Earlier this month, it was announced that after more than 20 years as medical director of University of Iowa Health Care’s Medical Intensive Care Unit (MICU), Kevin Doerschug, MD, MS would transition to a new role in the institution, Associate Chief Quality Officer. Below is a conversation with Doerschug about lessons learned and high points from his time in the role, lightly edited.

When you first took on the role as MICU Director more than 20 years ago, what did the unit look like then—clinically, culturally, or structurally—compared to today?
When I first started, the MICU was a 12-bed unit—much smaller than it is now—and it was located on the fourth floor in a different part of the hospital. The beds were separated by curtains rather than individual rooms. From a patient perspective, that meant very little privacy. From a provider perspective, though, you could visually take in the entire unit, which allowed you to quickly identify where attention was most urgently needed.

Structurally, it wasn’t ideal, but it did create a strong sense of shared space and awareness. Over time, we knew we needed to expand. We went from 12 beds to 14, then 20, and eventually to 26, where we’ve been for more than a decade now—and we’re still very full. We continue to look ahead to opportunities for further expansion as the institution grows.

Culturally, one thing that hasn’t changed much is the interdisciplinary respect within the unit. Even back then, the core group of MICU nurses had been there for many years, which really spoke to how much people valued working together. Physicians, nurses, respiratory therapists—everyone respected one another, and that mutual respect formed the foundation of the unit.

What has changed nationally is the nursing workforce. Many experienced bedside nurses now pursue advanced degrees, which creates turnover and brings in newer nurses more quickly. That presents challenges, particularly because ICU nursing takes years to truly master. But it also brings opportunities: new ideas, fresh perspectives, and a willingness to question longstanding practices. What has remained constant, though, is how we work together as a team, and that has always been deeply important to me.

Are there any early challenges you faced as MICU Director that shaped your approach to leadership?
One of the earliest challenges was my own inexperience. The nurse manager at the time later told me she had contacted the division chief to say that I was too young and too inexperienced for the role, and she may not have been wrong. I was still learning how to be a physician while also learning how to be a leader.

What helped me most was listening. That same nurse manager taught me an incredible amount about leadership simply by allowing me to learn from her experience. Others did the same. Joseph Zabner, in particular, offered a great deal of thoughtful advice, both about leadership and about being human. There’s a lot of overlap between the two.

That experience taught me something I still believe strongly: good leaders don’t tell people what to do. Good leaders help people do what they’re already good at.

Over two decades, what principles have guided your decision-making as a leader, especially in high-stakes situations?
It really comes down to understanding people. One of my guiding principles has always been listening and avoiding operating in a bubble. A recurring high-stakes challenge has been capacity. Early on, with only 12 beds, we were constantly trying to determine how to provide the best care while managing patient flow. As we expanded, the challenge shifted to building the workforce needed to care for more patients.

…And then there was COVID. It was unlike anything we had experienced. To some extent, caring for critically ill patients is what we train for. But suddenly, every patient in the ICU was critically ill with the same evolving disease. Our understanding of COVID was changing daily, sometimes hourly, which required constant communication and adaptation.

What stands out most, though, are the humanistic aspects. In addition to caring for patients, we took care of each other. That was essential. One example that still stays with me is a tradition started by Dr. Zabner, where one faculty physician each day ordered lunch for the entire ICU team. It reinforced that this wasn’t just about physicians. It was about everyone. It helped us to stay together in the unit and support each other.

We also made a point to order from local businesses, recognizing that the broader community was struggling too. That sense of shared purpose and mutual support defined that period for me. I truly believe we provided excellent care to Iowans during an extraordinarily difficult time, and I’m very proud of how our team came together.

The ICU is a formative training environment. What have you learned from mentoring fellows and residents?
I’ve learned humility, especially practicing an approach that recognizes that residents are humans who are learning. In the ICU, trainees often encounter levels of tragedy and emotional strain they may not be fully prepared for. That stress can show up in many ways: sorrow, anger, frustration. It’s important to recognize that those reactions reflect the environment, not a flaw in character.

We need to acknowledge imperfection in medicine. We sometimes have to make complex decisions with incomplete information, and those decisions don’t always turn out the way we hope. Providers can experience profound guilt or self-blame—what we sometimes call the “second victim” phenomenon.

I learned how to share my own experiences, including times when I wished I had made different decisions, to help trainees in their learning. I wanted them to understand that these feelings are part of medicine, and that what matters is learning from challenging moments and growing rather than withdrawing from the work.

How do you think the MICU’s culture has shaped trainees’ and fellows’ careers and approaches to medicine?
Our ICU places a strong emphasis on escalating autonomy, particularly for fellows. Early in fellowship, they require close guidance, but as they progress, they are supported in practicing more independently—always with appropriate supervision.

The size and acuity of our MICU provide an enormous breadth of experience, including exposure to rare and complex cases. That combination of experience, autonomy, and faculty support is critical. We regularly hear from former fellows who say that their current colleagues comment on their ICU skills and confidence. If we played even a small role in helping them develop that foundation, I consider that a success.

How do you hope patients and families experienced the MICU under your leadership?
I hope they experienced compassion first and foremost. For many patients and families, being in the ICU represents the worst day of their lives. I hope they felt that we recognized that—that we weren’t simply going through routines, but truly acknowledging what they were facing.

Unfortunately, in the MICU we care for many patients with illnesses that are not survivable or survivable only with outcomes that may not align with their wishes. In those moments, I hope patients were free from pain and anxiety and that families felt supported rather than harmed by the experience.

What makes the MICU here special?
It always comes back to care. Not just critical interventions, but care for patients and for one another. We work intentionally to avoid hierarchy within the team and to recognize that everyone brings a unique and equally valuable perspective. That culture of mutual respect is what truly sets the MICU apart.

As you step into your next role, what lessons from the MICU will you carry forward?
In my role as Associate Chief Quality Officer, the focus will be on quality and safety through a team-based lens. One example is nurse-first rounds, where nurses begin rounds by sharing their perspective because of the time they spend at the bedside. That practice reinforces the importance of every voice in patient care and has now been standardized across ICUs.

Moving forward, I want to continue emphasizing proactive approaches to quality and safety that include everyone involved in a patient’s care—not just providers. That philosophy was shaped in the MICU, and it will guide me in my next chapter.