Jada Bussey-Jones, MD (Host): Hello. This is Jada Bussey-Jones, the current president of the Society of General Internal Medicine and the host of SGIM's President's Podcast. We engage SGIM's former presidents who are leaders across health care, public health, policy, and academia.

As we lead up to the organization's 50th anniversary, we capture insights from our national thought leaders so that our organization, our members and healthcare broadly are in a stronger position to grow, innovate, and meet the challenges of our time. To our listeners, thank you so much for joining us.

Today, I'm excited to welcome and talk with Dr. Harry Selker. Dr. Selker is a professor of medicine and clinical and translational science at Tufts University School of Medicine, where he is the Dean of the Clinical and Translational Science Institute and the Executive Director of the Institute for Clinical Research and Health Policy Studies. As dean, he provides leadership for programs and infrastructure that support clinical and translational research across all of the Tuskegee University schools and affiliated hospitals and other academic, community-based, and industry CTSI partners.

Dr. Selker's research has focused on the development of treatment strategies aimed at improving medical care, including the development of clinical predictive instruments, mathematical models that are used as decision aids. He also has run large national clinical trials and has done research to advance clinical study design and execution and the repurposing of drugs for major public needs.

Dr. Selker, importantly, has also provided, advice about healthcare delivery and medical research to policymakers, including House and Senate authors of the Affordable Care Act. Not only has Dr. Selker served as president of the Society of General Internal Medicine, but he has also been the president of the Society for Clinical and Translational Science, the Association for Clinical Research Training. and the Association for Clinical and Translational Science. And he is currently the chair of the Clinical Research Forum.

So, you can tell with that introduction that Dr. Selker defines leadership. Dr. Selker, Harry, thank you so much again for agreeing to spend some time with me today. As I told our last guest, that I not only enjoy talking with our leaders, but I learned so much myself about this journey that I'm on as a president of SGIM. So, the introduction I gave epitomizes a career of leadership and impact. And so, you've had so many roles and experiences. I want to just start off by asking, how did you get started on this leadership journey? Can you tell me a little bit about that?

Harry Selker, MD: Yeah, how I got started in General Internal Medicine is a longer story. Because like many of us, I started out thinking I was supposed to be a subspecialist and gradually came to the realization I'm a generalist at heart and at mind, and finally acceded to that after a couple of decades.

But the leadership thing, I guess I love bringing people together to do cool things. I mean, it's just, you I love that feeling of all of us working together across disciplines, across perspectives, doing cool things. And I also just like organizing people, organizing things to happen, having impact. It's a passion. And I didn't really intend to necessarily become a leader, but I couldn't avoid it when I wanted to get cool things done.

Host: I was going to ask that question if it's something that you aspired to or always knew you're going to do, and it sounds like it was more of a means to an end.

Harry Selker, MD: Yeah, I didn't intend to be a particular leader. I wouldn't eschew that. But, as you indicate, I've been leader of five different organizations, and I didn't really intend for that to be the case either, but I just like building things, similar here at Tufts. And I guess my feeling about that is you should follow you like doing most. And sometimes that'll involve leadership just to get things organized. I run large clinical trials too, and that's kind of no different. It's kind of a big organizational challenge. And I like that kind of thing.

Host: That's wonderful. And you started to talk a little bit, I appreciate you sharing your thoughts about leadership, you started to talk a little bit about your journey in General Internal Medicine, Academic General Internal Medicine, specifically. I would guess that, like me, you entered the field at a time when it was It's less popular in academia. So, I'd love to hear how and why you chose this career as an academic General Internal Medicine physician.

Harry Selker, MD: Well, I mean, I think I was scarred by coming up in Medicine at a time where subspecialists were the smart people, then, you know, generalists weren't even mentioned. So, they weren't really lacking, they just didn't exist. So, I felt that my job was always to pick a subspecialty, even in medical school, but certainly by residency. By the end of my residency, I wanted to do so many of them, I decided to be Chief Resident for another year to stall. And then, as clinical scholar, I did basically two years of credit for Cardiology fellowship because I thought I have to do some subspecialty.

But when the third year came around to finish it off, I just thought, I really prefer the entire person to the left ventricle. So, my research is Cardiology because it's pretty simple. But I really love the feeling of when a patient comes in, it could be cardiac or it could be constipation. I mean, I just love that. And then, it took me years longer to realize that really that was a trait. And I'm sure many of us have done Myers-Briggs personality profiles. And the thing I find interesting about those are not the exact boxes, but the fact that we have proclivities that are built into our way of thinking. And I finally came to realize that I'm a generalist by thinking. I'm not a subspecialist. I don't want to dive down into the little itty bitty details. I want to see the whole picture.

And in some ways, you know, I'm also involved with the Clinical and Translational Science Award hubs. And that's also a generalist role. It's about all translational science, not just a specific area. Now, I really feel comfortable as a generalist, not only as a general Internal Medicine person, but as a scientist. And, you know, I've come to accept who I am. It took a while. It took a long time.

Host: Yeah. I mean, I completely identify with your story and the fact that I didn't know, mostly because I don't think we had models for it, you know, the way that we have more academic general internalists now, where our learners who fit that phenotype or that Briggs-Myers personality type that can see how it could work. So, you know, I really appreciate that you have chosen this career to manage and think about and innovate around the entire whole person. So, thank you so much for sharing that. Now, I'd like to hear a little bit about your SGIM experience. So, you chose this career, finally settled on it, accepted that you were a true generalist and then decided to join SGIM. You've clearly worked and led in many organizations like we talked about. I'd love to hear your thoughts about why SGIM and how this organization is perhaps different from some of the other on which you've served.

Harry Selker, MD: Yeah. Frankly, I joined SGIM long before I was sure that I was a generalist, but it seemed like the right place for me to be. And that's what I was practicing clinically. Even though I had my doubts. I joined when I was a fellow. And I've been a member ever since. It completely matched my perspective. It was about education. It was about research. It was about caring for the patients in the middle of everything. And also, the passion of people and their seriousness and their authenticity was just really engaging to me. And one of the things that just blows my mind about SGIM, and this reflects on both the organization and on its members, is we have 95% of people attend our annual meetings.

Most organizations is like 5%, 10%. That's just stupendously different. I got caught into that culture really when it was a very young organization, almost new. And I grew with it. My colleagues, who still remain my colleagues in SGIM remain, in sense, my academic and scientific family and also policy family. I mean, there's so many aspects that seem to fit what my aspirations were. It was just a great fit.

Host: Absolutely. Like you said, sort of finding your colleagues and doing similar work and feeling like it was a great fit. I have a very similar story. I'd love to hear, can you remind me when you were president of the organization and share with me, that experience, and particularly if you can reflect on something that you're really proud of, a successful experience leading the organization. I'd love to hear about that.

Harry Selker, MD: Yeah, I'm going to digress this slightly because I was president in 2012, I think, plus or minus a year. And I did some things that I'm proud of then, But I think, in some ways, that was a culmination of my organizing people to do cool things at SGIM, but I've been doing stuff there for years, especially in the policy committee. And when I think back about what I'm most, you know, I guess if you say proud of or happy about, it would be some of the policy things. And part of that was, I was on the policy committee, I've been on it forever. And we had great lobbyists, we took on things that seemed like they were almost insurmountable.

So, you know, the first thing I did, I actually, what got me into policy by accident and actually got me working with Teddy Kennedy for about 15 years was when I was editor of SGIM Forum, it turns out that Ted Kennedy was running against a guy you probably haven't heard of, Mitt Romney, for Senate. And, you know, I thought that it was clear that Ted Kennedy needs support. And so I inappropriately, I, think now in retrospect, wrote an editorial in SGIM Forum saying how important it was that we support Ted Kennedy because of universal healthcare and all that.

And then, I got called, of all things, by Ted Kennedy's office. They had read this. And one thing led to another. I ended up being an advisor to them for many years. And the first thing I worked with them on, but also was really with SGIM, was on AHRQ. It was about to be zeroed out. And we mounted a huge fight. It's actually recounted in the SGIM policy book. There's a chapter on our experience with that. And I was lucky to work with Kavita Patel, who was then a senior staffer in Ted Kennedy's office. And she was incredibly helpful, but also so were our lobbyists, Lyle Dennis and many others. And we successfully preserved AHRQ. And I would say, it was a huge effort by lots of people. I remember it changed name to have quality in it, which helped engage certain senators who were very important at that time. But that was a great success.

Then, we had another experience like that, and that was when the Affordable Care Act came along and I was working at first kind of with Kennedy's office about it. But then, and this always makes me sad, you know, when he passed, I was kind of shuttled over to Baucus's office in the Senate, who was the finance committee that was taking care of it. And they had a great staff there and I worked with them on the design of PCORI and then all sorts of things started happening. Industry wasn't that happy about it. And we did various things like writing articles in New England Journal of Medicine and so forth, and finally actually got the configuration we thought was right. And it was a great success for SGIM to have PCORI there. And first of all, and I mean, now we have PCORI there to fund the kind of research we like and we think is important, but also it's just such a great group effort. So, those policy things which continue there's lots of other examples of that.

John Goodson has done wonderful things, for example, in the space of clinical reimbursement and lots of other people have made lots of other impact. SGIM's policy work has always been a great joy for me. So, I would say that's the part I love the most. By the time I was president, i felt very strongly about that and one of the policy things we did in that time was about physician reimbursement, and we got somewhere on that. But that happens to be, even though I'm kind of a researcher at heart and a clinician, it was the policy stuff I have had the most fun with.

Host: That is so awesome. Talk about getting cool stuff done and leading other people to that end. I mean, from AHRQ, The Affordable Care Act, PCORI, these sort of major transformative programs that you and SGIM have been a part of. So, that's amazing. Thank you so much for sharing that story.

I think the follow up question for me, and it's something I think that's a little personal because I am the current president and we have just had a recent election. But it doesn't have to be about policy necessarily, I just wonder if you have any advice for me, for SGIM, the organization, future leaders yet to be named or elected, if you could say, based on your experiences with decades now in the organization, any advice that you would give, I would love to hear that.

Harry Selker, MD: I wish I had good advice to give, but I guess, you know when I do chiefs rounds for medical students, I often will say, the practice of medicine is based on love of people. If you don't love people, you shouldn't become a physician. You can be a radiologist, but not a clinician. I know that's not really fair to say. And I think that we have to be that way at SGIM.

So for example, I'd say over the decades, we have made compromises as general internists on payment things, on capitation, and things that frankly are a little dubious in terms of their ethics and about conflicts of interest. I know we've done it for reasons for matters of compromise. And I've learned that if I learned anything from Teddy Kennedy, it was the importance of working with other people and compromising to get things done. So, I'm completely with that. But I think that we on occasion compromise too much. And now, it puts us to the position that we are in now, where we're seeing too many patients with too much paperwork and too little time, and it's not great for our patients. It's not great for us either, but it's really not great for our patients. So, I feel that my advice is don't compromise crucial things. Keep the patient and the love of people in the middle of this. You want people to be treated the way you would want your family members to be treated. And I think sometimes it's easy to slip. You know, I remember there was a time when we were doing Choosing Wisely initiative. And frankly, it was about saving money. It had. a veneer of doing the best thing for the patient, but it wasn't really about having dialogue with your patient and finding out what they really wanted to do. And I think that in everything we do, we need to really be authentic in keeping the patient in the middle of everything we do. And that also applies to policy. You know, I mean, the Affordable Care Act, for example, is obviously about something good for patients. They have insurance, for example.

Host: Absolutely. I think I know the answer to this next question, maybe, but I've been impressed by the role, pivotal role, that you and others have played in working in the policy changes that you just described. But more and more, there have been voices that suggest that clinicians should sort of stay in our lane, focus on patient care. Like I said, I suspect I know your answer to this, but I'd love to hear any intentional thoughts about that, especially as it relates to the future of our organization.

Harry Selker, MD: Yeah. I mean, people who tell you to stay in your lane are obviously just wanting you out of their lane. I mean, the principle has to be what's best for patients, what's best for the public, and everything else should follow from that. I remember, actually John Goodson and I and several others wrote an article about capitated care because I was very much concerned about it because I thought it was a conflict of interest. Would I be in a position where someone has a headache and maybe I should get an MRI, but then again, I have a ski vacation coming up and I really would like that bonus? I just think that's a terrible conundrum to put a clinician in. And I think that we shouldn't be afraid to say what's right in circumstances of that sort.

I mean, I could go on, but I think we should just keep what's best for the patient in the center of things. I think looking at our healthcare system, which everybody knows costs twice as much as any other system, and doesn't provide as good of outcomes, we sometimes forget that if you look at the overall health adjacent budgets of other countries, theirs are actually just as large as ours. It's just that they're spending more money on the health safety nets, on nutrition, on education, and the social determinants of health. We should do more of that. We can change a lot of things, but we have to keep in mind what is best for people.

Host: I love that. And it sounds like what you're saying is that is our lane, right? These other things that impact health, the non-medical determinants of health is the thing that keeps people healthy. So, it's putting the patient first.

Harry Selker, MD: That's our lane.

Host: Absolutely. I'd like to come back to General Internal Medicine more broadly. As you think about the trajectory of academic General Internal Medicine as a career path, what have you seen as the most important changes and what challenges still remain? You may have already articulated that in some of the things that we've just been talking about, but anything else that you want to add?

Harry Selker, MD: First of all, I mean, as implied by my earlier comments and your comments, I mean, General Internal Medicine has evolved in our careers. At the beginning, it was kind of a fringe thing, a bunch of fringy people, you know, in this organization. Now, we're kind of mainstream. I mean, there was a few people who started taking major positions. Maybe John Eisenberg was one of the first, but there's many others who have as well. And now, you know, it's very usual for deans and presidents of universities. In fact, our friend, a general internist, Alan Garber, down the street is a president of the local university. And, that's really changed. The trajectory is now we are respectable, I think.

In terms of advice, I guess, my advice to SGIM has to do with what I already said, which is just to keep the health of people and their welfare in the center of our focus, whether it's in clinical care, research, policy, whatever it is, that's our special lucky role that we get to fulfill. What a deal. It's a great deal.

Host: Yeah. So, honored to have that as a part of our job, right? It is a joy.

Harry Selker, MD: It's amazing. Who would have thunk?

Host: Yeah, exactly.

Harry Selker, MD: I did not grow up wanting to be a doctor. I knew of no doctors at all. It caught me by surprise.

Host: Wow. Well, maybe that's a question that you can tell me a little bit more about. I'd love to hear about you, maybe any advice that you would give to your younger self, especially since you didn't know about this health career journey that you would eventually take on. But is there any advice that you would give to your younger self?

Harry Selker, MD: Well, one piece of advice I would give me is, "Harry, you're going to get older. You probably should do some planning. I didn't ever think I was going to get older, so it's still a surprise to me. I think it is. It's worth telling oneself. It is worth planning because things will evolve. And you think that you're just living in the present, but things will happen. Nonetheless, I've muddled through kind of with the idea that chance favors the prepared mind, and also I'd say, you know, it also favors the prepared heart. I mean, you have to kind of know yourself and what your passions are.

I also think what I alluded to earlier when I finally settled into being a generalist, which took me, you know, a few decades, knowing that, again, with the Myers-Briggs thing telling me, "Well, you know, people have characteristics," I suddenly realized, "Yes, and I do too," and, you know there's a reason why I really am much more interested in seeing overall patients, not just patients with certain diseases, and why I'm interested in policy.

One of the things is my mother was a public health nurse, both my parents were super politically involved. They did things like in jails for rights of prisoners, for Indian rights. I grew up in the Pacific Northwest where that was very important and was involved with anti-war things during the Vietnam War. So, the idea of social responsibility was really a part of my perspective from very beginning. And it was just lucky that I picked something that allowed me to kind of merge that also with a personal being able to care for people. So, it was the right thing for me. I just hadn't realized it. I hadn't seen the doctor. I didn't know any doctors.

Host: That's wonderful, I have one final question for you. As I've talked to you today, I've been so inspired. As I think about you and many of our past presidents who have sustained this sort of long successful career and do all these great things, I'm wondering about who or what are your sources of inspiration? Also, what are your sources of joy? Like, with all this work that you were doing for other people, putting the patient first policy, how are you inspired? What brings you joy?

Harry Selker, MD: Sure. A lot of my inspiration comes from my patients. I see people rise to things to handle things that are just unspeakably difficult, and yet they do it. And it really inspires me. It makes me realize how small my thoughts are in many cases.

There were certain individuals who surely inspired me. Ted Kennedy was one of them. And the reason was-- you know, I'm sorry, I choke up because I still feel terrible about it. It was a loss. But he worked with people with very different opinions and came to compromises. And also, he cared about people. And, guess I'll tell a story. Well, I'll just tell you that when my daughter was in college, she came up, I had to leave a meeting that was going on in his office to go help bring her home from college. And, you know, I got home and so forth. On the Monday, his office called me up and said, "How's your daughter?" I hadn't told them anything, but they had found out. And that's the kind of attention to individual that he always had. He was so patient-- I say patient, but people-focused.

I also learned a lot from my first Chief of Medicine, Shelly Wolff, who taught me kind of rules of conduct, such rules as only deliver bad news in person face to face. You know, never promise something you can't deliver and so forth. Lots of just important rules of conduct. I also owe inspiration credit to Bob Brook. When I was a Robert Wood Johnson Clinical Scholar at UCLA, he did projects on a scale that no one else would attempt, and it made me realize there's no reason not to do big things. Little did I realize that when I was starting to run large trials with over 10,000 patients, that wasn't just a normal thing to do because that's kind of the example I'd had. So, that was helpful. Mainly, I'm just still learning how to be a doctor, how to learn to be a person. And those are some of the people who inspired me.

Host: Wonderful. Well, I just want to give you maybe one final opportunity to have any last final comments as we wrap up our time today. Is there any last thing that you want to share with our audience?

Harry Selker, MD: I guess it's hard for me to adequately articulate how much I'm grateful to SGIM. I mean, it's been the perfect fit for me. It allowed me to grow, to learn, to work with people whom I love. I mean, they're just great people. And I also really appreciate your going to the trouble to kind of interviewing us all, because I think you're going to probably hear very similar stories, and it'll hopefully reinforce people who are earlier on in their careers in SGIM realize what a special organization this is.

Host: Well, Harry, I want to thank you again, not only for joining us today, but for doing all of those big things that you have done that have impacted not only SGIM, but society as a whole. And so, I also want to thank our SGIM staff, the production staff that's helping us out today and, finally, our listeners. If you have been listening to SGIM's President's Podcast, if you like what you've heard, please rate us and leave a comment wherever you listen to podcasts, as it helps others to find us. Also, look for us on the SGIM website, sgim.org, and follow us on X. Thank you.