The CEO of Dallas County’s safety net behavioral health provider is set to retire at the end of April.
Metrocare serves more than 50,000 people annually, making it Dallas County’s largest provider of mental health and developmental disability services and one of busiest community mental health centers in the state.
John Burruss stepped into his role as CEO of Metrocare in April 2013, with a goal to continue the growth of the organization and improve the spaces and services people in Dallas rely on.
"That's the emphasis over the last 13 years is to be ready both quality and quantity for the needs of Dallas," he said. "And we’ve done a lot of that."
Burruss, who began his career as a general practitioner, has been a physiatrist for more than 25 years. He was in Houston at Baylor College of Medicine before he moved to Dallas for his position at Metrocare.
His time with the organization included a global pandemic, devasting winter storms and other challenges he didn’t know to expect.
The chair of Metrocare’s board, Stacy Cantù, said the search committee hopes to select the new CEO by May 1, so there isn’t an open spot or an interim in place. However, if the board needs more time, Cantù said the next CEO may step in later in May.
“The board will continue its focus on the mission – on oversight of finances, quality of care, the service standards, support and fundraising,” Cantù said. “We're looking for a CEO who can motivate the team, be a leader, be dedicated. Be dedicated to the team, dedicated to the mission, dedicated to growing, but also sustaining the organization.”
Cantù said the board is looking for someone with strong management experience and a focus on maintaining quality of service and care. But, she said it will be difficult to find someone to replace Burruss.
“There’s no replacing John Burruss,” Cantù said. “So we just hope to look and pivot to the next leader that will take us through the next few decades and put, and keep, Metrocare where it is today.”
Ahead of Burruss’ last day, he sat down with KERA’s Abigail Ruhman at his office at Metrocare’s new campus in Southern Dallas to talk about his time with the organization and the future of mental health care in Texas.
Questions and answers have been edited for length and clarity.
Abigail Ruhman: You became CEO of the safety net provider in Dallas County over a decade ago. Take me back to April 30, 2013. What challenges were your main focus when you first started?
Dr. John Burruss: The center had come through a rough time and had put itself back on its feet. The previous CEO did a lot of hard, hard work to make that happen. And the next step for the center was going to be how to create a presence in the community that was not just surviving but thriving.
They had to work hard to survive, so thriving meant we had to make efforts to improve…to improve the facilities, to improve the workforce’s compensation. We’ve spent a lot of energy in the last 13 years doing all of those things. We have revamped, refinished, rebuilt essentially all of our buildings.
The other thing is that Dallas is growing, and, I mean, Texas is growing, so everybody who does my job in Texas has the same challenge. But Dallas is really growing. Every time somebody's born here, every time someone moves here, that's a chance for us to have a new client or clients.
We had to keep finding ways to have more front doors, more clinicians. You can't offer help and then not give it when somebody finally shows up.
So we had to have enough capacity to have walk-ins. We have 135 walk-ins per day. And back then, we were averaging about 50, I think, walk-ins per day.
We had be ready to say, "Okay, we got to step up and take people who showed up today because a lot of them, it was all they could do to just show up today."
If we tell them, "Come back in a few weeks," we certainly haven’t done them any favors.
That's the emphasis over the last 13 years is to be ready both quality and quantity for the needs of Dallas. And we’ve done a lot of that.
How have those challenges changed over the past 13 years. Were there any that you didn’t expect?
The trajectory of things like anxiety, depression and substance use were already cemented before the [COVID-19] pandemic. When I got here in 2013, those numbers were already on the trajectory they were going to be on.
The pandemic threw in something that none of us had experienced, obviously.
I remember the day I was talking to Phil Huang, the head of the [Dallas County] health department, and he said "Yeah, you’re going to have to go fully remote."
And I said, "I don’t even know what that means. What does that look like? How do I take this enterprise and make it fully remote?"
That obviously threw a curveball like we’ve never experienced…Credit to the staff who did it. We didn’t even know what Zoom was until we started this and then we all got on to the remote platforms and we were able to still deliver services. The teams didn’t miss a beat.
And then the ones who had to be in the building despite the pandemic, I have enormous respect for them. We had staff who were in the building despite the pandemic the whole time.
And that happens all the time. Like, we had this weather, the ice storm a couple weeks ago. We were open every day. The staff here are extraordinary in the lengths they will go to deal with whatever the world brings us.
You’ve helped Metrocare hit several really important milestones, I mean, including this campus that we’re currently on…You have a long list of accomplishments, what accomplishment are you most proud of?
My job is to make sure people have the opportunity to do those things. Give them the circumstances for success, and then the 1,200 plus people who work for Metrocare, they create the success.
The credit goes to them. Every day they're putting in work to make that we see the people who need us. We don’t make anybody wait. We see more than 3,000 clinical encounters a day, which is the busiest in the state. And that's because of them.
I’m proud of what we’ve done together. I’m proud that we’ve been able to create the circumstances for success like we have, but mostly what I did was just make sure the paperwork got done and the buildings were available and the computers worked and all that.
What I'm proud of is that Metrocare is the busiest community mental health center in the state. That we don't make people wait. That we see people with anything that they present with. And we don’t care what they come to pay with. We don't care if they have anything to pay with.
I don't think people in Dallas realize how unique and special this center is. The jewel that they have here in the community. The building’s important, our campuses are important, but it’s the people who do the work every day.
In health care it’s not always guaranteed that leadership has experience as clinicians. How does your experience as a doctor inform your experience as a leader?
I know what’s it’s like to be both the clinician and the client…I’ve been in that room countless times.
I know what it is like the first moment somebody comes and talks to you about the struggle they’re having. I know what it’s like to see them do better. I know what it’s like to see them do better. I know what it's like to see them years later when they’re thriving. I’ve been through all that in the room, not just as a clinician, but also with my family.
I bring to this role an understanding of what happens in the room…that you may not have if you come from administration in some other place. You may know all about HR, you may know about IT and you may know how to make sure all the insurance is paid, but you don’t necessarily know what goes on in the trenches, so to speak, with our teams.
How would you describe the current state of mental health care in North Texas and Texas broadly?
It’s interesting that it’s a mixed bag. In many ways, if you're a client, patient, whatever we want to call, of the public system, you have better access than you do if you have an insurance card in your wallet.
The way our society has managed mental health care, like all health care, is that the public system, the safety nets, are generally more readily available than, not emergency room stuff, but if you need a specialist. If you need specialty care, if you need a psychiatrist today, where are you going to get one?
If you, Abigail, walk out of here and say, "I'm going to go find a psychiatrist this afternoon." If you're going to do it with your insurance card, good luck.
But if you do it with Metrocare, we'll see you this afternoon. We'll see right now if you want to walk across.
I think the state, it’s mixed because people would often presume the opposite. They’d presume that there’s big waits in the public system and lines to get in, but that’s not what happens.
What happens is it’s very hard to get into the private system. I have strong feelings about the way we’ve organized our health care payment. Health care itself has actually got some amazing and world-class, world-leading aspects.
Texas has made significant investments in behavioral health in recent years. What else do you want to see the state do to improve access?
Texas has come a long, long, long way. I’m not sure that they were ever as low as they were often portrayed to be…because we separate mental health payment streams into different aspects of government in Texas.
There’s some in criminal justice and there’s some in education. It’s hard for third parties to that create ranking data to know where it all is.
Texas is holding our own in being able to deliver services for people who don’t have resources. We have charity and indigent care programs that’ll take care of everybody, anybody who shows up. We just see them. We worry about payment, but we don’t make them worry about the payment.
That’s because of Texas, Texas working with the federal government and some of the Medicaid waiver programs that support us. We live off those. That’s how Metrocare thrives. Without those, we wouldn’t exist in any shape like we are today.
Could they be better? Of course. And I would have my own opinions about what they should do. They may not agree with them. But for what they’ve done, it’s been the lifeblood of us being able to do what we do.
To brag on this team, last year, the data from the state, we saw 15% of all mental health visits in the state of Texas at Metrocare. The state of Texas population says that [Dallas County] is 8% of the population. That would say that we’re overperforming by double. One in every seven mental health visits in the state of Texas was at Metrocare last year.
I say that to say, we do that because Texas has enabled us. We couldn’t do that without the support they provide.
Especially at this moment, where you’re retiring, there are people entering this field. There’s a lot of instability in health care. What advice do you have for future mental health providers entering the space now?
I think the current conventional wisdom is that [Artificial Intelligence, or AI] is particularly suited to replace mental health clinicians. I don't know that I believe that's going to be true.
When you give people the option of remote verses in-person, they choose in-person. Everybody gets the option of seeing us remotely or in person. Ninety percent are still in person. Why? Because they want to be with a human. I believe people want to have a relationship with a human – that includes in-the-room, direct contact.
Online therapy has its advantages, sure, but I’m not a believer that it’s going to replace everything.
So if you're in the business, if you trying to get into the business, if you’re in school, this is going to be a profession that will have openings, that will have jobs, that will have a future for you, regardless of what happens with that or other technologies.
What do you want to say to the person who takes over for you? What advice do you have for them as they step into this role?
Mental health care is a low margin business.
You’re, to some degree, always on the knife’s edge. You’re always trying to push for doing the most you can for the most people, which requires that you have a nimbleness to your ability to manage the business.
Be ready for that, because that just takes effort.
If Metrocare was going to be a bank and just have tons of resources that we put away and held, we wouldn’t be good for the community. If we could do that and deliver all the care we do, we would. But that’s not possible.
The business aspects of running Metrocare are going to take a lot of attention.
The clinical aspects are fantastic. We have a great clinical group, so overseeing that – keep it where it is.
Then keep your eye on the business aspect. How do you deliver more all the time and stay solvent and stay sound.
Is there anything that you're hoping to accomplish in the last little bit of time that you have, or is it making sure that it's handed off to someone who's capable?
So there's projects that are in midstream that need to keep going ... and if I was not leaving, I would be working on the same things I'm working on now. I didn't save a coup de grâce for the end.
We’ve got to get these things going. Whoever's next, I want it to be on the move. I don't want everything to stop now because I've decided to retire. And so that person, like a relay race, right? We're both moving when the baton gets handed as opposed to the starter’s pistol.
Is there anything you want to tell the community you’ve helped Metrocare serve over the past 13 years?
The community in Dallas has been extraordinary. Particularly the philanthropic community, but also the elected officials, also the people who have vested interests in the community.
My colleagues at Parkland, at the health department, at [UT] Southwestern, the community has embraced everything we’ve done and mostly been incredibly supportive. They have helped us get to where we are and get the agency where it is.
Kudos to Dallas for doing that and kudos to the philanthropic community for making the building we’re sitting right now possible so that Dallas has best-in-class facilities just like they do across the rest of the city.
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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