Models and Mentors

In Conversation with Douglas Grey, MD

Dr. Douglas Grey, a thoracic and vascular surgeon at Kaiser in San Francisco , co-founded Operation Access, a non-profit organization that provides free outpatient elective surgeries to uninsured individuals.

When did you decide you wanted to be a doctor?

I decided to be a doctor in high school. I had two relatives – one aunt, one uncle – both of whom were physicians (one was a urologist and one was a family practitioner). And it seemed like a good career to me, as far as you get the chance to actually help people, and get paid for it, and have a profession that is held in esteem by society. It also sounded very interesting from a scientific standpoint. So, growing up in Marin County, I went to a high school program at Marin General Hospital every Tuesday, where they had specialists come in and give lectures. I did that for two years in a row and decided it was the right thing, so I went to Stanford, and was pre-med, and there it was.

What sparked your interest in surgery, and cardiothoracic surgery in particular?

I think it’s hard as a medical student to know what you want to do because your exposure to different specialties is so biased by the people you meet, and you only interact with them peripherally and only for brief periods. It’s hard to know what it really entails to be a specialist until you get to residency.

I actually went into residency with the intention of being a urologist. I was going to be in Boston for two years and then go out to California and be a urologist at UCLA. But I soon found out that I was color-blind to a degree that I couldn’t, because urologists need such high color acuity to discern disease processes visually. And I can’t see reds very well. I thought, “I can’t see what they’re talking about”! So I kind of hesitated for about six months and thought about other careers. And then I got exposed to an excellent cardiothoracic surgeon at the hospital where I was training and decided that is what I wanted to do. It’s technically challenging, it’s interesting, and it involves complicated cases. It was a very good decision.

Were there any other surgical specialties that you considered?

Orthopedics was also interesting because I like to tinker with my hands. But that’s pretty much it. I considered cardiac surgery, and then ended up doing thoracic & vascular surgery. It’s a good compromise, a good variety, a lot of smoking-related problems.

You worked briefly in private practice in the mid-1990’s, before joining the Permanente Medical Group in San Francisco. Can you tell us about your experience in private practice? Why did you decide to switch to Kaiser?

I worked in private practice for a year and a half. A very close friend of mine, with whom I trained in Boston , had moved down to Jacksonville , Florida . We visited in April and it was just magnificent - the dogwoods were out, the flowers were blooming, everything was fragrant and healthy looking. And we said, “This looks great”! So we moved there on July 1 st and by July 3 rd we thought, “This is ridiculous – it is too hot!!!” The weather killed us. And so we decided two or three months after that to start looking for other jobs. My wife and I decided to live near one of our families so we looked in San Francisco . At the time, I thought I would take this job, and then go figure out what I wanted to do with the rest of my life. But it worked out so well that I’ve been here twenty years!

What is the best thing about working at Kaiser?

Kaiser is all about shared risk and shared reward. If we’re successful in keeping people healthy, then the hospitals spend less money, the patients pay less money, and the doctors get paid more money. If, on the other hand, you provide bad medical care, the hospitals pay more money, the patients pay more money, and the doctors make less money, and everybody loses. So we’re all on the same page. And that’s in contrast to some of the hospitals you’ll go through where there are inherent conflicts, where if you do more operations you get paid more money. Those conflicts are legitimate, and there’s no incentive for prevention. Our system, however, has a very strong preventive arm, which is the way it should be. If you walk down the hall and talk to all these people that work here, what it all boils down to, in simple terms, is that there are no inherent conflicts of interest. That’s why they do it.

Also, at Kaiser you get business because it’s the right thing to do, not because it’s your friend or a buddy. When I was in Jacksonville , I was doing all the complicated cases because I was the new kid. It was all based on referral patterns. So these cardiologists would refer to me all the impossible cases, and refer the simple cases to their friends. So I like the fact that at Kaiser you have colleagues with appropriate incentives in taking patients. You’re surrounded by people who have the same motivations, the same goal of high quality care. And I would point to my partners here in this department. I would let them all operate on me, and would have no qualms sending any of my relatives to any of their offices – I know they would get excellent care. And that’s why I work here.

You’ve also spent a lot of time teaching, at Harvard and at U.C.S.F. How did you get into teaching? Why do you continue to teach?

I enjoy teaching. I taught all through residency and really liked it. And when I first came here in 1984 we had a free-standing residency program that I thought was probably not a good thing, knowing that the relationship with a University program is critical. We were training a lot of people who didn’t have exposure to research nor the breadth of exposure to transplant, or trauma. I also think it’s valuable to have the basic science interface that Stanford and UC have. Kaiser is a great place to practice, but I’m not sure it’s a great place to do all your training. It’s a great place to learn how to operate and learn how to take care of patients, but surgical training is more than that. So we merged with UC, and we’ve had between four and six UC residents here ever since. Our role is to teach the residents how to do simple procedures, as well as some very complicated procedures, but not the complicated procedures like they do at UCSF or Stanford – the heart/lung transplants or pancreas transplants - because that’s what they do! They do it very well. Why should we try to duplicate that? But the things we do, we do very well, so it works out great.

You are currently working as the sub-chief of vascular surgery and thoracic surgery at Kaiser, and as a clinical professor of surgery at U.C.S.F. What do you enjoy most about your job? What do you find most difficult?

I enjoy taking care of patients. Each of them has a story, and our job is to put their disease in the context of their story. I enjoy being able to pull a thorn out of somebody’s paw and solve the problem. The most difficult thing, I guess, would be dealing with the patients whose problems you will never solve. No matter how good a job you do, they will never be happy. It’s very unsatisfying.

In 1991, you co-founded Operation Access (a volunteer organization providing surgical services to uninsured patients) with Bill Schecter. What motivated you to start this organization?

It started when Bill Schecter and I went to a meeting, and heard about the plight of the uninsured. The fellow who gave the talk, a professor at UC Davis, had noticed that family practitioners and internists have many venues by which they can volunteer their services, but surgeons have no opportunities unless they go outside the country. Why have surgeons not been able to organize an infrastructure that would allow people to volunteer and provide simple surgical services to some of the 40 million uninsured in this country? Bill Schecter and I looked at each other – I had never met him before – and he made some comment that caught my ear, that made me think this is a guy I could work with. I think we can solve this problem.

So he and I started talking and we realized that a) this was a problem we both wanted to weigh in on, b) we had some skills in leadership and organization that could be helpful, and c) we had enough hospital contacts and “clout” within our organizations to be able to convince them of the need for their involvement. And so we started, and it was like the Field of Dreams movie - every time we would come up with a problem, the problem’s solution would come to us within a week, by some random force. If we had no funding, then we’d get an unsolicited letter in the mail the next day, offering money. It was the weirdest thing I’ve ever seen. So we spent two years in development, before we did our first operation, and I think we’ve done about five million dollars worth of operations since.

At what point did you realize that Operation Access was a success?

I think I realized it was a good idea when we were recognized by both sides of the political spectrum. First, the Haight Ashbury Free Clinic said that they really liked our services, said we were so easy to use because we’re willing, able, and enthusiastic, and they decided to give us their volunteer award. So that was the liberal end of the spectrum. And then someone submitted our name to the ultra-conservative Pacific Research Institute, and we got their award for the most entrepreneurial way to solve a social problem (Margaret Thatcher gave us that one!). I saw that people were now jumping on the bandwagon and helping us solve the problem. People were recognizing the value to society, no matter where you stand in politics. You’re helping people who need help. Over the past twelve years we’ve had lots of funders, including the Robert Wood Johnson Foundation, Blue Shield, and some private foundations. But now we’ve got people asking us if they can give money, so we’re making progress.

You always wonder what type of impact you’re going to have on your community. I have three girls, who are growing up, and I think this has been a really good example of what you can accomplish as far as community activism and social volunteerism. Can individuals make a difference? Yes, they can make a difference. And you can do it in addition to your regular job. It’s gratifying, and people benefit.

What has been your proudest moment as a physician?

Kaiser gives away Exceptional Contribution awards, to people they think have contributed above and beyond their regular responsibilities, and I was one of five recipients last year to get that award. It’s a competitive career, and a competitive partnership, so I was very happy to be recognized. I’m also proud that I work for an organization that recognizes the value of people doing more than they have to. A lot of private entities want you to make money, and that’s their benchmark of success. Universities want you to write papers and gain prestige, and that’s very legitimate. But I was proud that the organization I chose to work for was recognizing the value of going above and beyond in a field like surgery.

Who are your role models and influences?

My father is the most compassionate, caring, and brightest person I’ve ever known. If I had to emulate someone in terms of how they conduct themselves in their career, there’s no question that he’d be the one. There was also a fellow I met while rotating through a private hospital in north central Massachusetts: George Walker. He was the chief of surgery, and was just a superb technician. He could do things in the operating room for his patients, like keeping incisions small and getting them out of trouble quickly, that I’d never seen anyone do before. He actually considered it a contest to see how well he could do. He also got along very well with his patients. He would crack jokes for them, would kid them. He wanted to be their friend as much as their doctor. So I tried to do that too. Finally, my partner in Florida is an incredible intellectual and brings this to his care of patients. He changed the way I would look at complex diseases.

How have you managed to balance the demands of a career in surgery with a family and life outside of medicine?

It’s hard, and it’s hard for everybody, because you’re trying to be fully constructive and supportive to this practice, and also still be a father or a mother or whatever. But Kaiser assumes that you’re going to work 40 to 45 hours per week, and everything beyond that is compensated, either with time off or with money, so your family can come first. We can finagle our schedules to spend more time with our families, which is the way it should be.

What do you do for fun?

I paint with watercolors. I was collecting watercolor supplies for eight years before I started actually doing it. I knew I was going to do it, but I didn’t know when. Now what I try to do is have my daughters or friends pick out scenes that they particularly enjoy, and then it’s a nice way to remind them of fond memories or certain aspects of their lives. So I do a lot of scenes around college campuses, or homes, or cabins, or travel, or whatever. Watercolor is great because it dries quickly and it travels well. And I can do a painting during lunch!

I think medicine is a superb career in almost every way. The one thing medicine hasn’t really addressed is the fact that people have a need to keep on growing and being educated, and medicine doesn’t necessarily reward that. So you have to figure out how you’re going to keep yourself motivated and curious, and satisfied, and it’s stuff like this that helps you to do that.

Interview by Lauren Cochran