Dr Liudmila Schafer of the University of Missouri Kansas City: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

Give people access to special programs that allow them to get affordable health care. Advocate for patients to obtain low-cost or no-cost treatment using cutting-edge technologies and therapies at big medical centers and tiny community clinics.

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. Liudmila Schafer.

Dr. Shafer is a board-certified medical oncologist specializing in gastrointestinal cancers at Saint Luke’s Cancer Institute and an Associate Professor of Medicine of the University of Missouri Kansas City.

Growing up and starting her career outside of the United States, she understands health disparities and focuses on delivering passionate patient care and economically sustainable treatment to underrepresented populations. Based on two decades of work, Dr. Schafer helps the medical community keep up with the massive amount of information and new technology available while leveling the playing field of knowledge around research and medicine so the public can make informed decisions. She works with medical trainees and healthcare professionals empowering them with strategic knowledge, always advocating for diversity, equity and inclusion.

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?

I’m so excited to be here!

Everyone has a story and there are a lot of unspoken stories. After the pandemic, we learned so much about communities and people thanks to the digital world. Personally, I’m still humbled when someone admires the “six letters” after my name the other day, because my life was never glamorous. I grew up on the border between Poland and Belarus, where we had very few clothes and had to cultivate and collect most of the food we ate. It was difficult to own books and we borrowed eagerly from each other or from the library, and there were of course no computers in the 1980s!

I wanted to be a doctor since I was a little girl. For me, being a doctor is a combination of science, collaborative learning, being a giver, educator, and subsequently my passion for cancer care, precision oncology, ongoing personal and professional growth for both medical trainees and healthcare professionals and translating all that into human leadership.

I worked in a hospital after graduating from medical school and witnessed the personal side of healthcare. There were limited resources, but I kept a strong focus on patient care during physical exams and conversations with them to learn about their primary complaint from a detailed history, so I obtained the best clinical diagnosis.

I was accepted into a postdoctoral fellowship after graduating from residency, but serendipity happened when I was invited to a medical conference in the U.S. At that time, I didn’t have many resources or much support, and there was no clear path for me to follow. I was dealing with the challenges of being a young woman, a physician, and the mother of a young child, while seeking new opportunities.

Have you ever been offered an opportunity so appealing that you couldn’t turn it down even though you didn’t have a clear path to achieve it?

I was invited to a conference in the United States, and through translation I discovered new medical advances, and I really wanted to speak English, so I could learn everything myself. I was not interested in clothing, cars, homes, cosmetics, or anything else; all I was interested in was new scientific knowledge and learning the English language. After I came home, I was still very motivated to continue my English studies and I was fortunate to stay connected and study more about the United States Medical License Exam (USMLE). I felt that my life was gaining meaning and saw an opportunity, so I took the risk and went to the United States. I started off as an entry-level researcher while continuing to learn English, translating all medical literature, and studying for the board-certification exam to become an oncologist.

As a foreign graduate, you must pass all medical examinations in the United States, just like all Americans who are native English speakers. I knew very little English at the time. To understand, I translated every single phrase word by word.

To get by, I just learned a few fundamental sentences. Then in the late evenings after work, I prepared for the medical license exams. I confess that I would frequently fall asleep in my chair — and even almost fell off a couple of times — because I was exhausted from working, caring for my child, and studying on top of daily chores. I’ve always wanted to contribute to other people’s lives, to share ideas, knowledge, and provide the greatest education possible for my son.

When I first got here, I was already a board-certified physician, but I had to retake medical residency and a medical oncology fellowship in the United States. I’ve had an “old school” training. When we were house officers, we worked at the hospital as trainees for 30–35 hours, followed by 12 hours for several days and again, and we rotated like that for several years, studying medicine, taking care of patients. There was very little time for our families.

That’s why I work with young trainees now and advocate for the improvement of education, so it supports them during this time. Especially as a female physician, and a minority, I understand how important it is to help young medical trainees advance now.

I’ve spent most of my career as an academic physician, so gastrointestinal oncology seemed a natural fit for me due to close relationship with the patients. We meet them at the vulnerable time when they’re facing difficult decisions — especially now when it is so difficult to navigate the healthcare system.

Years ago, when I started practicing, medicine offered little advances and limited technology. We had paper medical records and wrote everything by hand and now, there’s so many breakthroughs and we’re functioning in a new digital environment.

Over the last several decades, medical knowledge has grown at an exponential rate. For example, when I finished medical school in 1996, just a few medicines were licensed to treat cancer; currently, the Food and Drug Administration approves a new medication practically every week! It is so exciting to see that artificial intelligence and digital technologies are taking over the world. On the other hand, it brings with it new problems and difficulties. I felt like I had been through so many phases of medicine, that COVID-19 brought an extra experience from which we are all still learning.

Can you share the most interesting story that happened to you since you began your career?

I actually have so many stories to share that I need to write several books! Changing from one country to another gave a bird’s-eye view to so many transformations! I had one patient who had an advanced disease, and we chose to treat him with a more developed protocol and investigational treatment involving chemotherapy and radiation. And his chances of survival quadrupled. Several years later, when I examined him and we discussed a plan of follow up, he laughed and said, “Oh you see — I told you.” My favorite thing is when someone says, with a smile in their eye, “I told you so.” Because currently in medicine, statistics are behind. We have a tendency to give a prognosis but now every cancer is different. I call it “treating by mutation and not location”, because it’s not based on the location of the organ. We think we know how long people will live, but every day new molecular tests and treatments prove that we still have a lot to learn. We used to be able to give out statistics and prognoses more easily than we can now, but with so many new molecular platforms, many cancers are seeing improved survival rates.

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?

We often hear about the burden of cancer and other chronic diseases, so it may come as a surprise that we cancer specialists have our funny stories. There are probably many other occupations that can relate to this. Being a female oncologist, we sometimes have to speak with a stronger voice. Years ago, I was discussing the result of a radiologic image with a patient. I started speaking with a particular tone of voice because I was delivering the unfortunate news of the cancer’s progression. This was a very vulnerable and tender time for the patient, who was understandably very sad. It was impossible to discuss the results without feeling deeply for the patient. After that, the patient received a new treatment and improved. When receiving test results the second time, the patient said, “Dr. Schafer, you’re speaking in your “cancer voice.” The patient then smiled, showing that they recognized who I was and that we had an excellent working relationship. We joked about it later. Now, every time I deliver a prognosis, I recall my “cancer voice.” That is how sensitive the patient is. I think it’s an important reminder for all of us to be careful of how we talk.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

The expression “knowledge is power” is frequently ascribed to Francis Bacon, who wrote it in 1597 in his Meditationes Sacrae. I’ve always believed in knowledge since I was young and now share this with medical trainees and healthcare professionals in my talks.

Are you working on any exciting new projects now? How do you think that will help people?

My passion is to help patients and their loved ones navigate and treat cancer through clinical trials and personalized treatment so that they bravely achieve their goals and live their best life every day. One of my research projects relates to new potential molecular biomarkers that emerge on circulating tumor DNA. Using molecular platforms and introducing new options is my true love. I bridge the gap between cancer treatment and research, bringing it to the patient’s bedside.

Now my goal is to reduce health inequalities and provide equity for all patients. Navigating the healthcare system is a stressful and complicated task. I have a desire to create something that will assist others in learning how to tackle their unique issue. Many locations provide general information, but we need to create better ways for obtaining exact information.

This brought me to working on a book that focuses on how to develop resilience, as well as how to find ways to liberate yourself and be brave in order to live a better life. My book offers steps to find yourself, discover your personal why and identify your personal strategies to achieve it.

How would you define an “excellent healthcare provider”?

As a physician with an academic background, and by teaching and learning every day, I’ve discovered that every healthcare provider has unique skills. We’re all taught certain programs in school and there is a strong system in place, but during this pandemic we discovered how many healthcare providers offered their best. I strongly believe in personalized patient care. It’s important to look in their eyes and understand the unique situation of every patient, including their social environment. An excellent healthcare provider listens, takes a personalized approach, and always seeks for new and better ways to identify a plan of care. Collaboration with other healthcare providers plays a major role. For example, your magazine plays a huge role in helping bridge the gap between healthcare providers, patients and their caregivers, and this is important. I discovered that it is stressful not just for patients and their caregivers, but also for physicians, nurses, and other medical personnel. I believe that finding new avenues to offer digital technology and new information helps us provide excellent, personalized care, where we never lose sight of the individual person. Over the years in my practice, people occasionally comment, “You’re probably used to this. You’re an oncologist; you see a lot of people dying.” But the truth is, after all these years, I’ve never gotten used to it. Every time I witness a tough scenario, my heart breaks.

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?

Learning to strengthen the healthcare system after a pandemic is both expensive and stressful. However, many new molecular platforms and new digital technologies offer advanced ways to care for patients. In addition, a major landmark was established when the American Medical Association and the Centers for Medicare & Medicaid Services did an adjustment in the evaluation, management, documentation, and coding of office visits on January 1, 2021. While patients have access to their medical records, the complexity of medical terminology makes it challenging for them to interpret the records. In my view, a liaison between the public and healthcare professionals would improve communication and understanding. Finding ways to help patients and healthcare professionals will benefit everyone. Now telemedicine has changed how we conduct office visits. We are finding more practical ways of communicating in the new era. Doctors spend a lot of time on computers. We’re also developing a new structure with the help of new technologies to help physicians spend more time with their patients and less time filing electronic medical records.

The question is, how can we assist everyone? According to a recent survey commissioned by Access One, despite insurance increases, around 66 percent of Americans are anxious about their ability to finance medical care this year. We need to see more collaboration between medical associations. For example, an integration of alternative medicine societies and scientific organizations would help patients understand more options for care. However, patients may not be able to hear well or have limited access. Collaboration between doctors, patients and stakeholders will offer new ways to improve the U.S. Healthcare system.

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.

With telemedicine, everyone steps up; some need to stay at home, others are busy at work. Many individuals are unable to visit a doctor, and we now have greater communication than ever before to handle the condition. On the video visits, cancer treatment options such as chemotherapy and immunotherapy education are provided. Personally, my intention is to help every patient heal and the pandemic showed the strength of so many healthcare providers. Attending patients every day with double masks adds a barrier to communication and care. Not being able to see facial expressions while discussing a new cancer diagnosis is very difficult for patients. New alternatives like telemedicine remove that barrier and improve communication. I only know how some of my patients look thanks to telemedicine. I’m grateful for the new options, because we’ve recently learned a lot about prevention and how to prepare for the next step.

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.

1. Eliminate inequities in healthcare and push for equity for all patients.

To research and discover gaps in delivering high-quality medical care to all individuals, as well as to give the greatest possible experience for everybody.

2. Establish a constructive connection between healthcare and digital technologies.

Our healthcare system has been stretched as a result of the pandemic. One issue that must be improved is the method through which digital technology assists healthcare personnel in avoiding burnout. This will improve the quality of care.

3. Give people access to special programs that allow them to get affordable health care. Advocate for patients to obtain low-cost or no-cost treatment using cutting-edge technologies and therapies at big medical centers and tiny community clinics.

4. Create an effective cost-reduction program before visiting a doctor or a healthcare provider to also focus on prevention and find resources to use.

5. Create a system that avoids duplicating services between specializations. This will provide a platform for connecting hospitals and healthcare networks.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

Eliminate physician burnout by distributing tasks. Currently, physicians and healthcare practitioners spend a significant amount of time dealing with technology, with 20–30 computer clicks necessary to place a single patient order. The digital burden of technology and documentation increased computer time but decreased time with the patient. Balance is the key to ensuring quality of care for the patient, professional development, and physician’s personal life. In my opinion, this is one of the best ways to address physician shortage.

How do you think we can address the issue of physician diversity?

It should start during the medical educational process. Many medical trainees, as well as physicians who have been in practice for decades, are currently struggling to keep up with the fast development of new knowledge. Specifically, we see this in oncology, because there are so many new scientific discoveries. Trying to keep pace with so many advances can have a significant negative influence on the quality of their life, and hence can determine who goes into medicine. Trainees are disciplined to develop certain skills, strengthen their ability to self-learn and gain experience to be educators in the future. As an educator myself, I focus on fresh and novel techniques for improving our trainees’ ability to acquire and assimilate knowledge found in the literature.

How can we rate physicians based on how many “stars” they have? People filling out questionnaires are affected by whether they are in a good or poor mood, if they have just had good or bad. Teachers evaluate differently too. This is why standardized tests were created. But what if a person has a bad day or lacks test-taking skills? Why should we classify a person based on one moment of one day and impact their life? The educational system is at a crossroads, and it is time to make a change.

How do you think we can address the issue of physician burnout?

Our healthcare system has been strained as a result of the pandemic, which has resulted in clinical exhaustion. But it was always like this; we simply recognize it better now. We want to see more sensible use of technology in the clinic. We don’t want to increase physician burnout by requiring them to spend more time on the computer, but rather to use technology to save time. Like I mentioned before, doctors spend a lot of time on their computers and billing, so they have less time to visit patients. Face-to-face contact and resolving patient concerns protects future generations. It is vital for institutions to have “human leadership,” as Bob Chapman put it.

What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

As individuals, we should begin with our body and start at the personal level. Pay attention to your body and speak with healthcare experts if something changes. The number of preventative and diagnostic clinics will rise as a result. The sooner the diagnosis, the less burden, expense, and morbidity. We may reduce the gap in communication between different institutions and recurrent medical tests by developing a plan for distributing duties across departments and connecting with digital technologies as corporations. Spread a call to action in your community to raise awareness and educate people before chronic diseases emerge. As leaders, we can make it simpler to browse and provide information, form partnerships with major companies, build centers where people can get information before seeing a doctor, and have more options and a more open network. For example, women continue to face prejudice in the advancement of their careers in medicine, and relatively few women hold positions of leadership. There are very few minority women in positions of leadership. I would like to see additional clinics developed where minorities have access to the basics, know who to contact and where to go, and are not scared to obtain testing. Covering up an issue does not mean that it does not exist.

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. :-)

Eliminate health disparities, which are differences in outcomes across various populations, such as Asian Americans, Pacific Islanders, American Indians, and Alaska Natives. Minorities have a distinct frequency of not just cancer survival but also other diseases, and their reaction to therapy is entirely different. There is a shortage of scientific data in certain populations, and one size does not fit all. Cancer and chronic illnesses do not impact everyone in the same way. Minorities often wait until the condition has progressed before seeking medical attention; therapy might be prohibitively expensive at times. At that point, the quality of life has already been lost, and a susceptible population that is unaware of cancer might not be diagnosed. They often seek medical treatment in the late stages or whilst they’re sick, therefore we need to educate the public and create centers to assist them. Increase screening for all patients in all areas of the country. People must know where to go and who to contact. Don’t think “if it’s not there, it’s not an issue,” because if you conceal the message today, it affects future generations. We need to make changes today that address health disparities and advocate with equity and inclusion actions.

How can our readers further follow your work online?

Please reach out to me on my website www.liudmilaschafer.com. I would love to hear from you.

Thank you so much for these insights! This was very inspirational, and we wish you continued success in your great work.