Good evening. Thank you for joining us tonight for the AOSSM Fellows and Emerging Leaders webinar, Leadership Development, with moderator and panelists, Drs. Michael Banfi, Lee Kaplan, Anil Ranawat, and Robin West. Dr. Banfi is tonight's moderator. He is a sports medicine surgeon focusing on hip arthroscopy and joint preservation. Dr. Banfi is team physician for the Los Angeles Rams and the Los Angeles Dodgers. He is program director of the Orthopedic Sports Medicine Fellowship at Kerl and Jobe Orthopedic Clinic and associate professor of orthopedic surgery at Cedars-Sinai, Kerl and Jobe Institute. I will turn this over to Dr. Banfi to begin and introduce the panelists. Thank you very much, Meredith. We have a great panel this evening to complete our second to last of the virtual webinars, and this is going to be focused on leadership and how particularly our young members can look to our older members on guidance on how to emerge as leaders as they move forward with regard to their career. First up will be Dr. Lee Kaplan. He's the chief of sports medicine in Miami at the Petra and Stephen Levin Endowed Chair in Sports Medicine. He's the director at UHealth Sports Medicine Institute, professor in the Department of Orthopedics, Kinesiology, and Biomedical Engineering, medical rector and head team physician, University of Miami, as well as the Miami Marlins medical director and team physician. We'll also be introducing Dr. Anil Ranawat from Hospital for Special Surgery. He is the chief of the hip and knee division of sports medicine at HSS. He's also an associate professor of orthopedic surgery at the Cornell Wheel Medical College, associate attending orthopedic surgeon at HSS, medical director of the physician's assistant department as well as an assistant team physician for the New York Mets. And then also Dr. Robin West, who is the president of the Inova Musculoskeletal Service Line, chairman of Inova Sports Medicine. She also is the lead team physician for the Washington Nationals, an associate professor at both Georgetown as well as the Uniformed Services, University of the Health Sciences. So we will begin with Dr. Kaplan. Take it away. Thank you very much. I think I have my slides. So the first thing that kind of cracked me up about Mike's introduction, number one, all of us, and if you gather one thing, you'll probably wind up collecting titles that you have to present at each talk. So I'm embarrassed even by my opening slide at those. Most importantly, you know, I also laugh when we're now the older people. I think I've known Robin since we were 18 or 19 and we went to college together. So Robin, I guess we're on the other side of this thing now. We better teach somebody. I'm going to just go through a couple of antidotes and some thoughts. Could you switch so I can advance my slides, please? Great. So I think, I think when you're thinking about leadership, you really need to take this in bites. One of the things, you know, we're really privileged this year. We have an excellent fellow, Matt Wolfson, who's here. We're actually at the ballpark tonight. And one of the things we're talking about is you guys have gone through your entire career looking at what the next level will be, right? You go from second year to third year, you're worried about fellowship. And then all of a sudden you're out and it's okay. There went my first year, my second. I think you have to really establish a growth mindset. You really have to think about what the order of importance is. And still the most important thing is taking care of your patients. So establish your clinical presence early, think it through. Everybody gets this weird sense of, you know, Robin and I both went to the Pittsburgh fellowship. Who should I operate like? Which parts of it? and you develop that. And a lot of that's just planning and doing a good job at doing that. Realizing it's a marathon, not a sprint. As you develop, especially around team sports, especially around leadership positions, you start in a position where you're the, you know, just the person in the room. And in doing that, you can learn to seek opportunities. You can learn to seek opportunities, obviously in the OSSM and the national organizations, but work through that and realize it's not, you know, you're going to develop into those positions. Could you advance the slide? So I think that leadership is really, leadership and management are really an evolution. I think it's an evolution and transition. Many of you are already in a leadership position. If you look back towards some of the teaching that you're doing with the residents that are below you, it's really, you're evolving into these positions. You're getting a leadership position just through your clinical care. But look at your organizational structure. One of the things that Mike asked is what is about our leadership positions within our institution. One of the tough things is, as a position, you want to stay there. You want to grow. Even if you get a new opportunity, you're putting your roots down. Realize that a lot of the administrators are leaving every few years. So look at the organizational structure, assume what the organizational behavior will be, gather as much information on finance as you can. I actually got stuck in a lot of different positions that really seemed ridiculous at the time. And it was incredible with learning opportunities. So for instance, I was on a council of faculty. I represented a hundred physicians at the University of Wisconsin when I was there in surgery and orthopedics. And although that sounds like a good thing, it's not, right? And, you know, I couldn't represent two physicians, much less a hundred. But what we did was we learned the financial acumen of the institution. We weren't making final decisions. We were making recommendations. But I understood funds flow. I understood how the position of the finance worked, how people looked at us. Knowing all those things will empower you to go through your career because you'll understand how decisions are made. It's not just volume. It's cost accounting and all those things. And then realizing your education is not really over. It's just evolving. If you could advance the slide. So I think it's very important to participate at your appropriate level. And what I mean by that is when you're doing your clinical business, meaning either in clinic or in the OR, realize that people are looking at you for the first time. So how do you develop the process? And you want to really establish yourself in the most professional manner. So even little things, you're not a resident anymore, right? Your sense of humor has to be appropriate. Your dialogue has to be appropriate. You should be having fun. You should be taking control of the situation and doing the same on the educational component. So wherever you are, whether you're in private practice, whether you're at an institution like the other people that are on the panel, realizing that that educational component will allow you to be involved in another such as administration. One of the big lessons I would tell you is in team coverage. I started my career at the University of Wisconsin and I could tell you that the opportunities were around football because the doctor wasn't a shoulder surgeon. So we had that experience coming out of Pittsburgh. And then I took care of hockey and I'm a South Florida kid. So going around hockey was something that I had to learn, but learning from the primary care who shared with me, learning the coverage with me and learning all those things was important. A lot of people take care of a meniscus on a famous athlete, but it's everything else that goes around. And I could tell you that among the people on the panel can only imagine who we listened to. Robin and I have had some of the same mentors. Neil's had some people that I really look up to at HSS, Michael working with Neil and Bert, et cetera. So look at those people and utilize their availability rather than trying to jump too far ahead. Next slide, please. I think you should set standards and expectations. I think one of the things that's changed remarkably in the own process from when I was a medical student and a resident and going on has really been an understanding that at each level there are expectations that are well verbalized. I just heard Bill Levine give a great grand rounds at the University of Miami. Bill, if you don't know, is the chairman at, he's been the president of the American Shoulder and Elbow Society, but he's the chairman at Columbia and was fabulous on how learning changes. So I would say you have to set expectations of yourself and you can make those known. You make it known by your behavior and those will give you leadership opportunities. Believe me, when you show up on time, when you do the little things that are now considered part of citizenship, they make a difference. And then within your own group, offer yourself up, be enthusiastic. One of the things that I've learned is that paying attention to the things you really enjoy doing, it won't seem like a burden. It really won't. I mean, you want me at 8.30 at night to do something for the fellowship, Jeff Dugas, no problem, I'm there. And so realize that you're continuing to learn, but by doing these things, you'll meet people and they'll give you opportunities. Next slide, please. I think you have to continue to learn. And one of the things is everybody gets frustrated, right? You'll get frustrated because something's not going well in clinic. You'll get frustrated because you thought you should have been on some leadership committee and somebody else is on it. You'll get frustrated because you feel like the administration isn't listening and you have the practical skill. I think you need to further yourself when you have those positions, when you have a position that you know you can do better or do better than the people that are trying. And I would say a lot of this are the administrators of the hospital system. Some of you will work at, figure out what their language is, figure out what they're seeking out as important, figure out why they think sports medicine is important. Believe me, we're a major revenue driver at most institutions with a huge halo effect. How do you do that? In fact, Matt was asking me today, how's our signage up at the Marlins games? Robin has the same situation, HSS, Michael Crow and Joe. Learn why it's important to them. And sometimes you have to continue. My wife was going to kill me, but this year I went back and started, I just finished my first year of a master's in health care management because I kept going into these meetings and saying, I'm telling you, this is not the way that we do cost accounting. And so there may be times, depending on what your future holds for you, that you have to look to do that. Next slide, please. I think I'm going to end so that other people can talk, but I think there's a lot they don't teach us in training. I think part of it is on the practice side, but I'm just going to briefly talk about life. You know, it happens, stuff happens. I was talking to one of my junior partners this morning, who's now actually in the midpoint of his career, Mike Baraga, an excellent doctor. And I said, one of the differences that you didn't realize was you're going to have two children. You're going to get married. All of those things occur in learning from the people ahead of us. And quite frankly, learning from your generation of how you process things, how you put them into a sense of importance. Don't be afraid to set what your limits are. You'll be much more successful doing that than spreading yourself too thin and realize, you know, you've heard it a million times, but make sure that whatever's going on at home does have some prioritization because it is important and people are depending on you. Next slide. Let's skip through the goal setting. I want other people, I just, there was one more I want to touch upon. To me, this is the most important slide for tonight. And it's the importance of mentors. If you look at business and something we're studying in school right now, but also if you look at any of the great finance people right now, you look at Buffett, all of them will say, find a mentor. People with mentors become more successful. Don't be afraid to ask. Just ask somebody for their advice. I would say that the most important lesson that I've learned through all of this is I had a lot of teachers. A few of them actually became mentors. And then a few of those now are friends. So Mike said, we're old. Well, now we're all going to go next month to AOSSM. And it's going to be unbelievable, right? Because there are a lot of people we haven't seen in 18 months. And we grew up with these people in many ways professionally. And I think taking those opportunities and turn them into positive, I'll just give you the last example, and then I'm going to stop. Last year, I was the program director for the AOSSM. If you don't know, it's a four-year process and you read a lot of abstracts. I probably read a couple thousand abstracts over the time you learn. And then all of a sudden it was over. We weren't going to do it. We weren't having the meeting. The academy was shut down. But one of the mentors for both Robin and I, Jim Bradley, had given me the opportunity. And I said, you know what? He deserves to go out with a meeting. So we tried to turn something that was very negative into something positive. We actually had one of the largest meetings. It encouraged people to do a lot of these other Zoom things. So use those opportunities, ask for help, and most importantly, kind of be true to yourself as you go through this. Mike, I'm going to stop now. I want everybody else to have a chance to talk. Thank you. Thanks, Lee. That was fantastic. And I can't agree more with regard to the importance of mentors. I don't know where I would be without the help of Neil and Clarence and everyone that's kind of pushed me in the direction with regard to the teams and societies and whatnot. One quick question before we move on to Robin, or if Neil's on, then that'll be perfect. I don't know if he's on yet, but we can switch over to him. You mentioned that when you first started, it sounds like you were in Wisconsin. You were putting to several different committees within the hospital system. And one of the questions that we received earlier is kind of a bit of an insecure question. How did you establish yourself as a leader within these committees as a young orthopedic surgeon and have been taken seriously by the hospital administration, as well as other specialties within the hospital? It's a great question. The first thing I did was listen, right? So I listened to how they ran the meetings. I listened to where they were, and then I looked for opportunities. So for instance, I was on a committee to build a clinic because nobody else wanted to be on that committee, but I learned what was important. I learned that it was the number one thing for women that we interviewed. They wanted nice bathrooms, and they wanted to make sure their time when they brought children to clinic was appreciated. Learning those steps later on opened opportunities for me. So I think it was number one, doing jobs that people didn't do. And then the way to fit in in those committees, especially with experienced people, is to listen, to give your opinion when asked, and they want that youthful opinion. So don't be afraid to say it. Just be respectful of the process, and that's why I mentioned the organizational structure. All right, great. That's awesome. We'll save the rest of the questions until the end. And I would love to introduce Dr. Anil Ranawat. He is on the call. I do not see his camera yet. I think he was just on audio, but now he is off. I think he's trying to reconnect. So we can move forward with Dr. West. All right, Robin, take it away. I'll share my screen. Let's see. Can you guys get this here? Can you see this? Yep, I can see it. Put that up. Can you see that? Yep. Okay, terrific. Thanks for having me, Mike and Leigh. That was great. I'll touch on similar things to what Leigh talked about in a little bit of a different format. But I'll start off with starting a practice. And it's always a very stressful time. It's great coming out of fellowship and finally getting your feet wet and getting to start this practice. It's super exciting, but it's also a really stressful time that first and second year. You're finally getting to do things really on your own and making decisions on your own. And I think the most important thing when you first start is to look and to identify your interests. What are your interests? Is it to have a busy clinical practice? Is it to be very involved in research and teaching residents or fellows? Is it community involvement on the orthopedic side? Is it leadership within your department or your practice? So I think that's important to kind of think about that as you're starting your practice. Again, you're going to be starting busy and working on this clinical practice, but what other areas of interest do you have? And then next, you want to define success. And success is really described as an accomplishment of an aim or a purpose. And it may be providing exceptional care, developing a huge research portfolio, being financially secure. We all have different definitions of success, but really to have you achieve success, you need to define it on your own. And then you want to start developing these early goals. And again, the way you develop these goals is taking those interests and also this definition of success and putting those together to develop early goals in those first couple years. And as Lee touched on, finding mentors, this is really key because the mentors can help you to achieve your success. You're likely going to have different mentors from all areas, from residency, from fellowship, and even your mentors may be your own co-fellows or your co-residents and colleagues. And so it's important to find these mentors to help you along your way. And then after a couple of years, you want to look at these leadership opportunities. And you want to start to think about 10-year goals. You want to look further out and not just these first couple years. And really, how do you start developing these leadership opportunities? There are lots of ways to get involved. On the Orthopedic Society, there is national, regional, and local ways to get involved. You can be involved in governing boards, committees, obviously teaching opportunities like surgical skills labs, there are traveling fellowships. So those are all different ways that you can, on the orthopedic side, start getting involved. And then there are leadership opportunities within AAOS, the Leadership Fellows Program. AOA has a Residence Leadership Program, as well as Emerging Leaders Program. And also, a lot of institutions have their own development programs, like Duke has the Fagan Leadership Program and Forum. So these are opportunities where you can really start to promote your education, camaraderie, and get a network of colleagues, especially during those traveling fellowships. We always think about orthopedic surgeons are really natural-born leaders that really wish to be the captain of the ship in our clinic and in the operating room. So maybe we're natural-born leaders, but there are a lot of successful leadership qualities that aren't always innate. And so you often have to be taught or these have to be fine-tuned. So taking an opportunity, like getting involved in these leadership opportunities, can really help promote that. Then we look at this and, you know, there are different, all these leadership programs really focus on a couple things. They focus on mentoring, on you being a mentor, and also in working with mentors of your own. Networking is huge, you know, networking and having colleagues across the country who you can rely on, you can send patients to, who you can run cases by. And the hardest part is negotiation. We're never trained in negotiation, and I think that's probably the hardest part in leadership is, you know, negotiating for yourself, negotiating for your team. That's tricky. Teamwork is, you know, we're all used to that, and many of us played sports and played on a team, but teamwork is key. And as Lee kind of touched on as well, you know, relying on everybody else, learning from everybody around us. It's the athletic training, it's the coaching, it's the it's the athletic trainers, it's the physical therapists. It's everyone I work with that I learn from. Every day I learn something. And so working together as a team to collaborate to take these opportunities. They also focus on individual leadership style in these programs and difficult conversations, emotional intelligence, and then the development of these specific leadership qualities. You know, I think that the difficult conversations are tough. I was at the University of Pittsburgh for 12 years, and then I came to Inova, and Inova is a big health care system in Virginia, northern Virginia. We have five hospitals and five ambulatory surgery centers. And I came here to build a sports medicine program and then ultimately took on this role as president of a musculoskeletal service line. So I oversee about 350 surgeons and physicians. But the hardest part are these difficult conversations, right? When I have to fire someone, when I have to talk about someone's productivity, or someone's surgical skills. I mean, these are these are tough. And so these are things that don't don't come naturally and have to really be be taught and you develop them over time. So what I've learned along the way is really you have to step outside of your comfort zone, you have to seek opportunities, and try something new. Don't be afraid to fail. You know, we always say stepping out of your comfort zone is where the magic happens. You need to be smart and challenge yourself, you know, be daring and challenge the organization. If you have concerns, you need to question it, question best best practices, and don't be afraid to come forward. And then also be bold and challenge that the talent and that's what I've had to do is I built this program. And now building out this musculoskeletal service line, you have to look around you, you want the best, most highly talented people on your team, and you can promote them and you can help them. So this is important as a leader also to work on that skill. So you know, people always ask me, it's interesting, like, what is it like to be a woman in professional sports and serving as the president of the MSK service line, overseeing all these positions? And what I always tell people is really, it's it's luck. Luck's what happens when preparation meets opportunity. Because I get questions like, you're so lucky, how did you get to be in this position? How did how did this happen? And how that happened? It's all luck. But it's actually not luck, right? Luck is what happens when you're prepared, and this opportunity arises. So you've got to take advantage of it. And again, touching back on that team effort, you know, it's a team, right? It's a team in the operating room, it's a team in the training room, it's a team in the clinic. And so you've got to, you've really got to remember that you're a small part of this team, you know, you may be considered the leader, depending on where you are, and you may not, but together, you're the small part, but you work together to provide the best care, to do the best research and to, and to, you know, promote your program. So really, don't forget about about your team. And also don't forget about your family, you know, families, family's important, and times go quickly. So you need to make sure that that's not forgotten as well. Thank you. That's great. Thanks, Robin. One follow-up question that I had, similar to what I was, what I asked Lee, is again, that young orthopedic surgeon, you know, again, in a leadership position, you know, you said you had to make some tough decisions in the past, particularly, you know, when you're dealing with having to, you know, talk about someone's surgical skills, but what about when you're having to advocate for your department? Any tips you have with regard to that for the young surgeon, or if they have to, if they're, say, in charge of the residency, they're having to advocate for their residents against the hospital, any words of wisdom on what to do or how to have confidence doing that? Yeah, Mike, you know, it depends on what you're doing it for, right? Because everyone's going to have different roles within the hospital. So when I'm working with the executives, I'm working with finance, or am I working with the education department, it depends on where we're working. And so you want to come forward and say, what your goals are, right? So we actually started our fellowship, we just got our ACGME accreditation this year. So we built this fellowship. And so going forward to ask for funding for it from the hospital, and you know, why is it going to be beneficial to the hospital? And so we have to go forward and present what's this going to offer the hospital? How's this going to, how's this going to grow our clinical practice? And so that I think just coming prepared to the meeting and knowing what you're getting yourself into, right there, I look on my schedule, some days I have all these meetings in between surgeries or in between patients and, but you want to be prepared for every meeting you go to. And early on in your career, I agree with Lee, you know, take an opportunity and it may not be, it may sound horrible, like, like we described, you know, overseeing that group of 100 surgeons and, but I agree with that, you know, take those opportunities, you can learn so much. And, and being part of those and having a voice there and listening to other people is really the best way to, to continue to build that leadership. Yeah, every, every step definitely built on the next, that is for sure. And there's, and there's still painful opportunities, Lee, but you, you know, they come and I think the hard part is you, as you get further along, as Lee said, that the titles grow and grow and grow. And, you know, when do you say no, also, I think that's the hard part too, Mike, is you're starting to develop your leadership, right? And then you start getting these opportunities and they kind of come in, in waves, all of a sudden you have all these things in front of you and you want to continue to grow and be a leader, which ones do you have to say yes to and which ones, you know, you have to start to, to really look at them critically, because if you accept all these roles, you're not going to do anything well. That's a great point. I know myself that, that is something that I've really had to learn is, you know, when to say no, because you can become overwhelmed and then you are not doing anything well, you're, you're, you know, really strung out with everything you're trying to do. It's, it's, that's the hardest part, I think. I think I'm finally learning it in the past month, but it takes, it takes a long time, you know. Yeah. All right, well, we'll move on here. I'm pleased to introduce Dr. Anil Ranawat, coming from us from HSS. He, he told us earlier, there was a mini hurricane that, that hit New York, but it looks like he survived. Thanks, Mike. Can you guys hear me? Yes. Great. Yeah, there was definitely some AV difficulty because we had our power out for a while, but I just want to thank ASSM, thank Michael, and the one thing I can tell you about leadership development, being trained in HSS, but also be more trained in Pittsburgh, a few years behind Lee Kaplan and a few years behind Robin West. Although I have the least hair, I'm probably the youngest, which you would never see. Nothing about those two individuals is about luck. It's all about effort and really Robin and Lee, you know, personify that to the T. And if I tell any med student, someone mowing my lawn, anything in life, if you work hard, you will get what you want. And that's really the fundamental thing I've seen in my career in medicine and whether it's in athletics and in just professionalism is that it takes 10,000 hours, but to Robin's point, you know, 11,000 hours that you miss your family, maybe too much too. So life's always about balance, but effort is always the key. So I will give you some of my pearls. A lot of these pearls are outside of sports medicine because they're more related to my father, who was an orthopedic surgeon who gave me my pearls, which goes to Lee's point about mentorship. So I don't want to belabor, you know, all my titles, but this is what I was told to say. But I would say that my titles start very innocuously. My first title was that I was a son of a very famous surgeon, which means I had to take my ID card and turn it around because I had to prove who I was for myself. But from that, from effort, I eventually became, from one of my titles, my early titles as a doctor, the medical director of our PA department, which went from three PAs when I started to now 130 PAs. I then, you know, slowly got on to the medical board of our hospital. Because of that position, it got me on the medical board, which really got me a seat at the table. A classic line about politics, if you're not at the table, you're on the menu. So that was a really big growth effort that really made me understand how other departments, how administration view us. It's really intriguing what Lee said like you have to learn the other side of the game. You can't just think of what you care about in the operating room. How can I do an ACL? How can you do 10 ACLs, 10 shoulders? It's you have to see their perspective. And then ultimately you know I became a because of my relationships with my with Pittsburgh and HSS, I became a board member of ASSM. Then through Jeff Dugas who became we started a surgical skills committee and then I became a fellowship director at HSS. I've also been now a board member of the EOA for 10 years and it's all about relationship building. So it's not just how who you are, it's about who you can relate to and how you build it. But really how did I get there? You know I always call it the triple threat and this is what my father taught me. First you do have to establish clinical volume but I don't think volume is the right word. It's becoming an expert at something. Take some extra time, learn a field, learn whether it's hip, ankle, knee, shoulder. Something that makes you a little bit different and become a true student of a procedure. And then once you understand a procedure well, develop it from a research perspective. Do clinical and basic science research and speak at conferences. You know I never said no to a conference. You know there's a difference between an early leader and a late leader. And I do think I have some gray hairs now that I'm starting to say no like Robin is because Robin truly is a leader and Robin taught me a lot. But when I first met Robin she told me say yes to everything. If you want to lead you say yes to everything. And every Steeler game I went to with Jim Bradley, Robin was always there. And that's just even though I knew she was like I should run this ship, I could run this ship, she was always there. And then guess what? She got her ship to run. So when you're younger you just want to you want to talk as much as you can. You want to be a leader. And then through that you know I became a med team physician. Now I've been the Rangers last five years. But I started with a local high school. That's where you start. You start you know and and Lee's done the same thing when Lee started from Wisconsin. And now he's you know he's at the U. I mean like that's just kind of them it starts where you know where you start and to where you end and where you can grow. But my father always taught me balance out that triple threat of being a clinical expert, doing research, and being a team physician. If you start that process from the time you're a PGY4 by five years in practice people will consider you a leader. But the irony of leadership is that that's not really leadership. So this is the thing that I was you know I thought this panel was rigged for a reason. Although I'm not sure if you know Jim Bradley did it on purpose or not. But I know I see Lee laughing. I see Robin laughing. Because these are the three lessons I learned from one of our greatest mentor Jim Bradley our former president. And he always talked to us about the three A's. Now Russ Warren who is probably the only mentor that Bradley would say that's beneath him or above him, sorry, would always agree with this. But the irony is when I went through this with my research assistant this morning she reversed the order. Because Jim always said it's availability first, it's affability second, and it's ability third. Because it's really ability is not your hardest thing. It's you being available for your patients, for their families, for your teams. You being affable for what Robin was saying to learning from everybody to being you know communicated. That's really the key. And what I've learned the most is I've come from an early leader to I guess a bald leader is that you have to learn how to listen. When you're a resident you don't have an option you just or a fellow you have to listen. And then you stop listening a little bit because you have to learn your way. But as you become a mid-level leader you have to learn how to listen again. And that's my biggest teaching point is that we're taught to learn how to make decisions then we get to be retaught to learn how to listen to other people's opinions. And that's really critical to being a true thought leader. Not just think that you are the captain of the ship. So my last kind of point is learning how to be a mentor. I really pride myself on being a mentor. I think I'm a mentor to my neighbor's kids, my kids friends, some high school students, pre-med students, med students, residents, fellows. Of course I've been a teacher my whole life and I really pride myself of teaching. Mentorship requires a lot of time, energy, and especially a lot of patience. And Lee's right Lee's at the training room right now. I mean he said you know you have to you have to really love what you want to do. But if you love what you want to do it's not work. But I always say to you know the the struggling young attending who was a great fellow teacher but they become a young attending young attending audience they get a little edgy. And I'm like don't don't you forget you were that one guy too. And we all were that one person too. So we were all that one kid that somebody saw some inspiration said hey try this do that. And that to me is you know one of the greatest things about our profession that we can lead in so many ways whether it's research surgery or just helping people to get better in our field. And so I love our work. If you go to the next slide. I think it's amazing. I'm honored to be on this panel. It's I appreciate Mike for putting it together. And you know it's you know you get a little bit older when you've started giving the leadership meetings. I used to give the young attending meetings. But I guess you know when Robin knew me I had a lot more hair. So I guess that's how it goes. So thank you very much Mike. Thank you Neil. That was great. You know I think that what's what's really obvious is that all of us see the importance of mentorship and how that's really shaped our careers. And you know I think that one question that I want to ask all of you and I'll start with you and Neil has to do with you know what what role did you find to be the most significant in your career with regard to leadership. So I know for example you know I'm younger than all three of you guys. Probably not by much. But you know I've developed a nice list of things after my name as well. But despite you know the the team position stuff which has its own sexiness in you know that the fellowship director stuff. I actually think that the society involvement for me was probably the most important. You know it allowed me to make the connections, develop the relationships, and really branch out with regard to becoming more well-known. And then that probably affected my ability to become the fellowship director and whatnot. You know this is a very hard question. But but you know do you have one role that you thought was probably the most significant for you? Well I would say that you know becoming I was if I was elected to be fellowship director by Brian Kelly about seven years ago to HSS and that it was very young. I was you know that was probably the my first time that I was like he was we were both thrown into leadership positions a little premature. Okay what do we do with this? Let's step up. And some of the great leaders of time that's what happens whether it's Ulysses S. Grant or whether it's you know Sarah like that I'm a big lover of history. And I think that's always a great opportunity you know with a little fury of great opportunity. So I would say that was my big thing where I had to say you know what I had to stop just thinking about myself, thinking about my department, thinking about all the surgeons, and most importantly thinking about the residents and fellows. So I would say that was my but I want to go back to what Robin really said is that it's not luck. You know you make your own luck. And and there's no Robin's not lucky to be the chief of her department. Robin's excessively skilled and same thing with Lee. And so but once you get that opportunity you know you got to be a Pittsburgh running back and take it through the hole and slam it through the you know find that hole and go through like the bus. That's what I would say. How about you Lee? Do you have one particular role that you felt was most significant in shaping your career or pushing you in one direction? Yeah I mean for me it was the opportunity you know at six years out of fellowship to have an opportunity to meet Donna Shalala who was President Clinton Secretary of Health and the President University of Miami who asked me to come build a program. The University of Miami hadn't had a program, hadn't had any sports people work for the university since 1997. So by 2008 that was an issue. So it was a real opportunity to build. But I would tell you that that even listening to what Anil said I was thinking back to my opportunities in high school and in college and things that other people either didn't want or fell in their lap. I would tell you that and Robin's gonna laugh because we were horrible but and Robin's husband is a fraternity brother of mine at Johns Hopkins. We had a horrible football program just horrible and our coach basically started throwing people off the team on a Thursday night. We had a game Saturday and I was captain and learning how to deal with that. Robin mentioned difficult discussions when your roommate is an all-american and gets thrown off the team it's a problem. And so learning all that dialogue and then something just jumped out at me when Anil was giving and I just want to throw something out. Chris Kading when I was at Wisconsin invited me over to Ohio State to give grand rounds. We were playing really good Ohio State football team that weekend number one in the country and the resident was sitting next to me. They had a nice dinner. Leaned over and said boy you know a lot of people. We were looking at your resume or CV and everything and I thought about it probably, Anil's probably been at some of those dinners probably a little while later because in Ohio, Wisconsin, Michigan they want you to eat a lot of meat at some point in the dinner. I looked over at this guy said you know you're wrong. It's not how many people you know it's just what Anil was alluding to. It's the relationships you build and those people that you can rely on. So I just want to touch on that really quickly. I grew up third generation New York Giants fan. My grandfather drove to the Yale Bowl when there was no Giants stadium. So I knew Russ Warren's name just like many new Phil Simms name. So when I actually didn't even remember this but my senior of high school they did a skit and the person who ran it was a friend of mine made me put on a white coat because I wanted to go to med school even back then. And what I didn't remember until my mom showed me the picture was the back of it said Giants Russ Warren. And I don't even know if I had that opportunity to tell Russ. But I remember a story that he told a guy named George Caldwell who took care of the Dolphins in the wilds for a long time which was when he wanted to go to fellowship he said I have a quarter. Most of you don't even remember but but you know mobile you know when we want to use a payphone it was a quarter. And he said I'll call one person for you. And have that type of relationship is even more important than that particular opportunity Mike. And I hope you all have those kind of relationships. I mean all of us brought up Bradley, Freddie Fu, Chris Horner you know for me John Uribe and you know but also coaches and people like that. And then lastly and I want to end here Anil's comment about the neighborhood kids really hit home for me. My daughter is going in her senior of high school. She wants to maybe be a physician but the number of people around us that have reached out that's important. So if you have those you never know when you're gonna make a difference. And I think I don't come from a medical family. Those people that took the time were important. And Anil I I love your comment about turning your name tag around. I actually interviewed with your father at Lenox Hill and I could tell you that I may have been too confident of a medical student interviewing but the one guy that definitively got my attention was Dr. Ranawat and still always would. So you should be proud of that heritage. Thank you. Robin how about you? What do you excuse the what shaped you the most? Actually there were so many things you know I think about that those those opportunities that that present itself and trying to get out of your comfort zone or trying something new. Even just starting him into my after fellowship when Freddie asked me to stay on at the University of Pittsburgh as faculty and then Jim asked me Jim Bradley asked me to help him with the Steelers. You know at first I wasn't really that interested. I was interested in sports medicine. I went to Hopkins with Lee and I I swam there at Hopkins actually and then I got mononucleosis and I had to miss a season so I want to become an athletic trainer. So I started taking care of the football team and that's kind of how I started being interested in orthopedics and in football. And so when Jim asked me to do it I was like yeah I guess sure I'll help you and he's like come on just do it. And you know we're kind of encouraged me and I came home and I talked to my husband like is this you know so I'm so excited about starting my practice like this is gonna take a lot of time away from my practice and and he said and he grew up in Harrisburg a huge Steelers fan and he's like you've got to take the opportunity Robin you can't miss this like just try it for a year or two. And so I did it and and loved it and obviously and it was a it was a great great transition for me to do that and then I wound up being a head team position for the Washington football team. And so you know with things well take an opportunity try it you can always go back if you don't but if you miss an opportunity then that door may be closed. So I think stepping out of that comfort zone and you know early on in my career like seeking out the committees at AOSSM and Anna and AOS that those were important you know I remember I was on the public relations committee at AOSSM and I'm like why am I on I don't really know anything about public relations but I I've tried it I put my name in the hat and just tried to get on a committee and I met a lot of people in the committee and then you start networking and and that's important and again having this network of people that you can count on you can call with questions that really helped me tremendously I think throughout my career. Again just from taking care of patients from providing the best care from opportunities that that arise so you know make make sure that you look at these opportunities that that present themselves and don't pass on them. It's interesting because we all you know we all kind of really had a different answer to that you know in the first thing that I said was was the committee involvement or society involvement Robin you brought the relationship with with the team, Lee talked about relationships and Neil you talked about the your long your young role as a you know fellowship director at HSS and so you know no matter what you do you can see that it can still shape you and put you in whatever direction you want. One question that we did get from the audience was you know with regard to this issue with with time we never really have enough time and you know how do you demonstrate to your institution that leadership and roles associated with leadership such as mentorship and committees etc are valuable when there's this growing emphasis on productivity clinical surgical volume you know you got to make your your RVU number you know to make sure you get the you know appropriate promotion within your institution. Anyone want to take that one? I can take that one I think that's I mean we have that at where I am I mean you know we're part of a big health care system and so we've employed physicians as well as private practitioners operating at the hospitals and so it is I mean because if you miss time then you're gonna miss your clinical volume like you said and if you're in private practice it's the same thing you're gonna miss an opportunity and so for me it's been interesting trying to build this this service line because I have section chiefs that we've named and the section chiefs are either the private practitioners or the employed physicians and trying to get people to commit you know it's a hey it's it's almost a volunteer position I mean we're paying you but it's not paying being paid at a surgeon salary so how do you do that and I think it's a combination of having the interest and and how do you as as a person making that that decision you know what do you want to do really and what are your goals and if you want to take a leadership role on you may have to cut back on your clinical volume a little bit but again how do you propose that to the hospital system that you're working for the hospital system wants leaders and they want physicians involved at least ours do they really want the physicians input so they're willing to accommodate your schedule for that I think you'll find that probably at many hospital systems and academic institutions that that physicians have a big voice and so they're gonna seek you out it's just gonna be really up to you on you know is that it's a time commitment it's a huge and when the meetings at 11 o'clock on a you know Tuesday when you're in the operating room you have to figure out is that is that worth it to try and make those meetings or I think that's the hard part as you're growing your leadership roles you know Mike that's a really interesting question that I think the person who asked is asking from their perspective to the outside I think they have to look internally to I'll tell you that money and medicine often don't mix right in terms of patient care if you're worried about our views you know a lot of times if you want somebody to do it find the busiest person in the room right and so you do get to figure it out I just have a basic premise I talked to many of the residents and fellows about contracts and all these different kind of things I could tell you at the end of the day you want to do a job where you feel that you add value and a lot of us have a lot of value so look I love fixing fixing different joints I was thinking when Anil was talking I was like man I keep thinking about the rotator cuff you know the anterior cable all these kind of things that he was talking about but the reality is if I fix another ACL or I fix another another rotator cuff is it as effective and important to my group as if one of my other partners does it and I can explain to them our additional benefit for doing another team or doing something else but I would really try to leave you with a basic premise if you are treated fairly don't worry about every our view don't worry about I mean I can't even tell you how many times you know a team and I'm probably laughing with it with Anil and Robin if we sat down what we actually spend on these teams time wise and then to even think of any remuneration there there is none that's that's equal to you know multiple nights a year doing this right so you have to love that and I think at the end you have to say yourself is that of interest to me because if they tell you they'll pay you 10% of your salary whatever it's probably doesn't seem worth it or is that am I being treated fairly and for me it's always very simple do I feel like they're treating me fairly and then participating however you think you can add benefit instead of working worrying about just the volume because I promise you that if you're well organized you'll probably even get busier doing these things from the clinical side and you'll get much more efficient and you'll get support to be more efficient because you're doing those other things and Anil will get you the best PA in the country because he's trained him at HSS yeah I agree Lee I think that you know just having that and making sure that you love what you're doing what you do because when you do look at the time commitment for all these teams and and you look at how much money you're paid right and we joke around my husband's like yeah you get like $2.20 an hour or whatever whatever it is right we joke around about it's not at all by about the financial it's really about like Lee said he knows it is it what you're interested in doing will it help you build your clinical volume what way why are you doing it and if you like doing it it's never going to be a problem yeah I totally agree I'm I mean first of all I'd always say team coverage sounds extremely sexy when you are a PGY 5 6 7 it's not only sexy when it's you know Tuesday night and you're 10 games out of first place or you're losing by 30 it's Sunday Saturday night and you know you're in you know Alabama and Lee wants just go home now Robin didn't win a World Series so I mean I'm gonna yeah she's got you know she's got a ring to say forget it but that's a lot of hours to get that one ring I will say in terms of the RVU question is that if you became a physician and I use the word physician versus surgeon very distinctly because of to just make money then that's not the path I think of a leader you can be a great doctor but if you want to be a leader you have to be a balanced physician and sometimes you have to make hard decisions what Lee just said he's like wow is it better for the collective team for me to make harder decisions to give a rotator cuff to a junior partner so I can build a bigger group team grow my health care system and you look what Robin's done in northern Virginia it's amazing and you look what you know Michael has done and you know something California how this you know how curling jobs grow tremendously that's what you really want to do so I I love to train surgeons but I teach leaderships for physicians I think another thing is another thing that you want to think about might just add to a Neal's point is you really want to think about what happens on the day where you walk out the door because it's gonna happen there's gonna be a day where that's your last day and part of doing these leadership positions is really giving back it's giving back so that you leave a legacy and if I always look at this as a long-term investment I don't look at it as it's gonna change something this year but and you don't see the results immediately but I could tell you you know one of our former residents is now is now ten years nine years into practice he just became the vice chair of operations for our department he has tremendous opportunities and so you take pride in the fact that you're trying to leave a legacy it'll change the way you look at it and you have to think about that coming out of the gate because you don't want to make moves early that hamper you from having those opportunities yeah I think those are all great points and I think that you can really be smart about it as well you know there are certain leadership positions that take less time away than others so at the very beginning of your practice if you just get involved in one of the society committees you go to a few meetings you'll do some stuff that are after hours it's really not going to take away from your overall practice and then you know ten years into it what I found in general is that when I do have to take time off to go do certain things be it the team stuff or or meetings or or whatnot that those patients still want to come back and so unfortunately I want to pay him for it where you know that the day I'm back I'm seeing twice as many people but you know if it really is a self-fulfilling prophecy you know just as all you all the guys have stated Mike I say one last point is that um we all were very ambitious we all worked extremely hard we all still work extremely hard we all love what we do my one thing about leadership is that there's a right way in a wrong way to do it and don't want it too fast too quickly at other people's expense that's my it's like you know when you train as a resident and you signed off to another resident and I go Robin yeah yeah okay yeah I cleaned everything up but there was five consults to do but I kind of you know that mentality as a resident which you what we all appreciated exists even as a young physician and I'm just saying it will all come just work hard do the right thing take care of your patients as Lee said be a good doctor go for what you want you know rock you know go for every opportunity that Robin said but never take advantage of anyone I I have to say you know being trained by Robin I've never saw an iota of I call it malicious ambition that is you know that's the one other point I want to say is that it will come but but don't don't take advantage don't push too hard it's just one comment that has to be talked about on the other side of this coin that's certainly true we all know those people that have elbowed their way in there and they certainly have that reputation you know you don't want to be that person exactly well you know we're wrapping up here it's been an hour of our a lot of time I think that you guys brought up a ton of great points and you know I think this has been very beneficial to our you know young physicians that are headed out there at the end of fellowship as well as those ones that are you know in their first year use of practice you know thank you it was a Sam and Meredith for again putting this on you know it's been another great webinar and I'll hand it over to you great thank you thank you doctors man be Kaplan Rana Watt and West for your time and preparation tonight thank you for having us thank you thanks for having us it's great thank you I have a few other slides I'm just gonna wrap up for a OSSM education additional resources on transition to practice lectures may be found on the American Orthopedic Association's website they have utilized sports med representatives and creating these lectures on four different topics the AOSSM would like to remind the current sports medicine fellows about candidate membership if you have not already you may apply online for free candidate membership by clicking on the membership tab at sports med org if you would like to sign up for the AOSSM emerging leaders program for sports medicine orthopedic surgeons under age 45 visit sports med org register today for the AOSSM Anna combined annual meeting taking place on July 7th through 11th in Nashville upcoming course at the OLC in the fall be on the lookout for registration opening for the upcoming baseball course youth to the big leagues reminder for the current fellows who completed the fellows exam pretest the post-test will be open for completion until June 21st and you may download the e-learning zone app to complete the post-test and for more educational activities for more online and on-demand educational resources visit the online AOSSM playbook and surgical video library at sports med org playbook page and we will see you next month on July 13th thank you for participating everyone thank you faculty good night you have a great night I hope to see you next month in Nashville take care

doctors

leadership development

sports medicine

setting goals

seeking opportunities

mentorship

building relationships

stepping outside comfort zone

advocating for leadership