1 00:00:00,160 --> 00:00:03,760 Speaker 1: Okay, Doctor Jim Keeney, chief medical officer for Dignity Saint 2 00:00:03,760 --> 00:00:07,880 Speaker 1: Mary Medical Center in Long Beach, And Jim. 3 00:00:07,680 --> 00:00:10,360 Speaker 2: First of all, good morning, good morning. 4 00:00:10,200 --> 00:00:11,479 Speaker 1: There you are. And I want to start with a 5 00:00:11,560 --> 00:00:14,640 Speaker 1: quick story, and that is one of my surrogacy stories. 6 00:00:14,680 --> 00:00:17,720 Speaker 1: So I had one of my surrogates who was pregnant 7 00:00:17,760 --> 00:00:20,840 Speaker 1: and about to deliver a baby, and she decided towards 8 00:00:20,880 --> 00:00:22,680 Speaker 1: the end of her pregnancy that she wanted to do 9 00:00:22,720 --> 00:00:26,680 Speaker 1: it at home with a midwife. And I said, no, no, 10 00:00:26,720 --> 00:00:29,840 Speaker 1: you don't understand. We have real doctors and real hospitals here. 11 00:00:29,840 --> 00:00:32,560 Speaker 1: She goes, Nope, I want to do it at home. Okay, 12 00:00:32,600 --> 00:00:36,240 Speaker 1: then I'll have I'll make sure one of our midwives, 13 00:00:36,760 --> 00:00:38,960 Speaker 1: like a certified midwife, and you have to be within 14 00:00:39,040 --> 00:00:42,440 Speaker 1: ten miles at a hospital in case something goes south. And 15 00:00:42,560 --> 00:00:46,560 Speaker 1: we're arguing, and I said, listen, you can have whatever 16 00:00:46,600 --> 00:00:50,440 Speaker 1: you want and your house. You can have the shaman, right, 17 00:00:50,479 --> 00:00:52,879 Speaker 1: the witch doctor with a bone through his nose and 18 00:00:52,960 --> 00:00:56,080 Speaker 1: taking chicken blood and putting at every corner of the room. 19 00:00:56,120 --> 00:00:58,040 Speaker 1: You can do it, you know, and chanting whatever the 20 00:00:58,120 --> 00:01:02,560 Speaker 1: hell you want. It's a doctor. And that's and the 21 00:01:02,600 --> 00:01:05,080 Speaker 1: problem is that more and more people are doing exactly that, 22 00:01:05,200 --> 00:01:05,640 Speaker 1: aren't they. 23 00:01:07,200 --> 00:01:09,920 Speaker 2: Yeah, they are, and they're doing it with success, by 24 00:01:09,920 --> 00:01:13,200 Speaker 2: the way. So I mean, I guess maybe I'm not 25 00:01:13,280 --> 00:01:15,240 Speaker 2: as extreme about it as you are. I think it's 26 00:01:15,280 --> 00:01:19,679 Speaker 2: just understanding the risk, right. So you know, I was 27 00:01:19,720 --> 00:01:22,840 Speaker 2: trained by midwives when I was learning to deliver babies 28 00:01:22,840 --> 00:01:26,080 Speaker 2: as a medical student, and they actually do a great job. 29 00:01:26,200 --> 00:01:31,039 Speaker 2: They really work hard to not over medicalize deliveries. That 30 00:01:31,520 --> 00:01:35,720 Speaker 2: and that extra stuff we do can create complications and problems. 31 00:01:35,720 --> 00:01:37,800 Speaker 2: You know, we put every baby on a baby monitor. 32 00:01:37,840 --> 00:01:40,480 Speaker 2: You can't find a hospital that will deliver without being 33 00:01:40,520 --> 00:01:43,600 Speaker 2: on a monitor the entire time of the pregnancy or 34 00:01:43,640 --> 00:01:47,360 Speaker 2: the entire time of the delivery. But no research has 35 00:01:47,400 --> 00:01:50,320 Speaker 2: ever shown that that helps the outcome. You know, bad 36 00:01:50,360 --> 00:01:53,160 Speaker 2: things still happen during delivery, and the monitor doesn't stop that. 37 00:01:53,600 --> 00:01:57,560 Speaker 2: And when you're putting monitors on people and reacting to 38 00:01:57,640 --> 00:01:59,920 Speaker 2: what you see on those, you can kind of sometimes 39 00:02:00,040 --> 00:02:02,360 Speaker 2: you overdo it. So well, let me ask you. 40 00:02:02,480 --> 00:02:05,680 Speaker 1: Even let's say you get a false positive, but what 41 00:02:05,840 --> 00:02:09,920 Speaker 1: ends up happening when it's a real positive and you know, 42 00:02:10,200 --> 00:02:12,760 Speaker 1: a life is saved or a complication can be averted. 43 00:02:12,960 --> 00:02:16,440 Speaker 1: I mean, you've had kids, would you have a kid 44 00:02:16,440 --> 00:02:17,480 Speaker 1: outside of the hospital. 45 00:02:18,480 --> 00:02:21,639 Speaker 2: No, I wouldn't because you know, I understand a little 46 00:02:21,680 --> 00:02:24,720 Speaker 2: bit differently about what happens when things go wrong, right, 47 00:02:24,760 --> 00:02:26,720 Speaker 2: And I'm an e R doctor, so I'm more focused 48 00:02:26,720 --> 00:02:29,000 Speaker 2: on when things go wrong. And that's the point of 49 00:02:29,200 --> 00:02:32,560 Speaker 2: there's a recent study that showed, look, if you have 50 00:02:32,760 --> 00:02:35,240 Speaker 2: the baby out of the hospital, actually, the outcomes are 51 00:02:35,280 --> 00:02:38,640 Speaker 2: better out of the hospital as long as everything goes well. 52 00:02:38,960 --> 00:02:42,359 Speaker 2: And that's about eighty five percent of deliveries. So fifteen 53 00:02:42,360 --> 00:02:44,680 Speaker 2: percent of deliveries, a little more than one out of six, 54 00:02:45,280 --> 00:02:48,200 Speaker 2: something's going to go wrong. And when that goes wrong, 55 00:02:48,320 --> 00:02:52,919 Speaker 2: the outcomes are disastrous. Right. It's a big delay from 56 00:02:52,960 --> 00:02:55,360 Speaker 2: the time you're in the house until the time you're 57 00:02:55,680 --> 00:02:59,600 Speaker 2: sitting in an emergency department or an operating room or 58 00:02:59,600 --> 00:03:02,480 Speaker 2: whatever you need. If it's the mother, sometimes in an 59 00:03:02,480 --> 00:03:04,800 Speaker 2: operating room because there's heavy bleeding or something like that. 60 00:03:04,840 --> 00:03:08,480 Speaker 2: If it's the baby, you need a neonatal intensive care unit. 61 00:03:09,080 --> 00:03:14,280 Speaker 2: So so in that fifteen percent, they do worse. And 62 00:03:14,320 --> 00:03:17,440 Speaker 2: that's I guess as a doctor, that's I'm more focused 63 00:03:17,440 --> 00:03:19,600 Speaker 2: on what could go wrong. Let's make sure we're in 64 00:03:19,639 --> 00:03:23,160 Speaker 2: the right place. If anything does go wrong, and that's 65 00:03:23,160 --> 00:03:24,720 Speaker 2: why for me, I would I would do it in 66 00:03:24,720 --> 00:03:25,240 Speaker 2: the hospital. 67 00:03:26,400 --> 00:03:28,360 Speaker 1: And how about and you know, I don't know the 68 00:03:28,400 --> 00:03:30,520 Speaker 1: medical aspects of this, whether it makes sense or not, 69 00:03:30,639 --> 00:03:33,280 Speaker 1: but there was a time when the big thing was 70 00:03:33,320 --> 00:03:37,280 Speaker 1: having kids delivering underwater, which was really weird. 71 00:03:37,440 --> 00:03:39,520 Speaker 2: You know, in a day we still do that, do 72 00:03:39,640 --> 00:03:41,040 Speaker 2: they really? Wow? 73 00:03:41,320 --> 00:03:44,160 Speaker 1: Yeah, they still or on a trapeez or whatever the 74 00:03:44,200 --> 00:03:46,880 Speaker 1: hell they do. And does that work out? 75 00:03:46,880 --> 00:03:47,080 Speaker 2: Well? 76 00:03:47,080 --> 00:03:49,880 Speaker 1: Would you would you have one of your babies delivered underwater? 77 00:03:51,840 --> 00:03:54,320 Speaker 2: It works? It really works, It works out well. I 78 00:03:54,320 --> 00:03:56,360 Speaker 2: mean that's not the way I would do it. But 79 00:03:56,880 --> 00:03:59,640 Speaker 2: now I had an er doctor partner that actually did that. 80 00:03:59,720 --> 00:04:03,040 Speaker 2: I dilri It was. It was shocking because he came 81 00:04:03,320 --> 00:04:06,560 Speaker 2: after the baby was delivered with a photo album and 82 00:04:06,600 --> 00:04:08,000 Speaker 2: I thought it was going to be a cute photo 83 00:04:08,040 --> 00:04:11,240 Speaker 2: album filled the pictures with his baby, and I opened 84 00:04:11,240 --> 00:04:14,280 Speaker 2: to the first page and it's him, you know, behind 85 00:04:14,360 --> 00:04:18,400 Speaker 2: his wife in a jacuzzie in their house with his 86 00:04:18,480 --> 00:04:22,159 Speaker 2: wife completely naked and uh and they're waiting for the 87 00:04:22,200 --> 00:04:24,880 Speaker 2: baby to come. And I just slammed the thing shut. 88 00:04:24,960 --> 00:04:28,200 Speaker 2: It was like WHOA, I was not expecting and what 89 00:04:28,520 --> 00:04:29,239 Speaker 2: and what a mess? 90 00:04:29,480 --> 00:04:33,680 Speaker 1: And what a mess that is in the jacuzzi. I mean, 91 00:04:33,720 --> 00:04:35,680 Speaker 1: who's going to who's going to clean that up? 92 00:04:37,200 --> 00:04:39,880 Speaker 2: It's not like a delivery in the hospital isn't messy either. 93 00:04:40,160 --> 00:04:41,960 Speaker 2: It's just you don't get you don't see it, and 94 00:04:42,000 --> 00:04:42,960 Speaker 2: you're not floating in it. 95 00:04:43,720 --> 00:04:47,839 Speaker 1: Yeah, for sure, all right, Jim. This Friday, uh is 96 00:04:47,960 --> 00:04:50,600 Speaker 1: National Residency Match Day and a lot of people don't 97 00:04:50,600 --> 00:04:52,719 Speaker 1: know what that's about. And it's it's a fun part 98 00:04:52,760 --> 00:04:56,039 Speaker 1: of medicine that you are on your way to killing people. 99 00:04:56,080 --> 00:04:58,240 Speaker 1: So tell us about it and your experience, because I 100 00:04:58,279 --> 00:04:59,000 Speaker 1: know you went through this. 101 00:05:00,480 --> 00:05:05,000 Speaker 2: Yeah, it's super interesting, it's fun, it's exciting, but it 102 00:05:05,040 --> 00:05:07,359 Speaker 2: also is a good barometer, right for you know, we 103 00:05:07,440 --> 00:05:09,880 Speaker 2: know we're going to be about eighty thousand physicians shorts 104 00:05:09,880 --> 00:05:13,039 Speaker 2: and short in the next ten years, and this kind 105 00:05:13,040 --> 00:05:15,760 Speaker 2: of gives us a barometer for what's coming through the pipeline. 106 00:05:16,000 --> 00:05:18,960 Speaker 2: But what it is is you go through medical school 107 00:05:19,080 --> 00:05:21,440 Speaker 2: and then you need to apply to a residency program 108 00:05:21,520 --> 00:05:23,640 Speaker 2: to decide, you know, what specialty you want to go 109 00:05:23,720 --> 00:05:27,599 Speaker 2: into and what training you'd like to receive, and to 110 00:05:27,720 --> 00:05:30,800 Speaker 2: do that, you enter into a match program where you 111 00:05:31,320 --> 00:05:34,800 Speaker 2: applied all these different facilities you may interview, you may not, 112 00:05:35,320 --> 00:05:39,960 Speaker 2: and then the facility ranks their people after interviewing them, 113 00:05:40,000 --> 00:05:42,520 Speaker 2: from one to one hundred or one to one thousand. 114 00:05:42,560 --> 00:05:44,480 Speaker 2: I mean, in our case at Long Beach, we got 115 00:05:44,480 --> 00:05:49,039 Speaker 2: three thousand applicants and we interviewed a little over two hundred, 116 00:05:49,480 --> 00:05:51,440 Speaker 2: and then we rank those two hundred from one to 117 00:05:51,480 --> 00:05:53,960 Speaker 2: two hundred. On the other side, the applicants doing the 118 00:05:54,000 --> 00:05:56,720 Speaker 2: same thing. The places they went to, they now rank 119 00:05:56,800 --> 00:06:00,120 Speaker 2: them from one to however many they applied to, and 120 00:06:00,880 --> 00:06:05,120 Speaker 2: then a computer matches that up. So Monday, the people 121 00:06:05,200 --> 00:06:08,200 Speaker 2: who matched. Anybody who match or didn't match, was just 122 00:06:08,240 --> 00:06:12,440 Speaker 2: notified you matched, You're safe, right, or you didn't match. 123 00:06:12,520 --> 00:06:15,599 Speaker 2: And then there's a supplemental program to try and match 124 00:06:15,680 --> 00:06:18,719 Speaker 2: people outside this process kind of a scramble around and 125 00:06:18,760 --> 00:06:22,440 Speaker 2: call residency directors and see see who maybe had an 126 00:06:22,480 --> 00:06:22,919 Speaker 2: opening that. 127 00:06:22,920 --> 00:06:25,880 Speaker 1: Didn't fill all right, So in your case, in your case, 128 00:06:25,920 --> 00:06:30,160 Speaker 1: you apply to many, many programs, and I assume they 129 00:06:30,240 --> 00:06:33,080 Speaker 1: then told you you better learn to speak Spanish because 130 00:06:33,120 --> 00:06:35,960 Speaker 1: you're not getting any place in the United States. Let 131 00:06:35,960 --> 00:06:38,560 Speaker 1: me ask you a question about how this works, and 132 00:06:38,600 --> 00:06:42,719 Speaker 1: that is you're raked. You had two hundred, you ranked 133 00:06:42,720 --> 00:06:46,160 Speaker 1: one to two hundred and so the top five, ten 134 00:06:46,320 --> 00:06:49,680 Speaker 1: twenty five. I'm assuming you make an offer and saying, hey, 135 00:06:49,720 --> 00:06:52,480 Speaker 1: we'd love to have you. At the same time, every 136 00:06:52,480 --> 00:06:56,560 Speaker 1: other program wants these people too. How does that work out? 137 00:06:56,920 --> 00:06:59,720 Speaker 1: Do you end up outbidding each other? And that's in 138 00:06:59,760 --> 00:07:03,400 Speaker 1: this early for pay but for benefits. You know, we 139 00:07:03,440 --> 00:07:05,839 Speaker 1: have a great Starbucks down the street and we're a 140 00:07:05,839 --> 00:07:08,640 Speaker 1: great restaurant town and means that come into it. 141 00:07:09,200 --> 00:07:12,040 Speaker 2: You know, absolutely people are asking questions like what's the pay, 142 00:07:12,080 --> 00:07:14,000 Speaker 2: what are the benefits, what are the days off like, 143 00:07:14,080 --> 00:07:16,320 Speaker 2: what does the schedule look like? So all of those 144 00:07:16,360 --> 00:07:19,760 Speaker 2: things you're trying to optimize those before this match day, 145 00:07:19,840 --> 00:07:22,440 Speaker 2: because again, it's not like you're doing a one to one, 146 00:07:22,480 --> 00:07:25,760 Speaker 2: this is a this is across the board. You interview 147 00:07:25,800 --> 00:07:27,760 Speaker 2: these people, you tell them what the programs like, take 148 00:07:27,800 --> 00:07:31,240 Speaker 2: it or leave it, and then they decide where you 149 00:07:31,320 --> 00:07:34,400 Speaker 2: fit on their rank list. So yeah, it's both sides 150 00:07:34,400 --> 00:07:36,440 Speaker 2: are competing for the best you know, they're competing for 151 00:07:36,480 --> 00:07:39,000 Speaker 2: the best spots, and we're competing for the best applicants. 152 00:07:39,320 --> 00:07:44,640 Speaker 1: And you did your residency where at low Molinda, Okay? 153 00:07:46,240 --> 00:07:49,320 Speaker 2: And how many like go ahead five spot? Back then 154 00:07:49,360 --> 00:07:51,320 Speaker 2: it was a little easier. I applied to five places, 155 00:07:52,200 --> 00:07:56,280 Speaker 2: and then on that dawn, that match day at UCLA, 156 00:07:56,520 --> 00:08:00,000 Speaker 2: I went to ACLA Med School. They take the envelope 157 00:08:00,200 --> 00:08:05,280 Speaker 2: in alphabetical order along the wall in a hall and 158 00:08:05,320 --> 00:08:07,640 Speaker 2: then there's like the letters above it for which letter 159 00:08:07,760 --> 00:08:10,120 Speaker 2: of the alphabet your last name starts with, and everybody 160 00:08:10,240 --> 00:08:12,440 Speaker 2: is allowed the room at the same time, and you 161 00:08:12,520 --> 00:08:14,760 Speaker 2: all run over to your envelope, grab it, take it 162 00:08:14,800 --> 00:08:17,840 Speaker 2: off the wall, and you know, ninety nine percent of 163 00:08:17,880 --> 00:08:20,400 Speaker 2: the people are cheering and having a good time and excited, 164 00:08:20,440 --> 00:08:22,360 Speaker 2: and there's a few people that just didn't get what 165 00:08:22,400 --> 00:08:25,600 Speaker 2: they wanted to get, so they're a little disappointed. But 166 00:08:25,760 --> 00:08:26,800 Speaker 2: that's how about the party. 167 00:08:27,160 --> 00:08:29,720 Speaker 1: Yeah, that's how we learned my in my world, that's 168 00:08:29,720 --> 00:08:32,040 Speaker 1: how we learned about the bar exam. You go to 169 00:08:32,080 --> 00:08:36,280 Speaker 1: the bar office downtown and they literally taped up the 170 00:08:36,400 --> 00:08:39,280 Speaker 1: names of everybody who passed the bar and you look 171 00:08:39,320 --> 00:08:41,360 Speaker 1: at your name and if it's not there, guess what 172 00:08:41,640 --> 00:08:45,200 Speaker 1: you didn't pass. And so, yeah, it's a lot of fun. 173 00:08:45,200 --> 00:08:49,040 Speaker 1: Today it's very different. And you applied to five places. Oh, 174 00:08:49,120 --> 00:08:51,280 Speaker 1: by the way, do you sit on I'm just we're 175 00:08:51,320 --> 00:08:53,880 Speaker 1: going through This is not medical news. Is just fascinating stuff. 176 00:08:53,920 --> 00:08:59,480 Speaker 1: The way the medical world works. I did, do you 177 00:08:59,520 --> 00:09:05,320 Speaker 1: sit on the boards hiring physicians at at Saint mary 178 00:09:06,000 --> 00:09:09,640 Speaker 1: at I'm sorry, your your facility? 179 00:09:09,720 --> 00:09:14,840 Speaker 2: Yeah, yeah, so I participate with the faculty as we 180 00:09:15,160 --> 00:09:17,079 Speaker 2: you know, we get the applicants, we look at who 181 00:09:17,080 --> 00:09:19,920 Speaker 2: we want to interview. Again, trying to go through three 182 00:09:20,000 --> 00:09:23,880 Speaker 2: thousand is actually a massive underall bit quite a bit 183 00:09:23,920 --> 00:09:25,880 Speaker 2: of time and then kind of narrowing it down to 184 00:09:25,920 --> 00:09:28,080 Speaker 2: who we'd like to interview and who we think would 185 00:09:28,160 --> 00:09:32,360 Speaker 2: really fit well and would actually again, because they're applying 186 00:09:32,400 --> 00:09:34,679 Speaker 2: to every other program of so many other programs, you're 187 00:09:34,720 --> 00:09:36,320 Speaker 2: you're trying not to waste your time on people who 188 00:09:36,320 --> 00:09:38,080 Speaker 2: would never come here, you know. 189 00:09:39,880 --> 00:09:42,960 Speaker 1: Okay, that was it. That was just fascinating how that works. 190 00:09:43,760 --> 00:09:46,760 Speaker 1: I've always enjoyed hearing about the inside baseball when it 191 00:09:46,760 --> 00:09:51,559 Speaker 1: comes to almost anything. Jim, thanks much, And we'll talk again, 192 00:09:51,920 --> 00:09:53,920 Speaker 1: probably over the weekend, which we normally do and yell 193 00:09:53,960 --> 00:09:57,480 Speaker 1: at each other. I will and you, well, that's right, 194 00:09:57,600 --> 00:09:59,679 Speaker 1: that's right. You're coming to the barbecue. Yeah, because you're 195 00:09:59,679 --> 00:10:00,320 Speaker 1: part of the show. 196 00:10:00,440 --> 00:10:01,760 Speaker 2: That's right. Okay,