123. Angelo Milazzo, Pediatric Cardiologist and Chief Medical Officer

Show Notes:

After graduation, Angelo Milazzo returned to his home state and attended medical school at the State University of New York at Stony Brook. He developed an interest in cardiology and decided to pursue post-graduate training in pediatrics and pediatric cardiology at Duke University. Angelo completed his post-graduate training in 2002 and joined the Department of Pediatrics as an Assistant Professor of Pediatrics.

A Growing Practice and Becoming Chief Medical Officer
In 2002, he was offered the opportunity to start a pediatric cardiology practice in Raleigh, North Carolina. The practice grew from a one-man operation to a practice with about 30 physicians across various specialty areas. In 2017, Milazzo became the vice chair for practice for the Department of Pediatrics at Duke Health, which has grown to 250 clinical faculty and 50 research faculty. Angelo then became the Chief Medical Officer for the Duke Health Integrated Practice, overseeing all physicians who practice at Duke Health. This role allows him to take the best of his administrative leadership within one clinical department for children's care and spread it across the entire enterprise.

The Economics of Health Care and the Business of Medicine
Angelo's hands-on administrative experience and managerial experience have led him to become interested in the didactic aspect of his career. He believes that his administrative experience and managerial skills have allowed him to excel in various aspects of his career, including pediatric cardiology. Before the pandemic, Angelo enrolled in business school and completed his MBA in just under two years. He was interested in the economics of healthcare and the business of medicine, but also enjoyed the perspective of classmates from various industries and walks of life. Today, he is a practicing pediatric cardiologist, spending about 40% of his time in clinical practice and 60% of his time in administrative work. He is also interested in health equity research and is part of a project funded by the CDC.

What it Takes to Be a Physician Leader
Angelo explains that, to be a great physician leader, one must first be a great clinician, and this takes so much more than just medical knowledge. He believes that engaging with patients and families is a privilege and that this energy and insight can inform his managerial work. He has had the privilege of mentors in medicine and being taught by amazing clinicians, which has allowed him to feel comfortable with fraught conversations. He explains how his managerial experiences and administrative experiences make him a better clinician. He has had to negotiate with professionals from different backgrounds and training perspectives, enriching his perspective and broadening it. This constant bilateral communication within him allows him to enhance both sides of his career.

The Executive MBA Program Experience
Angelo talks about the value of his Executive MBA program, and how he appreciates the practical aspects of the program, such as lectures, video calls, and team meetings. However, he also highlights the value of teamwork and learning from professionals from different industries. He shares his capstone project, which involved working with a delivery firm in Eastern Europe, a firm far from his daily work. The team consisted of professionals from various industries, including military, micro brewing, airline, and healthcare professionals. The challenges faced in his work were unique but universally applicable, and he learned valuable lessons from the experience. He also talks about systems used during a public health emergency, the A3 structure and how it is used for improvement projects, and the journey of improvement. 

The Performance Improvement Journey
Angelo talks about management principles adopted in health care and the performance improvement journey that began with the introduction of a standardized electronic health record in 2013 and the adoption of Epic, which is now used by two-thirds to three-quarters of major health systems in the country. This allowed for a common set of data mining tools to collect clinical information and understand success or failure around quality initiatives. The organization's new leaders, including those from other health systems and academic centers, were committed to this continuous improvement environment. By the time the CMO became vice chair in 2016, they were ready to bring these principles into their department. Now, almost a decade later, the organization has built a culture where everyone wants to be a quality improvement scientist. They have developed an academy to train healthcare professionals to become quality improvement scientists, which involves a rapid boot camp that teaches principles over a concentrated period of time. Many of these projects have been presented at regional, national, and international levels, covering various medical specialties, from complicated heart surgery to solid organ transplant to medical genetics to obstetrics and gynecology. 

Influential Harvard Courses and Professors
Angelo mentions three courses and professors that have resonated with him at Harvard: Arthur Kleiman's course on Illness Narratives, Professor Dante Della Terza’s Divine Comedy class, and Gregory Nagy's Heroes for Zeros class. Angelo's course with Professor Kleiman was about the idea that hearing patients talk about their illness is a form of storytelling, which he uses in his work. He also mentions Professor Nagy’s use of a clip from Blade Runner, a sci-fi noir film, in his class. He believes that this class spoke his language and that he was in the right place for him. Angelo also mentions missing the Michael Sandel Justice course, which he later took through the Harvard EdX program. 

Timestamps:

01:29: Angelo Milazzo's Journey After Graduation 

05:29: Transition to Administrative Roles and Business School 

09:48: Balancing Clinical Practice and Administrative Roles 

14:30: Learning from Business School and Applying Lessons 

26:11: Implementing Continuous Improvement in Healthcare 

36:40: Influential Courses and Professors at Harvard 

Links:

LinkedIn: https://www.linkedin.com/in/amilazzomd/

Featured Non-profit:

The featured non-profit of this episode of The 92 Report is recommended by Julie Cotler Pottinger who reports:

“Hi. I'm Julie Cotler Pottinger, class of 1992 the featured nonprofit of this episode of The 92 report is every library. Every library helps America build support for libraries and also helps us fight book banning in our communities. I'm proud to be the National Ambassador this year for every library under my pen name, Julia Quinn, and I've been working real hard all year to help them raise money and awareness. You can learn more about their work at www.everylibrary.org and now here's Will Bachmann with this week's episode.”

To learn more about their work, visit: https://www.everylibrary.org/