All right, welcome everybody, appreciate you coming out on a Saturday morning. Hopefully everybody had a good time at the reception last night, if you could make it, but we're glad to have you here. I'm John Alm, I'm chair for the University of West Virginia, and I have the privilege to talk to you about physiatric leadership. One of the things that we wanted to bring to the table is to give you ideas and potential pathways for leadership opportunities through your career. You know, coming through academic environments, a lot of times we see typical pathways, but we as physiatrists, we have that special skill where we operate in multidisciplinary teams. And so some of that is kind of open your eyes and that skill set that we kind of take for granted really sets us up for opportunities to be leaders in health care industry, health care systems, and even other areas. So that's going to be a big part of the topic today. I'm going to give kind of a good 10 minute just overview, and then we've got a couple good speakers to talk about their paths to their leadership positions that they've taken so you can see what may work for you or what you're thinking about in your own careers. No financial disclosures, objectives, so again, talking about different leadership paths moving forward, some how you can transition from a clinical practice to more of a leadership practice or administrative role. Looking at some of the competencies that you're going to need. There's skill sets from financial to leadership to communication skills. So again, try and harness these throughout your career so that you can make those next steps. Also, looking at the challenges of being a leader in health care because we know it's a challenging industry. There's a lot of complexity to it, and so we want to address some of that. And then how do you collaborate? So again, we as physiatrists, naturally through training, going back to when we were residents, we were ingrained in multidisciplinary types of teams, but now we need to look at that at a system level and how you integrate and use those skills that you had and go beyond that. So again, pathways, you have kind of your academic areas, department chair, service line leaders, maybe medical director of an inpatient unit, maybe director of a cancer rehabilitation unit. So those we tend to know about, but then we're getting into chief medical officer roles. So now you are in charge of not just your specialty, but looking at other opportunities. And then again, back to some of the academics where you can be a program director or go the route of being a dean or a chancellor, you know, climbing through academia throughout your careers. But then we're going to get a little bit out of there. And so getting into health care policy and advocacy, you know, these are also things that we as physiatrists do naturally. We have a lot of challenges where we're trying to get things done for our patients. We have patients with high needs, but those are skill sets that are starting to prepare you for other avenues of leadership throughout your careers. Looking to health system executive positions, looking at C-suite positions, how you can shape policy, improve quality, delivery of health care. So again, looking at those opportunities where you think you can benefit your own health system. Entrepreneurship. We see this a lot in industry. There's collaborations you can do with industry, and in some cases, you have people that will leave clinical practice to go to be entrepreneurs. You know, there's a lot of industry right now where we're talking about AI programs, you know, VR, AR technology, and delivering telehealth communications. So again, there's a lot of this where they're going to rely on physicians and how to do that. And so there are opportunities moving forward. And even within a health system, you can be the chief innovation officer. You know, we're seeing a lot, I know right now, a lot of AI, especially in like dictation programs, you know, bringing these programs to your health system. These are opportunities for you to kind of take a hold and move your career forward. Quality improvement, always very important. Patient safety officers. So these are roles where, again, taking the skills that you have and applying that to a health system standpoint. And again, sometimes these are pathways to higher levels down the road. So that transition to leadership. Some of it is you do have to seek out the opportunities. You kind of have to set yourself up for success, whether that's enrolling in leadership courses, getting an MHA, an MBA, you know, these are things that you want to have getting beyond just your clinical and your medical degrees, but looking at it from a business aspect. So again, you want to have these opportunities, but you've got to build some of that structure behind it when you're applying for those types of positions. Finding a mentor is also very important. Again, a lot of times we get so tracked in academia in a lot of cases, hey, this is what you should do. This is the type of care we deliver. Oh, sorry. And then, but now if you're going to get out of that realm, try to find a mentor that you may want to mimic throughout your career and find that path. Because again, you don't need to necessarily reinvent the wheel, but listen to somebody who's gone through that process to help you out. Build a network as well. So this is paramount in any leadership position. You can't do it on your own. You know, the big difference from being a clinical or just a clinician where you're doing the work, being a leader requires you to be involved with other people and you can't do that alone. So you need to start building your network. But as you continue to build your career, those networks and those friends are also going to help you and guide you in different ways. Again, developing key leadership skills, so emotional intelligence, communication. You've got to be able to develop plans. You've got to be able to communicate that plan, but you've also got to understand people. And so again, skill sets that if you don't innately have, try to recognize that. And if somebody says that to you, whether they're a mentor or a friend or somebody within your network, again, these are not necessarily negative criticisms, but be open to that so you can make yourself better and improve yourself moving forward. And take on leadership roles. And so one of the challenges too is you're going to have to volunteer some time. It's not every leadership role you take is going to be paid. So some of that is you're building stepping stones moving forward. You're gaining experience. So whenever you have an opportunity to take on a leadership role of any type, try to grab onto it because that's going to help you moving down the road. And also, it's good to be the person that can be counted on because those are the people that are asked to take that next step. So again, when those opportunities come about, really try to grab onto them as much as possible. And in some cases, if you're earlier in your career or maybe you're still in training, find opportunities to shadow. You don't necessarily have to be on a role, but find that mentor and say, can I spend a day with you? Can I spend an afternoon with you? I'd like to learn more about what you do behind the scenes. So you can figure out, is that something you want to do? What skill sets are you still needing to develop and cultivate in order to take that next step? You need to understand the healthcare landscape. And so again, if you're going to start taking these next steps, be involved. You got to get out of just reading our normal medical journals. Be involved and read Becker's Health. That's an easy one. Being aware of what the market is doing. For Dr. Finoff, he's already looking at the next quad. I'm sure plans he's doing right now is looking at LA. And so you need to be able to figure out the long-term goals of what you want to develop and where those markets are going. So again, you've got to understand that even beyond just your health system level, but looking at a state level and a federal level so that you can make strategic plans moving forward. And you've got to embrace change. Healthcare is an industry. It's a business. And we know that any business that is stagnant is not going to survive. We're constantly changing and evolving. And if you want to be that leader, you need to be able to embrace those changes. And so again, whether that's technology, whether that's finances, you need to be able to understand that to a degree. You don't have to be the expert at it, but you need to be able to communicate information. So again, having some foundational knowledge of those areas is going to be paramount for your success. And team building. So again, trying to gather that network, see who's going to be on your team. Because again, as you climb through leadership opportunities, there's going to be tasks that are given to you, challenges. Maybe you're given an assignment. And again, you don't want to be the person that has to do it on your own because you're probably not going to be the expert in it. But if you can surround yourself with a good network and a good team that's successful, that will help drive your overall team success. I'll leave this. The slides will be there. I don't want to get too heavy into it. But again, shifting from a contributor in a clinician setting to being a leader. So again, some of those things, like I said, from developing your team and your network. Got to get some management training. There are some people that seem like they're natural leaders, but even natural leaders have had some form of training. Because being able to communicate, being able to strategically plan with a team, with other members within a health system, you've got to have the skill set to do it. So again, seek out training opportunities. And the hard time is balancing time. Your clinical duties are still going to be there while you're trying to advance your career. So again, those administrative duties and your clinical duties, don't over-task yourself as you're trying to make opportunities for yourself. Because again, you don't want to stretch yourself so thin that you're not good at anything. And so again, be mindful of your time. Be realistic in it. I think it's a common phrase where we say, my bandwidth is full. But you need to recognize where your limits are. And so when you know, you need to get help. And so again, that's where having a good team and a good network comes into play. Being able to look at resistance to change. Again, if you're staying and keeping up to date with healthcare changes, some of these changes and ideas that you may look as being a good idea, you may find resistance. So again, being able to communicate that, that's going to be very important. And then how you can go about changing sometimes cultures to make these changes acceptable. Because again, everybody has some tendency to resist change. Because if it seems like it's going well, even if they don't know what the market's going to look like in a year, five years, if you're looking down that road, but today it looks fine, sometimes it's very hard to make those changes. And then again, navigating organizational policies and politics. Again, having a good network. Being able to know who you can count on within your system. You're going to have to develop that as much as possible. Kind of went over some of the emotional intelligence. Again, the financial acumen. You've got to be able to read it. You don't need to be the CFO. You don't need to know how to do everything. But again, if you can't read a spreadsheet and you're going to try to step up to a leadership role, you're going to have a hard time understanding what people are telling you. So again, gaining some of that financial knowledge. The other part is, always maintain your clinical competencies. If you're going to be a leader, you can't be the person that's the lowest person on the totem pole from a clinical aspect. You still need to represent yourself in a very positive way. You're keeping up to date with medical changes and being that good clinician. Because as a leader, you don't have to necessarily be the best, but you're still going to serve as a role model for others. So again, try to stay up to date as much as possible. This is kind of just going over everything. But again, looking at degrees to move on forward with. Leadership training. Those networks. Getting mentors. Kind of build up your surrounding team. People you can count on to help you when you're going to need help. And vice versa. They may need help. But you want to be that person that they can depend on as well, because that's part of that overall team. Take on leadership roles. There's a lot of volunteering that happens as you try to climb a ladder. You're going to have times where you're going to be working extra hours and not necessarily be compensated for it. But again, having a vision of where you want that career to go to, so you're not spreading yourself too thin. And we'll hand off here. And we'll actually go to Dr. Arnold. I'm sorry. Okay. Great. So I'm not going to introduce like you normally do, because what I'm having our speakers talk about is themselves. So I want them to be able to tell their own story. So welcome, Dr. Arnold. Thank you. Thanks, John. It's a pleasure to be here this morning. All right. Let me make sure I have the technology managed. All right. So let me introduce myself to you. My name is Michelle Arnold. And I currently serve as the chief medical officer of a hospital in Grand Junction, Colorado, part of the Intermountain Health System. And I'm going to talk to you about life in the C-suite. I've had a number of different physician executive roles, from VP of a medical group to CMIO to executive medical director to chief medical officer in various aspects of clinic and hospital care. And so I'm going to talk to you kind of about organizational leadership and why we as physiatrists are uniquely, we're uniquely positioned to be in this role. And anyone who's watched Glockenflecken knows that he's got a great administrator hat that he wears in his TikTok videos. And so I don't have disclosures other than it's up to you to determine whether me as now a hospital administrator has or has not moved to the dark side. So this is my leadership journey. I started in Texas. I came from blue-collar workers, first college graduate of my family. I didn't know I could leave the state, so I stayed there for undergrad and medical school and residency. And then I took a gig in the middle of nowhere in Nebraska because they paid off my loans. They were good to me, but that's where I met a mentor. And we'll get to that momentarily. It was a pivotal change in my career trajectory. Then went out to Seattle, spent almost a decade there. Went back, got my MBA while I was in Seattle, and then transitioned to where I am now in Grand Junction. Beautiful Grand Junction, Colorado, which is getting snow this weekend, and ski season is upon us. I also should disclose that I have a bad habit of collecting board certifications, and I apparently am just bored because I've kind of practiced in each of these areas through parts of my career, and I love all of them. So you have that. Our objectives are going to be to give you some stepping stones from where you are now to various leadership opportunities, and I want to kind of dispel some misconceptions about them, you know, the admins. We're going to talk about a few physician executive roles. I'm going to give you a day in the life of a CEO and CMO so you know kind of what it looks like, and I'm going to tell you why physiatry is uniquely positioned to lead in the C-suite. So this is a depiction of a C-suite journey, and this is kind of the classic pathway where you kind of start and you climb the ladder, right? And climbing the ladder is one such path. But I'm going to give you a little different path. And so these are the stepping stones, awareness, volunteering, stargazing, networking, investing, knowing yourself, and then giving back. So let's go here. Perhaps you've had a leadership call of your own, and you're ready to respond. That may be why you're here right now. Or like me, you got dumped off the boat here onto the beach, straight out of residency. You're spit out on the beach, and you start running up the beach in the war zone, right? And that's what I did for many years, and I found myself just running up the beach, you know, head toward the sand, just running up the beach. And when I got up the beach, I looked around, and all of a sudden I was in leadership. And I didn't quite know how I got there. It was a bit of a trial by fire. And so I call it like leadership by Normandy, but that's probably a misconception. Because no matter where you are in your leadership journey, this is now the perfect time to stop and look around and ask yourself, where do I want to be in three to five years? Because you've been on a boat, and you're just on the journey, or on the train, right? That's how it goes from kindergarten through the end of your residency. You're on a path. And then you get spat out, and you have choice. And so in three to five years, where do you see yourself? Sounds like an interview question. But if you don't know where you're headed, how do you point yourself in that direction? So clinical roles change. Leadership roles change. And the last thing I want you to do is get swept up the beach. So ask yourself where you want to go, and point yourself in that direction. So I want to give homage to the guy who pointed me in the right direction and scooped me up off the beach. So this is Dr. Todd Sorenson. And it would seem that I arrived at leadership by accident, but I didn't. He was the one who looked at me in an executive meeting shortly after I was recruited and sat across from me and said, Dr. Arnold, have you thought about being a physician executive? And I said, a what? Right? Like, what's that? And so I'm going to look at you, because we're going to check a box here. We're going to check the awareness box. You're already on stepping stone number one. So have any of you thought about being a physician executive? Nice. OK. Some of you probably are. How many of you are already? Yeah. Great. OK. All right. Step number two requires an investment of time, but not money. So I feel like volunteering is a great place to get your feet wet. So there are a lot of volunteer opportunities. You might have opportunities to volunteer in your clinic, be a leader, volunteer in your hospital. You could run for department chair and get voted as department chair or sit on your board, be part of your board of directors. Or there are tons of volunteer opportunities right here at AAPM&R. There are committees that you could participate in and just sit and watch and learn. And then I would encourage you to chair them, and you learn in each of these steps. And it's absolutely free leadership training here. And you can dabble in it and decide, well, do I actually like this? And you also get the chance to look around and see role models in various opportunities. So volunteer. Step number two. Step number three is stargaze. And I like this term because there are north stars that you're going to run across in your career who inspire you. And they have traits and characteristics and habits and behaviors that you want to emulate. And I've had a number through my career, and I honor them with their photo here because they have shaped who I am. They've asked hard questions of me. They've pointed out things that I'm doing that stymie my own leadership journey. And they've helped mold me. Really important to have north stars. But the people who aren't pictured are the south stars. And I've had a lot of south stars in my career, and you have too, and I've learned a lot from my south stars. The people who have habits that I do not wish to emulate, the people whose behaviors are things I do not wish to carry forward, and those are the things I don't want to be to my team. And I've probably learned more from them than I've learned from my north stars. And so everyone is here to teach us something, right? And so learn from your south stars and your north stars. And then number four is networking, and this may be easy for some of you, but it was not easy for me, and I felt like networking was kind of schmoozing or, you know, like playing a manipulative role, but everyone is here to teach you, and so networking is part of connecting to others, not so that they can give you a hand up, but so you can support one another, you can support them, and they can support you. And networking within your own circle of influence, whether it's your clinic or your hospital or your professional association, your community, those are all important areas to make connections, because you do come together in times of crisis, and you'll want to have those network connections fully formed. They really will help sustain you during difficult times. All right, so number five is invest. So invest in leadership training or even an advanced degree. So your professional associations, AAPMNR is one of those. We also have AAPL and the American College of Healthcare Executives, and I've listed them here. AAPMNR has a leadership program where they have expert program facilitators that take participants through a two-year curriculum and introduce them to association leadership. So you get to learn how the AAPMNR works and how you support a large not-for-profit organization, which is awesome. You learn strategic planning, you learn media skills, advocacy, the governance of the AAPMNR, you learn the products and the services, and that curriculum combines these facilitated sessions with reading assignments, peer discussion, and mentorship, which is amazing. And I'm honored to have gone through the inaugural group. It's a great program. It's free of charge. It requires an investment of your time. You don't get a degree, but you get to network, you get to meet some North Stars, and you get skills that you wouldn't have otherwise. So if you're in the first 10 years of having completed residency or fellowship, check this out. This might be an opportunity for you to apply to. And then I'll just give a plug for the AAPL, the American Association for Physician Leadership. This is a separate organization that has a sizable due cost every year, but they have basically a CPE, or a Certified Physician Executive Program, which is kind of a credential that you can add that provides like a mini-MBA-type program, but they also provide preparatory programs that could let you transition into an MBA, an MMM, which is a Master's of Medical Management. And they have a means that you can skip the GRE, so you don't have to take that before going for your Master's degree. So that might be another opportunity for you to check out. Okay, so we talked about awareness, volunteering, stargazing, networking, and investing. And now I'm going to go to know thyself. And I know this feels a little fluffy, but this is probably one of the most important steps that I had ignored all along. And I think if you're coming through medical education and you get plugged into your clinic or your hospital, you're surrounded by people who tell you who you're supposed to be and where you're supposed to go and walk and how you're supposed to behave. But I think at some point, it behooves each of us to sit down and ask ourselves who we are and what we stand for and what our values are. So what is your why? What authentically motivates you? What personality traits or characteristics define you? What are your values? What are your fundamental beliefs? What are your guiding principles? And what do you bring to the roles that you serve in? And I don't think that many of us stop long enough to sit down and reflect on these things, but it's really important because organizational leadership has its own set of values. You've probably seen mission, vision, values. Most organizations define those for you, and you want to make sure that your values fit with the values of the organization that you're a part of. Otherwise, you're going to have conflict. So it took me years to get to the point where I knew who I was and what I brought. And I've defined my values. There's a process that you go through in a lot of leadership programs where they help you refine your values. So you've got a list of, I don't know, 100 values on a page from integrity to teaming to authenticity, and you basically hone down the things that really at your core drive your decision-making. And I know this sounds really weird, but it's something that you can kind of reach back to when you have to make a difficult decision. So my two main top values are fire, which is warmth in the cold, light in the dark, and spark. Fire, right? Anybody who knows me is like, oh, yeah, Michelle Arnold, yeah, she's fire. So fire. And the other one is resonance. And resonance is hard to describe. It's a combination of things. You know that THX theme at the beginning of movies where it's got like this dissonant song and then it like comes together and it's like a thousand points of light aligning in a single point. It's like order and maybe a little spirituality and purpose, resonance. And I have found that I can reach back to those two values, and when I have to make a tough decision, that's how I approach decision-making. I know that sounds really fluffy, but yeah. Okay. And then the last step on the stepping stone is giving back. So leadership isn't about crowns or thrones. It's about mops and brooms, right? It's servant leadership. And so giving back to the people who have to work in the organization you're leading, that you're there alongside them, and that you're joining in the collective purpose of your organization. That's the giving back part. So it's constantly learning, continual curiosity, teaming, partnering. It's seeing the unseen and hearing those who never get heard. That's leadership. Okay. So let's dispel a few misconceptions. So what we have depicted here is the number cruncher, the bean counter there on the left, and then there's like this banker in some game of like bizarro monopoly, right? So you probably look at hospital administration and think they're just a bunch of bean counters. They only care about the bottom dollar. And while I have to be accountable for finance, let me tell you that administrative leaders know that the patient is at the center of everything we do. And when it comes to managing our finances, it's about sustainability. It's not about revenue or profit or shareholders, right? It's about making sure that we distribute the limited resources that we have the best we can so that everyone has what they need to do their job and we reach the most patients that we can. It's a difficult job when there are competing initiatives. So in the organizational chart, like very few people actually report up to me, but yet I have to manage, I think I manage about somewhere between 10 and $12 million in contracts that are part of our call agreements and transfer agreements and whatnot. And so I have to be sustainable and I have to be accountable. And sometimes at the physician end, that feels like, well, why can't you pay me more? Because I have to make sure that there's equity in the way we share the resources that we have, especially when they're limited. So that brings us to this, administrative values sometimes clash with physician values and that's usually what drives most of the conflict that we have. And let's be honest, from a physician standpoint, I care as a clinician how much you pay me for the work that I do. I'm bringing valuable work, right? I take good care of patients, I have good outcomes, I have good experience scores, and so my compensation matters to me. And for those of us on a production comp model, we probably know what our work RVUs are. And so that drives behavior for a lot of physicians, whereas the administrators might be more focused on do we have enough revenue to cover our cost? And how do we reduce the overall cost of care so that we can be good partners with our payers? Because Medicare dollars are not expanding. And I think we're all feeling the pain of this. Every year, those reimbursements get smaller and smaller. And so we need to make sure that we distribute things appropriately. But when it comes time to come to the table, when one person is focused on their production and their compensation and the other is focused on sustainability, that can create some conflict. But they're both coming from a good place, so it's not about good guy, bad guy, or us versus them. We can come together and find commonality. And then there's the values mismatch. So most physicians care about what's happening with their individual patient, the one across from them in the clinic or in the bed. Whereas a lot of administrators are focusing on the overall population and the community as a whole. And sometimes that creates a little bit of a different lens that leads to conflict. And similarly, I have physicians that come to me and say, this is a real safety problem, and yet we also have these limited resources. So I could make every patient nursing ratio one-on-one. And I bet we would have no falls in our hospital if we had one-to-one nursing. But I don't have the stewardship responsibility and that deep bench of resources. So sometimes these things have to balance. And we have to make sure that we deliver on safety, but also that sustainability and stewardship. So when you have a conflict with your administrators, I want you to think about what values they're bringing to the table so that you can understand maybe what their perspective is. And it's okay for you to speak to your values as well so that they understand your perspective. Okay. So let's talk about workload. I'm gonna tell you a tale of two kinds of workers. They're at the bottom. Does anybody recognize the screenshot, this guy in the teal shirt at the bottom? Anybody? Okay. You wanna speak up? Yes, Kevin Wachtell is his name. Nice. So if any of you have watched this show, so who is Kevin Wachtell? He's a man of great wealth and power who spends more time on the golf course than he does in the boardroom. He's done his time. He's earned his keep. And now he gets to sit back and earn his reward. And we call this type of worker a golfer. So there's golfers. And then there's another type of worker which I call toilers. And I'm curious if anyone... Probably nobody recognizes the photo at the top. Anyone? Go ahead. Hadestown. Hadestown. Oh, my goodness. I'm so impressed. Thank you. So Hadestown is a Broadway production. And it's a very interesting commentary on the worker as a slave. And there's this song that they sing which is dark, gloomy, and industrial in Hadestown. And these workers are enslaved by Hades because they've sold their soul to Hades who works them in the factory. And they sing this song called Why We Build the Wall. And we build the wall to keep us free. That's why we build the wall. And the wall keeps out our enemy. And the enemy is poverty. And we build the wall to keep out poverty. And to keep out other people who... What should they want that we have? We have a wall to work upon. That's what we have. And the work is never done. And we build the wall to keep us free. To keep out poverty. It's a very interesting song. I see the smiling back here. So toilers, right? How many of you feel like toilers? Oh, yeah. Right? I do. How many of you feel like golfers? Nice! Oh, that fits Andy. Andy's a golfer. Okay. So there's golfers and there's toilers. And where do you think the executive is? Is the executive a golfer or a toiler? You might think... Now, save a few of them. I'm gonna maybe let you decide whether you think your executive is a golfer or a toiler. And I'll get you through a day in the life of a hospital CEO. So there was an article published after a survey of CEOs, hospital CEOs. They work an average of 57.8 hours a week and about two and a half hours on a weekend. They get about six and a half hours of sleep most nights. They spend their day in meetings with executives, with finance, with various departments, working on operations, working on legal. They sit with the board of directors. They work on mergers and acquisitions and strategy. They do rounds in the hospital, the good ones. They attend community events. They're a pillar of their community. They invest in their own community. And then when they do get some alone time, they spend about 21% of that reviewing reports and data. They sift through about 250 emails a day. And then they prepare reports and keep up on news in the industry, in the community, things that impact healthcare and their own market. So that's the CEO. I'm going to take you through my day. So typically the alarm goes off most mornings at 5. I get up. I try to do my ACL recovery exercises. I usually commute with some music or a podcast. It goes off at 4 a.m. if I want to go for a run in the morning or if I want to hit the climbing gym. I'm usually in the hospital at 6.45 unless I have a meeting with anesthesia because anesthesia has to be in the OR at 7 so they can get their first case on time start at 7.30, which is one of their key performance indicators. So anesthesia meetings start at 6.30, which is usually about once a week. But the first thing I do when I hit the door is I review our event management system, which is every safety or quality event that occurred in the last 24 hours. It's a sheet of about 5 to 15 pages of events so that I know what happened in the last 24 hours. I also look at the house supervisor report to see what our census is, how many patients we have on every floor, how many are in isolation, especially during respiratory season. That gets me appraised at what's going on in my building. That way I can know about any unanticipated deaths or escalations of care, facility transfers in or out. And then once I'm informed by 7 a.m., I usually start my meetings. Typically I have a medical staff meeting. Most Mondays I have a medical executive committee meeting, which is the governing council for the medical staff in a hospital. And we review reports from the credentials committee, which helps decide who gets to do stuff in our building. And the peer review committee, which helps us determine whether care was appropriate when we have a harm event. And the medical staff leadership council, which is our team of folks who decide how to manage physician misconduct events. Sound like fun? Yeah. Okay, then I go to a safety and quality meeting. Then we start our huddles. We have a senior leadership huddle at 9, and then we have all of the C-suite members there. And then we report to a tier 3 huddle, which is all our managers and directors. So anything that's happened in the last 24 hours can get escalated. And then we have a regional meeting. So between 9 and 9.50, anything that's happened anywhere in our organization can get escalated to leadership, whether regional or organizational. I usually get about 100 emails a day, so I spend some time doing that. I might have some one-on-ones. And then I do some rounding, the ED, the ICU. We have a rehab unit, so I get up there a lot to remind myself of who I am. And then in the afternoon, I might have project meetings or meet with risk management, work on some contracting. I usually do a few other rounds, get some desk time, so I actually get some work done. And then in the afternoon and evening, sometimes I'm meeting with individuals or doing strategic planning sessions. I usually get home for dinner about 6 p.m., walk the dog, try to catch an episode of Ted Lasso, but fall asleep about 10 minutes in, and then call it a night about 10. So that's like a typical day. So what do you guys think? Like golfer, toiler? Okay. All right, I'll be brief with the next few slides. So the ABCs of the C-suite can get a little overwhelming. And what I've done is, on the left are all of the full-time roles, for the most part. On the right are kind of the part-time roles. And so in bold are the roles that, from time to time, are filled by a physician. So I have worked under and with many physician CEOs. The CMO is most often a physician. The CMIO, or Chief Medical Informatics Officer, helps run the electronic health system and all of the different software interfaces that connect to your electronic health record. The CIO, or sometimes Chief Technology Officer, is a larger issue. They work with healthcare data security, network communications programs to help with hospital management. The Chief Quality Officer, I've seen a few physician Chief Operating Officers. They run hospital operations. Chief Experience Officer, sometimes called the Chief People Officer, which is all about patient experience and employee engagement. And then Chief Strategy Officer, which I would love to be, that'd be a fun, I think that's a golfer role. I think that's what I should do next. And then Chief Clinical Officer is often a regional role for larger organizations. So those are typically full-time. On the right, you'll see part-time. So Medical Director, Executive or Senior Medical Director, Program Director, whether it's academic or a clinical program, Service Line Director, which is usually like MSK, and that involves orthopedics and physiatry and therapy services, all of that. And then there are a couple elected leadership positions, which usually have a term around two years. The Chief of Staff is a two-year term, and then Department or Division Chair. So all of these are roles that you could aspire to just in the healthcare sphere. And so that's our team. And if you go around the table, I've got the titles of the various people around the table. I want you to kind of look at this and think, what does this remind you of that you do probably in your residency or maybe in your clinical practice? Does this look like something that you're already doing? Does anybody look at this and think, oh man, that looks like my team conference? Right? So guess what? It is. And that's why physiatry is uniquely positioned to be in the C-suite, because we're used to teaming. I'm going to talk briefly about the curse of the ampersand. So the ampersand between PM and R, how many of the older folks in the room remember we had this whole thing on the curse of the ampersand, right? Like PM and R, we can't even decide who we are collectively as a specialty. And so we carry around this scar when people are like, hey, what do you do? Oh, I'm a physiatrist, or I'm a rehab doc, or it's like a two-minute elevator pitch, not like a 20. You have to explain it to everyone, right? And so the curse of the ampersand is that we're super heterogeneous, and we kind of don't know who we are. But I think there's a blessing here, because we are specialty agnostic. Like we work with everyone. We are primary care, right? Primary care for the disabled, primary care for the athlete, primary care for the spinal cord injured, right? We are outpatient clinicians. We are rehabilitationists. We are proceduralists. We are inpatient consultants. We are post-acute care experts. And we're subspecialists. And so we drink all this Kool-Aid. Like if you get a family practitioner in a leadership role, they only have like a couple of these. We have all of these, right? We're also age group agnostic. So we're birth to death docs. I can't tell you how many times you get an internist in a leadership role, and they just don't understand or have perspective of pediatrics. So we're birth to death. And we're also care site agnostic. We are preventative. We are post-acute care. We're inpatient care. We're outpatient care. We're all of these things. And so maybe the curse of the ampersand is the blessing of the ampersand, because we can be all of these things, and we can bring that to leadership. And team conferences are a lot like team leadership. No one is better taught how to lead diverse teams than physiatry. We're multidisciplinary. We have mutual respect and understanding of our allied health professionals. We respect our nurses, our therapists, our techs. We get it because we're in the trenches with them. And our focus on function helps us see the big picture. We're an advocate for the disabled and the marginalized. And we have a balcony view of the care. Thank you, everybody, for coming. Oh, sorry, you guys. Hang on. We'll get to that in a moment. So I think we're uniquely positioned. And if we don't have time for the video, I'll skip it, because... We'll enjoy it. Okay. All right. We'll enjoy it. All right. Here we go. Hopefully it works. Thank you, everybody, for coming to the faculty meeting today. As you all know, the hospital has been struggling financially over the last few years. We've had to make a lot of budget cuts. Is that why the neurosurgeon's wearing a bouffant surgery cap? Yeah, that's the only type of surgical hat we can afford right now. He looks like my lunch lady from elementary school. Speaking of the cafeteria, we had to switch from Diet Coke to Diet Pepsi. I'll drink it, but I don't have to like it. Even pediatrics had to cut back on stickers. They're handing out alcohol swaps. But don't worry. We found a solution to all of our problems. We're selling the hospital. You got to be kidding. Who's going to buy this dump? Bartholomew Banks. Private equity. Private equity? Boss, you can't do this. He doesn't care about patients. He just wants to make money. That is not true. Mr. Banks has assured me that he values patient care. I trust him. He's obviously lying to you. Radiology, how do you know? Look at him. Well, Mr. CEO, let me handle this. You go ahead and put on your denial headphones. What are denial headphones? It's easier for CEOs to make terrible decisions when they don't have to hear the consequences of their actions. Yes, it's true. I only care about money. I'm not sure what the big deal is about these patients you speak of. What are you going to do to the hospital once you buy it? Well, I've already laid off all the non-essential staff, except for one person in the ophthalmology department. Goes by Jonathan. No last name. Anybody know him? No. There is no Jonathan. Never has been. Now I realize these changes will make your lives miserable, so I've determined what each of you are worth and will pay you accordingly. Welcome to private equity-owned health care. One year's salary. Bro? Bro. All right. Thanks, you guys. So, yeah. Here's step number one, have you thought about? So, keep going. All right. Well, my name is Jonathan Finoff. I'm the chief medical officer for the U.S. Olympic and Paralympic Committee. I do have a lot of different experiences with association leadership and program director and medical director for different things, and so if people have questions during Q&A, I'd be happy to answer those, but I'll focus on my sports medicine career during this presentation, and a lot of it actually is going to mirror what was said, but it'll talk about my personal experience so that hopefully it puts it into real-life context. So, the opinions I'll share are mine alone. They're not those of the U.S. Olympic and Paralympic Committee, and I do receive royalties from up-to-date and demos publishing, but it's not relevant to this presentation. Let's start off with this video. He caught that! Welcome to the most exclusive gymnastics club, SUNY. The United States in a world record! Sidney McLaughlin is bringing it to Dalilah Muhammad! McBain, he wins another world record! Both fell in for the keeper and the United States. Evan Austin for the goal. So, we hadn't put together a video from Paris when I was putting this presentation together, so that was obviously from Tokyo and getting ready for Paris, but, man, it just gets me excited and I always get shivers when I watch that, and I feel so privileged to work with Team USA. So, what was my path? Well, I grew up in Boulder, Colorado, which is a great little college town, but it's also a place where there's tons and tons of elite athletics, and that's really all I cared about when I was growing up. I didn't think too much about school. I did reasonably well in school, but I was really focused on sport, and while I did a whole bunch of different things just based on my skill set and who I am, my genetics, I ended up doing elite endurance sports, and cross-country skiing and mountain biking were my main two sports, and by the time I was going into college, I was a professional athlete, and so making my living at that, and so that's what I thought I was going to do for my career, and when I had finished and retired from professional mountain biking, I would go into business, probably in the industry of cycling, so that was my career trajectory, and so while I was studying business at University of Colorado, they had a test that I took that was late at night. It was from 7 to 10 p.m. I finished up with the test, and I was riding my bike home from the test. It was kind of a dark, stormy night, and I was going across a bridge in the middle of Boulder over Boulder Creek, and because it was stormy, there were two lights on either side of this bridge, and it was pretty dark in the center, and I was going fast because it was kind of crappy weather, and there was this guy laying in the middle of the path right in the middle of this bridge, and so I kind of swerved around him and slammed on my brakes and flipped around to just see if he was okay, and I came back, and because it was kind of dark, I couldn't see him very well, but he was breathing weird, and it looked like a college kid who'd probably drank too much and thrown up, but as I looked closer, I realized that that fluid around him was getting bigger, and so I was looking closer, and I realized it was blood, and his breathing was really weird, and something serious was going on, so I jumped on my bike and rode to a payphone, which is a thing that's on the side of a building that you would put a quarter into and call, but it was pre-cell phone, so I went and called the public library, 911, and then went back and waited for the ambulance to arrive, and he stopped breathing, and by the time the ambulance arrived, they didn't even try to revive him, and it was really obviously super traumatic that day. I just sat there and watched it. I didn't know what to do. I had no first aid training, and the sport that I was competing in, mountain biking, it's dangerous. You're in the back country a lot. There's often not a lot of medical around, and people get hurt, and I was like, I am never, ever, ever going to be in a situation like this again, where I don't know what to do. At least I should have been able to render some type of first aid. Unfortunately, that person had committed suicide. They'd shot themselves in the head, and so I was not going to save them, but at the time, I just realized my lack of skill set was a huge deal, so I took an EMT course, and I loved it. I was like, oh my gosh, I think I like this better than being a bike racer, and so it changed my whole career trajectory. Now you have to figure out, okay, this is what I've wanted to be this whole time of my life, but now I wanted to go into medicine. Well, so now you have to figure out what's your path in order to get there, so you really need to, I think it kind of ties into what you were talking about. The first thing that you need to do is know what you want to achieve. Look at your long-term vision. Everybody should be thinking about this, and you know, at the time, I was young, and so I looked at something that was going to be many, many years in the future, but a three to five-year plan is a pretty easy thing to start thinking about, but I was like, you know, I really want to work in elite athletics, and so I'll talk a little bit about my vision, and then, you know, if you want to be in a leadership position, you kind of need to know how you want to lead, and that's your mission statement, and then you want to know what your core values are. What do you want to be characterized each day when you go into work and with the people that you're working with? So my vision is to lead the sports medicine team that takes care of the best athletes in the world. I want to create programs and policies that have societal and global impact on athlete health and well-being. I want to educate and mentor health care professionals in the field of sports medicine, discover new information to better understand and prevent injuries and illness in sport, and then build a diverse and inclusive team. So that's what I want to achieve, and how do I want to achieve that? What are my leadership, what's my leadership mission, and so this is where I think it's really important to have those amazing mentors and look at how they lead and who they are and what you want to do with them. I love the North Star and South Star analogy that you were talking about, and you want to look at those North Star people and figure out how can I be like them, and so this is my mission. I want to lead with intent, have courage, act with integrity, treat people with kindness, want to be optimistic, create a fun, innovative, and successful work environment, and then you want to think about what makes you tick. How do you want to be characterized each day when you go into work, and those are your core values. These are things that do change over time, and so you should be reviewing them and revising them based on your experiences in life because they truly do evolve, and I'll talk a little bit about what you are saying, a core values, a way of identifying your core values, and so they have these different words charts that you can use of all these different core values, and the way that I did it is I took all of these and I put them into categories that fit for me. I thought, you know, these things are similar, so I color-coded them, and I said these things are similar, and I chose a word from each of those different categories that I thought best identified what I wanted to have within the core values of that group, and so those are the ones I chose, which are learning, service, integrity, optimism, and resilience, and I think the important thing is you don't, all of these exercises that you go through, whether it's career development or personal growth, you really have to think about this regularly because if you go through it once and then you throw it away, then you've done it once and you don't remember it. You don't actually live it, and you don't achieve the goals that you're looking for, so if you write these down, and each day when you get up, just kind of read through, here's my vision, here's my mission, here are my core values, and then you go through your day, and at the end of the day, you reflect. Am I doing things that are moving me towards that vision? Am I living my mission? Am I exemplifying my core values? What can I do differently? What can I improve upon? And you're really going to, I think it gives you the best chance possible of having success in life. There are a whole bunch of different great leadership books, but one of the ones I really like is called The Speed of Trust, and when you're building a team, which is one of the ways you're going to be most successful, I think that they have some really nice suggestions in The Speed of Trust because if you have trust within that team, you're going to be far more effective as a leader, and the first part of it is having character. So you want to be trustworthy, but not only do you want to be trustworthy, you want to do ethics-based actions. That is integrity. So you may be honest and tell people the truth, but if you don't actually act upon things and move forward, then people will not actually believe in you. They will not follow you. They do not trust you, and you should always have good intent. You should be thinking about what you want to do and want that to be positive, but you also have to be competent. So as physicians, you know, you really want to make sure that your skill set is fantastic, that you're taking care of patients at the highest level, and that you have repeatable outcomes, and if you're competent and you have character, then those are the people that everybody wants to work with. Those are the people who make great leaders, and so I'll just give you an example of this. At the Olympic Games, for the Olympics, we have a medical group of about 250 physicians and other health care providers that we bring. We take care of about 1,600 people, 600 of whom are athletes, but the remainder whom are staff, and every single day I start out with a medical meeting, and we talk through what happened the previous day. We talk through changes in policies. We talk about learnings from the prior day. How do you get into the hospital? Who are the right people to know? What are the phone numbers to call in emergencies? All the different things that you learn as you're going through the Games. You make sure everybody's updated on it, but I start every single call talking about what is our mission, what's our purpose, and it's to provide world-class comprehensive care to Team USA athletes. So I want everybody to think about that every single day. What's our vision? We want to be the leaders in providing patient-centered care, and then I talk about character and competence. You need to lead with character. You need to be trustworthy. You need to act with integrity. We need to help those around us. We need to be service-oriented, and we need to be the best health care providers possible, and so every day when I talk about here is our purpose or our mission, here is our vision, these are the values that we're going to live by, and then we go through our meeting. Everybody is thinking about themselves as a leader. It creates team cohesion. It creates expectation, and I think it makes a huge difference as we move forward. So what was my path? Well, after I decided I wanted to go to medical school, first thing was improve my grades, so I started studying really hard. I changed my major to molecular cellular and developmental biology, and then I applied for medical school and thankfully got into University of New England College of Osteopathic Medicine in Maine and had a great time there, really thought I got a very thorough education, and I studied hard and did very well in medical school, which set me up to be able to get into the residency that I wanted to do, which was physical medicine rehabilitation at University of Utah, and then I went to Mayo Clinic, and then each step along the way, I met people that I wanted to exemplify. I wanted to learn from them. I wanted to be like them, and this was particularly true at Mayo Clinic with a couple of people who continue to be mentors for me, Jay Smith and Ed Laskowski, who are just phenomenal people. They are great physicians and great leaders and I think they've done really good things for our specialty and for our patients. But that also, you know, having that education, doing well in school, doing well on boards, getting into good programs, opened up a lot of doors for me. So within two years of graduating, I had the opportunity to be the head team physician for Utah State University, which has 18 varsity sports including football and basketball, so some of the major American sports. But it gave me, it was absolutely a trial by fire. I was young, I was, I thought I had a lot of experience, but I did not and I learned a lot from the athletic trainers and the physical therapists and the former physicians and really, really, that was an amazing experience for me and with a wide variety of sports. Also at that time, the Salt Lake Olympics came to town, so that was in 2002, and so I applied to be one of the physician executives within the Salt Lake Organizing Committee, but I was still very young in my career. But they're like, yeah, this guy is aspirational, he's, he's had a lot of, you know, experience even though he is young in his career, so they made me the medical director for the Athletes Clinic of one of the venues. It was a Soldier Hollow venue where cross-country and biathlon took place and so during the Olympics, I was the Athletes Clinic medical director and then during the Paralympics, they made me essentially the chief medical officer for the venue, so I took care of staff, athletes, and spectators. And that gave me a ton of experience, but it also allowed me to meet the head team physician for the U.S. Ski Team, which enabled me to start working with the U.S. Ski Team. And so, similar to what you were talking about with volunteerism, you know, number one, all of these things are unpaid positions, but they're amazing opportunities. It was really, really incredible, and so I started out, I covered national championships in Maine, and then I covered the Under-23 World Championships in, which was in Utah, and then I covered the next year's Under-23 World Championships in Italy. And then, you know, the athletes liked me, the coaches liked me, I was doing a reasonable job, I was very available, I answered my phone 24-7, so they invited me to some World Cups, and then they invited me to the World Championships, and then they invited me to Olympic Games, and I became one of their head team physicians within the U.S. Ski and Snowboard Association. And because I had worked with a organizing committee, the Salt Lake Organizing Committee, with the national governing body, U.S. Ski and Snowboard Association, been to multiple Olympic and Paralympic Games, my collegiate experience of multiple sports, and then I also, in the meantime, started working with professional sports, so in the NBA and WNBA as a team physician. When the position for the chief medical officer for the U.S. Olympic and Paralympic Committee came open, I was a very good candidate for that role because of the experiences that I had had. So thankfully, I was selected for that, and at this point, I've gone to ten Olympic and Paralympic Games. I've served in a lot of different roles, and there's a ton of different things that I have learned over the years, and I continue to learn, and I continue to have mentors that I work with, and I call one of the people that I talk to on a regular basis is Stan Herring. And it's interesting, when you get to a specific level and the decisions that have to be made, and, you know, in my position, I moved into my position on March 2nd, 2020, so when I accepted my position, they had not discovered SARS-CoV-2, and then I started, and it was the declaration of the pandemic. One of the first things I had to do in my first week was close the Olympic and Paralympic training centers. Then there was a financial crisis, and they told me I had to fire 20% of my staff. There had been a lot of scandals within the U.S. Olympic and Paralympic Committee, and gymnastics, and some other areas, and so there was a lot of distrust with healthcare professionals, and there was a lot of bad behavior within the national governing bodies, and they were used to being able to manipulate and change policy just by yelling a lot. So I came into this situation, and there are very few people that have been in situations to some degree similar, and Stan is one of those people that has. So when I was setting policy and having really big pushback, I'd call Stan and say, am I doing the right thing? Are there things I should be considering? And he would really help give me advice, or at least help me talk through the situation so I felt more comfortable with what I was doing, and I think that that's probably one of the main things that's helped me to be successful is really learning from my mentors, learning at each step of the way, and those mentors aren't always physicians. At Utah State University, it was the athletic trainer. He'd been an athletic trainer for 40 years. He was a Hall of Fame athletic trainer. He was an old, crusty guy, Dale Mildenberger, and he was really hard on me, but man, did I learn from him, and he eventually developed a lot of trust and appreciation for me, and so it's looking at those around you, identifying the people that you want to learn from, making sure that you're expanding your skill set through your entire career, and you know, even now, I'm learning a ton of new things, and just the last thing I'll say is, from a responsibility standpoint, it's interesting because how I kind of made my name was through doing a good clinical practice, and then working into research, then working into education, working into different leadership roles, but all of those different things. Now, my position, I do about 20% clinical, and then the rest is I administer elite athlete health insurance, so we insure the top 1,400 athletes in the United States. We're self-insured, so it's about a 14 million dollar policy. I administer all of our medical network relationships, which is with the hospitals around the country that we work with and where we get our care, and so it's kind of a marketing relationship in exchange for our athletes being able to go and get world-class comprehensive care. We have a medical assistance fund and a mental health assistance fund, which pay for out-of-pocket expenses for athletes. They have to apply for all of that, and I have to review all those applications and approve those. We are an IOC research center, and so we are doing injury and illness prevention research with 11 other centers around the world, so I lead that part. We have created a psychological services program, which is mental health and mentor performance with all of the depth of resources for all of Team USA athletes that I've developed in the last five years. I'm leading the initiative to establish national governing body medical standards that tell the national governing bodies, which there are 60, and it's all the small businesses of sports, so USA Swimming, USA Gymnastics, U.S. Ski and Snowboard, what things they need to have from a medical infrastructure standpoint in order to deliver the best care for their athletes. I run three medical clinics at the different training centers, Lake Placid, Colorado Springs, and Chula Vista in San Diego, and I plan all the medical care at the Olympic and Paralympic Games for the summer and winter games, but also the Pan Am Games, Parapan Am Games, Youth Olympic Games, winter and summer, Youth Parapan Am Games, Youth Pan Am Games, Beach Games, World University Games. All of these are all over the world. You have to export and import all of your medical supplies, recruit staff, get medical licenses for them in countries all over the world, and then handle all the emergencies that happen in those different locations, whether it's a femur fracture, or spinal cord injury, or a stroke, or new onset diabetes, or a suicide attempt, and so you have to have those emergency action plans and coordinate the care of that athlete. And you know, in conclusion, I would just say that physiatrists are uniquely prepared to serve in those roles. We have the skill set that you were talking about with the team building and understanding how to leverage the knowledge and expertise of all sorts of different people and bring that team together to deliver the best care for our athletes. So that's my conclusion, and I'm happy to answer questions. So thank you very much. John, I think you're a toiler. We have a couple minutes, so if you have some questions, please share them. If you could step up to the mic so our virtual audience can hear it as well, that'd be great. So I'm Andy Hagen. I'm the only person who studies a golfer instead of a toiler, and I teach this stuff in our business school, and I think that there's a difference between management and leadership. You toilet management, you do not toilet leadership, you golf. I teach with a guy named Noel Tichy, and one of his last books was called The Leadership Engine, right? And now I'm in a little town in Middlebury, Vermont. I've got two office staff, but I'm running global rehab programs all over the world. And John, thanks for teaching my folks. You are their hero now. You taught our African fellowship, right? And my job is absolutely to be the anti-toiler. The worst thing I can do is show up in front of a minister in front of a minister of health in Ghana and be the guy who's out there making it happen. You want the African to be the person's making it happen, right? So when you separate out your thoughts, and in the dean's office I was toiling, and I was toiling, right? When you separate out your role as a manager from that of a leader, you find that you end up being a golfer and you don't want to be in a golf course with me because I'll hurt you. I'm bad. Good morning. My name is David Chang. I work in Los Angeles. This is really more of a comment than a question. I've been with the Academy for about 15 years or so, and during that time I was on the Program Planning Committee for about five years in MEC, and also did the Young Leadership Program. And I just wanted to thank you so much for the panel, for spending this time with us. I think a lot of us have been toilers during our residency training, fellowship training, and as we're making this transition to look for opportunities and leadership. Very, very grateful for both of you, all three of you, to share your experiences and time with us. So I just want to say that out of the 15 years I've been an Academy member, this is probably one of the most impactful meaningful sessions. So thank you so much. So where are you going to be in three to five years? That's a great question. I have been in clinical practice and academics all my life, and a few years ago I started a Master's of Health Administration program. I am finishing up next year. I made the transition to an admin role. Right now I am at the VA in Long Beach, where I serve as Associate Chief of Staff for Rehab and Extended Care. This trial-by-fire analogy, I think can't be more true. And even now, you know, I'm learning something new every day, and having the platform and a community and role models to look up to, it's one of the reasons I stay very engaged in the Academy, because along that pathway, along that path, I should say, there's always someone that I can reach out to and learn from. Thank you so much. Thank you for a wonderful talk. I'm Alan Novick, and I'm sort of at the later stage of my career, and have served multiple leadership positions. What I wanted to add for those in the audience is, you know, I served as a Chief of Staff, and I was always looking for volunteers, but I didn't know you were out there. So I would really encourage you, if you are interested in sort of a leadership journey, go to your leaders in your organization, say, hey, is there something I can do? How do I become a department chair? You know, I would have loved you coming to me. Secondly, as many larger organizations will have internal leadership programs that you can access, and the C-suite doesn't know you're interested unless you tell them. So by all means, talk to them and say, you know, I know I'm young in my career, but I'm really thinking about X, Y, and Z. Is there any resource there? My organization put me through a leadership program, and then, which I had no idea until one day, they came to me and said, you know, we'll pay for your MBA. You will? What? Had you ever thought, you know, and so I probably would have never taken that journey, because I wasn't gonna put the bill, honestly, it didn't interest me that much, but it was a wonderful experience. I didn't know it was there, so ask your C-suite. They can help you. There's resources there, but thanks. I just want to throw that in. And then one last question. Hi, thank you so much. This is very insightful, and I appreciate all you've been able to provide. I do actually have a question. So I am probably one step up from the bottom of a pretty large health organization, and looking up from the bottom, I can't help but notice that there seems to be a lot of just turnover and rotation in the C-suite, and I can't help but wonder, you know, is this a kind of a requisite for these type of positions in terms of cycling, or is it possible maybe just a, you know, a tale of the times, because, you know, this is not the easiest, you know, position. It's rough, but I think, you know, the last year or two has been particularly rough for healthcare, and so, you know, I guess it's kind of a twofold question. A, is that typical for the C- suite, and then B, is that almost a requirement for development, you know, into the C-suite in terms of experience? Like, can you develop, you know, you know, with, you know, vertically within an organization, or is there almost some necessity to work laterally amongst different types of organizations to gain, you know, the experience that you would need for the C-suite? Great questions. So to your first question, most non-clinicians tend to have a turnover cycle around three years. About once every three years, they transition into a new role, whether that's vertically within the organization or a lateral move within another organization. I've been told that you tend to get a little stale in your position if you stay longer than five years. I mean, I guess unless you love it, but it's not unusual to have a high degree of turnover. Once you get into leadership, I suspect that some of that turnover is related to contract negotiations. People may leave one major organization and go to another if their values are misaligned or if they feel unheard and unseen, right? Some of those south stars force you out, or you choose to leave that scenario if you're not valued. And there's some pretty good data that says that moving from one organization to another has some negotiation leverage and contracting improvements. So people are looking for pay raises and can often get it by transitioning laterally or, like, diagonally into another organization, because I think it's, it becomes more business at that level than it is clinical. Does that make sense? No, absolutely. Yeah. And do you think, so you mentioned this, you know, non-clinical tend to have that rotation. Do you feel from a clinical, you know, having clinical experience almost insulates a little bit from having to make those type of changes every three to five years? I mean, I only have kind of my own little sphere of reference, but, like, I stayed in the same clinical-ish environment. Let's see, my first step out, I was there ten years. My second step out, I was there nine years, and now I'm two years in. So I'd say about a decade in each organization, but in, within that, I probably shifted my leadership role about once every two to three years. And maybe that's a restlessness and a, like, desire to learn, but that's kind of what I've seen. John, do you have anything you want to add? Well, if you're looking in an academic setting, which can be different than a standard health system, but if you're looking at program directors, fellowship residency, medical directors for different service lines, your chairs, a lot of that is specific to the institution. Some will have rules where you can only serve for a certain period of time, and others don't. And so you'll see a chair in a position for 25 years, where you'll see another institution where every four years they have to change chairs because they want new blood in that position. So I think it is, to some degree, location-specific. I would also just add that, like, there's this assumption that when you step into a role, you've figured it out, and you're just doing the work, but you actually learn into the role. And with every new position I've taken, I cue up a song by The Fray, and it goes, Everyone knows I'm in over my head. You know this song, right? And what's funny is you get a year into it, and you kind of look over your shoulder, and I'll cue up the song again, and it doesn't apply so much anymore. So just know that you're gonna feel over your head for a little bit, and then you won't. And some of it is the difference of the clinical part. So paths that I've taken at prior institutions, I mean, I went from sitting on innovation technology committees, and then doing a good job, but then asked to transition to another committee. Then, like, I got tasked to then lead implementation of lean management, Six Sigma, and then did well. And then I was asked to serve under our ambulatory VP, you know, where he was gonna take me and groom me. He was a great mentor for me. But some of that too is, I think, figuring out where some of the people are going, depending on the culture there. But sometimes it is, it's not that they're necessarily leaving, it's they're being asked to go on to this, and being groomed for other positions. So that's something to look into it as well. Got it. Thank you for that song. And I'm actually, I'm pretty early in my leadership position, but I will say, you know, to the younger folks who are thinking about this, I mean, kind of back to your point about, you know, you survived, you know, we did our residencies, the team. Think along that line. If you survived residency, you know, which is every year you're learning something incredibly new, and you're figuring it out. I think leadership has a very similar experience, and personally I enjoy it, because you keep learning, you know, and it keeps you from staying stale and, you know, being stuck in a rut. So, but thank you so much. Thank you. All right. Thank you, everybody.

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