For Dr. Tama R. Van DeCar, the decision to pursue a career in medicine was made early. In fact, she believes the profession chose her. It was a long family history in medicine and a sense of discipline that runs deep in her family that led her to study at the Uniformed Services University of the Health Sciences, where she received her medical doctorate degree — and where her third son is currently in school, and from where her first son’s wife graduated. With a continued commitment to service, Dr. Van DeCar began her medical career in anesthesiology and quickly grew into leadership positions. Near the end of her military career, she was selected as Group Commander for the 96 Medical Group, the sixth largest hospital in the Air Force Medical Service.
Dr. Van DeCar brings her leadership skills and unwavering dedication towards achieving clinical excellence to the HCA Healthcare TriStar Division as Chief Medical Officer. In addition to a long list of accomplishments in this position, Dr. Van DeCar is leading the charge in the division’s response to the opioid epidemic. Read on to learn more about the trajectory of Dr. Van DeCar’s career and how the HCA Healthcare TriStar Division is creating greater awareness surrounding the opioid epidemic through new pain management initiatives, education and community engagement.
Tell us about your responsibilities in your current position as Chief Medical Officer (CMO).
HCA Healthcare was one of the first companies to embrace bringing chief medical officers into their company. There are things about medicine that if you are not a doctor, you are not going to understand or know how to work through the challenges to achieve the best possible results. The concept of the CMO role is that in the highest echelons of leadership of hospitals and healthcare companies, there is a unique role that can only be filled by a physician and the experience that comes with treating patients. Also, as a member of a leadership team, you’re not in charge of the entire medical staff. You are in charge of making sure the physicians and hospital administration have the information and the resources they need to avoid potential roadblocks. Above all else, it is a responsibility for the level of care we provide, and there is a complex and intricate critical excellence agenda that is our sole responsibility. To me, you need a member of leadership who is appreciated and holds the same status as a chief nursing officer and chief financial officer, but is also someone who fully understands physicians, understands medicine and has a high comfort level in those discussions.
In what ways did being a woman impact your career path? Did you face any gender-related roadblocks?
The answer is honestly, no. I am not a big, tall, dominant force. I walk in the room, and you probably can’t even see me. But I was never denied anything I pursued — maybe it is because I was always working hard to make sure I was the most qualified candidate. People would reach out to me for leadership opportunities; that is why I am here now. I never had anybody say I couldn’t do it because of being a woman.
But did being a woman help me? ABSOLUTELY. The biggest challenge is also why it helped me the most. The difficult part was ensuring that my husband, who is also a physician, and I were able to fully care for the needs of our four boys. Being a really good mom and parent made me a better leader. Being a leader and not having the time to be with my kids every single day made me appreciative of the time we did have together. It brought our family closer. When you come home to kids who unconditionally love you and need you, it is hard to stay down about work when you have a bad day.
I noticed that it wasn’t as easy for my residency colleagues who weren’t married as it was for me. Having four kids in six-and-a-half years — people think we are the crazy ones, but I have been married 32 years, and my kids still think I am alright.
Can you tell us about efforts made locally in response to the opioid epidemic?
Here at HCA Healthcare’s TriStar Division, I have the privilege of working with such tremendous physicians — the best I have ever experienced in terms of both clinical excellence as well as compassion and connection to the community and the world of health. In August of 2018, our ER physicians came together and introduced new pain treatment protocols with the goal of reducing the administration of opioids while still treating pain appropriately. The program is called ALTO, or alternatives to opioids, and is an initiative that employs an evidence-based approach to care that ensures that each patient receives effective and responsible treatment for their pain – but without the need to introduce them to the inherent risks that come with the potentially addictive medications. We know that the odds of becoming addicted and continuing to use opiates a year after starting significantly increases after only five days on the medication. The ALTO program employs a strong focus on safety and education. Patients are advised on the importance of using alternatives as a first line for mild to moderate pain, while reserving the potentially addictive opioids as a second line treatment. Opioids remain an important part of pain management and our emergency room physicians recognize that in some cases a patient’s condition may be more appropriately treated with opioids if alternative therapies fail. All emergency room providers continue to follow established Controlled Substance Policies and fully provide for the pain management needs of each patient. The program has been highly effective and in a little more than a year’s time we have seen a 31% decrease in prescribed opiates in in the emergency department.
We also introduced the Enhanced Surgery Recovery program, or ESR. ESR is an evidence-based patient care protocol that is designed to help expedite the recovery period for patients after surgery. The enhanced surgical recovery program was developed by a multidisciplinary team of surgeons and clinician specialists. The team’s goals were to reduce complications, improve recovery time after surgery, ensure a faster return to normal activities and – more importantly – reduce a patient’s dependency on opioids for pain management. The ESR protocol utilizes pre-op, intro-op and post-op arenas as opportunities to perform multi-model pain management. Multi-model pain consists of things as basic as non-steroids that can help lead to a significant decrease in the number of narcotics providers use for many surgical procedures.
Last, but certainly not least, I must talk about our hospital division’s Crush the Crisis Opioid Take Back Day events. The opioid crisis has been declared a public health emergency. Every day, more than 130 people in the United States die from opioid-related drug overdoses. Last year, orthopedic surgeon, Dr. Jeff Hodrick approached me with the idea of utilizing our hospital system’s size and scale to host an opioid medication take-back initiative with the goal of educating the community on the dangers of opioid addiction and to increase awareness on proper prescription disposal. Dr. Hodrick was inspired by the bi-annual national prescription drug take-back days which are hosted in the spring and again in the fall by the federal Drug Enforcement Administration (DEA). So, in the fall of 2018, the HCA Healthcare TriStar Division – in partnership with local law enforcement – hosted Crush the Crisis Opioid Take Back events at nine hospitals located across two states. The response from the community was incredible and our team’s efforts resulted in the successful collection and disposal of more than 224 lbs. of prescription opioids.
As thrilled as we were with the results of our hospital division’s opioid prescription take-back events in 2018, we still knew that we could do more. So, for 2019 we are expanding Crush the Crisis Opioid Take Back Day across the country. I’m excited to share that on Saturday, September 7, the HCA Healthcare TriStar Division will join more than 65 HCA Healthcare hospitals and local law enforcement agencies across the nation to host Crush the Crisis Opioid Take Back Day. Opioid addiction can happen to anyone, and unused prescription opioids are a major source of misuse. Crush the Crisis Opioid Take Back events provide an opportunity for the community to properly dispose of unused opioid medications anonymously, with no questions asked.
When you aren’t working, where can we find you?
That’s easy — on my boat in Niceville, Florida, with my husband, dogs and any son who chooses to come with us. We bought the boat when I retired and named it “Inconceivable.” Military medicine is a great thing, but there are not huge salaries in military medicine. And with four kids, there wasn’t a lot of disposable income. I worked really hard, and this was a gift to represent the transition in our lives.
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