Michael Genovese

Full Transcript

ex judicata:  With us today is Dr. Michael Genovese, Chief Medical Officer at Acadia Healthcare.  Our core mission at ex judicata goes to redefining what it means to be a JD in the US workforce. That is, providing lawyers with new viable alternatives to the practice of law and making these jobs accessible to many for the first time. As someone who was first a lawyer and then became a doctor and head of a huge network of behavioral healthcare facilities you are a wonderful example of the value and flexibility of the JD degree.

Over the years I’ve met a few doctors who were also lawyers.  In each case, they had first gone to medical school and then to law school.  You did the opposite.  First you went to law school and later medical school.  That must be tremendously harder.  Theoretically anyone can go to law school.  But, with medical school, you need a complete grounding in certain sciences before you can even apply.  How did it all start?

Dr. Genovese:  There were 3 doctors in my law school class.  I talked to them about going to medical school.  My dad was a doctor. He did internal medicine and cardiology. My mother was an emergency room nurse. All their friends were doctors and nurses.

For a long time growing up I thought I was going to follow in that path. When I got to college, I was going through different stages of thinking about what I wanted to do in  life.  I was more attracted at that time to the law.  But still with the health somewhere in the background.  For example, I served as the president of the Health Law Society, and I had different internships with local hospitals. And when I got out of law school, I went to work for a law firm that defended doctors in medical malpractice litigation.

ex judicata:  You must have enjoyed that, although ‘enjoyment’ and ‘associate’ often times don’t go together.

Dr. Genovese:  I really enjoyed it. The senior partners would do the trials and the junior associates would do the research. So, I spent a lot of time doing medical research because if my boss was defending an OB/GYN, say, in a hysterectomy case, he needed to know everything there was to know about those sorts of cases.  And as I was getting more and more interested in medicine, I thought, ‘Geez, I don’t have enough student loan debt.  Why don’t I just take on some more?’

ex judicata:  Okay, to go back,you go to law school with medicine very much in the back of your mind.  You graduate and do med mal work getting closer and closer to medicine.  When did you get the grounding for medical school?  That is the chemistry, the biology, the math.  Was that at night when you working for the law firm? 

Dr. Genovese: Yeah, you know, it’s interesting. I started taking to the doctors in my law school class in the cafeteria etc.  I was fascinated by the things they were doing and planning on doing with the double degree. They asked me why I wanted to go to medical school?  I explained and they said I was thinking about going to medical school for the right reasons.

So actually, during the summer between my second and third year of law school, that’s when I started taking courses like biology, physics and organic chemistry at a nearby community college.

ex judicata:  I’m thinking back a million years, Doctor, organic chemistry.  Isn’t that the class that weeded out who was on the path to medical school and who no longer was on that path?

Dr. Genovese:  Yes, it is. It was quite a threshold to cross. I remember during my residency I was doing an intake. A patient came in and I’m taking their history. I asked him what he did for a living.  He said he taught organic chemistry. And I said, ‘what’s wrong with you?’

ex judicata: So, you’re about 6 years into the practice of law. Perhaps on the partnership track which was shorter back then and you announce you are leaving to go to medical school?

Dr. Genovese:  I told the partners first and they looked at me like I had two heads. But, they became supportive. I wasn’t leaving to work at another firm. They knew I enjoyed what I was doing.  I was always requesting to do medical research.

ex judicata: Here I must interject how unusual it is for a law firm associate to ask to do more research.  There must have been something else going on and here there was.

Dr. Genovese: So, I left the firm with their blessing. I still maintain friendships with some people from the firm today.

ex judicata:  A little while ago, you referenced debt. Most of the attorneys we talk to who have transitioned out of the practice of law take a financial hit. But they are at least making a salary, being paid something.  When you went to medical school your salary went to zero.  How did you manage?

Dr. Genovese:  Luckily, I was not married at the time. I didn’t have any kids.  A guy could live on a pair of jeans, t-shirts and 3 meals a day. Given my lifestyle it was doable.

ex judicata: So, you didn’t you didn’t move back home or anything?

Dr. Genovese:  No, I just took out way too many loans. When I was applying, they said ‘how much do you want?’  And I said, ‘well, how much can I get?’ They said that I really needed to think it through. But that seemed like such an ethereal, nebulous sort of idea.

ex judicata:  Yeah, somewhere in that distance you can’t see. Its so far away you can’t even think about it.

Dr. Genovese: Yes, it was kind of that way.

ex judicata:  You get out of medical school and determine you want to pursue psychiatry. 

Dr. Genovese:  It was the most interesting specialty to me. During the 70’s my dad practicing internal medicine had the time to talk to patients. The mind was part of it. The practice of medicine changed so much and the relationship with patients changed. But the mind was really interesting to me. The patients fascinating. 

And by the time I did my residency things had changed so much.  In my dad’s time it was pretty much Thorazine, a few other medications and psychotherapy.   Now we were looking at things like functional MRI research for diagnosis, dozens of medications.  The pharmacology was really advanced.  There was a lot we could do for very sick patients and it made it attractive.

ex judicata:  When I first saw your background, the combination of law and psychiatry, I was thinking this leads to some kind of career in forensics.  Did that ever enter your mind?  It seems like such a natural.

Dr. Genovese: Yeah, I did.  And a lot of people suggested that I focus on forensic psychiatry. I did for a bit and then something took me down a different path.  It was the opioid pandemic. I started getting referrals from other doctors of patients suffering with opioid use disorder. The patients had tried 12 step meetings, therapy and done everything to get themselves off OxyContin.  Nothing was working. 

Then I read about a brand-new medication, Suboxone. I tried to find a local doctor trained specifically in addiction who knew about this and could administer it.  I tried all over Nassau County and Suffolk County as I was working on Long Island.  The closest doctor I could find was in Manhattan. So, I said, ‘you know what? I’ll manage you myself.  I’ll get a license to prescribe the drug.  And then I became sort of the de facto addiction guy. That’s how I got into all of this.

ex judicata:  I know you took a fellowship in child and adolescent psychiatry. 

Dr. Genovese: Yes, I thought to understand the adult, you must understand the child and the fellowship is how I wound up working on Long Island.

ex judicata:  So, after completing the fellowship you set up a shingle in private practice.

Dr. Genovese:  I did, and I also was on staff at what is now NYU Langone. Long Island on their consultation liaison service because you can hang a shingle, but then you can have a 10:30 am. and 2:00 pm patient.  So, you must do something to fill the time and get your practice moving.  A lot of the work was covering the emergency room. So, you would get called in to screen patients who, maybe, were either presented with suicidal ideation, presented with psychosis, presented with mania or you could get called in for capacity evaluations if somebody wanted a DNR.  There were all sorts of things that you would get consulted on.  Like making sure that someone had capacity to make a decision to either have or refuse surgery. Or, if someone was admitted to the hospital with cardiovascular disease but they had comorbid anxiety or depression, you would get consulted on that.  It was a busy service. It was great. I learned a lot.

ex judicata: It certainly sounds like it. So, you’ve got this busy private practice, all this emergency room work, how do you make the turn to the corporate side of medicine or broadly behavioral health?

Dr. Genovese:  So, I was doing a lot of work with addiction.  And sometimes you find that patients suffering with a substance use disorder need a higher level of care.  There’s only so much you can do for them as an outpatient just like any other field of medicine. It gets to a point where they need a more intensive sort of 24-hour therapeutic milieu.  I was working with several facilities where I would send patients who reached an acuity that in my mind necessitated an inpatient admission. And one of the facilities I worked with a lot was called Sierra Tucson, which is a great facility out in Tucson, Arizona.

They asked me to present at one of their conferences and then at some point they contacted me, said they were looking for a Medical Director and would I be interested in  interviewing.  And Sierra Tucson is a very reputable facility, has a long history.  I couldn’t say no.  So, I interviewed, and I got that position and served as the Medical Director.  While I was their Sierra Tucson was acquired by Acadia Healthcare. So, I was now the Medical Director at one of the largest facilities at Acadia Healthcare. And things sort of just progressed from there.

ex judicata: That is quite a journey. A wonderful story from JD to MD to leader of the largest provider of behavioral healthcare in the US.

ex judicata:  What’s exciting right now in behavioral healthcare?  Are psychedelics catching on?  And, what’s the intersection with the law?

Dr. Genovese:  I’m excited to see that field advance.  I mean, ketamine is categorized as a psychedelic medication.  It’s also, as you may know, used in anesthesia, but that was the first one that sort of broke through.  It’s remarkable that it is the one thing in psychiatry where you can have someone come in with suicidal ideation and leave feeling significantly better.  And some of the literature that’s come out of NYU and Johns Hopkins concerning psilocybin’s use in treating anxiety in patients with end stage cancer is very encouraging. If you think about it being effective in that population, what can it do for other people?   We need to overcome the old thinking that psychedelics are about tripping and The Grateful Dead.

ex judicata:  Amazing.  As mentioned earlier, our focus at ex judicata is broadening the applicability of the law school skillset.  Meaning JDs are great hires, not just in quasi-legal areas like compliance, but in brand management, HR, investigative services, insurance underwriting and so many other occupations.  If you could talk a little, doctor, about how your law school training helped you throughout your career.

Dr. Genovese: Sure. In thinking about law school, I didn’t necessarily learn how to be a lawyer. Rather, I learned a different way of thinking.  More tangibly, in my current setting, learning how to see both sides of an issue is critical to what I do. Situations where you have very smart people arguing one thing and very smart people with an opposing view.  It’s helped me be a mediator, to understand both sides and to help come to a resolution. I also think being trained to think critically starting with the worst-case scenario and identifying all the remaining issues has been very helpful to me in medicine and helpful in running a very large company.

ex judicata:  We’ve talked with many JDs who transitioned to business about a concept we call, for want of a better term, positive issue spotting. Typically, issue spotting is identifying all the things that can go wrong in a given situation.  Here we are talking about visualizing as many potential opportunities as possible.  Take ex judicata as an example.  We started by wanting to help JDs who wanted to leave the law by creating the first-ever job board for non-practicing attorneys. Then we thought what else can we offer?  We came up with courses, then a psychometric test, then LinkedIn/CV rewriting and then inspirational interviews with JDs who transitioned like the one we are doing here.  With much more to come.  Always trying to envision other opportunities arising from the same situation.  Sorry, this is shameless self-promotion.  But I don’t feel so bad because it is accurate.

ex judicata:  What advice might you give, doctor, to those that are young associates or 3Ls still in school who are questioning if law is really the career they are best suited for, the career they want.

Dr. Genovese: You know, the world is your oyster. Having graduated from law school. means that you have gone through a training which gives you the ability to realistically assess situations in the world in a way that a lot of people can’t. You’re going to be valuable to someone.  You have the agency and the autonomy to make decisions.  And, you shouldn’t be afraid of making decisions that are outside of what is considered the traditional or normal way of doing things.

ex judicata:  And you are a perfect example of utilizing your JD to chart a path that has taken you in surprising directions leading you to your current role.

Dr. Genovese:  If I didn’t have the law degree there is a very good chance I don’t sit in the seat I do at the largest behavioral healthcare provider in the US. The JD is a differentiator.  It has also throughout my career allowed me to understand aspects of medicine that a lot of doctors can’t even think about.  In that regard also the distinction has been a positive one.

ex judicata: The JD is a differentiator. A good place to leave it. Doctor, thanks so much for taking the time.  Such valuable information for our readers and listeners.

Dr. Genovese: It’s really a pleasure to speak with you, Neil. Thank you.