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Reshaping URMC’s physician group


(Photo by Kimberly McKinzie)

The operation was a success but the patent died goes the macabre punch line of a hoary joke.

It was not a line Michael Rotondo M.D. would have found funny in the late 1980s when he started operating on inner-city gunshot victims in Philadelphia.

Rotondo, who serves as CEO of the Rochester area’s largest physician practice, the University of Rochester Medical Center’s 1,300-doctor Medical Faculty Group, and vice dean of UR’s School of Medicine and Dentistry, then was a trauma surgeon working in Philadelphia hospitals.

Before street gangs started arming themselves with automatic weapons in the 1980s, the gun wounds that came into the City of Brotherly Love’s hospital emergency departments were comparatively simple to treat: Remove the bullet, stop the bleeding and patch up the patient.

The shooting victims who started showing up as Rotondo was beginning his surgical career were another story. Raked by multiple rounds, few could be saved.

“We’d do everything exactly right in the operating room, but patients would die anyway,” Rotondo says.

It was a tough problem. But Rotondo gathered and led a team that developed a trauma surgery technique that let them beat the odds.

Known as damage control, a term Rotondo coined in a 1993 “Journal of Trauma” paper he and fellow team members wrote describing the technique, the method is deceptively simple. Instead of trying to completely fix the extensive damage in a single heroic session, operate in stages.

Rotondo and his surgical team had to figure out the exact point at which a patient could be stabilized, determine what measures would keep the victim alive until his body had recovered sufficiently to finish the job and then go in to finish the work.

“Usually it takes two operations,” he says. “Sometimes it takes three.”

Between surgeries, damage control patients are kept sedated or in an induced coma in an intensive care unit—closely watched by surgery team members and ICU staff.

Pioneered on victims of street shootings in Philadelphia, damage control has been adapted to serve military surgeons’ needs in Iraq and Afghanistan, where Rotondo has toured military surgery sites as an adviser, helping forward surgical units refine the technique.

“When I decided to go into trauma surgery, this is the kind of thing I dreamed of,” Rotondo says

The technique has helped move injury from the number one cause of death among 1-year-olds to 44-year olds to the number two cause, a downward adjustment in which Rotondo takes great satisfaction.  

The reorganization
While it is not a comparison Rotondo makes, his current assignment in some ways calls for similarly staged efforts.

The URMC Medical Faculty Group’s structure is changing. The planning stages of the reorganization preceded by some two years Rotondo’s 2013 return to his native Rochester as the URMC physician group’s chief.

Rotondo is one of the top officials tasked with overseeing the effort. He is URMC CEO and medical school dean Mark Taubman M.D.’s vice dean.

URMC traditionally has been a somewhat loose confederation of relatively independent units, each with its own hierarchy, budget and imperatives. While its clinical departments, teaching, Medical Faculty Group and other departments were part of the same organization, their first consideration could often be their own needs.

In a recent interview, Taubman described the restructuring as “a very aggressive program on the clinical side to create the ideal integrated faculty practice model that will allow us to thrive. Mike Rotondo is highly regarded by the department chairs, and is the process of doing that.”

Rotondo is the first full-time head of the Medical Faculty Group. Running the group had been a part-time job. His predecessor devoted 20 percent of his time to the job and was concerned mostly with third-party payer rate negotiations, Taubman says.

Organized in the 1990s, the group previously was “highly silo-ized,” Taubman says.

Each department had its own budget and functioned as a largely independent unit. New reimbursement models that pay for coordinated care rather than individual services call for a group that was more internally cohesive and better integrated with the whole URMC organization.

After commissioning a six-month study by an outside consultant, URMC started searching for Medical Faculty Group candidates.

“We winnowed the field down to five or six,” Taubman says. “Mike Rotondo very quickly rose to the top.”

Factors in Rotondo’s favor included his previous experience helping to organize a smaller medical faculty group at East Carolina and his national reputation as a trauma surgeon. 

“It’s a paradigm shift,” Rotondo says. “Departments now are coming together to work in a multidisciplinary mode to coordinate care.”

But changing the course of a ship as big as URMC is no overnight task. 

The approximately 25,000-employee UR is the region’s largest employer. The medical center, which employs some 19,000 of the university’s staff and has a $2.3 billion budget, is UR’s biggest component. URMC’s sprawling main complex, which includes Strong Memorial, the UR medical school and the Wilmot Cancer Institute, has its own ZIP code.

Friction and resistance to change are unavoidable. But Rotondo points out there can be an upside.  

“We’ve got 1,300 faculty and 22 departments” Rotondo says. “Managing anything of that complexity is not easy, but dissenting opinion is incredibly valuable.”

Rochester native
Rotondo, 58, spent most of his career outside of Rochester. After attending a local Catholic elementary school and Bishop Kearney High School, he earned undergraduate, graduate and medical degrees from Georgetown University, spending 10 straight years at the Washington, D.C., school.

“I went from the Sisters of St. Joseph to Bishop Kearney to the Jesuits. I had a great Catholic education,” Rotondo says

Rotondo met his wife, Lydia, who was a Georgetown freshman at the time, in 1978 when he was senior.

“We met at a party and we’ve been together ever since,” he says. “We both feel like we were always meant to be together, but I guess she realized that before I did.”

Now approaching their 32nd anniversary, the Rotondos married in 1983. They live in Brighton and have three grown children.

When Rotondo took the URMC job, Lydia Rotondo, a nurse, started teaching part-time at the UR School of Nursing. She soon was tapped by the school’s dean to head its doctor of nursing program.

His wife’s work also promotes the integrated care-delivery model he hopes the URMC reorganization will help foster, “so we’re really kind of working toward the same goal,” Rotondo says.

Despite—or perhaps because of—a more than 30-year absence, “coming back to Rochester was really a great pleasure,” Rotondo says. “I grew up here.”

The youngest of four siblings, Rotondo grew up mostly in Irondequoit, where his family moved from the house at Bay and Rohr streets they occupied until Rotondo was five.

His father, an Eastman Kodak Co. researcher, kept a chemistry laboratory in the family’s basement. Rotondo’s mother was a nurse.

Career path
An accomplished jazz drummer whose office walls are lined with carefully chosen artworks, Rotondo once wavered between a career in medicine and one in music.

He cites two pivotal incidents as cementing medicine as his choice. The first came when he was 4 or 5 years old.

His mother was a private-duty nurse. Surgeons would specifically assign her to deliver individualized care to post-operative patients who needed close attention. She worked a mid-afternoon to late-night shift and generally came home long after Rotondo had fallen asleep. But on this night she came home early.

Rotondo crept out of bed and into the room where he had heard his mother and father talking. He saw that his mother was crying.

“Mommy, what’s wrong?” he asked.

Rotondo does not exactly remember what she said then but he does remember not fully comprehending it. Still, the event stuck with him and he asked her about it years later when he was 11 or 12. She told him that she had come early because her patient had died and that was why she was crying. 

As a child, Rotondo studied drums for 10 years on a Hochstein School of Music scholarship and took instruction from local jazz notables. He was a talented enough musician to have performed professionally with a small combo at a local club as middle school student. His father would chaperone the gigs.   

Music, science, math and medicine were his childhood guideposts, Rotondo says. His mother and an older sister sang beautifully, and his father was a more than competent rhythm guitar player.

“He would take his guitar to parties and play,” Rotondo says. “He could play any song anybody asked for.”

Trying to decide between medicine and music at the age of 16, Rotondo asked his father what he thought of the idea of him pursuing a career as a musician. His father did not reply—a sign that medicine, not music, should be Rotondo’s path.

“I totally got it,” Rotondo says.

Rotondo still plays the drums and toys with the idea of playing in public, but he has been busy.

“I haven’t really had the time yet to meet any local musicians,” he says.

Rotondo’s first application to medical school was turned down. Rather than giving up, he took postgraduate courses at the Georgetown University School of Medicine, earned a master of science in cardiovascular physiology and applied to the school again. On his second try, he got in.

After earning an M.D. in 1984, Rotondo did a general surgery residency at Thomas Jefferson University in Philadelphia. A trauma surgery fellowship at the Hospital of the University of Pennsylvania in Philadelphia followed.

In 1999, Rotondo moved to East Carolina University’s Brody School of Medicine as chief of trauma surgery and vice chairman of clinical care. In 2003, he became the trauma surgery department’s interim chairman and was named as its chairman two years later.

In 2007 Rotondo was named chairman of the entire East Carolina surgery department, a position he held until his 2013 appointment as URMC Medical Faculty Group CEO.

Brian Floyd is president of the Vidant Medical Center, a 910-bed teaching hospital affiliated with the East Carolina’s Brody School.

The Vidant Health system serves 1.4 million patients spread among 29 counties. Vidant Medical Center is the eight-hospital system’s flagship facility. It has the region’s only trauma center and is its only tertiary care hospital.

In the 10 years Rotondo spent at East Carolina and Vidant, he built systems and recruited staff in his own sub-specialty as well as bariatric, thoracic and other surgical disciplines.

“Mike’s a great recruiter. He understood how to create systems. He was definitely known as a builder,” Floyd says. “He had to have recruited 30 surgeons. He’s a big reason why we’re nationally ranked.”

While he was at East Carolina, Rotondo was heavily recruited and regularly weighed offers from rival academic medical centers.

“To tell the truth, I really hated to see him go,” Floyd says. “But I knew we couldn’t keep him.”

As he weighed various offers and possibilities for his next career move, Rotondo says, once he heard URMC was looking for a Medical Faculty Group chief, he knew he would go for it.

The URMC faculty talent is extraordinary as is the institution, he explains. But perhaps most important is the return to Rochester would be a homecoming, maybe even a fated one.

Brody School bariatric surgeon Walter Pories M.D. is one of several doctors whom Rotondo reveres as mentors. That Pories did graduate work, earned an M.D. at UR and served his medical internship at Strong Memorial formed part of the bond between them and served as sign, Rotondo says, reminding him of his link to his native city.

“To come back to the place that gave you everything you have. Who wouldn’t want to do that?”

Michael Rotondo M.D.
Title: CEO, University of Rochester Medical Center Medical Faculty Group; vice dean, UR School of Medicine and Dentistry
Age: 58
Education: B.S. in chemistry, 1978, Georgetown University, Washington, D.C.; M.S. in cardiovascular physiology, 1980, and M.D., 1984, Georgetown University School of Medicine
Family: Wife, Lydia; daughters, Alison, 27, and Paige, 23; son, Michael, 21
Residence: Brighton
Leisure pursuits: Jazz drumming, art
Quote: “To come back to the place that gave you everything you have. Who wouldn’t want to do that?”

1/16/15 (c) 2015 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.

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