“Exit interview” with Joseph Zabner, MD

In December 2021, after more than ten years as Director of the Division of Pulmonary, Critical Care, and Occupational Medicine, Joseph Zabner, MD, stepped down from the role. David Stoltz, MD, PhD, was named as his successor.

After a couple of months spent “keeping a low profile,” as Zabner put it, we sat down to talk about his thoughts on the role, the importance of fresh ideas in leadership transitions, and what had been standout moments in his tenure as Chief.

What did you value most in your time as division director?

I like people. I used to walk through all the areas where pulmonary had an imprint. I went every week to the ICU, the pulmonary clinics at IRL, to the rest, and talked to people and listen to what problems they had. You know, I really enjoyed, trying to listen to the people and what they expected me to do for them and try to get things done. And I was very, very proud to be able to work with a lot of people that were a lot better than me in every aspect of what they were doing. In the intensive care unit, there were several faculty that were mentors to me and continued to be mentors to me in a pulmonary clinic, routinely run my patients by a couple of our faculty, you know, Tom Gross, Doug Hornick, Jeff Wilson, and learn from them, master clinicians. For clinical research I’d go and talk to Alejandro Comellas and get his input, it was invaluable. In the intensive care unit, I’d talk to Greg Schmidt or Kevin Doerschug, and it was amazing. It was amazing to be surrounded by people who were really, really smart and challenged me every day. And as my job, as their division director, trying to anticipate their needs and trying to make them successful.

Are there specific accomplishments that you’re proudest of?

When I first became a division director there was a movement in the country to staff the intensive care units 24/7 with faculty. That created a couple of issues. First, our fellows lacked the autonomy they had had. Second, we didn’t have the faculty to staff the ICU 24/7. Third, if you took call at night and you were supposed to be in the lab the next day, you couldn’t come to work the next day in the laboratory for your academic pursuits. So I analyzed the data. And I realized that even though our length of stay in the intensive care unit had gone down, and our number of patients admitted went up, our income had gone down. If the length of stay was three days and the first day they were admitted at night, there would be no bill for the first night. And then the next day would have a bill. Third day, the patient would be discharged, no critical care bill. We were seeing more patients, working harder, but we were billing less.

So we came up with the idea of having a faculty member come in and staff from 10 to midnight. That faculty would have time to staff the patients that were admitted in the afternoon, would have time to teach the night residents and interns, and it would be valuable for the patients to be seen by staff in the middle of the night. Faculty would get paid extra for coming from 10 to midnight and would learn how to bill, because that money would go directly to them, and the RVUs in the division would go up.

And we did that, and it worked really, really well and achieved all its purposes. About three years later, I was at a Ground Rounds about new ways to teach residents. And I heard the person presenting talk about how “stealth supervision” was important. And they used the example of the faculty in pulmonary-critical care offering stealth supervision at night for the residents and fellows that were on call. So innovation and using creativity to solve problems is something I really, really liked.

What was another challenge the division faced and how do you think you solved it?

A big challenge that we continue to have is that physician-scientists are disappearing. So we need to attract the pulmonary fellows that want to do research. And then once they finish their fellowship, they need to stay for a couple extra years so they can get a K award. And then it takes some time for them to be productive, so they can get an R01. The only way to do that is for the whole division to be supportive of this program. I was fortunate that most of our faculty in the division agreed that we wanted to have an academic fellowship. And we wanted to support our research programs and the fellows that wanted to do research to stay after the fellowship for additional years. Some of them stayed as post-doc, some of them stayed as associates, some of them stayed as assistant professor on the clinical track. And as they got to produce data and write papers and write grants, they transitioned to tenured faculty.

I think it continues to be a huge issue. We are not gonna solve the problem of the disappearance of physician-scientists just by talking about it. It requires a huge investment, with the knowledge that not all the fellows that we train to become physician-scientists are gonna be successful. You start by knowing that some of them are gonna love it, but they’re not going to want do it. Some of them are going to want do it, but they’re not going to be good at it. And some of them are just going to be passionate about other things. But if we don’t try, we’ll never replenish the physician-scientists that are needed to take all the incredible basic science discoveries that have happened over the last 20 years and translate them into new treatments or cures.

Your successor is well-positioned to do something about that. What other qualities does Dr. Stoltz possess that equip him to meet this and other challenges?

I’m really pleased with the fact that there will be a different view to tackle the challenges that we’re gonna have over the next 10 years. I think he has the right instincts. He’s a good person, and he cares about people and most of us in the division know that. That’s a really important thing. Once you know that your division director, your department head, your dean cares about you and is fair, then you will rally to solve problems together. And I think he’ll be a great leader.

What is a piece of advice that you got in your first years in the role that made a difference in helping you adapt to the role? 

Geoff McLennan was also a really good mentor. After my first division faculty meeting, he called me to his office and said, “You did it all wrong. You are too informal. You need to have an agenda, it has to be printed, you need to sit at the front of the table, people need to raise their hands to talk.” But most important, he said, everything that is on the agenda has to be solved by the time the meeting begins. “You don’t go to the meeting to find out what people think, you find out before.” That was a very good piece of advice. I would speak to people before that I thought were going to have different views than I had, just to be aware of how we’re going to tackle the discussion.

Final thoughts, now that you have had time to reflect?

I made the decision to step down with my head, and I wasn’t aware of how it was gonna affect my feelings or my soul. In December I had to clean out my office and I was trying to avoid that day, because I thought it was going to be difficult. But the day I went and cleaned my office, I wasn’t sad. I wasn’t happy. I was just . . . it was time to do it, you know? I was happy that I was not doing it because I hated to do it. I wasn’t doing it because somebody told me to do it. I wasn’t doing this because there was a problem. It was just time for somebody else to lead. And I think we should expect that to happen.