Episode 292: Leadership Panel Live from The NEAR Conference in Boston
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Hello and welcome back to ACRAC. I'm Jed Wolpaw and I am really thrilled because I'm going to share with you today the recording of a live ACRAC podcast that we did at the Northeast Anesthesia Resident Conference. This was in Boston a few weeks ago. They reinvigorated this conference. It had not happened for several years since before COVID and some incredible residents participated.

at the various programs in the Northeast and in Boston, worked really hard to put this together. So huge shout out to Taylor, Karan, Cameron, Vanya, and Linda. You guys did an amazing job. And we did an incredible live episode where I interviewed three amazing people, and we had some great questions and answers from them, as well as Q&A from the audience. I think you're really going to enjoy it. I interviewed Alok Agarwala.

who is the Associate CMO at Mass General. I also interviewed Joanne Conroy, who is the CEO and President at Dartmouth Health, and Sunil Sunny Ipin, who is the CEO of UVM, University of Vermont Health System.

So two health system CEOs and an associate CMO of a huge hospital system. It was really, really a privilege and an honor to get to talk to them, hear about their perspectives on leadership, and really get some insight in from these amazing, amazing leaders, as well as hear them answer some great audience questions. So without further ado, I am going to play for you the audio of the live podcast from the NEAR conference in Boston.

Going with our next session, which I think we're all very excited for. So we're going to do a live recording of the ACRAC podcast.

So we're going to have Dr. Wolpaw host, and he'll do a more thorough introduction of everyone. But just to briefly introduce who we're going to be speaking with, Dr. Agarwala, who's the Associate CMO at MGH in Mass Eye and Ear, Dr. Joanne Conroy, who's the CEO and President of Dartmouth Health, and Dr. Sunil Ipin, who's the CEO of University of Vermont Health System.

So thank you so much for joining us. We're incredibly excited and humbled that you were all able to be here today. So big round of applause. Thank you, guys. All right. Well, hello, everyone, and welcome to a live ACRAC podcast. I'm really excited because this is the first live episode that we've done outside of the ASA annual meeting. We had one planned in Baltimore at Hopkins.

It was going to happen April of 2020, and we had it all planned. And then, of course, we couldn't do it. And we've talked about going back, but we haven't. And so I'm excited to have this opportunity to do it. And with an incredible panel, I want to echo what Karan and Taylor said. Thank you all for being here.

and being willing to do this. So this is a chance to really hear from people with a much more storied career and leadership than I have. I'm excited to learn from the three of you, and I know the audience will too. And our plan here is to do about a half hour of questions, maybe 40 minutes, and then we'll take questions from all of you for the panelists. So think as we go about what questions you have for these incredible leaders as you all think about developing your leadership in the future. So

I want to start by asking each of you to just talk a little bit about what your role is now. Karan said, and it's up there, what your official title is. But what does that mean? What do you do? And how did you get there? And maybe, Sonny, we'll start with you and just go down the road. Sure. So I got to start by thanking Janine and Alex and just fantastic talks. And you too, Jed. It was great. What a great way to start. I always feel like...

I come here, the idea being like, we're going to share something and I always leave more, right? With more than I came in with. So thanks for doing that. It's also just, I got it. I can't,

not say anything about just coming back here and sitting here. As I started here in 1992, and as a resident at the Brigham and rotating through the MGH, knowing Alex, Janine, having a really significant influence at my time, with my time at Messinier and really shaping even where I sit today, I think more than she probably appreciates. So thanks for letting me start with that. So I'm at the University of Vermont Health Network, which is a

Has what they call eight partners or what we call eight partners were spread between northern New York, the north country of New York and top half, top two thirds of Vermont where we provide health care there. Seven hospitals for New York, three in Vermont. We have a home health and hospice, about 450 hospitals.

Post-acute beds, nursing home beds that we manage as well. 15,000 employees, $3.5 billion in revenue, 2,000 doctors. And I sort of feel like my role there is to make sure that

we're running what we're supposed to be doing, which is how do we provide the best, highest quality, equitable care to everyone in that environment? We don't really compete with anyone. I would say our job is just to provide that care. And so when we don't do something or when we can't do something, it means that someone goes without or they have to travel far away to be able to do it.

My job is to just coordinate as sort of the symphony director of the people that are really leading that organization operationally, financially, philanthropy, our employees, our patient experience, quality and safety, and to sort of coordinate that so that we can deliver at the highest level possible. Do you want me to go on? I mean, I can tell you my brief history, or do you want to go down? Yeah, let's just hear, Sonny. So we heard you were a resident here, and now you're a CEO. And what were the kind of major step...

It's automatic. It was a big step. Born and raised in Chicago, University of Illinois, computer science major, kind of a late decision to go to medical school at the University of Chicago. Met my wife when I was 17. We wound up getting married between third and fourth year of medical school. She went to the University of Illinois in Chicago. She was one of seven kids.

I had a very overbearing family. We thought it would be good to get out of Chicago for a few years. And so we were very deliberate. She's an ophthalmologist. We looked at a couple of places and we wound up in Boston. So I was here at the Brigham. She was at Tufts.

And I started off my first three years on an NIH training grant. Here, after finishing residency, I was in a lab with Igor Akhisen three to four days a week in the basic science lab. Unlike Janine, I thought, oh, my God, I can't possibly do this for the rest of my life. The idea and all I saw, Igor, who was my mentor, who was a phenomenal MD, PhD anesthesiologist who never stepped foot in the OR here, as a researcher, he said,

And he was just going grant to grant to grant. And he loved it. And he loved writing. And I did not. I thought, oh, my God, that kind of pressure and the people that relied on you is not what I wanted to do. A bunch of life-related events brought me back to clinical work. So it was full-time clinical work.

I took a six-year jaunt out where I job shared with my wife. I worked three days a week and stayed home with the kids two days a week. My wife worked as an ophthalmologist. We did that for six years. It was an amazing time in my life to do that. I came back and started doing more administrative work. I was the clinical director here, the vice chair for clinical anesthesia here.

then went over to the Mass Eye and Ear where I was the chair of anesthesia, medical director of the OR, became the chief medical officer there, got my MBA at Yale during that time period, came back here as the CMO at the Brigham, and then I was the interim president for almost a year, about 10 months here, when Betsy Nabel stepped down during COVID. And I thought, oh, my God, I'd never imagined that I could do something like that. And I said, oh, I can kind of do this. And impact 22,000 people is...

is amazing. And I thought there's an opportunity here. And I thought it'd end my career by sort of going up to Vermont and being the CEO when they came knocking. Fabulous. Thank you. Joanne, how about you? You know, it's interesting. Sonny and I collaborate instead of competing. Our markets are actually divided by the Green Mountains and

And we actually meet, our executive teams meet with people from Maine Health actually three times a year, just emphasizing some of the early conversation about the path to success is really about collaboration and not just competition.

My path is a little bit different. I actually graduated from Dartmouth in 1977, so do the math. I recognize far too many people that I don't even know if they're alive yet on the slides still. And then I took a couple years off after graduating from Dartmouth and actually worked at the Oceanographic at Marine Biological Labs in Woods Hole.

Applied to medical school in South Carolina. I was a scholarship student at Dartmouth and a scholarship student in medical school. But, you know, South Carolina back then was $800 a semester to go to medical school. I know. I know. It's amazing, isn't it? I spent 21 years there and did everything except be the dean or the president, two jobs of which I was finalist for.

But found my passion and my real expertise in actually managing operations rather than pursuing a career in research. And after that period of time, I moved to northern New Jersey to Atlantic Health, where I was the CMO and then the EVP. And then I ran their flagship hospital, Morristown Memorial. After that, I

I did a head turner. So I took a 30% pay cut and went to work for the Association of American Medical Colleges in Washington, D.C., working on policy. After six years of that, I knew I wanted to get back to operations. So I took the job as CEO of Leahy Hospital Medical Center. I was there for three years. And when they were doing the tango with

Beth Israel, you know that there are never enough seats for everybody in musical chairs. And I was not even looking. And somebody from Dartmouth came knocking and they said, would you consider putting your name in the hat? And I said, I never thought about going back there ever.

And there are too many people up there that graduated from Dartmouth. You know, they say that you spend four years trying to get out of there and 40 trying to get back. And that is true. And but I applied for the job and within three months I was offered the job. And when you think about your life and you did a great job really talking about how you need to kind of think forward and reimagine your future.

I always thought about paying back the organization that actually supported me as a scholarship student at Dartmouth.

My dad had been disabled since I was 12 years old. And this was finally a way for me to actually pay back the community that actually gave me all the tools that I needed to be successful. And you don't often have an opportunity like that. So I've been there since 2017 and will be there for another three years. And my expectation is perhaps somebody in this room might be my successor.

Fabulous. Thank you for sharing that. And maybe just say a couple words about what your job entails in your current role. Very similar to Sonny's for $3.5 billion. We have 18,000 employees. We have eight hospitals soon to have hospitals.

Probably one or two more. We are the most rural academic medical center in the country. There are only 130,000 people within 30 miles. We have a 200-acre campus with a 1.9 million square foot facility in the middle of it, in the middle of nowhere. We were talking about there is no Uber, there is no Grubhub. Cooking is a survival skill up there. But we do serve largest employer in America.

New Hampshire, largest private employer. And we touch more people in New Hampshire than any other health system. And anybody that Sonny doesn't take care of in northern Vermont, we're taking care of in southern Vermont. So it is a job that, you know, it's fascinating that...

It is so unpredictable that it takes all of your skills as a leader to really not only kind of manage the size of the organization, but really kind of catch the curveballs that come at you that you cannot not always predict, but you have to be resilient and prepared to be nimble to survive them. Thank you. Alok, how about you?

Well, first, I'm going to say I'm humbled to be a part of this panel and in this room in front of all of you. Some of the people who have been critical to my own success thus far are people that are I'm sitting with here and that that came and spoke before you, you know, in the last hours.

So I'll start with my journey and with what it is that I do from a day-to-day perspective. So I grew up in Los Angeles. I went to UCLA for undergrad med school and got my MBA at a time when MD-MBA programs were still new. So I was in the third class of MD-MBA students at UCLA when there were only five programs that had such a program in the country.

But I knew even then that I knew I wanted to spend my time kind of split between clinical work and doing administration and leadership at some point. And that was actually formed from my rotations in California in the wake of managed care when there was a lot of disgruntlement, a lot of people who were upset with the fact that there were all these business people that were making decisions about how care was being delivered. And I sort of saw an opportunity. I thought, you know what, if I can get this set of skills,

at this time in my life, maybe I can be part of the solution making and be able to walk, you know, walk and talk to both sides of the aisle, so to speak. I was all set to do emergency medicine. That's what I thought I wanted to do. I did an anesthesia rotation at a hospital called Olive View, which is affiliated with UCLA. And every anesthesiologist I spoke to absolutely loved their jobs.

And that was different than every other group that I had met. And so I thought, you know what? Maybe I'm going to do that instead. So late, I switched and decided to...

I do anesthesia. One of the medical student clerkship directors, his name was Sam Wald. He's at Stanford now. He had trained at Mass General. And when he was advising me, he said, you know, you should get out of here. Go to the East Coast. Do something different for a little bit. So I would never have thought to apply to a Boston program. I applied to Mass General and ended up coming to MGH for residency after a one-year stop in New York.

Along the way, I met my wife. She's from the East Coast. She came to Boston to train. She's an emergency physician at BMC. And I took a job at MGH just for a year. Ended up being, you know, a whole lot longer than that now, 20 years I've been at and sort of in or around MGH.

I came out of the faculty and I just started sort of asking for opportunities. I started raising my hand and we will talk about this a little bit more later as well. But I tried to get on committees and I tried to do things in the department and tried to volunteer to find, you know, ways in which I could contribute to the problems that the department had in various different ways, you know, various ways. And ultimately was kind of had two parallel tracks of development in the department. I was.

team leader, then an assistant, then an associate, then a division chief of general surgery, anesthesia in the MGH department, largest department, about half of the ORs at MGH that that division covered. And in parallel had a quality and safety sort of track that I was developing, doing a lot of quality improvement work over that time period. A couple of key things that happened along the way with, you know, that I think

as we had different issues and problems that arose in the department, you know, found ways to be able to contribute to those

to solving those problems, things like staffing and compensation and going as a second or third year faculty member to Janine at the time saying, you know, I think I got an idea on how to fix our looming shortage of people to take call and being given the opportunity to develop that and implement it early in my career with support kind of led to, I think, developing skills to be effective in that kind of environment. So

I was humming along, actually doing happily humming along as a division chief and doing QI work. And Sonny actually called me and said, hey, I'm moving up. I'm moving on to the Brigham. You know, would you consider the chief of anesthesia position at Mass Eye and Ear? I said, I don't know. I'm kind of happy doing what I'm doing. I've got to do a little academic work, you know, some scholarly work. I'm doing QI as division chief.

And he said, just come over, come over, let's have a conversation. So I'm sharing this because it's really impactful, right? So I come over, it's like this beautiful May, spring, May day in Boston. And Sonny says, oh, take your jacket off, let's go for a walk. And so we go across the Longfellow Bridge and we're walking along and he's asking me, he

It sort of was an interview, though I don't think it was billed as that, but it sort of was this like asking me about my experience and history. And he says, oh, you've done a lot of quality and safety work. Maybe you should think about the CMO job.

And I thought, CMO? I never hadn't thought about that kind of an opportunity. But we chatted a little more, and I thought, yeah, what a great opportunity to try, right? To see if I could make this leap into the hospital-level administration without having to move my family. Actually, kind of a nice thing, too. Young kids stay here in Boston. Worst thing that was going to happen was that it didn't work out, and I'd just go back to MGH. Janine would hire me back. So...

So I applied and I got that job. And wow, what a great experience, right? To sit at the table at a different level from where I had been previously. Of course, six months or eight months into the job, COVID happened and everything that I thought I was going to be doing turned into a completely different thing, which we will probably talk about.

But things change, right? So those of you that are here in the Boston area know there's a lot of consolidation, a lot of things happening at the system level between our hospitals, MGH and Brigham and the system. And so last year, as sort of MGB transforms, my position as a CMO was being eliminated because

at Mass. Ioneer. And so that happens. We went from 17 to five chief medical officers across the system, and that CMO role at Mass. Ioneer was absorbed into the chief medical officer role at Mass. General.

And so then I have landed, I think actually have had the good fortune to have landed in a position where I really love what I do and get to have sort of tremendous impact. So I'm now the Associate Chief Medical Officer and Vice President for Quality and Safety for MGH and Mass Eye and Ear. I oversee quality, safety, clinical compliance, infection control,

and patient experience for both hospitals. I work with teams at the MGB system level, teams at the hospital levels, teams within the departments to really try to improve all of those areas and create sort of new programs and coordination amongst our departments and all of those areas. So that's my day-to-day now. Awesome. Thank you. And welcome back to the show, by the way. We did a previous episode on handoffs and checklists, which was fabulous.

All right, so what I heard there was that – and I hope you all heard this too – that here are three very accomplished leaders, and the paths were not straightforward. You all had times during your growth as leaders where –

Some opportunity came up that you had never thought about that you wouldn't have maybe pursued yourself, but somebody offered it or it came to be and you said, well, I'll give it a try. And it was part of an unpredicted path that took you where you are. And that even at times, I mean, suddenly you took time off and were raising your children and only working part time. And what I take from that is that you never know what path is going to lead you to where you end up being very happy and fulfilled.

try saying yes to things that maybe you wouldn't have thought to say yes to, and don't be afraid to take a deviation. Maybe taking care of your kids for a little while is the right move and that, you know, it certainly didn't prevent you from being very successful in leadership. So I think those are really important things to hear from people who have been successful. So thank you all for sharing that. I'd love to ask you to share with the audience of aspiring leaders maybe one or two things that you would recommend that they keep in mind as they work towards building their own leadership careers. And, Joanne, maybe we'll start with you this time.

Um,

There are two things. One is be prepared to take some professional risk. I think everybody here has taken that. And that means sometimes you get into a leadership role where your job can be eliminated. And that's a little bit of a foreign concept for physicians that often begin in communities and start their families and expect to spend their entire career there. So to move into leadership, it is professional risk. There's also personal risk.

And you have to be prepared for that. And that means that personally, I mean, some people would say you've moved around a lot. And sometimes you have to move around to move up. And there's a personal expense of that as well. And just eyes wide open when you enter into these roles, there's both personal and professional risk. Thank you. Sunny, how about you? Okay.

Taking the risk part is real. I think being a physician is a really stable role. If you just work as a clinician in general, unless you really mess up, you're going to have that job. And so I think the risk part of being willing to take that risk. I think for me, the key was having opportunity and Alok referenced it. Every step I took, the leader that was there gave me the chance to fall back.

And so when I went into the lab, Simon Gelman said, listen, what's the worst that happens? You come back and I'll hire you. You'll work here. Right. I took time off to go take care of the kids. It was similarly. Don't worry. You'll have a job when you come back. When I stepped over to the Mass Eye and Ear, I was really scared. And Chuck Vacanti said, no.

come back. Don't worry. It'll be fine. I think that really helps. And I think I've tried to do the same thing going forward when people have that opportunity that you've got to kind of give them that little push when you see the potential because it is a little bit scary. So I think that first part is really, really important in the opportunity. And I'm going to say something that's a little contradictory, I think, to today's world in the second part, second

answer is I'm, I sort of took the just say yes philosophy, which today I think has been, people are much more measured and careful and calculating. And I wasn't,

If someone asked me to do something, I said, sure, I'll try that. And sometimes it meant the weekends and the evenings. And sometimes it meant, I don't really like this. I have to go back and say that this isn't working out. But I just sort of took everything as it came. And I thought it was positive and productive, although sometimes you'd lose sleep over it. But I encourage that. And I'll throw two more things in. Show up early. Work late. Smile early.

I mean, it's not performative unless you make it performative. But I think there are very few things that break down barriers, break down language barriers, cultural barriers, economic barriers as a smile, especially as a physician or clinician that show compassionate care. And so I find that works actually in administrative areas as well. Awesome. Fabulous advice. Thank you. Alok, what would you recommend?

So I completely second the idea of risk, but I won't belabor that. I think a couple of things. So one is you have to be willing to invest in yourself. In the day and age we're in right now with anesthesia compensation, and it was not, I mean, the sort of magnitude that changes when you think about compensation from going from a resident to an attending, some of that still applied. But when I was a junior faculty member, and this is sort of building on Sonny's point,

I said yes to committees, to extra work, to other things in the evenings when I could have stayed in the OR and made extra money. There was always an opportunity to make extra dollars by working because the OR always needed it. And instead, I made a choice to invest in myself and say, you know what, I'm going to volunteer for this other service, which is really what it was.

But it was professional development and opportunity to grow my skills, to get to know people, to get involved in projects and initiatives that were interesting to me in addition to the clinical work I was doing during the day. I didn't work any less hours. I was still there until 730 every evening, but I wasn't getting paid for that extra time, right? The way some of my colleagues who were working extra clinical hours were. And I think whether it's research or research,

quality and safety or whatever your passion, like for me, it was work that I wanted to be doing. So it didn't feel like I was giving anything up. I felt like this is really cool that I get to be involved in this stuff. So you have to work hard. I think that's a given, right? Janine said, everyone's smart. Everyone's going to work hard. You're going to work hard. But if you find the things that are meaningful to you, then the work, the working hard doesn't feel that way.

And I think, you know, all of those years of doing that committee work and spending time in administrative positions that were uncompensated have now led to, you know, really being able to do things that are impactful and meaningful and that I really do love my job. Right. And that's not something that everybody gets to say in this world. And I think that, you know, so work hard, invest in yourself. That means giving up.

some time to be able to do things that are going to get you to where you want to be.

That's great advice. And you don't necessarily know. I mean, putting kind of some of those together is say yes to some opportunities. Try it out. You can always fall back. And you may not know that it's going to get you somewhere, but you're building some credentials. You're building some background. You're building some skills that will probably help you no matter where you go. And where you go may be a surprise. Let's talk about scaling up leadership. So all of you have had

at some time in your career, smaller leadership roles. You may have been leading, for example, a division where you knew everyone in the division. You could meet with them regularly. You could talk to them. If they had an issue, they could very easily come by your office or find you in the OR or see you in the hallway. And now, not so much, right? When you have tens of thousands of employees, you're definitely not meeting with them all. There are probably many of them for the two of you who you will never meet. How do you scale up leadership on that level and feel like you are able to

provide and create a culture in your organization that is one of support, where people feel they are cared about by leadership, when you can't do it all by yourself personally. Alok, you want to start? Sure. So I'll start by saying that my role is different than Joanne's and Sunny's, right? So I think they may have more insight.

from even a higher level. So MGH is a really big hospital, right? And it's impossible. It would be impossible for me to know. I mean, even when I was in anesthesia, to know all of the surgeons and all of the nurses and all of the trainees that were constantly rotating in and out was impossible. But then now at the hospital level, to work with 17 departments and, I don't know, we're up to like 35 different units, right? All the different places, there's no possible way.

But if I just sit in my office, I will never know all of those people in all of those places. So...

As a leader, you have to get down on the ground, I think. You have to be there. And it feels uncomfortable, to be frank. Like, I'm not a medicine doctor. I go to a medicine inpatient floor, and it doesn't feel comfortable, right? Put me in the OR, I'm totally happy. I can go anywhere in the OR. But you have to get past that discomfort and find some friends to go with you the first time, right, and to introduce you to some of the people. But being down on the ground and working –

Even if you're not working side by side with them, showing up to understand what the issues are that the people who you are working with and working for are dealing with, I think, is a key to be able to engender that trust. Then they feel like, oh, well, the next time they have an issue, they can reach out because you've made that personal connection. It takes time and energy, but it's, I think, tremendously worthwhile. Yeah.

So maybe you can't meet everybody, but still meeting some people is better than meeting nobody. Yeah. Get down and get your hands dirty. Sonny, what do you think? I think I do, I guess, two big ways to think about it for me is that

The people that work for me, I really think of as a directly work for me, are a reflection of me. So I really expect them to sort of carry out my principles and values as they go out. And then the idea is that they spread it to the people that report to them and it follows from that. So there's sort of that top-down idea of, and the things that I really emphasize and that we value as an organization, kindness, collaboration,

How do we create safety? Safety in the conversations that we have and belonging. How do we create an environment where people really feel like they can bring their whole selves into work? So I really believe in that, and I push that to the people that are right in front of me, and then my expectation is they're pushing it out from the top. And then I do exactly what Alok suggested. I skip levels, and so...

I go down sort of for people that report to my reports and then their reports. And I actually, every week I'm having a meal with somebody at that level where I'm going around and I'm traveling around doing that. So I'm having actually some really pretty focused time with one or two people to really understand what their roles are, what the challenges that they're feeling. And then I, once a week, will go to a different organization in a different department from food service to

to the emergency room, to wherever you pick, you pick the department people right into and I'll go and I'll go during the daytime. I'll go in the middle of the night. And so I'll spend a little time with, um, totally different area. And it is really uncomfortable because, um,

I don't know anything about that world. And there's sort of a weird expectation that you know something about it or you carry that with you. But it's fantastic. And it, again, shows you as an authentic human being, which people don't get to see. And that spreads.

And so even though I can't hit every one of those 15, 16,000 people, um, the authenticity that you're bringing to your leadership group then spreads out, uh, much more widely. So the ripples of that is what I'm trying to do. Fabulous. Thank you, Joanne. So authenticity is, I think one of the four tenants of leadership and it's incredibly important. When, um, I started at Dartmouth, I, um,

A couple of things, you know, I just parked my car in the regular employee parking lot and wheeled a wheelchair out there and stacked all my stuff for my office in it and wheeled it in through the front door up to my office. And, you know, not expecting people to roll out the red carpet for me. And people were like, oh, my God, the new CEO is pushing her boxes in a wheelchair down the hallway.

And then that day for lunch, I went to the cafeteria and sat down with a group of this lab workers that were having lunch and asked if I could sit down with them and said, what do you want to tell me about the organization that I need to know? And that rocketed through the organization like crazy.

You wouldn't believe everybody in the organization knew that I was down in the cafeteria meeting with anyone that would be sitting there eating their lunch. And I continued to do that really for the next three to four months. And I still eat in the cafeteria.

And you have an opportunity to actually ask people about why do they stay there? Why have they chosen the organization? How can we make it better? And I heard some things that I probably would rather not have heard from, you know, clinical services or housekeeping about everything they haven't

They didn't enjoy about the previous leadership. But, you know, you actually do need to hear all of that. I would say that people want to know you as a leader. Now, you can't be friends with 18,000 people. But there are ways that you can actually be present and communicate. And you have to change it up. But I did a journal that I wrote personally every single week for two and a half years.

And now I've kind of shifted that to a Q&A format. But people email me and I respond to every single email in less than 24 hours for any employee. And they just want to know that you're accessible and you're listening to them. We don't have all the answers, but sometimes just saying, I don't know, I'll have to look into that is what people really want to hear.

I think that's so right on that if you are willing to say, I heard you, I'm working on it, you don't have to have the answers, right? People, that makes such a difference to feel like the leader is accessible and at least acknowledging that they heard what you said. I wonder...

When we think about the skills that it takes to be a leader, it's not always the same, right? You could be a great division chief or a great program director and not a great CEO or CMO. So, you know, Marshall Goldsmith wrote a book called What Got You Here Won't Get You There. I think that's the idea that

you don't necessarily need one set of leadership skills that will take you all the way up. And so I'd like to hear from you all, what do you think the skills are at the level, at the kind of system-wide level where you're at now that are different than the same leadership skills or the leadership skills you had when you were at a kind of smaller leadership role? Sonny, you want to start? Sure. So I'd say when you make the leap from clinical leader to

to administrative leader is once you make that change where you go from having expertise in what you think you're doing. So if you're working in a particular part of anesthesiology, you've got that or you're a division leader and you've got that. But then when you take the next step, you don't anymore. And so for me, from that point on,

It was the same, which was I really need to be humble. I think those are great. I think I needed to be able to be willing to let go of what I thought was the right thing to do and be open to other ideas, the craziest ideas that came aboard and not go with my initial instinct of saying no.

and saying, I'm curious, right? That change, I think, is really important to continue that. And then to really, the idea for me is, how do I put the right people on the bus and the people that are not necessarily just like me, but have the same principles that I do, I think, is what I've really worked hard on. If I get the right people on the bus, the bus will get to where we need to be. It'll go at the pace that we need to do it. And so for me, that meant creating safety and

And creating safety is creating safety around the conversations so people feel safe disagreeing, people feel safe putting their ideas on the table and having civil discourse around that. So how do I create an environment where we can do that? And that for me, learning that and getting to that point where I felt really comfortable with that is what I feel like every step of the way hasn't really changed, quite frankly, from when I moved over really to the Mass Eye and Ear program.

and then took on the advancing roles from that. That's been my principal premise. Great. Joanne, what do you think? Peter Drucker has a saying that management is doing things right and leadership is doing the right thing. And often as leaders, we're asked to weigh in on when it's not about the data. It is often about leadership.

the strategic direction of the organization or the difficult decisions you have to make when you don't have all the data you would like.

I like to think about kind of how I make decisions as a leader. We start with beliefs and then we gather a ton of data and we make a decision. But then from decision to actually the outcome, there's a lot of other stuff in play that we don't have a lot of control over. And sometimes that's when you actually have to make the decision when you don't have all the information you would like to have. And then there are certainly...

moral decisions. You know, I've written articles about reproductive health freedom, and I have some Republicans on my board that didn't actually like it very much. And, you know, it's fascinating that they say, well,

In my for-profit organization, we would never be allowed to say anything political. I said, well, this is not political. It's care. It's health care. And we are a health care leader in New Hampshire. So we need to talk about it. And we chose to agree to disagree. But sometimes those are the decisions and those are the actions you have to take if you're really going to be a leader. Thank you. Alok?

I like the distinction that Sonny made between being a clinical leader and becoming an administrative leader. And I think along that spectrum, so when I was a team leader or division, you know, assistant division chief. Stay with us. We'll be right back. Hey, folks, absolutely no joke. Last night we were eating our factor meals and my daughter said, how do they make it taste so good? It's like we're at a restaurant.

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All right, and we're back with Dr. Agarwala's answer. Out of 100%, 80% or 90% of my focus was on the area that I was responsible for. Yes, there was this big organization that had goals, that had strategic priorities, but that didn't really matter so much. I was focused on the people I was working with, the people that weren't necessarily working for me, but my immediate sort of small circle.

As you move through these leadership positions at different levels in the organization, that balance changes. And where I am now, it's 50-50. It's actually probably more like 60-40 where the organizational priorities drive what I'm working on, how I'm working on them, where I'm spending my time. And for my colleagues on the panel here, it's 100%, right? It's all about the organization. So there's this transition that happens, I think, where your scope changes.

necessarily needs to change from where your priorities are and what you're, who you're listening to and what, you know, and not that you never listened to, to, to, you know, the people that are on both sides of you, but,

How you approach decision-making, I think, for me, has changed a little bit over those years as I have learned more about why we're doing what we're doing as an organization rather than just the impact on a particular unit. So I think that's one distinction for me as I'm reflecting on what's different from

you know, 15 or 10 years ago versus today. Fabulous. Well, we could obviously do an entire hour with just each one of you with each, just one of these topics, but I want to move on and do our random recommendations and then turn to the audience for their questions for each of you. So what is one thing you would recommend that the audience check out for fun? Could be anything. It doesn't have to be related to leadership, but could be a local. You want to start?

So there's a book called Unreasonable Hospitality by an author named Will Gadara who used to run – he doesn't anymore – a restaurant in Manhattan called 11 Madison Park. And he took it from being a good restaurant to –

winning the best restaurant in the world award over a period of time. And it's an easy, I listened to it on Audible, and it's an easy listen. It's a fantastic set of stories that describe, in a world different from our own, how you turn something from good to great.

and what it takes to be able to do that. And so I highly recommend that. I think that it was a great, it was recommended to me and it was a great read. Amazing. I love it. Madison Park is an incredible place. I haven't eaten there since it went vegan. Maybe it still is, but before it was amazing. And that story must be really interesting. I will check that out. Joanne, what do you think? This is for the women in the room. I took up golf. I took up golf.

In 2004, when I was at Atlantic Health, I realized I was the only person working on Monday afternoons. Every hospital in New Jersey between April and October golfed.

Monday afternoons. And I said, well, I'm going to stop this. So I went to a nine-holer built on a Superfund site and actually had lessons every Sunday morning. I said it was going to the Church of Golf at 8 a.m. Believe it or not, the teacher there was Sergio Garcia's swing coach, gave me some great fundamentals. And now I play from the whites.

I play from the whites and I out drive a lot of the men I play with. And that has probably done more for opening opportunities and getting people to take you seriously. I could write a book on when I go up to swing from the whites, almost every single man is telling me to go up to the reds and I don't. And I just stay there and swing and they don't say anything else. The entire 18 holes. So, um,

I would encourage women to take up some golf. Very impressive. Love it. Sonny, how about you? Those are both great. I swing from the women's tees, just so you know. I feel really comfortable with that as well.

I'm an avid reader, and so I've actually read that. I also encourage it from a patient experience point of view, right, is what you were thinking about when you were reading that. So I read every night. I've read every night since I was probably about 8 or 9. It's my method to go to sleep, so I read 25, 30 minutes at least every night. And I read fiction, largely fiction, so it is really my escape away. So today I would recommend...

I think it's Amor or Amor Towels. A Gentleman in Moscow was his earlier book, and he's got two tables that are out now. Anything by him is fantastic and just takes you away in a different world. And he does it so smoothly. So that's what I'm – I'll leave you with that. Fabulous. Thank you. Well, I recommended a book series earlier, as you heard, but I'm going to recommend a restaurant here in Boston that I had lunch at yesterday. It's called Moo with a lot of O's.

And it was great. I had lunch. I had a steak salad and some lobster bisque, and they brought out these just butter-covered salted rolls that were amazing. The service was fabulous. The place was very nice, and it was mostly empty at lunch, so it was very nice and quiet. So if you don't already know it, check out Moo. I'm sure dinner is good there too, but I had lunch.

All right. I want to turn to audience questions for our panel. How are we doing this? Are they going to come up, Karan? We have mics. We can pass. Okay. There we go. We've got mics. We'll bring to you. So raise your hand if you have a question. There we go. Okay.

Thank you, everyone, for your incredibly insightful thoughts. Everyone on the panel is either at or near the peak of your career. Looking all the way back, as a medical student, sometimes it feels like our reach is short and our impact is smaller. Do you have any recommendations on how to increase our impact, our early careers? Is it a skill set, a mindset, networking, or is it just the harsh reality of it?

I'm still peaking. I just want you to know. You're working your way up to the white tees. So I remember being really impatient as a resident, as a new faculty member, right? Thinking I just like, I just need to get to that opportunity. And then, and then I'll be, and then always like feeling like I wasn't getting to where I needed to be just like not fast enough, not having the impact as quickly as I wanted to have the impact.

And I'm solidly mid-career, right? I'm 47 years old. I've got like about half my career behind me and about half of it ahead of me, I think, I hope. And my perspective has changed, right? Every single step, every single project or initiative I got involved with helped me be better for the next thing and the next thing. So I would encourage you, you said, is it a skill set or a mindset? I think it's more a mindset.

That get involved in stuff and recognize that whatever you're doing, if it's worthwhile doing, it's going to be helpful to you for the next thing that you may or may not know is coming ahead of you. So don't be in that hurry. You got to put the work in because every one of those projects, every one of those initiatives that takes, whether it takes six months or two years, is teaching you something that is going to be useful to you

at the next step. So work hard. Nothing comes easy, right? No one just hands you a title or a position or it's never going to be that way. And it might look to you that someone else was just handed that thing, but you don't know what they put in to get to where they are. And most likely they didn't get handed that thing. They worked hard in an area that you didn't, you might not have visibility into. You might not see it from where you're standing, but they've put, you know, time and energy in just the same as you're going to have to.

I'll just kind of throw, so I have two things I'd say during residency that is going to be contradictory to, I think, where our generation is today as a resident. So my son's a second-year resident here at the Brigham MGH in emergency medicine. And there's a mindset among that group when he was a medical student, when he was undergrad, like we're going to change the world right now. Like what are we going to do right now? And that's great. It pushes us and it makes us think differently.

Like makes me think like, geez, I've done very little. But during your residency, here's my pieces of advice. Be the very best anesthesiologist you can be. Like this is time for you to learn how to be an anesthesia resident. And this isn't the time for most people to change the world. The way you're going to change the world is being really good at what you're doing and then thinking about, look at the opportunities that are out there. And then while you're a resident, and here's an opportunity that you do not get at any other time

It is to get critical feedback. Welcome it and ask for it. It gets harder and harder to get that information to make yourself better. It gets harder for people to give it to you. It gets harder for you to take it. This is your chance to do it. You've got to just open yourself up to hearing about what people are seeing in you because you'd much rather have them tell you than just think it and walk away and you're never hearing about it, right? So ask for that feedback and be the best anesthesiologist you can.

Yeah, that's great advice. I tell my residents the number one thing that will make the difference between you getting the kind of feedback that will really help you grow and not is asking for it. I mean, I wish that every faculty member would give great critical feedback every day automatically, but it doesn't happen. But if you ask for it, you'll get a lot more than if you don't. So advocate for your own feedback and learning. All right. Other questions? Thank you so much for being here. This has been so awesome so far. So...

Also a medical student here and looking forward towards residency. I'm still wrapping my head around being a full-time clinical doctor. What was your relationship as your careers progressed with the tension between... Let us give you a mic because we are recording for future release. There you go. Okay, this one, Carl.

Okay. Was there any tension between leaving or diminishing or decreasing the amount of time you were spending clinically? And what was that conversation that you had with yourself or your mentors that helped you figure out what your career was going to look like as you transitioned into a less clinical role?

I don't know. Take that one. You know what? When I was chairman at the medical university of South Carolina, I actually took full call work three days a week. And it was also senior associate Dean of the medical school. In addition to being chairman of the department, I would say, you know, when you need to decrease your clinical time because you just can't do it all. And, um,

When I finally stopped practicing, it was when I went to Washington, D.C. When, believe it or not, the AAMC did not actually support their physician leaders actually working. They didn't have any malpractice. They had no commitment to identifying clinical opportunities for you. You were on your own.

And it became difficult for me to do both jobs, meaning work with GW to try to see about working a day a week in the operating room and then always being on call for an advocacy opportunity where we were 90% advocacy, really, in terms of the value to our members. And that was a difficult decision, but it was almost a relief.

because I'm not sure working a day a week, I was a sharp. I used to roll out of bed in the middle of the night at MUSC and there'd be somebody shot in the

neck, and my heart rate wouldn't even go up. And yet when I was working a day a week, and I did my pre-op evaluation, I saw somebody in the ICU, like my knees were jumping a little bit as I rolled them into the room. And I realized I was doing it for me, and I really wasn't doing it for the patients. And that's when I basically came to grips with the fact that

It was probably time to just not practice clinically. And you get there as long as you're kind of aware of why you're doing it and who's really benefiting from it. Anything to add, Sonny or Loke? I'd say really well said. I worked here. I worked on the labor and delivery for, I think I took call the very last month on a Saturday that I was here.

And I thought it was really good to keep working. I remember Janine kept working when she was chair. There's a sense of credibility and a connection that you get with the department. But I think when you get to the point, and I was getting even here where I felt like I knew everything, I knew everyone, that's a big part of your comfort level. And when I went up to Vermont and they said, boy, we'd love for you to work on the labor and delivery floor, I thought, wow.

exactly what you thought. I don't think I'm doing anyone a favor by doing that. I worry about hurting people now that I'm not going to be the best. It would be doing it just for me as opposed to doing it for the patient. So I think that's beautifully said.

I'll just add, I do still work clinically. I am technically formally one day a week, but in reality it's probably more than that because I still take, I moonlight and do extra shifts on the weekends. And so I think one day a week is hard to maintain your skills. I would agree with that. And I seek out some additional opportunities to do so. And that works for my family to be able to do that. I do actually, so I think Sunny made the point that I,

There's a connection to the real work that comes from working clinically. I found that to be very true

as a division chief, as a department leader, as a CMO at Mass Eye and Ear, it was tremendously helpful to me in that CMO role to be in the ORs around the nurses and surgeons. I learned more about what my job should be focused on from the people I was working around when I was on my clinical days than I did sitting in Zoom meetings all the time. And so for me, I still find a lot of value in that time and I'm able to sort of feel like I can still do it.

Great. Thank you. Other questions? Hello. Oh, there we go. So Dr. Conroy mentioned sometimes your big systems-wide decisions are not just about the data but more about doing the right thing. Have there been times in your careers where you've had maybe some resistance from other people on leadership? I think our mic cut out again. Yeah.

adopting that ethos and what have you been able to do to kind of get them on board? Who wants to take a stab? I'll start since I provoked the question. So I would say leading people, there are, I think, three components of it. Number one is capturing their minds. You do that with data.

capturing their hearts. You do that with the why, the emotional reason why we're making the decision. And that a lot of it is just clearing the path for people to do what their minds and their hearts have agreed is the right thing to do. And that's actually how you create change. I'm not a micromanager as a leader. And like Sunny's team, I encourage my team to actually disagree with me.

That's really important because I have to say not all my ideas are really good ideas. And it's helpful if somebody says that's a really stupid idea. And it's creating that space where the people that you depend on actually feel comfortable telling you that. However...

Sometimes you do have to make a decision. You do have to say, I've listened to everybody. And I know this is not going to be universally or unanimously popular, but we're going to do this. And often less so with those strategic, but they're often people decisions that, you know, bonds, loyalties form in an organization. But as a leader, you see that one individual is creating too much chaos and

And you see it, but the other members of the team don't necessarily see it. And those are some of the toughest decisions you make because it's something that you can't always share completely your thinking with the entire team. But it's some of the most important decisions a leader does make. Thanks. Anything to add?

I'll just say I'll give you a very tangible example that sort of lived through during this current Israeli-Hamas sort of conflict going on. And, you know, it's like if I had my communications team here, they would be telling me –

Stop right now, right? And that's what it was like when it was going on and we had at the university as as we saw in lots of universities there's lots of Turbulence within our organization. There was lots of turbulence about what to do and I sort of wrote something that I wanted to put out that Was just talking about the humanity of everyone it was quite neutral in my eyes, right? It's it's

A life lost of a child, an innocent person is a life lost. And the pain that goes with that doesn't matter what you are, right? That it doesn't matter. I don't know any Palestinians. I have lots of Jewish friends. It was not about taking sides. No, no, no. This will not be good. This will not. This is only going to hurt you. It's going to hurt the organization. It's going to bring us blowback in a way that we didn't want to do it. So I took the advice.

We let it stop. Then over Thanksgiving last year, you may or may not have heard the story, there were three Palestinian college students that came back to celebrate Thanksgiving at the uncle of one of those Palestinian students. And they were, I think, six o'clock at night walking down the street and they got shot because they were speaking some mix of Arabic and English and somebody just walked out the street and shot three of them.

All three of them, you know, Palestinians who their parents sent to America to be safe, to go to college. I can't remember now. I know one of them was a Brown student. I can't remember the other, where the other two students were. The Brown student was paralyzed for life, right? The bullet still in his spine that came back. And at that point,

there was a need to put that note out about the humanity. Like let's stop and pause and think about hatred versus love and what that means. And, and putting that out, it was still, which at that point I thought is not unpopular anymore. Right. We have one of the most liberal States in the country. Um,

Bernie Sanders is the most pro-Palestinian senator in the country, and still there was apprehension about what the political fallout would be. Becca Ballant is also of Jewish faith. Peter Welch is the other senator. And we decided we were going to go ahead and put it out. And there was such fear, but we put it out. It was an internal. It was just to our employees and our local government officials. And it was okay.

But it was hard to do. And I think I just wanted to hit, like, it was hard to take that on.

And you try to go back to like, let's try to do the right thing. Even if you're trying to do the right, what you believe is the right thing, often there's consequences to it and it's dangerous and you take all the feedback that you have. But that was an example of sort of, of challenging that and pushing it out. And I got every one of those politicians came back and thanked me and said it helped them influence their decision-making about what they were going to do about the ceasefire. So I think, I think we have consequential roles and voices that we have to use appropriately. Yeah.

Thanks, Sonny. And that brings us back again to what you all talked about before of being willing to take risks in leadership, right? I mean, if you have to do what you believe and that may be a risk and, you know, if you are willing to do that, then I think that's courage and leadership. How are we doing, Taylor, on time? We have some more time. Okay.

All right, let's do it. Let's hear some more questions. Someone has a mic. There we go. This question is for Dr. Conroy specifically. I'm also a medical student. This talk has been very impactful. As a woman, I wanted to know what challenges you face to get to the position where you are today and any strategies you've used to mitigate those besides golf.

So I could write a book. All right. So, you know what? So I did a lot of my training in South Carolina. Fewer than 10% of our class in medical school were women. And it was a very, very southern culture. You know, when they say bless you, they're really saying I hate you. And...

So I'd have to say that, you know, navigating it through medical school, I tried to be as just focused on how I performed as a medical student, as how I performed as a resident student.

I don't think I, to be honest, I don't think I wore a dress for 20 years. And it was all about really just being so professional. I didn't kind of verge into the Lilith version. I mean, I'm dating myself because that's an old Frasier character. But I didn't veer into that category. But I was very, very careful to really let people only see my professional competence. And

There's a good and bad side of that. I would say the bad side of it is we have so much to contribute as women leaders that once we kind of shroud that and try to be as kind of asexual as possible, people don't actually get to experience a woman leader that often is far more –

consensus driven, far more relationship based. And frankly, a lot of the decisions that you want to have go your way are based on your relationships. And so I think for women, you

A lot of women leaders now are a little bit liberated from that, and they're not actually afraid to kind of let people appreciate that not only are they a great leader, but they're a woman, and they're going to lead a little bit differently. I have to say that my stance in terms of issues that affect women in the workplace have shifted considerably. You know, I used to not want to talk about child care, and that's all I talk about now. Okay.

because 10% of the women have not returned that have left during COVID because of childcare issues. I never thought I would be such an advocate for removing the barriers to women coming back to work as I am now. And so it's part of maturing as a woman leader. And I think everybody's got their own journey, their own tempo of when they feel courageous and when they just want to kind of focus on mastery.

I do remember, and I think the recommendation to be as good as you can be clinically was really important. I know that when I would walk into a horrible situation in the operating room or the recovery room, the surgeons would just say, okay, I can leave. Joanne is here.

And there is something to having that incredible mastery that they know you are managing that situation. I have complete confidence in you. That gives you the confidence to do a lot of the other tough stuff that you have to do as a leader. So, you know, you kind of build your experience portfolio and your confidence portfolio in certain stages as you emerge as a woman leader. Thank you. Hi, everyone. I'm Sarah.

Hello? Oh, hi. Thank you so much for being here. Everything you guys have shared has been extremely insightful. My name is Shelby. I'm actually a fifth-year MD, MBA student at Georgetown. My question for you guys is how, what are some additional leadership roles that we can pursue early on in our career? And what do the stepping stones to get to a top leadership position look like? Okay.

Thanks for coming from D.C. We may have been on the same flight and we'll turn it over to the panel. What do you think? So I referenced this a little bit earlier. I think that one thing that Jed has pointed out is that our paths are not always the same. There is no single path to become a leader. If you look at Dr. Wiener-Kronisch and the journey that she took to become an anesthesia chair, she

It's so different than the journey that Dr. Hanenberg took to become ASA president versus the journeys that we've taken, right? There is no single path. I think it is much more about your willingness to take some risks, do some hard work, take on things, from my perspective, take on things that other people don't want to do, right? When there's a problem that needs to be solved, volunteer to try to help figure out how to solve that problem.

At some point, we are not hired in any of our roles because we are good at the thing that we became clinical experts at. We are hired into these roles because we can solve problems. And we have a demonstrated track record that we've been able to solve problems of all different sorts. You can read all the books you want. You can take all the courses you want. You can go to business school like you and I have. It only gets you so far. You have to do the work, right? You've got to be involved in those things.

experience the barriers and figure out how to overcome them. Experience the pitfalls. You know, you think you know how to do something and you try that thing. It doesn't work. What do you do to, you know, redirect, right, to course correct?

All of those things only come from getting involved in projects, right? So early in your career, to me, that's the best advice I can give you is look for opportunities to get involved, and you will learn and create connections and network and build your experience, you know, that will help you get to those leadership positions. Thanks a lot. Sonny or Joanne, anything to add? I think you said it. I think you said it well.

I'm on the just say yes sort of kick, just like you are. And I think just what Alex had presented on opportunities to get involved locally to start. There are so many opportunities, particularly if you're willing to step out to do that, I think, locally. And then that builds the steps and the building blocks to get you to the next level. So I encourage that. I'll just add that for students and residents, yes.

Read your emails. I know no one does. But the reason I say that is, you know, we get stuff going around all the time where, you know, some organization could be ASA, it could be SCA, it could be anything is looking for a medical student or a resident delegate or representative, or there's a scholarship for a resident or a medical student interested in this or that. And it goes around in the email. And I know no one looks at it because then I will target individuals. And I'll say, I think you'd be great for this. Did you see this? Oh, no, I didn't see it, but thank you. I'd love to apply. Right.

But if you don't have someone targeting that specifically, but you could do it, right? A lot of these are self-nominations. So read those emails and take those opportunities that you can get involved in now as a student or a junior resident or a senior resident that are leadership opportunities. And when we're interviewing students, we absolutely see those things. Oh, look, you did this leadership role as a student. That's impressive already. So it does matter. And so look for those things. Perfect. I was just going to say, can I ask the next question? And we'll have one coming on.

Then we'll wrap up. Okay. Karan. I'm going to abuse my privilege as emcee here and ask a question, but I imagine there's a lot of imposter syndrome going from clinician to administrator in the various roles you've had. A lot of us in this room are going to go from medical student to intern, resident to attending. What advice do you have for all of us as far as overcoming that imposter syndrome that we're inevitably going to face?

I'll go back to end-stage renal disease. I mean, it's – we're all – that was a great story because we're all feeling like that. I feel like that every day. I'm meeting with – I mean, I'm doing so much more political advocacy than I ever imagined I'd be doing. Total, like, newcomer in that, right? I'm scared. But –

I think to know that at every step that you're taking, it's going to be the first time that you're doing that. And that's the way everyone is, is reassuring to me. And so I ask questions. I make myself vulnerable and I feel OK with that. I think that's probably where you have to get to.

Yeah, everybody around you wants you to be successful. So just kind of listen to the people around you. I always tell medical students, listen to the nurses, anesthesia residents. There's nothing better than a VA, CRNA, who's worked in a war, to talk to you about how you can actually manage the case on your own.

without having to have somebody else push medications for you while you manage the airway. And then as you move up into leadership roles, just listen to people. You, again, don't have to have all the answers, which is one of the themes of your presentation, Jeb. And, yeah, just listen. That is something that we probably don't do enough of.

I'd just add, I think when you have that feeling, but we all do lean into it, actually, your body's telling you, right? You have that, those nerves, that anxiety, your body's telling you that, okay, I got to be a little bit more on point. And yes, that all those things are true, but it's also, that's your opportunity to learn.

If you lean into that feeling of discomfort rather than shying away from it, that's how you're going to become a better whatever, better resident, a better anesthesiologist, a better administrator, a better leader is recognizing those opportunities and recognizing.

Going for it, right? And so many people have said this from Jed to Sunny. Don't be afraid to ask questions. It's okay to look stupid sometimes, right? If you do it, it actually, if you model that behavior as you go through from a resident with a medical student to attending to a resident and say, I'm not sure. Let's learn together, right? I think you've got to be open to that idea that none of us know it.

Any, you know, we only know what we know and it's okay. Yeah. I'm going to add two quick things or second one that you just said to look, which is embrace discomfort. It's so important. We cannot grow without discomfort, but we're all programmed to not want it. And so you've got to teach yourself to be okay with it and to embrace it.

Uh, that's one. And the other is, and this kind of applies down the road, but I mentioned it earlier, the most powerful way you can help other people with their imposter syndrome is talk about your own mistakes, failures, uncertainties, and insecurities, right? So when you hear, uh,

leaders get up and say, listen, this is where I screwed up. This is when this didn't go well for me. Then it makes you feel a little more okay sharing that or doing that or pushing yourself to be in a situation where you may make a mistake. So be those leaders who will do that for others too. All right. I think we have one more audience question and then we're going to wrap up. Yeah. Okay. Thank you guys so much for taking the time and sharing so many of your stories. I know Sonny and Dr. Conroy spoke about the,

dealing with sharing opinions that have repercussion and using a voice that you gain louder each year to talk about reproductive rights or share an opinion on the recent Israel-Palestine issues.

As we all move up in our years and gain a louder voice, how do you navigate the obligations and appeasing your superiors, your colleagues, and those that you serve versus standing up and risking standing out and worrying about the repercussions for doing so? How do you decide when to make waves and when not to? You know what? Yeah.

I encourage people that are in our organization to find their voice. And I just like to know about it. So I had a head of OBGYN at Morristown Memorial. I mean, I used to actually have to have him park his car in front of the front door and have security look under the car.

Because he would receive so many death threats because of his stance on reproductive health freedom. And he wrote about it extensively. You know what? I just said, listen, Joe, let's agree on how you're going to sign those letters, because I would never want to tell you not to say that. But I'm not sure that you can say it as a chairman of OBGYN here at that point.

But you can certainly say it as an individual. And that didn't actually necessarily protect the organization from blowback because of his beliefs, but I would never stop him from actually saying that. But I would just inform people that you feel passionately about it, and nobody is going to say no. They're just going to give you some parameters around how that could be delivered and how you should identify yourself. Other thoughts?

I think your example again was really good about in the heat of the moment in the OR may not be the time to challenge the evidence on X. So if you're not going to do any harm, you go along. And I think the timing of how you do those things is really important. I think when you're a medical student, when you're a resident, you're more vulnerable to face the reality of that and think about, is this the battle I want to take on now or do I want to live to take on the bigger one that's going to have impact? And so I think that judgment of

how to use that voice and how and when to say it is really important. And I do think that the how winds up being really important because if you don't say it properly, it becomes more about

than the issue at hand, right? So you've got to get that down, that the way that you describe or deliver that message is also not going to become the focus, but actually the point of the message is, right? So I think the timing is the really hard thing. I think getting advice and listening to it is also valuable from people that you respect. I think oftentimes people hear the advice or take the advice and then don't listen to it and then go, you know, ah, but...

Yeah, I have routinely will go and this is where really trusting your leaders and having accessible leaders and join. You just mentioned this is so important, but I will go and say to my chair or to the D.I.O., whoever, you know, look, this is what I'm thinking about putting out there. What do you think?

Right. I think asking people who you trust for their opinion is really important. And and then being you know, if you trust them, then you got to trust their advice. Right. And then ultimately you're going to make a decision whether to take it or not. But, you know, if you if you have leaders you trust, then, you know, they often are going to give you the right advice. All right. Well, I want to say a huge thank you to our panelists for being here and for being part of this live.

live podcast episode, as well as to our audience for your fabulous participation. And I'm going to end how we always do by saying, I know for you students and residents, it's a long road and a hard one. And you are out there in the ORs, on the floors, doing everything, doing incredibly hard work every day. And I know that some days, maybe a lot of days, it feels thankless. But I am very confident that I can speak for all four of us when I say that

You are appreciated. What you are doing out there every day is truly, truly important, and it is really valued. So thank you. Thanks for being here, and thanks for everything you do. Thank you so much.

All right, folks, I hope that you enjoyed that recording. It was super fun to do that live episode. There's just something about doing it in front of a live audience that is so much more fun than sitting in a studio doing it. So I hope you enjoyed it. Really amazing leaders, and they had a lot of great insights to share. I hope we will do it.

be doing more live episodes. We certainly will be doing one from ASA coming up in October in Philadelphia. As usual, we will be doing a live episode from the exhibit floor. So check that out. It will be Saturday of ASA at two 30 from the exhibit floor on center stage. If you're going to be there, please come by. Hope you enjoyed this. I will skip most of our usual signups since we already did it as part of the recording, but I'll just say again to thank you all for listening and for all you're doing out there every day.

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