Dr Andrew Greenland: 0:04

Welcome to Voices in Health and Wellness. This is the show where we bring together forward-thinking practitioners, innovators and educators who are reshaping care delivery across every corner of the health and wellness landscape. Today I'm joined by someone whose journey truly cuts across medicine, law, education, and systems before Dr. Chereka Kluttz. Chereka is a board-certified family physician with over a decade of experience, including seven plus years in emergency medicine. She's also an attorney with a JD earned during the pandemic, driven by her desire to rewrite the narrative of a broken healthcare system. Today she operates at the unique intersection of clinical care, regulatory consulting, and policy advocacy, working to protect provider integrity whilst enhancing the patient experience, whether it's freelance regulatory writing, telehealth, or guest lecturing future clinicians, Chereka brings bold compassion and strategic insight to everything she does. So with that, Jarica, I'd like to welcome you to the show and thank you so much for joining me today.

Dr Chereka Kluttz: 1:03

Thank you so much for having me. I really appreciate it.

Dr Andrew Greenland: 1:06

So you had a very interesting journey and a very interesting career. Can you talk us through it a little bit? You know, how you moved from family medicine and emergency care to now holding both a DO and a JD.

Dr Chereka Kluttz: 1:18

Yeah, yeah, it's been it's been an interesting path. Um, you know, when I was uh when I was a resident, um I always kind of knew that I was gonna work in the emergency room. I trained at a small community hospital, um, and I loved working at the emergency room there, and most of the physicians there were family medicine or internal medicine boarded. So um that was always kind of the idea for the path. And of course, when I finished residency, I kind of jumped right into it. Um, and it wasn't until, you know, you you know, I'm working full-time nights in the ER that I started to really um feel as an attending um the disparities that we we typically see that patients deal with in healthcare. And one of the things that was very uh very frustrating to me was not being able to have meaningful input other than you know what most of us do, which is send an email or send a memo and and you know try to get clarity on new policies and such. And so um fortunately, um, along my training, I was able to meet up with um another physician who had actually relocated to the city I lived in for the part-time evening program for for her law degree. And I was like, oh my gosh, this is fascinating. This is this is crazy. Can I do this? Because I'm working full-time in the ED. Um, and and I did it, you know. I just I was like, you know what, I'm gonna go for it. I applied to one school, got in, and I'm like, must be must be my path. And so um doing that part-time ER full-time was a was a wild ride over four years and um finishing literally in May of 2020, so two months after the world shut down uh for the COVID-19 pandemic. And of course, the ER was pretty much booming at that point because that was one of the only places that was open for patients to be able to access care just because of how scary things were. Um, and then of course, coming through the pandemic, um, that in turn led to some other interest that I developed because I realized I'm like, man, this even doing this in the ER, I'm glad that I can be here to help patients, but I just felt like there was so much more I could be doing. And so um literally while I was in the midst of doing that, not really doing much with the law degree at that point, um, I was approached by a company who was kind of paying attention to the work I was doing in the ER and paying attention to the fact that I was fired up and trying to fix things. And so they asked me to be uh a local medical director for a clinic and they had never had one before. So that was kind of my first um, you know, attending level segue into leadership. And um, you know, after doing that for a year, they were like, well, hey, let's do this on a bigger scale, you know, across the country in a different city with nine clinics instead of one. And so there I went. And so it's been kind of like this ever-evolving process. And as I moved up the, I guess, medical corporate ladder, if you will, I started to really see um even more frustration because I thought I was positioning myself to truly make an impact. And and then what ended up happening was I I ended up working with a lot of individuals who were very passionate about you know making meaningful change, but because of the corporate machine and because of insurance restrictions, we just couldn't move things forward, um, which was, you know, as a physician, when you're really trying to make meaningful change, that's uh you know, very disheartening. And so um that's when I honestly decided to, you know, start independent consulting. And um it just kind of, you know, my career has kind of taken off from there. And so now I have the opportunity to work with different organizations, law firms, healthcare startups, um, and I'm able to, you know, provide um some meaningful um influence on their policy development and their workflows, and you know, work in a way that we protect first and foremost, you know, the safety of our patients, but also protect the integrity of the field and protect the integrity of what we do.

Dr Andrew Greenland: 5:10

Amazing. So was there a um a breaking point that made you realize you needed tools beyond the clinical to drive change? Was it something that happened in the pandemic or was there a specific thing that kind of flipped the switch?

Dr Chereka Kluttz: 5:21

You know, it was it was probably a lot of little things along the way. And then the pandemic, of course, for a lot of us, really kind of set things in motion. And unfortunately, like I said, you know, since I was in the ER, I didn't really have a chance to do that. So um, once I got into the leadership position that I was in, that was honestly my breaking point, if you will, because I was so ready and so hungry for, you know, really making a good impact on healthcare. And you end up getting to a point where you're having meetings with all of your C-suite individuals and the agenda doesn't change in six months, eight months. Nothing changes, nothing moves, nothing evolves, nothing develops. And if you become the squeaky wheel in those environments and start, you know, challenging, you know, perspectives and challenging the system, you know, change makes people uncomfortable, you know, especially when you know the powers that be that ultimately run these organizations, you know, want to make sure that profit is ahead of, you know, um our care in a lot of ways. And so that was my breaking point. That is when I decided, you know, if I gotta walk away from everything that I've worked for, from all these positions that I had worked up to, um I'm gonna do that because that's this is why I went to medical school, this is why I went to law school. You know, I'm not being able to effectuate change in the way that I thought that I would be able to. So that's that's when I made the shift.

Dr Andrew Greenland: 6:49

Thank you for that. Really, really helpful. And how specifically has the law um degree helped you with your kind of ambition and what you're doing? How does it kind of um link in?

Dr Chereka Kluttz: 6:58

Absolutely. So, you know, the um the main benefit that I notice um is being able to speak uh different business languages, if you will. You know, I I grew up in a medical household, you know, mom's a doc, mom's a um nurse, dad's a doc. And so, you know, I grew up speaking medicine, you know, even before I really knew what medicine was. And so when you actually start practicing, sometimes that regulatory compliance, legal language, you know, it feels very, very uncomfortable when you don't understand what it means. And you want to be able to um talk to your leaders in your organizations and express how you feel, but there is a feeling for me of inadequacy because I felt like I knew I didn't understand that half of things. And so um that is why I pursued that. And after coming through um the law program, by the which, you know, I ended up getting a health law concentration in addition to finishing my JD, um, that was kind of the focus, and that's that's where it's helped me the most. And so when we're looking at drafting policies or looking at clinical workflows, or you know, looking at um patient outcomes, I am able to have that clinical eye because I'm in the trenches still providing care to patients, but I can also have meaningful conversations with the business side of organs of the organization, with the operations team, um, and and honestly, you know, correspond with their legal team and and really understand what's happening on that side, and then be able to mesh the two because I can see through both lenses and I can see, you know, a little bit of or I can see see a little bit of what either side is missing, you know, the the regulatory, legal business piece, they don't always understand the clinical side and vice versa. So it allows me to kind of um to look through both lenses and and come to you know um outcomes and solutions that that are going to be beneficial for both sides.

Dr Andrew Greenland: 8:54

Really interesting. So that's obviously giving you the ability to connect at a different level because you have to understand these nuances and you can communicate with these other people other than medics. What do you think has been the biggest disconnect with between medics and other people involved in healthcare from your perspective? Now that you've got these other tools, what do you see as the biggest gaps?

Dr Chereka Kluttz: 9:13

Um honestly, the the biggest gaps that I see as far as you know dealing with the medical professionals that I work with is um the fact that there's quite a few that don't understand why things can't be fixed quickly in some instances, or why some solutions are not viable or feasible within the context of an organization or a healthcare system. Um, and that's because as clinicians, you know, we're trained to fix the issue. There's an issue, why can't we fix it? The solution seems like it should be simple. And that's exactly how I felt, you know, at several points in my career. But I see that disconnect now that I have a greater and a deeper understanding of the regulatory um side of things, because I understand, okay, if we're going to build world-class systems, we really need to make sure that we're doing it in a way that protects the integrity of what we do, that protects the safety of our patients, but that also follows all of the compliance and rules so that healthcare organizations don't, you know, get into trouble and really don't miss anything critical, which is the you know the main reason why those those regulations are in place.

Dr Andrew Greenland: 10:26

So thank you. So what does your um day-to-day look like at the moment? I mean, how are you balancing consulting and telehealth and ER shifts and the clinical work that you do? It sounds like a pretty big portfolio.

Dr Chereka Kluttz: 10:38

It is, you know, and this is it's probably the question I get asked the most. Um, I am, you know, fortunately, I'm one of the individuals that likes a varied schedule and I like change. And so my schedule kind of varies, but in the for the most part, you know, I work from home doing um telehealth and the consulting part of it. And then when it comes to the ER, I usually work, you know, I still want to stay clinically active because I generally I genuinely love what I do. And, you know, I think when you're an ER physician, you're, you know, for a lot of us, we're just lifers. We we want to go back, we want to stay, we want to, you know, see our ER family and we want to take care of our patients. So um I do that, you know, anywhere from three to six days a month, um, just kind of depending on the month and and what's you know, what my other schedules look like. Um, and then the rest of the time, you know, I I have scheduled days where, you know, I'm doing telehealth and consulting, and I have scheduled days where, you know, I'm just doing follow-ups and and um other uh networking and connections, like you know, when you and I got a chance to connect, you know, a while back. So um it it definitely varies from week to week. And I love the flexibility because it gives me an opportunity to um to give back in other ways outside of just what I contribute with my job because I do you know medical mission work and things like that as well. So I like being able to have that flexibility where if I have a trip that I want to go on or if I want to participate with something in my church, for example, you know, I can I can very easily adjust. So it's it's busy, but it's it's interesting and it's very fun.

Dr Andrew Greenland: 12:08

Sounds fascinating. I mean, having that sort of portfolio where you can wear so many different hats um sounds really interesting. Um, so you obviously working in regulatory writing, patient education, and policy. Who are you kind of primarily serving in those roles at the moment? What kind of problems are you um helping to solve?

Dr Chereka Kluttz: 12:26

Absolutely. So uh primarily I'm serving um, you know, uh healthcare startups and um telehealth organizations primarily. Um, and what we what I typically do in those spaces is we look at where the clinical gaps are and what the regulations say, you know, we should be doing in order to mitigate risk and in order to address those gaps. And then because I've actually worked, you know, in the trenches, so to speak, in the clinical space, I can then say, okay, the regulations want us to do it this way, but realistically and practically speaking, we know that this is actually how it works in real time. So let's figure out a way to kind of mesh that so that we're compliant, but we're also um not losing any quality of care that we're providing for our patients. And so that's that's typically what um the the, I guess to simply put, the basis of kind of what we do. And that that comes from policy drafting. Um, you know, if we need a protocol for something, you know, I can draft, help uh the regulatory team draft policies, or I'll put the clinical eye on some of the policies because they, you know, regulatory team and compliance people um have a very technical, difficult job. And a lot of times once they've drafted this beautiful piece of of work, um, it's always nice to have the clinical input to say, okay, yeah, this looks like this is checking a lot of regulatory boxes, but clinically this is not feasible, and here's why. And so that's you know, I get to kind of be a liaison for that. Um, and that's kind of the the basis of the work that I provide. And I do it in um in other spaces. Like you mentioned, I do I draft uh patient education pieces, I draft provider training pieces. Um, if there's any kind of knowledge gap that we're starting to see in, you know, auditing cases and looking at outcomes, patient outcomes, then we address that head on and we're like, hey, what do the providers need? You know, I do one-on-one meetings with our providers as well, just so that I can get a sense for what they feel is missing or what they feel that they need the most help with. Um, and I make sure to uh to bridge that gap between the provider and the organization. So serving as a consultant and as a medical advisor kind of allows me to kind of enter into several of these spaces and just make sure that all of the pieces connect and all of the policies are drafted and solid.

Dr Andrew Greenland: 14:42

So are there any parts of the healthcare system that you find particularly frustrating or limiting right now? Or maybe that's been shaped by you having two hats on. Obviously, you've always got your clinician at heart, but with these other hats on, just curious to know what you find most frustrating at the moment.

Dr Chereka Kluttz: 14:58

Um, you know, I one of the things I think that is the most frustrating for me is wanting to fix it right away. You know, I am a, especially coming from the ER, we are kind of trained to identify the problem and fix it quickly. That's just that's how we're wired. And, you know, when you're working in in different healthcare spaces, especially in policy drafting and regulatory writing and things like that, you know, it's that that those things don't move as quickly as we would like for them to. And so that's that's that's definitely a frustration that I have to kind of juggle and and understand. Um, and I will say, you know, after having gone to law school and after, you know, working in, you know, this part of the healthcare space, I definitely developed a tremendous, like a tremendous more amount of respect for the attorneys and the compliance folks that are that are um working hard to kind of keep healthcare organizations in track. Um but but even with that being said, it's still a challenge for me to really um you know propose things, propose changes, hey, let's do this, hey, let's execute. But then there's still other operational things and business things that have to be done and boxes that have to be ticked. And so, you know, just trying to trying to be uh patient with the process, I think, is is uh one of my biggest challenges that I face.

Dr Andrew Greenland: 16:24

So if I just to give you a magic wand and you could change one aspect of healthcare immediately and quickly, and because I know you mentioned that time was a big thing and it's frustrating how long things take, what would that thing be?

Dr Chereka Kluttz: 16:35

Um, you know, the the top thing I would fix is healthcare for everybody. Healthcare for everybody. And and um I would also add to that um getting rid of a lot of the red tape that we have to jump through as providers, even when patients have access to care and they have insurance, then insurance of course is an entirely different beast that you know could be you know a whole thing in and of itself. And so if I could wave a magic wand, I would get rid of you know all of the insurance hurdles that slow slow down care and make care access, um or make care accessible for everybody.

Dr Andrew Greenland: 17:17

Wonderful um aspirations. I mean, how now you've got these both hats on and you've experienced in both sides of the equation, how would you do that? What will be your grand plan? Do you have any ideas? You must have thought about it.

Dr Chereka Kluttz: 17:29

You know, I have thought about it uh for a while. And um a lot of it, a lot of what I would propose is rooted in the fact that we think that limiting access for some people doesn't affect the system. It's like, well, they can't access the care, so how does that affect the system? Because people will be seen regardless. And there's this wonderful little rule here in the US called Intala that requires us to give everyone a medical screening exam when they come to the emergency room. And a lot of times that is where I saw the most disparity is patients coming to the emergency room because they did not have care accessible outside of the emergency room, um, whether it was no insurance or insurance wouldn't cover or whatever the case was. And so um I think that would be one of my starting points, um, which of course is going to be so much easier said than done. But one of my starting points would be to figure out a way to make um healthcare universal as it works well, you know, in other places outside the US, um, just so that um we can at least make sure that access is there and that we're using our resources appropriately. Because, you know, for example, if a young mother doesn't have insurance for herself or for her children, um, it would be it's astronomically more expensive for her to come to the ER for them to be treated for ear infections or strep throat than it is for them to see their primary doctor. And and the other part of that is that if they don't have insurance and don't have the means, they're not paying the hospital bill anyway. So the hospital's eating the cost and it drives healthcare costs up for everyone else. And so, you know, those are the things that kind of drive, you know, the brokenness in the system. So, you know, that's you know, not to put you know, too much detail into it, but that would be, you know, kind of a starting point. You know, we um we have some systems like that in place with, you know, Medicaid and Medicare and things like that, but I think um a more global reach, you know, where healthcare was an even footing for everybody, um, would be so much more feasible and make healthcare, quality healthcare so much more accessible. Fixing healthcare kind of start with understanding where a lot of the gaps are and understanding what part of the healthcare system is eating those costs when we don't have, you know, equal access for everyone that's here. So um, you know, for example, if if patients don't have access to care, they don't have insurance, they don't have, you know, primary care physicians or anybody that's close to them, um, a lot of times they end up at the doorstep of the emergency room and we end up seeing them. And if they don't have insurance or they don't have the funds and they don't pay those bills, and the hospital eats the cost. And so that's, you know, those are the things that silently in the background drive up health care cost and really make the system even tougher to navigate. And that's the side that people don't see. They think, well, they can't afford care, so they just shouldn't get care. And it's like they're gonna get the care. You know, patients will come in and be seen. It's just that, you know, where is that, where is that cost being funneled and where, you know, where are those resources being used and can we use them more effectively? And I certainly think that we can. And so, you know, very similar to you know, other places that have you know universal health care systems, I'm a big, big fan of those systems. Um, they are not perfect, of course, but no system is. But any system that at least gives um our patients, you know, equal access to healthcare. Um, if I could do it uh globally and if I could do it efficiently, quickly, um, that would probably be the you know the magic wand moment for me.

Dr Andrew Greenland: 20:53

So really interesting insights. Um wish I could give you that magic wand and you can do your thing.

Dr Chereka Kluttz: 21:01

I wish so, yeah.

Dr Andrew Greenland: 21:03

So you must be um a highly organized, efficient person to balance all the different apps that you wear. But what's your biggest time drain at the moment for you?

Dr Chereka Kluttz: 21:11

Oh gosh. Um first, thank you for uh believing so so highly in me being organized. Um, you know, my um my biggest time drain is um I would say, oh gosh, I would say reading and reviewing, and and I hate to say it as a drain, like it's not a negative thing, but reading and reviewing and drafting a lot of the work that we um that we discuss when I'm in meetings with some of the you know operations uh team members and things like that. Um it takes a lot of time to go through all those regulations and to make sure that we're not missing anything, um, to make sure that we are compliant, of course. Um I think for some healthcare workers, you know, the word compliance is almost uh you know, almost a naughty word because it invokes, you know, feelings of. You know, oh my gosh, we're not doing something right. Um, and in all honesty, you know, when you really dive into those compliance things, it really kind of shows um it'll also show the strengths of the system as well. Um, but regardless, you know, going through those those guidelines, going through the um the workflows at you know different organizations, executing it, coming back and having a meeting about what worked and what did what didn't, redrafting, you know, of course, because drafting is an ongoing continuum when you're you know fine-tuning policies, uh, that definitely takes uh probably the most time of the things that I'm doing right now.

Dr Andrew Greenland: 22:36

And I'm thinking to the future, where would you love to take your consulting or advocacy advocacy work over the next six to 12 months? What's on the cards for you?

Dr Chereka Kluttz: 22:44

Oh, wow, that's a great question. Um, you know, I would love to just take some of the concepts that, you know, that I've that I've learned and that I've found with doing individual consulting and just move it out on a global scale and understand that there's so many different things that um that affect um workflows and access to care in healthcare. And, you know, we talk over and over again about how in different places healthcare can be a broken system. And I think it's because a lot of times, you know, as as a whole, as a unit, companies or even, you know, governmental systems, uh I think they focus uh on the wrong things. I think they're not prioritizing the correct things. And so that would be my ultimate goal, would be to just kind of spread that awareness and be able to say, hey, let's have, let's sit down and have a conversation with, you know, where your workflow gaps are, where your quality care gaps are, you know, what what kinds of things are we seeing that um that are limiting patients' access to care or contributing to provider or clinical staff, you know, frustration and um disillusionment. And let's let's let's meet in the middle and let's make that happen. Um, and it's it's very um interesting what I've learned working as a leader in different spaces, that the one of the most important things to do is to pay attention to the needs of of what your what the members of your organization need, both the customers or the patients that you're serving and the people that are that are helping helping everything run and flow. Um and if you don't pay attention to those things, you know, you're gonna end up with companies that constantly crank out policies and regs and things like that that you know that will just continue to frustrate and not actually accomplish the job that they were set out to do.

Dr Andrew Greenland: 24:24

Thank you. And if you were starting your career again tomorrow, with everything that you now know, would you do anything differently or would there be a risk that you would take sooner had you known?

Dr Chereka Kluttz: 24:37

Let me ask for a little bit of additional clarification on that question.

Dr Andrew Greenland: 24:42

I was just thinking if you were to restart everything tomorrow, whether it be medicine or the law or the other things that you've taken on, I just wonder whether you would have done anything differently with everything that you now know. Um, would there be perhaps a risk you would have taken sooner? Obviously, hindsight's a wonderful thing. This is a very hypothetical question.

Dr Chereka Kluttz: 24:58

Of course. You know, the one thing that I would have done differently is um I would have done um a combo program, uh, you know, a medicine leap a medicine and law school combo program instead of going back to do it again. Um, because that was that was a great time to be alive, you know, working full-time in the ED and and going to school part-time, which eventually became full-time by the second half of it. Um, but that's what I would do, but that's what the only thing I would do differently. But knowing what I know now, I still feel like the tools that I've that I've gathered and the knowledge that I've you know compounded over the years um really allows me to not just exist in a healthcare space, but to really kind of push it to thrive. Um, and and I don't know that I would do anything differently in my career from that angle, um, just because I still want to be able to do that. I would just probably do it a lot sooner when my when my mind and my body and everything else was young and a little bit more fresh. So um, so yeah, that's what that's probably what I would do differently.

Dr Andrew Greenland: 26:04

Well, Sharika, with that, I'd like to thank you so much for this conversation. It's been such a powerful and layered conversation. Thank you for giving us your insights into medicine and also the kind of the legal and operational sides that we don't perhaps understand as clinicians. I think you've really given us some fantastic insights. So I'm very grateful for your time and thank you very much for coming on.

Dr Chereka Kluttz: 26:23

Thank you for having me. Thank you so much.