Lessons, thanks, and the future

For the last 33 months, it has been my honor to serve as Interim Chair of the Department of Internal Medicine. Nearly three years is unusually long for an interim, but I have been grateful for the extra time to shepherd several projects farther down the road. I am indebted to those who have held this role before me both for their direct advice and the examples they have set for what it takes to lead this department successfully. And I have already been in regular conversation with our incoming chair, Dr. Upinder Singh, preparing to hand over the reins. Dr. Singh has quickly grasped the fundamentals of our department’s operations, its position within UI Health Care and the Carver College of Medicine, and the immediate and long-term challenges and opportunities unique to us. I hope you will all take the opportunity to attend one of her town halls next month.

In this last Views from the Chair from me, I would like to offer some final thoughts. As I said, it is unusual for an interim chair to have such a long tenure. Our department could not stand still during that time. Immediate changes were needed, given the same constraints that every academic medical center in the country was facing in the post-pandemic landscape. I am proud of what we achieved amid so much dramatic change, including the ongoing integration of UI Health Care’s first major acquisition. Internally, we drafted a clear-eyed accounting of our financial situation, established a strategy that should make future budgets easier to build, build pathways to streamline faculty recruitment and designed and implemented a compensation plan that accounts for our diverse activities. We have aligned our nine divisions more closely, while still recognizing the variety of circumstances among our sizable and dramatically expanded faculty roster. I believe that in the last three years we have also aligned our department more closely with the strategic goals and philosophy of the hospital and collegiate leadership, which should make us more efficient as a health system and gives us a strong voice at the table.

The challenges in alignment may have been the biggest surprise in taking on this role. An effective department chair must navigate a matrix of sometimes competing priorities, advocating for the needs of those who report to them and then communicating the needs of those to whom they report. Faculty, division directors, and staff within the department comprise a series of overlapping circles and outside of those circles are even more circles—other departments, collegiate and hospital administrative arms, which can include everything from the UIP and the CMO to accounting to human resources to patient advocacy to capital management, and of course beyond, with other colleges and the university itself. This idea, that we are large and complicated, may seem obvious, but its manifestations are often difficult to anticipate and then to satisfy. It is too much for any one person, which is what leads me to the biggest lesson and my biggest source of gratitude. An effective department chair must surround themselves with talented and experienced professionals and then trust them to do their jobs well.

Working among so much talent has been my favorite part of the job. I think good leadership boils down to this: Inspiring people to do the right thing. If there is any measure of success for a leader, it is only in the success of those they lead. There was a moment recently in a meeting of our Vice Chairs, while they discussed ideas on how to improve our retention practices, that I just sat back and listened. So many good ideas were floated, and the discussion was so lively and engaged on a topic that clearly mattered so much to everyone. It was both illuminating and inspiring. My years in this role are filled with many such moments. What a privilege to have access to so much passion and intelligence. Great ideas abound in our department, and we all get to hear them every day if we are ready to listen.

We all know the challenges of delivering care, of training the next generation, and of enabling research and discovery here in a rural state that depends on our singular persistence. Low reimbursement rates, patient access, aging infrastructure, the payor mix, the multidimensional political climate, integration of AI, nurturing creativity, the competition for people and resources . . . Some of these are new or just newly complicated, but I believe if we pay attention to more fundamental concerns, solutions will emerge. What is that fundament from which all future success flows? It is you. Each of you. If we all feel like our contribution matters and is valued and that our voices are heard, we will grow in a sustainable and positive direction. I am sure Dr. Singh and the other leaders will keep open established forums and channels or create new ones. These spaces are how we stay connected across distance and packed schedules and how we feel seen and appreciated.

Any leader in an institution of our size and age is a brief steward, serving those they lead, charged with leaving things better than when they started. I am deeply grateful to have been given the opportunity to serve each of you and to have been inspired by daily evidence of your commitment to this noble mission. Special thanks must go to the administrative team of this department, a perpetual-motion machine ensuring that all of our great activity does not falter. And a very special thanks to Sherry Mattison, my always constant executive assistant, without whom I would have long ago drowned under a mountain of emails, calendar invites, and documents to sign and organize. Thank you, and thank you, all.