Dr. Brendan Carr - Chief Executive Officer of the Mount Sinai Health System

Colbert Cannon: Welcome back to Season 10 of the HPScast.

I’m your host, Colbert Cannon. If you’re new to the pod, HPS is a global investment firm. We manage approximately $110 billion in assets for a broad range of institutional and retail investors. That capital is invested across private credit and public credit strategies. Each week, I sit down with key relationships to, partners of, and friends of the firm to learn from their experience, ask how that experience shapes their current roles, and give insights into HPS and how we operate.

So, with that, let’s bring in our guest. Our guest this week is the CEO of one of the largest healthcare systems in the country. He grew up in the Philly area and attended school there. As is often the case, your host is feeling undereducated at the moment, as our guest has, at last count, I think four different degrees under his belt at Loyola, Temple, and Penn.

He’s a world class emergency room doctor by training, but he’s dedicated his life to both the practice of medicine as well as deep work and advocacy on the policy side of healthcare. After a successful career in the emergency room and as a well-published researcher and policy expert, he joined his current employer when he became the Head of the Emergency Department of the Mount Sinai Health Care System here in New York City.

He’s always had an incredible sense of timing. That’s a job he took February 1st of 2020, just in time for COVID to sweep across the world and pose existential threats to health systems, globally. He handled that crisis with his usual combination of preternatural calm and flawless execution. And in January of this year, he became the CEO of the entire Mount Sinai Health System.

I’m honored to call this remarkable gent a dear and longtime friend, and we’re all lucky to have someone of his talents leading such a critical healthcare system in one of the great cities of the world. So, without any further ado, I am honored to welcome in this week’s HPScast guest, Dr. Brendan Carr, CEO of Mount Sinai.

Brendan, welcome to the pod.

Dr. Brendan Carr: Colbert, it is wonderful to be here. Thank you so much for the invitation.

Colbert Cannon: Alright, Brendan, I like to start from the start. Where’d you grow up? Where are you from originally?

Dr. Brendan Carr: I am from a part of Philadelphia called Delaware County, affectionately referred to as Delco by the folks that grew up there. It’s an extraordinary place to grow up right outside of Philadelphia.

Colbert Cannon: Alright. So, you end up at Loyola and eventually Temple for medical school. When in your college career did you decide medicine was the right path for you?

Dr. Brendan Carr: After my college career, I was in graduate school for clinical psychology. I was working on a mobile crisis team and was entering a 24-hour suicide hotline while I was in grad school, and I had a bunch of experiences interacting with psychologists and psychiatrists. And the dynamic between the two of them convinced me that, to do what I really wanted to do, I needed to leave the PhD pathway in psychology and go the MD pathway to become a psychiatrist.

Colbert Cannon: And why, Brendan? What was it about that, that mattered to you?

Dr. Brendan Carr: So, I was doing crisis work. It wasn’t the plan, but the urgency and the opportunity to intervene when people are at their worst and when people are in crisis really resonated with me. There was an amazing opportunity to find just that right window where you could really turn people in a way that was incredibly meaningful to them.

Colbert Cannon: So, you end up going to Temple. You graduate. You do your residency in the emergency room at CHOP – Children’s Hospital of Philadelphia. Why was that the right spot for you to continue on?

Dr. Brendan Carr: So, I went to a one-year post baccalaureate, pre-medical program at Bryn Mawr, where I met my now wife. We were both redirecting our careers from what we’d been doing beforehand to go into medicine. So, 12 months, you get all the work that you need done, all the classroom work that you need done, in order to go to medical school.

And then onto Temple medical school, and then to Emergency Medicine Residency, which is a four-year training program split between the medical school, The Hospital of the University of Pennsylvania on the adult side, and Children’s Hospital of Philadelphia on the kids side.

Colbert Cannon: So, you know, you talk about wanting to be there at the moment of crisis. Obviously, emergency medicine is part of that. What about the pediatric side? Did that have a particular resonance for you? Why pediatrics?

Dr. Brendan Carr: Pediatric emergency medicine is a part of a general emergency medicine training. When you train in emergency medicine, we’re creating a workforce that’s going to stand at the front door in all of our hospitals across the country and globe. So, you’ve got to be ready for anything that walks in. That includes delivering babies and taking care of children, and of course, adult critical illness and injury.

Colbert Cannon: So, before we get to your current employer, I want to talk about the path in-between. And I mentioned this at the start – you balance various facets of your career in a pretty broad range of work. I know docs who are incredible physicians who could care less about research or policy, or, on the other hand, policy experts who aren’t really the right person to call when there’s a medical problem.

You’ve built your career around being involved in all facets of medicine, I think, very much the benefit of both of those disciplines. Why have you always been interested in more than just being in an operating room or a lab or even in the halls of DC?

Dr. Brendan Carr: Thanks for asking this one, Colbert. It means a lot to me, but I think it also means a lot for the specialty. You get extraordinary opportunity to be in rooms where you sometimes wonder whether or not you should be in the room. Well, what do you really know about policy when you are busy, seeing, learning how to take care of patients’ clinical problems?

When I’m surrounded by folks that have PhDs in, you know, statistics and epidemiology, and I’m wondering why they’re listening to me as a researcher, it is important to acknowledge that those teams that get built really require people to have different perspectives on things. So, for me, practicing clinical medicine is enormously grounding, especially in the emergency department. I toyed with lots of other professions. As you heard, I went to school thinking I was going to be a psychiatrist. I almost went into trauma surgery. In fact, after emergency medicine, I ended up doing a fellowship in trauma and surgical critical care.

The clinical grounding that happens in emergency medicine is amazing. You see every failed social policy, you see how they manifest, you understand people’s fears because they are raw, and you have the opportunity to inject just a little bit of stability, a little bit of certainty into their path forward. That translates really well into policy because you become aware of why people are slipping through the cracks.

And you know, my training after clinical training was in health policy research. So, I’m a researcher but not the kind that most people think about. No pipettes and petri dishes, large data sets and sophisticated analytic tools, so that we can get the information about what improves healthcare delivery and how we can then use policy levers to drive outcomes in the direction that we want them to. That could be payment. That could be transparency. That could be a lot of things.

Colbert Cannon: So, tell me quickly through your career then, post residency and pre Mount Sinai – because you did a whole bunch of different things, and we could talk for hours about all of that – but give, give our listeners a highlight before we get to your most current job.

Dr. Brendan Carr: I can do it quick. A lot of clinical care, mostly squeezed into weekends and overnights so that during the week I could be a full-time researcher funded by the federal government to do research. And then, I use that research leverage to get access to direct policy conversations. Frankly, one of my mentors in the research and policy world who had stopped being a researcher and started doing direct policy work called me and said, “What are you doing? It’s time to get off the bench and get in the game. Come on, move to DC.”

So I spent eight years in DC running the Emergency Care Policy Office for the federal government.

Colbert Cannon: So, as I said, it’s the first quarter of 2020, you take on a new role as the Head of the Emergency Department at Mount Sinai here in New York. First, for our listeners less familiar, give us a sense of the scope and scale of that department at Mount Sinai overall as a system.

Dr. Brendan Carr: Mount Sinai is the biggest private health system in Manhattan. So, eight hospitals and half a million emergency medicine patient contacts over the course of the year, 40, 000 employees. It’s a big footprint across the five boroughs of New York.

Colbert Cannon: So, we’re now four years on from COVID. We all remember it well, you better than most. I’m not going to ask you to recount every moment, but I’m interested in the learnings. When you think back about that time, what did that experience teach you?

Dr. Brendan Carr: Oh, this one could take a long time. I’ll skip over the operational and administrative learnings inside of the health system, though, I will say those are really important to thinking about what the next couple of years, hopefully longer, will look like in the CEO role here. And I will instead focus on what happened to the nation and what happened to the workforce.

For people that were in New York during COVID, it’s really hard to ever fully be at peace with what took place. What was astounding was the way that we saw the people that were delivering care day-in and day-out, really respond to the community’s need for them. We saw wild disparities in health outcomes. That’s been talked about all over the place. I think that most people in healthcare could have told you that they were there before – it’s just that the nation really saw them. And, what we saw on the workforce front was, we saw a level of burnout, a level of crippling exhaustion, and a level of hope that you really couldn’t get your head around. Every day was a different story that was both inspiring and heartbreaking. There’s lots of individual stories.

I’ll give you two. If you remember back to the fact that people were delivering babies with their partners on Zoom, you have to also remember, what we didn’t talk about a whole lot, was that people were saying goodbye to their loved ones over video chat because we couldn’t have them at the bedside. So, knowing with certainty what was coming and having families that were on work phones and on iPhones and iPads, talking to the loved ones in the hopes that they would hear their voice before they died, is just crushing. And then, thinking about the conversations and the need to bring in lawyers or notaries, so that our workforce could create clarity for their families about who would raise their kids and about what their will would look like – it’s just not something that you ever imagined was going to be part of running a clinical, educational and research mission within an academic health center.

Colbert Cannon: Yeah, it’s amazing. I mean, complete heroes through-and-through. Tell me about what that experience was like for you personally, Brendan, in particular, given the newness of your role.

I was thinking about you a lot then. If that had happened when you were sitting at Jefferson in Philly, where you’d been for a long time and knew everybody, how different was it? Because, you’d been on the job a month – I can scarcely imagine.

Dr. Brendan Carr: Yeah. The one-month anniversary was our first case in New York, and it was diagnosed in our emergency department. A couple of weeks before that, we’d been running tracers through the system. We were asking med students and nursing students to present with a false history to see if it would flag on our triage screenings and how long it would take us to isolate them. And then, my two-month anniversary, we’d partnered with an open-to-field hospital in the East Meadow of Central Park, because we were at capacity.

The thing that I didn’t have with people when I got here was the thing that you would imagine, which is the relationships that you’re talking about. And with relationships comes trust about my leadership ability, about my competency, about my level of commitment to them, about everything, about whether or not I was going to prioritize their safety. Remember, these are the days where there’s fear every day about whether or not there’s going to be PPE masks, whether or not I’m going to tell them the truth about what I know or don’t know, about how contagious this disease is.

Remember, we didn’t know. It was a brand-new virus. And so, that trust is a very hard thing to rush. Thankfully, I had never stopped having a clinical presence even though I had done work in DC, and I had done lots of research about the healthcare delivery system. I was always very comfortable in the clinical space. And I think that, being in that space, shoulder-to-shoulder with,folks, was the only way to really demonstrate to them that I could be trusted, and that they could follow me, even though I was asking them to do things that I should have never have had to ask them to do.

Colbert Cannon: You were in an incredibly difficult time. You did a remarkable job, I know. And as part of that and an acknowledgement of that, in January of this year, you became the CEO of Mount Sinai.

Tell me, Brendan, first about the management of that transition. How different is it running the whole system now versus an actual department?

Dr. Brendan Carr: It’s pretty different. It’s the learning curve. So, I replaced a gentleman named Ken Davis. Ken had been in this role for 20 years. So, when you’re transitioning something that is in your DNA because you’ve been doing it for so long, it is a tricky thing to just, sort of, write it down on a summary document. You know, when the transition team comes into DC, we’re all asked to put together the portfolio – please walk your replacement through your portfolio. Ken could only do that by downloading over months.

Colbert Cannon: 20 years of muscle memory.

Dr. Brendan Carr: Yeah, right. So, there’s not a playbook for that. And, of course, he’s been a great mentor to me, but the learning curve is unbelievably steep. And, you know, I’m grateful for his mentorship and the team that I inherited. I’m grateful for the board that supports me. We have some extraordinary folks on our board, many of them with long, historical knowledge that has been extraordinarily helpful.

But at the end of the day, there are things that only the CEO can do. Only the CEO can meet with our workforce, meet with our patients, meet with some of the folks that want answers from us. We have a bunch of difficult things happening right now inside of the organization. I walked into a couple different crises that were getting ready to boil over, and it has been a very steep learning curve. Lots of support, but lots of times where there is not a surefire way to put a playbook together ahead of walking into the room.

Colbert Cannon: If only they had somebody who was good in a crisis.

Brendan, you’ve talked about some of the issues facing healthcare that you’ve lived with for years, specifics around Mount Sinai. Let me put you five years from now. If you look back on the first five years as a CEO, what’s success look like? Like, what do you look at and say, this is what I’ve got to get done for this all to work?

Dr. Brendan Carr: Yeah, I mean, let me paint a little bit of a backstory here. Healthcare right now, especially for giant health systems, we have not recovered fully from what happened to us during COVID. So, there’s the emotional toll of COVID, but there’s the administrative chaos that happened inside of healthcare deliveries.

And in the healthcare delivery, we have to think about the entirety of the sector. Your insurance product or distributor, your pharmacy benefit, and then the pointy end of the spear on the delivery system side in your doc’s office or in your hospitals. It’s important, I think, to think about the supply chain running through all of that.

So, when I think about five years plus from now, looking back, what would be the key ingredients? Some of them are surprising, even to me.

One of them is that you almost can’t run your business based on running your traditional business. You can’t cover costs if what you’re doing is delivering healthcare. This is why you hear so many different entities that have other components of their academic medical system business, which is to say, they’re trying to develop and spin-out drugs. So, we’re trying to run a little pharmaceutical company inside of our academic medical center. We’re trying to create delivery system innovations that we can then spin out into companies and, create a new book of business. We are partnering in ways that, you know, most people had not thought academic medical centers would need to partner in order to create new revenue streams. If we can do that successfully, that is going to help us to get to the next level.

At the same time, it is essential to say that Mount Sinai was a hospital that was started by resourced Jews to take care of Jews that were not resourced. That hospital then built a medical school. That medical school then grew from a little medical school to a top 20 funded research powerhouse that then built a health system. The justice equity mission, the service mission of that hospital health system, school of medicine has never changed. We will maintain our cultural identity and our commitment to our values while making sure that we preserve our legacy and innovating and driving healthcare delivery forward. That’s the win.

Colbert Cannon: You mentioned on your learning curve, you know, you obviously have a mentor who was there for a long time. How else do you do it? I’m always interested in how people come up the curve on new experiences. How else do you figure out how to do what you didn’t have to do in the old gig?

Dr. Brendan Carr: Yeah. Well, so the good news is that there’s an enormously deep bench of expertise here. For those who don’t know what emergency medicine is, it means that we stand at the front door and whatever comes, comes, and we figure it out. And figuring that out when you are alone in a rural hospital in the middle of nowhere is very different than figuring that out when you’re at a giant academic medical center where, at 3:00 in the morning, if I would like the power of Mount Sinai to emerge, I just  light it up and it will. It means that you get very, very comfortable knowing when to know what you know, and knowing when you need some guidance and some help; knowing when to call the consult and when not to call the consult.

And so, I am very happy to reach out to the brilliant finance folks that we have here, or the brilliant business development folks that we have here, or the brilliant clinical leads in pick your specialty, or the brilliant policy, et cetera, et cetera. So, you know, I very, very much believe that the best leaders are mostly invisible. And that when people look back, they just pat themselves on the back for having gotten there. I think that, with this many superstars on the team, as a GM, I should mostly be a servant leader.

So, that’s it, you know. I’ve spent the last couple of months, as you can imagine, talking to lots and lots of folks that have amazing knowledge about what we could be doing, and I need to help to stitch together the team so that they’re all rowing in the same direction rather than learn each one of their individual roles.

Colbert Cannon: Well, listen, when I started, Brendan, I said, we’re lucky to have you. And I’m sure our listeners understand that now. We ar lucky to have you at the helm of as important of a healthcare system as Mount Sinai. Before we move to the last part of the podcast, I’m going to go a little lighter for a moment, Brendan, with you.

And as listeners know, for guests I know well, I like to do a speed round. I’m going to ask you now, Brendan, a series of questions. Give me a simple answer. First thought, best thought. Dr. Brendan Carr, are you ready?

Dr. Brendan Carr: Not really.

Colbert Cannon: All right. What is your favorite arena in Philly in which to watch live sports?

Dr. Brendan Carr: Citizen’s Bank Park.

Colbert Cannon: That’s the right answer.

Favorite purveyor of Philly cheesesteaks?

Dr. Brendan Carr: Dalesandro’s.

Colbert Cannon: Oh, that’s an off-the-beaten-path pick.

Dr. Brendan Carr: That’s exactly right. You’ve got to be from Philly to know that one.

Colbert Cannon: I like it.

You split time between Philly and New York. What’s your favorite place to eat in New York City?

Dr. Brendan Carr: Man, it’s a local. Isn’t it always a local? It’s Sfoglia.

Colbert Cannon: I love it. That’s Italian. What are we dealing with there?

Dr. Brendan Carr: It’s Italianish. Yeah.

Colbert Cannon: Alright. What’s your preferred adult beverage on a Friday evening after a long week?

Dr. Brendan Carr: Yeah, it’s Scotch.

Colbert Cannon: Good answer, especially this time of year.

What’s the last music concert you went to?

Dr. Brendan Carr: I went to the Grateful Dead with two of my three kids. I’m sorry, I went to Dead & Company with two of my three kids. It was a joy.

Colbert Cannon: Because you’ve raised your children well, Brendan, is my takeaway.

Your favorite place to go skiing as a family?

Dr. Brendan Carr: Jay Peek, 100%.

Colbert Cannon: I was hoping you’d say that.

Have you ever watched the TV show Grey’s Anatomy?

Dr. Brendan Carr: I think I was in residency and fellowship during Grey’s Anatomy. I was watching, you know, my inside of my eyelids whenever I had the opportunity.

Colbert Cannon: I love it. All right, Brendan, always a true pleasure to catch up. Appreciate you sharing your thoughtful perspectives and, and excited to hear about what great things are to come from Mount Sinai.

I want to move then to the last segment of the podcast, something we like to call “Best Ideas.” Brendan, this is where we offer up something that’s added value in our lives recently. “Best Ideas” because it’s our goal as investors to maximize exposure to those.

Dr. Carr, you’re our guest. I’m going to ask you to go first. What’s your best idea this week?

Dr. Brendan Carr: My best idea is the best idea of the last two-and-a-half months as I have taken on a new role, which was, you know, I’ve had to learn, I’ve had to meet a lot of people, and learn their perspectives on things. And as I read about how best to do that, and as I talked to folks that had done that, I really, really try hard when I’m doing it to take a deep dive on their perspective.

So I think I’ve, I’ve always functioned like that where I really want to understand where people are coming from, but it’s been much more intentional in the last couple of months. Because, every person I meet, I just can’t see the world through their eyes, but if I’m really, really thoughtful about it, most of them are willing to help me to see it that way.

And so, you know, that’s really it. It’s about understanding what people have been going through and understanding why they see things the way they see things. I think if we pull that together, if I pull that together, I’m really going to have an opportunity to, to help this organization. Too heavy?

Colbert Cannon: No, I think that’s fantastic, Brendan. I’ll tell you the best leaders, the best investors that I know are always the best listeners. It’s a skill that I don’t think everybody in our line of work has. And, have to be really, really good at that to see other perspectives, to synthesize it, to get to the right answer.

I think it’s a great idea. I will go lighter though. Well, sort of. For my best idea this week, as people know, I like to be inspired by the guest. You heard this earlier. Dr. Carr hails proudly from Delaware County in Pennsylvania, aka Delco. Don’t be fooled by his mid- Atlantic accent. He loves Wawa, Hoagies, and the Eagles.

And I started thinking about his upbringing, and I got to one of my favorite TV series of recent memory. I’d also note, because the HPScast believes in intellectual honesty, and frankly, noting how small the world can be, this show was produced by a good friend of both of ours, Mark Roybal, who is the husband of former HPScast guest, Megan Colligan. I’m talking about 2021’s Mare of Easttown, originally released on HBO.

Mare of Easttown tells the story of the titular detective Mare, played by the incomparable Kate Winslet. It’s set in a small town outside of Philly, in Delco, and the story is about her investigation of the murder of a teen mother while trying to keep her own family, which has faced its share of hardships, together. The cast is incredible,  particularly her mother, played by the remarkable Jean Smart. And the creator and writer, Brad Inglesby, is himself a Philly local – went to Villanova, was obsessed with making it feel authentic to the city of brotherly love, and I think he succeeds greatly. It’s a heart-wrenching show, but ultimately redemptive and a truly remarkable watch.

They’re talking about making a second season, but season one stands on its own and is well worth your time. So, in honor of one of Delco’s most prominent, favorite sons, let me recommend a show set in Delco in all its glory, Mare of Easttown, streaming now on Max.

Brendan, thoughts on Mare?

Dr. Brendan Carr: Strong endorsement. You know, hard to not love Mare. I was on the edge of my seat for every episode as they came out.

Colbert Cannon: I love it.

With that, I think it’s time to wrap up for the week, Brendan. So, I appreciate you coming on and am grateful for a truly insightful conversation and excited about what’s next to come at Mount Sinai.

Dr. Brendan Carr: Thank you very much, Colbert. It was amazing to be here.