field, was in health class in high school, honestly.

Todd Schlosser: It wasn’t for me, either.

Van Beverhoudt: Well, no, well, so our health teacher wanted to do things a little differently. It was pretty much taught like an anatomy class. We had to memorize all the bones in the body.

Todd Schlosser: Oh, wow.

Van Beverhoudt: Pretty much, close to all the muscles in the body is a lot of muscles so, for some reason, I just kind of took to that task and I just memorized. I did very well on that exam and that course, but I just took to that. Just from there, when I got into college and I started pursuing, I looked at different fields, econ and everything but I just went back to that, just wanting to learn more about the human body and health care and medicine, and not just anatomy textbook, rather, but being able to explain the physiology and understand just physiology and medicine and so I just kind of gravitated towards that.

Todd Schlosser: So when you, I guess, were in college, what did you study for your Bachelor of Science, I imagine?

Van Beverhoudt: My Bachelor’s is in health sciences. Technically it’s health and exercise science. It’s kinesiology, essentially, so exercise physiology. I initially wanted to be a physical therapist, thought about medical school. I wasn’t really sure if I wanted to pursue physical therapy, but when I graduated I just knew I wanted to be in health care. I was kind of unsure about grad school and which direction to go down.

Todd Schlosser: Med school can be quite a commitment.

Van Beverhoudt: Yeah, absolutely.

Todd Schlosser: I mean, not that, what they do is important. I don’t mean to say that or disparage surgeons or medical doctors in that sense, but I do feel like what you guys do as a neurophysologist provides an immense amount of vale. So what is it that drove you to that field of neurophysiology? So you’ve got your Bachelor’s and, you know.

Van Beverhoudt: Yeah, health sciences. So my school didn’t have a neuroscience major at the time, but I took some neuroscience classes and I found that the nervous system, and neuroscience in particular, really peaked my interest. I took these courses pretty late in my college career, so I’m graduating and I’m like, that’s kind of the direction I want to go. How do I do that now at this point?

Van Beverhoudt: I actually kind of got lucky, in a way. When I graduated college I applied to just a bunch of jobs in health care to just kind of get my feet wet in the field while deciding what I wanted to do as far as grad school was concerned. I interviewed at Temple University for this job, to be a neurophysiologist, and I actually did not get the job my first interview.

Todd Schlosser: It happens to all of us.

Van Beverhoudt: Yeah. But, apparently, I interviewed really well. At that time, they weren’t looking to train anyone. They wanted someone with experience, so they kept my resume for a year, and a year later when a position opened up they called me. They wanted me to come back in for an interview, and they really wanted to train me. They wanted me the year before, but they just did need an immediate fill in that position, so they called me back and they trained me at Temple.

Todd Schlosser: Okay, so in that lag time for the year, you must have made quite the impression on your initial interview, to have that. That’s awesome.

Van Beverhoudt: I guess so.

Todd Schlosser: And it paid off because obviously you’ve been in the field for, I think you said 11 years, when we were talking before?

Van Beverhoudt: 11 years, yeah.

Todd Schlosser: So it paid off. Now when you, I guess, got into neurophysiology, when you started with that company, that’s when your training began, or did you have some training in that year in between your first interview and your being hired?

Van Beverhoudt: The person I interviewed with really encouraged me to look up the field and learn a little more about it, and such. At that time, in the meantime, I was a weight loss counselor. I took a job and I had that health science and exercise physiology background.

Todd Schlosser: May as well use the degree.

Van Beverhoudt: Right. So I was a weight loss counselor for a little while, and I knew that I wanted to do something else. I didn’t want to do that, so I drew on some of my other college health care experience, and I accepted a job reading and interpreting EKGs in a cardiac unit. I did that for a little while, and in the meantime I did learn more about neurophysiology, researched, looked at programs to go to. At that time there weren’t really a lot of established programs. This is about 2008. 2007-2008.

Todd Schlosser: It is a relatively new field.

Van Beverhoudt: Yeah. There are some programs now popping up, but back then there really weren’t many.

Todd Schlosser: It’s really the first field that I can think of in health care that is 100% digital. Perfusion is updating to digital now but it started in the ’30s, so it’s been in analog mode forever. Neurophysiology is really the first field that I know of in health care that was born in the digital era.

Van Beverhoudt: Yeah, for sure. And it’s kind crazy, you can speak to someone else in health care, maybe a nurse or something and they could be an OR nurse, but if they’ve never done any neurosurgery or worked on spine cases or any cases where neurophysiology’s involved, they have no idea who we are or what we do. So, right now, we’re kind of really getting out there a bit more and people know who we are and what we do. We’re called by many different names: neurophysiology, and-

Todd Schlosser: IONM.

Van Beverhoudt: IONM, yeah.

Todd Schlosser: ONM, and yeah.

Van Beverhoudt: One of our surgeons calls us NIMS.

Todd Schlosser: NIMS.

Van Beverhoudt: Right. NIMS monitoring. There’s a NIMS machine that you can use to monitor, so he just calls us like the machine, more or less. I take that as a compliment, I think, but-

Todd Schlosser: As long as you’re as accurate as the machine.

Van Beverhoudt: I try to be.

Todd Schlosser: So you get a call back a year later?

Van Beverhoudt: Right.

Todd Schlosser: And you start with that company.

Van Beverhoudt: I do, yeah. That company was an in-house program at Temple University, so I actually worked for the medical school, Temple University School of Medicine, covering surgeries at Temple University, and at Shriners Hospital. Going in there I worked with a great team of very experienced neurophysiologists who have been doing this for a while, and they all trained me pretty much on the job.

Todd Schlosser: Let me ask you about that. Was it like you got hired, day one, they bring you into the OR and say, “This is what it’s like to work in an operating room.”

Van Beverhoudt: Absolutely, yeah.

Todd Schlosser:  I mean, that could sort of be trial by fire, I’d imagine.

Van Beverhoudt: Oh, absolutely. They’ll learn very quickly if you can hack it or not.

Todd Schlosser: Or if you can handle just that setting, because it’s not like many other jobs. Not all of them are life and death situations, but you’re sort of seeing the patient on the worst day for them, and you’re helping them through that. Sp that’s incredibly high stakes, but also there’s compassion there that I find very appealing. But you weren’t nervous at all on that first day?

Van Beverhoudt: I mean, I didn’t show it.

Todd Schlosser: Or “What am I getting myself into?” Okay.

Van Beverhoudt: The person I interviewed with did actually take me into the OR during the interview. Sat down, had a face-to-face interview, and I guess the next step, he liked what he heard, and he said, “All right, well, we’re going across the street to the OR now.” I’m like, okay.

Todd Schlosser: Awesome, let’s do this.

Van Beverhoudt: Brought me in, let me see a surgery. It was a cervical surgery. He didn’t have me in there for long, but of course, I imagine he kind of assessed how this individual’s doing in this environment, just being in this environment, can they handle it, and how are they interacting with everyone. That’s a huge part of the job and the career, just talking to people and being able to talk to people competently and confidently.

Todd Schlosser: I imagine that’s huge, especially when you’re, and I’d imagine, when you were on Temple and you were finished with your training time period. I imagine that was sort of like a little hands-on at the beginning, and then they slowly let you do more and more and more while they watch you more and more and more, right? And then, eventually, you got to do cases on your own and you joined your own team. Is that how that works?

Van Beverhoudt: Well, yeah, really, one person really, really trained me, and I had a couple of other people on that team who trained me, but one person, he was very, very much hands on so, while some of the other people were like, “All right, it’s been three or four months. He knows how to do these types of surgeries. He’s good,” he would still kind of hover and make sure I was okay.

Todd Schlosser:  Hover and discover.

Van Beverhoudt:  Right, which I appreciated. I would probably say it was a solid six months, there to six months, before I was alone in the room. It was a great environment for me to learn in because if I had a problem, people were there on site. It was in-house team, so that was great. We didn’t always have a bunch of cases to do for everyone. Someone was usually available to go around and help out, so that was a great learning tool. So if I had a question, I could always call my boss or any one of my senior neurophysiologists. They’d come in and help me.

Todd Schlosser: That was before remote neuromonitoring was a thing, right?

Van Beverhoudt:  Absolutely, yeah.

Todd Schlosser:  So now, we have someone who’s doing that, like a Dr. Cohen, who’s at an office somewhere not even on site, but can help and dial in and help out, right?

Van Beverhoudt: Right. The remotes are great. It’s nice and they’re a nice stopgate, backstop rather, to help-

Todd Schlosser: But it really is your surgery. It’s your responsibility.

Van Beverhoudt:  Absolutely. And in the environment I trained in, too, without a remote, I really had to … it was my surgery. I had to communicate with the surgeon, and later on someone reviewed it. But, yeah, no remote back then.

Todd Schlosser: Let me ask you a few questions about that. So when you’re joining a surgery team, the surgeon’s the head of that team. You also have an anesthesiologist, perfusionist, perhaps, yourself as a neurophysiologist there.

Todd Schlosser:  As a neurophysiologist, if the surgeon’s doing something that is affecting the central nervous system and you see those signs, or it’s affecting certain modalities, it’s your responsibility to speak up and stop this surgeon who is highly skilled and highly trained. It’s your job to stop them from doing what they think is best because you have more information then they do because of what you can see. Is that a daunting conversation to have?

Van Beverhoudt: It can be. You kind of learn how to approach different surgeons, and just like being out in the world with anyone, you meet someone, you go in and introduce yourself to the surgeon if you don’t have an established relationship with that surgeon already. You can kind of assess how they feel about neurophysiology, and surgical monitoring, usually right away.

Van Beverhoudt: I’ve found if you are confident in what you see, and you have to remember, ultimately, everyone in that room is there for the patient, so the surgeon is doing his best or her best for that patient. If you see something troubling, all you can do is bring it to their attention, and have that conversation with the entire team, really, not just the surgeon, about what you think is going on, or ask them what they think is going on.

Todd Schlosser:  I guess, ultimately, it is their decision. It’s their team that they’re leading, so they want to take in all the information they can and make the best decision as a team leader. But I would imagine, and correct me if I’m wrong, most surgeons welcome that communication because they want to do what’s best for their patient.

Van Beverhoudt:  Nowadays, they do. Back when I started, not necessarily, and even now there are some surgeons out there who are a little hesitant to listen to this person sitting in a corner of the room. So, if you go in with confidence and you develop a good rapport with the surgeon and you pretty much show that you’re valuable, that you are also there for the patient, that you’re invested in the surgery and the procedure, and you’re invested in what the surgeon is doing. I usually, whenever I have to communicate with the surgeon, I will ask questions. I’ll say, “What are you doing now?”, or “What’s going on here, because I’m seeing this,” or “Dr. so-and-so, this just happened.”

Todd Schlosser:  What could have led to that?

Van Beverhoudt: Yeah, right.

Todd Schlosser:  It’s all in how you frame and position it, I suppose.

Van Beverhoudt: You also want to make sure that you have already done all your checks and balances before you approach the surgeon, with anesthesia and everything, because the surgeon’s going to ask, “Well, is it a technical issue? What have you done? What has gone on? What do you see?” So you can say, “I tried, A, B, C, D, E, F, everything. We’ve had these conversations with anesthesia, and this is what I’m seeing.”

Todd Schlosser:  Ultimately, you’re trying to prevent negative outcomes, and it’s not always the binary of alive-or-dead. It could be paralyzation, or partial paralyzation, or things like that. So, I mean, you’re just protecting those negative outcomes, which is ultimately good for the surgeon, and the patient, obviously, and the hospital as well.

Van Beverhoudt: Sure. Absolutely.

Todd Schlosser: So you’ve been in the IONM game for a while. You said 11 years. So how has the reception of IONM as a field, or neurophysiology as a field, changed since 2008 when you started?

Van Beverhoudt: In 2008, so where I trained I was fortunate enough to work with a lot of surgeons who respected what we did and why we were there. I was at Temple for about three years, so after I left I went to a company where I traveled around a bit, and so that’s when I really got to meet some surgeons who weren’t as receptive to us being in the room.

Van Beverhoudt:  Back then I would be told, “You’re here for medical-legal purposes only.” So pretty much, you’re in a corner, don’t say anything.

Todd Schlosser: “Don’t talk to me.”

Van Beverhoudt: Right. Of course, though, you still had that responsibility. If you do say something you have to say something. If you do see something rather, you have to say something.

Todd Schlosser:  It’s you’re responsibility.

Van Beverhoudt: Right. That has changed over time, and I think, with the quality of people doing this job, this career, they’re in this is field, especially a lot of people, especially people that I’ve met since I’ve been here, the training and the knowledge base that you can draw from from everyone, especially the [inaudible 00:16:01] team has been great.

Van Beverhoudt: So, over the years, I just haven’t always seen that knowledge base when I’ve come across other neurophysiologists but, like all fields, it has a way of weeding some of those people out. They find out it’s not for them.

Todd Schlosser: Or just change their perception of it.

Van Beverhoudt: Right. I’ve also gone into some surgeries where the surgeon is not very receptive to having us in the room, but I’ve worked with them, or some of my colleagues have worked with them, some people who are a little more competent and know what’s going on, who are invested in the surgery, and completely changed that mindset.

Van Beverhoudt: The field is growing rapidly, and there’s still some gray area on what is the best standard of practice as far as what do you monitor here, or what the modality should you do here, but over time there’s been a lot of meetings and collaborations and literature that’s been put out that has really helped.

Van Beverhoudt: I know when I started and I took my CNIM, my certification, there was no literature, there was no course work, really, out there. You kind of had to find some stuff, and now there’s courses and everything. I know SpecialtyCare has a great program.

Todd Schlosser: I know Julie Trott heads it up. [crosstalk 00:17:25]. She’s awesome.

Van Beverhoudt: Absolutely, yeah. When I came on board, I met her and I met the team and I was very impressed, actually.

Todd Schlosser:   Let me ask this final question in closing, if that’s all right.

Van Beverhoudt:  Of course.

Todd Schlosser: If you could give advice to someone who is just entering the field, or maybe hasn’t entered the field yet. They just have their degree in a medical science type field, and they’re thinking about neurophysiology as a path, what would advice would you give them?

Van Beverhoudt: I would say, ultimately, to really be passionate about what you’re doing. If you enter this field, and you’re going to know pretty quickly if it’s for you or not, if you enjoy it or not. You’re not going to enjoy every day. There are many days that I did not want to do this job. But the days that were rewarding outweighed those bad days, you know, for sure, so there’s going to be bad days.

Van Beverhoudt: But to really go forth confidently and to really put passion and drive and put forth to work to learn, especially to draw upon experience from other people who have been in the field for a while. I would say learn as much as you can because even if it doesn’t help you, even if you don’t stay in neurophysiology, it’ll help you if you decide to do something else.

Van Beverhoudt: It’s been a blessing for me, this field. Like I said, I fell into it, and the best thing I could have done was really just to kind of sit back and listen to the experience that other people have had. Also, once you do have some experience, don’t be too proud to ask for help. I ask for help from my manager or other people on my team, and some of these people I have been doing this longer than they have, but there’s no pride when it comes to … It’s what’s best for the patient. You shouldn’t be afraid to ask a question or to seek out help if you need, any time.

Todd Schlosser:  Well, thank you so much, Josh, for joining us here on Scrubbing In. I really appreciate it.

Van Beverhoudt:  Absolutely. Thanks for having me.

Todd Schlosser:  Absolutely.