New surgical oncology chief outlines plans

Kevin Roggin, M.D., has a straightforward philosophy on patient care.

“I think of patient-centered care as – if I had cancer, this is how I would want to be treated,” he said.

A surgical oncologist who specializes in both upper gastrointestinal tract and hepato-pancreato-biliary (HPB) cancers – meaning cancers of the stomach, pancreas, liver, gallbladder and related areas – Roggin joined MUSC in September as chief of surgical oncology in the MUSC Department of Surgery and clinical director for surgical oncology at MUSC Hollings Cancer Center.

 

“I would want immediate access to specialists and providers,” he continued. “I would want someone to communicate clearly with me. I would want someone to, even though they were busy, make me feel like they were there in the moment and empathize with me about what I was going through. And that they’d be available to help even if things didn't work out. So that's my philosophy – to just make it about the patient. If there's ever a conflict, what is best for the patient?”

Roggin developed this philosophy during his residency and fellowship as he watched surgeons – “exceptional role models” – at work.

“I learned how to talk to patients, how to model the behaviors that I was seeing. That was something that you can't learn until you see it and experience it, and then you emulate in your own practice what those surgeons were able to do,” he said. “They see the person on the worst day of their life; they empathize with the patient. They hear them. They take the time and then rationally come up with a multidisciplinary plan and execute it – and then be compassionate if it doesn't work out or if the cancer progresses.

“It really was an incredible education on being a complete physician.”

Roggin put that education into practice at the University of Chicago, spending 18 years there and taking on leadership roles like director of the general surgery residency program as well as serving on the Society of Surgical Oncology executive council.

Ready to take on a new challenge, he decided to head south to Hollings.

“One of the things that appealed to me about this institution was the mission to take care of all patients in South Carolina and to treat underserved patients that needed better access to high-quality care,” he said.

"One of the things that appealed to me about this institution was the mission to take care of all patients in South Carolina and to treat underserved patients that needed better access to high-quality care."

Kevin Roggin, M.D.

He was impressed with the work done by David Mahvi, M.D., former director of surgical oncology, and Prabhakar Baliga, M.D., chairman of the MUSC Department of Surgery.

He was also given a logistical issue to work on right away: getting HPB cancer patients immediate access to the surgical team.

His ambitious solution, set to be implemented as a pilot program this summer, aims to provide next-day access for abdominal and HPB cancer patients. In other words, a patient calls on Wednesday and on Thursday is at an intake appointment at Hollings.

“Patients with cancer need to be seen faster. If you had cancer, you’d want to be seen yesterday,” he said.

Implementing the idea requires careful thinking through of schedules and personnel. The current clinic schedule is jampacked – medical oncologists and surgeons for nearly all cancer types share the same space in a carefully choreographed exchange of exam rooms. HPB and abdominal cancer surgeons see patients on Wednesdays. But that means that some patients could wait for up to a week before first meeting a surgeon.

“Like anything, you examine the problem, and then you think about simple ways of solving it that don't always rely on adding resources,” Roggin said. “I looked at it as an access problem. And I felt like we could make some simple improvements by reorganization.”

The plan will be for next-day access patients to see a nurse practitioner or physician assistant at the first intake appointment and meet the surgeon for a brief, preliminary meeting. A treatment appointment will be scheduled in the next week, and during that week the surgeon will take the case to the multidisciplinary tumor board; the patient will meet with other providers as needed, and the clinical trials team will assess whether the patient could benefit from a clinical trial.

“I think that it will be successful because I'm committed to it, and I think that's what patients and providers ideally want,” Roggin said. "It's going to be a challenge, and we’re going to have to navigate difficulties. But it’s exciting because it’s something that we can do as a team and build together.

“I think it will help patients have better access to our system and ultimately get under a provider’s care faster.”

 

While Roggin immediately jumped into the administrative aspects of his new role, his primary focus remains on patient care.

His surgical practice includes both open surgery and robotic surgery, which he points to as an example of his willingness to put in the same work that he expects of trainees and colleagues.

“I was an open surgeon, meaning I did traditional open surgery, and at 47 years old, after independent practice for 12 years, my leaders asked me if I would be willing to learn robotic surgery,” he said. “That experience forced me to say, ‘Do I want to put myself through the exact same teaching paradigm that I would want my residents to go through to learn a new technique?’”

His answer was a resounding yes.

“I took the approach that I was going to learn from scratch, so I went to a simulator, and I spent 100-plus hours on a simulator learning basic drills,” he explained. He traveled to training sessions, observed experienced robotic surgeons, operated under the mentoring eye of other surgeons at his institution and watched videos to assess his own performance.

“In many ways, the lesson was you have to walk the walk,” he said. “You have to be willing to do what you're asking your trainees to do, and, as a guiding principle, I can't ask faculty to do something that I'm not willing to do myself. I have to hold myself to the same standard.”

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