The CEO of Dallas County鈥檚 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鈥檚 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鈥檝e 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鈥檛 know to expect.
The chair of Metrocare鈥檚 board, Stacy Cant霉, said the search committee hopes to select the new CEO by May 1, so there isn鈥檛 an open spot or an interim in place. However, if the board needs more time, Cant霉 said the next CEO may step in later in May.
鈥淭he board will continue its focus on the mission 鈥� on oversight of finances, quality of care, the service standards, support and fundraising,鈥� Cant霉 said. 鈥淲e'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.鈥�
Cant霉 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.
鈥淭here鈥檚 no replacing John Burruss,鈥� Cant霉 said. 鈥淪o 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.鈥�
Ahead of Burruss鈥� last day, he sat down with 四虎影院鈥檚 Abigail Ruhman at his office at Metrocare鈥檚 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鈥o improve the facilities, to improve the workforce鈥檚 compensation. We鈥檝e 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鈥檛 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鈥檝e done a lot of that.
How have those challenges changed over the past 13 years. Were there any that you didn鈥檛 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鈥檙e going to have to go fully remote."
And I said, "I don鈥檛 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鈥檝e never experienced鈥redit to the staff who did it. We didn鈥檛 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鈥檛 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鈥檝e helped Metrocare hit several really important milestones, I mean, including this campus that we鈥檙e currently on鈥ou 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鈥檛 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鈥檓 proud of what we鈥檝e done together. I鈥檓 proud that we鈥檝e 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鈥檛 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鈥檚 important, our campuses are important, but it鈥檚 the people who do the work every day.
In health care it鈥檚 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鈥檚 it鈥檚 like to be both the clinician and the client鈥鈥檝e 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鈥檙e having. I know what it鈥檚 like to see them do better. I know what it鈥檚 like to see them do better. I know what it's like to see them years later when they鈥檙e thriving. I鈥檝e 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鈥hat 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鈥檛 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鈥檚 interesting that it鈥檚 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鈥檚 mixed because people would often presume the opposite. They鈥檇 presume that there鈥檚 big waits in the public system and lines to get in, but that鈥檚 not what happens.
What happens is it鈥檚 very hard to get into the private system. I have strong feelings about the way we鈥檝e 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鈥檓 not sure that they were ever as low as they were often portrayed to be鈥ecause we separate mental health payment streams into different aspects of government in Texas.
There鈥檚 some in criminal justice and there鈥檚 some in education. It鈥檚 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鈥檛 have resources. We have charity and indigent care programs that鈥檒l take care of everybody, anybody who shows up. We just see them. We worry about payment, but we don鈥檛 make them worry about the payment.
That鈥檚 because of Texas, Texas working with the federal government and some of the Medicaid waiver programs that support us. We live off those. That鈥檚 how Metrocare thrives. Without those, we wouldn鈥檛 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鈥檝e done, it鈥檚 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鈥檙e 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鈥檛 do that without the support they provide.
Especially at this moment, where you鈥檙e retiring, there are people entering this field. There鈥檚 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 鈥� that includes in-the-room, direct contact.
Online therapy has its advantages, sure, but I鈥檓 not a believer that it鈥檚 going to replace everything.
So if you're in the business, if you trying to get into the business, if you鈥檙e 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鈥檙e, to some degree, always on the knife鈥檚 edge. You鈥檙e 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鈥檛 be good for the community. If we could do that and deliver all the care we do, we would. But that鈥檚 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 鈥� 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 gr芒ce for the end.
We鈥檝e 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鈥檚 pistol.
Is there anything you want to tell the community you鈥檝e 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鈥檝e 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鈥檙e 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 四虎影院鈥檚 health reporter. Got a tip? Email Abigail at aruhman@kera.org.
四虎影院 is made possible through the generosity of our members. If you find this reporting valuable, consider . Thank you.
