The essential ingredients to develop as a physician leader with Dr. Anna Thomas

Have you ever stayed late charting after your clinic session, been charting after dinner in the evenings and weekends, where you’ve had to tell your child or someone else, that you can’t spend time with them right now, because you’re still working. If you wish that you could finish your charting faster, so that you can leave your work at work, and get home sooner for what matters most to you. I want to invite you to join me in January for Charting Mastery. It’s gonna be a six week coaching program designed to help you finish your charting faster. There’ll be a free masterclass on January 4, and then an opportunity on January 5, to hear more about how you can take it deeper. And how you can join me for this beta group to be able to launch this for you. So you can get stuff done, you can head over to charting mastery.net to get signed up. I look forward to seeing you there. Welcome to the MedEdWell podcast, empowering physicians to get work done at work, and then be able to reflect and choose what is important for both their life and medical practice. I’m your host, Dr. Ryan Stegink, general pediatrician and life coach for physicians. Hello, everyone and welcome to another episode of the MedEdWell podcast where physicians come to be encouraged and equipped to take the next step in their own wellness journey. Thank you so much for subscribing and sharing these episodes and for really engaging with these concepts. Today I’m honored to have as a guest, Dr. Anna Thomas. Dr. Thomas is an internist and Board Certified Hospice and Palliative Care Physician, serving as the medical director of a community based palliative care program in Doylestown, Pennsylvania. She has the John Maxwell leadership team certified coach, speaker and trainer with a passion for medical education, personal and leadership development. She founded attending hood.com, a platform for early career physicians to connect, learn and grow their leadership potential through blogs, YouTube videos, courses, as well as small group and individual coaching. Dr. Thomas, welcome to the show. Thank you so much. Thanks for having me. Yeah. Tell me a little bit about yourself. So let the audience get to know you and kind of your journey to medicine, where you are today. Sure, that’s a great starting point. So I went to medical school in Canada actually, I went to medical school at the University of Chicago School of Medicine in London, Ontario. And I went in with the intent to pursue primary care, I wanted to be the type of physician who got to know my patients over time to serve patients as well as families and provide a really well rounded, comprehensive medical care. During my medical school training, I met my husband and he was living and working in the United States at that time, so I kind of had to make a difficult decision to change. To change gears a little bit, I ended up when he made that decision, I had already matched into a family medicine program in Canada, and then I had to reapply to the United States. Thankfully, I’m asked into internal medicine programs, I finished my residency at Colchester in Pennsylvania. And then during my residency, I fell in love with palliative care. And I pursued a fellowship in palliative care in Bethlehem. I now I’ve been here in Pennsylvania for about nine and a half years, almost 10 years now. And I’m really happy with the team. Thanks for sharing a little bit of your journey. Each of us has our own unique path. And it sounds like you really had opportunities to see different medical systems and different patient populations and just seeing how you ended up in in palliative care. Yes, it was an interesting journey. Sure. So as you finished your fellowship, and then got out into practice, how did different leadership opportunities come up for you? Or how did you get so interested in in coaching and this opportunity to start attending her.com? And tell me a little bit more about about that process for you? Sure. So for me, I had I think like all of us in undergrad medical school, I had exposure to various leadership opportunities, most of it through extracurriculars, and a sense of community involvement, but never really did like a formal leadership training, like what does it actually mean to be in a leadership role and help them and I didn’t, I had, I didn’t really have any plans on taking on a leadership role early in my career. Truth be told, I thought that most of those sort of roles were reserved for physicians to I 20 years or more 20 years plus experience or people who have undertaken an MBA or an MSA, but I didn’t, I didn’t really think that that was going to be a place that I was going to pursue. Coming out of fellowship, I was actually a little bit taken aback. And perhaps this is part of those are relatively new field. When I was applying for jobs, about 50% of the job was for established palliative care programs through joining a group. And then the other half of the job, the medical director positions and Medical Director for hospice Medical Director for palliative care. And then hospital systems are looking for someone to be like their one physician that they have a nurse or they have a social worker, but they don’t have a physician or hospital systems that are looking for someone to come and start something. And so I was kind of taken aback by that a little bit because I wasn’t I wasn’t prepared for that at all. And to be honest with you, my first job out of out of fellowship was not meant to be the leader. I wasn’t prepared. But I think most of us in our first job out of out of residency out of training, we want to kind of get our feet wet, we want to get comfortable, especially in the role of attending, right? Because that’s staff and training for 10 minutes, it was a good learning gap there. So my first job I was part of an established practice. And it was really was really helpful for me. When my second job my current job involved not only being the hospice Medical Director, but also developing the Doylestown palliative care community based program. And that was completely new to the system. So now I have to learn not only how to how to create a project proposal, how do you obtain sponsorship? How do you figure out a budget for this program, develop goals, metrics, policies, policy and procedure, picking out office furniture, like all this kind of stuff was suddenly being asked me and I really didn’t have, or maybe the office furniture, things like that was fun. But a lot of us like I didn’t have a lot of training for that. And then also the leadership skills, right. So I feel very comfortable presenting patients who are attending or doing, you know, gang round style presentations. So when it comes to marketing your programs, selling the program to other department chairs, Board of Directors, the public doing various marketing type calls, again, not something that I was experienced with. So as I was preparing for this, as well, and for the launch of the program, I really had to learn a lot of those sorts of skills. And even now, as you launch the program about a year and a half ago, it’s it’s going really well, but I assume is a very small interdisciplinary team. And when your team is small, you have to be even more careful about things like communication, because even small personality clashes can lead to big conflicts, right? So communication, managing conflict, empowerment, accountability, all of these are skill sets that as a leader I need to learn. And like many early career physicians, I’m, you know, I’m I’m busy. I’m a young mom, I got two little kids when I time because you know, they’re an MBA. So I ended up going into like the internet blogs, videos, journal articles, short books, short courses. Most of those were geared towards, like, general leadership, some healthcare, really nothing was palliative care specific, obviously. But still, whatever event was very valuable and helpful. And also, during that time, I came to learn more about John Maxwell. I’ve read some of his work before. So John Maxwell, he’s an author on leadership, he has written more than like 100 books, and I want to say other authors newspaper like Stephen Covey, for example, the author of the seven essential habits. So macro philosophy on leadership really resonates with me. And he talks about how leadership is about influence, it’s about relationships. And how the job of the leader is, is to have that relationship with a team, to inspire them to be be the one to really help them along. And that really resonate as well. So I did there, the certification program and completed that earlier this year, and a certified coach and speaker and trainer. And I found a lot of faith training also to be very valuable to me, in my workplace. So, as I went through this process, I thought, hey, I really wish in residency and fellowship, as I was preparing for this role, that there was an easy place that I could go to, to find out some of this information that was geared towards me as an early career physician, and that’s kind of where it’s coming from. I believe that all physicians are leaders, we have the capacity, the capability to take on strong leadership roles in our healthcare system, we don’t have to wait till we are know, well, like 30 years into practice to start doing those needs to start getting involved now. And my hope that attending has been to help empower early care physicians to do this, that. That’s so great, because I think I remember in medical school, we had kind of interprofessional communication, or just these exercises, where we’d be in a small group and talking about it. And they were like, Alright, who’s the leader? And it might have been not the person who is speaking up because it was like, alright, the influence, but then we just kind of left it there. Rather than saying, all right, these are some of the skills you’ve learned all these different, really complicated things throughout medical school, throughout residency and fellowship. And yet, I think it’s easy to let the imposter syndrome say, Oh, I’m, I’m not that CEO of my clinic system. That’s 2030 years into practice. And so then, therefore, I can’t do it. And as opposed to saying, well, there are skills and so resources like attending hood, can then empower people to say, No, you can do it. You’ve been in training, you’re a physician, you can do this. Exactly, exactly. So as you think about now, building into these new physicians coming out of training, how would you define leadership in relation to management? Because as people think about, Do I need an MBA? Do I need a Health Administration thing? Or how do I interface if I am, say, the leader of the clinic, and then I have the clinical leader, for the support staff, and nursing, medical assistants and so forth? How would you kind of contrast those. So I would start off with understanding that leadership and management, there’s two, there’s different skill sets, an excellent leader needs to understand both for sure. So I’m going to kind of borrow a little bit of Maxwell’s definition here, again, he describes leadership as important. And that’s based on our relationship with the people that we work with. And we leverage the influence we have with them to make positive change. So leadership is about influence. It’s about relationships. So let’s think about it. If you if you have a group of people, they want to go somewhere, and someone’s going to lead them. And they want someone that they trust that they know, that knows the way that’s going to help guide them, right. That’s what the leaders job is. And if you have two people who know the way, they’re gonna follow the person that they know and trust, right, it’s all about that relationship they have with management. On the other side is about process. It’s about workflow, it’s about metrics, managers are very good at the specific so this is like, the project needs to be done by this deadline. These are the outcomes that we need. This is how we’re going to control the variation. And if it doesn’t happen, this is what we’re going to do. Instead, the management’s about process and workflow. So if the leader is telling you follow me, this is the path we’re gonna take the manager saying, All right, let’s make sure that we packed with a food or we’re gonna walk 10 miles every day, right? Everybody needs a leader wall wants to be led Well, nobody really quite likes to be managed. But when it comes to big organizations need people who understand both? Right, especially for us as physicians, I think the management skill set is actually very easy for us to learn, you can learn about metrics and practices and pay our system you can learn about that just by reading books sort of thing. The leadership skill set is about relationships, about communication, and that requires us to practice and to really engage. And we need to know about the C suite. They speak and management language, right? The most of the people. When you look at healthcare systems across the United States, only a minority of them are led by physicians. That means the majority of them are being led by people with MBAs and Aboriginal languages they speaking is management language. So if you want to mingle with them, you have to understand metrics process, strategic planning, all of that is important for us as physicians who are considering entering into leadership roles to understand some of that lingo. But remember that we need to be more than just a manager, we need to be leaders. And that’s actually the skill sets about communication, empowerment, coaching, and those are skill sets that can be even more powerful, because we’ve all had bosses that are really good at telling us these are the you know, the RVs that you have to get used to to so many more patients per day. And none of that is inspiring. That’s that’s burning us out and motivating. As you get more engaged, right? So when I think about leadership and management are two different concepts, both very important to two very different skill sets that physician leaders should work to acquire. That’s really helpful to just draw those contrasts. And really, they are two skill sets, but both valuable and how we blend those together. It’s like, if you’re just a leader, but you don’t take some of those management things and like, how are we going to actually get some of these things done, but on that destination, or on that journey, as you’re leading them through that? What do you think the kind of the space currently, the current iteration as you continue to grow attending head? Where do you see that really speaking into either growing young physicians as leaders or as managers? Or is it kind of a hybrid at this point? I think I think it’s a bit of a hybrid, I think now, when we think about our role in patient care, the management part, we do a lot of that in the patient therapies, right. So even for the individual patient, if you’re a primary care physician, you’re thinking about, you know, these are the labs I need to get done. Every so often, right, we’re already in that manager role for that particular patient. And even in clinic settings, when you have physicians take on leadership roles, they’re often very easily drifting into the management type of role. What I what I’d love to see is for them to also take on the leadership type skill set, because that’s where I, that’s where I think there’s a lack of, and where physicians can add both of those skill sets. And we can see more and more physicians take on leadership roles and higher levels within the organization. Figuring out how you connect to maybe the organizational goals, while still aligning with the the vision and the values that each of the individual physicians may be prioritizing more highly to say it’s like, this is what I want to do to take really good care of our patients. And this is how we can both meet these metrics, but also continue to really push this forward, because it’s like, hey, we really care about this particular patient population or whatever it may be. I could see that being especially valuable. Right, we’re finding ways to connect with you bringing those two visions together. Absolutely. So what would you say? If people are like, Okay, I’m getting some of these leadership skills, what would kind of help them say, take it to the next level? They’ve had this position, they’ve had opportunities to really practice? How could they go deeper in terms of growing their leadership skills? Sure, so when it comes to levels of leadership, and this is true, regardless of what field you’re in, there are, again, I’m pulling from John Maxwell’s literature a lot. Let me just say that it’s more for physicians. So if there are five levels of leadership, we’re going to have more the Fifth Level top level is like celebrity status. And ignore that. The first level for any sort of condition is the title that you have, as a physician, your title is your MD. That’s where you start off with. But if you just say, right there, if you just go around the clinic, or the hospital origin says, Put these orders in, I’m the physician, follow my follow my direction, you’re gonna get so far. Because when you when you try to leave, just from the authority of your title, people only give you the bare minimum. The next level of leadership and leadership is about influence. These levels are about levels of influence that you have with people. The next level of influence is it’s permission that people want to follow you, they want to work with you, because they like working with you. You spend time with them, you build rapport with them, you you’ve gotten to know them, they’ve gotten to know you. And that’s really important. It’s not so much that you want to be your their friends forever. Eventually, you do have to, you do have to provide direction for them. But now they want to work with you. They’re not just following you because of the title, the level after that of influence, not only are they following you because of your title, and because they like to work with you, but they know that you can make results. You have production value. The fourth level and this is I think, as physicians, we’re pretty good at the first three. The fourth level is when we start identifying people in our data thinking, You know what, I’m gonna start coaching and developing you. I see potential in you as a future leader. Whether this is a future physician leader, or someone else within your clinical practice, too. has the potential to again bring positive change to the organization, coaching and mentoring them. That’s the next level of leadership because the physician wants to grow in their influence where they are in their organization, those are the kind of steps that you follow. Those levels are so essential that you will only be able to leave at your lowest at your weakest level. What I mean by that is, you could be the most productive physician in the group, you could be producing 100 avenues or whatever. But if you can’t work with people, they don’t like working with you, when you are only leaving based on the title, right? If you want to grow influence, need to learn those skills about building, building the core, all the things that we do in our patient encounter, all of that applies in the leadership realm as well. The other caveat to this is that when you change jobs, if you go from like a, you’ve been in an organization for, like 20 years, and you have built up a reputation there, people know you, they like you, they follow you, they know you make results. And now you take a position and replace, you do start back at level one, right. And now your first task is to get to know the people that you’re working with, to build that rapport with them to go from the I’m sure I’m the new medical directors to let me get to know you know, my team. And once you get to know me, now let’s start making results. Let’s start, you know, making this program amazing. And then you go from there is that when I when I think about levels, and like the next step for someone who’s looking to grow their level of influence, their level of leadership, those are kind of the levels I think about. It’s really helpful just as I reflect on my own growth, and just getting integrated into, like my own clinic system, because for a while I was split at two different clinics. And so sometimes that building relationship and getting to know people, and even just knowing names is there’s turnover and it it really matters. But some of that just takes time and intentionality. And so, yeah, how can I build into my medical assistant that I’m working with? And I really see is doing great work and being proactive on things, how can I encourage and affirm that, but it starts with, okay, how do we work together? How do I communicate that I added on some orders, and I can close the loop and make sure that I’m not just leaving them high and dry when they come in? And the patient’s asking for it? And they’re like, no, they didn’t mention that and, and even just empowering them to speak up when they’re like, Did you mean to do this? And it’s like, no, that’s part of a certain amount of humility, which I think also goes with that influence. And getting people to follow you is saying, Hey, this is the vision of where I see we should be going. But I also know that I need to step in and serve but also be open to other input. Absolutely. And you know, one of the funny things for me, so I program, we’re about a year and a half old. So we started in the middle of COVID. So for a good part of our first year, even in the office, we were all wearing masks. So I never saw the majority of my team, like what their face actually looked like because we met we weren’t when we interviewed we were all wearing masks. In the office setting. We were wearing masks at one point in time we were allowed to stop wearing masks and no apart from patient encounters, and we’re looking at us like Oh, is that what you look like? To see what your smile was like? Oh, so when you were when you roll your eyes or at best, you’re actually yes, humor. Sarcasm that’s that’s you showing jeweler and like, so much shame is when you can actually see the person face to face. I think a lot. A lot was lost with COVID For sure. For those reasons. Yeah, no, I definitely have found myself when residents have come through. And yeah, finally seeing faces. It’s like, your brain just kind of fills in, or just doors, some of that context is just lost. That’s fascinating. So as you think about a busy, busy practice, and especially early on, when physicians are trying to get up to speed and figure out their processes, how their flow is not having an attending to run things by I mean, sure there’s colleagues but you’re trying to figure out what do i What do I say for this particular situation or follow up instructions? How do physicians build this into their already busy schedule? Like is this just one extra thing or how Have you coached people through this? Yeah, so time is a big one, especially for physicians who are earlier in the year, you may be looking to establish, establish yourself as an attending, and you’re looking to build your practice, it could be studying for boards, it could be applying for jobs. If you’re like a fellow or training, you can be like me, I have a young family. So it’s time is definitely the most challenging part, I would say. And it’s very easy to get overwhelmed, and then put off a leadership frame, right? It’s very easy to say, I don’t have time for that, I’m going to put it off. But then what happens is that we wait, we wait for the manager older or we wait till we’re established. And we may never get to that dream. Right? So we have to figure out a way to balance this and how do we take all the responsibilities that we have the new skill sets that we that we have just from our training and Avenue new skills like that we have to learn on the job related to our clinical responsibilities, as well as some of these new administrative responsibilities together. And it comes down to prioritization in a way, if we wait too long, we’re not going to be able to achieve that thing if we put it off too long. But if we, if we can find time over the course of the day to start working on it slowly, that can really help us and know, for some people, it may be perfectly fine to put off that dreams no later because it’s what is important for you today is always going to be the most important thing, because today is the only day that we have, right, we can overestimate yesterday over a mile. Today, the only day that we have control. So we need to think of you know, what are the activities that I’m doing today, that’s really going to provide value to me, it’s going to fit with my goals. And the things that I want to say yes to should be that they should provide value to the things that don’t, I should feel comfortable saying no to. And when perhaps you can start to sift through the No, you find space and time in your schedule to do more activities that add value to you. And for some people that may be doing additional training or learning about leadership skills, management skills, or other things. And I know for you, Ryan, when you have your charting course, that’s so valuable for early career physicians, because I’m going to admit, okay, so I’m a palliative care physician, my notes are like narrative, alright, so I write long notes, they take a lot of time. And if I spend all my time charting, I don’t have time to build relationships with the people in my office, to do that sort of important work, which I need to do, if I want to become a leader there, if I want to increase my influence with them, if I want to have a relationship with them, so that later on when I need them to do something for me, they’re gonna feel that I’ve added value to them already. If I’m spending all my time charting, I’m not able to do that. Right. So in the same way, whether it is charting or other things that you do in your life, finding, finding the activities that add value to you, continuing those and putting aside the things that don’t add value, delegating them to other people, that’s an important skill set for every physician, for every parent, and especially for every leader, because trust me, as a leader, you’re going to get all sorts of demands on your schedule, and you have to learn how to prioritize. So that’s an important skills that we want to provide. Yeah, no, I really appreciate you bringing some of those things up because intentionality, like and priorities and delegation. Honestly, I think those are some of the core things that in order to be able to say, what is most important to me? And what is important to me today, how does that fuel it’s like, if you really want to be able to invest in your team, then yeah, that’s going to really shape why you invest in your charting so that you’re able to build those relationships. And it, it just takes a little bit of stepping back to really examine those thoughts. Because so many times we at least I felt that I had to do these different things and I had to go faster, I had to respond to this particular message that quickly and really, some of them I may intentionally choose now to call patient, but sometimes I can say, Okay, this one can wait till tomorrow or later in the week because it’s not as urgent or my staff can do that when they get to it. It’s just think taking that step back really allows you to then be able to move forward and you and kind of that paradoxical way. And guess what, when you’re doing that you’re making leadership decisions. Those are the exact same decisions that high levels of leadership they’re having to make. These are the priorities for our organization. These are things that it’s nice to have, but we can’t get it done right now, these are not our priorities, we’re going to have to put them aside the exact same sort of process that you’re going to go through. So there you go, right. Even in your day to day practice, you’re using those skills, which I think is all the more reason why opportunities like attending her.com are so important, because it just, it gives you a framework to be able to say, these are leadership skills, some of them you will develop along the way as you interact with your colleagues as you observe what they’re doing, and try and say, hey, I want to be more like the senior colleague that really has influence in our clinic, or in my division. And then to be able to say, you don’t necessarily have to put off those dreams, it could be that you with a little bit of framework can move forward on them in a way that makes sense for you. It’s like, it may be different because you want to prioritize being there for your family or developing some other outside interest. But by putting that in the framework, you can still do it and be a leader. So what would you say to a physician who says that I’m I’m not, I’m not a leader, or I don’t want to be a leader? Maybe that’s someone, the colleague in your office that may have just joined the group and they just want to do their work and go home? What would you tell them? So for any physician who says I don’t want to be a leader, you’re in tough luck, because your your physician degree is, it does afford you a little bit of a leadership title within your workplace, that people will be looking to you to show a certain level of leadership with a physician who says, I’m not sure if I can be a leader. Now, that’s a limiting belief that believes that they’re like that I don’t have experience, I don’t have to know how I don’t have the ability to be a leader. And that limiting belief, a limiting belief, or any of those are the beliefs that hold you back. That prevents you from taking action. And that limiting belief, I’m going to say is nonsense, right? So we as physicians, we are how talented group of individuals, highly educated, if we didn’t learn how to do all sorts of procedures, I’m going to tell you this and learn management skills, they can learn leadership skills, those are things that we did. So the limiting belief that I don’t think I can be a leader should never hold us back. It should never hold us back. Because we are already leaders. But we have a responsibility, I believe to grow from just bleeding from our title, to leading people, leading our peers, our colleagues, and taking on bigger challenges within our healthcare organization, because I think all of us can agree we need better leaders, we need better leaders in our hospital systems and our healthcare systems. And I don’t know even like, state level federal level, right. And I think physicians are less engaged nowadays. But they should be more involved, because we have the opportunity to have the education, we have the training, the passion to really make positive change. Well, I think that’s really helpful to say, if we can shift from that limiting belief of I don’t know if I can be a leader to that intentional thought of, I am a leader, and to really own that, and then to take actions out of that confidence that you’re able to generate. So if if you had one final piece of advice for someone that was early in their career and that you wish you had known when you were first coming out of training, what would you what would you leave the audience with? Probably don’t be afraid. Don’t be overwhelmed at the process. I know they don’t like when I when I was applying out of fellowship. There are a couple opportunities were available to me. Those type of opportunities I interviewed for, I got offers for and I shied away from the leadership opportunities. I shied away from the ones where I would be medical director straight out of fellowship because I was afraid. I was afraid that I wasn’t talented enough. I didn’t have the know how. And so I had to overcome that fear. And I would encourage other early dispositions like don’t let that fear hold you back. Because again, these are skills that you have unlearn that you can develop and you can become the type of leader that every health system needs. Thanks for that. So if someone wants to learn more about you how to work with you, where could they find you? Sure, so our website is kind of attending a.com. On the website, we have blog articles, so I write on a variety of leadership topics. In November, for example, I talked about some of the principles of strategic thinking about communication, working with teams. I also offer some webinars workshops. In November, I tried to do some programming also for early career physicians, also those who are in training for medical students and residents, like it’s a mock interviews for them. That was really helpful for them myself. I’m working on some courses for women in leadership and for graduating residents that’s in the pipeline. But if someone wants to work with me directly, I do offer one to one coaching opportunities. So with coaching, you get the opportunity to really explore your individual values, your strengths, and weaknesses. What what, what motivates me to personal leadership? What are your limiting beliefs that are holding you back, identifying them find ways to kind of work around them, figuring out your growth plan. So those are some of the things that with one to one coaching, we can we can work on developing. And what I encourage you to do is if you’re interested in working with me, check out my website. I’m also on Twitter. I’m not sure how much longer Twitter’s been exists, but I’m on Twitter currently. Please join me there, follow me. And I’m looking forward to working with you. Thank you so much, Dr. Thomas, for joining me on the MedEdWell podcast and sharing such amazing insights. Thank you so much fine. For all of you listening, I want you to consider how you can apply what you’ve learned from Dr. Thomas in today’s discussion. And then please share this podcast episode with another doctor in your life. And make sure you subscribe to the podcast. And if you haven’t done so already, please leave us a review. You can help change the culture of medicine and promote wellness for your patients, your colleagues, and yourself. Thank you so much for all that you do, and have a great day. And now for our important disclaimer. Dr. Ryan Stegink is a practicing general pediatrician. But the MedEdWell podcast does not reflect the views, opinions or beliefs of his employer, nor is affiliated University. Additionally, the MedEdWell podcast is for educational and entertainment purposes only and should not be considered advice regarding financial, legal student loan, medical or any other specific topic. Such a case you should seek consultation with a certified professional in that particular area. Again, thanks for joining us on the MedEdWell podcast. Have a great day