In this episode, Ronak interviews Dr. Rob Filler, a seasoned professional in both occupational and lifestyle medicine, with a fascinating background as a flight surgeon in the United States Navy. Dr. Filler shares captivating stories from his military service and offers insights into the challenges and trends in occupational medicine. Join us as we explore his unique experiences and perspectives on healthcare.
Ronak 0:00
Hi, I'm here today with Dr. Rob Filler. He's currently practicing occupational medicine, but is boarded in occupational medicine as well as lifestyle medicine. He settled down in Southeastern PA after completing residency training in Boston during the beginning of COVID. Prior to that, he was a flight surgeon in the United States Navy, where he was able to fly in military aircraft, including F-18s. Dr filler, thanks so much for coming on, and special thanks for your service in the Navy. So what was that experience like?
Dr. Filler 0:29
Yeah, so that was a pretty cool experience. As a flight surgeon, I was embedded into an aviation unit, and so I did all of the primary care for the unit. But one of the perks, so to speak, of the job, was flying with the unit. And so there's, there's probably no greater vote of confidence in your clearance for duty physical than getting in the back seat with someone that you cleared for duty.
Ronak 0:57
Did you serve in any of the wars?
Dr. Filler 0:58
I was in the Middle East, and I also did a non combat deployment to the West Pacific, so I got a pretty good flavor in the short time that I was in.
Ronak 1:09
Wow. Any crazy stories you can share?
Dr. Filler 1:11
Definitely lots of crazy stories. An Iranian missile commander told us they were going to incinerate us over the radio while we're flying in international waters. And so, it's really interesting, I think, from a medical perspective, you can understand some of the stressors of flying, but when you're you're flying kind of a training sortie near warzone, and then you have a third party kind of yelling at you, it kind of gives you a much more in depth understanding of some of the cognitive task flow that a pilot has to deal with while they're flying.
Ronak 1:50
Yeah, I mean, I can't imagine that level of stress. Like you mentioned, there's so many different factors, and if you're in an active war zone, it's just, I think that's why civilians are so thankful, because it's something that I think only a few people can really do and do it well,
Dr. Filler 2:09
Yeah, I think that's one of the challenges the military faces in recruitment, is the number of people that are kind of physically fit for military services is on the decline as a lot of chronic medical conditions have become much more prevalent. So obesity is one of the biggest disqualifiers for military service, and so that's something where our health system really needs to become less reactive and more proactive in terms of disease prevention.
Ronak 2:40
Yeah, I agree 100% so your background is in occupational medicine. What inspired you to pursue a career in that?
Dr. Filler 2:49
So occupational medicine is one of those specialties that you do not get exposed to in med school, and so in your last two years of med school, you kind of rotate through a lot of the hospital based services. You don't get a whole lot of exposure to the services that kind of operate outside of the hospital. And so occupational medicine is classically one of those where you're working in an outpatient setting, you're not necessarily really affiliated with the hospital. A lot of occupational medicine physicians are employed by standalone practices or directly by employers. So I really got exposed to it in the military, kind of doing the job every day, but not not really knowing about it, until trying to figure out what I wanted to do when I left the military. And that's when it kind of struck me like, Hey, I've been doing occupational medicine for the last like six years. Let me kind of continue doing that.
Ronak 3:49
Makes sense. And I mean, what type of cases or patients do you typically encounter?
Dr. Filler 3:56
Yeah, a lot of what you see is soft tissue injuries. The Pennsylvania work comp annual report just came out, and so you can see a by industry breakdown. Upper extremity injuries are fairly common, so kind of shoulder, neck, down to the hand, that represents about 30% of injuries that you see. Low back injuries are very common. Any kind of work that's involved in the transportation sector, you're going to see car accidents, and so you do see some more significant injuries there, but a lot of the injuries are folks that still have some residual work capacity, and so trying to navigate the injury recovery, keeping people working and kind of working at the highest level they can, is really the name of the game.
Ronak 4:52
Yeah, so I'm assuming, a lot of this must be in heavy labor jobs, right? Like construction, like you said, transportation, do you see a lot of cases in typical office jobs?
Dr. Filler 5:05
You will see some, you see injury rates are kind of present across all sectors, but the types of injuries that you see are going to be radically different. And so construction, you're going to see, obviously, a lot of material handling. You'll see people that are struck by construction equipment. You can always think of the Three Stooges turning around the two by four and hitting each other in the head. So you certainly see accidents like that. Hospitals, healthcare workers, you tend to see a lot of injuries involving patient care. So lifting patients, rolling patients, in some respects, construction or if you went to a warehouse job, you know the box weighs a certain amount, and it's not going to do anything to help you or not help you with lifting, with moving people around, it's a much more variable lifting experience,
Ronak 6:02
Yeah. So what emerging trends or challenges do you see in occupational medicine?
Dr. Filler 6:08
Yeah, I think the challenges are many. There's not a lot of output of occupational medicine physicians. And so one of the challenges is an aging workforce in occupational medicine, residency programs. Output of occupational medicine physicians is fairly low, and one of the challenges is that there's not a lot of exposure by other healthcare workers. And so one of the issues is that a lot of the Workers Compensation care happens by a very small number of treating providers, and when whatever that pool kind of shrinks further, that's a detriment to folks that need care for workplace injuries.
Ronak 6:48
Yeah, and I think that's a common theme in healthcare in general, where there's a shortage of doctors to support, you know, the growing population.
Dr. Filler 6:58
And sometimes it's a situation where the rich get richer and the poor get poorer. And so some areas where those robust medical systems tend to attract more physicians, but that comes at the expense of places where physicians are needed. And so, that's something that Congress is going to have to figure out.
Ronak 7:16
Yeah, and I see this. I mean, this is so evident in like, rural areas, right? So when you go to rural America, there's a shortage of so many different types of providers that a lot of them settle for no care or care from, the closest urgent care, or they have to travel, out of state or drive for hours before they can actually get the treatment that they need.
Dr. Filler 7:41
Yeah, that's one of the things. Like, when you look at kind of the founding of occupational medicine, it started off as industrial medicine, but it largely emerged because of the transcontinental railroad. They realized, hey, we're out in the middle of nowhere. People get hurt on the job. We need to take care of folks, to get people to keep coming out to do these jobs. And so obviously those foundings kind of created the Kaiser Permanente system, which is, I think most people have heard of, yeah, but it's definitely kind of a re it's a recurring trend where there's not a lot of access to care in more rural areas. And so trying to figure out how to, how to better those, those workers, is critically important.
Ronak 8:26
Right and I think one of the emerging trends in health care right now is just preventative care. Do you see that with employers, employees, where you're giving advice just on prevention?
Dr. Filler 8:38
Yeah, that's something that we see quite a bit of. There's obviously a huge trend towards wellness in the workplace, trying to be more proactive around mental health. Obviously, we spend a lot of our waking hours at work, and so work as also the funder of a lot of general health insurance. There's kind of a complicated web where the employers want to intervene and have some captive audience time to intervene. And so trying to figure out how those interventions work is going to be the big thing. When you look at prevention systems, we are oftentimes kind of reacting to things that have already happened. And so that's kind of in the tertiary prevention. How do you make the world more accessible for someone that broke their leg, fallen down the stairs and ended up in the work in a wheelchair? We can certainly cut sidewalk curbs and do things to make the world more accessible, but are there things that we could have done in the medical care to prevent that person from having ended up with a permanent disability? That's kind of the idea of secondary prevention, and then looking at, hey, was there something we could have done to prevent that person from falling down the stairs? That's your primary prevention. And so that's, that's kind of the continuum of space that occupational medicine occupies, is hey, we can manage the injuries. We can figure out how to accommodate people and make and minimize disability, but let's use the data that we're we're collecting while this happens, and try and figure out how we can better prevent injuries, if in some situations, let's look at seeing, can we move the needle past zero and say, Hey, let's let's not worry about just preventing people from getting hurt. Let's see if we can make people healthier through the workplace. And that's kind of the new thing with workplace wellness. And so I think a lot of that emerged from tech. And so people were looking like, hey, how do we attract workers? And so you end up with kind of clumsy ideas like, hey, we'll put a ping pong table in the break room. And people love that. And so figuring out how to make work fun, how to keep your workforce engaged. Those are all things that HR has been involved with. Saying, hey, how do we get the most out of our workforce? How do we make it easier to attract a workforce? But even looking farther beyond that, hey, how do you minimize your group health spend. How do you keep your workforce from getting injured, and make your workforce more resilient? Those are all things I think we're going to see a lot of effort in, kind of in the coming years.
Ronak 11:13
Yeah, so let's take a deeper dive into mental health. How do you address mental health issues in the workplace?
Dr. Filler 11:19
Yeah, that's really challenging. When you look at the occupational medicine literature, injury for injury, even receiving the same care, people with workers compensation claims, tend to have worse outcomes than Group Health claimants. And so one of the challenges there is the psychological overlay of work. If you don't like your work environment, you feel you're not well compensated, your manager picks on you. Those are all things that kind of drive worse outcomes. We see that repeatedly in the medical literature. And so one of the things that kind of the fundamental underpinning is you don't necessarily need a psychiatrist or psychologist. You need to make sure that HR is training managers and supervisors so that they're creating as positive a work environment as possible that'll get you better outcomes with your work injuries. But it'll also kind of foster that mental health. It's much better to not create the problem than to try and treat the problem.
Ronak 12:27
Yeah, I agree. And you know, for me personally, as an entrepreneur, you work long hours, you deal with a lot of uncertainty, and it's, how do you stay productive and also not burned out. You know, we opened our first location four years ago, and it's been like a grind ever since, right, not just for me, but for my partners as well. And sometimes the employees can feel that pressure as well. So it's how do we keep them happy, productive, and over a long period of time, right? So not just like doing a temporary solution, but you know, if we're in this for the long haul, just keeping them and everyone healthy and motivated is a challenge.
Dr. Filler 13:12
Yeah, that's definitely a challenge. And as soon as you kind of decrease the amount of resources you have to apply, if you're Google or Facebook, that kind of the sky's the limit for spending on things. But when you're kind of bootstrapping a startup, the funding isn't certain. The outcomes are a little bit less, less clear. And so it's critically important for people engaging in entrepreneurial pursuits, you need to take time for yourself. You need to disconnect as much as you can without missing opportunities. Yeah. But I think one of the big protective factors that exist, kind of in in startup culture and entrepreneurship in general, is being able to self direct a little bit having more autonomy over what you're doing if you're the person, the third person in the widget manufacturing line where you you put fastener A into hole B, that's a very monotonous position. You're working at the pace of the assembly line. With entrepreneurship, you definitely have a little bit more free time to kind of self direct, kind of pursue interests to the extent that that's financially feasible. And so I think that's a protective factor.
Ronak 14:24
It is. And the other thing that I find that works for me is that doing something that I love, and I feel like I can do 80 hours of that versus doing 20 hours of something where I hate. So, you know, coming into a work environment that's fulfilling, it's a lot easier to kind of deal with that stress and those hours because of that. I don't think I'd be able to do this if I was, you know, in something else.
Dr. Filler 14:49
Yeah, I think when you look at physicians, kind of a similar category, a lot of people do a lot of extra reading, a lot of professional development, kind of in their free time. It's, people always say it's a calling, but you're certainly called to do a lot of off the clock work and so kind of that, that drive to kind of refine your skill set. It's kind of like professional athletes, they're kind of always grinding, always getting better. I think you see a lot of parallels in medicine entrepreneurship in general.
Ronak 15:24
Interesting. Yeah, so talking about research, like, how do you stay updated on the latest research and the best practices?
Dr. Filler 15:31
Yeah, it's really challenging. You got to really look for a lot of different sources with occupational medicine. Some of it is medicine. Some of it is kind of refining your business acumen, understanding the secular trends in industry. Hey, wellness is an emerging trend, and so, making sure that you're looking at the medical literature and seeing how that interacts with the business thinking. And then you end up reading a lot of journals, the Europeans, particularly Northern Europeans, have a lot of epidemiology research based on having single payer systems. They get really good data capture of what's a work injury, what might not be a work injury. And so it's a lot of Scandinavian journals of ergonomics and stuff like that that you end up reading but also drawing upon, kind of non traditional sources. So I fall upon the hotkey on LinkedIn, and kind of see what the what kind of the legal thought process is obviously their thought leaders in kind of the playton side of injury and disability and work comp cases and so looking at, looking at the whole, the whole process, I think, is really critical to kind of understanding your role and where you fit in.
Ronak 16:53
Yeah, makes sense. So what are some of the current projects and side gigs that you're working on?
Dr. Filler 17:01
Yeah, so I'd say I'm kind of a perpetual dabbler. And so I think one of the things with medcare shares is kind of the opportunity to kind of scale and try out new concepts. And so I'm doing a little bit of medical writing right now, obviously working on all the clinical positions. And then the other thing I was looking at doing was doing some independent medical exam work and chart review. And so it's, it's an opportunity to kind of see how other people manage cases, and I think that's something that, as you look at other people's work, that gives you an opportunity to kind of learn from what they did and kind of refine your own process. And so I think that's kind of critical to being successful, it's just kind of, you're going to have to learn from your own mistakes, but if you can learn from other people's mistakes too that's all part of the process.
Ronak 17:54
And I mean, do you have time for fun?
Dr. Filler 17:57
Yeah, I was at a Reading Phillies game with my kids earlier this week. And so I think that's one of the things you have to do is you do have to disconnect from work. It's not healthy to work all the time, but make sure that you're doing things that are fun, making sure that you're keeping kind of broad interests and medical training that people always tell you that the hospital won't love you back. So, you may love your job, but there are some thankless things that come with that, and so make sure you're taking time for yourself. I do a lot of gardening. Stay active, fixing all the stuff that breaks around the house, working on cars, all things I think that give you a different perspective. And I think trying to have those broad pursuits gives you the ability to engage with patients and understand what part of life they're missing out on as a result of their injury. And then sometimes, depending on folks' education levels, being able to make better analogies, not everyone spent a whole lot of time learning about medical problems and with Latin names, and so being able to make the connections, I think, helps people understand what they need to do, and helps the healing process.
Ronak 19:19
Yeah, amazing. Well. Dr Fuller, this was fun. Thank you so much for joining and look forward to seeing you in the office.
Dr. Filler 19:26
Yeah, thanks for having me.
