Well, hi, I'll start off by first of all, welcoming you all tonight. It's just so delightful to see all of you and we're very excited and I think Mike can give you some of the history of this and tell you why we're so excited to see you this evening. But my name is Kathy Bell and I am sort of representing kind of leadership, medical leadership, sort of on the academic side. I've spent my professional career first at the University of Washington and then at the University of Texas Southwestern, where I was just the just prior chair of the department there. So have some experience in in large academic settings and also some leadership experience and volunteer advocacy organizations like the AAPM and the Foundation of PM&R and some other some other things as well. So that's who I am. And like I said, I'm just delighted to be here. This is a this has been very dear to my heart for a long time. So I'm glad to see it finally coming to fruition. Mike, you want to hop in there? Yes, I too am very excited to have everybody here. And thank you so much for being our young leaders. This is what this is what this program is all about. I represent the practice private practice side of the equation in medical leadership and medical directorship. I trained at Baylor Houston, spent a few years at Thomas Jefferson and academics, and then came out to a freestanding rehab hospital in Harrisburg, Pennsylvania. And I've been the medical director here for many years. Also, I'm the chief medical officer of a large private practice group, US Physiatry. We have probably 90 hospitals that we provide staff and medical directors for. So I've just been privileged to have a really broad view of what's happening in the world of medical directorship in the country, predominantly in the private practice domain. But believe it or not, we have some of our providers and academic centers as well, which is kind of an evolving trend. So Kathy, I'll just go ahead and kind of tee us up on what got us here. And so, you know, basically, what you all need to know is that we need leaders in all aspects of PM&R, every aspect, whether it's academics, whether it's private practice, the minute you step out of your residency, you will be a leader because we are team leaders in PM&R naturally. That's what we all do here. What you need to know, if you look at the supply and demand graph, the baby boomers, of which there are a couple on the screen here, are aging, we're aging, and we're filling hospitals on the older end of the baby boomer generation in great numbers. And we're filling rehab facilities in every domain in great numbers. And people are really very ill when they come to our doorsteps. So I know Kathy and I have a love for taking care of our patients who are very vulnerable. But these hospital systems, the inpatient hospital systems, academic-based, freestanding, need people that step up to the plate and take care of complex patients in a complex medical environment where everything around you, consolidation-wide, is changing. The needs of the patient are changing. We have the issues with the carriers being more aggressive, and us having to be the advocates for the patient now more than we ever had been. But the medical director course is to give you skills to be the helmsman of the ships that take care of our patients and to take care of our communities, right? Because once you're somewhere, whether it's in Washington State, Seattle, Harrisburg, Kathy and I have been part of our communities. And these people that we care for are not only our patients, they're our neighbors. You'll get a much better sense of that as you mature. So our goal here is to make you feel comfortable with the challenges that you're all going to face. And I would say, speaking for Kathy and myself, no matter where you are in your career, this course will give you skills that you will remember because there's going to be a time and a place where you're going to need each of those skills. So that's the tee-up. This has been planned. Kathy and I have worked hard on this curriculum since pre-COVID. We've been pushing it along. It's been starts and stops. And we're delighted to be here today to help you all succeed in what we know is our wonderful careers in medical directorship. And I think I'll just add to that a little bit that, you know, in addition to, you know, hospitals or inpatients and that sort of thing, we realized that physician practice is also changing pretty dramatically in other settings as well, in spine care, musculoskeletal, general rehab, in physician practices or in acquired physician practices or in multidisciplinary practices. So I think that, you know, many of the skills I think we'll be talking about, some will be applicable to, you know, inpatient skilled nursing settings, etc., big institutions, and some will be actually very applicable to, you know, dealing with a large, say, multidisciplinary group or one of the mushrooming kind of physician acquisition groups that are going on right now in terms of how do you deal with that? Because it does change, it does change your role. And there are things you need to look out for to be happy in your practice as time goes along. You know, being alert and being proactive for yourself and your patients is, I think, what ends up bringing satisfaction to you over the long period of time and not feeling as though you're being buffeted by waves that are uncontrollable. So, and PEDS is fine. I see a little note here from Stacey. Hey, PEDS, this will be applicable to PEDS, don't worry. We're not just talking about old people, we're talking about PEDS too. So, and we will have some pediatric people who will be participating in some of the presentations as we go along. Yeah. Okay. We thought this session should be really kind of relaxed. It's a conversation. We want to set you up with a mindset of the skills you're going to learn to be directors of anything within the realm of PM&R that needs medical direction. And so, Kathy and I thought we would start the discussion with asking each other some questions and getting the voice of knowledge and experience to the best of our abilities out there for you. Feel free to raise your hand if you want to join. We're happy to have people speak up and ask questions. If not, some people just assimilate things as a listener and that's perfectly fine as well. So, but we're going to kind of make this a little free floating because you'll have plenty of structured presentations going forward. The live discussions of which there will be three will be where you really get to interact with each other and the faculty on a much more intimate setting as we all learn these skills together. And Kathy and I would say are still learning these skills as we go on in our careers. So, Kathy, I'll start with the first question. And so, as a leader, so much experience, so much contribution to the field, how would you paint the healthcare landscape today? How is it evolving and how are we getting this intense need for PM&R leadership development? Yeah. So, I have gray hair for a reason, right? Keeping up with what's been happening in healthcare, I would say over the last, I'd say maybe 15 years or so has been a real combination of a sprint and marathon. I think things were quieter back in the day. Things happened a little slower. And I wouldn't say that's been the case over recently. And I think that what we have seen and are continuing to see are some really interesting evolution of healthcare structures. One thing that I mentioned is some of the consolidation of physician practices. I mean, back when I first started being affiliated with the academy, I mean, probably most of our members were in independent private practices with a minority being in more structured private practice. That's not the case anymore. I think that's shifted drastically. And most of our members, I think at this point, we saw that chunk of academic folks, but what we have, a lot of people who are in private practice in the community who are practicing in other structures. So, they say either large conglomerations of practitioners, multidisciplinary groups, being employed by large health systems and by national health systems, such as the one that Mike works with, more and more are doing that. Even as Mike said, I think in academic medicine, we're seeing more marriage between academic institutions and privately run or privately funded institutions. And I think that's becoming more common for a lot of reasons, most of them financial, I think. And then the question is, how do we navigate that again, proactively, as opposed to feeling like we don't have a place? And one of the things that I think has been very much in the forefront during all of this is that people are realizing that as healthcare has been evaluated on more than an individual basis, but on a population basis, PM&R and physiatry becomes more and more important because we are looking at not only the individual and the individual disorder, but we're also looking at community and overall function and transitions between models of care, transitions between levels of care for people. And that's become more and more predominant. And I think that we can either stand back and watch it being done badly, or we can step up, get the skills we need to be leaders and see it done the way it should be done. And it's one of those things that, again, I will talk about that there are so many changes in even how we describe things or we practice. I mean, the whole scribes, artificial intelligence, the place that electronic medical records have taken in our lives, all of this, I think, kind of mitigates against good patient care, in my opinion, unless someone at the top, someone who's in a leadership position, is molding what we're doing with all of these things in service of the patient and in service of the practicing physician as well and healthcare team. Because I think, again, once you move into a position where you are leading, you also are looking for good outcomes for your fellow physicians and your nurses and therapists, because it's very important to keep those people happy and flourishing and on your team so that you're not having this turnover, which is going to be a part of everybody's life over the next five to 10 years. Because as Mike said, I mean, not only do we see the baby boomers coming in as patients, but we see the baby boomers retiring as physicians. So we see a large chunk of physiatrists that are going to be stepping off the mat over the next few years, and we need people to be able to step up in this new model and start taking over. Does that make sense, Mike? Yes. Yes. And again, going back to the supply and demand curve, so the demand of patients is up here, the supply of us is here, and the challenge really is how to move people up quickly. And so one of the things we talked about is how do we identify leaders? Like what are the qualities that can make your path easier if you develop them, or even better if you have some innate skills? And because if physicians, if PM&R doctors retire two years earlier, I saw this graph illustration, that's going to actually push down the supply curve. It's going to flatten it just two years. It's remarkable. So we all need you to come on in and come on in really quickly. So I think one of the things I want to comment on is you probably are all wondering, do I have the right stuff? Can I do this? I'm assuming that all of you here feel you do have the right stuff because you're here. And I think if we look at, I mean, Kathy and I have had similar experiences in different domains. If you look at what qualities a leader needs to have, I think we talked about one of our previous conversations is that you'll know it when you see it. You'll know it when you see it that it's budding and innate, and you'll know it when you see it's not there like aggressiveness or inability to meet in the middle or duplicity or just untrustworthiness. Those are the clear ones. But obviously those of us in PM&R actually have the opposite type of qualities of being consistent and transparent, taking risks, admitting your mistakes. So one of the things on the leadership scale in relation to skills is that you have to understand you're going to be in various settings. And as you become more experienced, your administrative leadership is going to vary. You'll have very skilled leaders, you'll have mediocre leaders, and you will have poor administrative leadership. But your job is to make the system work because the only ones that pay the price if it doesn't is the patients. It's not us. It's not the administrators. It's that front line interaction you have. So you have to make it work regardless of the skills and quality of the administrative hospital component, the administrative hospital system. Because if you approach it from that way, then you will have the energy to do it. If you approach it from a them versus us, it's going to be exhausting and no one's going to come out ahead, including the patients. So I think as you self-examine, it's good to watch the people around you and you will see qualities in your peers and your people that are more senior than you that you say, yeah, they kind of had the touch to walk in. They read the room. They had the intuition to do that. They developed the intuition to do that. They listened before they spoke. And those are the type of leaders that will continue to thrive in this very, very challenging and sometimes contentious environment. So I went on a little off-tangent, Kathy, but I'll let you contribute. I'll let you continue. Let me just add one thing to that. And then I have a question for you, Mike. The one thing I do want to bring up at some point here, and again, all of you guys have signed up to learn more about being a leader. So right there. Wow. That's impressive right there. But what I do want to bring up, and I hear this from so many people, and I think it's kind of, it's something that might be more present in PM&R than it is in other specialties, is this whole imposter syndrome thing. Like, I can't be a leader. Sure, the orthopedic surgeon can be a leader, or this person can be a leader, but maybe not me. Yeah, stand back a little bit. If you're feeling that, I think stand back a little bit and say, and really kind of view the people around you. And I think you'll see that leadership, yeah, some people are innate leaders, but a lot of things can be learned because there are leader leaders and there are leaders and there are leaders. I mean, there's, you know, lots of different levels of leaders and there are there are Nobel Prize winning leaders and then there are good solid leaders. So, you know, I think that everybody doesn't have to be like the world's best, but you need to work on developing and having that confidence in in what you are learning that you can take that forward. And that's what one of the things we're hoping to provide for you during this course is those skills to bolster your feeling that, yeah, I can do this. I can be the one who's up front and kind of leading and molding and helping to develop a vision and a mission and a forward motion for the practice you're working with. So let me ask you, Mike, so what to you, what does it mean to be a leader? I mean, what describe what you mean by that? What are the qualities? How do you display that? Yeah, the I think, Kathy, you and I believe very strongly in the concept of servant leadership. Right. You're leading. The people that work with you, you have the privilege, they've given you the privilege of leading this an organization. And they feel that they can trust you. That you'll be reliable. That you will be a good judge in giving a read on a situation that you will listen before you talk and make a decision or judgment. You will gather all sides. You'll take a step back when people are having difficulty meeting in the middle. You'll judge the temperature of a room of an interaction. And then you will, you will give guidance when there's a moment and you see the guidance is needed. And those are those are just skills that, yes, you can definitely learn by seeing other people do it. I know you and I really believe very strongly in the concept of kindness and giving people space because whatever domain they're leading, leading with alongside you at any level, it can be hard. It can be very satisfying because you can really affect patient care immensely. But everybody has opinions. Some people have stronger opinions. Some people like to be very verbose and talkative and insert themselves in front of the group and other people are in the background. And so you have to realize, okay, that's this one's kind of out there and that's good. They have good concepts, but how about asking the person that hasn't said anything in the back corner what their thoughts are on it? Open up the floor to them. There's this whole analysis of who's a better leader, introvert, expert. It doesn't matter. Actually, they're equally good. They can be equally good. They have equally good qualities. But you as the leader of that group have to intuit, how do you bring them into this conversation, into the discussion, into this decision? Because their perspective, everybody's perspective at the table is equally valid, no matter what's going on at the table. And how do you draw that out? So I could probably talk about an hour on that, Kathy, but I have to stop on leadership. Yeah, we're just getting started today. So we have lots of time to talk about this. Yeah. Yeah. All right. Good. So, no, go ahead. No, go ahead. No, you go ahead. Your turn. So I'm going to ask you the complex organization leadership, because you have, you deserve that question. And the organizations that you've worked with are very challenging and very complex. And it's an art to navigate through that as a leader within those large organizations. Yeah. Yeah. Yeah. Well, I'll tell you that that was something that, you know, I thought I knew something about kind of leadership until I took over an academic, as a chair in an institution that was rapidly growing and expanding and changing. And it was a very, very steep learning curve. And I have to say that I certainly reflected on a lot of this to my dean and the president of the university after I got there for a while, because I think that, you know, there's, you need to know the lay of the land. I mean, the first thing you need to do is not do things unless it's a gross emergency. You need to figure out who's who, who's pulling the strings, who's, not only who's pulling the strings in terms of being an administrator at MD, but what secretaries and admins know what the hell's going on? Who are those key people in a big organization? There's always a couple that you just, you just have to know. And the first thing I think to do in a large organization is to spend a lot of time meeting people, talking to them, finding out what they do, how they do it, what can they offer to you, and, you know, and cast your net widely. I mean, because, you know, you don't, you don't know what you don't know, especially when you go to a new institution or new practice or whatnot. So you, you need to spend some time data gathering and just kind of being a sponge. And again, that's particularly the case if you're, if you're dealing with multiple, multiple levels of people, you know, as I was dealing with, you know, academic physicians and nurses and therapists and administrators and business people and marketing and whatnot. And, and the community, you know, what's the community you're serving to? I think that's, that's a big thing to think about. So that data gathering is, is really, really important, I think, to do first. And the other thing that I think was very helpful was being very free about sharing data with other people. You know, so, so bringing my stuff to other people and saying, this is what I have. Can you look at it and tell me what it is that I have here? You know, what should I be doing? What, what's going on? So, you know, really seeking out mentorship from lots of different people. You can't be a good mentor unless, unless you have mentors, you know, unless you've got people who are holding you up, you can't be holding other people up. So that's really, I think, a very important thing. Give yourself a timetable, you know, make sure that you know, how long you're going to be doing data gathering, when you're going to feel capable of starting to make plans and, and be a little bit more hands on and, and how you're going to do that. And I think the other thing that's extremely important is once you kind of get your feet on the ground, and, you know, in a big complex organization, you could be talking three to six months. I mean, you know, finding the bathrooms are the first week or two. And then after that, it's three to six months before. And I'm not joking about finding the bathrooms, by the way, which is, you know, in a giant place sometimes can be really a challenge. But so I think that, you know, once you get through that point, then you need to start thinking about strategic planning. So part of the strategic planning you do is within yourself. Okay, I always have asked all of my faculty members to have their own personal strategic plan that they update and write down and update every year. And you need to do that, I think, as a leader to have your own internal personal strategic plan on where am I going to be in relationship to this organization in this amount of time in a year in three years in five years. And then you have to do that, you have to be able to then bring that process to your leader, your group that you're leading, whether that's an institution, whether that's a practice, whether that's a whether that's a I'm laughing at the chat about the free food. You know, I worked at this place for two years before I found out there was free food. Two years it took me to find a free food. But then you need to, you know, then you're working on on starting to take your whole group in terms of bringing them into a strategic planning process, because I think that's extremely important to to get everybody rowing in the same direction. Make sure everybody's head screwed on straight. We all know what our goals are. We all know what we're striving for. And that, you know, that's an incredible team building effort to do that as well. So once you have your personal internal plan, then you start working on the next step, which is the strategic planning for, you know, the group that you're leading, however big that group is. And that will often require identifying where you have to be really developing strong collaborations and partnerships. And again, in a complex institution, you have to be developing this complex those partnerships, those people that see you as being, you know, part of their enterprise, too. But it takes some time to figure out what those are. And then they'd be constantly turning them. That's why I say you have to do it on a regular basis, because every year things are changing. Every year things are changing. You have to change, too. Does that answer the question? Yes. Very well. Very well. We have a number of questions. Thank you for all submitting. And we promise that if not tonight, during the course of this program, we will answer all of these questions, questions. The one that popped up is a reflection of our experiences. And as you just said, balancing the stakeholders. I think you've answered this question. Community, co-workers, administrators, departments, finance people. And I think you have addressed that, how you need to do that. That is a constant challenge in organizations that we are directors in. Yeah. And I think that, you know, in a big complex organization, if you can find somebody that can hold your hand a little bit, that's not only be a mentor, but be a parent. You know, and I was lucky enough, for instance, you know, when I first started and I was going to like interview and go to hire my first faculty member, I realized I didn't know how to do that. I had no clue. I mean, literally, that day I was going to do it. And I thought, oh, my God, I don't know how to do this. And so I was on the phone then to the chair of surgery, the chair of neurology to say, how the hell do you do this? How do you guys do this? And they were wonderful. I mean, I was amazing how people dropped everything and either rushed to my office or I rushed to their office and I got a crash course in how do you hire faculty? Literally, how do you sit down and negotiate that and hire them? So, you know, fortunately, I had met with all of them before I knew them. I knew who I could kind of count on to admit that I didn't know anything about this and would be gracious and kind. And so, you know, that's one of the, I guess, embarrassing things that happened to me on my kind of leadership curve. There are other things, too. I mean, there are, you know, I think that there are other things that happen that are particularly challenging when you're going into a leadership mode. And one is admitting when you're wrong and how do you do that? When you make a mistake, you make an error. And that's maybe a little bit far down the course here. But in terms of behavior, it's something you have to think about because, you know, it's modeling. What do you do when you really stuck your foot in it? And I certainly have done that. I mean, I did something behaviorally that was just terrible in front of a large portion of my team and was just bad. And what possessed me? I can't tell you. But, you know, fortunately for me, some managers below me felt comfortable in coming to me and saying, geez, you screwed up, man. What were you thinking? And I said, you're right. I don't know what I was thinking. And, you know, the way that I ended up handling that, and I have seen this done, and it's advice I've given to someone else that worked very well too, is, you know, first of all, I apologized to the person in question. And the second thing was I apologized in front of everyone and let them know that I realized that that was wrong, why it was wrong, and how that would never happen again. And it allowed everybody to feel like they could trust me to say I was wrong and that I was going to move forward. And I was able to actually help a few people in their careers do this very thing. And it's amazing how it changes the tenor of the room when you're able to admit you're wrong, why you're wrong, and what you're going to do about it. And it just, everybody says, okay, we can relax. She really does have our back. So. So presently, thinking about this whole, how do you work with all the stakeholders? And I've been thinking on this question. So if I look at what I do now, I work with stakeholders that own and operate and lead hospital systems. I work with stakeholders that create a physician's, PM&R physician's practice, and it's a national organization. So we work at all levels nationally. And then I'm the medical director of a hospital in my community. So I have all these different levels of interaction now. So one of the, one of the biggest lessons that I have learned is that you need to find allies at any level of stakeholders that you find yourself in those circles, because there are people that you can trust. They can trust you. They're smart, knowledgeable people. They feel the same with you. They're there when you need them, and you're there when they need you. And that can help modulate some of the challenges and the conflicts, subtle and overt that happens at all the levels in a healthcare organization, every single level from the top down. And a lot of it is dealing with ambiguity, right? Ambiguity 101, and realizing that not everything's going to be perfect. And my personal desire is everybody should do the best job they can, and it may not be perfect. But when you get all, this is the story I tell our staff in US Physiatry. I said, listen, when we started this organization, every single one of you is like a rock with a lot of spikes on it, like really sharp and spikes that will injure you slightly. And then we all were put in this huge rock blender. And then we had to learn each other's points that was a little, irritating and or their high points and their low points. And we had to work together. You press the button on the blender. And then after a period of working together, everybody smooths out each other's work abilities, qualities, so that we're getting the job done. And you turn the blender off and all the rocks are smooth. So, and they're like, oh, I said, yeah, we're going to have some conflicts. You're going to have some disagreements. You're going to have different ways of getting there. But in the end, in order to move the mission forward, it has to happen that way to the best of everybody's ability. So when I think of, you know, how do we all navigate this, all the stakeholders? I think it was a great question because there's so many in PM&R. You just need to stand your place, do what you do well, try to help the people around you. They'll know when you're helping them try to always be on their, on their side. Let me ask you a question though, Mike. So, so say you're, you join an organization, you're in an organization that has some real issues. I mean, they're just not functioning real well. Some maybe other poor leadership or whatever. And how do you work between being a micromanager, which everybody is, and being like loosey goosey so that anything happens, which is what has been happening, right? At some of these places, nobody's running anything. So how do you go between the not running anything and letting everything just kind of implode or being a micromanager? I mean, I think, you know, that's really, it happens all the time. At least those situations you find yourself in. But I really think the best way to handle that is once you know what people are good at, because everybody's not good at everything. Like, let's say Sam is really good at getting people into the organization on a provider base, of showing them the way, but not so good at strategic planning. You know, Joe is good at strategic planning, but not so good at innovation. So it's a matter of identifying, if I were leading that situation, which is, you know, all of you will lead in that situation in some capacity, it's really a matter of finding what people do best, get them pointed at that direction. And, you know, it's just gonna have to be, you know, if you're great at innovation, then we're gonna let you run with it. If you're great at getting doctors into the organization, we're gonna let you run with that, but we're not gonna let you innovate. And we're not gonna let your strategic plan because people have different strengths and different affinities. And I think that's really hard, but that's really the only way I've seen that it can be done in an organization. And some people are gonna be disappointed they don't get to do what they think they can do because they can't. Yeah, yeah, yeah, yeah. Okay, it's interesting. I mean, I've certainly had the experience of having a group of people that, again, none of them knew that they knew how to do things. And I think it actually took a small period of planned micromanagement to model what should be going on and then withdraw. So, you know, I've had at least, I can think of one really clear opportunity where I kind of had to do that. Not that I wanted to do that, but it didn't, nothing was happening. And then with the modeling, I was just able to withdraw and boom, boom. It was just the people who had those skills could just felt like they could rise up and take over that. I see that, okay, all right, all right, you know? So, I think sometimes, you know, it's really that modeling. But you would be a great micromanager because you can step in and step out, right? It's a step in and step out. That's the thing, it has to be planned. And an exit, you have to plan and then plan an exit. I think you really will drive yourself into the ground. And this is another question, if you don't have that exit. And in fact, Mike, I'm gonna ask you this question because we've got a little time left here and I'm kind of curious to hear what you have to say. How do you, so you move into a leadership position, medical director, and you're doing all of this stuff and how do you balance your life? How do you balance your clinical responsibilities, your leadership responsibilities, your institutional or practice responsibilities, your financial, your spiritual, the rest of your growth? How do you balance that out? Well, see, here's where I have to divulge if I follow the advice that I give. So I do a lot of resident lectures on more of the business side of medicine but it also includes work-life balance and spirituality. How do you get there? And what I tell them is like, you all are busy now in residency, right? Or because they're just finishing, they're in their training in some capacity or fellowship. I said, what you need to understand is life is going to be equally busy as a doctor forever and you will need to be able to manage your time with your work, what you wanna do, what you like to do, what you need to do with your family because you love them, what you need to do with your pets because you love them, what you need to do with your sports if you wanna play pickleball and tennis and golf, you're going to have an ebb and flow of what you can do when, sometimes you can do more of one and other times you can do more of another but you can't do it all. And you just might as well realize that stepping in, if you're waiting for life to be balanced as you go forward, it's not gonna be balanced unless you balance it and there's always gonna be trade-offs. So I guess that's my long and short answer to that because you and I know that's true. I mean, there's never been balance in my life. I, and I, I, you know, when people ask me that, it's like, I don't know what that is because, you know, I mean, balance means that things are changing. I mean, if you're, if you have a balance, balance, balance is, even if you have pretty good weight on each side, you still get a little bit of tilt back and forth. And, you know, it doesn't take much to tilt things back and forth. And, and, and, you know, I think it's, it's, it's having that acceptance that it's okay. And it's okay as long as you're communicating well too. I mean, I think if, as long as you're, you're keeping yourself healthy, but as long as you're communicating well to the people that you're working with that, you know, I will need to be doing this and you will see my notice in my email that I'm doing this. And unless it's truly an emergency, don't call me. Or you may have to tell your family that I am really going to be working on this. Leave me alone this Saturday because I've got to get this done. And, and, you know, it goes back and forth and back and forth. And, you know, as I've managed, you know, my three children still talk to me and, you know, so it's okay. I think it's going well. I'm still married. 45 years this week. So, yeah, yeah. So I think, you know, I think someone once told me that the more you love, the more you have to love, the more love you can produce. So, you know, I think that in some ways you have to look at that with, that's why it's very important to be me, to be mindful of your career and of your leadership role and of where you're going so that you could feel that love, to be mindful. Then there's love there. And it's not just being beat down. And if you find yourself in that position where you're feeling beat down, you have to take a step back and say, where's the love leaking out? Like, where can I patch this little love bubble I have? Because I, you know, again, I think that's what keeps us all in this and what keeps, what makes a wonderful leader is somebody who loves what they're doing. And, you know, that's when we talk about spirituality at these presentations, I kind of get a little feeling of tenseness in the crowd because they don't have any expectations around going with that. But, you know, I say, listen, the bottom line is try to identify what you love to do. It's very hard. It's easy to say that. And realize what you love to do is going to fluctuate over the course of your career. It's never going to be 100% spasticity management. It's never going to be 100% brain injury. It's going to fluctuate. And then you'll gravitate to something that does really resonate with you as a physician and what's in your heart as a physician. And to me, once you reach that point where you can pull yourself into that type of work, no matter what happens around you, that's why you get up in the morning and do what you do. And everything else you can't necessarily control around it. But that doesn't come on day two. No. No, that's for sure. I'm sure it comes on day 1,000. It takes, you know, it takes at every step that you are. I think it's being, like I said, I think mindfulness is the key to me in forging your way into a medical directorship or leadership position is that mindfulness. Because it'll keep you from, keep your feet on the ground, keep you from losing those pieces that are really meaningful to you. And will, you know, kind of keep your heart light and where it's supposed to be. And, you know, I always loved the idea of the happy warrior, you know, the person that goes out there and is doing battle with, you know, the administration or the insurers or the, you know, whoever, but they're doing it with a happy heart because they know why they're doing it. They have meaning behind what they're doing. And so it's not so much, you know, it's not a negative thing. That takes some work, takes some work. I want you to comment on, because we've also had this discussion before, personal branding and what your journey has been through the initial introduction of that concept to how you feel about it now. You know, I thought that that was just weird as hell when I first heard about the whole business of personal branding. It's like, what are you talking about? It's like, I don't, I'm not a brand. I don't need to brand myself. But I have to say, the more I thought about it over the years, some years now, you do have, it's kind of knowing yourself and knowing who you are so you can advertise yourself appropriately. I mean, you know, I don't mean this in the way of marketing or advertising, but kind of like sort of what your leadership profile is and what your, and when I say leadership, I include in that all the clinical and the other stuff, because to me, that was all, you know, kind of bound in, maybe not when I first started, but very quickly became to be bound in the concept of leadership. So it's understanding what your profile is and what you want people to see from you. So, you know, thinking about how you want to be. Conceived of by other people. So, you know, there are, you can do that in a number of ways. I mean, obviously your communication is very important. Communication style, your willingness to be transparent and communicate is one thing that helps or doesn't help, depending on how you want to present yourself. You know, I've always, and I know people think this is ridiculous, but I'm sorry, what you wear has something to do with what people see. And I'm not, people don't have to be like fancy dress, but, you know, people look at you and they'll think, I trust that person, or that person should have combed their hair this morning, or, you know, and I always found that difficult with residents, because I thought I was just being an old fuddy-duddy, but the fact is your patients look at you. And so do the people you're working with, your collaborators, your, I don't want to call them enemies, your, what should I call them? Your people with whom you have interest, but you may have conflicting interests. You know, you want them to be able to look at you and say, there's a competent person that I'm dealing with. So I do think that at a certain level, there's communication between your gestures, how you hold yourself, how you dress, and how you present yourself in other places. You know, I actually did start us on things like Twitter and Instagram, my department, because I felt that people needed to know how we saw ourself. And that was one way to do it, was to kind of put yourself out there the way you wanted to be seen. And so, you know, Mike, I don't know if I'm answering that question. What would you say to that? It's an interesting question. Yeah, it is an interesting question. And I was hoping you'd give me the answer for that as my mentor. And speaking of- Do let me talk about mentorship. I learned how to run meetings by watching Dr. Lupinacci run the AAPM in our board meetings. He is amazing. He's one of the people from whom I learned how to run a meeting. So anyway. So speaking of mentorship, we've had a number of queries on the chat about mentorship opportunities, even within the program, how they will spring from this program. And I want all the physicians here to understand that that is great feedback for us because we have built this program, but it's very flexible. We can build around the concepts of leadership, how do we identify a mentor. I'm very, very big on mentorship and I do a lot of mentorship via text and phone to the other docs in my practice, new medical directors, things happening at facilities where administration kind of goes wonky. And it is really helpful to have a peer to be able to talk about it. Kathy and I feel very strongly about that. So thanks for that feedback. We'll work something out where you have some really solid opportunities for that. And the other thing that's come through on questions is the ability, Patrick in Arizona, the ability to be more confident in medical directorship and to build skills. We're going to get a lot of skills training in this course that we've never had in a PM&R presentation before for medical directorship. But thank you for that feedback. Kathy and I are in a position to incorporate that feedback as we move forward through the rest of this course. Yeah. So I guess we have a few minutes left and I guess I'm wondering, does anybody want to throw something out there that they want to make sure we absolutely do not miss in this course because it's so crucial or something other learning thing that we need to talk about today? Hey, we've gotten a lot of comments on what they'd like to see. So this is great. Thank you all very much. And you definitely are our future leaders. I love it. I love it. Well, future and current. I mean, we have some like current folks here who are like in leadership positions that we are going to milk them for all their worth for this program. Don't think you're going to get away without sharing your expertise and your thoughts. And you're right. I think that there may be some opportunities to set up some dyads or triads here to kind of work with each other on skill development. Yeah. Another of the questions was on, you know, dealing with contentious administration, people that were kind of retaliatory and that type of environment, which does exist. It does exist. And, but again, these are things we can build into the program because that in and of itself is a very important and unfortunately an intermittently needed skillset, even in stable institutions, stable institutions. Right. Oh yeah. I mean, you know, how do you deal with other leaders who don't want you around? Yeah, that happens. Yes. That's why I said you need to choose allies because there will be the opposite of allies floating around. For sure. And oh, we're really nice in PM&R. We weren't just born yesterday. So. Yeah. Yep, yep. Yep. All right. Well, thank you all for, yeah, we're just about there for your participation tonight. We feel very honored that you're all joining us. I think Kathy and I feel very hopeful about the future of leadership in PM&R having interacted with you to this point in time. And we are very, we will stand forward and say this course will help get you on the right trajectory. And we'll be meeting next week. We'll be going over all of your input to make sure that everything gets addressed one way or another. So thank you so much for sharing your goals and being here and it's so exciting. Yeah. And we'll be communicating with you as we finalize all the details of the ongoing virtual course. And again, thanks so much for your time. Thanks, Kathy Bell. I love working with you always. And we're gonna make this worth your while, you're in time. Thank you so much. Good night all. Have a good evening. Take care. Bye-bye.

medical leadership

PM&R

Kathy Bell

Mike Lupinacci

servant leadership

strategic planning

mentoring

healthcare structures

personal branding