Residents in a Room

Episode Number: 65

Episode Title: Nontraditional Pathways – Leadership

Recorded: June 2024

(SOUNDBITE OF MUSIC)

VOICE OVER:

This is Residents in a Room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesia residents.

Something that I'm continuing to look forward to is I get to work with my junior residents and help guide them and teach them.

We're in a unique position of always having to work with other clinicians. So learning how to collaborate, learning how to listen, learning how to make sure things don't fall through the cracks.

Speaks to kind of finding an angle that you enjoy, even in something that you may not enjoy.

DR. JONATHAN COHEN:

Welcome to Residents in a Room, the podcast for residents by residents. I am the host for today's show Jon Cohen, I’m a nearly graduating C3 at Tulane Anesthesiology in New Orleans. We're going to pick up on last month's theme, nontraditional paths. And today we're joined by an anesthesiologist with deep leadership experience to talk to us about leadership roles.

First up, let's meet my fellow resident.

DR. JEREMIAH FOWLER:

Hi, my name is Jeremiah Fowler. I am a CA2 at Beaumont Hospital in Royal Oak, Michigan. Thanks so much for having me. Happy to be on the show.

Welcome to the show, Dr. Lin. You can get the ball rolling, if you don't mind introducing yourself and telling us a bit about your journey and leadership roles.

DR. DELLA LIN:

Thank you very much. I'm really looking forward to this time together.

So I have been in practice now I don't want to tell you how many decades, but let's say more than three. And I practice in private practice out here in Hawaii. And my journey, I would say I trained at UC San Diego, and from there, when I moved to Hawaii, I became the department chair of our department. At the time, we had 70 anesthesiologists, so a pretty large department, department chief for about seven years. And then after that I thought, what do I want to do? And I started to branch out outside of anesthesia, which I think is part of the nontraditional pathway we'll talk about today. I became sort of a speaker. I became part of a think tank on health care transformation. I found myself invited to be keynote speaker for several types of conferences, facilitator for board retreats for hospitals, and then found myself as a board of director for different health care organizations, including my Blue Cross Blue Shield here in Hawaii for, I don't know, ten years or something like that. And I'm currently back kind of in the anesthesia realm. I'm the Anesthesia Patient Safety Foundation secretary and on the board of directors there. But I think the nontraditional part is like well over 20 years of my career was outside of anesthesia. I still practiced anesthesia all during that time, but not so much in in the traditional pathway of, of only focusing on anesthesia.

DR. COHEN:

All right. So moving on to on one of our other questions here, I kind of have a multi-part question here. So first I want you to define what it means to be a leader. And then if you could speak a little bit more about what kind of leadership roles are out there for anesthesiologists, both early on in our career but also later in our careers? And then what do you feel like the universe of options for leadership in anesthesia looks like?

DR. LIN:

You know, I think the what does it mean to be a leader? I kind of want to be clear that I think we should not think of leadership as a role or a label or a title. Um, leadership really is, to me, more of a I don't know if it's a criteria or it's behavior. It's how you influence people, how you can shape culture, how you can help bring people together, solve problems, make things possible that otherwise might not be possible. So I love situations where I can stop and think, how might we? And that we can be all sorts of people. They don't have to be anesthesiologists, they could be other clinicians, but they could also be community leaders. And they they could be board members. They could be my patients. But how might we do things together? And how can I help, influence and help people tap into what matters to them? So I would refrain from thinking about leadership so much as a as a title.

So with that, then, the universe of options is huge. So when I think about my journey, I'm not sure if this has ever happened to you in your training, but probably everybody at some point, kind of in the grind of their everyday work sort of stops and sort of thinks, I don't think I could do this every day of my life for the next 30 years.I don't know if you've ever thought that, but I have fortunately, I can say confidently, I've never thought that because I've kind of decided that I want to practice great medicine and. Before I was a department chief, I was a medical director. So those are kind of traditional things, right? You become a medical director and there's lots of opportunities for that in anesthesia. And, you know, there are things within peer review. There's things in terms of quality improvement. There's things within your department. There's things that cross collaborate with your department. But then to me it was, well, how can I practice great medicine and. So how can I take what I've foundationally learned as an anesthesiologist, as a clinician, as just in my journey of life and go beyond the or so. So I think if we think of it that way, you know, you really should think about our lives as not just like, oh, I'm going to be doing anesthesia every single day for the rest of my life. It's it's really to tap into what you really want, what matters to you.

DR. FOWLER:

Following up on that, did you feel that the anesthesia helped set you up for leadership? You talk about practicing anesthesia and or medicine and. Did you feel like it was easy to dovetail an anesthesia into something leadership oriented?

DR. LIN:

I would say on hindsight, yes. I don't know that I knew that at the time. When I think about that, a lot of that comes from while I was a department chief. So while I was a department chief, it gave me the opportunity to look at different initiatives, projects, problems that needed to be solved. And within my department, you know, we were looking at things like length of stay in the recovery room, nausea and vomiting rates or I'm sure there are many more, but those are two that come to mind. And I realized that, let's take the length of stay in the recovery room, that that actually microsystem of what the hospital has to look at when it looks at length of stay for a, for the entire length of a stay of a patient. So what I was able to do was to, um, get involved in conversations that were outside the OR. But I could bring our microsystem learning from the operating room to the hospital in general.

So, you know, we are in a situation where in anesthesia, we're always, always having to work with at least one other clinician, right? So it's the surgeon. It could be a hospitalist, it could be a cardiologist, or it could be an emergency room physician. But we very rarely, unless you're in a private practice, even if you're an ICU, you would be hard pressed to be just, you know, the patient's only clinician. And even if you practice pain management, you probably have a collaborative group of physicians. So we're in a unique position of always having to work with other clinicians. So learning how to collaborate, learning how to listen, learning how to make sure things don't fall through the cracks. So I think that's one thing that anesthesia brings as a as a positive thing.

I think another thing is that we often approach patients and we design our anesthetic plan, we kind of think of different scenarios, and in our mind we work through the worst case scenario. And I think that's helpful as you strategize any kind of project you might have, being able to think strategically that way, think multiple options, multiple alternatives. And what's the worst case scenario? I think that's very helpful in any kind of business leadership role.

DR. COHEN:

So following up on something that you said earlier--and I'm going to push you a little bit on this because this is something that I hear a lot from people who are in leadership positions--you know, I found myself doing this. I sort of found myself in this role. Are these things you actively pursued? Do you have a goal in mind and like, what governed what you were saying yes to and what you were saying no to?

DR. LIN:

Yeah, so that's interesting. I probably am wiser about that now than I was when I was in the thick of it, in the early part. I would guide colleagues like yourself and people who might ask me now to to take the time to think, you know, what really lights you up? What do you enjoy doing? So for me, there's a piece of me that loves to be able to help people kind of have aha moments, learn something. And so the speaking roles when I found myself, you know, first of all, they they would say, okay, sure, could you do a lecture about whatever. We've all had that sort of situation. Right. But then when you really push yourself and say, okay, instead of just a lecture, what about something like a Ted talk? What about something where my entire room of 500 people are all non-clinicians? What would I have to say to those folks? So in that sense, I guess I would push myself into those roles. And a little bit of discomfort is not always a bad thing. A little bit of ambiguity is not a bad thing to test the waters and see what fits, but then being able to afterwards say, okay, so was that fun for me or not fun for me, right? So over time, I mean, I would say even like keep a diary at the end of the week, sort of ask yourself, so what things this week made me light up, what things brought me joy and put a column for that? And then what sort of things just like, oh, I like, I would never want to have happen again, or I just wouldn't want to wish it on my, you know, worst enemy kind of thing and put a list of those things. And then over time, you know, you will find what things you really value, what matters to you, what's really kind of pushes your buttons, which makes then saying yes and no to things easier. Right? So if something looks like, yeah, it's a leadership opportunity, but gosh, those are not people I like to be with or it's not a project that I'm at all interested in. It may not be worth your time.

And I think also we again overrate the title. So we overrate. Oh yeah, I should jump at that because then I can be the chair of this or the director of this or whatever it happens to be. But really leadership, one can exercise their leadership muscle in front of a group as a director or a chair or whatever. But you can also exercise your leadership muscle in the middle of a group, like being with peers and, and and even in the back of the room. Right. So, um, there all different ways to exercise leadership. And so this is all about, over time, practicing different leadership skills and exercising that muscle. So I wouldn't say you have to have a title to be able to do that. Hopefully that opens up some more opportunities.

DR. COHEN:

That's definitely really helpful. And especially as we're starting our our careers.

DR. FOWLER:

Yeah, absolutely. I thought that was really interesting. Something that you spoke about was trying to find what lights us up, and I'm wondering if you can speak a little bit more to what you find, you know, most rewarding about being a leader and maybe what frustrations or maybe some cons go along with that.

DR. LIN:

Yeah. So I like being around people who think, wow, let's make the impossible possible, or let's take this very complex problem and try to understand it better so we can come to a solution. So an example was during the pandemic. So in our state as in many places, we ran into a situation where we started to think, are we going to need to ration care here? Are we going to be in a position where we don't have enough ventilators and we're going to have to make some choices, difficult choices, or are different treatments just could not enough to pass around? And that's a very different situation than what we're accustomed to, which is I have my patient in front of me. I am the advocate for my patient. I will advocate for this this person who's my patient. Now suddenly it's about the population. And will the population in my situation, my state, will the population survive? So how do we make sure that resources are allocated fairly and justly? So we decided that the best way to do this was to get all the hospital, all the chief medical officers together, some people in the community as far as community physician leaders together and try to architect this together because no physician wanted to play God if in fact, we got into that horrible situation. And nobody wanted to do that. And everybody was looking for some sort of framework. So, um, again, it's ethically it's not a place you want to be, but it was very intriguing in terms of what I could learn about ethics, what I could learn about the people around me, the other leaders around me. And how can we come together to make sure that we resource allocate in a fair way and create something that every clinician in our community could utilize if they had to, and would feel comfortable that we were supporting them. That was an example of something where I got myself involved with that I would not have thought I would have gotten involved with. On the other hand, the rewarding side was being able to make sure that when we get to a point where we have to make policies, where we have to do things in medicine, that we don't forget the humanism in care, and to be able to have that voice at the table.

For me, the one of the most important roles I have as a leader is to make sure everybody's voice is heard, that everybody is treated with dignity and respect, and that includes the patient's voice critically involved. It includes the patient's voice. So in this situation, like the rationalisation of care, how do we get the patient's voice into this? How do we hear the patient's voice? How do we make sure everybody is treated with as much dignity and respect as we can under these kinds of horrible possible situations?

The challenge of that particular exercise, if you will, because thank God we didn't have to actually ration anything, is the ambiguity right? It's the unknown. Like nobody had solved it. I couldn't go into a book and say, oh, well, there's a best practice, we'll just do that. We were in really novel ground, so that's good and bad, right? The scary thing is, if we're not comfortable with ambiguity, some of these things can be very challenging. On the other hand, if we're okay with exploring the new and creating the new and having that courage, that can be pretty exciting.

DR. FOWLER:

I really like that speaks to kind of finding an angle that you enjoy, even in something that you may not enjoy.

DR. COHEN:

You know, starting 61, it's like, okay, every case has a learning opportunity and like, it's true. Sure. Uh, there's an angle that you can take for for things you may not necessarily think that you're, you're going to enjoy.

DR. LIN:

Here is an acronym for All of you. The acronym for fail FAIL. FAIL stands for for all I've Learned.

DR. COHEN:

That's great. It sounds like, you know, overcoming challenges and finding the reward in those unique situations. It's something that I think a lot of us look for and why we've chosen careers in medicine. And I think hearing you speak about some of those same concepts in regards to leadership really speaks to, you know, how rewarding it really can be.

DR. LIN:

Yeah. And again, remember, it doesn't have to be in front of, you know, 500 people or a chairman of a department. I mean, there is a leadership opportunity, even with the patient that you will be anesthetizing tomorrow. I mean, that patient is. In one of their most vulnerable times of their life, right? To be getting ready to be anesthetized and have surgery. And they're looking to you for leadership. They're looking to you for for guidance. They want to be able to trust us. So a key, I guess, attribute that we strive for as leaders is to gain trust. And so even with our patient, so important to gain that trust, to listen, to really listen to them, I think sometimes we're a little too quick with the versed and the, you know, production pressure. But I love to ask my patients, uh, actually, at the end of my pre-op evaluation, what matters to you today? And sometimes they look at me like, huh? Because they don't expect that kind of question. It also is a better question than do you have any questions for me? So even if you don't like what matters to you, which is the question I ask, But even if you say, what questions do you have for me? Just changing that instead of do you have any questions for me? “Do you have any questions for me?” means that you're asking a pretty transactional question to the patient. They answer, yes, no, and we're done with the conversation. What questions do you have for me, or what matters to me, to you means that I'm interested enough to want to listen to what you have to say. And this is less of a transaction, but that you and I, patient and doctor, we have a relationship here.

DR. COHEN:

Could you talk about a leadership opportunity that you realized that you weren't a good fit for, or gave up, or is there something that in retrospect, you think that maybe someone else could have been a better fit or anything like that?

DR. LIN:

Yeah. You know, I think sometimes if you think that the people in the room, the in this case, I'm without going into details because I don't want to give away too much. But if you know that the person that you will be reporting to or that this whatever thing is, you know, whoever the CEO or CEO equivalent or board chair, that your values aren't aligned with theirs, that you know their agenda is different than what you feel comfortable with, even if it's like, gosh, this could be like a career move for me. I wouldn't do it because you're not going to feel good about yourself. And, you know, I like I mean, not every project has been wonderful, wonderful, wonderful. But I like to think that even the ones that were not wonderful, that they were either cut short or that I've had enough good ones that I like, the ones that I've been happy with. But I would say, yeah, if you don't think that your values align with the majority of the people you're going to be working with, especially those in other leadership positions that are influential around you, then I wouldn't go there.

DR. COHEN:

That's very helpful. Thank you.

DR. LIN:

I mean, a lot of this goes with all the the talk we've been having about clinician wellbeing and burnout and whatnot. Right. So thinking about these nontraditional--nontraditional just means maybe 90% of people haven't thought about it, but 10% of people may have thought about it. So it means really tapping into what you love and saying, yeah, I can do that. And I can bring what I know about anesthesia to help me do this.

You know, when I think about when I was first doing sort of keynote sorts of things, I would get people coming up to me afterwards and saying, well, I don't know why you should be up there. You're an anesthesiologist and you're talking about, you know, things that really a primary care physician should be talking about. And they would challenge me and I would just, you know, thank them and listen to them and continue to do what I was doing because I did feel like I was potentially able to make a difference. But then over the years, what I found was, you know, people stopped saying that to me. The comment was more, oh, I can't believe you're an anesthesiologist. You don't sound like an anesthesiologist. But, you know, that's the thing is that at some point we shouldn't be labeling people right? As a leader, a leader can be a leader. It doesn't matter if you're an anesthesiologist or a banker or a, you know, grocery checkout person or whatever. It's just the leader is the person who's listening, who's trustworthy, who's taking away the barriers that are getting in the way of people being able to get things done. Um, somebody with courage, somebody with humbleness. You know, there's a great book called Humble Inquiry by Edgar Shine, and it's a great little thin read, and it's just about asking questions. I think everybody can do this. You just have to just have to go find the venues to make it happen.

DR. FOWLER:

All right. So another question I have for you, Dr. Lin, is where do we have a play in terms of community health? And if we think about patient safety as working to ensure our communities are healthier, where can we make a difference today?

DR. LIN:

Yeah. So the secret passion I have is around patient safety. When I finished as a department chair, I actually did do a fellowship in patient safety. So asking about patient safety to me is key in anything that I look for to do. You know, how can I make the patient safer or have less harm come to them. And part of that is that patient voice, right? For patients to take the time to understand why they're behaving as they did.

Let me just step back here and just say that one of the cases that I had when I was a early in my career, I was a Friday afternoon, and it was a patient that had needed to have an amputation, leg amputation. And you know, you know the story. So it's Friday afternoon. It's an add on case. The patient has, you know, gangrene or close to gangrene and, you know, renal failure and poor ejection fraction. So you know you can do the anesthetic right. You you've been you're training now. You're, you know, all the things about okay, not the best patient for, for you to be assigned to but you and your attending or you as an early career anesthesiologist, you have the skills to be able to get this patient through the anesthetic and have the surgery done. But the question then is. Why was this patient here? Right? What could we do? What could I do to have made a difference that maybe this patient would never have to have been here on a Friday afternoon having their leg amputated, right? So that's that upstream. That's that community health, that's starting to understand that everything we do is part of a bigger system. And starting to ask that question, you know, if you had a magic wand and could make everything as good as it could be, what would you do? And so then I start thinking about all the times you have a pre-op conversation with a patient, all the times that, you know, you might say, oh, you know, they're going to continue smoking, you've talked to them, people have talked to them so many times they're never going to quit smoking. But, you know, you never know. You might be framing it that one time they're about to have surgery or whatever is happening in their life. And, and you are able to connect with that patient and they actually change their behavior. So I, I found myself really thinking about many more upstream kinds of things. Now, when we think about now as anesthesiologists, you know, we do enhance recovery and all these things where we're getting much more involved with patients before surgery and after surgery. We have a lot of opportunity thinking about brain health, thinking about how we can prepare patients before surgery, you know, getting them to stop smoking, getting them to reduce the amount of opioids they're on before surgery, as again, an opportunity where they may have not been doing it for years and years and years, but now because they're coming to surgery and we can potentially utilize that timing, make that difference. I think there's a lot of opportunity, um, for that.

And then it just in terms of patient safety again, you know, why is the patient not treated with dignity and respect? You know, what assumptions are we making? What biases implicit biases do we bring that we need to hold in check for you know, oh well that patient is just not complying with their meds. Well, maybe because they don't have enough money to pay for the meds. So I think I think we have lots of opportunity to to think about how we can impact our patients, not just in the operating room, not just in that small little bit right before and right afterwards, but actually for a much longer period of time. They say that patients aren't visitors to the hospital, we’re visitors in their life.

DR. FOWLER:

I’ll have to remember that, I like that.

DR. COHEN:

Earlier you mentioned about, uh, production pressures. How did you convince the hospital this was worth your time or convince higher ups that this was worth your time to pursue, even if it meant taking time away from the operating room itself? The production operating room.

DR. LIN:

Yeah, that's a good question, right? I mean, I must say, I have a little more luxury now to be able to take that time and do that. I would say early on, um, trying to match up whatever I was interested in and be able to make a business case with it. So if I was interested in, um, some sort of quality improvement work, um, and I'm thinking that it is for patient safety, which may not have its own business, I would make sure that one of our metrics included being able to convert that into dollars, so that if I was speaking to the CFO, I could say, hey, you know, six months, we just saved you. $600,000 or $1 million or whatever it is. So we do have to, as leaders, start to learn the language of others and be able to not speak only our language. Um, I often tell people, if you have a slide set that you're using to present something, that slide set should be different with every audience. So it's not the same one that you give to your department. Uh, it's not the same slide set that you would give to the medical executive committee, for instance. Or it's not the same slide set that you would give to the board. It's not the same slide set you would give to patients. Every single time just kind of really think about the audience that you're speaking with and make sure you're targeting what you're saying to their language. Take the time to understand their language. And I think as a leader, I think that is something that we have to learn to be very nimble across languages.

All right. So I get to ask the question. So I'm going to give you an option between two questions. The first question kind of refers to what we talked about before. So what lights you up? Or what scares you about leadership?

DR. FOWLER:

Yeah. So I'll take I'll take the first question. So what lights me up. And as I'm a CA2, transitioning into CA3 year now, uh, we have our new residents starting boot camp, and I've had the opportunity to work with them and guide them in the operating room over the past couple of weeks. Uh, and it's something that I feel like I have been missing more recently, uh, in, you know, my day-to-day grind of caring for patients is teaching younger residents and just teaching, uh, those people that are going through something that I went through, you know, fairly recently. And it's really just kind of reignited that passion that I've had for teaching, which is something that drew me to medicine quite a long time ago and something I always enjoyed throughout my entire academic career. So transitioning now to being a senior resident in the coming weeks, it's something that I'm continuing to look forward to, is I get to work with my junior residents and help guide them and teach them. You know what I've learned in this short amount of time as an anesthesiology resident.

DR. COHEN:

The thing that scares me about leadership is sort of my ability to corral people who are doing this sort of pro bono. Like, it's different and not necessarily like someone's boss. If I'm on a committee, like maybe I'm, you know, in a leadership position, but convincing them that this is worth their time and that the results are worth the time and effort when they could be doing something else.

DR. LIN:

So I would think about maybe framing it less about trying to convince people. So if we think more about, again, the kind of the first question, what lights you up is kind of approaching the people you're trying to, quote unquote, you use the word corral, what's lighting them up. So you want them to be drawn to it, not feeling like they got pinned in or they happened to be voluntold to to do something right, because the energy will be there if they feel committed and they can join you in the same passion of why you're there. If you have non committed people or people that don't bring their passion to the table when the going gets tough, we're going to lose too much steam, right? We're going to lose ground and we're not going to get where we need to go. So it's so important to take time to get to know each person.

So when I was a department chief, I actually tried to get to know all 70 people in some way, each one of them. What was the thing that they just loved to do? So get to know that. I'll tell you a really quick story. So we had to change anesthesia machine workspace in one of the hospitals that I was working in, and we were trying to decide between one company and another company, and there were various things that were going to be changing. People don't like change, right? So one person who just like, oh, you know, every time I saw him, he was almost like going to run away from me because, oh my God, here she comes again. She's going to ask me to do something. And I flipped it and said, you know what just frustrates you when you come to work? Like what frustrates you in the operating room and from this particular person. What frustrated him was when he needed to use scissors in the operating room. They were attached to the anesthesia machine with two short of a tether, and he couldn't get it to the patient like it'd be added to cut, you know, as they cut an armband and replace it because of whatever reason. Right? That just frustrated him. So I said, okay, I've heard you. I will guarantee you that the scissors will have a longer tether when we're done with this. He was in my camp.

So as far as for you, Jeremiah, which I'm sure probably Jon shares this, you know, one thing I would say I wished I did earlier and I would advise for both of you is find a mentor. If you have a mentor, find a coach. So now you might say, well, wait, what's different between a mentor and a coach and a department chair? So a department chair obviously leads your department is somebody who you report to or your residency director. They're going to do your performance evaluations. That's a leader, okay. You have to have that person. And that person can help guide you. They may even mentor you and coach you, but that's their job is for you to report to them or they do your performance evaluation. A mentor is somebody who's maybe been a little bit further along the block and can help guide you within anesthesia. Hey, this is where I've been. This is what I would suggest. I would say go talk to so and so over here maybe or you know, you might tap into this over there. So they're guiding you very specifically in part based on their own journey. Okay. That to me is a mentor. A coach is standing next to you and and will listen and just try to get you so that your life will be the best it can be. And they may actually have no background in anesthesia, but they are a good listener and you and them have a connection. So tap into those things that you really love and make sure that you don't lose sight of that.

DR. FOWLER:

Thank you so much.

DR. COHEN:

I really like that. That's an awesome place to end. That was truly an interesting conversation. Definitely something that I'm going to carry with me as I graduate in a day and a half. I learned a lot.

DR. LIN:

Wow, a day and a half.

DR. COHEN:

Yeah. No, no one's counting. That's fine. I learned a lot. I really did, and I'm sure our listeners did too. Thank you for sharing all your expertise and experience, Doctor Lin. Thanks to Jeremiah and our listeners for joining me. Come back again next month for Residents in a Room, the podcast for residents by residents. Thanks again.

(SOUNDBITE OF MUSIC)

DR. FOWLER:

Thanks so much.

DR. LIN: Thank you.

VOICE OVER:

Be the first to find out about new job opportunities. Sign up for alerts at the ASA Anesthesiology Career Center and search hundreds of openings nationwide. Start your search at careers.asahq.org/jobs.

Join us for Residents in a Room where we'll share timely info, advice and resources designed to help residents succeed in residency and beyond. Find us wherever you get your podcasts or visit asahq.org/podcasts for more.