Q&A with Dr. Scaringe: Breaking Down Silos and Staying Ahead of the Curve
To understand where Southern California University of Health Sciences (SCU) is headed, it helps to know a little bit about the man leading the charge: SCU President and CEO Dr. John Scaringe.
Raised alongside three sports-loving brothers, Dr. Scaringe enjoys the camaraderie of a team. In sports, he knew that success relied on the ability of players to maintain their own identities while also working together toward a common goal.
When it was time to choose a career path, he pursued chiropractic because of his positive experiences as a student-athlete. “As athletes, we would go to our chiropractor when we were injured,” Dr. Scaringe explains. “I originally got into chiropractic to work closely with athletes.”
After graduating, he also volunteered at athletic events almost every weekend, where he had his first experiences with team-based healthcare. “The medical doctors, chiropractic physicians, athletic trainers, and EMTs—we were all there because we loved it and wanted to help the athletes,” he says. “We weren’t battling for revenue.”
Today, as Dr. Scaringe begins his 10th year as SCU president, he still carries those team-based care experiences with him as he leads the university’s academic mission. Recently, we sat down with him to learn about what he’s seen at SCU over the last decade.
Q: How have you seen SCU change and grow during the last decade?
A: When I came on board as President, we had only the Chiropractic and Masters of Acupuncture and Oriental Medicine programs. Since then, we’ve seen tremendous growth and diversity in our programs. To achieve what the Board of Regents set out to do in 2000—move from a singularly focused chiropractic institution to a multi-purpose health sciences university—we started looking at not only integrating holistic professions, but also integrating within the system. We took a hard look at integrative healthcare and the team-based approach, and how to use it to make a significant impact in the local community and beyond. In the last 10 years, SCU has developed a strong reputation in integrative health and interprofessional education. For example, roughly 65% of the first-year physician assistant (PA) curriculum includes classes with chiropractors and acupuncturists.
Q: How does SCU’s approach to integrative healthcare make it unique? How does it prepare students to provide team-based care?
A: It’s pretty simple. We look at the patient and patient outcomes. We want improved quality, improved patient outcomes, and better ways of delivering care. Patient outcomes are enhanced through team-based care.
There are still silos we need to break down, but they’re easier to penetrate early if we keep our finger on the pulse of what’s happening and remind ourselves that the walls are unacceptable.
We take it a step further by preparing our graduates to be better team members through interprofessional education. Traditionally, healthcare practitioners are trained in silos. Then, at a certain point, they may be encouraged to work with other healthcare professionals. At that point, however, you’re jumping into that team with biases and preconceived notions. So we help our students develop a dual identity from the start: one dedicated to their team and one dedicated to their specific profession. We’re a small, independent university. We try to stay ahead of the game in some areas while positioning our graduates to be successful in the current healthcare environment, and be ahead of the curve as the environment changes.
Q: Is healthcare moving toward the concept of interprofessional care?
A: There are pockets across the United States that offer integrative healthcare or value-based care—but not on a system level. Many pockets of the country work on an incentive program based on fees for healthcare services. Even if a surgery is botched, for example, the hospital and physician get paid. It has nothing to do with outcomes. The fee-for-service model can sometimes incentivize over treatment—which isn’t in the best interest of the patient.
On the other end of the spectrum, there are pockets where physicians are paid based on the number of people they care for. This approach can sometimes lead to under-treatment. The key is to find balance. Even within team-based care, it’s still a fee-for-service system. It’s going to be hard to put integrative teams into this business model unless the system changes. But we’re moving in the right direction. For example, during a hip replacement or knee replacement, more orthopedic teams are bringing internists and cardiologists to the table to consider factors like diabetes and heart disease, and how patient outcomes may be impacted by these factors.
Today, nearly 75% of healthcare dollars go toward chronic conditions. There are conservative estimates that 80% of these chronic conditions are preventable through lifestyle changes. This presents a great opportunity for SCU and our students. Our strengths include looking at the whole person and offering natural, preventative care, combined with the best that mainstream medicine has to offer.
Q: Which SCU successes are you most proud of?
A: I’m proud of the way we’ve changed our culture and vision, transitioning to an integrative university from a chiropractic-focused institution. We have a 100-year history in chiropractic care, which is outstanding. Our largest program is still the chiropractic program. But we’ve expanded to include many other types of programs, including our PA program, sports medicine, and acupuncture.
We’ve also become better at describing what we do and the impacts we make. A decade ago, when a faculty member was asked, “What do you do at SCU?” the answer would likely be, “I teach anatomy.” Today, we’ve arrived at a point where that same instructor would respond, “I teach students to be the best integrative practitioners out there, and I use anatomy to do that.”
There are also successes that aren’t highlighted as often: Things like our sports medicine program and its direct pipeline to the U.S. Olympic Training Center and our participation in keeping teams in elite shape for the Olympics.
Q: Tell us about some of the challenges SCU faces—and how those challenges are being handled.
A: We’re trying to balance and be relevant despite two crises happening in the United States: the healthcare crisis and the higher-education crisis. All small, focused institutions face financial and sustainability risks. The cost of delivering education continues to increase, which impacts healthcare and higher education. There are increased regulations from the federal government, the state, and professional accreditors, which adds more costs. Fifteen years ago, SCU didn’t have the need for a large IT department. Today we do, which increases costs again.
In 2013, a prediction was made that approximately 50% of colleges would close over the next 10 to 15 years. Right now, 25% of private colleges are running at deficits because their expenses outpace revenue. But SCU has a great opportunity to integrate within the system and make an impact on the health of the nation—and that’s what will set us apart and keep us going.
Q: When you think about the future, what’s in store for SCU?
A: In three or four years, SCU will be a totally different institution. We’re going to leverage technology in the classroom and within business operations to become more efficient and data-driven. We’ll double our current enrollment thanks to the innovative programs we offer.
We’ll continue to diversify programs at the graduate and first professional levels, and consider programs for the skilled workforce, such as medical assistants and lab techs. There’s going to be lots of demand for these types of positions. They give people the opportunity to invest $15,000 or $20,000 in an 18- to 24-month program and then double their income and significantly impact lives within their community. If they’d like to “tier up” down the road, take their careers to the next level, and build upon the education they already have, we want to make it easy for them to move to the next level at SCU.