In this conversation, Sam and I discuss what sparked his interest in healthcare, how his career has progressed as a clinician and leader in IONM, and the importance education plays in making surgery safer.

Announcer: Bringing you conversations with leaders within the operating room and healthcare community. This is Scrubbing In.

Todd Schlosser: Hello and welcome to this episode of Scrubbing In, a podcast powered by Specialty Care. I am Todd Schlosser and today my guest is Sam Johnson, Director of Operations for Intraoperative Neuromonitoring at Specialty Care. In this conversation, Sam and I discuss what initially drew him to a career in healthcare, how he progressed his career as a clinician and now a leader in IONM, and the importance education plays in making surgery safer. Enjoy the conversation.

 So Sam, I like to start out by asking a very similar question to all the people that are on the show, and that is, what was it initially that drew you to want to work in the healthcare field?

Sam Johnson: That’s a long-winded conversation. We could be there all night for that, but I’ll try to be as succinct as I can with that. My undergrad was in education, actually, music.

Todd Schlosser: Really?

Sam Johnson: Yeah. So I had aspirations of being a jazz musician when I first started out.

Todd Schlosser: What did you play?

Sam Johnson: Piano.

Todd Schlosser: Awesome.

Sam Johnson: Yeah. And was pretty decent.

Todd Schlosser:  You’d have to be to play jazz.

Sam Johnson: Yeah. Yeah. Pretty decent coming from New Orleans, Louisiana, so definitely was something I was aspiring to, and took some classes later on when I got to be a senior to really start getting serious about my career, and I really felt that I wanted to get something that was a little bit more solid, little bit more predictable, so to speak.

  Took some classes, took physics and got exposed to the profession of audiology from that. And so before even graduating from my undergrad, I knew immediately that I wanted to enroll in the audiology program, and start a career as an allied health professional at that point, and I was fortunate because audiology is the science of hearing and hearing impairment, but what most people don’t realize is that audiology was one of the pioneering professions that really helped to start the foundations of intraoperative monitoring. Some of the grandfathers of intraoperative monitoring were audiologists.

Todd Schlosser: Really?

Sam Johnson: Yeah. So when I started the program, the program that I went to at Harvard University, it was one of the few programs that actually had a track in intraoperative monitoring. So when I graduated with my graduate degree in audiology, I had a foundational understanding. I couldn’t monitor a case on my own, but I had a foundational understanding of monitoring and so I was really, really excited about it. I worked in the traditional audiology setting for a few years.

Todd Schlosser: Yeah, I saw that in your … I did some light stalking, as I told you today, on your LinkedIn, and some things that have been written. And I noticed that you started out in audiology-

Sam Johnson: Correct.

Todd Schlosser: … and did that for roughly three years or so from ’98 to 2001, something like that. And then you sort of made the switch to neurophysiology.

Sam Johnson: Correct.

Todd Schlosser: What was it that facilitated that switch, which I think you were sort of getting to in your story? What caused you to change from audiology to

Sam Johnson: Well, audiology was changing or going through a transition right when I came on the scene. We had a lot of diagnostic tests that were very, very sexy, very, very unique that really test for cytolysins and try to determine tumors and so forth within the brain. Those tests with very high level, very sexy, but imaging and the technology that arose out of imaging, really kind of made those tests be obsolete. It wasn’t as impactful for clinical differential diagnosis as they were before.

 So audiology started to fall into more of the scale of hearing aids. I did cochlear implants for a second. That was exciting, but I wanted more. I wanted more engagement. I’m wanted more utilizing my training that I got from audiology as far as intraoperative monitoring, so I knew going into it that traditional audiology is only going to give me a foothold, giving me a foundation, but eventually, I wanted to be in monitoring.

Todd Schlosser: Sure. So, and I’ve never talked to an audiologist on the podcast before, so I have just one question about that. Did you work in the OR in that capacity at all? Was that more, like you said, with cochlear implants, helping people here?

Sam Johnson: There was some OR work, but it wasn’t at the level of what we do here.

Todd Schlosser: Sure, yeah. I mean, intraoperative neuromonitoring is all about monitoring the nervous system and you’re in the OR helping the surgeon, which of course you know. I talk to a lot of people who end up as neurophysiologists that started out in different fields maybe like from nursing to chiropractors that come through. So I just never talked to an audiologist that made that transition. But it sounds like you had that path in mind when you started your first job as an audiologist because you sort of had that foundational knowledge. So when you switched over and started doing your neurophysiology full-time, was there additional training that you had to undergo to be able to do that or did the audiology prepare you for all of that completely?

Sam Johnson:  No, absolutely. There was definitely a lot of training that needed to go into it, and it was so funny. Coming to specialty care, I was able to reestablish a relationship with the person that actually allowed me to cut my teeth in audiology, Jeff Loman. Loman is a well-respected senior clinician in specialty care and he was the first guy that gave me my start. As I started working at Penn State Medical Center, Jeff was running that program and that was the first introduction to really providing intraoperative monitoring in the OR in a such a way that really changed the way I looked at it. I mean, the collegiate relationship that Jeff was able to establish with a lot of the surgeons and the department heads with something that I kind of patterned my entire career on after that.

Todd Schlosser: Oh, excellent. So you started out working, I’d imagine, closely with Jeff.

Sam Johnson:  Correct.

Todd Schlosser: And then he sort of showed you the ropes. Was there a facilitated class you had to attend or was it all sort of on the job, hands on training?

Sam Johnson: Well, back then, things were different.

Todd Schlosser: It’s sort of a new field even now. So I understand even 20 years ago it was probably a very different.

Sam Johnson: Yeah. Don’t date me, please. But telemedicine wasn’t as robust as it is today. So when I first started, there was no a remote physicians online. So the training really had to be very, very well thought out. So it was mostly like a residency program that you was put through. So you went through rotations, you did rotations in ENT, cardiovascular and neurosurgery, orthopedics. You did all that. And then at the end of the day you’d come out with a good foundational understanding on how to apply monitoring techniques to many different types of surgeries. So it took longer. And for companies this day and age, it’s really not cost effective to pattern a program like that. But back then it was really needed because you need a clinician that can really stand in the OR by him or herself without a remote supervision. And it was very difficult and very challenging at that particular point.

Todd Schlosser:  I’m glad you brought that up because I don’t think a lot of people understand that now the way, at least it is through specialty care, we have not only the neurophysiologists in the OR with the surgeon and the patient kind of helping in that capacity, we also have someone who is trained who is off on a remote site sort of monitoring that case as well as a second set of eyes.

Sam Johnson: Correct.

Todd Schlosser:  But back then that remote capability just wasn’t an option.

Sam Johnson:  It was there. Yeah, it was there, but it wasn’t as prevalent as it is today.

Todd Schlosser: You worked in the OR as a neurophysiologist for … Was it three or four years before you stepped up to a director of operations role?

Sam Johnson: It was a little bit different. Jeff Vinci left. He joined a private practice group, Surgical Monitoring Associates, which is a part of the legacy of specialty care right now, and lots of talk about with that as well. But at that point he left me and a colleague of mine at the department. And right after he left, the department started to grow. We started getting really, really busy. I was taking on a lot of dynamic cases and so forth to the point where the administrator decided that it was in the best interest of everyone to outsource the program. So I got my first taste of what outsourcing looks like when you take an house department and parse it out to a for profit company. And so I went to join that group and it was a very small company at the time. I was employee number 27.

Todd Schlosser: Oh wow.

Sam Johnson: And we grew and we grew, 10% a quarter even during the recession, and to the point where a lot of opportunities opens up when you have growth of that magnitude, which happens to me.

Todd Schlosser: Yeah. So I mean, and you stayed sort of in that capacity as a director for quite some time and you’ve recently switched over to specialty care. And I wondered, because you’ve worked at least for one other third party outsource as you put it, is it a different culture especially care than what you’ve experienced in the past?

Sam Johnson: Absolutely. It was refreshing to come into this company and see the culture and the differences. I’ve been with other companies. I’ve been with a smaller company. I’ve been with a publicly traded company. And I can tell you that the culture here is very, very unique. I had great experiences where I’ve come from and I’ve learned a lot throughout my tenure at other companies. But here, it is unique. And one of the things that I like about specialty care is the clinical focus is not something that can be replicated very easily in other companies. When you have the CEO of the company that’s a clinician, when I talk about Sam Weinstein being a cardiothoracic surgeon, that is in itself a testimony to the seriousness that we have in specialty care about clinical focus.

  SMA, which I talked about, Surgical Monitoring Associates, I know a lot of people that was in a group. I have a lot of colleagues in that group. So when that group came over and I walked into specialty care and I see the amount of influence this company has had on the culture at specialty care, it’s rewarding because this company has always been highly regarded in the industry as being some company that is really about standards. And when I see the amount of clinicians who are driving and leading a company in specialty care, I know that this company has a culture that’s unprecedented where it’s not easily replicated in other institutions or other companies.

Todd Schlosser: Yeah, absolutely. And I think, and I’m not talking about just outsourced medical companies like specialty care, but I think outsourcing has sort of a negative connotation in any medium. And I think you can look at any field, whether it’s healthcare or call centers or whatever, and see good examples and bad examples of that.

 But let me ask, because you are now in a leadership capacity and you have been for quite some time, and I wanted to touch on the training that you received compared to the training that’s done now for IONM. And I know for a fact because we’ve talked to Julie Trott, who was the Director of IONM Education, that it’s a year long program, that new FN1s, as they’re called, as they come through, it’s a year long program. So what difference does that focus on training make to a surgeon in the OR? How important is that training?

Sam Johnson: That’s a great question. I can go onto many different avenues with that question. But let me start by this. When a surgeon walks into an OR and introduces himself as John Smith, “I’m Dr. John Smith,” and you see that MD behind his name, you know his pedigree. You understand what it took for him to get to the point where he can introduce himself as doctor so-and-so with the MD attached. You know the medical training that he had, the schooling, the board exams, the tests, all the long hours, the types of cases. You understand so much to the point where even if you don’t know that surgeon, you know he has a certain amount of competency based off of that that’s consistent across the country.

 IONM is totally different. A person could be cutting someone’s hair one day and conceivably be walking into OR monitoring cases any other day. So even though we have a lot of talent within this field of intraoperative monitoring, it’s still a field. It’s not a profession. And there is not a whole lot of standards that has been put forward to really drive that. Specialty care being one of the biggest, if not the biggest company in the country, and being the one that’s really, really focused on clinical and training, we are setting the standard here.

  And so what I’m seeing that’s arising from the training and education that’s happening in specialty care is when a surgeon sees a person from specialty care walks in the room, they know that person’s pedigree. Right? And so there is a bit of trust that comes in just by announcing yourself as, “I’m John Smith of specialty care.” And so that is revolutionizing the industry. And I think we’re setting the pace. We’re trendsetters and we’re going to be the ones that actually takes the field to a different level. At some point we should start to understand that this field has evolved to something of a profession.

Todd Schlosser: And I see these emails all the time from Julie’s team celebrating how every one of the surgical neurophysiologists class that she does pass their tests. And it seems like it’s been a long time since we’ve had someone fail, but the industry rates or pass rates on that test are much lower than 100%.

Sam Johnson: Absolutely.

Todd Schlosser: So that speaks very highly of our training program and I’m sure that as word gets out that that is our standard, that sort of forces everyone else to pick up their standard.

Sam Johnson:  That’s important. And the test is not where we stop, because the test, it tests theoretical knowledge but it doesn’t test the application of what you’ve learned. And so yes, we can get people to pass that test and I think we’re doing a lot and we’re leading that charge in the way we approach that but it doesn’t stop there. So once they get that test and once they pass their, there’s a lot more training, a lot more development that goes into it that helps someone to become a really true clinician in the field.

Todd Schlosser: And I’m sure it takes not just practical application. It takes classroom knowledge but practical application of that knowledge is how you drive home those skills.

Sam Johnson: Exactly.

Todd Schlosser: You can teach me anything in a room. If I had to do it in the OR, that’s a very different setting, right?

Sam Johnson: Absolutely.

Todd Schlosser:  So you’ve got to learn it and then practice it.

Sam Johnson:  Exactly.

Todd Schlosser: And that’s I think something that Julie drives home and kind of drills into them in the training program. Absolutely. So not to date you, but you’ve been in the field of inter-operative neuromonitoring a while. So you’ve seen the evolution of it since your beginnings with it. Where do you see it going in the future and what sort of things excite you about upcoming things that you might see?

Sam Johnson:  Oh man, that’s another loaded question there. There’s a lot of places I can take that question and there’s a lot of conversation that could be had. There’s people with a lot of depth of knowledge that can actually give a lot of insight to that. And there’s a lot of opinions about it as well. What I do see, and this is what excites me about specialty care as well, hospital systems, hospital networks are going to be the primary partners that we’re going to have to be focused on.

 The day of grabbing a machine and grabbing a surgeon and hooking up with that surgeon on a one on one basis and just following them from hospital hospital and monitoring cases, the expectation is going to rise. Hospitals are going to demand more of us and more of our services. So service fulfillment is going to be something that’s going to be standardized to some degree and expectations that are going to be placed on a monitoring company, it’s going to be a lot.

 And so we are setting the stage. We’re setting the standard on how we’re going to deliver that care and partnering with large scale institutions as they grow, and they’re growing really at a rapid scale as they acquire new hospitals that come on board. More and more, it’s going to be very, very important that we have those C-suite level conversations on how are we going to partner. So data analytics is going to be very, very useful and very, very important. And we are partnering up with a lot of big organizations to really maximize our ability to grab the data that we’re capturing. And the amount of data is overwhelming, and our ability to consolidate that and package it and really bring it back and present it to a hospital in a way that allows them to be better as far as their patient care and as far as their ability to develop their surgeons is going to be key.

Todd Schlosser: Absolutely. So, I mean not even just making your surgery safer, but being able to show the data that says, “Patient outcomes are X amount better by having a neurophysiologist in the room.”

Sam Johnson: Exactly.

Todd Schlosser: So that information is going to be huge I think. Let me ask you one final question. And I’d like to close with this, especially with people who have had a leadership position for awhile as you have, and you’ve sort of been in the clinician space and in the managing of clinician space. So I feel like you have sort of a wide breadth of knowledge in the area. So if you were talking to someone who was considering going into neurophysiology, like a nursing student, a chiropractor, someone who was considering the career change, what advice would you give them to sort of sway them that this is a great career to go into?

Sam Johnson: See, questions like that gets me excited. And I talk to people all the time about that, just that very fact. And I get a lot of people that call me up, but don’t take shortcuts. That’s the first day I tell you. It’s very easy to get in this field with not a whole lot of foundational knowledge. It’s very easy to partner up with a company that’s going to give you a little bit of an orientation and send you on your way monitoring cases in a few weeks to a month and you’re done. Don’t take shortcuts. You want to carve out a career for yourself. You don’t want just a job. You want to be a person that’s going to be a patient centered patient advocate. You’re going to be someone that’s going to be a professional and a clinician.

If that is your goal and that’s your drive, then you want to make sure you partner with the best. You want to make sure you partner with the best and the people that’s going to help develop you and see the end result. You want to grow and develop and you want to be the one that’s going to be the change maker in this field. So I tell people, especially young people coming out today, this field is going to continue to grow and it’s going to continue to evolve. You want to set yourself up to win, and what better way than to set yourself up with an organization like specialty care that’s really going to be the pioneers that going to help develop you in your career?

Todd Schlosser: Yeah, absolutely. Thank you so much for being here, Sam. We really appreciate it. Thanks for joining us here on Scrubbing In.

Sam Johnson:  Thank you. Appreciate it.

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