Jim Burkhart

“I had a lot of relatives who were physicians or dentists, and I thought I wanted to be a dentist at one time. My parents knew a dentist in the small town where I grew up, and he was left-handed, and so am I. The chairs in his practice were oriented in a different direction, and he encouraged me to go to dental school, come back and work with him, and take over the practice when he retired. But when we started operating on lab animals in my college biology class, I did not like it. If I didn’t like that, I decided it probably would not be a good idea for me to work in someone else’s mouth.”

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After giving up on his original plan to become a dentist, James Burkhart worked as a hospital orderly while taking classes at the University of Tennessee in Knoxville, near his hometown of Maryville. He met an administrator there who helped change his career path.

On the road to working in health-care administration: “I had a mentor at the hospital, and he encouraged me to consider getting a master’s degree in hospital administration. He recommended UAB to me because he’d had a good experience with residents from the program who had worked for him.”

Burkhart has more than 30 years experience in health-care administration and is president and administrator of Shands Jacksonville Medical Center, the largest hospital in Jacksonville, Florida. He has maintained close ties to the UAB School of Health Professions. He is president of the alumni chapter for the M.S.H.A. program and serves as a preceptor for the program, working with UAB students who complete residencies at Shands.

On maintaining connections to UAB: “I learned a lot of valuable lessons at UAB, and I’m proud that the program has continued to stress the need for a residency. I did my residency at the VA Medical Center in Nashville, and I know how valuable it is for students to actually spend time in the field. “It gives you an opportunity to impart a little of what you have learned, to try to guide students as opposed to dictating to them. I try to allow them to experience certain things that I know they need exposure to. But I let them guide their own residencies in terms of projects they are most interested in. “I’ve had more than 10 residents from UAB, and I have two with me right now. In every case but one, the UAB residents have stayed to work for me, and the one that didn’t wanted to go into physician-practice management.”

The military has played a critical role in Burkhart’s career. He joined the Air National Guard in 1972, right out of high school, and an Army ROTC Scholarship helped pay for his undergraduate training at Tennessee. He served six-plus years on active duty in the U.S. Army before rejoining the Air National Guard in Knoxville.

Burkhart’s first job in the military was as a medical platoon leader in a cavalry unit in Colorado Springs, Colorado. He served as a general’s aide at Fitzsimmons Army Medical Center in Denver and also was a medical logistics officer before becoming medical group commander at the 134th Air Refueling Wing in Knoxville. He retired as a colonel earlier this year, completing 35 years of military service.

On his work at the Air Refueling Wing: “I was running a big clinic, with about 70 doctors, nurses, medical technicians, and lab technicians. We did the enlistment physicals and flight physicals and took care of the personnel in the wing, which included more than 1,000 people.”

On the value of his work in the military: “It gave me a strong appreciation for what we have in this country, compared to other places out there. It gave me a lot of discipline and drive and determination. It helped me learn to keep my nose to whatever it was I was trying to achieve. I made many lifelong friends, and it was an opportunity to learn from some exceptional people. I’m just proud to have been able to serve my country for that long.”

Burkhart worked 16 years for Covenant Health in Knoxville and went on to start Endeavor Health Group, a small health-care consulting company based in Fort Lauderdale, Florida. Consulting work took him to Shands Jacksonville in 2001, a difficult time for the medical center.

Shands once was the county hospital in Jacksonville and historically served a high percentage of the area’s indigent population. It eventually became part of the University of Florida Health System. By 2001, the hospital had serious financial problems, and public officials were considering taking it into bankruptcy. They hired a large consulting group, which subcontracted with Burkhart’s company to handle operational work on the ground.

Burkhart was able to help start a turnaround and was appointed president and administrator of Shands in 2003.

On the challenges facing Shands at the time: “Shands lost a significant amount of money over a two-year period, with about $64 million in negative numbers. In my first year, we made $2.4 million, and the hospital has done well since then. This past year, we made almost $18 million. The hospital was talking about becoming insolvent or going into bankruptcy, and this year we received a Moody’s bond rating of Baa1, which is investment grade, just one tick short of an A rating.”

On keys to the turnaround: “There were a lot of moving parts. One of the big things was restructuring the debt. Once we did that, we were able to get better interest rates and refinance some bonds, which allowed us to pay down a fair amount of our debt. “The rest was blocking and tackling. We had bad managed-care contracts that we renegotiated; we had other contracts where we were not being paid what we were supposed to be paid; we had too many layers of management and too much contract labor, which is very expensive; we had supply-chain issues, and we needed to better manage that area.”

On the importance of teamwork: “It was a team effort; one individual can’t achieve anything of this nature. If the refinancing hadn’t happened, the other changes might not have been possible. What’s satisfying is to see not only the financial turnaround, but also the turnaround of our image—both with the public and our own employees and physicians. “When people are talking about big losses, a lot of heads are down, and your hospital is not thought of as a great place to work. We’re now spending $26 million a year in capital improvements. We have a healthy bottom line and a positive reputation in the community. Our physicians feel better about being associated with us, and our employees feel Shands is a viable place to work.”

One of Burkhart’s favorite classes at UAB was his health law class. That information has remained important in a complex, rapidly changing field.

On challenges for health-care administrators: “The issue of uninsured patients is on everyone’s mind. Here at Shands we have experience taking care of those who don’t have insurance or who are underinsured. We try to work them through the maze of ways by which they can become eligible for certain kinds of funding. “We are involved in graduate medical education, and the lack of funding for residencies is a major issue. In Florida, we don’t have enough graduate resident slots to adequately take care of the number of medical students we have. As a result, we’re losing a lot of talented students to other states for their residencies. “Another big issue is making sure we have access to the human resources we need, particularly in nursing. We’ve had cycles when we needed more people in radiology, physical therapy, and occupational therapy. “A big part of my job is staying up on legislative initiatives. We have to make sure that Florida legislators understand why the things we do are important. For example, we are now dealing with possible changes in the way Florida pays for the care of trauma patients who don’t have insurance. The state has also passed property-tax cuts, and those taxes are a major source of income for counties and municipalities. We have to pay attention to how they might deal with possible shortfalls.”