Episode 084 | January 20, 2025 | 42:49
Guest: Dr. Reed Omary
Published: January 20, 2025
Duration: 42:49
Description
Dr. Reed Omary — professor of radiology and a sustainability advocate — shares his journey toward integrating environmental consciousness into healthcare. We talk about how sustainability can drive innovation and improve efficiency, with practical insights for clinicians, administrators, and policymakers. Discover actionable steps to reduce waste, improve outcomes, and make a difference.
Full transcript
About this transcript
This transcript was automatically generated and may contain inaccuracies, typos, or mistranslations. Episodes recorded before 2024 were transcribed by an on-site model and may have a higher error rate. The content reflects the original conversation to the best of our ability. For the authoritative version, please listen to the audio episode.
Joachim: Welcome to the Sustainable Healthcare Podcast Reed Omary. You are a professor in radiology and an outspoken advocate of sustainability. Welcome.
Reed Omary: Thank you for the important work you lead in advancing the mission of sustainability within medicine.
Joachim: What caught you on to sustainability in healthcare?
Reed: Like many listeners I’ve always cared about the environment, but had gone through my career in medicine mostly separating my professional life from my home life on sustainability. I would recycle at home, compost, buy used clothing, ride my bike. But it never occurred to me at the hospital, short of making sure that if I put stuff in the bloody waste bag it truly was bloody and not just habit.
That all changed during the pandemic. During lockdown I had my eureka moment. As a physician, scientist, educator I had the capacity to help my community in really pragmatic ways — is it safe for kids to play sports together? How do I bring my 85-year-old grandmother to meet her grandchildren? Is it okay to go to a concert? There are no randomized controlled trials. By the time we go through government-funded science we don’t have time. We need to be pragmatic now. And the decisions we made as individuals, communities, nations had effects across the other side of the world. We are all tied together. I recognized this is such an analogy to climate change — what the WHO has called the single greatest threat to health.
Joachim: What’s the status in US healthcare on sustainability?
Reed: The United States has the most complicated, expensive, maze-like healthcare system in the world, yet we don’t have the health outcomes those resources should deliver. Think of it as a maze — every part is a place where some entity extracts payment. Services, insurers, pharmacy benefit managers. If you presented the US healthcare model in business school, you’d fail. We spend 18-19% of GDP and yet 40% of hospitals are losing money. The largest academic health system in the US is currently losing money. 50% of rural hospitals are at risk of going under. The number one concern is staying alive financially.
The real challenge is people. We don’t have sufficient workforce. The workforce is incredibly burnt out — 2 out of 3 nurses, 1 in 2 radiologists. Moral injury from not being appreciated for what we endured during COVID. Day in day out, healthcare in the US is about survival.
So sustainability presented as “good for the planet” goes nowhere in the US C-suite. They are thinking “if we cannot deliver care and generate margin we go under.” But it is exactly the opposite — for all the reasons healthcare is a mess in the US, embedding sustainability provides fantastic tools to address all those concerns.
Joachim: A lot of similarities between countries — the NHS and Danish systems also lack clinical staff and are overworked. Financing is different but it’s a challenge everywhere. Sustainability is a great lever for innovation that achieves other goals like financial stability and staff stability. How have you experienced that?
Reed: Sustainability is not something to consider by itself — it should be glued to all existing priorities. If we don’t have enough staff and we reduce unnecessary healthcare, that is functionally equivalent to increasing the staff’s capacity. From a quality lens, reducing plastic waste and waste incinerated in neighboring communities — and I can tell you with certainty, medical incinerators in the US are not located in the communities where physicians live. The US doesn’t have anything like the Copenhagen net-zero incinerator that’s almost like a grass ski slope.
Joachim: Only a couple of places in Denmark incinerate hazardous waste — transport is high and they need extra diesel to reach temperature. In Green Innovation Group we work a lot on embedding sustainability into care pathways. There is more evidence that good treatment of chronic disease — detecting early and avoiding progression — is super sustainable because you reduce intensive care, amputations and eye trouble that are very resource-intensive both for the healthcare system and CO2-wise.
Reed: Sustainability is eliminating unnecessary waste, stewarding precious resources, helping systems live, adapt, survive and thrive. With complex systems, if we dive in to doing anything there can be second and third-order effects that cause more harm. “Open up the ER to anyone” sounds logical but if you don’t have the people or beds you create a backlog and bad outcomes.
Time we cannot generate. No amount of money makes 24 hours become 25. So we must ask: what’s the most impactful way to spend our time? Same applies to carbon emissions — we are in a race we don’t have a lot of time for. Use 2×2 grids: feasibility on x-axis, impact on y-axis. Go to the upper right.
A bad-feasibility example: “our organizations need to divest from fossil fuel companies” — immense effort, unclear impact. That doesn’t mean I support unchecked growth of fossil fuels, but if I have limited time that’s not where I invest it. Ask: is my goal to make a difference reducing emissions, or to talk about making a difference?
In radiology — first place to start: X-ray dye. We can buy it in small euro-sized vials, or in big tubs (like Costco vs the dollar store). The money saved from big tubs is enormous. At Vanderbilt with five CT scanners we save half a million dollars a year. With 20 CT scanners that’s $2 million we save. That gets the CFO’s attention.
Joachim: CFO is often the best person to talk to for sustainability change. You need a baseline. Consumption emerges as public enemy number one for hospitals — 80-90% of emissions come from stuff bought outside. A lot of things consumed at a hospital don’t improve health outcomes — medicine going past date, double or triple consumption “just in case,” surgery kits with sterile edge-case items used 1 in 30 surgeries.
Reed: Too many examples. Balloon catheters or stents bought, sit in the supply room, expire unused. The glove and gown waste — going to grab a glove and a bunch fall out the box and on the floor. Same with paper towels in bathrooms. Artists have documented patient care journeys by collecting all supplies used for one surgery — fills a gymnasium. Not saying withhold care — saying if we reduce waste we have the opportunity to provide care for even more people.
Joachim: We need to deliver more health outcomes not only per dollar but per CO2 equivalent. Any small advice for clinicians starting their own sustainability journey?
Reed: Recognize you are not alone. There is a whole host of listeners, LinkedIn readers, individuals you can connect with. I feel empowered, energized, lucky to be around so many people interested in sustainability. The more you dig in, the more you realize most people care about sustainability — they just may not use the words.
Joachim: Where can people find you?
Reed: LinkedIn at Reed Omary, on X @ReedOmary, and a blog at reedomary.com — guest posts welcome.