Okay. Hi, everybody. Thank you for joining us here in the, I don't know, the sticks of the meeting. I needed a compass to find the room. So it's a small group, so hopefully we can keep this a little informal. We don't have a slide presentation, per se, so this is basically going to be more of a panel discussion, and I'd like the audience to feel free to ask questions or interject. And my name is Alyssa Sharbonow, Lisa, to my friends, and I'm the chief medical officer for Encompass Health. And for those of you that are not aware, Encompass Health is a company that owns freestanding rehabilitation hospitals. That's all we do. We're really focused on inpatient rehab. And we just opened our 161st Rehabilitation Hospital yesterday in Fitchburg, Wisconsin, which is somewhere in the country. I'm not good at geography, but we're really excited about that. And we actually feel very optimistic about the future of rehabilitation and the future of inpatient rehabilitation in particular. So we have a very aggressive growth plan at the company of building eight to ten new rehab hospitals a year for the foreseeable future. So with that, all of our hospitals actually have medical leadership opportunities. So we have medical directors in each one of our rehabilitation hospitals, and then some of our hospitals, depending on the size, might have an associate medical director as well. And then we have program medical directors also. So if someone has, let's say, a particular interest in spinal cord injury or traumatic brain injury, they might also be hired to lead a program, a specialty program like that. And we have disease-specific certification in many areas as well. So those program medical directors can work with the team and the other clinicians to help with those specialty disease-specific certifications. So the reason that I was motivated to get together this panel was partially selfish. So we heard Dr. Flanagan this morning, for those of you that were at the plenary, talk about the need for more physiatrists. And particularly in the space where I live and I work, we are in dire need of more physiatrists who want to do inpatient rehabilitation. And we have so many opportunities in our company to bring on physiatrists, even straight out of residency, and have them get exposure to how our hospitals run. And then if they're interested, have leadership opportunities in the hospital. And as Dr. Flanagan said, I think we have, physiatrists have great characteristics to attain leadership opportunities, even beyond the walls of your unit or your hospital. So in, you know, looking at leadership opportunities in different systems and advocacy with the government and other ways for you to get involved. So I assembled this panel of excellent speakers, and I'm going to let each one of them introduce themselves. And these are three of our stellar medical directors from our rehab hospitals that also have other roles that they're going to explain to you. And I thought it would be really helpful and also hopefully inspiring for physiatrists that are interested in escalating to a leadership role to kind of hear our stories and hear how we came into being in our leadership role and what opportunities you might have in the future. So I'll start out first telling you just a little bit about my own life story. I never thought I would be in this position, and it's really all the fault of this lady sitting in the front row here, Dr. Dexanne Clohan, who was one of my mentors. So I was happily toiling away at one of our rehab hospitals in Portland, Maine, and Dr. Clohan got me involved with a committee on the academy, and I was also on her physician advisory board, and then I got introduced to—I was asked to do some chart reviews at the time for the legal department of the company. And then in 2014, about, after I had been practicing at my hospital for about 23 years, I was approached to start a new department basically for physician education for documentation issues in our EHR. And that was a tough decision for me because I loved practicing, and this really meant giving up my medical directorship. And I remember my mother, who at the time was, I think, 95, said, well, what if they don't like you and you get fired? And then what will you do? Thanks, Mom. And I said, well, I will not be able to be medical director anymore because they'll hire someone else for that, but I can always just go back into practice if it doesn't work out. But I did that for about six months, and then when Dexan retired, somehow they had the idea that I should try and take her place. So I stepped into the chief medical officer role of this big company, which has been—I think when I started, we had 96 hospitals, and now we have 161 hospitals. And basically, I lead up our clinical quality department, clinical excellence, and our physician education department, medical services. So never in a million years if someone had asked me even 10 years ago, would you be the chief medical officer of a big publicly traded company with 160 hospitals, I would have told them that they were nuts. So I think, for those of you that may have an interest, I would advise maybe being a little bit more careful in your planning than I was, just kind of meandering through life and falling into this role kind of accidentally, but it's all worked out. So with that, I'm going to just start, and I'm going to just have each of our panelists introduce themselves and describe what their current position is. So we'll start with Susan McDowell. Yeah, go ahead. Okay. Susan McDowell, I am the chairperson for physical medicine rehabilitation at the University of Kentucky, and I also currently serve as the medical director for Cardinal Home Rehabilitation Hospital, which is now an Encompass Home—Encompass Health-owned facility. It's a 158-bed inpatient acute rehab located in Lexington. Dr. Lubinacci? It's so wonderful to see we have early career future leaders, we have mid-career leaders, and we have latter career leaders, and that's pretty impressive. It's just not like—these are just not all newbies in here, so thank you for taking your time and coming to this for your younger colleagues. So I'm Mike Lubinacci. I'm currently medical director of Encompass in Mechanicsburg, Pennsylvania, which is just outside of Harrisburg, Pennsylvania, and I have a long trajectory there. We won't do that at this moment, but I've been there 33 years, and it's been a great experience. Everybody says, how can you be at a place for 33 years? Well, the place has been several places, and I've had several iterations of great staff, and we are very different than 33 years ago. Everything's changed, so I've survived that. Just as everybody who actually made it physically here for the 30-mile walk to this, you are the survivors. Survival of the fittest right here. We got you. So about eight years ago, I joined U.S. Physiatry. I'm sure many of you have heard of the company. We're a company that basically provides a group practice structure, particularly on the business end, but also for mentoring and transition into practice for a lot of early career physiatrists. We're predominantly private practice, predominantly inpatient. We do work with some academic institutions as well. So our job is to protect people from a very volatile environment that medicine has evolved into, and to help mentor them and guide them, give them advice, and also provide a very strong and consistent business background for them. So that's been very interesting. We have 160 physicians now, physiatrists, and we started with 20 when I joined seven years ago. So for me, from a leadership perspective, I'm just going to mention this very briefly, but I really get great satisfaction knowing that we helped a physician transition as seamlessly as possible into real-world practice, because it's a little bit of a tougher job, certainly tougher than when we started. And that's what keeps me going in that position, and I have a goal to continue to move forward our excellence in patient care for our vulnerable patients and make sure they are advocated for. So that's what drives me every day as a leader. Good afternoon, everyone. Just by brief introduction, I'm Kenesha Kirksey. I am the medical director at Encompass Shelby, and I've been there now for about three years. It's a 34-bed hospital outside of Birmingham, Alabama, where the Encompass headquarters are. So I'm happy to be here, and I will talk a little bit more about the trajectory when that time comes. So why don't we just start with you? We'll segue into that. So could you describe your career trajectory and when, in your trajectory, you began to consider pursuing a leadership opportunity? Well, honestly, I can't say there was any particular moment that I said, I'm going to be a leader. I think it was something that kind of happened organically. Just a little bit of background, when I left residency in Charlotte, North Carolina, Carolinas Rehab back in 2007, I always knew I wanted to have my own business, so I ended up actually in academic medicine. It has been a great journey in academic medicine. I was at the University of Alabama, Birmingham, for almost 15 years. So during that time at UAB, I had an opportunity to experience both the outpatient setting, but I ultimately ended up being the medical director of the spinal cord injury unit there. And for those of you who know a little bit about model systems and spinal cord injury, there are several types of model systems, but the spinal cord injury model system is a huge deal. So I had an opportunity to take care of true spinal cord injury patients at a level one trauma center. So after becoming medical director there at UAB, I ended up later becoming the program director. And again, that evolved organically. It's just one thing to realize, a lot of times when you are out there doing the right thing, taking care of your patients, the leadership part kind of comes. I mean, people see that you are advocating for your patients, and also being there for your colleagues as well. I think it kind of organically happens. So along that way, being program director there for nine years, I ultimately advanced. I always knew I wanted to advance further. You have some who might decide when they onboard, I just want to be a great clinician. But starting off, I always knew, even amongst the onboarding process, it's like how do I advance? How do I go to the next level? I don't want to be an assistant professor forever. How do I get to the next level? So I leveraged and got involved amongst the university, not just the department, but also across the university, allowing other departments to know who I am, know the type of work that I produce, and knowing what I want to represent, not only for my patients, but also for the specialty of PM&R. And again, I think that kind of organically leads to opportunities for, you know, for further leadership. I did ultimately reach full professorship. So I was, at the time, one of three African American women who were actually full professors in PM&R. So that was a huge accomplishment for me. So as you can imagine, making that decision to leave academic medicine, you know, wasn't a very easy decision that I had to, that I undertook. So it took a lot of thought, a lot of, you know, reflection on what exactly I wanted to see my career going. And I think that's a point to make. It's like, you know, a lot of times we think, you know, we have all the answers. When we first are out of residency or out of fellowship, this is what is going to happen. It's going to be a straight trajectory up to whatever you envision yourself being, quote, when you grow up. But ultimately there are opportunities and times when there are, you know, times you have to reevaluate what is it that is most important to you? What is it you want to really see and be not only in your career, but what are those personal aspirations that you have? So ultimately I ended up leaving academic medicine. I say leaving. I always consider myself being an academic physician because I'm still very involved within my department. Being a mentor and being available for those who have, you know, been an example for me and being able to give back is one of those things that, you know, I will, it gives me fulfillment. So that's something that I will, you know, never give up regardless of what practice setting that I'm in. But ultimately, again, I ended up at Encompass Health in Shelby during the pandemic. So it was a big transition and a big decision, like am I making the right choice and the timing of it all? But it was a great transition because it's the support that I have received while I was there, while I'm there, it's been, you know, I just would have never imagined. So for me, again, being involved and also allowing the residents and the medical students, you know, still be involved to see that, yes, there's an academic side, but there's also opportunities to see other practice types and ways that we can give back as PM&R physicians. So I guess I'll stop there. I can keep going, but I'll just stop there. Okay. Mike, do you want to give us your story? So giving some thoughts as to how this group is not a boastful group. So giving any, you know, thoughts on how we got to where we are is a little hard to think about. So in a way that's appropriate. So, but a couple of things, as I thought about it, I thought, you know, I have to briefly include my family upbringing because when I thought about it, it was really related to how my thoughts evolved over time. I had to bring up experiences I had outside of medicine and outside of academia. And I had to really think about what happened to bring me the next step to U.S. physiatry. But I won't, I promise I won't be long in describing it. But I grew up in a family who immigrated, my parents immigrated from Italy. And when they came here, that's a whole nother story. But they're, my family were very hard working, really strong work ethic, which is not uncommon for everyone who joins us in this country. And they actually had a very strong business acumen and they grew two very large businesses in the restaurant and in automobile dealership world. And so how that applies is I grew up in a rural area of Rhode Island with a very rural high school. So, step one, they influenced how I thought about things and what type of work I do. And I always tell everybody that believes I'm a perfectionist, I say, I'm not a perfectionist. I just think people should do the best they're able to do. So next step was I went to school in D.C. at Georgetown, both undergrad and med. And how that was influential is that I had to eventually go to an Air Force scholarship. So they paid for my medical school education and then I owed them some time back. And so I did my internship after medical school up in Boston and then went into the Air Force. So as things in life often are, they're quite random. And Stu, this is for you. So as I went into the Air Force, Stu's a rising star in the VA from PM&R. So thank you for that. I was assigned to something that was very influential in my decision to go on to a leadership position. I was assigned to a special operations squadron, which happened to be near Eglin Air Force Base in Florida. So I go from the ivory tower world of academia to a frontline world of special ops. And what our job was at that time, which clearly is declassified because it's been a while, is my squadron worked with hostage rescues. So I was a flight surgeon. So as the medical piece, I would accompany them on exercises and on real deals, real work. And I was assigned to a special operations squadron. So anyway, that's that part. But I remember very distinctly the first meeting we had as a squadron, which was a hundred people, all about my age at that. We were all very similar ages. And the commander, who was a colonel, came up and addressed the team. And, you know, basically he said, you know, our job is going to be to learn how to fly all of our inventory, which were basically helicopters, large, specially equipped C-130s. And go into enemy territory, obviously, you know, we've seen movies on that. And we're going to fly in at low level in the dark, in the rain, in the mountains. That's what we do. That's how we get in, under the radar. So I'm looking around, and, you know, of course, I was just newly, you know, from medical school, and I was looking around, and I thought, and everybody was really excited about this. I said, everybody's really excited about this? It's like, I don't know about this, you know? So, but somehow he was able to convince that group. This was our mission in the world, and this is what we were going to do for the next four years. So I thought, oh, my God, this guy just tells us this impossible thing, and everybody's into it. How does he do that? I just looked at him. He was cool as a cucumber and very hands-on, very front-line hands-on. So that kind of—I have that memory very distinctly. So anyways, moving quickly from there, I finished my service there. It ended up being in special ops for half of my required years, and then I went to a fighter squadron. So this fighter squadron basically worked—they flew—they were all academy graduates, Air Force academy graduates, Ph.D. level physics, aeronautic engineering, mathematics, pilots, amazing people. So that was a whole other experience on the front-line stuff. Basically, I was required to fly in the F-16s, which is the two-seater, which is the ones we recently sold to Ukraine. And again, that was a whole other experience. It's like, oh my gosh, these people are so focused on the mission, and the leader is just— they just do—they work together. Everybody's an equal. So left there, went on to Baylor-Houston, and then did my residency, and then I was, you know, asked to be chief resident there. And I never quite understood it because when I made that transition, all the residents were complaining about the call schedule, and I thought, you really don't know what to complain about, do you? So anyways, I think the attendings like that. Attitude's like, what's everybody complaining about anything for? This is great. So from there, I started my academy work, which I strongly recommend you all consider, at an initial committee. That was like my first year out of residency, influenced by Marty Gray Boys, who was another great leader and our chairman there. So the academy roles kept coming. I was never one that, like, jumped for them. It just kind of just happened, and it was very confusing to me why that was happening. But obviously, somebody saw something that I didn't see. So I culminated in the year of presidency, and I still do some past president things. So anyways, that was my general trajectory. There were a few moments, as I described, that were influential in why I wanted to, you know, why I recognized eventually that I had qualities that I could help the specialty with for a long period of time. So that's my story. And I just want to point out for, because there may be some people in the room who were not, you know, around when you were president, but to have someone who was in private practice become president of the Academy of PM&R is quite unusual. I'm not sure. I think you might be the only one. I'm not sure. There's two. There's two. So, you know, that's just another example of how, for those of you that are interested in promoting the field, you can think, well, I don't have to be in academia in order to increase my involvement with the Academy, and there's always a lot of opportunities for volunteers. And, you know, I was on the Clinical Practice Guidelines Committee at the recommendation of Dr. Clohan, and I learned so much and met some wonderful and very smart physiatrists. So, who became my friends. So I would encourage that as well. So just a little plug. Susan? So I guess I represent the pure academic career. I graduated from the Medical College of Georgia, actually born and raised in Augusta, Georgia, and didn't leave until I came up here to do my, didn't leave until I went to Kentucky to do my residency. They still don't have a PM&R program at Georgia for whatever reason. But, so I, too, served as a chief resident in my final year of training, and then I stayed on as an assistant professor at that time. I spent my, I remember my first day as an attending. It's always, you know, the July 4th weekend. So, of course, I was on call, and I was always also minted as the new Associate Program Director. So those are my two jobs walking in on the first day. And Jim Atchison was my program director at that time. So my mentor in that realm for about 364 days, at which point he left, and I became the program director. And this was well before the time of you had to have some leadership skills and some prior training before you could be the program director. So, and classic with leadership transitions, we had not less than one resident that was misbehaving and needed to be managed. But, so I was a program director for almost about six years, and then I have a disruption in my career. At that point, my mother was diagnosed with colon cancer. She had been living with me. She had a stroke during her chemo and became dependent for her care. And so for about five and a half years, she lived with me and my family, and we were her care providers and took care of her needs. And so, you know, at that point, I stepped out as a program director and really didn't do a whole lot of much other than going to work and coming home and doing what needed to be done. I did manage, however, to keep my foot in at least one door, and that was in graduate medical education. I was still on one of the subcommittees for graduate medical education. I didn't give that up when I stopped as a program director. And I'm not sure why I didn't give it up. I think I liked it. It was a compliance committee. So it was like, are you following the rules or not following the rules? And so I did stay on that committee during that period of time, but really didn't do much traveling at all. And so shortly thereafter, in 2006, the senior associate dean for graduate medical education decided they were going to retire. And so I had been on their compliance subcommittee for four or five years. And so I said, OK, well, maybe it's time to get back in the game. And so I applied for the position, and I was named assistant dean for GME. So I stepped out of pretty much most of my clinical role at that time. I did a couple clinics a week, but really full-time GME administration. After a year, I became the designated institutional official for our training programs at UK. So 55 training programs, 650 learners, slogging through the ACGME requirements. And I did that for about nine years, nine and a half years. And I wasn't really smart enough towards the end of that to plan my succession. And so when I was asked to be the chair of physical medicine rehabilitation, I really didn't have a succession plan for GME. So I spent about 18 months doing both jobs, training my successor, who is still there today doing a great job for UK. So I wouldn't advocate that, because it was kind of a distraction. Being a chair is a big enough job. You don't need to have any other large responsibilities, particularly when you're just first starting out and trying to figure out where you're at. So I've been chair of the department since 2013 with a couple years of extra jobs. And so I've been able to grow the number of faculty we have, grow the clinical space that we have, add additional rehab programs within the University of Kentucky Health Care. And then in 2018, I had the opportunity to become the medical director for Cardinal Hill Rehabilitation Hospital. The facility was purchased in 2015 by Encompass Health, or at that point it was HealthSouth. And then that medical director, who had been there for at least 20, 25 years, decided to retire. And so at that point, the company and the CEO asked me to take on that role as well for the hospital. So that's what I do every day. And I remember meeting you, I don't know if you remember this, but we were at a baseball game for the regional meetings at St. Louis. Was it Cincinnati, maybe? Oh, I don't remember. But I thought, wow, she's pretty cool, and she's nice, and she's smart, and awesome. Okay, so going back to Dr. Kirksey, what do you think are the qualities that have made you a successful leader? Can I just touch a little bit back on that first question about the leadership, just quickly, just bringing up, for those of you who are interested in further leadership, I do encourage you to look at your academy and the ways that you can get involved here. And the thing about it is, it doesn't have to be something that's longstanding. You can, you know, we call sprint. You can find opportunities for those of you who are medical students or, you know, early in your residency and think, how do I have time to do one more thing? There are opportunities to do short periods of short-term involvement with volunteerism. And if you're interested in getting involved in committees, you know, I am chair now of the membership committee, which is now, you know, overseeing the future leaders program. So for those of you who are truly interested in further leadership, it's something to look into as well. I am also a board director of the ABPM&R, which is, again, something that is very time-consuming, but it's an example of also being in private practice and still being able to give back to the field. So to touch on the area of qualities that makes you a successful leader, I guess the one thing that comes to mind is just being authentic and being true to yourself and being, you know, understanding the things that, you know, excites you and being able to truly knowing what you want to give back to the field. When I think about being authentic also is, you know, re-evaluating, constantly re-evaluating, what are those things that, you know, are important to you. I think communication and managing people is a huge asset or a huge quality, an important quality to be able to be an effective leader and also, you know, being able to listen, even when you might not agree on, you know, the issue at hand, but knowing how to agree to disagree and also seek to understand the other's viewpoint on a particular issue. And I, you know, can't just stress the importance of building relationships. You know, it's something about, you know, gaining the craft and understanding your, the area, the field of PM&R and, you know, developing and being the expert in your area, but it's also very important to know how to communicate and build those relationships with others. I think a huge part of leadership is being able to manage, not only manage people, other people, but managing yourself, managing your own emotions, manage and understanding, you know, what makes you your best self and what are the things that, you know, you're constantly working on to, again, being, to be an effective leader. But I think first and foremost is how do you develop those relationships. So, getting out, you know, being involved in, you know, the receptions here and going to the poster presentations, any type of social engagements, networking is so very important and that way it allows you to build that community, the community that's needed to be able to take it to the next level because, again, if you're interested in leadership, you can't do that alone, you've got to have allies, you've got to have people, you've got to have buy-in and so in order to get that, you've got to build those relationships and make those connections and this is a great way to do it in these types of academy meetings. I think you're going to see a lot of similarity in what we have to say about behaviors that mark you as a leader. I think one of the things that's been mentioned is the listening part and to dive down on that, the better the listener you are, the better the leader you will be. And the most important part about what I call evaluative listening is that what happens if you practice that, you start to be able to read the room as to what isn't said and surface it to that discussion. And, again, that's just a talent you can practice, a skill you can practice. You'll be amazed when you start to see their things under the surface and encourage them to be out in the open, that has remarkable transformative powers for a group. The other thing you touched on as well is this ability to have emotional and interpersonal IQ, you've heard that probably. And it's hard to, I think you just, if you start with empathy, the rest will follow in that particular domain. So another skill that can be developed, a lot of people have it naturally. Some people have it naturally and then they grow it and other people have to work a little bit harder on that. But people recognize when you can see through an invisible, you know, curtain and just read the room, read the room, which is a talent. I'm also a little bit old-fashioned. I do believe in the term of servant leader. I think that's applicable now and into the future. And I know sometimes social media leads us to think a little bit differently. There's a lot of wonderful things about social media, clearly, but I'm not sure if a servant leader concept is constantly reinforced there. It's something to think about. People recognize that when you're there for them. You're not there for you at all. And the last part about the listening part is to be sure to ask for opinions. You've probably heard this before, but the most powerful people in a room, in a discussion, are more often than not the quietest ones. They sit there, they listen, they take in the information, and then they reply with more wisdom than if they spoke too soon. So remember that when you're leading a group or you're in a group. And then, particularly if you ask people for their opinions, then that gives them the floor. And it's a very powerful technique to get the best from everybody in that particular decision-making arena. I think the other thing that's important to consider is, you know, clearly as leaders and you as future leaders, you need to be thoughtful, like we just described, in a room. But there are times where you need to be decisive. So that skill will develop because the thoughtfulness will eventually lead to, when you need to make a decisive decision, you're able to do that with a relative degree of comfort. The other thing, and I'm sure you recognize this, but your ability to translate the information the team or the group, the work group, is putting together, translate it to the audience that it's meant for so that the audience that it's meant for knows you understand their world. And this is how you translate them to help move that organization or that group in a certain direction. So the translational part, you know, we're all in this room like, well, how does that affect me or what I do? Your ability to intuit how to say it so that they know their world is affected and this is a decision that is important to them, again, a very powerful tool to use. In my organization, I love doing this at Encompass Mechanicsburg, you know, I give praise openly. Someone does a great job, we're in a meeting, I will make every effort to praise them in front of their peers, in front of their groups, because they deserve it, right? And I think it's a good way to form relationships and have people feel good to be part of a team. And our work at the rehab hospitals is hard enough, so we support each other 100%. The other thing I've learned to do is to promote new leaders. If we have a great leader, Herb, in St. Louis, who's in our group, and I would do anything to promote him, I will go above and beyond promoting people, helping them do better, referring them forward, moving them forward. Because, again, we can't be here forever, so someone's got to take our roles as you found the delegation part, and you'll know new leaders and young leaders when you see it, but I would also make the caveat that take your time in seeing it, because first glance is not always accurate, right? But I think we all know that. Take your time. But you'll know it when you see it, but take your time to make sure you don't miss anything. And the last couple of things. You know, I have a mentor. Everybody needs a mentor. So if you can follow a mentor, and you just need one, maybe two, to help you with the spots that you're not quite the strongest at, perfectly great. And even I have a regular mentor that I ask questions for on the business aspects, usually, of things. We could all use a mentor. We can all be a mentor. And we need it in our specialty on both ends of that. And the other thing, too, you know, I've worked with a lot of different CEOs. They've had really strong skillsets. But not everybody has a perfect skillset. So, you know, I think we can all help people fill the void, help them fill the void as leaders. Whatever they need a little help with, you're there, you know, either overtly or covertly helping them. And then sometimes you just need to let people learn from their mistakes. So you take a step back, and you can kind of see the future a little bit. But, you know, people have to experience, we all have experienced our mistakes and learned a lot from them. Thank you. So how many people in the room are introverted? Okay, this is for y'all. So I, like Kanisha said, you come out of your residency confident and incompetent, overconfident and incompetent in your ability to lead and to move forward. And that was a little bit of me, but I also am very much introverted, which I've worked really hard on over the last 30 years to change. And I think not knowing that and what that meant for me really delayed my trajectory into leadership. And it was probably a little bit complicated by I didn't have as many mentors as I would have liked to have, but it was probably also my lack of awareness that I needed a mentor and I should go find one. And so I would say I went through most of my program directorship a little bit more like a bull in a China shop. Listening well, but still very, this is the way it needs to be, this is how we should do it. And it worked out fine, but I think as I experienced those leadership opportunities, I began to realize that I don't have the same skill set that everybody else has. And so my turning moment was when I became the assistant dean and I realized that I needed to be a better leader. I needed to know more than I currently knew. And so I started with knowing myself, what is my personality and where are my blind spots? And then I did a lot of emotional intelligence training on primarily related to social awareness and relationship building, because that was a place that I had a lot of holes. If you do the 2.0 test of where are your opportunities. And then I was blessed during my GME training to actually go to what's called DIO school. So it's a three year curriculum and they teach you how to do your job. And it's you're mentored by folks that are seasoned designated institutional officials for ACGME at their different universities. And so during that, not only did I learn how to do that job, but I also learned from a lot of good leadership folks in that and how they ran their programs. And so that was really, I think, transformational for me to take those classes and to begin to read and to learn how to be a better leader and then to have an opportunity to practice that in perhaps a low risk environment, where if you made a mistake, it was okay. They were your peers, they're there to help you. And so that would be my, I agree with everything that's been said so far, but I think if you're on the front end of trying to lead, you gotta know yourself first and then you have to build your toolbox in order to be able to lead. And then some of the higher end conversations about empathy and come into play, but build your toolbox. How do you run a meeting? How do you follow up with people? You know, how do you be authentic to yourself with trying to lead forward? Those are things that take time to understand and learn and practice and there would be missteps. You just hope that none of them are career altering maneuvers, which is always could be a problem. Yeah, I'll just add a couple of comments for those of us that are naturally introverts. Don't despair because this is something that you can actually practice getting more comfortable with. So I'm a person that like a cocktail party is like my worst nightmare, but don't tell anybody because I think I fake it pretty well. And that's something that I've really had to like, you know, get myself like psyched up, like this is gonna be okay. You can do this, you know. But it's truly not something that comes naturally to me, not something that I particularly enjoy. So, but recognizing that you do need to make those connections and be social and be the face of, in my case, the face of Encompass Health a lot of times, that's something that you can practice and get better at. So I'm sure that these guys would all agree that it's something that as you get older, I once had an older physician tell me, Lisa, don't hide your light under a bushel. And at the time, I had like no idea what that meant. But what I've learned is that it's okay to kind of be a little bit self-promoting. And especially as you get older and more experienced in your career, I think you get more comfortable with those kinds of situations. So the next question, and I'll start again with Susan because I think you kind of touched on this a little bit, but if you could go back in time, is there anything you would have done differently in terms of advancing your career? I think things that would have helped if I would have been able to identify a mentor, someone to be there, it might have been a little bit more helpful, but part of that would have also be recognizing I needed someone being receptive to what they had to say. And early in my career, it took a long time to realize I needed that. So I think that would have been helpful. I think, I know some of it is just stay in the game, right? I mean, when I had a disruption in my career, I could have easily gone nowhere after that. I could have easily just shown up at work and spent the next 20 years just seeing patients and having no other responsibilities. But I kept my little toe in the game, in that committee, and it gave me the opportunity to continue to grow and demonstrate some leadership, which then turned out to be just a huge opportunity for me to be involved in all 17 departments of the University of Kentucky and then become a chair. I think it was an easy, I hope it was an easy decision for the dean to make at that point. So always stay in the game somehow. Even if you're tight on time and you can't give a lot, you just never know where that opportunity or experience might take you. Right, and I would just add to that, don't burn your bridges, because if you're going to change a course, we have really a relatively small specialty, and you never know who you might run into in the future that you had an interaction with in the past. So another just bit of advice I would give is don't burn any bridges. Don't talk badly about people. You really never know what will happen in the future that might come back to bite you, and especially in this day of social media and things like that. You know, when you publish things online, they're there forever, and I'm sure you guys are all aware, but that would just be another thing I would watch out for. Mike, anything you would have changed if you could go back and talk to your younger Mike? I have to say, there's so many great comments from the panel here, and I think we all relate to everything that each of us is saying. So yes, I think there's a couple of things. One is I wish when I was younger, I started, as I started to see a trajectory where I was going to have higher levels of responsibility, that I, as Susan had mentioned, had more education on some of the basic principles of leadership. A mentor would have helped. I agree with that. But things like negotiations, there's the ability to negotiate. There's a huge body of knowledge out there that I wish I was exposed to a bit earlier, or conflict management. It's like what, you know, it's great when you do things or everything's going well. It's really what distinguishes you is how do you get through a sticky situation and a sticky wicket with one of your colleagues, which, you know, Lisa and I have had some practice on over helping them. Yeah. So, and the last thing in that regard would be a little more knowledge on organizational behavior. I did, when early in my career, took a week-long course at the executive school up at Harvard, which their courses are amazing. It was on organizational behavior. So that was kind of a tipping point. Like, oh, there's an organizational behavior. And so just, that's what I would say. If you have an interest and you have abilities, and obviously everyone in this room, I'm hoping are all gonna be future leaders in their capacity and their organizations, that you get a little bit of formal education early. Just dip your toe in it, because there's definitely, the world has a lot of experience on that, and high-level educators have a lot of experience on that. And you can build, at least, from basic ideas that you learn those first few times you do that. The other thing is, I would, when you think of things, I would do more, I would act more forward, and I would have worried a lot less. Right, you have to sometimes just trust your intuition. You know, I think as doctors, we probably overthink things because we're trained that way, right? We're trained to looking at, what's the worst possible thing that could happen to this patient that we need to change that, you know, a little bit of, in a better sense. So, do more, do more that you know you should be doing and worry a bit less about it, and let it unfold. Yes, I would say you have to be intentional, and I will repeat that. You have to be intentional with your actions. You have to be intentional with your goals. And it's okay, and it's important to set those goals, but also, you know, set short-term goals. One year, five year, 10 year, write them down, revisit. Also, by being intentional, it's more than just working hard, going to work every day, doing a good job, taking care of your patients. But you have to be intentional if you are seriously thinking about any type of leadership. You know, it's been mentioned about mentorship. Mentorship is so very important. I think, you know, I'll talk a little bit more about that on the next question, but, you know, find a mentor. I have met several mentors, you know, not just for a private or from a professional standpoint, but also, you know, from a personal standpoint. You know, I have mentors as well to bounce ideas out. You know, network, you know, get involved, you know, put yourself out there. And I know sometimes this is uncomfortable, you know, but it's almost like getting comfortable being uncomfortable if you really are truly thinking about being a leader. And it gets easier. You know, the more you get out there, the more you interact, you know, you realize, you know, well, we're all the same, you know, we all have common goals. You know, don't work in silos, you'll get nowhere. You know, it's like, you're out there, you're doing a good job, you're in the grind, is more than just that, you know, being collaborative, you know, working not only amongst what's happening within your department, but also getting out there amongst other departments, amongst your community, you know, getting out there, getting your name visibility. And also, you know, that creates that reputation and people will see, you know, who you, the true authentic person that you are, you know, even when you're not trying. And I think that, for me, has been, you know, one of the things I would look back on, you know, again, just not being in the grind every day, but just taking the time to, you know, really build those relationships and getting out there and more, being more collaborative. And it's hard, and I'm sure that we can all appreciate, you know, we get so busy, we think, you know, there's no time, you know, I'm working so hard. If you have family obligations or other things, you know, the days are long, but I do think that's really good advice is to be intentional and also find something where, that will help you recharge your battery. I always, when I talk to our young medical directors, say, you know, you have to take vacation. Like, I don't care, like, even if it's just a few days, you have to find time for yourself and recharge your battery and have some peace away from work because otherwise I've just seen too many people get really burnt out or get sick. And so I am a big advocate of taking good care of yourself as well. So with that, and we'll just go back to Dr. Kirksey again, do you have any advice specifically for young physiatrists or residents who think they might be interested in pursuing a leadership role at some point in their career? I don't know, just, you know, with my experience, you know, I got involved, you know, I was one of those, I don't know if it was good or bad, but if I was asked to do something, I did it. Because I knew, well, at the time, I didn't really know what area, you know, whether it would be education or more administrative, you know, was I interested in medical education and continuing on or graduate education. So try to identify, you know, what area you're truly, you might be interested in. And oftentimes, early on, it involves you saying yes to a lot of things. But at some point, you've got to realize you can't say yes to everything. You've got to be able to, you know, hopefully, you know, within your, you know, second or third year out as a resident or, you know, getting into your early career, you're able to have a mentor or someone to kind of help guide you in helping determine, you know, what exactly or what trajectory you would want to take. But again, you know, it does require that direction. We talked a little bit about, you know, the mentorship, you know, getting a mentor. And it's so many types of mentors. You know, you don't necessarily have to have a mentor. Even in your specialty, you don't have to have a mentor in your specialty. You can have, you know, a mentor across other departments and other institutions. And I would encourage you to do that. And then also take an advantage, again, with, you know, meetings such as this, the academy meetings, you know, meeting other, you know, physiatrists, young physiatrists and making those connections. Because again, if you're interested in advancement, you know, if you're in academics and want to get promotion is more than just what you're doing there within your institution. You've got to show value of what you're doing on a national level and oftentimes internationally. So you want to keep that in mind as well. And then, you know, I talked about, you know, the mentorship, but to taking it a step further, you know, when you are on committees and getting involved, I think that also creates sponsorship, you know, that individual who's going to speak for you when you're not in the room, but they've got to have some validation. And so, you know, when you're committing yourself to various committees and different job tasks, you know, you want to make sure you're able to do it. And if you cannot do it or commit to it or meet those deadlines, it's important to communicate that because honestly, when you're in, when that person is in the room sponsoring you and trying to put your name up for a particular leadership position, but if they don't have anything to vouch for, it makes it very difficult to take it to the next level. So again, I think that goes back to being authentic and being true to yourselves and realizing which trajectory you want to take. And it's always important to know, you don't have to get it right every time. You know, particularly in the field of PM&R, there's so many different areas, so many different avenues that you can take, but you have to be true to yourself and you have to be able to reevaluate and reevaluate frequently and don't be hard on yourself because, you know, if you get it wrong, it's okay. You know, there's ways to, you know, we all, as leaders, we all have had, you know, made decisions and done things that wasn't quite, you know, what we had intended. But again, as a leader, you know, that's a part of it. And the thing is you learn from it. And once you've learned from it, that's an experience that continues to lead to further growth and being a great leader. Yeah. I'm finding less and less that I can add to this excellent discussion. But a couple of things I wanted to emphasize as we've moved on here is, it's hard to go up and ask someone if they'd be your mentor. Right, so how do you do that? Where do you start the conversation? And it's very clear, first of all, identify someone who you think is a good role model. You like the way they move through their professional life. And follow that along. You may have more than one. You may have one or two role models. And then develop that relationship, that one or two that seems to resonate with you. And then once you have a relationship, you can ask them the question. Like, it'd be great if, you know, however words you, whatever words you wanna use, if I could ask you for advice periodically. So that's the way to get from, how do I get a mentor? You know, how do I ask someone if they want a mentor? There's a way to warm up to that. I think it's just professionally good, a good relationship. The other thing, and we've said this a number of times, to trust your intuition, so I'll give you an example. I think physicians in general, it's very hard for us to say no. I'm not going to take a poll from this room, but I'm sure most hands would go up. It's something about the way we're made up where we don't like to lose opportunities. We don't like to have doors closed, you know, but so a lot of us say yes a lot more than no, which is great, you know, that's how things move forward. But I think you also, probably the more important decision is when you say no, because your psyche is going to fight you against that. So take your time, do your evaluation of the facts, what you know, what you can glean, what you can learn, and in the end, it's going to be mostly your intuition that guides you for that final decision. And if it's an intuition yes answer, great. If it's an intuition no answer, your mind is going to fight you a little bit on that, but that's what it has to be. So just a piece of advice from our experience. And I'm curious, how many in this room have seen the series The Bear? Raise your hand. Okay, a little bit less than half. Highly recommend. So I'm going to explain to you very briefly why we highly recommend it. So there's a, the story goes there's a Michelin chef whose name is Carmy, Michelin-rated chef in New York, whose brother dies unexpectedly in Detroit. His brother owns a beef sandwich, a really popular beef sandwich restaurant in Detroit. Is it Detroit, right? Chicago. Chicago, okay, one of those. But in any event, so Carmy, for some reason, goes back home where his family is and starts to try to rejuvenate, regenerate, reframe this business that his brother had. And then, of course, family dynamics and all this come into play. But the reviews have been, and I agree, and I'm sure those of us on the panel saw it, it's actually an incredible story in the deployment of leadership as Carmy tries to pull this beef sandwich restaurant together from having been to a highly-rated Michelin restaurant, just the top, the top of the top. And to me, I think it's worth, it's kind of a modern way to look at it because it's an entertaining story. And then you realize what he's doing and how hard it is to be a leader and how many mistakes you might make and how your team responds to you or doesn't respond to you and how you respond to challenges, how you respond to victories. It's a hard uphill climb. But I think I would recommend it because it's a great story, and if you look at it from the leadership perspective, it's a great dialogue on leadership. That's my perspective. Would you agree? Yeah, absolutely. So, anyways, I don't have anything to do. No financial gain from the bear for me. No disclosures. No disclosures. Susan? So, I mean, I agree completely with Kenesha. Set your goals. Be intentional with what you want to do. But you can lead at any level, right? If your goal is to lead at an academy level and be a president, well, you have an example up here. If your goal is to be chair of a committee, then you have an example up here. If your goal is to be, you know, the chair of a department or just a great faculty member who leads the hospital, you have examples here. So, set your goal and be intentional to get there, but just remember you can lead at any opportunity. And sometimes it doesn't even have to be medicine related. Sometimes doing things in your community are a good way to practice your leadership skills with less risk. So, take as many opportunities as you can to build your repertoire. And as you go forward, don't sell yourself short and work toward whatever it is you feel brings you meaning as you build your career. So, last question is we're, we've got about 10 more minutes and I want to leave some time for questions if there are any. But if you just had to describe what was the, what has been the most rewarding aspect of your career to date and could you describe how it has been fulfilling for you as a physiatrist and a role model? And I'll just start with Susan. So, my, one of the first things I did when I started trying to figure out how to be a leader is I read a book, I think it was Sinek's book on getting to why or what is your why? And I said, what's a why? And so, when I was reading the book, I was thinking, oh boy, how do I create a statement as to why is my why? And because at that point I was a mother, I was a coach, I got into leadership by coaching my daughter's t-ball team, really good opportunity to learn some patience. But so, I'm thinking what is my why? And so, I was able to conjure up, I think, the why that has helped me throughout my career. And my why is to have a positive impact on every life that I touch. Because that doesn't mean, it could be a resident, it could be a faculty member, it could be a patient, it could be my own children. And so, it guides me, it guides me well in my decision making and making sure that I head my compass in that direction in all the decisions that I make. So, that to me has been really helpful. I love that. Mike? I would, and what I would tell you with where I started, I think that over the course of time, the most satisfying thing has been to advocate for our patients, right? For everything that I do, it comes down to that. It's not me directly advocating, I'm helping someone move towards the ability to affect advocacy in their community, as well as, you know, excellent patient care for our group of patients. That's the first thing, so I end where I started. And the other thing on a broader view of that, which I didn't expect to feel fulfilled, it's actually the ability to understand my peers and all the other stakeholders in PMRNR healthcare, in our community, and nationally, as well. Everybody has a perspective, right? And everybody, there's a lot of stakeholders, and to be able to really glimpse into their world from their perspective that you've, that I've gained over time is a very, it's been very satisfying, and the corollary to that is, you know, as physicians, PMRNR doctors, you know, I'm always amazed. I've been in it long enough, and I've been in my community long enough to recognize when I have caused a butterfly effect, and there's a ripple. The ripple could be 30 years later, and I have numerous stories to tell you on connectivity of how, in my community, I've taken care of, you know, people's grandfathers. You know, it's like, it's a lot of generations I've cared for, and all of a sudden, they come into the rehab hospital and say, oh, Dr. Lupinacci, how are you? And it's like, nice, Mr. Wilson, how are you, and how do you know me? And it's like, oh, you took care of my nephew. He got hit in the head with a baseball, you know, 25 years ago, and now he's an attorney in North Carolina. So it happens frequently. So the point about the ripple effect is what I've realized that over time, in all of us have the fortune as physiatrists and as leaders to take care of your community, take care of the people around you, and it's very powerful and very satisfying when you get that feeling. So it makes all the past work seem worth it, right? And, you know, I think that in leading—I'm going to end with this—is that the fulfilling part on the leadership of any group that I'm participating in is that I've learned to— leaders in general, you will learn to, when you see potential future leadership in someone, you will realize that some people will have flashy skills, and other people will have great skills but not as flashy. And to make sure you recognize everyone at that particular time and know that your goal is to have a very diverse skill set with diverse people, and that will make your ability and our ability in PM&R to care for the people that we care for in a much more effective way. So that's how I do it. Let's see. So I would say, you know, for me, it's the gratification to be able to give back. And also using the platform as being a minority underrepresented in medicine as a physician, I have utilized and continue to utilize the platform to encourage other minority underrepresented individuals in medicine. And also using the platform to give back to my community. I grew up in rural Alabama, you know, population 21,000. So I utilized the, and blessed, being blessed with the current platform that I have, being able to give back to my community back at home. Also using it as an opportunity to educate, creating different programs within my local community, and also sharing information and knowledge, and giving them the empowerment as well to understand and navigate through some of the challenges that we all have experienced in healthcare. And also focusing on some of those social determinants, and helping them realize how can we close the gap and making a more level playing field for everyone. So again, the most rewarding part, not only being able to take care of my patients, but also being able to represent the underrepresented individuals in medicine as well. That's awesome. And I want to just, please join me in giving our panelists a round of applause. We have about five minutes left for questions, so does anyone have any questions for anyone on the panel? Please don't be shy. And of course, Dr. Glassman is never shy. He is not an introvert, and here he comes to the microphone. Well, I never took a personality test, but I'm probably not an introvert. Derek Glassman, Deputy Chief Physical Medicine and Rehabilitation in Los Angeles, UCLA faculty, one of your AMA delegates. So this is for the audience, but you get to answer the question. If any of you ever go for a leadership interview and they ask you a performance-based question, you're going to get this question. Tell me a time when you were really passionate about a project that you wanted to be successful and it didn't get through. What did you learn from that? Did you revisit it? And if it was successful the second time, what had you learned to make it successful the second time? Because we all fail. We all never get it right the first time. And as leaders, you are often ahead of the curve, going to places that nobody else really wants to go to, and you often meet resistance along the way. So I'm curious as to if you have a story from your background or from your experience where it didn't work out the first time, but you went back, rethought it, made changes, and it worked out. Because you will get asked that question if you want to be chairman someday or head of a company someday. I'll volunteer to go first. I know Stuart, so I know how to go first in this particular question. That is a huge dilemma in leadership. But I'll give you my take on it. So I'm going to assume, knowing you, that you did everything you could to persuade the leadership. I'm asking your experience, not me. Did you ever hit something at US Physiatry or HealthSouth or on campus where it didn't go through and you had to rethink it? So then reversing that slightly, if it wasn't going through, I usually get much more quiet, like nonverbal. And let's say it's someone I have a professional relationship with. They know if something good goes through, then I highly compliment them and give them very positive vibes in person and publicly, number one. So I try to establish the fact that I want to make them feel good about their best decisions, and not that I want to make them feel bad about their best decisions, but I want my emotional response to be very neutral and non-supportive, but not saying I'm non-supportive. Because you can't break down that relationship, right? Because if you want to try again in another way, that relationship has to survive. But then, I'm sure you knew the next thing I would say, I try vigorously to let them know what are the potential negative consequences, how do I see this unfolding, right? Tell the story and make sure that they understand the potential challenges for them should your thoughts as a physician not really be recognized. You know, and beyond that, that hasn't always worked either. Sometimes it's worked, because sometimes they don't think of things. But if it doesn't work, then it's not going to work. And I wish I could have a magic, I don't know, I wish I had a magic wand for you. Because that's what it's going to take. I have an example for you that I think is more, so I think, so I've had experiences where I think, let's say we need to create a new position to support my department, and it doesn't get approved. And one way to kind of, is to kind of wait and speak to other stakeholders and find out why they felt that position wasn't necessary, and then maybe come at it from a different angle by getting that advice from other people who could influence the ultimate decision maker. So that would be, that would be my example. Any other questions for the panel before we adjourn? Thank you, panelists. It was always very helpful, and everybody had good insights. And I think each of you mentioned mentoring, and Mike took on, like, that could be a little awkward. I can't take credit for this idea, but I'll see what you think about it in your experience. In a recent issue of JAMA, sometime in the last two months, I think, the Peace of My Mind article, that's always the first person type narrative that's in the journal, brought up the concept of a mentor quilt, and the concept that this physician wrote about. And I wish I could quote her specifically and give you her name, because I found it powerful. But talking about at different points in her life, she had had multiple mentors that she realized there's no one person who can solve all of your needs. And so she talked about this concept of a mentor quilt, people who had mentored her at different points in her life and for different things. And as you were talking, Mike, how do you ask somebody to be your mentor? And it's pretty overwhelming on the receiving end if somebody says, oh, I want you to be a mentor. It's like, do I have to adopt you legally, or what's involved? But you could go to somebody and say, I really admire the way you chaired that meeting. It could have gotten contentious, but it seemed to me you really handled it. Would you be willing to maybe spend an hour with me over a cup of coffee to talk about just how you lead a meeting? And so you may be asking somebody for a specific thing. It could later turn into an even more comprehensive mentorship. So I don't know if you've had that experience of maybe somebody mentors you on a certain thing, but you're not expecting them to be your whole professional mentor. Yeah. So yeah, so just briefly, so with mentorship, you think more about developing those types of relationships, but you also have to think about advising. Some is just taking a moment, spending a few hours, and giving advice every now and then. So I think that's a little bit different. But I do agree, true mentorship has to be a mutual agreement on both individuals. And it's one of those things that, in addition, it's usually it could happen organically over a cup of coffee, getting to know that person more closely or intimately, if you will, and then letting it evolve. And I think you still have to be intentional, because we're all so busy. As a mentor, or being a mentee, you want to be intentional with what you want to gain out of the relationship. And at the same time, as a mentor, you want to be up front to really be truthful. Can you offer what that mentee is asking for? So I think it's important. Again, we're all so busy. To be intentional with being up front with what are you expecting to gain from that relationship. And I have mentors certain periods of my life. I have fewer mentors now, but now I feel like I'm at a point where I don't need as many. But again, I have them all across various facets of my life, not just from a professional standpoint. So I want to thank you all for attending. I'm being told that we're out of time. There's another talk coming in, but I think we can all stay up front if anyone has any additional questions for us. But thank you so much to our panelists. Thank you.

medical directors

physical medicine and rehabilitation

career paths

successful leadership

developing relationships

communication skills

emotional intelligence

being authentic

active listening

mentorship

recognizing new leaders