I have always loved traveling around this country.  As a child, I enjoyed going on trips with my family and checking off the states we visited, making it a point to buy post cards from every state.  One of my biggest thrills as a young adult was going to Four Corners and doing a dance around four states simultaneously. For some reason, I like this state thing.  Maybe I should talk to my therapist about that.  But it took me 50 years to visit my 50th state, North Dakota.

So, the prospect of visiting all 50 states in a year was an intriguing challenge for me.  I’m told that Nixon tried to campaign in all 50 states in 1960, got sick on his travels, and some say it was instrumental in his ultimately losing to JFK.  Maybe it’s not such a good idea for me either. But I love to travel with my job.  I love to see new things.  So maybe it would be worth a try.

In a typical year, I speak and consult in about 40 states.   In 2012, I visited 49 states, missing only Alaska.

I decided to set a goal for 2016 to visit all 50 states.  Today, on December 19th, I visited a CMO of a hospital in South Carolina, for my 50th state.  I did it.

So, now I’m sitting on an airplane in Charlotte, waiting to go home.  The airlines just announced a delay, a good opportunity to reflect on my year’s journey.  What did I learn through these dozens of presentations and so many thousands of miles?  Let me list them:

1.  We live in a big country.  Even with the advantage of living relatively centrally in Austin, it takes a lot of hours on planes to do what I did.  Anchorage and Honolulu are ten hours away, but fortunately most of the other destinations are a lot closer.  The United States is a beautiful country.  There is so much to see from coast to coast.  From beaches to mountains to deserts, there is incredible diversity.  Incredibly gorgeous scenery everywhere.  I typically take advantage of even a few hours when I travel to take see as much as I can.  I filled up my smart phone and social media with pictures.  How blessed am I to experience so much of this country.  And the local food?  I’m amazed I have not gained any weight.

2. Every medical group and hospital that I visited is truly unique.  I was impressed with the operational complexities and the individual challenges that each institution must face.  Each market has different demographics, payor mixes, etc.  There is no common model and there is no universal formula for success.  It proved to me the old adage that when you’ve seen one hospital or medical group, you’ve seen one hospital or medical group!  One size does NOT fit all.

3. Despite our geographic diversity and uniqueness, we all share many of the same problems.  Once I get in a room with the physicians, administrators, or Boards, we talk about virtually the same issues.  Whether I am in Portland, Maine, or Portland, Oregon (and I’ve been to both within a week), the challenges, fears and hopes of all the health care professionals are amazingly similar.  I’ve discovered that we can learn so much from each other if we adapt the common knowledge and best practices we have acquired to fit our unique situations.

4.  There is tremendous dedication on the part of our physicians, nurses, administrators and Boards.  Everyone wants to do the right thing despite the increasing hassles that get in the way of our taking care of patients.  Almost to a person, everyone I met was truly interested in providing superior care and improving the health of their individual communities.  I leave every institution with a profound sense of pride in our caretakers and leaders. I am particularly impressed by our young physicians, many of whom have large debts from their training, but their enthusiasm and optimism is inspiring to an old doc like me (who could be needing their services).

5.  Virtually all caregivers I meet are hopeful to achieve true population management and better health for all Americans.  Despite the hassles, burnout and general dissatisfaction with the powers that be, there is still a general optimism.  There are huge obstacles ahead, not the least of which is controlling our spiraling, out of control health costs, but despite these issues, the outlook is good.  No matter which state we live in, we are Americans.  We are professionals.  We will face our difficulties, overcome them, and be the best.

6.  Folks are proud to be in health care.  All too often we just hear the horror stories of how people want to leave medicine and how they hope their children would consider another profession.   Having been in the trenches now in all 50 states, I was constantly reminded of how much our caregivers CARE.  (I like that alliteration).  Even in busy emergency departments, crowded hospitals and bustling clinics, there is that pervasive sense of the joy and dedication of taking care of our sick.  I cannot count how many smiles I received from staff when I was walking through the hospitals or clinics.

I really did learn a lot this year from my travels.  And doesn’t count the technical experience I gained by visiting, speaking, and consulting with so many diverse organizations.  What a privileged year for me.  I learned so much about America and about our profession.  This 50-state thing was a pretty good idea.

And if that’s not enough, my Broncos won the Super bowl, and MY CUBS WON THE WORLD SERIES.  

But there’s one final thing I learned that I must share with you….

7. I never want to do this darned 50-state thing again.  Although I love the speaking, the consulting, and even the travel (but not tonight!) I now realize the value in being home, crashing in my media room, or simply playing music with friends.  I love Austin.  I am grateful my two children are nearby and that I am in good health.  Couch potato here I come.  Or at least until January when it’s time to start again!!

The pilot just announced we are clear to go.  I will sleep in my own bed tonight, three hours late and tired, but safe and happy.

This 50-state journey has left me feeling very invigorated and inspired.  Wherever I may travel in this terrific country, I know I will be in good hands.  It gives me a tremendous feeling of comfort.  I have seen it and felt it everywhere I went.

Health care folks, I salute you all.  I am proud to be an American and I am proud to be a physician, and most of all I am proud that I can contribute my small part to a dedicated team across the country that will work tirelessly to improve our health and wellbeing.

In all 50 states!

Merry Christmas and Happy New Year to you all.

The Latest

The Future of Generative Artificial Intelligence

The Future of Generative Artificial Intelligence

What Does the Future of Generative AI Hold? It was only a little more than a year ago that ChatGPT exploded onto the market. Within two months, it had acquired over 100 million users, an accomplishment rarely seen with emerging technology. As an example, it took Uber 70 months and Instagram 30 months to obtain that same level of ...
Lies, Damned Lies, and Statistics… And Now AI!

Lies, Damned Lies, and Statistics… And Now AI!

Exploring Potential AI Bias in Healthcare We have all heard of the quote attributed to Benjamin Disraeli: “Lies, damned lies, and statistics.” Lately, there has been increasing concern that AI outputs may be either intrinsically or intentionally biased. When coupled with the reality that AI’s power and intelligence is progressing at an ...
Ambient Clinical Intelligence: A Welcome Benefit to Providers and Patients

Ambient Clinical Intelligence: A Welcome Benefit to Providers and Patients

Ambient Clinical Intelligence Is an Exciting Use Case for AI in Healthcare Of all the AI innovations that are exploding into healthcare, this is one of the most exciting. Ambient clinical intelligence (ACI) is a process that uses advanced AI and voice recognition technology to automatically document patient encounters in real time, without ...