Alddo Molinar

Anesthesiologist

Alddo Molinar is an attending anesthesiologist at the East Ohio Regional Hospital and the Ohio Valley Medical Center. Born and raised in Texas, the medical doctor is the eldest son of two Mexican immigrants. He was the first U.S. citizen in his extended family, expected to avail himself of the opportunity presented by his family’s new country of residence.

From an early age, it was clear the future doctor had the capacity to make good on that expectation. Picking up skills with exceptional ease, he reached many of his developmental milestones much faster than his peers. Early mechanical aptitude eventually led him to tackle increasingly harder projects, leaving appliances dissembled and reassembled to better understand how they functioned.

Fueled, in part, by the tragic losses of his grandfather and grandmother to cancer, Alddo Molinar would eventually turn his natural aptitude to medical school in order to use his skills to ease suffering in others. That decision led him to earn his medical degree from the University of Texas Southwestern at Dallas and eventually complete his residency at the prestigious Cleveland Clinic.

That residency not only provided him with a training of the highest quality, it also introduced him to someone who would play a pivotal role in his life — his wife. After a courtship in which they navigated residency together, the two married and have since given birth to two daughters and a son. Alddo Molinar calls his close-knit family his new crew, showcasing the love he and his family have created in their home.

When reflecting on his life to date, the doctor notes that what he initially thought of as a destination has become an ongoing journey. That journey is built on values he learned from an early age and continues to lead him along his path of self-betterment.

Where did the idea for your career come from?

From as long as I can remember, I wanted to be a doctor. According to my parents, at the age of five, the dream started. However, when I lost my grandmother in 6th grade to the sudden and insidiously progressive disease of pancreatic cancer, my calling truly began to gel. She suffered needlessly as cancer robbed her of physical strength and vigor. She was deeply religious. Despite the incredible suffering she endured, from the agonizing physical pain, endless nausea and vomiting, and even the intractable itching from her jaundiced yellow skin, she remained a rock of strength in my life. I watched helplessly as our family went through the cycle of hope in medicine’s ever more aggressive therapeutic options, followed by the let-down of continued disease progression. Ultimately, we lost our matriarch. As an impressionable young grandchild, my resolve to help with suffering tempered. As I became older, I shadowed at the Rio Grande Health Clinic in El Paso, Texas. I found different ways of serving my community through various specialties while taking extra time with patients and their families. I continue the fight to this day – with all my training and all my might – against the formidable foe of disease.

What does your typical day look like and how do you make it productive?

The best analogy for what an operating room is like is a busy airport. Much like an airport has scheduled flights, the operating room has scheduled surgeries, often weeks in advance. Surgical instruments are sterilized, grafts or implants are made available, operating rooms are cleaned and restocked before beginning every operation. Also, like an airport has an abundance of specialized personnel, the operating room does as well. The pilots in the operating room are the anesthesiologists or nurse anesthetists. They take the patient to high levels of anesthesia, where surgery can happen safely. Taking off and landing are the most challenging and often necessitate extra hands on deck.
A typical day begins the day before as a schedule develops to best accommodate cases in the most efficient manner. On the day of surgery, I wake up at 0515 in the morning, and I am in the hospital seeing my first patients at 0615. The first surgery starts around 0700, and it remains reasonably busy starting some rooms, watching others, finishing other rooms while seeing patients in the preadmission clinic to prepare for upcoming surgeries. It is essential to remain available to the preadmission clinic, the preoperative area, the operating rooms, the recovery rooms, the postoperative floors, the intensive care unit, as well as
the main desk as any of these, can turn into a hotspot where you need a well-trained anesthesiologist to stamp out disease or work through a process issue. Around 1000, I make protected time for my “10 o’clock cup of coffee.” It is a time to reflect on the progress of the morning and strategize to get the primary goals for the day accomplished. It is a fascinating and rewarding profession, especially if you can do it well. Teamwork and playing well with others is essential.

How do you bring ideas to life?

The first part of this has to be the quality of good ideas. Excellent ideas are relatively easy to bring to fruition as the need and momentum provide wind to the sails of progress. I often reflect during the day to find needs that breed good ideas. Necessity is the mother of invention, and it applies to ideas, this is no exception. Also, I immediately write these down for further brainstorming later. The second part of this, for me, is gathering a good team. Often, it is essential to bring multiple heads together for added perspective. I try to have clear goals. I believe in a well-documented mission statement to solidify purpose. It’s also essential to identify potential trouble and develop a plan for how to get through them. Inevitably there will be a setback, during which it is crucial to accurately diagnose the problem to get to the root cause. In medicine, the goal is to have the best outcome for a patient and their family, as timely as possible, with the best use of your healthcare system’s resources. The ultimate customer is the patient, and if you always do the right thing for the patient, simply put, everything else will sort itself out. Finally, the importance of the team cannot be underscored enough. The building, cultivating, maintaining, and nurturing your team is the key to delivering consistently excellent results. Much like a championship team, shared battles forge deep bonds and lead to an understanding of individual strengths. You would be surprised how wonderful it is to be a part of the championship-winning team that wins great battles for patients daily. Harnessing this esprit de corps sustains ideas better than any singular individual can. It is a privilege to be a part of this team.

What’s one trend that excites you?

One trend that gets me very excited is the ever-increasing use of technology in medicine. We have come a long way since the 555 timer chip you could buy at Radio Shack as a kid. Microcontrollers and sensors are much more present now than ever. Our ability to monitor and administer therapeutics has improved exponentially since the middle of the 20th century. On the horizon is the use of artificial intelligence (AI) as it relates to patient care as well as population health. In regards to anesthesia, it can help monitor many more patients and help bring important trends to the attention of the appropriate provider. One can imagine a situation where specific data points, like blood pressure, respiratory rate, pulse oximetry, can be monitored in all the patients in a hospital. When specific trends are apparent based on alarms and algorithms, it would instantly flag and dispatch an advanced early response team to the patient’s bedside. On a postoperative floor where patients arrive after surgery, such as after knee replacement or abdominal surgery, there is a very fine line between patients getting enough pain relief without getting too much pain relief where they can stop breathing. Imagine asking Alexa to find any patients at risk of respiratory depression after surgery and ring your pager? Hundreds of lives per year could be saved in our country alone. Once the software is written, there is a minimal ongoing, and if it is the difference between your grandmother coming home after surgery or not – it is hard not to justify the effort. In this current climate of COVID 19, major players like Apple are taking the lead with heart rate, respiratory rate analyses to improve population health. With so many potential data points, you still need good medicine to find meaningful trends and develop the alarms and algorithms that would be the most beneficial. We still need generations of well-trained providers, but their impact can be even more significant. The appropriate use of technology to further the health and wellbeing of a patient or group of patients is one of the most exciting changes to medicine I anticipate in the next decade.

What is one habit of yours that makes you more productive as an entrepreneur?

One of the greatest challenges is keeping yourself motivated. I watched a documentary a few weeks ago about Michael “Air” Jordan. Michael Jordan was ever-present. He would take the lessons of yesterday, spend countless hours on preparation, and worry about what he could do today to maintain an incredibly high standard. When he needed to, he would build a narrative in his mind that would help him visualize and ultimately deliver success. In medicine, you give so much of yourself each day. It is a tremendous privilege to help patients get better and get them back to their daily lives. Since patients get sick at all hours of the day, we often have to be on call after hours and weekends. During my call days, usually on Saturdays, I frequently call patients at home to follow-up—this feedback on how we did as a team and how we can improve our healthcare delivery model. The team also appreciates the updates of past patients served.
Also, I keep a running journal in the form of a wide-ruled composition notebook with me at all times. I journal ideas as well as keep track of ideas and track the progress of my goals to completion. Some of my entries even serve as a blank canvas to brainstorm ideas. Other entries are to-do lists to help prioritize through a busy day. By constantly reviewing and prioritizing my short, middle, and long term goals, I can better track and follow through on goals; I can make the most productive use of my work time. At the end of the year, my journal is a good way of tracking the accomplishments and accolades of the year that passed. I usually use this to send an email to the team of a job well done.

What advice would you give your younger self?

This is a great question. It is often said that many of us would gladly return to a younger self if only we could take the wisdom of age with us. Medicine, in many ways, is a calling where you can easily give too much of yourself. There is no-one that tells you that you have worked too many hours this week as a physician. We generally do not clock in and out, and even when we are “clocked out,” we still think about patients and progress outside of the hospital. Being a doctor is not something you can turn on or off; instead, it is a part of us and our identity. As such, I would tell my younger self always to find time to take care of yourself. Physical and mental health is vital and constant attention is required. A younger version of myself would easily spend days, weeks, and months on singular work goals. I understand why it is so easy to do this now; it is a just cause.

However, I now recognize the importance of balance. I still spend time on work priorities, but I also find time to go fishing with my daughters and son. I go on dates and even walks with my wife. Watering the garden and hanging out in the garage is therapeutic. I use meditation and yoga to keep me in the present. Conveying the importance of balance to my younger self would just be great.

Tell us something that’s true that almost nobody agrees with you on.

This is interesting because, as it applies to medicine, rarely do you do something that nobody agrees with you on. One of my mentors said that you never want to be the first person to prescribe a new medication or the last person to prescribe an old medication. If you carefully weigh the risks and benefits of each decision, with consideration of the alternatives, you generally arrive at the best answer, at least for now. It is relatively easy, once you know the diagnosis, to lookup the treatment. This is a fundamental tenet in medicine, and if you get the diagnosis correct, you have a chance at a reasonable outcome. Having trained at the Cleveland Clinic, our standard there was considerably higher. Aside from emphasizing the importance of collegiality and collaboration, there was also importance given to the timing. For example, once you make the diagnosis that a patient on an operating room needs blood, there are still many steps until the patient has red blood cells added to their bloodstream to make a difference. The sooner you can start this, safely, of course, the better for the patient. I do think that you can bring this same high standard to any hospital in the country. Appreciating the importance of timing is just one of the many ways to deliver world-class outcomes to less well served and represented communities. Sometimes it is even easier to deliver world-class outcomes at a smaller hospital because there less “red-tape.” I don’t think there is a general appreciation of this by larger institutions and sometimes even by the community.

As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?

I was fortunate to attend a liberal arts university that really made it mandatory to study many different subjects, not just the courses needed for a degree. I learned about Asian religions, cultural studies, music, etc. I really wish I would have taken more courses in finance realm and maybe even double majored or minored in business. It seems to do medicine well, you also have to appreciate fiduciary responsibility and be good stewards of our resources. I have had to learn much of this on my own but a more structured fashion, as provided with an undergraduate education would have been something I would do over.

What is one strategy that has helped you grow your business?

I think it is incredibly important to continue to study. One of my previous department chairs, Dr. Dave Brown, who was on the board of the American Board of Anesthesiologists (ASA), quantified this best by saying you should spend one hour per day on professional growth. I continue to study and read an average of an hour a day. I usually try to find something throughout the day to delve into excruciating detail. Over the year, with additional dedicated time to scholarly articles, I can maintain an excellent working fund of knowledge. I usually print these articles and leave them around my desk to prompt discussions with my colleagues to keep our collective knowledge base well proficient.
As much as we have progressed to be a digital generation, I prefer to have something on paper to mark, highlight, and take notes on. At the end of the month, I usually scan these articles or file an electronic copy, so I have these articles readily available should I need to review them. To maintain our medical license and board certification, we are required to log a certain number of continuing medical education hours; I always try to be well above the minimum requirement.

What is one failure you had as an entrepreneur, and how did you overcome it?

I enjoy reading about successful people. It helps me understand their motivation and learn from their mistakes. It is clear that most extraordinarily successful people also have big, painful failures. The most important thing to do is to gather the lessons those failures give you and gain humility and open-mindedness to succeed the next time. Steve Jobs, on reflecting on getting fired from Apple, famously said, “It was awful tasting medicine, but I guess the patient needed it.” The pain of failure will fade, but failure and reflection are the best gifts life can give to prompt profound personal and professional growth. In my own life, a young version of myself felt very self-made. I was the first in my family to finish college, to complete a graduate school, the first doctor, etc. I spent time at Yale and went to the best colleges and the 14th best medical school in the country in terms of academics. Yet, at the risk of revealing the importance of faith in my life, I realized that I was not very self-made at all, but I was very much supported throughout my journey by the good lord above. My journey came full circle back to my faith, and I became very much born-again. When I recognized this, I realized the importance of not-self but rather the team. The ability to cultivate, motivate, and promote a winning team was a better way of helping not just the patient in from of me but the system that cared for many patients at once. In fact, with humility, you can, in essence, become a better, more effective doctor. I too, have taken tough medicine, and am better for it.

What is one business idea that you’re willing to give away to our readers?

As I mentioned earlier, whoever pioneers the use of artificial intelligence in medicine, especially in anesthesia, will make a significant impact on healthcare. Back to my airport analogy, you still are going to need pilots in the operating room. The power can glitch, and the delay in getting to backup power can reset the computer. What if the situation is in itself so critical that the generators are prone to failure like the Fukushima Daiichi nuclear disaster. What if something simple like the monitor backlight fails. What if there is a cyberattack and you lose access to the patient information. I worked at a facility that was the victim of a ransomware attack, and we had to divert patients from coming to our hospital system. Ethically, it just isn’t right to target a hospital that is helping patients – this is like purposely aiming your weapons at a red cross ship or a hospital during a time of war. Nonetheless, we had to return to pen and paper until it was sorted. It is also natural for the operating room pilots to feel a concern for job security with the discussion of new technology. In fact, in the Boeing 737 Max 8 disaster, the more control was taken away from the pilots to override the technology, the worse the outcome. Anesthesia has long been at the forefront of using new technology to monitor a patient’s vital signs and even depth of anesthesia. So, whoever develops this into a working model first has significant potential to effect positive change. The challenge is that few coders have the training or credentials to understand medicine. Few physicians who have decades of education, training, and practice have any coding or understanding of microcontrollers or have any idea the number of sensors a simple website like digikey.com can provide. Marrying the two, especially with a team to get it done, can truly change the world. The business will undoubtedly follow.

What is the best $100 you recently spent? What and why?

Well, this is a no-brainer. My oldest daughter was recently hospitalized with a terrible infection that almost cost us her eyesight. She had to be hospitalized at our local children’s hospital, Akron Children’s in Boardman, Ohio. As part of her hospitalization, she had to have labs drawn, and it was excruciating as a parent to see her phobia of needles cause her to get flushed with anxiety and paralyzed with fear. She knew the importance of the lab draws. My wife and I are both medical, and we could convey that to her. However, the catecholamine release from her as a pediatric patient caused everyone else to be nervous. I could see this as a board-certified anesthesiologist. One of the best pediatric emergency nurses we have ever met suggested she try the Buzzy® Bee. It works by blocking and distracting the brain with a cold pad as well as a fairly strong vibration, the buzzing sound a vibrator makes, and the look of a Bee. It covers three of the five major senses (sight, touch, sound), and I would include hot/cold differentiation as a fourth. It was developed by an emergency room physician, Dr. Amy Baxter, and she apparently even pitched the idea to Shark Tank. At first, it seems a little pricey but as a parent seeing your child in distress, there is almost no price I wouldn’t pay to help ease her suffering.

What is one piece of software or a web service that helps you be productive?

Record-keeping in medicine is highly essential. It helps you remember what happened the last time you saw a patient, helps track progress, and it conveys your thoughts and plans to the rest of the team. Since your brain works much faster than your ability to type, the use of dictation software can significantly increase productivity.
I have used several, but Fluency’s M-Modal seems to be the one that works best for my workflow. As electronic medical records and dictation software alike help with record keeping they now also allow the use of macros, or quick buttons you can press to minimize the need to do repetitive tasks like opening a window, clicking tab twice, and starting a not with the patient name and date.

What is the one book that you recommend our community should read and why?

One of my favorite books that I am re-reading at the moment is the book Principles. It is written by Ray Dalio, the CEO and founder of Bridgewater Associates, one of the premier investment management firms in the world. I really enjoy reading about how Ray Dalio built a multibillion-dollar company first by developing a competitive advantage through careful study and dedication. Over the next 40 years, Ray Dalio built a world-class team, even using psychology tests to best position the team for success. I know this is more of a financial book, but the principles of making a successful team apply to medicine as well.

What is your favorite quote?

“I’m a great believer in luck, and I find the harder I work the more of it I have.”
—Thomas Jefferson.
This really emphasizes the need for preparation to do well. How often does someone wish you luck on an exam or a project presentation, only for you to think about all the blood sweat and tears it took to get to this point. Of course, I never turn down well wishes, but preparation is vital.

Key Learnings:

  • First, I would emphasize the importance of balance. It is really easy, especially if you are good at something professionally, to neglect the things in life that matter personally. Taking good care of your physical and mental health are first and foremost. Make spending time with your family a priority, simply put – your kids are only small once, enjoy.
  • Second, be humble. You get far more accomplished by speaking softly than you realize. The big stick is just for carrying. If you find yourself needing the big stick, you may need to rethink that tact or the idea itself. Surround yourself with a good team that can not only help get things done but keep you humble as well.
  • Third, if you don’t have a competitive advantage, don’t compete. To flip that to the positive, find a competitive advantage to compete with. Use all the technology at your disposal and push the boundary a few inches further.
    Mastering these three takeaways can really help make the world of medicine a better place. The cause is a noble one, and the stakes are high, but the journey is undoubtedly worthwhile and rewarding. Thank you for the opportunity to contribute.