Robert Piccinini 00:00:00 Mentorship is a two way street and it is. It is such a rewarding thing because what it does at its core is bring back the community.

Austin Luttrell 00:00:23 Welcome to Off the Chart, a Business of Medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Littrell. I'm the assistant editor of Medical Economics, and I'd like to thank you for joining us today. In this episode, we'll hear about leadership in the future of osteopathic medicine. As Medical Economics Senior Editor Richard Payerchin sat down with Dr. Robert Piccinini and adult geriatric and forensic psychiatrist who was recently installed as president of the American Osteopathic Association. They discussed his journey into psychiatry and private practice, what it means to be the first psychiatrist to lead the AOA and his vision for strengthening physician mentorship, supporting first generation medical students, and improving mental health resources for physicians. Dr. Piccinini also shared his perspective on integrating behavioral health into primary care, addressing the physician shortage and the role that artificial intelligence plays in all of this.

Austin Luttrell 00:01:16 Dr. Piccinini, thank you again for joining us. And now let's get into the episode.

Richard Pearson 00:01:26 I'm Richard Payerchin, reporting for medical economics. With me today is Dr. Robert G.G. Piccinini. He's an adult geriatric and forensic psychiatrist and the newly installed president of the American Osteopathic Association. Thank you for joining us today.

Robert Piccinini 00:01:44 Thank you, Richard.

Richard Pearson 00:01:45 And certainly, congratulations on your installation.

Robert Piccinini 00:01:48 Thank you very much.

Richard Pearson 00:01:51 Just to begin at the beginning, so to speak. Can you introduce yourself and talk a little bit about your own background and experience?

Robert Piccinini 00:01:59 Well, I, as you said, I'm a psychiatrist located located here in Michigan, and I am a proud graduate of Michigan State University College of Osteopathic Medicine. I graduated in 1992. I did my residency, at first psychiatry at Henry Ford Hospital down in Detroit. Prior to that, I did a rotating internship in internal medicine at Flint Osteopathic Hospital. Prior to going to Henry Ford, I went to the Medical College of Wisconsin to do my fellowship in forensic psychiatry. been in private practice initially.

Robert Piccinini 00:02:42 I came back after that was done. I, worked for a hospital group, and then I went into private practice and have been such for approximately now, just about 25 years.

Richard Pearson 00:02:58 Congratulations on that tenure. Only because private practice can be a tough road to hoe in the economy that we have the health care economy.

Robert Piccinini 00:03:06 You definitely learn to take the ups and downs and roll with the punches.

Richard Pearson 00:03:12 In your inaugural address. You had a lengthy list of thank yous that you wanted to include, and it really felt like you wanted to address what seemed like a whole community of support. I wanted to ask why that is so important to you as a physician, and how that informs your practice of medicine and your leadership style.

Robert Piccinini 00:03:32 You know, I really appreciate that question. because it's it's a multi-layered because one nobody rises to be a physician on without the help and mentorship of somebody, growing up. I remember the stories of my grandparents telling me of different members of our family that strive to make things better for their children and their children and, you know, a long generational thing.

Robert Piccinini 00:04:10 So, you know, growing up family was always there supporting you. And then nobody definitely rises to the level of president of the AOA without a lot of mentorship and a lot of support from all different people.

Richard Pearson 00:04:31 Every doctor we know is incredibly busy, of course, and sometimes it might be hard to reach out to colleagues when your first priority is your patients. If there are some physicians out there, especially practicing physicians who might want to reach out to some of their younger students or, I'm sorry, younger colleagues and maybe medical students, what advice would you give them?

Robert Piccinini 00:04:54 It takes 30s to ask somebody how they're doing in the day, and that itself can be a mentoring experience. It doesn't take. You don't have to have a special skill set. you just need sincerity, empathy for when somebody is having a rough time, maybe some self-reflection about your own hard times that you went through that you can possibly pass pass on to somebody. and mentorship is is a two way street. I, I asked my younger colleagues and medical students when I'm teaching, you know, what's what's the newest app to use? How do you do this? How do you do that? mentors mentorship is a two way street.

Robert Piccinini 00:05:42 And it is it is such a rewarding thing because what it does at its core is bring back the community. And we know, with mental health and we know with society and it's art. It's really what we need is the sense of community to weather the pitfalls and the ups and downs. Because again, if you're isolating yourself, you're if you don't have those connections, you're at higher risk for burnout. You're at higher risk for depression or anxiety. so mentorship is both a gift and a necessity in in our profession.

Richard Pearson 00:06:27 I really am grateful for your taking the time to share some thoughts on leadership here, and I. That is something that we try to, you know, I've, I've had doctors who have told me that, you know, every physician is trained to be a leader. It emerges in different ways. I was curious about in your inaugural address, you talked about leading with strength and humility. What does that mean in the medical profession?

Robert Piccinini 00:06:51 Well, I think it it, you know, it means accepting the fact that we don't know everything and that sometimes it's it's you.

Robert Piccinini 00:07:02 The humility part of it is, is reaching out and saying, I don't know everything. I need to search for the answers. And sometimes searching for the answers means going to somebody else and asking them. yes. It's sometimes easy to look it up or. But there's there's not. It doesn't always mean finding that information in the book. So strength is comes when you accept that you're just like the next person. And you know, you can lead through strength by showing the fact that you need to be able to outreach to others. To that collectively we can succeed. Not you can't do it all on yourself and accept that and move forward.

Richard Pearson 00:07:52 In your inaugural address, you had talked about some of the, shall we call it nuts and bolts logistics of of running the association. And you mentioned specifically about wanting to improve communication among AOA and its member physicians. How do you intend to follow through with that?

Robert Piccinini 00:08:11 Well, I mean, the the other thing I spoke about in my inaugural speech was, mining the gap.

Robert Piccinini 00:08:18 And that is a something that if you're familiar with the London subway, you see the signs, and you hear the statement mind the gap. And it speaks to the distance between the train and the platform and not to fall in between or have a missed occurrence. And I think as osteopathic medicine has rapidly grown, which is wonderful, sometimes when we grow with speed, we forget not to take along with us some of the things that we. Necessarily need to do to make sure that our growth is sustainable and on on a firm footing, so to speak. so I think at times are we assume, and this is both a association trait and a human trait. We assume that somebody else is hearing our message or understand our message, but we never circle back to make sure, well, did they hear the message? Did they get the message? And do they have questions about the message? So I think as an association, it's behooves us to make sure we're circling back and making sure all members feel connected to the association, that they're hearing the message, and that they have input into the message, so that it is a collective where we want to go, not just where a few people want to go and try to bring everybody else along.

Robert Piccinini 00:09:48 It's is there a shared vision of our membership as a whole of where we need to go?

Multiple Speakers 00:09:58 Say, Keith, this is all well and good, but what if someone is looking for more clinical information?

Multiple Speakers 00:10:03 Oh, then they want to check out our sister site, Patient Care Online. Com the leading clinical resource for primary care physicians. Again, that's patient care online. Com.

Richard Pearson 00:10:17 Also as part of the issues, you know with the association you had mentioned about addressing the certifying board services reform. How does the certification process happen now and what would you like to see in improvements?

Robert Piccinini 00:10:33 so I mean, the certification is very similar. both on the, allopathic side and the osteopathic side in that you take a series of exams at at designated times and in, in the past, obviously the osteopathic boards and tests, look at the distinctiveness and have questions of distinctiveness within the osteopathic profession in how we approach patients, the whole person, treatment of patients and how our principles and practices integrate into our board exams. But again, circling back to the communication aspect of that is I think we can do so much more in making preparing our, our, our students and residents for the process by informing them more so and than what we are doing currently.

Robert Piccinini 00:11:41 I think we allow in the past. It's sort of. At least when I was a student in resident, you kind of asked the next person, well, what's the process? And then you, you kind of try to find it out. we need to step up our communication to the students in residence so that they don't have a question. And if they do have a question, it's very clear to them where they can turn for the answers and and make that process easier for them. you know, more so than any time before they there's a lot of stress in medical school and in residency. there's a lot of things happening in their lives. Any way we can make it easier that that's one less anxiety point. We should be doing it. And, so that's where I think we can step up our, certifying board services, our communication and helping them educate exactly what the boards are for. sometimes there's misconceptions that as medical students, you have to take, you have to score a certain number of a certain number on a test to be able to be considered for X, Y, and Z when that really isn't what it was designed to do.

Robert Piccinini 00:13:07 your board certification as a resident wasn't designed to get you a job. It was to certify that you've reached a position of excellence with so that the states could give you a license, not necessarily that you would get a job at X, Y, and Z facility.

Richard Pearson 00:13:27 You know what, doctor? You make a great point and a great segue to a question I wanted to ask about for medical students and young physicians, because this was something that you also emphasized in your inaugural old address. Can you discuss your own experience as a first generation American and the first doctor of Osteopathic Medicine in your family? And why is that so influential in your presidential initiative to really nurture those first generation do students?

Robert Piccinini 00:13:57 Yeah. I remember a time in my life it very clearly where we were at my we were at home and my, it was a summer day, and my parents called me out to the backyard. And my mom only had a high high school education. My dad a sixth grade education in Italy. And, they said, you know, we we know you want to be a physician and we don't know how to help you.

Robert Piccinini 00:14:33 We don't know how to guide you. We'll always be there to love you and support you. but that's something you're going to have to figure out. The other half on your own and where there's some missteps. Yeah. Was it difficult? Definitely. And possibly by focusing on what the first generation, students go through, and making that pathway smoother with a lot less bumps. it is, is something that is important to me because I don't want them to necessarily go through the same bumps I went through. and, you know, being the first osteopath in my family. you know, it's funny, when I go to Italy for a while, they're explaining to them when an osteopathic physician was, you know, because they have osteopaths, which only do manipulation in Italy, but they don't have osteopathic physicians at the time. So who are trained in the American form of medicine and that so, you know, explaining, no, I'm not an osteopath, I'm an osteopathic physician and, you know, explaining those things to them, but then also taking pride in the fact that I was charting a new course like, you know, my parents did, as you know, my father as an immigrant, my mother as a first generation American in her family and doing the things that they had to do.

Robert Piccinini 00:16:13 So as hard as it was for me, so much harder for them coming over to a country with no language. and that is I'm I often think of, you know, a pure first generation student who English may not have been their first language. those things that they have to go through. Can we make it easier so that they can succeed and take that skill set back to their family and their homeland or, or even their, you know, their community where they're living and really providing health to that group in an osteopathic way.

Richard Pearson 00:17:02 In your speech, you mentioned your experience of evaluating more than 10,000 suicide attempts regarding physician mental health. How would you describe the current state of professional support for physicians who may be struggling, and what would you like to see improve?

Robert Piccinini 00:17:18 So you know, the current state, I think, I would say is not that great. You know, I, I don't know how else to say it. It's it's not that great. It's usually one off. It's oftentimes Times I've evaluated physicians, but it's something that, you know, they prefer not to do because they don't want to have a licensing impact on their licenses.

Robert Piccinini 00:17:47 Some states still ask questions about their mental health, which I think is an a hindrance. And I've spoken to the federation state licensing boards chair, about that. I think that, you know, eliminating barriers to seek help, is the first thing we can do. Making normalizing the fact that as humans, we go through ups and downs. I mean, we you couldn't expect a physician who loses a patient. you spoke that, medical economics speaks a lot to primary care doctors. Well, you may have a patient who has been a patient of yours for 2030, maybe even longer amount of years. They are patient, but they become a part of you. You know their stories from words backwards and sideways. And when they pass, that's going to take a a hit on you emotionally. I don't know any physician who it doesn't when they, when they lose a patient just due to the fact that the patient passes away. It's a it's a personal. Even if, even if it was nothing done, inappropriate, wrong.

Robert Piccinini 00:19:05 It's just the process of being human. We pass. And that's going to be an emotional hit. To be able not to be able to reach out and talk about those emotions to somebody or seek help if you're having trouble with that, is a hindrance, and that affects the patients down the line. So if we don't seek help for ourselves, we're not able to seek help for ourselves. We're actually putting our patients in our community in a worse situation. So we have to recognize that that we are human beings and we are we are subject to every both positive and negative negative aspect that can possibly happen to our patients. And to accept that somehow we don't need or require the same amount of help is just a fallacy. So first, acknowledging that fact, second, then making information more accessible, easy and appropriate, and then allowing taking away barriers that exist currently today and that might be existing for whatever reasons they were put up in the in the past. It doesn't necessarily make sense to have barriers today to seeking help.

Richard Pearson 00:20:29 One of the questions that now comes up. I'll switch gears again slightly, because this is a question that comes up in literally every interview. Of course, because of the change in administration earlier this year. Currently, the administration of President Trump and HHS Secretary Kennedy have begun the initiative to make America Healthy again. How would you like AOA and osteopathic medicine to play a role in that?

Robert Piccinini 00:20:51 Well, I think one, some of the things that, that are proposed and make America Healthy again fit right into our, you know, food as medicine concept at AA. Com, as, has proposed, you know, we have always looked at lifestyle, nutrition, the whole person care. So I think in some ways that fits right into our philosophy as osteopathic medicine. I also believe that, you know, you know, we do believe in, thorough, research and studies into treatments, and I would never want anything to take that away. so I think there are we can advocate for continued research and, thorough vetting of research.

Robert Piccinini 00:21:47 But also, I think as osteopathic physicians, it's in our philosophy to be, as healthy as possible. And, some of those things of nutrition, health, whole person care fits right into it.

Multiple Speakers 00:22:10 Hey there, Keith Reynolds here. And welcome to the P2 Management Minute. And just 60s we deliver proven real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction. North. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before launch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow hack and employee engagement win, or a lesson learned the hard way? I want to feature it. Shoot me an email at Kay reynolds@lifesciences.com with your topic, quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching and I'll see you in the next part.

Multiple Speakers 00:22:55 Two Management Minute.

Richard Pearson 00:22:57 Again, another great segue to a point that I don't know if you'd call it emerging or perhaps already existing within healthcare right now, but I know there's been, you know, some discussion across healthcare about the best ways to integrate behavioral health services and mental health services and primary care. How would you discuss or describe the cooperation between primary care and mental health care, and what are some strengths, maybe what are some areas of improvement?

Robert Piccinini 00:23:29 you know, I, I think, well, in my own career, when a lot of my family practice colleagues would, would call me up and say, hey, I'd like to do a curbside consult with you. I have a patient who they would give me the, the statistics and say, I'd really like them to see you, but, you know, you might be booked for, you know, 2 or 3 weeks or maybe longer, but what can I get them started on and then have them follow up on you? or some patients may say, you know, I just don't want to go see a psychiatrist.

Robert Piccinini 00:24:11 I'd rather, you know, can't you, as the primary care physician, give a treat. Me and my colleagues would call me up and we'd review the case, and I'd give them my, my thoughts and where they should go. And to me, that was, again, extremely osteopathic, part of the osteopathic medicine training in that, you know, you helped out your colleagues. You you were you work as a family together. and so having that ability to not feel like you have to be out on the ledge, just, you know, out there kind of doing what you think is best and maybe not being able to reach out to somebody. Again, you know, oftentimes we think mentorship is, you know, older physician to younger physician. It's not necessarily that way it either. It can be, you know, physicians at the same, you know, chronological age or practice level or, you know, attending to attending. That's mentorship, because I might tell them something about, hey, you know, with X, Y, and Z drug, you just need to watch out for X, Y, and Z or this is a great population to use this one or that one.

Robert Piccinini 00:25:37 that give and take that exists, especially from what I've seen in osteopathic medicine among colleagues, is, is where I think where we can fill the gaps of what's lacking as opposed to, oh, well, I can't touch you at all from a primary candidate. I can't deal with your mental health because you have to go see a psychiatrist, which might, depending on where you're at or how long or, reimbursement reasons might take, you know, four, six, eight, 12 weeks or however long to see that that specialist is there a way that we can fill the gaps and be more communicative, community based in the sense of the community of physicians. and that give and take would help promote, both make our primary care physicians feel more comfortable if they were had an outlet source from from a pure beer. I mentioned earlier, I've been in private practice, from a pure business sense, if I can. You know, my I have patients, but I also have customers such as primary care doctors.

Robert Piccinini 00:26:54 If I'm helping you out now with a difficult case, who do you think you're going to refer to when you can refer to me? Right.

Multiple Speakers 00:27:02 So it was it was both.

Robert Piccinini 00:27:05 smart business. It it fit into the the osteopathic medicine training of community, and it just seemed natural. So I think that's where we have to go is rediscover our community in which not do the the very segmental silo approach that we have in medicine. You know, if you have X problem you need to go here. Well, it may take you to so long to get there. really, is there a way to kind of move that treatment along?

Richard Pearson 00:27:40 You know what? I was going to say? Another great segue, because this deals with not only, I think that sense of community that you talk about or perhaps communication and interaction, but. Yeah. And thank you for touching on the business side too, by the way. But I am curious about your thoughts about just in terms of sheer numbers, given the shortage of physicians, whether it be in primary care or any specialty.

Richard Pearson 00:28:03 What policies or actions would you like to see to increase the number of physicians generally?

Robert Piccinini 00:28:10 Well, obviously, if we can help with GM or graduate medical education funding so that we can, get more residency spots, for training of physicians. and ideally, you know, enhancing payment to primary care physicians. you know, that would help a great deal. I mean, many of our students are picking their specialties. You know, one, both because of the desire and the interest in a certain specialty, but out of the pure practical sense that if they're walking out of medical school and residency, you know, with 3 or 4 or $500,000 in debt, you know, students are not unintelligent. They're going to pick a they're going to pick, especially in which they can pay that off. And, you know, the low, lower numbers that you see in primary care are not one that's making them run to it. If they're looking at a $500,000 ticket that they got to pay off over the next 20, 30 years.

Robert Piccinini 00:29:23 You know, it's it's basically you're going to get a mortgage for your house and you have a mortgage for your education. I you can't you can't blame them. So if you want more and we definitely need more primary care, we have to fund it properly and we have to make those spots available.

Richard Pearson 00:29:48 You know, doctor, if I may, I'll shift gears just slightly because I am curious about. You're really curious about your perspective on this because and this is another question that now comes up in every interview. I call it the technology question, frankly, the AI question, because artificial intelligence has really exploded across healthcare and all kinds of different sectors. AI has been suggested as a substitute or surrogate for professional counseling. As a psychiatrist, what are your thoughts on how AI should be used specifically for mental health treatment?

Robert Piccinini 00:30:20 These are my personal opinion that the human interaction can never be replaced by a computer. there is too much. You have to be too not too nuanced and nimble. That AI won't be can't be the primary source.

Robert Piccinini 00:30:44 So I am all for not allowing AI to be your therapist. As a physician and the rapidly, Flood of information that we are gaining in medical research, AI is a can be used as a substantial tool in helping curate information and things that I can then disseminate whether or not they're applicable to that patient's, situation. But it should never be the primary source. It should always be at adjunctive or, you know, augmenting source for what I'm trying to do in the mental health treatment. and I know, you know, AI is a learning model, and it grows and it improves. I just don't see that, it's going to improve to the point where or should improve or be used to the point where it ever substitutes that human connection. that itself.

Multiple Speakers 00:31:57 Is.

Robert Piccinini 00:31:58 A treatment modality. Being connected and having contact with a human being. is is so important in the development of our mental stability that, just like we see in babies that imprint to their mothers and their fathers their voices. we see that, you know, you can't substitute that.

Robert Piccinini 00:32:25 You know, early on we would say, don't, don't use an x ray to make the diagnosis or to make the diagnosis. Use an x ray to confirm a diagnosis. you know.

Multiple Speakers 00:32:40 So it it just.

Robert Piccinini 00:32:43 I'm trying to keep my answers higher level than.

Multiple Speakers 00:32:48 Just.

Robert Piccinini 00:32:49 AI shouldn't belong in the shouldn't belong in the role of a primary treatment model. It can be there as an adjunct of or augmenting use, but I don't think it should ever be the primary.

Richard Pearson 00:33:04 Our main audience is primary care physicians. What would you like to say to them, or what would you like them to know?

Robert Piccinini 00:33:12 you know, I first want to congratulate them because they've picked, you know, a hard specialty. you you I often say I, I do primary care as a specialist because as a psychiatrist, we see people at their base level. and but I understand, you know, the the trials and tribulations that they go through. the thing I would say is, you know, you don't have to do it alone.

Robert Piccinini 00:33:51 even if you're in a small town and you're the only doctor in that town. we and and the osteopathic profession especially for would love to help them build communities in which they can, contact others, communicate with others. Be connected. Both in. In both the sphere of your town, your specialty, your community. Or. In this in this specific way, the osteopathic profession. we. Welcome all physicians into osteopathic medicine. and we.

Multiple Speakers 00:34:35 Have.

Robert Piccinini 00:34:36 Our association is built on the fact that. You know, it's a community. It's a family. we're having, some great we have some great educational conferences that what strikes me is the sense of community when you attend those, no matter who you are, when you attend.

Multiple Speakers 00:35:00 Those.

Robert Piccinini 00:35:01 Conferences, you can feel the osteopathic community, the osteopathic medicine community that is there, and it's a welcoming community, and that's based on a sense of, really just trying to grow and and be connected. So what I would say to primary care physicians is don't ever lose that connection with the people around you.

Robert Piccinini 00:35:30 Don't ever feel like you have to do it on your own. There's always people out there that you can reach out to to toss ideas or, you know.

Multiple Speakers 00:35:43 Throw.

Robert Piccinini 00:35:44 Difficult cases at them. It's a matter of for for our own health and wellness as a physician community, to go forth and make sure we're doing just that. We speak of physician communities. We need to make sure we're building the community. And, you know, I'm sorry, I'm going off on tangents here as I think, But that to me is the striking point. And that's why, being a osteopathic physician, I feel so good about our community in which we have developed and we continue to develop and our we're just building a bigger tent for all of medicine. And we would love all of medicine to come and join the osteopathic community.

Richard Pearson 00:36:32 I'm Richard Payerchin, reporting for Medical Economics. My guest today has been Doctor Robert G.G. Piccinini. He's a psychiatrist and the newly installed president of the American Osteopathic Association. Doctor, it's been a great conversation.

Richard Pearson 00:36:46 Thank you so much for taking the time.

Robert Piccinini 00:36:49 thank you, I appreciate it.

Austin Luttrell 00:37:03 Once again, that was a conversation between medical Economics senior editor Richard Payerchin and Dr. Robert Piccinini, President of the American Osteopathic Association. My name is Austin Littrell, and on behalf of the whole medical economics and physicians practice teams, I like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories that Medical Economics and physicians practice publish delivered straight to your email six days of the week, subscribe to our newsletters at MedicalEconomics.com and PhysiciansPractice.Com. Off the Chart: A Business of Medicine Podcast, is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell. Medical Economics, Physicians Practice and Patient Care Online are all members of the MJH Life Sciences family. Thank you.