Dr. Nirmal Joshi’s primary interest has always been to keep the patient at the center of care. He has helped implement novel and innovative methods that improve doctor-patient communication, and remains strongly interested in humanism in healthcare. Joshi was appointed Mount Nittany Health chief medical officer in November 2017, and was recently named chief medical officer, population health. In this role, he provides leadership for clinical operations related to clinical quality, population health, and medical staff.
Prior to joining Mount Nittany Health, Joshi had served as the senior vice president of medical affairs and chief medical officer for Pinnacle Health System (now UPMC Pinnacle) in Harrisburg. Joshi is a fellow of the American College of Physicians (FACP). He served on the board of Asian Indian Americans of Central PA, a large nonprofit community service organization; the Harrisburg Academy, an independent school system; and Wilson College, a liberal arts college in Chambersburg.
Born and raised in India, Joshi earned his Bachelor of Medicine and Bachelor of Surgery degrees, and his medical degree in internal medicine from King George’s Hospital Center in Lucknow, India, in 1983. He completed his internal medicine residency at Prince George’s Hospital Center in Cheverly, Maryland, and his infectious disease fellowship at Penn State Milton S. Hershey Medical Center, staying on as a faculty member for eight years.
Town&Gown founder Mimi Barash Coppersmith sat down via Zoom with Joshi to discuss Mount Nittany Health’s COVID-19 efforts, the hospital’s biggest challenges, and what is on the horizon for healthcare in the community.
Mimi: I’m absolutely fascinated reading where you’ve been and where you’re going. What attracted you to leave the commonwealth’s capital and come to Happy Valley?
Nirmal: You may have answered part of that question yourself, Mimi. It was the Happy Valley feel to the place, quite honestly. When I was evaluating this opportunity, I was at a point where I had spent approximately 16 years with Pinnacle Health, now owned by UPMC, the last six years of that as chief medical officer for their system. I took a year off; it had been so intense for so long that I thought it was important to take a short break. I was looking for something where I would enjoy what I was doing. I wanted to see a more direct outcome of my efforts in a place where I could seemingly get my arms around, a small- to medium-sized health system. As you know, there are not many of those left in the entire Commonwealth of Pennsylvania, and this was one of them.
When I came in and spoke to the folks up here and then began to evaluate the opportunity closely, it was obvious to me that this was a unique place. Also, it had a feel to it that was very similar to where I grew up in a small north Indian town, where my dad was a surgeon. It just felt very similar in some ways, [and I was] sort of nostalgic about that. That’s what got me here; both the professional kind of feel to the place and the personal feel to the place.
Mimi: This is a marketplace that’s now served by Geisinger, Mount Nittany, [Penn State] Hershey, and UPMC. That’s the big picture. You worked in Hershey and now at Mount Nittany. Do you see a merger in the near future?
Nirmal: We are really stewards of the community. What the community demands and wants as far as healthcare is what we are here to provide. What we hear repeatedly is that our community values having a say in their local healthcare system. We also see ourselves as interdependent with a number of important clinical partners, including Penn State Health, Geisinger, and others. We’ve built these very strong relationships that have up until now served us and our community extremely well. And we plan to continue to have those strong relationships. That’s our goal and what’s best for our community.
Mimi: It must be a huge job. You employ how many people at the hospital?
Nirmal: We have upwards of 2,500 employees.
Mimi: Where does that stand, other than the university?
Nirmal: After Penn State, we’re the largest employer.
Mimi: That’s a lot of people and a lot to be responsible for. You’re very vital to the community. We all have had a real experience of how important it is for our hospital to be in front of an issue, taking care of people on this [COVID-19] virus thing. Is that getting any better? Are you getting more [vaccine] to disperse?
Nirmal: An increase in COVID-positive inpatients was seen at the medical center in early April, averaging in the low 20s. At that time, for the safety of the community, visitation limits were reintroduced. Because our goal throughout the pandemic has always been to deliver the safest, best possible care to our COVID-positive patients, as well as all other patients, including surgical cases, we continue to monitor COVID cases in the community and within our health system to determine whether – at any given time – patients should be rescheduled or continue their plan of care as previously recommended. We will continue to use clinical judgment to assess which patients have the greatest need at any given time and treat them appropriately.
With the Pennsylvania Department of Health’s acceleration of its COVID-19 vaccine strategy – including the ability for all Pennsylvania residents to begin scheduling vaccination appointments by April 19 – we will continue to closely follow the DOH timeline and administer as many vaccines as are made available to us, during each approved eligibility phase.
This is a positive step toward putting this pandemic behind us. … We will continue to vaccinate as many people as we can, as quickly as we can, but this will still take time. For now, it is critical that everyone continue to practice COVID safety measures, including masking, social distancing, and frequent hand-washing.
Mimi: Tell our readers how to get on the list to make an appointment.
Nirmal: We are ultimately dependent on what we are able to get as a supply. Every hospital is the exact same, as in we are dependent on the state Department of Health to be able to buy a certain amount of vaccine. If you qualify [based on state guidelines], there is a process to be able to register online for a vaccination. And then that gets you to our doorstep, where we administer you the vaccine.
Every week, we open up slots based on what is available to us. So, we don’t put you on and then say, “Oops, we don’t have a vaccine for you.” Some states have done that, which is why our vaccine efforts have been lauded so much by the community. We’ve gone out of our way to make sure that we have not restricted vaccinations to our own staff, but we have actively engaged in vaccinating our community along the lines of the guidelines offered by the state. It’s a very, very designated process for what we are now calling sort of a mass vaccination effort for the community.
Mimi: Let’s turn for a moment to the area of mental health. How seriously are we planning to help people who come out of this isolation period with little hope or a positive attitude? What role does the local hospital have in that challenge?
Nirmal: As a health system, number one is we need to acknowledge whenever we can that this is real. And what the health system has – which is a remarkable thing – is we have a very large group of physicians, providers, and nurses with whom people interface. So, we have this kind of window into the community, where there’s an opportunity to educate our community. One of the big things [staff] were doing is offering counseling and advice to people as they were coming through [during appointments], beginning with telemedicine screens, and then as the opportunity begin to come up to physically see people, to talk to them in person.
Mimi: You’ve had a lot of experience along the way. You’re in Happy Valley, where we do amazing things and you’re at an amazing hospital that the community has taken an alive-and-well interest in over a long period. What do you see in the crystal ball?
Nirmal: When I came to this hospital, even during my interviews with senior doctors, community leaders, and board members, one of the things very clearly articulated was building the next generation of physician leaders. In a sense, that is developing not only your own replacement, but also developing a whole variety of physician leaders at multiple levels in the organization who can then take the organization forward. That’s one of the things I’ve been very actively engaged in, and I plan to continue to be. We’re strongly investing in physician talent and physician leadership talent. And quite honestly, providing that opportunity for other physicians who we’ve coached, developed, and mentored over the course of the last year, two years, three years, to bring them up and for them to be able to take leadership positions in the organization.
Second is what is now referred to as population health, meaning looking at large populations of people – for example, diabetic populations, or high blood pressure or another chronic disease like heart failure. What can we do at a population level of diabetics or hypertensives? And how can we improve their health so that they use healthcare less, as opposed to more? And when you do that, you are investing truly in the community’s health, which is really our mission at Mount Nittany.
The third thing from my own standpoint is what I broadly call second mountain-type initiatives. If you’ve read David Brooks’ book The Second Mountain, what that refers to is that in the first mountain, we are doing all the things that everyone does: we’re making money, we are investing in ourselves, we’re getting pleasure out of the mechanical and the material things in life. And the second mountain is when you begin to truly get joy when you begin to invest in others than yourself, whether it be the community, other people, other doctors, and so on. So, I look at myself as in the second-mountain phase of my life, where more amounts of money, more titles, and more amounts of anything else will not give me joy. But what’s going to provide me with joy is investing in other people. And I’m uniquely positioned. We have a remarkably supportive executive team, including our CEO, who’s offered me the opportunity to do what I enjoy doing. And I’m both very, very privileged, proud, and also very humbled because of that.
Mimi: What’s your biggest challenge at the hospital? What’s the thing that may keep you up at night?
Nirmal: I think when you have a smaller ship, you’re able to move it around faster, so I love that fact about our organization. That brings challenges as well, which is when we have no control of nationally and regionally how the healthcare landscape will change, to be able to deal with those kinds of pressures that other organizations have faced 10, 15, 20 years ago.
The second thing is, I am a physician leader. From my vantage point, I look at getting physician talent here to keep physicians professionally fulfilled. Let’s say a specialized cardiologist. We can’t offer the entire spectrum of the highest level of sub-specialization in cardiology. And that limits the ability to get a certain number of providers, because they may want to be able to do the more complex work. The challenge always is, how do you balance that?
You have to realize your limitations and do what you do really well, instead of trying to do it all. The challenge there is to be able to do as much as you can, while attracting physician talent to this community. Everyone in the hospital and in the system realizes how much of an effort it is to get high-quality physician talent. We’ve gone out of our way to do the very best we can to get that. And in some instances, we’ve been downright fortunate.
Mimi: In many cases, the presence of a nationally respected university in our backyard has been a very good selling point.
Nirmal: I absolutely agree. The presence of a large local university, the games and everything else that comes with it, offers a certain community vibrancy.
Mimi: Well, I could go on talking to you forever. But I want to thank you for taking an important chunk out of your day. I don’t know how you get it all done. Keep up your spirit and belief that we will be as good as we possibly can be.
Nirmal: Thank you, it was an absolute delight talking to you.