It’s loud in here. I’m beginning to worry that my digital recorder won’t pick up our conversation. When I’d been to Cindi’s NY Delicatessen for breakfast previously, I had been seated in the more spacious main dining room. This time we’re ushered to the alcove over by the bakery counter, where it’s impossible not to overhear the patrons engaged in animated discussions at the packed tables around us.

Erol Akdamar doesn’t seem bothered by the noise. As we take our seats in the booth, he pulls a few sheets of paper out of a blue folder and sets them to his left on the table. They look like notes that he might want to reference as we talk. I’m hoping he didn’t come overly prepared with canned talking points. (He didn’t.)

He orders coffee, I order orange juice and a glass of water, and we peruse Cindi’s novella of a menu. Akdamar has never been here before, though it’s quite close to Medical City Dallas, the hospital he has run as CEO for the last four years.

“It looks great,” he says, before settling on some scrambled eggs and a side of bacon. I go for the oatmeal with slices of banana.

On this day in late September, Akdamar is readying for big changes in his career and his industry—taking the reins as president of HCA’s North Texas division on Oct. 1, overseeing 15,000 employees at 15 hospitals in the Dallas-Fort Worth and Oklahoma City markets. The date also happens to be the day that the government healthcare exchanges established by the federal Affordable Care Act open for business, marking the semiofficial launch of Obamacare.

“Seeking to define quality and doing it in a public way is a novel concept in health, and it’s not easy,” Akdamar says. “We’re focusing on the right things. The devil’s going to be in the details. We’re just going to have to see, as they hang the detail on the Affordable Care Act, does it drive the result that was intended? And are we going to be able to organize ourselves around it?”

Our food arrives quickly, disturbingly so. The bananas on top of my oatmeal are mushy. The orange juice tastes artificial, straight out of a fountain dispenser. But I’m hungry, so I eat. Akdamar offers no complaints about his meal, commenting only that at home he’d usually opt for turkey bacon. We return our attention to the complications of the ACA.

“It’s a fundamental shift from managing episodes of disease to managing population health,” he says. But the industry has dealt with massive transformation before—as when Medicare was established in the 1960s—and Akdamar doesn’t doubt that it’s “creative and resilient” enough to adapt again.

Healthcare is something of a family business for him. His Turkish father came to the United State as a medical resident, met and married Erol’s mother, and moved back to Turkey, where Erol and his older sister were born. With greater opportunities for a gastroenterologist in the United States, though, the family returned to New Orleans, where his father joined the medical faculty at Tulane University.

Akdamar’s summer jobs growing up were at the hospital where his father practiced and taught: cleaning test tubes and helping with clinical study enrollments. Fast forward about 15 years, and Akdamar was on the staff of Tulane himself, as chief operating officer.
“A fair amount of those doctors who knew me as a snot-nosed kid were still around, and they were kind of looking at me like ‘I remember you when ...’” he says.

“Did that make your job harder?” I ask. No, he says. He believes it made it easier because those doctors knew he understood medicine from a physician’s perspective, thanks to his father (who died when Akdamar was in college).

The waitress comes back around to refill his coffee, apologizing for neglecting us too long. It’s understandable, as it’s difficult to keep an eye on this corner of the restaurant.

Akdmar’s 19-year career in the industry—most of that time spent in management positions with HCA—has taken him and his family to a new place every few years, from Georgia to New Orleans to Austin to Dallas. So his latest career change is especially sweet, since he’ll remain in Dallas. “This was nice,” he says. “My kids appreciated that I got promoted and there was no moving van involved.”