Kardie Tobb, MD, a cardiologist and clinical integration officer at Cone Health in Greensboro, North Carolina, makes a compelling case that physician leadership does not require a formal title and that early and mid-career clinicians are uniquely positioned to drive meaningful change. In this conversation with SoundPractice host Mike Sacopulos, Dr. Tobb draws on her own experience founding a cardio-obstetrics and women's heart health program in her first year of practice to illustrate how informal leaders can identify care gaps, build cross-departmental coalitions, and implement solutions aligned with organizational priorities. She offers practical frameworks for leading by influence, navigating institutional culture, avoiding common pitfalls, and sustaining well-being throughout the process.
This transcript of the discussion has been edited for clarity and length.
Mike Sacopulos: My guest today is Dr. Kardie Tobb. Dr. Tobb is a board-certified cardiologist specializing in cardiometabolic disease prevention. She is the founder and medical director of the Cone Health Heart and Vascular Cardio-Obstetrics and Women's Heart Health Program. Dr. Tobb's work on disparities of care has drawn national attention. Dr. Tobb, welcome to SoundPractice.
Kardie Tobb, DO, MS, CPE, FASPC, FACC, FACOI: Thank you so much. I'm really happy to be here.
Sacopulos: I gave you the briefest of introductions. Could you describe your path to becoming a physician leader?
Tobb: Thank you for that opportunity. I'm here in Greensboro at Cone Health, and I still very much enjoy my clinical practice alongside the leadership work. Coming to Cone Health was actually my very first job after fellowship. I started in 2020, right in the midst of COVID, which was a really difficult time to begin practicing medicine. But I'm genuinely grateful for it, because when I arrived and looked at what I wanted to build, I could see that we didn't yet have a fully coordinated cardiovascular care program for pregnant women. The care existed, but what I was able to add was coordination connecting cardiovascular care for women across preconception, pregnancy, and the postpartum period, and aligning closely with our OB partners on what they needed.
That program came together in the second half of my first year as an attending. Some senior colleagues suggested I wait a bit. I gave it about six months and then came back and said, "I'm here, I've passed my boards, I'm ready." And we got it started. Alongside that, the role I now hold as clinical integration officer for our Center for Health Equity grew entirely from volunteering joining committees, leading a health equity team, showing up and taking action. Nearly six years in, I can now call myself a physician leader, and I mean it.
Sacopulos: You've spoken about physicians leading without formal authority in a clinical setting. What do you mean by that?
Tobb: It's a really important distinction. In medicine, hierarchy is ingrained from the very beginning as a medical student you look up to the resident, as a resident you look up to the chief, and that pattern follows you all the way through fellowship. When you enter clinical practice as an early-career physician, that hierarchy is still in your head, shaping what you think you should and shouldn't do.
But leading without formal authority means exactly that you can lead without any title or positional power. It means taking responsibility for improving outcomes, whether those are clinical, operational, or cultural, simply by stepping in to help solve a problem. What makes it work is credibility, not rank. You are building trust, you are aligning your goals with others, you are demonstrating that you understand the problem and have thought through a solution. When I was a first-year attending and saw that our cardiovascular care for pregnant patients wasn't truly collaborative, I didn't need a medical director title to start having those conversations and developing a coordinated program. That was leadership.
Sacopulos: Why is leading without formal authority especially important for early and mid-career clinicians?
Tobb: Early-career physicians bring something invaluable: fresh eyes. If you've just transitioned from fellowship into a new health system, you will see inefficiencies that have existed for years and that long-tenured colleagues no longer notice. You can identify care gaps and recognize patterns precisely because you haven't been acclimated to them yet.
Mid-career physicians have a different but equally powerful advantage. By that point, you deeply understand the operational workflow and you have built genuine relationships and credibility. That combination allows you to influence decisions through collaborative conversation rather than directive authority not walking in and saying "this is what needs to be done," but instead asking, "here is the problem I see; how can we work together to address it?" You've earned the standing to have that conversation, and the relationships to make it productive.
Sacopulos: Can you share some specific, actionable ways physicians can start to lead without formal authority?
Tobb: A few things come to mind. First: volunteer for a committee but actually do something once you're there. Don't join it just to put it on a roster. Engage with the quality improvement projects that committee oversees. When you're in meetings with senior leaders, speak up constructively, ask questions, and listen. And note the difference between arriving at a meeting with a problem and arriving with a problem plus a proposed solution. You may not have all the answers, but bringing a solution even a partial solution invites senior leaders to help you shape it rather than simply react to a complaint.
Second, be reliable. If you raise your hand and say you can get something done in two weeks, get it done in two weeks. That is how you build credibility, and credibility is the currency of informal leadership. Everything else relationships, influence, opportunity follows from it.
Sacopulos: We often hear the phrase "stay in your lane." How do you advise clinicians to navigate that fear of overstepping?
Tobb: It's a real concern, and it's rooted in the same medical hierarchy we talked about earlier. What matters is how you frame the conversation. Instead of walking into a meeting and saying, "you've been doing this wrong " which puts everyone on the defensive try something like, "Could we explore a solution together? I've noticed something that seems different from what I've seen elsewhere, and I've been thinking through some possibilities." That framing invites collaboration rather than triggering defensiveness.
There's also something early-career clinicians often underestimate, and that's organizational culture. In every health system, there are people who hold no formal title but are genuine leaders by influence. Those individuals understand the timing and the right audience for a given idea. Building relationships with them is enormously valuable, because they can help you bring a concern forward in a way that lands constructively rather than in a way that gets dismissed or worse, held against you.
Sacopulos: Can you share an example from your own experience of leading without a title?
Tobb: Yes the women's heart screening event is a good one. As part of building the women's heart health program, I wanted to create an event where women in our community could receive cardiovascular disease screening at no cost to them. Heart disease is the number one killer of women in the United States, and awareness and access to screening remain significant gaps. This was my first year as an attending physician.
A service line leader told me it was a good idea, but that an event of this scale potentially hosting 100 or more people couldn't live within a single service line. So I needed to socialize the vision across departments: marketing and communications, our philanthropy group, community outreach, the lab. Each conversation had to be tailored. How I spoke to physician colleagues was different from how I spoke to the philanthropy team or the marketing department. I needed them all to see the problem and share the vision.
It took time and intentional communication, nearly a year of relationship-building and planning but the result was that we hosted 100 women in our first year. By year five, we were hosting more than 300. And we tie outcomes directly to metrics: how many women are being screened, how many are being identified with early coronary artery disease through calcium scoring, what our survey data is telling us. That's how a vision becomes sustainable when you can show organizational leaders how it aligns with institutional priorities and what the return on investment looks like.
Sacopulos: You mentioned socializing the idea across divisions. How long did that process take, and were you surprised?
Tobb: It took real time, and communication was the heart of it. The key was clarity making sure people could genuinely see this as a problem worth solving, not just a nice idea. And I had to tailor the message for each audience. The way I presented the need to cardiologist colleagues was different from how I framed it for our marketing and communications team, and different again from the conversation I had with philanthropy. No two audiences are the same, and a message that resonates with a clinician will not necessarily resonate with a healthcare administrator.
Timing also mattered enormously. Starting the conversations nearly a year before the event meant that stakeholders had time to weigh in, to express what they needed, and to feel genuine ownership over how the event would unfold. That's a very different dynamic than approaching people three months out and asking them to support something they had no hand in shaping.
Sacopulos: Do some clinicians need a shift in mindset to effectively lead without formal authority?
Tobb: Yes, and I think the most important element is intentionality. If you're not intentional, you won't take ownership. And without ownership, you can't drive real change. You have to give yourself permission to step forward not wait to be handed a title that authorizes you to care about something.
Frame your concerns as observations, not accusations, and come with data. Data transforms an aspiration into a proposal. It tells your system leaders that you've done the work, that you're not just reacting to a single bad day, but that you have identified a pattern worth addressing.
And lean into storytelling. Physicians practice storytelling already every patient presentation is a story but we haven't always recognized it as such. When you connect an initiative to a specific patient whose care was affected, you help leaders feel the urgency of the problem, not just understand it intellectually. The combination of data and story is extraordinarily powerful when you're trying to earn organizational support.
Sacopulos: We've been talking about leadership in positive terms. But there are pitfalls. Any advice on how to avoid them?
Tobb: A few come to mind. The first is confusing individual thinking with systems thinking. If you observed something go wrong once for one patient, that is not necessarily a system-wide problem. Before raising an alarm, understand whether you're seeing a pattern or an outlier. Acting on a single data point especially with urgency can damage your credibility fast.
Related to that: talking too quickly. Seeing a problem and immediately reacting with "this is always wrong and needs to change" without data to support it is one of the most common mistakes I see in early-career clinicians. Take time to investigate, verify, and then propose.
Another pitfall is failing to include the right people early. If you develop a solution without involving the frontline users who will actually live with it, or the stakeholders who need to support it, it will stall either because it doesn't fit the real workflow or because the people responsible for implementing it feel no ownership over it.
Then there's the importance of listening. Early-career clinicians eager to contribute sometimes underinvest in understanding the culture and the operational day-to-day before advocating for change. What worked brilliantly in your residency or fellowship program may not translate to a different organization with a different mission and different priorities.
And finally, wellbeing. Burnout is real. Clinicians who take on leadership work in addition to clinical responsibilities can end up running on empty if they don't actively protect their own health. Sustaining impact over a career requires sustaining yourself.
Sacopulos: As our time draws to a close, do you have any final advice for clinicians who want to start leading today but feel some hesitation?
Tobb: Start small. You don't have to launch a program or overhaul a department to lead. Start by focusing on the relationships around you those are the foundation of everything else. Stay curious, because curiosity is what drives you to understand a problem deeply enough to bring a real solution, not just a complaint. When you combine curiosity with data and a patient story, you're no longer presenting an aspirational wish; you're presenting an identified problem with a supported solution that senior leaders can act on.
And enjoy your practice while you're doing it. That's why we're all here to care for our patients, our colleagues, and our communities. Leadership is one more way to do that at scale.
Sacopulos: It's hard to leave it on a better note than that. My guest has been Dr. Kardie Tobb. Dr. Tobb, thank you so much for being on SoundPractice.
Tobb: Thank you so much for having me. I really enjoyed our time together.
