Continue to find ways to diversify the field and make training more accessible to people from all backgrounds. There are a lot of populations that we’re not serving equitably for both mental health and medical health because we’re not speaking the same language. Not only literally, but also in terms of understanding the concerns or the cultures and customs of different people. In the medical landscape and behavioral health landscape, we aren’t really speaking to that. With increased diversification and more training on cultural competence, I think we would see great changes here.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Dr. Ryan Drzewiecki.
Ryan Drzewiecki PsyD, LP is a licensed psychologist and has served in administrative and leadership positions in the field of behavioral health since 2003. He has served as Clinical Director at A New Leaf and All About You Behavioral Health in Phoenix, and founded Mara Psychotherapy and Consulting Group. Dr. Drzewiecki is currently the Director of Clinical Operations and Programs at All Points North Lodge in Edwards Colorado.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
Right out of undergraduate school, I started to work in special education, and I really found my passion for this line of work there. I worked with developmental disabilities and in particular young kids with autism, and that really resonated with me. From there I ended up as lead teacher of that classroom and started to work my way into administration and leadership and ended up starting a behavioral health company with a friend and colleague. It was around that time that I decided to get back into school and pursue my doctoral degree in psychology. I did my internship at Hazelden Betty Ford Foundation, and some post-doctoral work as well. From there, I ended up in Phoenix as a clinical director for a couple of different agencies and then had this fantastic opportunity to come to All Points North (APN) Lodge. I am now the Director of Clinical Operations and Programs at APN Lodge. I oversee the clinical programming and I directly manage the clinical department and the recovery advocates. I also oversee our telehealth division and we are poised to open a new assessment and detox center, which I’ll be leading as well.
Can you share the most interesting story that happened to you since you began your career?
My time at APN Lodge has to be the most interesting story. To get in at the very ground level of a company that’s really committed to excellence and treatment has been a fantastic and interesting adventure to go on. I joined when we had one outpatient client, and to be able to build the outpatient intensive outpatient program (IOP), open the Colorado lodge, and get the partial hospitalization program (PHP)and residential program started has truly been an amazing journey.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
One of the programs I managed in Phoenix was an office of the refugee resettlement program. We had a lot of clients, many of whom were minors, who had just crossed the border and we helped house them until we could find a more permanent living arrangement for them in the US. A lot of the clients didn’t speak English, and a lot of the referrals didn’t speak English, either. One time, we had a client who was getting sponsored by a religious organization. It was a shelter run by nuns, and the nuns would come to the houses where our clients live. So, after polishing up my Spanish (or so I thought), I went to my clients and tried to say, “The nuns would like to meet the clients in the house.” However, “nun” in Spanish is fairly similar to “monkey” and “house” is similar to “bed,” so I actually said, “The monkeys would like to meet the client in bed,” which was not a good look. I apologized profusely, and thankfully, everybody thought it was quite funny, but I did learn a valuable lesson from that experience. Number one is the importance of communication, especially when speaking to people in their native language. Additionally, it’s leaning in and embracing your mistakes. For the rest of my time there, everyone had a lot of fun with that statement. Every time we worked with the nuns from then on out, I got to hear all about it.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
A quote that has resonated with me for a long time is from D.W. Winnicott which is, “what a joy to be hidden and a disaster not to be found.” I’ve recognized that so much in my clinical work with clients, and in particular, with substance abuse. I think so many clients come to a place where being hidden equals being safe, with substance abuse being a cause or the effect of that, and they place such a value in hiding from other people … it’s almost an allure to them. And this is often one of the more difficult pieces of addiction to unravel. It’s been a survival mechanism for so long, usually long before they started using, but certainly after they started using, that they don’t even notice themselves doing it.
After treating clients, I also see that most people really want to be seen by others. And at APN, we view addiction largely from an attachment lens. I think a lot of people who come to treatment are at that point where they’ve used all of their defenses to hold a lot of attachments at bay and keep people at bay, while also really wanting people to connect with. They become frustrated and struggle to understand why people aren’t connecting with them. They often ask, “Why am I not closer with more people?” To help people understand the ways that they’re hiding in order to protect themselves and to put some of those walls down is, I think, something that’s come up time and time again in my work.
Are you working on any exciting new projects now? How do you think that will help people?
A big project we are working on right now is preparing to open a new location with some additional services. (I can’t make the big reveal quite yet, so stay tuned with us.) It’s going to be a really great resource for us and will allow us to treat a lot more patients. It will also ensure that we’ll have the right level of care for everybody when they’re coming in for treatment. It’s always tricky during pre-admission to screen people and make sure that we’re the absolute best environment for them. This will give us an opportunity to help people get their feet on the ground, help them get through the earliest phases of withdrawal, and to make sure that they’re the absolute best fit for APN Lodge — or, most importantly, that APN Lodge is the best fit for them.
Additionally, the expansion and growth of our telehealth program has been incredibly exciting. In early 2020, everything switched to telehealth when it came to mental health and healthcare services. And now, as we’re looking at how to navigate that transition back, we’re thinking about how to really grow a meaningful and amazing telehealth program that is valuable and helpful for patients. We’re taking all the lessons that we’ve learned over the pandemic and trying to create something really special; to lean in on the things that we’re doing well, play with the things that are more difficult to do, try out different methods, and rethink what treatment could be. The telehealth format really changes things from a therapeutic lens, but it’s been amazing to learn about and figure out.
How would you define an “excellent healthcare provider”?
I think an excellent healthcare provider, first and foremost, strives to be a center for excellence, and collects outcome data so you can analyze it and use it to improve treatment. Additionally, especially in this day and age, it involves a lot of flexibility as well. Being open to all the new research and all the different methods that are available, and looking at the evidence behind it to find appropriate avenues is the key to great healthcare.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
The healthcare system, whether its behavioral health or medical health, is entirely based on an in-person model, with very little flexibility. In-person has always worked very well and has always had great advantages; we’ve never been forced to try anything different. But having to do things virtually now has definitely been challenging for all healthcare professionals. For example, if your foot hurts and you think something may be wrong with it, how do you manage that over telehealth as a clinician when you can’t truly see or feel the issue? It’s the same thing, to some extent, with behavioral health. You lose a lot of the non-verbal communication that might’ve otherwise helped to make progress.
I think one of the things we can do to correct those specific issues moving forward is to keep track of what it is that we’ve learned and to continue to innovate around that rather than just saying, “Yay, COVID’s done. Let’s all go back to the way things have always been.” It’s certainly possible that something like this could happen again in the future, and we’re still not fully out of it. I think if we continue to develop technological innovations to try to address these issues, it can be a really big step forward.
Behavioral health-wise, I think it’s important to continue the efficacy and outcomes research on what works and what doesn’t work so we can rethink the structure of therapy and develop new therapeutic orientations and modalities that are better suited for the telehealth format. On the medical side, continuing to develop ways to improve at-home assessments so that people could have more accessibility to utilize whatever it is that might be recommended in order to provide information to doctors and healthcare systems.
Right at the start of COVID, we all focused on what was missing, what was wrong, and what the limitations were. Recently, at least in behavioral health, I’ve been hearing a lot more talk about what the advantages were to telehealth that you couldn’t do in-person. And I think that’s what we need to continue to focus on, rather than just saying, “Well, that’s over. Thank goodness.”
Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
In general, I think the healthcare system did a good job of managing the paradigm shift. Within the mental health space, I think we did a particularly good job shifting within individual therapy to a telehealth model. I saw so many colleagues who were able to successfully take their business and move it to a virtual space.
I still remember the night we had our first COVID outbreak and thinking to myself, “All right, we’re in trouble.” We sat down as a team and I think we were there until at least 2:00 in the morning thinking through options. We put together a piecemeal system of how we would switch everything to Zoom overnight, printed up information and steps to do this, slid them under some doorways, and never looked back.
Thankfully, we didn’t have to stay full virtual for too long, but over the next three weeks of quarantine, we addressed each issue that came up and managed it the best we could. We had quickly created a sustainable program and had successfully done so very quickly.
Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- The mismatch between quality client care and the payer system. There is pressure on everybody to see so many clients in behavioral health, and to maintain a private practice with insurance-dependent clients is incredibly difficult. With private paying clients, you can see four clients a day and have a four day work week and do reasonably well for yourself. But to do the equivalent or bring in the equivalent income for insurance clients, you’re going to be seeing nine clients a day, back-to-back, and you’re not getting no-shows reimbursed. There is just such a huge amount of pressure through the current payer system to see so many patients, and that can ultimately compromise patient care. We are seeing the same thing on the medical side for physicians, too, where they’re blocking out clients in 15-minute increments and there is mounting pressure to churn out work. I really think this compromises patient care in the long run.
- This leads into my second point which is, we need to see additional research into the quality of care based on client load. From my perspective, when a clinician sees five clients a day and has plenty of breathing time for documentation, consultation, and interdisciplinary work, you’re going to get much better results than if you’re going through eight or nine clients a day. I believe that less burnout, combined with more quality time for each patient, would ultimately save payers money. If we’re doing a good job the first time because our clinicians aren’t burned out, then we won’t see as many clients needing to come back for more visits.
- Leadership and training are key to improving the overall US healthcare system. During my graduate training, I spent seven years in my program and still came out knowing next to nothing. You learn so much through experience and through training and consultation. If training and consultation are a built-in part of our curriculum, I think we can build a greater foundation of skills than what graduates currently receive. This isn’t to say there are shortcomings in the current education system, this is just to say that both medicine and mental health are incredibly complex fields and we should be learning the complexities as part of our schooling.
- A change in the Continued Education Units (CEU) system. I believe CEUs should be provided regularly, and the cost for licensed clinicians or medical professionals should be dramatically reduced. If CEU opportunities were more affordable and more available, and if we could really focus on identifying the very best opportunities so there’s more cohesion, that would be very beneficial to clinicians’ practices.
- Continue to find ways to diversify the field and make training more accessible to people from all backgrounds. There are a lot of populations that we’re not serving equitably for both mental health and medical health because we’re not speaking the same language. Not only literally, but also in terms of understanding the concerns or the cultures and customs of different people. In the medical landscape and behavioral health landscape, we aren’t really speaking to that. With increased diversification and more training on cultural competence, I think we would see great changes here.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
Within the industry, there is an issue of pay and compensation, especially as you are getting started. On the medical side, people do such long residencies for such low pay and with challenging hours. I think we need to break down some of these barriers of entry.
In addition to that, on the physician side, there are some specialties that give you a comfortable living and there are some specialties that really don’t — and that’s a strange disparity in medicine. People shouldn’t have to go into plastic surgery if that isn’t their interest in order to make a decent living.
Same thing on the clinical side, too. Community mental health does not pay well at all, and even some of the best paid mental health clinicians just aren’t making a lot.
How do you think we can address the issue of physician diversity?
I think it’s a matter of accessibility for the field and putting people from diverse backgrounds in leadership positions, as well as having the right avenues available for people to enter the field. We also need to have enough training and cultural competence from current clinicians and physicians to break down any stereotype, stigma or preconceptions around the field itself, which I think will help more and more people want to be involved.
How do you think we can address the issue of physician burnout?
Going back to quality versus quantity of care: if we’re trying to fill schedules with tons of appointments, seeing a patient every 15 minutes, documenting at some point, there is going to be a lot of unnecessary follow up with patients to get the full picture. We can miss the underlying issue, the most important piece. When we spend more time with clients upfront, we can do a better job and reduce the likelihood of them having to come back to address the original issue. If we give physicians more time to connect with patients and more time for documentation, they can do a great job the first time.
If we can make that change along with adding more support for more physicians with diverse backgrounds, making it more equitable for people to enter the field and stay in the field, addressing physician shortages, and addressing pay gaps for community mental health, it would greatly reduce a lot of the physician burnout we see.
What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
This is a bit of a loaded question that probably starts with the overhaul of the payer system, the burnout, the quantity, and quality of appointments. All of this is really reinforced by the rates of reimbursement and how much time physicians are told they can spend with clients, knowing that it is a setting that’s also business with a reimbursement structure — we really need to take a look at that.
For individuals, we can look at the initial assessment phase. The first time that someone comes to see a physician or a psychologist or any sort of mental or behavioral health professional, a lot more time should be spent gathering information. That should be the standard, so that they’re able to gather accurate information the first time and go from there.
On the other side, corporations could make concentrated efforts towards hiring diverse care providers and supporting them in the workplace. Corporations can work as a community and within a larger community to try to destigmatize mental health and physical health and really switch the messaging around those sorts of issues. We have a society that really promotes independence and individualism, and it would be great if we promoted seeking health as a strength — we could talk more as a society about how seeking help is a sign of strength and maturity.
A lot of change can come from leaders in healthcare and leaders in mental health prioritizing, valuing, and treating their employees well. This could look like leaders giving employees the support that they need rather than burning people out and having them do too much without support or supervision. This could also look like more interdisciplinary team meetings, more training, more continuing education opportunities, all built into the structure of the day.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Being in a leadership role, I see a lot of people who don’t support our direct care workers very well, who don’t encourage self-care and a good work-life balance, and who aren’t really promoting ongoing efforts to improve through education and Continuing Education Courses. Finding a way to take some of the edge off of the profit motive we sometimes see in the industry would be the movement I would want to inspire. I’m blessed to currently work in a place where we aren’t motivated by profit and just giving each of our clinicians 20 clients and saying, “Make it work.”
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.