EP. 5: EMBRACING THE ROLE OF THE PHYSICIAN LEADER

WITH LLOYD MINOR

Mar 23

WITH LLOYD MINOR, MD

The dean of Stanford Medical School reflects on his path as a physician-scientist and what it takes to be a compassionate leader.

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Episode Summary

Few people have a more well-rounded understanding of our healthcare system than Dr. Lloyd Minor, Dean of Stanford Medical School. With his diverse experiences in research, surgery, healthcare education, clinical care, and institutional leadership, Dean Minor has cultivated a unique bird’s-eye view of the obstacles that face our increasingly complex medical system. In this episode, we ask him to share insights on how to create robust support systems for both patients and medical staff alike, in order to address difficult institutional challenges such as burnout, work-life balance for healthcare staff, and racial inequities in care.

Dr. Lloyd Minor is a scientist and surgeon who, since 2012, has been dean of the Stanford University School of Medicine, where he is also a professor of Otolaryngology, bioengineering, and neurobiology.
At Stanford Medicine, Dean Minor is passionate about advancing Precision Health, which harnesses the power of biomedical data to keep people healthy and provide care that is tailored to patients’ individual characteristics. Under his leadership, Stanford has rapidly expanded its basic science and clinical research activities. Through bold initiatives in medical education and increased support for PhD students, Dr. Minor is committed to inspiring and training future physician leaders.
Prior to Stanford, Dr. Minor was provost and senior vice president for academic affairs at Johns Hopkins University. And before that, otolaryngologist-in-chief at the Johns Hopkins Hospital. With more than 160 published articles and chapters, Dr. Minor is an expert in balance and inner ear disorders, for which his work has resulted in multiple groundbreaking new treatments. In 2012, Dr. Minor was elected to the National Academy of Medicine.
In this episode, you will hear about:
• How Dean Minor’s early interests in math and science shaped his career as a physician scientist - 2:13
• Dean Minor’s belief that earning trust and respect as a leader is paramount to making a shared vision come to life - 8:57
• His challenges with work/life balance during his years of training - 10:23
• Stanford’s commitment to precision health initiatives - 13:23
• Racial disparities in our healthcare system, and what we can do to create better outcomes - 27:18
• The importance of teaching leadership skills to medical trainees - 32:26
Henry Bair: [00:00:01] Hi. I'm Henry Bair.

Tyler Johnson: [00:00:03] And I'm Tyler Johnson.

Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful? Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?

Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom. Probing the moral heart that beats at the core of medicine, we will hear stories that are, by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.

Henry Bair: [00:01:02] Our guest on today's episode is Dr. Lloyd Minor, a scientist and surgeon, and who since 2012 has been dean of the Stanford University School of Medicine, where he is also a professor of otolaryngology, bioengineering and neurobiology. At Stanford Medicine, Dean Minor is passionate about advancing precision health, which harnesses the power of biomedical data to keep people healthy and provide care that is tailored to patients individual characteristics. Under his leadership, Stanford has rapidly expanded its basic science and clinical research activities. Through bold initiatives in medical education and increased support for PhD students, Dean Minor is committed to inspiring and training future physician leaders.

Henry Bair: [00:01:43] Prior to Stanford, Dean Minor was provost and senior vice president for academic affairs at Johns Hopkins University. And before that, Otolaryngologist in Chief at the Johns Hopkins Hospital. With more than 160 published articles and chapters, Dean Minor is an expert in balance and inner ear disorders, for which his work has resulted in multiple groundbreaking new treatments. In 2012, Dean Minor was elected to the National Academy of Medicine.

Henry Bair: [00:02:09] Dean Minor, thank you very much for your time and welcome to the show.

Dean Lloyd Minor: [00:02:11] Thanks, Henry. It's great to be with you.

Henry Bair: [00:02:13] So as a physician scientist, you dedicated a significant portion of your career to discovering new knowledge about diseases and treatments. The training involved in this is often long and intensive, and balancing this research and patient care can be quite challenging. What inspired you early on to pursue this career path?

Dean Lloyd Minor: [00:02:32] Sure. Well, I guess one thing I would say is that oftentimes our challenges are our best opportunities. And I became interested in science... Math and science, in junior high and high school. Going back a little further than that, I'd been a pretty precocious kid in elementary school, and I credit something that we both share, and that is music sort of helping me to focus. I started playing the cello when I was 11 and it's been a part of my life ever since with some sabbaticals along the way. But once I did sort of develop the self discipline to to study and sort of learn that if I applied myself I could probably be pretty good at whatever I wanted to do, it was clear that math and science were really of paramount interest, and medicine is a great way to bring them together. It was when I was growing up and it's even more so today. And then, in college I took a course as a junior undergrad in bioengineering, and the course used mathematical models of physiological systems to show how relatively straightforward linear systems and other analytic approaches could be used to not only describe a physiological system, but actually understand how it works. And one of the examples used in the class was the inner ear balance system or the vestibular system. And I thought then, as I do now, that it's just an incredibly beautiful biological control system. And I decided, well, you know, I'd really like to do science in this area. And it also would be a great way to combine the science with the clinical career.

Dean Lloyd Minor: [00:04:11] At the time, I embarked upon my postgraduate training in medicine, both as a research fellow and then my training as an otolaryngologist. There was a big disconnect between the neuroscience of the vestibular system and what was going on in clinics. There were very few people taking care of patients with balance disorders. Physicians, otolaryngologist neurologists, by and large, didn't have much interest or knowledge of the way the system was working. And similarly, the people doing the science didn't have much interest in the clinical manifestations of the system, and I saw an opportunity to bring those together, as had been done so effectively in other fields, just not as much in my field of the vestibular system. And as I look back on sort of the contributions I've made, it's been at that interface between fundamental discovery based science and clinical medicine that my contributions have probably had the greatest impact.

Tyler Johnson: [00:05:09] I'm curious with that. You know, research strikes me as particularly difficult because things almost never go as you plan and usually don't work out right the first time, right? I mean, there is an element of genius there, but there's also just an element of going back to the grindstone over and over again until you figure out the way the thing actually works. All of which is to say, I have to imagine that there were times along the way when it was difficult to stick with it, right? Now, of course, we all talk about the term burnout, but I'm curious if you could tell us a little bit about an impasse that maybe you came to at some point or a time that was particularly difficult in your training or maybe your early faculty career? And how did you figure out how to push through that and keep going to the better stuff on the other side?

Dean Lloyd Minor: [00:05:52] Thanks. I think you're exactly right. I think in research, things oftentimes don't go as you planned and they don't work out right the first time very often. And that's a little bit like life in general, right? So I think that's true, but but not specific to research. But I think in terms of your question, something that didn't go well, certainly when when I was harkening back to the previous question, when I became interested in in the balance system, the vestibular system, and knew I wanted to do research in the area, I reached out to the person who at the time, I think was the leader in studies of how the peripheral balance system, that is the inner ear, worked. And that was Jay Goldberg, professor at the University of Chicago. And I made arrangements to work in his lab after I'd done my core two years of general surgery following graduation from medical school. And I'm very grateful. What I have done, what I've learned is the scientists really came from the four years I spent full time in Jay's lab, and then I did my otolaryngology residency at Chicago after that, so I continued to work in the lab and have the benefit of interacting with him during that period as well.

Dean Lloyd Minor: [00:07:04] But Jay's philosophy was very much that the only way to do science was to do science, and that really meant coming up with a problem yourself, deciding on how you would do the experiments, analyzing the data. And at that time that meant writing the software to digitize and then analyze the data. His belief was you had to do everything from designing experiments, and that include include making the relevant equipment and then analyzing data and writing the paper. And there were plenty of opportunities along that path to get derailed. And I think I pursued most of those opportunities along the way, but it was by far the most valuable training. And he also had an uncanny sixth sense of knowing when things were going sufficiently bad that he needed to provide some assistance. But not until you'd really, really tried to develop the solutions yourself. And I think that's the best training any person can have in science, and probably in life as well. So yes, there were plenty of things associated with sort of my main project that didn't go well and really took the better part of three years to get them to work. Once everything did work, the actual data collection for the project pretty much occurred over the course of about a month, but there was really three years that went into getting things to that point, and causing me at times to wonder if they were ever going to work. But I think it's a good lesson in perseverance. And I think anything that's really meaningful in life is going to have some sort of process and story like that. And it's been said, and I've certainly found in my life that the journey turns out to be more important than the destination, usually, in terms of our growth and oftentimes in terms of our impact as well.

Dean Lloyd Minor: [00:08:57] Those are things that I learned from my training. And then they were repeated time and time again when I started my lab, my independent lab, when I joined the faculty at Johns Hopkins. And certainly in leadership, now that I've moved away from running a scientific program. In leadership, it's really important to have humility and to understand that we as leaders only have the right to make changes based upon the right we've earned from others. It doesn't come from a title, but we have to everyday earn the trust and respect of others in order to bring about a vision. I can think something is a great idea, and it may be a great idea, but if others aren't equally convinced or even more so, then it's probably going to die on the vine because there's very little, particularly in a very matrixed structure and diffuse organizational structure, as is the case at every research university and academic medical center, it's particularly true that your success is dependent upon those around you in terms of bringing about your vision, much more so than it is on necessarily your ability to organize the vision. That's important. But how it's socialized and how you incorporate the feedback on the vision is as important as your initial conceptualization of the vision.

Henry Bair: [00:10:23] The course of your training was a lengthy one, what with residency and your clinical fellowship and your research fellowship. Now, I know that for many people who are in the midst of this very extensive process, the lines between the personal and professional spheres of their lives get blurred because they just impact each other so much. So I'm curious to hear whether when you were in the middle of this process you ever experienced this conflict between the personal and the professional spheres of life? And if so, how did you overcome them?

Dean Lloyd Minor: [00:11:02] Well, I'm glad you use the word extensive. That was the word that my wife oftentimes used when I spent 11 years after medical school and post-graduate training. And my wife often asked if I was going to qualify for Social Security before I finished my training. But yeah, I think it's been I mean, I've been really fortunate that my wife and I have been married 33 years. We met during our freshman year at Brown, but we didn't start dating until 11 years later when we, purely by coincidence, wound up in Chicago together. She doing her residency and family medicine at Cook County Hospital. And it was when I was a post-doc at University of Chicago, and we re-met through mutual friends and got married a year later, and fast forward, we've had the benefit of now more than three decades of being married. And I think we we understand each other pretty well. And she's been my closest adviser and supporter throughout all that I've done.

Dean Lloyd Minor: [00:12:00] It's an important topic and I think it goes under various headings and none of them is entirely satisfactory how... How we describe it, whether it's work life balance or work life integration or understanding the relationship between life outside of work and life in work. There are various ways it's described. What strikes me is that each person, each relationship is going to define those parameters a bit differently, and those parameters can also change at various points in a person's life and in the life of relationships. We're fortunate to have two children that have brought us enormous amounts of joy, each of whom is pursuing their own lives and careers, but in ways that we're immensely proud and they enjoy our company, which is even greater. So, you know, I think it's worked out, but it's a dynamic that's constantly being calibrated. And I think it's good that now we're examining those relationships between work and life outside of work more carefully. And younger people are expecting a more thoughtful examination of those relationships than I think I did when I was building my career. And I think that's a good thing.

Henry Bair: [00:13:23] Pivoting now to your current leadership role, not just at Stanford Medical School, but also in the adult hospital and the children's hospital. You have spent a lot of time setting a strategic vision for advancing precision health, which is using unprecedented amounts of data to generate treatment methods that are tailored to individual patient characteristics. So, I was wondering if you could tell us a little bit more about the inspiration behind this vision and what its success would mean for you?

Dean Lloyd Minor: [00:14:00] I'd begin by saying one of the things I'm most proud about in terms of the last nine years is that when I arrived, we really had three vertical silos within what we call Stanford Medicine. We had the School of Medicine, we had the adult hospital, the delivery system, Stanford Health Care. We had the Children's Hospital and the delivery system, Stanford Children's Health, Lucile Packard Children's Hospital. And there's very little interaction or coordination among the three entities. The leaders rarely met. We never had any sort of integrated strategic plan. The clinical departments that spanned both delivery systems would have one set of discussions with the Children's Hospital, a separate set of discussions with the adult hospital, and yet a third set of discussions with the School of Medicine leadership. And they never really crossed paths or interacted. It struck me as odd, to say the least, and also as being constraining in terms of the impact we'd be able to have.

Dean Lloyd Minor: [00:15:01] I think we are far, far better aligned today. We have for the past five years had a process of integrated strategic planning. We have one chief strategy officer for all three entities of Stanford Medicine. And by the way, we've done all of that without one change to the governance system. So the governance system today is exactly the same as it was nine years ago. What's different is that I have the privilege of working with two amazing colleagues, David Entwistle and Paul King, that are experienced, knowledgeable, dedicated health care administrators that bring a wealth of experience in the leadership of academic clinical enterprises to their current roles, and that are committed to working together as partners, and that we can achieve far more in an aligned way with a shared vision, recognizing that they are three independent entities, but that their success is dependent upon the interactions with the other two entities. And that really is what is enabled us to come up with the vision for precision health. It's enabled us to have far more integrated planning of our clinical enterprise so that we don't wind up with a pediatric clinic and an adult clinic across the street from each other. And the two systems didn't even know that they were building clinics across the street from each other. Coordination, integration, when possible, alignment always, has been really important. And, and I can't imagine how we would have navigated COVID if we hadn't achieved that alignment and that agreement that we had to have a shared strategy and that each entity had to be responsible for the success of that shared strategy.

Dean Lloyd Minor: [00:16:51] Now, precision health came about because shortly after I came here was when, and the first time I ever heard the words precision medicine used was in 2014, when Susan Desmond-Hellmann, who was at that time the chancellor at UCSF, sponsored a national conference on precision medicine at UCSF. And it focused on areas which are certainly important, such as personalization of cancer therapies based upon, I mean, most notably breast cancer receptor status. But the conference was focused entirely on the treatment of disease and the individualization, based on molecular genetic characteristics, of tailoring treatments to individuals based upon their body, their phenotype, their genotype. And I convened a group of faculty and we said, Yeah, well, we do precision medicine here at Stanford, for sure. But what wasn't being talked about is that these same enablers of genetics, data science, personalization... The same enablers that were being applied to the treatment of severe acute diseases, also could and should be applied to how we keep ourselves healthy. So we announced our Precision Health Initiative with sort of the mantra that precision health is about keeping us healthy. Precision medicine is about sick care, treating us when we're sick. But when we all like to be healthier for a longer period of time? And if we're successful with precision health, maybe we won't have as much of a need down the road for precision medicine, because we would have prevented or forestalled or attenuated the severe acute diseases that are benefiting from precision medicine.

Dean Lloyd Minor: [00:18:34] And the two are not in conflict at all, of course. But that's helped to drive us scientifically and diagnostics, where we have a tremendous amount of faculty expertise in early stage diagnostics. It's helped to focus the way we leverage data science. We created a department of biomedical data science as a result of our planning in precision health. And I think in general, it's helped to recast the framework for what we do as health care professionals. Yes. What we do every day at our two hospitals on the Palo Alto campus is precision medicine. We're treating the sickest of the sick patients, and we're achieving results that few other places could achieve. But always in the back of our minds, and increasingly in terms of our programs that are getting to the clinics, it's focused on how we keep people healthy. And of course, that's important, too, for people that we've treated with precision medicine and and gotten them to a better place with their disease. Then how do we keep them healthy after they've recovered from the acute episode?

Henry Bair: [00:19:40] Yeah, I actually, I hadn't realized the difference between precision medicine and precision health until now. So thank you very much for clarifying.

Dean Lloyd Minor: [00:19:47] Sure.

Tyler Johnson: [00:19:48] I wanted to take the baton for a minute. We're grateful for the chance to talk to you, in part because you do have this unusual vantage point. Sort of the impetus behind this podcast our hypothesis, if you will, is that part of the reason that there is such an epidemic of burnout among physicians is because so many of us, at some point along the way, lose touch with the deeper meanings for going into medicine. And our hope is that by exploring stories and ideas and approaches with the people who are in the trenches, or in your case, maybe directing the armies, if you will, that we can help both current physicians and maybe future physicians and other allied health care professionals to ameliorate this problem.

Tyler Johnson: [00:20:35] So, from your vantage point as Dean, I wanted to ask a couple of questions. The first one is, in general, as you look out, especially now we're two years into the pandemic, things have finally gotten better. Palo Alto has just dropped its mask mandate, I think last week or the week before. I think that all of us are even more intimately aware of the problem of burnout now than we ever have been before, because most physicians have given everything they had and then been asked to give a little bit more over the last couple of years. I'm curious from a strategic or a personal standpoint, as the Dean of Stanford Medicine, what do you see as the most important things that you and the enterprise can do to try to help the doctors within the system to battle the epidemic of burnout here at Stanford?

Dean Lloyd Minor: [00:21:23] Well, the first thing we can do, we should do, and I hope we are doing, is to listen. And we've tried since the very early days of the pandemic, in March of 2020 to reach out to understand what our community needs from us. Our community within Stanford Medicine and more broadly, the community that we serve. We fortunately had established our Well MD and now Well MD and Well PhD programs before the pandemic. We recruited Tait Shanafelt here several years before the pandemic, and we were the first academic medical center to establish the position of Chief Wellness Officer and Tait had built a program associated with that office that we had up and running prior to the pandemic. So we could leverage that, make sure that we increased its funding and its reach. And what we can do to support people depends upon where the person is at that point in time. For some people, it was providing hotels early on because they didn't want to go home or if they had a sick family member, they felt like they couldn't go home. It was providing support for child care. Early in the pandemic when we shut things down and we stopped in-person lectures for our pre-clinical medical students, we had a number of medical students that volunteered to provide child care for health care professionals that needed to come into work because the daycare centers were also closed then.

Dean Lloyd Minor: [00:22:51] As you stated, the stress on people in health care delivery over the past two years has been without parallel in our lifetimes. It's going to have an effect long term, and I think that's one thing we have to be conscious of. I still believe that we are in a magnificent profession. Every year we continue to see increases in the number of applicants to our MD programs, to our residency programs, to our fellowship programs. Medicine is still popular, but we can't take that for granted. I think for most of us, medicine is a calling. And it brings together so many things, but at the end of the day we can do those things in other areas. But for those who choose to be actively involved in patient care, I think they make that choice and they continue to make that choice even in the face of the challenges, because they view it as a calling, as a place where they want to have an impact. And there are a few things in life that I found that provide that direct feedback, that direct knowledge of impact as clinical medicine does. Certainly, as a surgeon scientist, when I did a surgical procedure, I got immediate feedback on the effects of that procedure on a patient. And fortunately, most of the time they were very positive effects. And that's remarkable because you're using your knowledge, your skills to improve the life of someone else. And people are grateful. And there are few feelings, I think, in human nature that are quite like that. And we have to make sure that those experiences continue to exist for those of us in clinical medicine, because that's what will sustain the health care delivery workforce during these extraordinarily challenging times.

Dean Lloyd Minor: [00:24:48] Burnout is a real issue. It was an issue before COVID 19. That's what led us to create the Office of Chief Wellness Officer for Stanford Medicine. But it's certainly going to become a greater issue moving forward. And again, back to the first thing we can do and the most important thing we can do is to listen and to act upon what we hear. And no, we're not going to be able to meet every request. We're not going to be able to address every concern. But we've got to make sure we are hearing those requests and those concerns and doing as much as we can to respond appropriately.

Dean Lloyd Minor: [00:25:26] No profession is more dependent upon its human capital than health care is. If you look at the expenditures, the health care expenditures in the United States, which are extraordinarily high, as we know, where are those expenditures going? By and large, going to the human capital. To the physicians, to the nurses, to the staffing that it takes to provide care to patients and increasingly care to patients that are sicker and sicker. That has been the other change that we're already seeing from the pandemic and that our epidemiologists and actuaries tell us will continue. And that is the people we provide care to, particularly in academic medical center, the illnesses in those people are becoming more complex, more multifaceted and more chronic. And that is going to increase the demands for the types of services that in particular we provide, but that increasingly that will spread out into other... Not just the academic centers... but other aspects of health and health care as well. And how we think about that and where we can leverage technology and advances in telehealth and digital medicine to extend the efficacy of us as individuals, not supplant us, but to extend our efficacy and certainly provide more meaningful data than we're able to get right now outside of the hospital or the patient care delivery site. I think it's going to be bringing all those things together as well as acknowledging as we spoke about before, people have a different idea about the interaction of work and the interaction of their lives independent of work. And we have to respect that and plan... Make plans for that as we think about providing for the health care needs of our country and beyond in the future.

Tyler Johnson: [00:27:18] Sure. I'm struck by what you've said that the most important, or at least the first step for addressing burnout from a systematic perspective is listening to the people who are affected by the burnout. One thing that I have been struck by during the pandemic, I think partially because of events as they unfolded, but I think also partly because we were at home and had a lot more mental space to focus on things we might not normally focus on. I feel like society as a whole has sort of suddenly sat up and listened to people who have been saying for decades or centuries, depending on how you want to think about it, that they are not being treated equally. And I think that diversity, equity and inclusion have ascended. Not that they weren't on people's radar before that, but I think that they're newly front and center in terms of our cultural consciousness in a way that they just weren't before. Again, not because people haven't been pointing these things out, but I think largely society just wasn't listening. I know that both Stanford University as a university and also Stanford Medicine have a number of initiatives that are ongoing to try to approach the ways that these problems, in very complicated ways interface with how we do research, how we deliver health care, how we recruit faculty, how we train our medical I mean, really every facet. But I'm just curious from your post as Dean, how are you thinking about those efforts? And even more importantly, how do you think about the sort of the moral heart, the moral impetus behind those efforts?

Dean Lloyd Minor: [00:28:50] Well, as you said, the disparities in health and health care have existed long before COVID, but COVID brought them into focus in such tangible and heart wrenching ways, that they're now forefront on people's minds. I think many of us have have been concerned about the social, behavioral and environmental determinants of health, which, by the way, account for 70% of the determinants of health. Many of us have been concerned about those determinants for a long time. We've written about them. We've done scientific studies on them. We've tried to have impact, but they are the most difficult determinants of health to address. What I think COVID has done is caused us to realize collectively, yes, they are difficult to address, but we have to address them. They can't be ignored. They can't be placed on the back burner. And we have to be more proactive about thinking of ways that we can address what underlies 70% of illness and disease. And there are lots of things we can do and that the COVID has provided us a platform for beginning to do. In our delivery system. It's meant reaching out to provide testing to communities that haven't had COVID testing. Setting up vaccination sites and communities that haven't traditionally had vaccination sites or availability of that sort of health care.

Dean Lloyd Minor: [00:30:17] The other important points are, you know, the murder of George Floyd occurring at the same time that we were seeing these striking disparities in the incidence and in the mortality of COVID related to race and ethnicity. That together, I think, has caused us to reexamine our collective conscience about social justice in our country. And as health care professionals, I think it's caused us to see that we can't be silent, that if we think of ourselves as the stewards of health and well-being, we're not alone in that.

Dean Lloyd Minor: [00:30:59] And we can't be effective if we're alone. But we have to be a powerful voice as a steward of health and well-being. And to do that, we have to talk about social justice and we have to talk about systemic racism. And we have to talk about the factors in our society that have made social, environmental and behavioral determinants such a prominent part of health and health care outcomes. What I'm saying is I think we have to be a part of finding ways to address those problems, to create a more level playing field for access to health and health care, and to think about how we bring the same intellectual rigor that we bring to doing fundamental and early stage translational science, how we bring that rigor and that focus to these much more thorny problems of what underlies inequity in access to health care? Or why is it that some communities, even though there may be the access, that people in communities aren't availing themselves of that access to the health care? It's not enough to simply say, well, it's there and people aren't using it. We have to think about why aren't people using it? It's because we have providers that don't know how to communicate with people in communities. I mean, these are all issues and problems that we we haven't focused on very much in the past that we have to focus a lot more on in the future.

Henry Bair: [00:32:26] I think what's a theme that's come up over and over again is the idea that the enterprise of medicine is facing a lot of change, a lot of challenges. And one of the fundamental defining characteristics of a leader is to be able to recognize that change is coming and adapt to those changes. To not just carry on with the status quo, but actually think of new ways to improve on the way that things are done. And I think something that's really fascinating for me is the idea of the physician leader. I think to some extent, all physicians, no matter where they operate, are leaders. Even if it's just a dyadic relationship between a physician and a patient. A lot of the ways of effective doctoring, of leading patients through behavioral change, I think has to do with good leadership in a way. And then, of course, most physicians work in a group, in a team. So as the dean of medical school, how do you see the role of physician leaders in the future? And how do you make sure that this idea continues to perpetuate in the medical school? And how do you cultivate that?

Dean Lloyd Minor: [00:33:32] I think physicians, as you said, are by virtue of their job, perhaps by virtue of what attracts them to to medicine, are leaders. And we need to be doing a lot more to provide opportunities for training the physician leadership workforce of the future. It's oftentimes asked, is leadership learned or is it innate? And I firmly come down on the side of most of what makes effective leadership is learned. I mean, yes, maybe there's some innate qualities. But with very, very few exceptions, I think people can, and when they choose to, they do, learn how to become effective leaders. And it's a constant learning process, or it has been for me throughout my career, and continues to be.

Dean Lloyd Minor: [00:34:23] Then how do we do that? Well, one is by providing formal training and biochemistry and genetics in the clinical specialty fields, in primary care. Providing leadership opportunities, providing learning opportunities. in leadership is critically important. We've done it that at the medical school. We've done it for faculty through various leadership development programs. And then giving people an opportunity to try out their leadership skills. And in our Stanford Medicine Leadership Academy, for example. One of the features for each of the participants is that they need to have a project that they choose. They need a mentor, an advocate, a colleague in the medical school who will help make sure that that project sees the light of day. But it's a project that gives them the opportunity to lead and therefore provides them with feedback on how effective they've been in leading.

Dean Lloyd Minor: [00:35:21] I guess what I'm trying to say is that education and leadership and becoming an effective leader is an active, dynamic process. For sure, dependent upon feedback from the environment, from others. And that just as we have to commit ourselves to a lifelong process of learning in our core disciplines, we have to commit ourselves to a lifelong process in learning about leadership. And we've devoted, so far, less attention, so much less attention to leadership as an educational goal, as a self development goal than we have to the other aspects of our profession. And that's one thing I hope that we're changing through what we're doing in Stanford Medicine.

Tyler Johnson: [00:36:05] So now we've gone up to the 30,000 foot view, and we've talked a lot about your vision for Stanford Medicine. If we can bring it back down to sort of more of a 1 to 1 level. Your career now has spanned clinical care, surgery, a lot of training, research, and now leadership. But if you sort of imagine yourself on the lowest day of your training, right? Maybe all the things in the lab had gone wrong or you were in the clinical part of your training and you'd been working for 36 hours in a row and just didn't know how you were going to even see your next patient, whatever that lowest moment was. If the 2022 version of you was to go back to that version of you at the very lowest moment of your training, whenever that was, what would you want to tell him about sort of what awaited him if he pushed through, as you have, and went on to have this career? What has meant the most to you or what do you think you would use to best motivate your former self? Or to motivate maybe someone who's going through that kind of a hard time in their training right now?

Dean Lloyd Minor: [00:37:12] I think it relates to something I mentioned briefly before, and that is the journey. And there are very few journeys that are constantly downhill. Journeys have ebbs and flows. Journeys have ups and downs. And if you don't take the bad as well as the good, you're not benefiting from the journey. That's what I've tried to keep in mind, and others around me have helped me to remember when when I may be forgetting it. But I think the advice I would give is, in particular, we've gone through these past two years through and are still in the most challenging period that most of us have faced in our lives. Not saying that others haven't had circumstances in their lives that haven't been even more challenging than in COVID. But for most of us, this has been the most challenging period. Yet we've also seen the enormous strength of people around us. People sometimes ask me, you know, how have I done during the past two years of COVID? And I think I'll be processing that question for the rest of my life. But overall, I felt like I've done well, but I've done well because of those around me who have provided a constant source of inspiration for me, and the power that human beings have when they're motivated and when they come together. And yes, it isn't linear and there are ebbs and flows and ups and downs in that. But I've never questioned the fact that we have the privilege of working with an amazing group of colleagues that provide support for each other and that are really, really driven by the mission.

Dean Lloyd Minor: [00:39:00] And I've also had that feeling at every point in my career. Not... I mean, it's been different during COVID, because it has been a crisis a minute, in many cases. But at the end of the day, I've always known that that I have the privilege of working with an amazing group of colleagues, and that we are looking out for each other and supporting each other. And that as long as we continue to do that, we'll be able to navigate whatever is in our future. And I think that's the type of feeling that I hope others have as well because I think if you have that feeling and that knowledge from your environment, then you discover an inner strength that for me... I mean, in March of 2020, I thought this would be, you know, we'll have a few months of a pandemic and then then we'll be out of this. And then, of course, there was last spring when things seemed to be declining. And then Delta came on the scene. And of course, we were getting through Delta in the fall, and then Omicron emerged in December. And so it's like, what is next? And I don't know what's next.

Dean Lloyd Minor: [00:40:12] And that's been one of the hardest things for all of us, is that we're basically creatures where we like to have some knowledge of the future. And I think that's particularly true for us in medicine. We don't like to go into things just completely in the unknown. And yet so many times we have been. Maybe not completely in the unknown, but largely in the unknown, about our future. And that's where the strength of relationships and sort of basic belief that as individuals at an amazing institution, we will get through this together. And I've had that feeling... I feel very blessed in my life and my career that I've had, the opportunities I've had that I've truly enjoyed every step. The last two years have certainly not been enjoyable, but they've been meaningful. They've been enormously meaningful on a personal level. And I've grown as a person and as a leader during that time, and I hope that others have as well. And collectively, I think that makes us a lot stronger than we were before all this began. And I think we're going to need that strength as we navigate some of the challenges we talked about earlier in terms of burnout, in terms of we still don't know that we're completely out of COVID. And of course, we now have a war in Ukraine and a host of economic factors that we are only beginning to experience and understand. There's going to be a lot that challenges our fortitude and our sustenance, I think, over the coming months and years. But I think the way we'll get through it won't be that dissimilar to the way we've gotten through the challenges up to today.

Henry Bair: [00:41:53] Thank you very much, Dean Minor, for your time. We're very grateful for the insights on leadership that you've shared.

Dean Lloyd Minor: [00:41:58] Thank you. It's been a privilege being with you.

Henry Bair: [00:42:04] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctors art. If you enjoyed the episode, please subscribe rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.

Tyler Johnson: [00:42:22] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor patient or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.

Henry Bair: [00:42:36] I'm Henry Bayer.

Tyler Johnson: [00:42:37] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.