Mike Sacopulos, host of the SoundPractice podcast, interviewed physician leaders Dr. Peter Angood and Dr. Jay Bhatt on strategies for career transitions.
This transcript of their discussion has been edited for clarity and length.
Mike Sacopulos: My guests today at the SoundPractice podcast are Dr. Peter Angood and Dr. Jay Bhatt. Peter Angood is the CEO and President of the American Association for Physician Leadership. Dr. Angood previously served as a Chief Patient Safety Officer and Vice President for the Joint Commission. Dr. Angood’s career has been focused on developing the leadership potential of physicians as a mechanism to advance patient care and public health.
He is joined by Dr. Jay Bhatt. Jay Bhatt is a nationally recognized physician leader and served as Senior Vice President and Chief Medical Officer of the American Hospital Association. Dr. Bhatt’s career as a public health professional has focused on underserved and vulnerable populations. Dr. Bhatt currently is a director at Deloitte and is the Executive Director of Deloitte’s Health Solutions and Health Equity Department.
Physicians go through several transitions in their careers, and opportunities sometimes appear when least expected. How can physicians prepare for career changes?
Dr. Jay Bhatt: Thank you so much for having me in this conversation, and I appreciate the leadership of AAPL and Dr. Angood. It has been a joy to work with you, Peter, over the years, and I’m excited about this conversation. To answer this question, as a physician it can be challenging to figure out if transitioning from practicing medicine to an administrative role is the right decision for you. It is important to remember that moving into management means shifting your focus from individual patients to an organization as a whole.
Leadership is about practice and not a role. As physicians, we’re exercising leadership quite often in care delivery with teams. I think clinicians think about that experience in shadowing, in working with other clinicians, as they’ve been on the journey to becoming a physician.
I would apply some of the same actions. Moving into a healthcare administration role means you can draw from your leadership skills as a physician and continue not only to help your patients but also to provide quality care from an organizational and system level. So, I would shadow some leaders. Take on a small project at your organization or in your practice and look at it from a system, population lens.
That experience will help you prepare for a career change. You’ve got to come back and ask the questions of what do you want to advance in healthcare? and how do you want to be a part of that? Also, think about accessing your network. There are a lot of physicians in your network over the years who may have changed jobs or gone into administration or policy or organizational leadership and management opportunities. And it’d be great to hear their experience.
MS: Dr. Angood, what led you on the path to physician leadership? Was there one catalyst that made you consider a transition to leadership and executive duties?
Dr. Peter Angood: Thank you. Jay’s response is excellent in terms of how we should think about what we consider leadership. And again, Jay, it’s a privilege to have worked with you over time.
As we know, as we advance through medical school and our training, none of us get any exposure to leadership or management skills.
I often say that at some level, all physicians are leaders, and that’s mainly because society looks at our profession as a lead profession. And so we have a responsibility to develop our leadership and our management skills over time. And we each do that in different ways.
In the first part of that, you have to recognize that you may have an aptitude for leadership. For me, I followed the clinical trajectory of trauma surgery and surgical intensive care medicine, both of which are fairly systems-oriented for them to function properly. And so, as I got further into my career, I began to appreciate that, “Gosh, I need to know and learn more about systems and processes and how to create change if I’m going to be able to effectively lead these types of clinical enterprises.”
There were a couple of clinical cases that wound up not having the best of outcomes because the systems and processes weren’t supporting the efficiencies there. And that bothered me on a personal level. It impacted the patient and their families. And so that was the impetus for me to say, “You know, I’ve got to be able to develop my skills and my aptitudes and my experience to help create those changes in the systems and processes.”
MS: Dr. Bhatt, what about your leadership journey? Can you tell us a little bit?
JB: Sure. I echo some of the sentiments Peter had—particularly around the system inefficiencies and that impact on outcomes and experience. And for me, I grew up as a son of a pharmacist who worked on the South Side of Chicago. I got a front-door view into the challenging health issues that underserved communities faced when we would make house calls and deliver medications or when they’d show up at the clinic. That sparked my interest to ask questions about why that was happening. Why are my outcomes and outcomes of others I see different than those that I’m meeting in communities of families? Why were they struggling with some chronic diseases—cancer, and others? I held onto that over the course of my career.
When I was in college, I spent some time with physicians who were looking at the health system from a systemic view, particularly with one of my early mentors, Dr. David Meltzer, who was looking at the hospitalist movement as an opportunity to deliver better care at a lower cost and manage the growth of HMOs that was happening in the environment.
So within that, as well as seeing how healthcare was delivered in the community at barbershops, it was meeting people where they were. They could be empowered to change their future; that was the catalyst for me. Another catalyst for me was my first year of training in medical residency, where I spent time taking care of a patient, an older woman, who’d come in with chest pain and difficulty urinating. And she ended up not having damage to her heart, improved her urination, but had a telemetry catheter.
Because there were so many patients that day, we did the rounds and kept going. Several hours later, we found out that she tripped over the wires and fell and had an impact on her hip. She then was sent to post-acute rehab, got an infection there, and came back from rehab. What should’ve been overnight, in and out, turned into a three-week ordeal. That caused me to wonder what we could do as a system to improve safety and quality. That led to a checklist that was consistent, reliably deployed, and made an impact, reducing adverse outcomes by 25% and saving money to the system, but most importantly suffering for patients.
There was another catalyst for me to launch into a system career in quality and safety. We started to organize as a team within the residency program on these issues at a system level, and that’s continued for me over the course of the years. I know that policy has such an impact on how we implement and deliver care, so I need to have a perspective on that.
I spent time on Capitol Hill, and certainly over the course of my work in public health and hospitals and health systems, as well as in health plans, I’ve been able to use my skills as a physician in leadership and management. Which I already felt I did just with patients we were caring for, but sort of taking it to the next level. I’ve been fortunate and grateful to have these experiences, mentors, and teammates along the way that have helped me learn and get better at leadership and management.
PA: Jay, both our trajectories have been different obviously, but we both have been fortunate in being able to experience some of that higher-level impact on the industry by policy and whatnot. And part of my trajectory included my time at the Joint Commission National Quality Forum.
Yet we both appreciate there’s this gap oftentimes between that policy development and the implementation versus what’s still going on out at the front line. For those who are listening, it’s important to recognize that as you aspire to different types of leadership roles, the policy isn’t always going to solve all the answers. We always, as physicians, need to be looking at how we bridge that gap, whether it’s policy accreditation, payer communities, and the front line. And I think both you and I have done that quite well over time, but for our listeners, I think that’s an important recognition—there is this gap out there.
JB: I agree, Peter. That’s so important and well said. That’s part of why it’s so important for physicians to provide their voice of experience from the front lines to help bridge that gap, and to help the policymakers and stakeholders understand the unintended consequences of policy and the challenges in implementing policy and too many measures that might be asked for, which we know can contribute to burnout. This is a really important opportunity for us to bridge that gap.
MS: Very good points from both of you. Dr. Bhatt, in your first answer, you explicitly mentioned networks. I’m interested in networks. How should physicians best grow their networks? Is this something that’s done through social media, clinical organizations, and state medical societies? What are your suggestions?
JB: I think about building relationships as an opportunity to look at your own experience and skills through a different lens because of the people you come across. Having some of these conversations and building relationships help you see a different view. For me, that was such an important catalyst. Early in my career, I spent a lot of time talking to physicians who were engaged in different areas of healthcare delivery, life sciences, and technology. That helped me broaden my view of the healthcare system. And I think the other thing is that we also have to think about language. We were oriented and anchored in a particular language as we were trained in medical school and residency. But if you want to switch careers or broaden your scope, you’ve got to come out of that shell.
It’s a ripe period in the evolution of the industry for physicians who want to engage in leadership in different ways and to do it in a variety of different channels.
Part of doing that means talking to other people who can help you think about the language and experiences differently. It’s not one or another, it’s finding the mediums that work best for you. For some people, that may be going to conferences and having the conversations and listening to talks and being in workgroups there. It might be, for some, contacting strangers on physician social media sites, career change sites, or in person. And for some that might feel hard. If you look at it from, “I’m building relationships, so I can better contribute to changing healthcare,” that reframe is important. We’ve already done this in our life and successfully, right? We were pre-med, we shadowed, we made friends with people that we are going to need for letters of recommendation. We did side projects. Whether we knew we liked it or not, whether that’s research or volunteering or other things we checked through some of those experiences, part of it is the realization that we can do this. We can have these conversations. For me, just exposure to a set of organizations I was aligned with from a value standpoint could make an impact, but also learning and building relationships. What was important early in my career was the American Medical Student Association—a community that saved me from feeling isolated in medical school.
I found my community there, which then really was a catalyst for all that came after. It was a group of people who acted as change agents and saw a different future for physicians and healthcare. I continued that through the rest of my career. I think my role as Managing Deputy Commissioner of the Chicago Department of Public Health was a result of shadowing and doing some projects in Chicago when I was in fellowship. You have to identify what’s right for you. And that will take experiences and time.
MS: Dr. Angood, the AAPL excels in this area of helping physicians develop networks and relationships. Maybe you could talk a little bit about how the AAPL does that.
PA: Yes, sure. Thanks, Mike. Well, Jay’s comments were spot on, regardless of if you’re an introvert or an extrovert. If you have this aptitude, you want to engage in leadership and management at whatever level in your community or your institution, stay true to yourself. We are fortunate in this day and age that we can channel our energies and our thoughts to network through a whole variety of mechanisms, whether it’s live meetings or whether it’s through social media.
It’s a ripe period in the evolution of the industry for physicians who want to engage in leadership in different ways and to do it in a variety of different channels. So yes, in our organization, we do several face-to-face meetings every year. Some of the most valued aspects of those live meetings are the opportunity to network and be amongst a similar peer group and to not feel like you’re isolated, be able to recognize that others are dealing with similar issues as yourself, and you can learn from one another in a spontaneous set of meetings. But we’ve also invested heavily in a technical platform that brings all of our programs, products, and services together under one umbrella on this technology platform.
There’s the learning management side of it. There’s the online community side of it. But there’s also a whole set of information resources, and we’re active in social media as well. It’s interesting, we’ve got more members in our LinkedIn group than we have actual members in the association these days—which is intriguing all by itself. But what that tells me is that physicians are out there looking to connect with like-minded peers.
So, again, I’ll say it doesn’t matter if you’re an introvert or an extrovert. You can find avenues and channels in which to connect with others. It’s being able to learn from those others that helps move you along in your own choices and your own experiences. Then you can begin to better create the impacts that any of us desire, whether it’s on a personal level, whether it’s at our institution, or whether it’s on a broader level within the industry as a whole. Multiple channels. Doesn’t matter what type of personality you are. Believe in what your voice inside is telling you. Follow that voice to leadership.
JB: Peter’s comments are correct. It’s also this sense that sometimes people think it’s an either/or, introvert or extrovert, but it’s not. You can be an introvert sometimes, and sometimes you’ll work to be an extrovert if you default to an introvert. But it’s then, what are the things that’ll help you accomplish the goals given your personality? That might be one-on-one conversations, or emails and phone calls versus larger group settings. There are a lot of different opportunities to forge ahead.
PA: Just to build on that a little bit further, Jay. In this day and age, still the best way to get your next position is through networking, and the search community folks will always tell you that. 80% of your next jobs come through networking, not through looking at the classified ads.
MS: Good information. Now, in this question, we’ll start with Dr. Bhatt. Somewhere out there, listening to our voices, is a physician who is thinking about making a transition to an executive position. Can we talk mechanically, nuts and bolts, about what you believe would be helpful or what is involved in that type of transition for the physician?
JB: I would think that it’s an important one, to spend some time reflecting on where your strengths are, and where do you want to grow? Most importantly, what issues do you want to impact and how? Some of that you may not know early on, but having an initial point of view will be important. That preparation is important as you talk to various individuals in the field—physicians, operators, and other C-suite leaders.
I also think it’s important not only to talk to physicians in that transition process, but to talk to the whole interprofessional team to get a sense of the dynamics and how you might need to work differently, work together in a system-level environment, in a transition to another kind of role. I learned lessons from my mentors about building relationships and communicating and being transparent.
Once you start to have those conversations, you come back and, after a set of them, reflect and see if your point of view has evolved and how it’s evolved. Then start thinking about, okay, well, what are the experiences I might need? It may be a short shadowing experience or a project experience to help you learn more about the questions that may have surfaced about what you may want to do in your next opportunity. Sometimes it takes a few opportunities to land the one that you then excel at, that makes sense for you. It’s okay to know that you may not get it right the first time. It’s important to know that. Also, believe in yourself. I think about Ted Lasso and that sign, “BELIEVE.” I think that’s also important.
Believe you can make this transition. Believe you have the skills and experiences to do it. Have your support system around you, whether it’s family, friends, or others that can help you through that process. But it can be a scary thing. For me, I was fortunate that a lot of the inquiry and desire for systems change happened because of community experiences and experiences with mentors and physicians I saw thinking about healthcare differently than we traditionally had.
Individuals have, over the course of my career, shaped my thinking—not just physicians, but others as well. And certainly, Peter’s been just an incredible partner and has pushed me to think differently about healthcare and evolving my leadership and management, as well as others at the Chicago Department of Public Health, the Illinois Hospital Association, the American Hospital Association, and now the Medical Home Network, which is an ACO, and Deloitte.
All of those experiences gave me unique and different insights. I’m just grateful to be in a role at Deloitte now where we’re driving system-level impact. Where we’re producing research in insights and eminence, along with the future of health, future of equitable health point of view that is going to impact the industry and the field.
MS: Dr. Angood. Same question to you. Because I know that you’ve seen this many times through the AAPL—a physician ready to launch him- or herself into the C-suite. What advice do you have and what should they expect in that transition?
PA: All of us enter into healthcare, whether as a physician or a nurse, or one of the other professions, because we are caring individuals, and we, therefore, carry a high level of altruism and idealism. And it’s not uncommon as an offshoot of that altruism to then, as you learn this system you’re working in, want to create larger system change. And so I think an early step for anybody is to recognize that you’ve got that awareness and then decide whether you have the aptitude.
Not everybody’s got the original aptitude to be a leader or to move into leadership roles. As Jay was describing, you need to look for ways to partner up, to get increasing experiences. Yes, we get the experiences in the clinical realm, but if you are becoming passionate about leadership and what you can do to create change, then look for the avenues in which you can gain more experience.
Each job creates a new growth opportunity and increases experience levels.
It becomes a gradation of experience, and none of us ever gets one experience that nails it. That’s why we all have different jobs over time, right? And each job creates a new growth opportunity and increases experience levels. Some move through a trajectory faster than others and that’s perfectly fine. That’s circumstances and to some degree luck, at times. But regardless, anybody can move along a trajectory and set up a ladder of success and progression.
In this day and age though, what Jay didn’t mention is oftentimes you need some extra education. You just don’t get it in medical school or residency. AAPL offers a whole range of educational programs and career development initiatives, and there are other channels out there for people to get that as well. Many delivery systems and even some of the nonclinical sectors in healthcare as an industry are looking for physicians who have the added experience, but to some degree, need some added education. And that doesn’t always necessarily mean a master’s degree or a doctorate. There’re other ways. And I’ll put in my plug for AAPL. We’ve got lots of great resources, including a Certified Physician Executive (CPE) credential. But it’s often that combination of education and experience and then the mentorship and networking with others.
But one thing that I think we have to pay attention to as well is that we’ve had experiences with the system’s inefficiencies and the failures and the flaws, as a part of all of the frustration in healthcare, especially in part as the pandemic has further shown. But there is anxiety, frustration, burnout, and all those symptoms going on at high percentages in the healthcare workforce.
And an initial reaction for many people is just to be angry and disgruntled and then they want to pull the lever, right? Okay. I’m out of here. But if you can productively rechannel that discontent and then learn where and how to engage with the systems and then begin creating the changes in the systems, that can often defuse some of that anger and some of that frustration. And that’s where you can gain the experience. Maybe gain a little bit more education. And to Jay’s point earlier, you start to learn a different set of languages and perspectives on healthcare. And so again, that helps decrease some of that anger, that hostility, that disappointment that many people have in the system overall. So it’s learning new approaches and there’s a whole variety of ways to do it.
JB: Peter, that was so well said. I just want to pick up on this education piece, which is so important too. When I mentioned reflection and having those conversations, it’s through that reflection and conversations one might decide that further education is needed. In my career, I’ve gotten public health training, was also trained in public administration, as well as physician leadership courses and other kinds of fellowship experiences.
All of those have helped me in different ways, but they’ve been so important to push my lens of thinking about challenges and opportunities, and solutions. I would say that you’ve got to find good mentors to help you navigate the space. And sometimes those aren’t always people decades ahead in their career. Sometimes they’re peers who are going through things differently. They’re maybe in different industries but have similar experiences. So there’s so much that translates beyond just the subject matter when you get into leadership. It’s really about relationships, communication, transparency, values and vision, learning and adapting, and then identifying metrics and goals that help drive your success trajectory. The other important thing is putting yourself in a position to speak and communicate and practice that until you get comfortable, because that’s going to be an important part of what you do in leadership and management.
MS: We’re wrapping up our time together. I want to think that there is some young physician out there who has started his or her career during the pandemic and is preparing for a future leadership role. Can you speak directly to him or her with your best suggestions for someone just getting started in their career that had already coped with the pandemic?
JB: The pandemic has certainly been a challenge. But I see challenges as an opportunity for positive transformation. And so young physicians should be recognizing that the pandemic has also made the field more confident in innovation. More confident in different ways of approaching challenges in the field. And that it has accelerated innovation, saying, “We can’t wait any longer.” It’s also accelerated the impact of virtual telemedicine.
One thing we haven’t talked much about is the opportunities around being an entrepreneur and startups that have emerged over the last 10 years. Healthcare has had significant investment and it’s continuing to grow. So there are opportunities. If there’s a particular issue that you are passionate about and want to advance, it’s important to also think about doing that potentially from a lens of working with a startup or a mid-stage company. But it’s also, I would say, about what skills are needed at different stages of your career. And early on it’s going from relational and clinical to adding business and strategic skills. I would say do the work, spend some time reflecting, getting out and meeting people as you can, or talking to them via social media, LinkedIn, or online, but get exposure and try some things out. Have some different experiences. And listen certainly to all the AAPL podcasts, which I think have been great about this topic. And as I go back to what Ted Lasso said, just “Believe.”
PA: As young people enter the industry, sure, you’ve got to learn the clinical aspects of all of this and how to care for patients and tap into your altruism of wanting to look after people. But come in with an open mind in that there are all of these deficiencies in the industry that need and are seeking solutions. The next generation of physicians and other interprofessionals in the industry have a wonderful opportunity to capitalize on this recent pandemic crisis and to bring in creative new ideas to solve some of the inefficiencies and inadequacies of the system.
And let’s not make any mistake here. Every industry has inadequacies and inefficiencies and all those sorts of things. We’re not a bad industry, but we’ve got some work to do. And we would welcome the younger folks coming in and helping with some creative, innovative, entrepreneurial ideas to help solve those issues. So thanks, Mike. Great question.
MS: We’ll let that be the last word. My guests on today’s podcast have been Dr. Jay Bhatt, who is the managing director at Deloitte and serves as the executive director of Deloitte Center for Health Solution and Deloitte Health Equality Institute. My other guest has been Dr. Peter Angood, who is the chief executive officer and president of the American Association for Physician Leadership. Gentlemen, thank you so much.