Leading the Rounds

Intro: 

Hey everyone and welcome to this episode of leading the rounds, where we look to inspire physician leaders through conversations about personal growth, leadership education, and health systems literacy. 

As always, if you like what we’re doing at Leading the Rounds, give us a positive rating on Apple Podcasts, Connect with us on Social Media, and you can now support us on Patreon. 

In today’s interview, we speak with Dr. Joshua Liao. Dr. Liao is a board-certified internal medicine physician and Associate Professor in the UW School of Medicine, where he is also the Associate Chair for Health Systems and the Medical Director of Payment Strategy. He is a national expert in health care payment and delivery policy. Dr. Liao's scholarship focuses on how systems of financing and delivering care work together with human behavior to affect health outcomes. He has published 200+ articles, including over 150 in peer-reviewed medical journals such as the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association. His ideas have also appeared in outlets such as the Washington Post, Forbes, the Boston Globe, the New York Times, NPR, and the Hill. We hope you enjoy this episode with Dr. Joshua Liao where we discuss health systems science and physician payment models. 

Questions We Asked: 

• How did you become involved with health systems science? 
• What is your role as professor of health systems science? 
• Can you tell us some history of payment models in the US?
• What will be the tipping point to changing from FFS to PFV payment models? 
• Have there been studies that prove PFV is superior to FFS payment? 
• How can we provide better care for lower cost to marginalized groups? 
• Where does the transition to Pay-for-Value start?
• How do physicians get paid under Pay-for-Value?
• Who defines positive outcomes? 
• Does Pay-for-Value incentivize selecting healthy patients? 

Quotes and Ideas: 

• The transition from Fee-for-Service to Pay for Value 
• A transition to Pay-for-Value will not fix all the issues we see in health care 
• Capitation model: a fixed fee per patient do deliver care throughout the year 
• “The alternative to mandates is not nirvana, the alternative is how it’s always been.”
• “Payment is a powerful motivator” 

Book Suggestions: 

• “The Long Fix” by Vivian Lee 

Intro: Colonel Joshua D. Hartzell serves as the Program Director of the National Capital Consortium Internal Medicine Residency at Walter Reed National Military Medical Center. Dr. Hartzell attended the Uniformed Services University (USU) School of Medicine and then went to Walter Reed Army Medical Center for his residency in Internal Medicine.He served as Chief Resident until starting his Infectious Diseases Fellowship. He has also served in the United States Army for 19 years, which included deployment to Afghanistan as a Battalion Surgeon. He completed an assignment as the Associate Program Director for the Internal Medicine Residency, Assistant Chief of Graduate Medical Education, and Army Intern Director at Walter Reed prior to joining the Uniformed Services University in 2016. There he served as the Assistant Dean for Faculty Development. He was responsible for the professional development of over 4000 faculty and delivered over 100 faculty development workshops. He holds the rank of Professor of Medicine at the USU. He is a graduate of the Stanford Faculty Development Facilitator Course, a Harvard Macy Graduate and now Faculty in the Harvard Macy Leading Innovations Course. Dr. Hartzell also completed a Masters of Science in Health Professions Education at Massachusetts General Hospital Institute of Health Professions in 2017. Dr. Hartzell’s academic interests include faculty and leader development. He developed LEAD (Leadership Education and Training) 2.0 curriculum for graduate medical trainees at Walter Reed. Dr. Hartzell also teaches Leadership and Organizational Change and Advanced Readings in Leadership for the Massachusetts General Hospital Institute of Health Professions Master’s program. Dr. Hartzell is committed to improving healthcare and personal well-being through developing leaders.

As always, if you like what we’re doing at Leading the Rounds, give us a positive rating on Apple Podcasts, Connect with us on Social Media, and you can now support us on Patreon. 

We hope you enjoy this episode. Welcome to Leading the Rounds. 

Questions We Asked: 

• How do you define physician leadership? 
• What is the best way to develop a medical leader? 
• Will making STEP1 allow for more leadership development opportunities? 
• What has the uniformed services done to build leadership into medical training? 
• What do you do in the hospital to help build your team?
• How should someone learn about leadership on their own? 
• Why has leadership taken a backseat in medical training? 
• What outcomes would you look at to evaluate the effectiveness of leadership training?
• What do physicians specifically have to add to the leadership conversation? 
• Why should trainees care about leadership? 

Quotes & Ideas: 

• “Leadership is using your influence to help accomplish the mission or task, while you’re taking care of the people you’re leading.”
• “Leadership development begins way before medical school.” 
• “We can learn a lot about leadership if we’re looking for it.” 
• “No one cares how much you know till they know how much you care.” -Teddy Roosevelt 
• “It’s not about being in charge, it’s about taking care of those in your charge.” -Simon Sinek 
• “If I really care about someone, I have to hold them accountable.” 
• “That’s a leadership issue.”

Book Suggestions: 

• “Drive” by Daniel Pink 
• “The Rise of Theodore Roosevelt” by Edmund Morris 
• “Extreme Ownership” by Jocko Willink 
• “The Leadership Challenge” by Barry Posner 
• “Athena Rising” by David G. Smith 
• “The Culture Code” by Daniel Coyle 

Today we spoke with Dr. Brent Lacey. He is a gastroenterologist by training who has a passion for financial management and career coaching. He is the founder of The Scope of Practice in which he runs a podcast, blog, and personal coaching service surrounding physician finances. He has spent hundreds of hours coaching and teaching these principles to people at all stages of their career. He hopes to continue to help others experience the joy of achieving financial independence and success in managing their clinical practice. 

As always, if you like what we’re doing at Leading the Rounds, give us a positive rating on Apple Podcasts, Connect with us on Social Media, and you can now support us on Patreon. 

We hope you enjoy this episode with Dr. Brent Lacey about personal and professional finance, from medical school to building a practice and having financial freedom. 

Welcome to Leading the Rounds. 

Connect with Dr. Lacey:

Website: www.thescopeofpractice.com

Podcast: www.thescopeofpractice.com/podcast

Brent’s Upcoming Summit “Marriage and Money MD” on November 15-17th 

Questions We Asked: 

• How did you learn about personal finance and start coaching physicians? 
• Did you always see yourself building a business around finance? 
• What advice would you give to medical students about learning finance when they don’t have any money? 
• What are your thoughts on the government repayment bailouts and deferment plans? 
• How should trainees factor in buying their first home? 
• What are common mistakes people make once they start earning a physician salary? 
• When and what should physicians invest in? 
• When can you begin to think about starting a business? 
• Is there a place for leveraging other people’s money to gain wealth? 
• What are the different types of insurance that physicians should consider? 
• What are books to learn about finance? 

Quotes and Ideas: 

• “People come out of medical school and residency as excellent physicians but they’re not very good at business.” 
• “You will be the same person in five years as you are today except for the people you meet and the books you read.” -Charlie Tremendous Jones 
• “80% of personal finances are behavioral choices.” 
• “I know people who were spending $1,500 a month on eating at restaurants. That’s why you don’t have a 401k, because you’re eating it.” 
• “Come out of medical school with as little debt as possible, and have a plan to attack it with a vengeance.” 
• “Relying on government programs for your future is a really hazardous approach [to loan repayment].”
• “NOW IT’S MY TURN is the most hazardous phrase that I hear.” 
• When you become an attending, don’t say “I have a lot of money now… you have a great income, but you’re probably deep in debt.” 
• Invest with The Tax Efficient Waterfall
• Brent believes that physicians should be investing 18-20% of their income each year 
• “No battle plan survives contact with the enemy.” -Sun Tzu 
• Every physician needs: term life insurance, health insurance, car insurance, homeowners insurance, disability insurance, and malpractice insurance 

Book Suggestions: 

• Dr. Lacey’s Reading List 

Intro:

Matt Abrahams is a passionate, collaborative and innovative educator on organizational behavior, communication, and speaking at The Stanford University School of Business. Specifically, he teaches Effective Virtual Communication and Essentials of Strategic Communication. Matt is also Co-Founder and Principal at Bold Echo Communications Solutions, a presentation and communication skills company based in Silicon Valley that helps people improve their presentation skills. Matt published the third edition of his book Speaking Up Without Freaking Out, a book written to help the millions of people who wish to present in a more confident and compelling way. He also hosts the Stanford Graduate School Business Podcast called Think Fast Talk Smart.  And, he curates the NoFreakingSpeaking.com website.

We hope you enjoy this episode with Matt Abrahams where we discuss why public speaking is so difficult, effective tools for communication and how to present better both in real life and virtually. 

Questions We Asked:

•How can we manage our anxiety when speaking?
•Do you still have anxiety with speaking?
•How can we obtain a flow state during speech?
•How can you feel confident when speaking to experts in a given field?
•What are things people can do to become more spontaneous with their speech?
•How can we use strategic pauses and tone to engage an audience? 
•How can you train out using filler words?
•How can we use speaking structure to improve our communication?
•What are some tips to improve communication over zoom?
•Book suggestions for improving speaking skills?

Quotes and Ideas:

•Ways to address speaking anxiety in the moment: Control symptoms [take a deep belly breath (double the exhale to the inhale), hold something cold in your hands] and sources [control anxiety by becoming present oriented (exercise, music, count backwards by a number)]
•Matt’s way to hack his anxiety: take a deep belly breath, remind himself that he has valuable things to say, and say tongue twisters
•“Dare to Be Dull”
•Improving spontaneous speech: practice in low stakes environments, pay attention to what others do with their conversation to build tools in your toolkit, associate practice with prior habits
•To get rid of filler words: end every sentence when you’re completely out of breath. You can practice with your calendar every day.
•Interesting research: With young kids, filler words (like, um) signal that something important is coming. With adults this changes and it now becomes distracting.
•The way to get good at speaking: Repetition, reflection, and feedback
•“Whenever you are communicating, you are a tour guide for your audience. The number one place that communicators lose their audience is when they move from one place to the next. In the transitions.”
•Speaking structure ideas:
oWhat-> so what?-> now what?
oProblem-> solution-> benefit
•Tips for zoom communication:
oTips for presence: improve posture on screen (big, balanced, and still), look directly at the camera, vary your voice
oImprove engagement: stimulate multiple modalities (use polls, videos, questions, calling on people) and use linguistic engagement (use the word “you”) with analogies
oBest way to practice: record yourself
•“Attention is the most precious commodity we have in the world today.”

Book Suggestions:
•Speaking Up Without Freaking Out by Matt Abrahams
•Made to Stick by Dan and Chip Heath 

 Dimitrios Tsatiris, MD is a practicing board-certified psychiatrist specializing in the field of anxiety management. He is a Clinical Assistant Professor of psychiatry at Northeast Ohio Medical University. He studies and writes about the interface of anxiety and achievement. His popular Psychology Today blog “Anxiety in High-Achievers” is viewed by more than 20,000 readers per month. He is passionate about empowering people to break free from the shackles of anxiety and develop a healthy relationship with achievement. His writing has appeared in Psychology Today, PsychCentral, NAMI, ThriveGlobal, KevinMD and the White Coat Investor, among other publications. Dr. Tsatiris enjoys spending time with his wife and two young children. He also keeps close ties with family in Greece and has fond memories from his childhood there. We hope you enjoy this episode of leading the rounds where we discuss the intersection of anxiety and performance. 

Questions we asked: 

• It seems paradoxical that high performers struggle with anxiety. What do you think is the root of the intersection of performance and anxiety? 
• Can you speak more about the biological roots of anxiety? 
• Why might the people who we often believe have everything together be struggling with anxiety? 
• How can someone balance chancing excellence but being okay with failing? 
• How do we build a society that doesn’t overvalue perfection?  
• How would you define stress and how can leaders work to manage stress? 
• Can how we look at stress impact how it affects us? 
• What do you see is the role for exposure therapy in the management of anxiety? 
• How have you as a provider been able to manage your stress through the pandemic? 
• What is the relationship between grit and anxiety? 
• What is the difference between the experience of anxiety and clinical anxiety? 
• What would you tell future leaders about managing their anxiety throughout their training? 

Quotes & Ideas: 

• “To have anxiety is to be human” 
• “Pressure is fuel for anxiety” 
• Anxiety often is the fear of being vulnerable. This can manifest as fear of danger or fear of being ostracized from the group. 
• “What excellence does is it allows you to have a growth mindset.” 
• “One can try to strive for perfection but it is an unattainable and unsustainable expectation.”
• Affect forecasting: We pursue things that we believe will make us happy. We often assume that success and money will make us happy. 
• “We combat perfectionism by combatting the myth associated with personal success. Success does not equal personal happiness.” 
• “If you’re under constant stress, that is not healthy.” 
• “Let’s face your fears at your own pace… exposure is gradual steps towards reaching and conquering your fear.” 
• A challenge of the pandemic has been maintaining safe distancing, but also recognizing the physical and mental benefits of physical connection. 
• Ways Dr. Tsatiris manages his mental health: Regular exercise, gratitude meditation, connection with others, and taking moments to pause 
•  “Yes you can be gritty and also have anxiety.” 
• “An anxiety disorder is when it begins to affect your day to day functioning.” 
• “The goal is not the absence of anxiety, but making it manageable.” 
• “When we have anxiety, we are not being present in the moment… what meditation does is it brings you back to the present by focusing on your breath.” 

Book Suggestions: 

• Seven Habits of Highly Effective People by Steven Covey 
• Man’s Search for Meaning by Victor Frankl 

Elisabeth Rosenthal is a physician and journalist who is currently working as the editor-in-chief of Kaiser Health News. She graduated from Harvard Medical School and completed residency and worked as an Emergency Physician before she began working for the New York Times as a reporter. In 2017, she published a book titled, “An American Sickness: How Healthcare Became Big Business and How You Can Take it Back”, which looks at the American healthcare system and how financial incentives have impacted it. We hope you enjoy this episode where we talk about healthcare costs, physician payment models, strategic billing and more.  

Questions we asked: 

• What led you to make the switch from being a physician to being a journalist? 
• What do you mean by “health insurance as the original sin” in healthcare?
• What are your thoughts on alternative models such as Direct Primary Care or Concierge Medicine? 
• Do salary based physician payment models improve overtreatment and overbilling? 
• Could whole genome sequencing further unnecessary medical care and treatment? 
• What are other countries doing to better align healthcare cost and effectiveness? 
• What can the next generation of physicians do to cure this American Sickness?
• What books would you suggest to medical leaders? 

Quotes & Ideas: 

• Paying Till it Hurts column by Dr. Rosenthal
• Insurance separates the consumer from the true cost of medicine which allows for business to increase pricing.  
• “When you receive a ER bill for $17,000 and you’re out $3,400 for a COVID screen... that’s not skin in the game, that’s like having a kidney in the game.” 
• Patient’s can’t shop around for healthcare prices if they don’t know the prices. 
• “Why does it cost that much? Because it’s legal and people can.” 
• “Salary based physician payment often becomes salary plus incentives for revenue generation.” 
• “The goal of the physician and nursing workforce is to deliver good care to patients… The goal of the business side of healthcare is often to generate revenue.” 
• Kaiser Health News Bill of the Month 
• Bad medicine is often good business. 
• “People say pharma’s bad or PBM’s are bad, but It’s the way the system interacts with itself that is the problem.”
• “If physicians don’t bring in patients, these hospitals are nothing.” 

Book Suggestions: 

• An American Sickness by Elisabeth Rosenthal 
• The Price We Pay by Marty Makary 

In this episode we interview coach Mark Dantonio. Coach Dantonio is the former head coach of the Michigan State University football team. He was the coach for 13 seasons and was the winningest coach in Michigan State history with 114 wins.  He had an impressive career as head coach where he led his team to three Big Ten Championships, Rose Bowl and Cotton Bowl victories, and an appearance in the 2015 College Football Playoff. In addition to his success on the field, he also was a leader off of it. He helped organize events to raise funds for Lansing Promise, Sparrow Hospitals Children's Center, and led trips for his team to visit schools in the surrounding areas of Michigan. He was given the Gene Stallings Award, which is given to head coaches who are humanitarians and promote healthy, vibrant communities around them. We hope you enjoy this episode where we talk about building a winning culture, creating buy-in, and overcoming obstacles. 

Welcome to leading the rounds! 

Questions we asked: 

• What was it like being a part of “the ball is free” MSU vs. Michigan game? 
• What makes a good coach? 
• What were your goals when starting as a head coach in 2007? 
• How do you maintain your established culture with changing players? 
• How were you able to create such buy-in with the fanbase and those outside the program? 
• How did you choose who to empower around you? And how did you make everyone within the team feel valued? 
• What made your players that were chosen as captains good leaders? 
• When you were in a tough stretch, what helped you keep your team on track? 
• How did you stay balanced when you’re coaching 80-90 hours a week? 
• What made you the coach who could outperform expectations? 
• What advice would you give to yourself if you could look back to 2007? 

Quotes & Ideas: 

• “When everything starts to fall down around you, which it’s going to.... You have to be the guy that steadies the ship.” 
• “Regardless of the plan you have, it will not survive contact.” 
• His model for team building: 

1. Build relationships 

2. Educate yourself 

3. Define a win

4. Choose to be a light 

5. Go to work 

• “Usually when there’s a problem, it’s because of a lack of communication.” 
• “People understand the product, but they don’t understand the process.” 
• “You earn the jersey that you wear.” 
• “Water your crops” 
• “Any time you put all your eggs in one basket and if you don’t win, you fail, you’re in for a tough landing.” 
• “Sometimes it is better to be fresh than ready.” 
• “Strive forward and dream big.” 
• “If we can all go in one direction, we can be extremely successful.” 
• “Do your job and usually you’ll get a bigger role.”
• “I want to be defined not so much by the wins that we had, but who I was.” 

Book Suggestions: 

• Chase the Lion by Mark Patterson 
• Legacy: What the All Blacks Can Teach Us About the Business of Life by James Kerr 

Dr. Gregory Corradino is a neurosurgeon by trade, a business owner, and most recently an author of the book, “Beyond Medical School: secrets of successful doctors”. He is a member of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and the North American Spine Society. He is also the Vice President of East Tennessee Brain and Spine. Dr. Corradino also enjoys painting, traveling, and spending time with his wife and children. 

Welcome to leading the rounds! 

Questions we asked: 

• How can trainees learn about business, finance, and leadership before they begin practicing? 
• How should medical schools be educating future physicians about these topics? 
• What are your tips for choosing a medical practice? 
• Why do you think doctors, who are trained on empathy, historically poorly treat their staff? 
• How do you hire the right people? 
• What would you tell new physicians about hiring great accountants, advisors, lawyers, financial planners, insurance agents, mentors?
• How do you build a great team to work with? 
• Can you explain what a mastermind group is? 
• How can we become better communicators? 
• As an owner of a private practice, how do you not let the business affect your relationships with patients? 

Quotes & Ideas: 

• The culture within an organization trickles down directly from the leader. Poor leadership within a medical practice will lead to employees who treat patients poorly and represent the practice poorly. 
• “If you don’t treat people well… they are going to figure out a way to treat you poorly.” 
• Your level of competence and prestige never gives you the right to treat people poorly. 
• “One of the best ways to get proper advice is to ask around.” 
• “If you think you can do it alone, you’re going to waste a lot of time, money, and emotional stress.” 
• “You’re the sum of the 5 people that you spend the most time with.” -Jim Rohn 
• “Do you want a culture of design or a culture of default?”
• Mastermind Groups 
• “You have got to be able to get your point across effectively” 
• Important facets of building a medical practice: 
  • Business/Marketing 
  • Operations 
  • Human Resources/People/Staff
  • Finances 

Books:

•  How to Win Friends and Influence People by Dale Carnegie
• Trust Based Marketing by Dan Kennedy 
• Think and Grow Rich by Napoleon Hill 

Dr. Colin West is a professor of Medicine, Medical Education and Biostatistics at The Mayo Clinic. His research focuses primarily on physician well-being, evidence-based medicine, biostatistics, and medical education. He has won numerous awards for work and is a thought-leader in these fields. Dr. West has developed and evaluated a comprehensive evidence-based medicine curriculum for Mayo Medical School and enacted change at the national level in the internal medicine resident career plans and current education climate. 

Today we further our conversations we’ve had previously about wellness and burnout by taking a magnifying glass to the role of the patient-doctor relationship and how this helps us as trainees and physicians find purpose and passion in our career. 

Welcome to Leading the Rounds!

Questions we asked: 

• Why did you start doing “wellness Wednesdays” on Twitter?
• Are patients more aware of physician burnout now more than ever? 
• In the airline industry, there are stories of pilots cancelling flights due to fatigue and to promote safety. How would that play out in the healthcare system? 
• How has Mayo Clinic been able to build in layers of backup to improve work environment and give trainees more time off? 
• What are ways that residency programs can support residents long term fulfillment?
• Are medical students more resilient than the general public?  
• How do we break the cycle of burnout being passed onto new trainees? 
• How does Mayo Clinic’s values mitigate bullying in training? 
• 
  

Quotes and Ideas:

• “We’re taught not to show our patients and our communities the stresses we are experiencing... but healthcare professionals are shockingly human first.” 
• “Healthcare professional and physician burnout is not the patient’s responsibility.”
• M.V.P.’s of Healthcare = patients 
  • They give us Meaning, Value, and Purpose 
• “Dehumanization and depersonalization is one of the hallmarks of burnout.” 
• “In our current training, we have to have layers of safety built in.” 
  • Swiss cheese model of avoiding errors 
• “Our own professionalism is used sometimes in a perverse way to say that you will step up; you will always step up.” 
• “We forget why we’re here.” 
• “Despite having higher burnout rates… physicians also have higher levels of resilience than the general public.” 
• Primary value at Mayo Clinic, “the needs of the patient come first” 
• Jobs, demands, resources model= “distress and burnout result when the demands of a job chronically exceed the resources available to meet those demands.” 
• “We work in healthcare teams, and the best team players lift those around them up.” 

Book Suggestion: 

• The House of God by Samuel Shem 

Welcome to this episode of leading the rounds where we interview Dr. Lauge Sokol-Hessner. 

Dr. Sokol-Hessner, MD, is an Assistant Professor of Medicine at Harvard University and the Associate Director of Inpatient Quality Improvement at Beth Israel Deaconess Medical Center. He is also faculty for the IHI Virtual Expedition: Is Your Organization Conversation Ready?​ which educates on end of life conversations with families and patients. 

We hope you enjoy this episode where we discuss the importance of Quality Improvement for medical leaders, difficult conversations, and more. 

As always, if you like what we’re doing, give us a positive rating on apple podcasts and connect with us on social media.

Welcome to Leading the Rounds! 

Questions We Asked: 

• As you developed as a leader, what sparked your interest in quality improvement?
• Who should know about quality improvement science?  
• What is the best way to learn quality improvement? 
• What is different about medical QI and industrial quality work? 
• How can we make quality improvement and change something that people want to do instead of another requirement that people grumble about? 
• Is there a benefit of being an innovator or a lagger with technology? 
• How did you become involved with the Conversation Ready Project?
• How do you deal with difficult conversations with a dying patient’s family?  
• When does standardization take away from the humanism of medicine? 
• What suggestions do you have to avoid moral distress as physicians? 

Quotes & Ideas: 

• “Anyone in healthcare who provides care should know the general principles of quality improvement and why they are important.” 
• Innovation/Adoption curve 
• Questions for starting a QI project: 
  • What is the problem? 
  • Is it really a problem for those involved?
  • Is this something that we can fix? 
  • How can we fix it? 
  • Is our change better? 
• “You will go much further, much faster if you are doing it with other people.” 
• Joshua Lakin article, https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2715161
• “We are all hoping that your loved one gets better, but we are worried that will not happen. Would it be okay if we talk about a plan B if that doesn’t happen?” 
• “The purpose of learning the skills is so that they are in your toolbox, and you can use them at the right moment.” 
• “We encounter moral distress… when we have cognitive dissonance between what we believe is the right thing for a patient, and what is actually happening.” 

Book Suggestions: 

• Long Walk to Freedom by Nelson Mandela 
• Our Iceberg is Melting by John Kotter 
• Just Mercy by Brian Stevenson