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 healthcare, public health, policy, and academia. As we lead up to the organization's 50th anniversary, we are capturing insights from our national thought leaders so that our organization, including our membership and healthcare broadly, are in a stronger position to grow, innovate, and meet the challenge of our time. To our listeners, thank you so much for joining us.

Today, I'm excited to talk to Dr. Monica Lypson. Dr. Monica Lypson, is a friend of mine, but she's also the Vice Dean for Education at Columbia University's Vagelos College of Physicians and Surgeons and holds the title of the Rolf H. Scholdager Professor of Medicine at Columbia University, Irving Medical Center. Dr. Lypson has several leadership roles.

In addition to being the past president of SGIM, she served as a Director of Medical and Dental Education for the entire Veterans Health Administration, where she oversaw national programs aimed at improving training and delivering care to our nation's veterans. She was also the Division Director for General Internal Medicine at the George Washington University. Dr. Lypson has authored over a hundred peer-reviewed publications on learner assessments, communication skills, and cultural humility and workforce. She has worked with organizations like the Accreditation Council of Graduate Medical Education, the Association of American Medical Colleges, and the National Board of Medical Examiners to address healthcare workforce and development and education.

The bottom line is that she's a boss. She has had a wonderful career dedicated to advancing medical education, improving health equity in healthcare, and preparing a culturally competent workforce. Monica, thank you so much for agreeing to spend some time with me today. As always, I'm so inspired when I read people's bios, people that I know so well as friends, but also as a colleague to sort of have this conversation. So, that introduction epitomizes the career of leadership and impact, particularly in the education space.

So, I'm curious, If we could start off with just telling me how it started in terms of your career. Why did you choose General Internal Medicine as a career?

Monica L. Lypson, MD: Thank you so much for a terrific introduction. Most of that my mother cares about. The other part, it was nice to hear that you're considering me your friend. So, thank you. My interest into General Internal Medicine was pretty simple. I just couldn't decide what I liked more. The thing I like about being a generalist is just that, that you get to dab a little bit into everything. There's not one thing that you have to sort of be wedded to for the rest of our career. So, that was important to me to have options.

The other thing was that generalists, I think, are in some ways created to be leaders. generalists have to flex. They have to understand that they're not always the expert in the room. And I think those are some of the key skills that you need for leadership.

Host: That's really important. And I don't know that that's something that I thought about intentionally. I can certainly identify with this idea that you don't want to focus on one thing and sort of think about the broader picture, but how generalism is tied or can be tied to leadership, and acknowledging where we don't have expertise and being able to engage others. So, I love that.

So, maybe I'll move on to this idea of leadership. And I'd love to hear a little bit more about your leadership experiences within SGIM and your approach to leadership. So, how did you get started in SGIM? Now that we know why you chose General Internal Medicine, how did you decide to join this organization?

Monica L. Lypson, MD: The reason why we have our student resident fellow sort of section within the organization is because my first SGIM meeting was as a second year primary care resident at Brigham and Women's Hospital in Boston. And they took all the second-- that was the treat, I guess, to take all the second year residents to Society of General Internal Medicine. And it has been-- I think I've missed three meetings since then, maybe four, but no more than that, since I went as a junior resident. I think at that point I realized that there were some near peers there that would be critical to my development, not only as an academician, but just as a human being.

And I think one of the things that started my interactions was sort of taking the course-- I think Valerie Stone created the Minority Faculty Development Course. And I think those are the things that really got me interested in the organization. I thought it was a home for me. It was a home not only across education and medical education, which I think we are expert at as an organization, but we also have health policy. We have clinical expertise and research expertise. And it lives, it thrives in its journalist format.

So, depending on where I was in my career, whether I was building primary care practices or involved heavily in education or deciding that I wanted to go to the Hill and advocate for Title VII programs, all those things were available to me within SGIM. You know, it was an email, a call away where I could find an expert that was going to help lead me to better understanding and really help me.

Host: That's awesome. And of course, I also have very fond memories of those professional development workshops. Valerie Stone, Neil Powe, Giselle Corbie-Smith are the reasons that I am still in academic medicine. I think that's probably true for many of us. So, you've talked about sort of your start in SGIM, and why you joined and why it's been important. I wonder, you know, because it also sounds like you've been involved in other organizations from ACGME, AAMC. How do you identify this organization? How is SGIM different perhaps from some of those other organizations?

Monica L. Lypson, MD: I think it's the breadth. I mean, I think it's that, you know, that breadth of experience, right? If I am hanging out with my colleagues at the Accreditation Council of Graduate Medical Education, I'm really focused on the education mission of residence. If I'm hanging out with the National Board of Medical Examiners, I'm thinking about licensing exams and student assessment. So, I think the issue around SGIM is that you can actually dabble into all of those things. But the other thing is, this is my home. This is the place where I go to a meeting and I feel better when I leave. I am refreshed when I leave. It is my academic home. You know, how do you describe your home? It's hard to describe that, but there is a different feel in many ways at SGIM than those other organizations.

Host: I love it. And I completely identify with it, especially the point about how, on varying years, you may be able to learn or be focused on different things. If you're starting a new clinical initiative this year or a research initiative the next year, that SGIM is still the place to be in addition to those relationships that we talked about earlier.

I'd like to transition a little bit to talk about your leadership within SGIM. And I know that you were president sort of maybe at the tail end of COVID or at the beginning of COVID, but during some of those COVID years. So, I would just love for you to share anything that you'd like to about your experiences, leading the organization and, in particular, if there's a successful experience that you're particularly proud of.

Monica L. Lypson, MD: So, Jean Kuttner, at the University of Colorado was the president at the start of the pandemic. And I took over, I was president-elect at that time. And then, my year as president was sort of the end of '21. We were coming out of lockdown in the spring of '22. It was a difficult time. Shout out to our treasurers, to our SGIM staff, and to Jean, really, who kept the organization afloat when we just didn't know if we could afford to stay open, that we could meet payroll. It is those critical moments where you understand the value of the organization, and people step up. They step up in a real way, and they say, "There's something core that I have to preserve." And we did that.

So to me, I'm going to give a shout out to Kay Ovington, Eric Bass, and Jean Kuttner. And then, when I came in, it was this idea of our annual meeting becomes the focal point of what we do as an organization. That annual meeting had been virtual for a couple of years. It was unsure how many people will come back in person. We were unsure if we could actually go to a meeting. And there was a leap of faith that had to happen in order to say, "We are going to have an annual meeting and we're going to have that annual meeting in person." and, you know, there's that critical moment that you just passed sometime in December where you're like, "Is the meeting a go or not?" And making sure that things were in place.

And I think that December retreat of the council during my year as president was a really trying time. We were able to meet, and it was one of the laws, we were able to meet in person. But the idea was, "Can we actually have a meeting in the spring? And then, oh, by the way, the meeting's in Florida." I had had experience as the secretary of the organization when the meeting was in Arizona when they were passing laws regarding searching, looking to persecute undocumented immigrants. So, I knew what that was like for the organization. There's a cohort in our organization that feels very strongly that we shouldn't support states or cities that are antithetical to our values. At that time, we kept the meeting, and we had a rally, and we were able to effect, able to get on the news in Arizona. And I think we used some of those lessons learned from that to say, "We're going to go to Florida and support the people who believe in the things that we do, specifically around LGBTQ rights." And with that, we're going to bring the power of our organization to bear on that. And so, again, in Florida we were able to have a milieu rally. We were able to support organizations that have our same values in Orlando, and we made it on the local news.

Host: That's awesome. I appreciate your leadership and especially during those difficult, sort of sentinel times where you have to make those tough decisions, you know? So, very appreciative of you and the entire team in those efforts.

So, maybe that leads to my next question, if you may feel like you've already answered this. But, you know, I'd just like to talk about what you see as some of the joys and maybe even some of the costs of leading the organizations. Again, you may have answered that or addressed that a bit in what you've just shared, but any additional thoughts about that?

Monica L. Lypson, MD: I think we're at some existential time in an organization. I started a job here at Columbia right when Lee Goldman was stepping down as dean, and Lee Goldman is one of our past presidents of our organization. I think he's the only one that's not a journalist who had been president of our organization.

And he had this interesting conversation at that point in time when I was president, and we continue to have that conversation about the size of the organization is the same when he was president. So, what are we going to do to increase the size, engage people, I mean, it's like it hasn't gotten smaller. But it also hasn't grown in the ways that I think he might have imagined when he was president over 20 years ago. So, I think we have to think about that and wrestle with that. It might be that this is our community and that's the size, sort of like the 150 people in the village, that something at about 3,000, we just can't sort of go past, but I think we're going to have to wrestle with that.

The other thing that I think we're going to have to wrestle with is people like me. it's interesting to sort of be a past president. And you're going, "I really want the senior leaders in the organization to participate in the organization, to come back, and be engaged. You know, I was like, how dare they not think that this is the most important thing.

And now, on the other side, it's hard. It actually has to be a volitional choice to sort of say at this point, "Yep, I've registered for the meeting and I'm going to the meeting. I'm going to sit on this committee because even though the committee might not benefit me from a career development point-of-view. I think my insights on that committee can benefit the career development of many others on the committee." and I think we're going to have to think about that. And now that again, I'm on the other side, it's purposeful. So, we might've thought more negative, quite frankly, about our senior leaders, sort of saying, "Oh, I don't have anything to do in the organization anymore," but I have to say it has to be a choice. And it's been one of those things that, you know, it's not until you experience it that you sort of understand the dilemma. And I think the things that you have done, the things that Eric has done, and LeRoi Hicks, LeRoi Hicks, when he was president, have done to really try to engage the past presidents, engage our most senior leaders in key parts of the annual meeting, gives a sense of purpose, gives us a sense of the organization still needs us.

Host: Yeah, absolutely. And we do. We do need your voice and your legacy. And that's one of the reasons for this President's Podcast. And I have been so overwhelmed from all the stories that I've heard and the experiences and the wealth of knowledge. But I think you're absolutely right. We have to be more intentional as I get closer to that other side about thinking about how we continually engage our best and our brightest, essentially. And so, it certainly means something for the organization, but making it have more meaning for our former leaders as well. And the point that you made about growing the organization, I think that's fascinating. And there has been some additional work that happens this year, but I think that's also a tremendous opportunity for us as well.

So, we've talked a lot about SGIM, the Society of General Internal Medicine. I'd like to just talk more broadly now about General Internal Medicine broadly. What do you see as some of the most important challenges or opportunities for academic General Internal Medicine? Is there anything in particular that sort of you think might be something that we should be thinking about?

Monica L. Lypson, MD: I'm actually excited about the future of generalism in general. And I say that with this eye towards really thinking about artificial intelligence and what that will do and change the practice of Medicine. And I think the skill sets that journalists have, particularly general internists have, is actually that skill that's going to help translate that into the useful information that our patients need at the bedside.

And I think generalism has that skill set to be able to understand the benefits of the technology, apply the technology, and then add the human touch that's going to be needed to deliver the care. So, I would like to see generalist sort of think about this time as a renaissance, right? It's going to be this important thing where communication skills become really key. That's something that we feel really good. That's the only procedure I do, right? I talk really well to patients. But those are the kinds of things that I think I are going to be needed in this new environment of healthcare. When we actually have immunotherapies, when we have genetic cures, you're still going to need somebody who's going to be able to translate that and hold the patient's hand. And I think generalist, in general, are those people. And I say generalism across specialties. I think you see that in the mental health fields, in Psychiatry. I think you see that in Surgery. I think you're going to see generalism, no matter what the discipline, become the way forward, when other things get cured.

Host: I love that. And this idea of a renaissance, I love the sound of that, but I also understand the importance of that humanism, that human touch and communication, the things that we do so well. So, that very much resonates with me. I'd love to hear, I happen to know that you have a family, you have two wonderful kids, and you have a husband who's also a physician I have been asking folks on the podcast, how do you juggle all the commitments that you have? How do you stay on track? Having talked with you a little bit about this, I'm just curious about how you make this work.

Monica L. Lypson, MD: I think the way that we do it as a family is really as a family. It's been interesting. We have a message chat group that is the four of us. And we actually now have a message chat group that the middle schooler named Favorite Offspring. We try to at least say You Were the Favorite Child and there was a Favorite Adult, but she didn't go for that. So, we're constantly communicating. You know, like last night, it was this conversation about how was the basketball game for the middle schooler, how was the first day back for the college student. And my husband was like, "Oh my gosh, the clinic was awful. And oh, by the way, the nanny was sick." So, those were all things that all of us were experiencing at the same time. And so, we were having that conversation really as a family.

So, one of the things that I've always done is involve the kids. So, pajama time kind of is the classic worry, that's when my kids do homework. So, we all talk about doing homework together as sort of the way to say, "It's okay to work at home. It's okay to sort of understand that I have unfinished work, just like you have unfinished work that you need to do." So, that's one way.

And then, I think the other way, as I'm coming out, you know, and seeing, I guess, the end of the light in terms of kids, is rediscovering my husband, and that's actually been the most delightful thing, believe it or not, about this commuter marriage. It re-establishes, at least for us, about sort of why we were together, and how we are going to have to be friends alone, right? There's this transition that's coming in a few short years where it's going to be the two of us. And so, the question is do we get along?

And so I think that's really the way forward. And I really believe, I think it's Caitlin Moore who wrote a book that for women in particular, the glass ceiling is your husband or your significant other or your partner, because my husband's like, "Whatever it takes to do what you want to do, we'll do it." So, that was the conversation around my current job.

So, I think it's a lot about communication. And I can say that, you know, my expert communication skills are really expert in the clinic room. I'm not so sure they're expert at home, but, you know, we try.

Host: That's awesome. and it's so great to have a supportive partner that allows you to do that, but how you have the entire family engaged in these kind of conversations. I'd love to hear a little bit about your hobbies or self-care that could include what you're listening to or reading right now, but what keeps you well and what brings you joy?

Monica L. Lypson, MD: We just got back from Orlando. Someone on my team made me try to count how many times I'd been to Disney World or to Universal, and it's over 30 in a lifetime.

Host: Oh my gosh, you're one of those folks.

Monica L. Lypson, MD: In a lifetime. And so, annually, we've been going down there for the holiday season, and we just got back. It's interesting, because people, like, "Monica, you don't seem like the Disney type." It's the one place that neither my husband or I work. It's actually a very interesting phenomenon,. And I think for us it probably is the ambient stimulation that's going ongoing versus, you know, we went to Hawaii, last year, we were working. You know, like we go to the beach, come back and kind of work, because it was quiet. There, we're going all the time. So, we always commit to that as a family, and that's important.

And the other thing is I actually take time. So, Saturdays, I don't work. Like I literally don't work. And I will say I do look at my email just because of the nature of my position. But if I don't need to answer, I won't answer. And in fact, there was an email this Saturday that came across that needed a response over the weekend, it didn't need it immediately. And I said back to my team, "I'm in the middle of a Netflix binge. I will respond to you when I'm done." One, it also gives my team permission to do the same thing, right? Like it's communicating another message that's important. And so, I do that. So, Saturdays, I really try to preserve and do no work. It might be the unfortunate part. It might be running errands or now it's going to swim meets. But we try to do that.

The other thing is, every morning, I'm an early morning person, I wake up, I literally have a cup of coffee and part of my time to sit still is I literally try to sit in bed or sit at the kitchen table at a counter and literally just drink that cup of coffee. And it's a purposeful act because it's sort of resetting me for the day. And so, that's been important. Those are two things that I do to not sort of feel like there's this grind that's ongoing.

Host: I love that. Just taking a moment with your coffee. I did not picture you as a Disney person, I just have to say, but I love it. So, I think, you know, we are wrapping up here. I want to give you one last, final opportunity to say, if you have any sort of final or parting thoughts for us.

Monica L. Lypson, MD: You had asked me before and I didn't answer, actually, is what is the joy of the organization? The joy of the organization is actually my friendship with people like you. The joy of the organization is opportunities to do things that I never thought I could. As a junior faculty member within the organization, I was able to do things that nobody at home in my organization would let me do. But once I was able to do them at that national platform, A, it gave me the confidence and showed that I could do a skill that was really important. If you remember, we did that together. It was the AAMC Health Disparities Conference where we got grant money, and we were able to run a parallel meeting at one of the AAMC meetings sponsored by Society of General Internal Medicine. So, the joy of the organization is hard to capture. But it's really critical to the professional development of academic journalists in this country. And I will continue to support it, and I hope others do as well.

Host: Awesome. Well, I want to thank you, reminding me of that collaboration. I know that we've been friends and collaborators for some time, but thank you again for your work for the organization. Thank you for taking some time for us today. I want to also thank the SGIM staff and Roz Bogle, our executive producer and the entire DoctorPodcasting production team. I also want to say thank you to our listeners. You have been listening to the SGIM President's Podcast. If you've liked what you've heard, please rate us and leave a comment wherever you listen to podcasts. It helps others to find us. Also, look for us on the SGIM website, sgim.org, and follow us on X.