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 aim to 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 am thrilled to talk with Dr. Robert Centor. Dr. Centor graduated from the Virginia Commonwealth University in 1975. He then joined the faculty serving first as a Residency Program Director and then later as Division Chief. He then moved to the University of Alabama, Birmingham in 1993, starting the Division of General Internal Medicine and serving as the Associate Dean for Primary Care. From 2004 to 2017, he was a Regional Dean of the Huntsville Campus.

His current title is as professor emeritus, but he still does inpatient attending at the Birmingham VA for four months each year. In addition to being the past SGIM president, he has served in many societies and leadership positions, including as Chair of the Board of Regents for the American College of Physicians and past President of the Society of Medical Decision-Making.

For his work, he's been recognized with countless distinguished awards, including the SGIM Glaser Award, which recognizes outstanding contributions in research, education, leadership, and mentoring. And the Jane Desforges Distinguished Teacher Award from the American College of Physicians. Finally, Dr. Centor is one of the world's leading experts on pharyngitis, developing the guidelines and decision aids that would become known as the Centor Criteria that bears his name.

He has had a major interest in diagnostic reasoning, and he's published in several Clinical Problem-Solving Cases in New England Journal of Medicine, the Journal of General Internal Medicine, and the Journal of Hospital Medicine. He currently hosts the Annals On Call podcast and co-hosts a Zoom conference, Unremarkable Labs. And he has appeared on many other podcasts, including The Curbsiders, The Clinical Problem-Solvers. And that's why I'm particularly happy that he's joined me on this podcast today.

Welcome, Bob. Very happy to have you. Thank you so much for agreeing to spend some time with me today.

Robert Centor, MD: Well, thank you very much, Jada.

Host: I've said many times before that I'm always so inspired to read these introductions, to read a little bit more and learn more about my colleagues. And so, I'm so honored to have this time with you today. That introduction itself really speaks to a career of impact, not only in leadership, but in clinical care and education and innovation. So, I would love to hear a little bit more about your professional and personal journey. If you're willing to share, how did you get started on this journey? Can you tell me a little bit about yourself?

Robert Centor, MD: Yeah. Let's see. I started medical school, had no idea why I was in medical school. I think it's because my mother told me that I was going to be a doctor. Partly because I had a summer job working with emotionally disturbed children in a psychiatric hospital, so I thought I might be a psychiatrist; and partly because when I got out of college, the best way to not go to Vietnam was to get into medical school. And I don't know which of those inspired me.

First two years, I hated. Then, I got to the third year and fell in love with medicine. I had no idea that I was going to be an internist until November of my third year. After one week, I knew I couldn't be anything else. And I've never, ever regretted it in any way. I thought I was going to be a nephrologist at one time. I did a year of research, hated rats and their kidneys, and knew that I was a patient doctor, not a lab doctor. I came back to MCV VCU, and they had just started a Division of General Internal Medicine, worked in that for a while, was chief resident, was going to go back and do Nephrology, but there was something that drew me into General Internal Medicine.

Back to when I was a resident, I loved everything. I mean, I still love Cardiology. I love Renal. I love GI. I love everything. And so, being a generalist really fit my personality. I like having a lot of breadth. I don't need to have the most incredible depth. So, I became a general internist very early on. I think my first SREPCIM meeting, the old SREPCIM, I think it was either the second or third meeting, that was ever held and went ever since, and got involved in that. I think my career was due to the people I met through what is now SGIM and learning all the different ways I could do things.

Host: I love it. I heard what you said about, and I think I read this as well, that you really did not like your first two years and maybe didn't do as well as you would have wanted to. And so, I'm happy that you were able to sustain to get to your medicine rotation.

One of the things that I was curious about, now that you're on the other side of being a learner, although we're lifelong learners, of course, but I know you've done some work also to understand what students want from their attendings. So, I was wondering if you might say a little bit more about that, now that you're on the other side, and our medical education is little bit of a ways behind us, and you're working as a faculty member teaching learners and something that you're very skilled at. So, tell me what you've heard or what you've learned about engaging learners.

Robert Centor, MD: I think the reason that I disliked the first two years so much is I was tired of sitting in a classroom. My learning style is to learn from patients and to learn from colleagues, and that has nothing to do with the way the first two years were taught to me. We did a really very interesting work. Brita Roy is the first author on the paper we did. My colleague Analia Castiglioni, who's at University of Central Florida, was very instrumental in this work, as were many of my colleagues in Birmingham, Lisa Willett, Ryan Kramer, Gustavo Heudebert. We found out that, to no surprise of anybody, that being a ward attending is a very complicated job, because the expectations of the learners are varied.

The thing that has encouraged me, ever since we did that study, is learners want to know how their attendings think. Being able to be clear about what your thought process is is how the students, interns, and residents learn. I always use the example that has happened to many, many learners that patient has a low potassium, the attendant comes by, they have 20 milliequivalents of potassium in a liter running at 100 cc's per hour. And he says, "Change it to 40," but doesn't tell them why. That's the opposite of the attending who goes in and says, "How fast can we give potassium? What's the deficit? Why do we need to give the potassium?" and make that into a learning experience. So, that's the first thing, is being very explicit about why we're doing what we're doing.

The next thing is treating learners with respect, knowing their names, talking to them by their names, knowing who they are, knowing what their hobbies are. I call them learners, but they're really the next generation. And I think it's important for us to always remember what it was like to be a medical student, intern, and resident, how did you want to be treated, and treat those people that way. Because these are the people who are going to be taking care of me in my old age. So, I need them to be very good. It's very important to give constructive criticism. This is how we can get better rather than you did that wrong. That's another piece. You have to have enough knowledge to do things.

And you also have to be a role model. We are the anti-Charles Barkley, the famous statement by Charles Barkley, "I'm not a role model." Well, we are all role models, and it's really important that we understand that how we interact with patients, how we interact with the nurses, how we interact with the janitor, that influences how they're going to interact. They look up to us, and they mimic us. So when we go in and we're comforting to a patient, they learn to be comforting to a patient when we don't make fun of patients. We've all seen attending physicians and residents make fun of patients. If we understand that our patients-- I work at the VA and I absolutely love my patients. And do I have the occasional patient that is difficult for me to get along with? Yes. And we recognize that. But most of the patients, I want to do everything I can to make their lives better for as long as they can be. And doing it and talking about it, I think those things, all those things, respecting time, there's nothing worse than being an intern and having attending go on and on and on and on, and you got a lot of work to do, you still have to do the work, and this attending is going on, so time limits are important. And all those things we found in this study, it's been found in other studies, it seems to work. It seems to work.

Host: In many ways, it makes intuitive sense, making your thoughts and your decision-making transparent. But I think especially the idea of being respectful for them and modeling respect to others, I mean, it seems so cliche almost, but the impact that it can have is incredibly meaningful. So, I really very much appreciate that work and we definitely reference that when we're bringing our new faculty on board. So, thanks for that.

I would like to transition a bit, if it's okay with you, to talk about your SGIM experiences. You mentioned that earlier, that you went before it changed, even before the name changed to SGIM, and maybe in the first year or two of its existence. So, I'm just curious about who brought you to the meeting. How did you even know about it? How did you get engaged?

Robert Centor, MD: In those days, we used to go to the clinical meetings and the clinical meetings were held in Washington and we would go to the clinical epidemiology section. That was where the academic general internists were going. And some people, as an offshoot of that meeting, there were two hotels, and one of the hotels would have the SREPCIM meeting. And I was going up for the other meeting. So, I went over to SREPCIM and met people and started seeing what other people were doing with General Internal Medicine. So, I kept going back. When the clinical meetings went someplace else, we kept on going, and I was there for the heated debate over changing the name from SREPCIM to SGIM. You would think we were changing the whole world that day, but it was really just meeting people, and being able to learn how other people were doing things. Because this was really the beginning of General Internal Medicine. This is the early '80s. And it was just how I was going to create my career.

Host: I mean, that's the thing, since I've been talking to various leaders and past presidents at the beginning of the General Internal Medicine movement, if you will, and I can very specifically remember in my own medical education, there were no general internists at that time. I was not aware at Emory that that was something that I could do. Only when I got to my residency did I have a model for what GIM could look like. So, very impressed about how people sort of fought through that. 

So, you sort of talked about how you began and, you know, started before the name change. And you've also gone on to lead many other organizations or be involved in other organizations. I was wondering if you could sort of compare and contrast or how is this SGIM different from those other organizations or not, or alike, but how do you think of SGIM compared to others?

Robert Centor, MD: So, I've always thought of SGIM as the organization that helped people have successful academic General Internal Medicine careers. And I think that we've done a good job. Some things I think we could do better, but certainly nobody else is looking out for the general internists academically. After I was president of SGIM, I was fortunate enough to be nominated to be on the Board of Regents by the president after me, Gene Rich, nominated me. And I was accepted and eventually became Chair of the Board of Regents. I love ACP also. ACP is really the organization that reaches out to the practicing physicians as well as the academic physicians. And it's a really great balance. I think I learned a lot from people who are in private practice and what their issues were that made me a better academic.

So, I think the big difference is who the organization targets implicitly, maybe not explicitly, but implicitly, is that SGIM has helped so many of my colleagues develop their career, go to regional meetings, present posters, get to meet other people, get new ideas, whereas ACP was more looking at all of Internal Medicine. It was a much broader scope.

Host: Yeah. And obviously, we've been able to partner with a lot of organizations like ACP and SHM in terms of advocacy and interest, but I appreciate your perspective on that. One question that I'd like to ask is as we think about our organization's history and as we begin to plan for our 50th anniversary, are there any memories or reflections or thoughts that you want to share? Something that you're particularly proud of or any memories that you'd like to share?

Robert Centor, MD: I think for the 10th meeting, I was the head of the program committee. And Tom Inui asked me to do that. So, I, to this day, feel very, very fortunate to have been asked by Tom, who's one of my heroes. I think the biggest thing is I think we've done a better job more recently of helping clinician educators.

To me, clinician educators are undervalued in most organizations. Sometimes they feel a little bit undervalued in SGIM, but less so now than I think in the past. There's more involvement in posters with residents, in sessions discussing cases. And I think that's really important because, at least at my institution, so many of my colleagues are mostly clinician educators. They do part-time clinical work. They do a lot of education work, both inpatient and outpatient. To me, that's the core of the Internal Medicine Residency and the Internal Medicine student rotations, trying to make sure that we have the very best and that those people feel appreciated and continue to do it. It's very sad to me when you have somebody who's really talented, they don't feel appreciated. And so, they go into private practice and it might work well for them, but it's sad for our learners.

Host: Absolutely. I agree completely that the art of being a clinician educator, it is beyond or in addition to what you do for clinical care and especially those who are really good at it, as you've just described earlier, with bedside and clinical teaching.

So, you've talked a little bit about something that SGIM has worked on over the years. Also wondering what you think, as we finish or we move towards our 50th anniversary, what do you see as the future of the organization? Anything that you would suggest for SGIM going into the next 5 or 10 years?

Robert Centor, MD: I think the biggest challenge SGIM has in my mind in the last 15 years is the hospitalist movement. How do we balance hospitals or general internists? Some people just do outpatient medicine. You know, we have people who do addiction medicine in our division. We have people who do palliative care, but how do we keep that big tent and make sure that there's a good interchange between the people who are focused on the outpatient side and the inpatient side. That didn't come up at all in the '80s. In the '80s, everybody did everything. I understand the financial reasons that that's happened. But I think we have a lot to learn from each other, the more we can be allies in terms of inpatient and outpatient internal medicine and all the different extra areas that we might mention, Addiction Medicine, for example. Then, we'll do a much better job together of training our residents and inspiring our students.

Host: Yeah, I think, your point is well taken as we've gone-- I mean, even the broad tent of Geriatrics and Obesity medicine, Hospital Medicine, I think that's a really important point, that all those fields would love to keep everybody engaged in SGIM. So, thank you so much for that. I know that you are emeritus faculty, but you're still very clinically busy, busier than I am, even as a full time faculty member in terms of clinical, in the clinical space, also actively podcasting and doing other things. I'd love to hear a little bit about your hobbies, what you do for self-care, if you are willing to share anything, like that about yourself.

Robert Centor, MD: Absolutely. I tell people now I have four major hobbies. Golf, I play a lot of golf; working out, I do something every day at different levels. I try to stay in shape and be as healthy as I can for as long as I can. Making rounds. So, the VA pays me to be a ward attending, and I do a lot of morning reports. And I probably would do much of it even if I wasn't getting paid because I just love it so much. From November 1973, when I first did rounds on Internal Medicine, I've been in love with rounds for over 50 years now. And fourth is going out to dinner with my wife and friends to nice restaurants, often accompanied by a really nice bottle of wine.

Host: That's so lovely, all of that. I'm looking forward to that time. Although, like I said, you're definitely not retired in my mind doing like almost a full time inpatient, but I'm so thrilled to hear about your commitment to doing those other things for wellness and self-care.

I'd like to give you an opportunity to have any final comments as we wrap up. Is there anything else you would like our listeners to hear about General Internal Medicine, about your career, about the society? Really any final thoughts in any domain that you'd like to share with us as we wrap up today?

Robert Centor, MD: Yeah. I think the big challenges these days is the burnout. And I just recorded a podcast with another member of SGIM, Chris Sinsky, that'll be out in about another month. We need to advocate for keeping some control in the lives of our faculty and our colleagues who are in private practice.

I really dislike the way some people have defined very explicitly, "This is what your job is, and you have to be there at 8:00." You know, "You need to take your kid to the doctor at 8:00 and you can't get there until 9:00. And that's not acceptable. That aggravates me beyond belief." I think that we need to allow people to sculpt their jobs as much as possible, to have control over the things that can be controlled so that we'll have happier physicians. And I worry about that a lot. I mean, I'm in a very fortunate situation, and I make rounds from 7:00 to 10:00 or 8:00 to 10:00, and then I have great residents and I don't have to hang around all day. I talk to them in the afternoon. Sometimes I come back if it works out and they need me to come back. But I have a lot of freedom and I've always had a lot of freedom and tried to encourage that, but I hear too many stories, especially in academics, of hiring someone and having such a rigid job for them, that they can't explore and grow.

We have to allow people to grow because you'll be surprised that someone who didn't realize was going to explode really explodes when they get to a certain point. Not everybody is ready to be a major player the day they get out of their residency or fellowship, and different people grow at different speeds. We need to understand that and not have unreasonable expectations of the rookies.

Host: I love that. This idea of professional autonomy, I would say not only in sort of work life, but even in how we manage and care for our patients, as well as we're having to do more prior authorizations and engage around treatment. So, this is a really important concept. But I want to thank you again so much for joining us today.

I also want to thank the SGIM staff and Roz Boggle, who is our executive producer and the entire Doctor Podcasting production team. I also want to say thank you to our listeners. 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. It helps others find us and also look for us on the SGIM website, sgim.org and follow us on X.