Stephen Williams: Well, thank you for having us.
Bishoy Faltas: Thanks for inviting me.
Zachary Klaassen: So, Bishoy, maybe I'll start with you. Just for background, how did we get into this volatile and uncertain healthcare environment? Maybe a couple examples for our listeners. I know most of them are listening and probably dealing with Epic messages and numerous messages from all over the place in the hospital, but maybe how did we get to this point?
Bishoy Faltas: Yeah, so Zach and Steve, so thanks again for the invitation. So, there are a few things that I think about, and I think it's the convergence of several forces. One thing is sort of the complexity of the care that we all strive to provide in our clinics and ORs and different settings, academic medical centers, community centers. It's all quite complex; ever increasing demands for documentation and administrative burdens, but there's also the convergence of I think two key factors that drive uncertainty. One is an opportunity, but also a driver of uncertainty, which is AI. That's moving very quickly, and that's making it hard for big organizations or even for individuals to try to plan for the future. And the other one is just the changes in policy and research funding.
And again, many of us are involved in research, but even for those that are involved only in clinical care and not a lot of research in an academic medical center, an academic medical center is a very tightly connected organism, and when something happens on one side, the research side, it affects the clinical enterprise and vice versa. And there's a lot of uncertainty about research funding and just general changes in healthcare policy. All of the conversions of the complexity, the changes in the healthcare policy at the national level and then all the technological innovation, which again is an opportunity, but also a challenge, makes that quite a bit difficult for individuals and organizations to adapt.
Zachary Klaassen: Yeah, it's a great background. I want to ask you guys both sort of a similar question. I'll start with you, Steve. When we think about embracing change and volatility and taking leadership positions, you've been at the forefront of this for the last decade or so with MBAs and leadership positions. Why is it important, first of all, for urologists to be at the forefront of that? Maybe use some of the examples in your career.
Stephen Williams: Sure. Well, we'll focus on urologists, but really I think just physicians at large. And taking a bit of a step back, physicians, our training is robust in medical education, biology, but really aside from the military, we have no formal leadership training. We don't even know what that word means. We know what management means, but more importantly, also business acumen. So, we start off as CEOs respectively of our own practices. We're leading teams, leading others, but really don't have that skillset and development. As you alluded to, I need formal education. I'm not as smart, so I needed to actually have someone sit me down and teach me the rubrics, whether it be a leadership development institute, a number of our organizations have that. Somehow I was anointed as one of those people to undergo that, but it's not prescriptive.
And then the other component is as well as also getting additional formal training, whether that be an MBA, which I did get, as well as a master in health administration, whatever it could be, but really it's experiences. We did a national survey through the American College of Healthcare Executives, so physician leaders, from presidents to medical directors. And really what was interesting, it wasn't the degrees that they found were most useful, although that's something I find that a lot of great physicians, which I've come across over the years have asked me, but it's the experiences and it's actually seeing someone like yourself. We see that in regards for diversity, equity, inclusion. When patients see someone that mirrors themselves, then perhaps they feel more comfortable, more willing to seek healthcare.
And I think the same thing holds true with leadership. When physicians are seeing other physicians as executives, particularly CEOs leading organizations, which about five to 15% depends what you look at are only physician CEOs, we have a tremendous opportunity. My personal experience, like I mentioned before, and I think I just really have enjoyed growing other people aside from programs over the years that really brought joy in my heart. That then cultivated in other people seeing programs and developing others that has led me to have really just wonderful opportunities and positions that I've been able to hold, but I call it serving.
And I think that's a key component as you never wanted to be one of those individuals, or I didn't, sitting in a chair that people wondered, "How the heck did he get there or what is he doing?" So, being able to be on the front lines and take those initiatives. I think urologists, just by way of our wonderful personalities, perhaps can have those conversations, and people feel very comfortable, level the playing field, if you will, feeling that you're coming to them with integrity, humility, and really just truly trying to help improve initiatives versus, "We need to improve a metric." People don't follow metrics.
Zachary Klaassen: Right.
Stephen Williams: They follow people that have heart and are passionate and really give a reason why they're doing that. And then change management, no humans like change, but we have to really understand... Bishoy, beautiful illustration. We have a tremendous opportunity with the human AI interface, the human component to make sure that we're understanding in an environment where things are exponential, our organizational structures at best are linear. And we have to restructure our education, our research, clinical trials, but really how healthcare is being delivered. So, I think those are my personal examples that I have.
Obviously I can get into more detail, but I think we're just such at a pivotal point. And our physicians want to be a part of the conversation. Obviously we're running on the RVU treadmill, so we have to do ownership particularly in academic environments where we provide time to our physicians to pursue whatever endeavors that they want. And I think that should be a key component of our mission in academic medical centers at large as we've taken the oath, if you will, academic clinical research, and really hopefully help developing future leaders to lead our health systems.
Zachary Klaassen: Yeah, it's great dialogue, Steve. Thank you. Bishoy, maybe along those same lines, but from a GU medical oncology standpoint, your robust research experience, why is it important for individuals with your portfolio and your pedigree to be taking these opportunities, these leadership opportunities to drive change and embrace change?
Bishoy Faltas: Yeah, so actually I want to echo something that Steve just said, which is really important, this self-development in leadership. So, as Steve was just saying, we don't really go to medical school or residency or a fellowship and really get that training to develop these management skills, develop these analytical skills, negotiation skills, conflict resolution skills, which are all really essential for leadership. And one of the interesting things about being a physician scientist and running a lab, which I have realized over the past few years, is that it's not just a lab for doing experiments, it's a lab for in some ways personal development because all of these... It's sort of a microcosm of all of these things. So, a physician scientist who runs a serious dedicated lab will have to figure out ways to do all of these things, to hire people, to maybe do performance evaluations, to let them go if there are issues that require that or corrective action or all... And these are really difficult things, and to do strategic planning over time to figure out, "We're at point A, but where are we going to be in point B, or where is point B, and where are we going to be in 10 years?" So, I think all of that comes with the job. But as Steve was just saying, there are really no formal ways to do this or easy formal ways to do... or informal ways to do this or not always very successful, but there are actually ways to do this.
So, there are lab management courses that I've enrolled in that are sort of a similar curriculum to some of the MBA courses where they teach you how do you hire somebody, how do you... So, there's an ESMO one and there was another one that was running called Spring Harbor that I went to. But also again, I completely agree with Steve, this is kind of like the recipe, but the experience of actually doing it day in and day out and trying to develop your own personal style of management and what kind of leader you want to be, because, again, PIs are essentially the leaders of that microcosm. And then also starting to think about, well, leadership amongst people who don't directly report to you, so your colleagues. That's a different ballgame and requires advanced the next level of skills. And how do you...
You're writing a large grant like a SPORE grant or an institutional cancer center grant, how do you make sure that everybody is collaborative? How do you make sure that everybody is invested in the mission? Do we have a mission? Do we have a mission statement? Is everybody aligned with the mission? Does everybody believe in the mission? So, again, agree with Steve, people will need to understand what that mission is and be personally invested in said mission, whether it's a smaller unit like a lab or a larger unit like an institutional unit. So, I think these are all really important things to realize early on that these are important for success of the collective unit, which is also part of the... or aligned with the success of the individual, but it's also about the success of the people.
So, Steve also said something important, which is building people, and building people comes when everybody understands their role. They're invested in the mission, they are aligned with the mission, and there's good leadership to help guide them through all these tracks, so I think that's really important. In terms of why medical oncologists and urologists should step up for leadership positions, I think naturally our training is sort of at the intersection of science, patient care, understanding technology, and also understanding some of the financial considerations. So, that's sort of a very unique perspective that physicians who are urologists or medical oncologists, just because of the nature of our training, we have a unique vantage point on some of these topics that we should try to contribute to the institutional perspective.
Zachary Klaassen: Oh, that's great. This is a perfect setup for my next question to each of you, and it's really somebody listening to our conversation who is spurred on by thinking about building their leadership portfolio, maybe some innovative leadership opportunities. Steve, I'll start with you. What are some actionable things that people can do tomorrow, whether it's in their institution, in their community, what have you?
Stephen Williams: Well, I think talking about mission statements, one of the probably most poignant ones that gets to where we are, it's, "People first, patient always." And that's something you could live by, right? And investing in people, you'll never go wrong. If anything, I look back, and I'm great at, I think, promoting people too well that they end up getting... Particularly nursing as well. I have... One of our nurses was in the OR, she wanted to broaden her horizon, made her our nursing clinic manager, and then they developed and then she became our overall urology clinic manager, and then now she's developed even further into the surgical service line manager. Another nurse, a current one, was an MA, and I challenged her because I saw that potential, and then really kept challenging. And probably she was so annoyed by me because every time we had clinic, I would ask her, "When do you enroll?"
Well, now she's four years past her degree, she's two years into her current job, and I'm constantly asking her, "What would you like to do?" But you have to really from a sincere point of the heart... People, I always say, have a great BS meter, but they know when you care and they know when you're invested, and I think that's the key component. So, I think starting building your leadership portfolio, what do you want to do? Do you really want to build others? I think most of us do. We care for patients, we care for human beings, and it seems like a natural dovetail, particularly for physicians and urologists. But I think the key initiative is first off, find your why. What's your purpose? What do you want to do? Could it be just urology? Could it be health system? Could it be... Whatever it could be.
But then reaching out. I think Steve Jobs had a great quote of many, "Everyone has dreams, but very few people make the call. Very few people reach out, and that separates the people between the dreamers and the doers, the people who actually end up pursuing these initiatives." And I think that very much holds true. Find someone out there that you see that is someone that you'd love to learn and hear about their journey. I do it routinely. Today I even had a call today with someone. I just love learning from others, and people are willing to share their stories. That's the amazing part. People are so fearful, "Oh, I can't email this person." And now we get their contact. You just go on even ChatGPT or wherever you want, but you could reach out to people. So, I think that's the first thing. And then everyone within their organizations, believe it or not, there is some form of a leadership program, whether it be a leadership institute, the AAMC has one, urology, the AUA, and just sending an email.
And people are willing to help, but you have to also too, reciprocate, pay it forward by doing the programs and then bring others, I think. So, I think those are the key initial recommendations that I would have that I've taken. And if you can't find it in your own organization, who cares? Go international, go global. And I think that I've learned so much from listening to other people's journeys. I called them sometimes... There's a book called Old Gorillas. Because they've been through the jungle, they'll tell you where all the pitfalls are, things to watch out for, but the lessons you could learn. And then you find out what works for you. It's kind of like studying, some people like flashcards, some people can just memorize, whatever it is. And then you find out how best... what curriculum or pathway you need to develop yourself further.
But I think it starts out with yourself, and that's the hardest part, to be honest. What do you want to do? I think, to be honest, all physicians lead, and I think we need to get some skillset development. And that doesn't mean tools. Tools are only one mechanism, but the skillset is also too, the exposure. And then reaching out into your own respective organizations, whether it be being a part of a committee. I know people don't like to hear that word, but being an active member. And choose something that you want to be a part of. And I know we don't have time, but even approaching your chair, chiefs, whatever, and even a health system-wide and see what opportunities are there, but I think you have to make the call.
Zachary Klaassen: Awesome advice. Bishoy, how about from your perspective, innovative leadership opportunities for our listeners?
Bishoy Faltas: Yeah, absolutely. So, I think I agree with Steve, that the hardest, but also the most important first step is knowing your why and knowing what you want to do, so do that soul searching. I have people in my lab that I mentor, and they'll say, "Okay, I want to go to medical school." And I'll say, "Why?" And if they can't convince me, I'll send them back to think about it for two weeks and come back and tell me. And I've had people who thought they wanted to go to medical school that ended up being graduate students at Harvard, and I have people who thought they wanted to go to graduate school, and they are going to be amazing physicians that maybe will take care of me one day. So, I think it's really important to get that why, and just do it for the right reasons and do the soul searching.
And I tell them, "That's the one question that you need to answer for yourself. I can ask you questions, I can give you some guidance, but you need to answer that for yourself. And it's a really important question. And once you figure out your why, I can help you get there, regardless of what it is, but that one, you need to do your homework." In terms of for physicians, I think there is... I agree with Steve also, there's a lot of structure in an academic medical center, which we're all going to go through at a certain point during training. And a lot of the times people don't avail themselves of the resources that are available. So, for example, I say for junior faculty members, "The first step is sort of understand the different promotion tracks within an academic medical center."
And I say that not because it is a restriction, not views this as a restriction, but view this as a decision making aid to help you figure out your why and your path. So, once you've figured out your why, this is some of the sort of preconceived path within different academic medical centers that you can follow. And whether that's taking outstanding care of patients, running a research lab, getting involved in medical education, getting involved in administrative positions, I think it's important to align what you want to do with what is expected of you on your track. And that's really important, and I'm always surprised when our fellows come to me asking for medical advice, and they have sort of no idea that these tracks exist and sort of don't bother looking at them. So, that alignment can save you a lot of effort, time and effort, going forward.
In terms of leadership resources, I went through a program that's called LAMP or Leadership in Academic Medicine at Weill Cornell. ASCO has a wonderful program called the ASCO
Leadership Development Program or LDP. I'm sure AUA has similar leadership programs. So, all of our national organizations have these wonderful leadership programs. And another thing that's really surprising to me, and in a good way, a good surprise, is that the medical... an academic medical center has so many roles in many different areas that are suitable for so many different talents. So, for example, I just got... I became the unit leader for the neoplasia unit for first-year medical students at Weill Cornell. So, the two-year course, I'm responsible for teaching it. And we had amazing colleagues who came in and spoke to the medical students. We had Dr. Varmus, who's a Nobel laureate, came and spoke to the medical students, gave a lecture. They got a chance to ask him questions, and that was a truly amazing experience for them.
So, many, many opportunities for people to contribute towards the educational mission, in this case, of the academic medical center. There are similar opportunities in administration and research, so many opportunities. And in some ways, there's no shortage of roles and of work that needs to be done, so if you inquire and, once again, you know what is it that you really are interested in doing and you show that you are proficient in your primary line of work, there will be no shortage of other opportunities for you to take up. And then last, I would say run for office. I had this opportunity to run as a representative for our general faculty council, similar to a faculty senate at many other institutions, and I ran and I'm serving my second term now.
And that has been, again, an eyeopening opportunity for me because you are in a room with the senior leadership of the Weill Cornell, and you are being part of all these conversations about how all these very important decisions are going to be made. So, you learn a lot and you have an opportunity to contribute in committees. And I was, honestly, surprised when I ran not expecting to win or to be elected, but I got elected for that for... And again, I got reelected, so I'm on my second term for that. So, there are, again, many opportunities within an academic medical center for you to contribute towards these different missions.
Zachary Klaassen: Gentlemen, we talk a lot about data on UroToday, as you know, but this is a perfect platform for discussions like this. And I think just your insights and your experiences and just a ton of gems in this conversation today. So, thank you for joining us on UroToday, and for your expertise and your honesty. Thank you.
Stephen Williams: Thank you.
Bishoy Faltas: Thank you, Zach. Thank you, Steve.