Leadership Interview

There have been so many generous teachers that it is hard to single out one person. However, I can recall the first person in medicine who had a very powerful impact on me. Dr. Edward Wallach was the chair of ob/gyn at Pennsylvania Hospital and a renowned infertility surgeon. He had a very dignified bearing and gentlemanly manner that reminded me of George Washington — fitting, given that he worked in America’s first hospital, founded by Ben Franklin and Dr. Thomas Bond, Washington’s personal physician.

I first met Dr. Wallach during my third-year obstetrical clerkship at the University of Pennsylvania School of Medicine and was fortunate enough to spend an additional month training directly under him as a fourth-year student. He was a very skilled tubal surgeon, had an encyclopedic knowledge of clinical medicine and was a highly compassionate physician and gifted leader. After my month with him I was certain of my choice of a career in ob/gyn and that I wanted to be under his tutelage.

From Dr. Wallach I gained an enthusiasm for both clinical practice and research and a deep sense of the immense commitment required by a career in academic medicine. I also understood the long hours needed to become a skilled surgeon. His grace, humility and calm demeanor in the OR were inspiring; one never wanted to let him down, and he became my “father in medicine.” In fact, true to form, since my residency there has not been one major professional accomplishment, award received or accolade garnered that has not been acknowledged by a warm note from Ed.

Dr. Wallach also shared what I have come to believe are the four common traits of a successful leader: commitment to one’s convictions, a truly infectious enthusiasm for one’s job, crystal clear vision for what one wants to achieve and fantastic communication skills. The other quality that Dr. Wallach shares with other gifted leaders is that he could inspire me to test my limits and push myself to the next level of achievement.

In 1991, I was nearing the completion of a postdoctoral fellowship at Mount Sinai Medical Center, studying tissue factor in the lab of the renowned hemostasis expert, Yale Nemerson, MD, who incidentally trained at Yale. Quite unexpectedly I was asked to meet with the dean, Nathan Kase, MD, another ex-Yalie, now at Mount Sanai, who had been our former chair of ob/gyn. I had absolutely no idea why he would want to meet with me. Had I done something truly horrific? Nate greeted me warmly and proceeded to summarize my progress in the Nemerson lab in astonishing detail. He then asked me how I planned to use my new knowledge of the molecular biology and biochemistry of tissue factor in the context of reproduction.

I suggested a few rather lame applications which he listened to patiently. He then, in the best Socratic fashion, led me to consider the potential role of increased endometrial tissue factor expression in preserving hemostasis during embryonic implantation and, conversely, reduced expression in facilitating menstruation. He also handed me several highly relevant articles to read from fairly obscure journals. That conversation led to my receipt of continuous NIH funding since 1992. That a very busy medical school dean could have been thinking about the academic career of a lowly postdoc was shocking to me at the time. Once I got to know Nate well, I realized it shouldn’t have. Not only did he display the four leadership characteristics I described above, but he was a truly superb mentor, master clinician and inspiring teacher. If Nate were a general I would follow him into battle no matter the odds of success.

Of the four traits I listed, “commitment to one’s convictions” is the most important. It is a requisite to greatness. Truly great leaders have an internal compass that allows them to develop a value-based vision for the future and remain true to that vision no matter the obstacles, opposition or resources at their disposal. In my opinion, this “compass” is derived from personal accountability and integrity, unwavering principles and a personal toughness. Leaders as disparate as Gandhi and Churchill have possessed it.

Those that create an environment that enables others to succeed in our tripartite mission of excellence in clinical care, research and teaching. Many of these decisions involve establishing a sound financial basis to permit investment in the careers of faculty. Others involve making truly tough calls on recruitment and retention of faculty.

By far my greatest challenge, and the one all leaders in academic medicine face today, is anticipating the future of health care delivery and sources of research funding.

The leader’s vision must be compelling and must be shared, but above all, it must be communicated with energy, enthusiasm and optimism.

I believe the same disciplined training and focus required to become a superior clinician, teacher and researcher are also required in administration. Thus, after years of acquiring managerial skills by observation and real-world experience, in 2007 I enrolled in the Harvard School of Public Health’s Master of Science Program in Health Care Management. Courses included “Health Care Economics,” “Financial Controls and Management,” “Organizational Behavior,” “Corporate Strategy,” “Physician Leadership,” “Health Policy and Payment Systems,” “Informatics,” “Quality Improvement ” and ”Negotiation and Conflict Resolution.” I have already found the knowledge and skills gained from this program absolutely indispensable in helping the Yale ob/gyn department transform its clinical operation to one that is innovative, patient-centered, safe and highly efficient.

Help create a vision that is both value-based and consensus-driven, a vision that you ultimately own. Listen to everyone you are trying to lead and keep on listening. Be enthusiastic but think carefully before acting, especially when your decisions affect people’s careers.