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, and policy, and academia. As we lead up to the organization's 50th anniversary, we capture highlights from our national thought leaders so that our organization, our members, and healthcare broadly, are in a stronger position to grow and innovate and meet the challenges of our time.

To our listeners, I say thank you so much for joining us. Today, I'm excited to talk with Dr. Steven Wartman. Dr. Wartman served as the President and CEO of the Association of Academic Health Centers, a nonprofit global association based in Washington DC that seeks to advance health through leadership of academic institutions that educate the next generation of health professionals, conduct cutting edge research and offer comprehensive patient care.

Prior to this, he was the Executive Vice President for Academic and Health Affairs and the Dean of the School of Medicine at the University of Texas Health Science Center in San Antonio. And in addition to being the former president of SGIM, Dr. Wartman's Career in Academic Medicine also includes chairing a department of medicine at two institutions and being the founding director of a division of general internal medicine.

He has more than 150 visits to academic health centers and is recognized internationally for his work involving organization and management, strategic alignment, leadership development and the changing dynamics of healthcare. Steven, it is so wonderful to hear and read about your leadership journey.

And I thank you so much for agreeing to spend some time with me today, to talk about your legacy, if you will. The introduction epitomizes a career of leadership and impact. And so, because you've had so many roles and experiences, I'd love to just hear a little bit about how you got started in your career, and particularly how you got started on your leadership journey. Sometimes I ask people, did you know that you wanted to be a leader? But tell me how it all started.

Steven Wartman, MD, PhD, MACP: It's a great question. When I started med school at Hopkins, I was determined to be a neuroscientist. That was my goal. My mentor at Hopkins, Dr. Vernon Mountcastle, who had done wonderful work describing the architecture of the cerebellum, arranged a three month work visit to UCLA's Brain Research Institute where I worked on pineal physiology and especially melatonin secretion with environmental lighting changes. When I drove back to Baltimore after the summer, I had a nice paper and a nice research project, and I felt good about it. And I went to the med school and opened, went into my mailbox. You know, when you're away for a few months and you open up your mailbox at the med school, it's all this junk, right?

I'm throwing things out right and left, and I got a pamphlet in bright canary yellow with black lettering that said International Clerkship in Healthcare. Call this number. For reasons I could not explain Jada, called the number, a very avuncular sounding gentleman, picked up the phone and said that the Milbank Fund and the School of Hygiene and Public Health and the dean had given permission for up to six medical students to have a international health experience.

Would I be interested? Why don't you come over and we can talk about it? And I, and I said, where are you? He said, I'm in the School of Hygiene and Public Health. And I said, where's that? He said, across the street. Right. So I went over and long story short, nine months later I was living in Belgrade, Yugoslavia. What a different experience for someone who had not even been out of the country. Right. And learned a lot of things about life and myself, and a facility for language and whatever. But the most important thing from the professional point of view was the project that I chose to really follow was differential rates of infant mortality in four selected areas of the former Yugoslavia.

 Why were there such striking differentials in infant mortality in between these four areas? And what I discovered was it's the social determinants of health that made all the difference. There wasn't that terminology then, by the way.

It had such a profound effect on me, Jada, that I came back from that experience saying, you know, I no longer want to be a neuroscientist. I want to be a social scientist. And I met with my advisor and he said, I think internal medicine is probably a good start. Make sure you do your internship.

And then maybe take a few years off and, really try to put it together for yourself. So I went to Stanford for an internal medicine internship, then took three years off and went back to Cornell, where I had graduated as an undergraduate. Got a job at the University Health Services. A faculty member asked me to give a lecture on smoking and health.

And I'd never done a lecture before. And I gave it and I liked it. I enjoyed it. And then next thing I know, the Chairman of Sociology said they had a crisis in sociology. Their medical sociologist was leaving and they had 90 students signed up for a course in the fall. In medical sociology, would I teach it?

I said, Dr. Rice, I've never, I, you know, I'm, so you'll figure it out. So I wound up teaching medical sociology at Cornell for a year or two as an adjunct professor, whatever you might call it. And that was it for me. I decided I want to be a social scientist, I want to get a PhD in a social science.

I want to probably do something in internal medicine that's meaningful. I spent a year, after that, as a Henry Lu Scholar in Indonesia, which furthered my idea about the social determinants of health and cultural sensitivity. And then went out on the market after the Robert Wood Johnson Clinical Scholar Program and got my PhD to get a job.

And, I was visiting with a dean at a prestigious school on the West coast, looking for jobs, and he asked me where I was looking and whatever, and I told him and he said, you know, and this is the advice that led me to the leadership idea. He said, you know, I don't think you should come here. And I was looking at a job in Boston.

He said, I don't think you should go there. I think you need to find a place where you can do something on your own that's new and exciting and creative and building for yourself and for others. And I found that at Brown University. They did not have, I never even thought about having a division of general internal medicine, much less a general internal medicine residency program.

So I wound up at Brown to start my career. I was so naive. I didn't even have an appointment in the Department of Medicine. My appointment was in the Department of Community Health. Right. And when I met with the Chairman of Medicine, he said, you get that grant for internal medicine residency training and we'll work it all out.

And I was lucky enough to get the grant and start the program. And the program is still running strong today, so many years later. Started the first class came in 1980 and they're still producing wonderful, wonderful graduates. But that's sort of the, the way things worked. I want to give a shout out to SGIM about this because I think this is important.

It was then called SREPCIM the Society for Research and Education in Primary Care Internal Medicine. I was all alone in Providence at Brown, and I so much needed a support system and legitimacy of what I was trying to create in trying to do. And the answer was SGIM.

And I remember going to my first meeting, I think it was 1979, maybe it was Dick Binney or David Dale, I can't remember who the president was. And I felt at home and I felt supported. And it made a big, big difference in giving me confidence, to build a career even further. I hosted a New England regional meeting in 1982, and I guess Suzanne Fletcher, who was then president of SGIM, got word of it and she asked me to run the national meeting in 1983.

So it was 1984. So I told Suzanne, I said, our national meetings have always been a one day affair appended to the AFCR meetings. And what we really needed was to have our own meeting and build on that. If you agree that I can put together a two day meeting, I'll do it.

And she she said, yes, I agree. Let's get the council to agree to that. It'll cost some more money, but let's see what you can do. So I think my major accomplishment was not as president of SGIM, but was really transitioning the, the society from a one day sort of add-on meeting to a full two-day meeting of just SGIM.

You know, we added all kinds of features and things like that, and I'm really proud of that. And I obviously, I, kept these things because they mean something to me. I was so pleased to see that happen. So that is sort of the story of how I got involved in, what I got involved in and where I began to see that I did have leadership potential, especially when the dean told me, you know, you need to find a place where you can do your own thing.

Host: What an amazing story. Thanks so much for sharing that. From neuroscience to social science, to general internal medicine and to and through society of general internal medicine,  SREPCIM, you know. Thanks so much for sharing that sort of winding journey. But it's not unlike many of the stories that I've heard, which is sort of finding passion and purpose, sometimes, not intentionally.

 The path might look different than what you thought when you started, but, really enjoying the journey it sounds like. One of the things as I was looking at your bio that I was impressed by and wanted to ask you about was, you know, after you shared your personal experience a little bit about the, as a leader, you literally wrote a book about meeting challenges in academic medicine and a changing landscape.

And so, especially now as things are rapidly changing, I wonder if you have any thoughts for leaders today, in terms of leadership roles in academic medicine. It sounds like you're still maybe doing some consultations and things like that.

So any, thoughts about meeting the challenges of sort of healthcare's changing landscape?

Steven Wartman, MD, PhD, MACP: Wow. We are in the middle of, uh, a really difficult time for clinical practice, for education, and for science. Right now I'm based in Massachusetts outside of Boston, and, you know, this is the MedEd state, right? And, you know, it's getting hit pretty hard with some of the things that are happening. There's never been a greater need for good leadership in the field of medicine and science than it is today.

 But the kind of leaders that we need have to be so well grounded in where they stand and what they want to do. One of the things that I've observed in my 150 plus visits to academic centers, including 42 outside of the country, is that leaders need to come to terms with who they are.

They need to have what's called an inward journey, learning who they are, what motivates them, where their passions lie, and more importantly, where their moral center is, because that's what's really called for now. And by that I mean, what are the lines that you just won't cross? We see examples of this in other fields right now, I think if we look carefully around the country.

So really I think the leadership process has to begin with knowing yourself and where you stand. And what is as far as you can go for some issue and where you won't go any further. That's a kind of a grounding thing that I think is really super important. And then after that, it becomes the external journey, right?

How you build a career, how you relate and manage people above, below you and parallel to you in a meaningful way. And the most important criteria here is it shouldn't be about you. You should be able as a leader to bask in the reflected glow of other people. I know that people listening to this podcast, I'm sure you've had an experience with an individual.

It's all about them, right? We did this, I did this, I made this, I, you know, whatever. It's all about basking in the reflected glow of other people to be successful in a leadership position. And that means motivating people to do something very difficult, which is to change their behavior.

To try to change things in a way that follow some important discovery or, political change or things of that sort. Most people say they are, they love change as long as it doesn't apply to them. Right? And, uh, I think a successful leader needs to be in this day and age, a transformational leader.

Transformational in the sense of, they've gotta change the way we do things. And my job is to show individuals who are impacted, which could be a vast medical center, it could be smaller venue, a group practice somewhere, whatever; that the changes I'm suggesting are as much in their own self-interest as it is in the interest of the organization and the patients that they serve.

That's a difficult and tough job to do, but it can be done if it's given enough thought and practice. And you have sort of the right approach in how you deal with other people. So I think today I would say leaders need to be grounded internally, morally grounded, and need to have perfected or be working on the skill of being transformational in getting individuals and by that institutions to begin to change their behaviors to meet these extremely challenging times.

Host: I love that. And I don't know that we spend as much time thinking about that inward reflection and journey. We're so busy trying to change individuals, maybe structures, but I don't know that we spend as much time as leaders, with that sort of sitting in that. So thank you for that. The other question I wanted to check in with you about, because I saw that you had done a fairly recent publication about the role of AI.

I mean, there's certainly big changes across academia and healthcare and, and policy these days. But I was curious about, your thoughts about the impact of AI in our profession, in the profession of medicine. Can you say a word or two about that?

Steven Wartman, MD, PhD, MACP: I don't know if I can keep it down to a word or two.

Host: Like it's more than that. Yeah.

Steven Wartman, MD, PhD, MACP: That paper Jada was a requested editorial, but I've been working on that for 10 years.

Host: Hmm.

Steven Wartman, MD, PhD, MACP: Because I saw a movie in 2013 that got me started on that, and that was the movie Her.

Are you familiar with that movie? Dystopian Future? Uh, this guy walking in Phoenix falls in love with his, you know, AI, I think Scarlett Johansson played it, but I came away from that movie in 2013 thinking, wait a minute, look how manipulative AI can be and how it can impact the emotions of us humans.

There's a dynamic there that I need to pay more attention to. And so it was a long journey and I started reading articles and books and going to conferences and meeting people and talking about it and following it as closely as I could. At one point, I felt I was at the end of a fire hose of articles and books and things coming out.

I just couldn't control it. It was every, every single day. But, my conclusions about this are that we have a serious issue in front of us, and the issue is this, very simple in one sentence. Who will be managing whom? Will the human physician be managing the AI and the AI applications? Or will it be the other way around?

And what is the role of corporatization in all that, that makes it even more difficult? I think that medicine has fallen behind the times in being prepared for this. We're more passive than we should be. We should be much more active, rather than so reactive. When you read the things that I've read and, and I, I don't keep up as well as I did when I wrote the article, but you know, the gurus don't even know what AI is capable of or how it works, which is an astonishing thing, right.

And medicine has, the doctor patient relationship cannot be supplanted by AI in some meaningful way that would help patients and doctors. And you, you've probably have heard discussions about, oh, well, we'll get the AI to do all this scut work, right? Will listen to the interview and write a synopsis.

Will gather all the latest literature and tell the doctor and patient what the odds are of this and that, and what the best treatment modalities would be. That it would have the ability for pattern recognition, to do a whole bunch of things, et cetera, et cetera. All the good. On the other hand, you know, is there anything lost between the doctor and patient and human to human interaction? Is there something that's super special about human to human interaction? Interaction that AI is not capable of doing and may never be capable of doing. I gave examples in that article of certain inner calendars where that could be the case.

You know, reading a person's body language, listening to a life story and history that's not programmable in the AI world because it hasn't happened to anybody else and saying, you know, I've got some experience in dealing with patients with this kind of issue. I can offer this, I can listen to the degree of how risk adverse a patient is and help them make decisions about things.

And there's a long list. I think I have a chart in the article about the kinds of things that can happen. So the article was in a sense, asking the profession to step up to the plate. And say, okay, let's be more reactive, less reactive, and more active oriented with AI. Let's see who controls who and where the interfaces are so that AI can be used for the betterment of the doctor patient relationship rather than degrading of the doctor patient relationship. And that's my primary concern.

Host: Thank you so much for sharing your thoughts in that thoughtful sort of review and article. I don't think AI is going anywhere, but I think the way that we use it, to your point is, is so important, in terms of whether it's generally a positive or negative thing for us in medicine. You've shared so much about leadership and AI and sort of where we are.

I, I want to come back to general internal medicine, SGIM specifically. You've shared a little bit about when you first came to the organization and even when you led the meeting, and sort of an impact. I was wondering if, something that's really personal and meaningful to me.

And really one of the reasons why I started this podcast is to kind of understand from these legacy presidents of the organization, what advice you have for current or future leaders of the organization. So really just is there anything that you think that current or future leaders of SGIM should be thinking about or doing, as we lead the organization?

Steven Wartman, MD, PhD, MACP: Oh, it's a really important question. In the 1980s was a time, at least from my perspective, where we were fighting for the legitimacy, the actual legitimacy of divisions of general internal medicine as academic units and departments of medicine. This was a fight that was carried on by a lot of places all over the country, and it was a successful one.

Divisions became established and necessary and credible, and got resources and grew in size. When I gave my presidential address, in 1989 at the meeting, I was so proud of the fact that we had increased our membership by 12% to a total of 2000 people. I won't ask you what the membership is today.

I'm sure it's a lot bigger than that. So a membership organization like SGIM, needs to have its finger on the pulse of what its members are dealing with. And to provide the support that's necessary for them to continue to flourish in their jobs. I think one of the shortcomings of SGIM might be that the focus on establishing academic divisions, lasted too long and there wasn't enough of a transition to primary care practice in general.

You know, the whole issue of payment, cognitive services, prior authorization, all the things that affect primary care today. I don't know where SGIM stands on that now, but it seems to me that it needs to be on the very, very frontier of primary care practice, what that means in today's environment and how that can be supported and changed for the better, politically, economically, whatever, the parameters are.

You may be aware that there are groups of primary care doctors that are starting to organize. To my generation, the idea of forming a union, for example, nobody would even think about that because we took the Hippocratic oath, and I remember one of the attendings in med school said to us in a lecture, doctors don't have to worry about political power because they have the power of the pen.

And with that power of the pen, you controlled so much, right? Well, that power of the pen is eroding, isn't it? It's less and less. So we need to regain some political power and we need to regain the ability to control a lot of our interactions and concern and with patients. So I would argue that the time has come for SGIM to be very bold.

If you're not already, and you may be, in looking at this kind of future. How do we maintain autonomy in practice? Especially in primary care. Once you begin to lose autonomy, physicians become subject to, in my opinion, moral injury. You want to do something for a patient. You can't because of whatever. I think that's the major cause of burnout. I really do. So I think regaining physician autonomy in the practice environment, in collaboration with all these other forces, corporatization, AI, government intrusion, I mean, the list is really important, but it's happening right in front of our eyes right now and requires I think a more proactive approach and more political approach.

Host: Yeah. Thanks Steven. I think that's so important, sort of autonomy in clinical spaces and the way that we engage and teach our learners and our scientific discovery efforts. So many threats that you've outlined today. And I, I think, like you said, that we will have to continue our efforts and perhaps even double down those efforts to be proactive in those spaces. I want to shift gears a little bit from the more serious topics. Really, I just want to acknowledge that you've had this very long and successful career, and so I wonder if you would be willing to share with us, what are your sources of joy and inspiration both today, when your career may be very different, but also in the height of your work. What are the things that have, brought you joy?

Steven Wartman, MD, PhD, MACP: So much, I've always worked to develop a team that I could, want to come to work with every day, that started at Brown. And I'm still, it's down the road an hour from where I live now, and I'm still close to people down there. And it went all through my job in Washington where we had a team and I everybody liked coming to work every day.

To me that was so important, because taking the joy out of medicine or taking the joy out of any job, I think sometimes begins with the environment that you're in. And if you have a team that respects each other and works well together, can disagree or agree, but do it amicably.

 I remember at Brown we used to have annual holiday videos that we would put up that were funny and things of that sort, you know? I think having a team around you that gives you joy and wanting to wake up and come to work every day is important. And that, of course, speaks right to the mission of doing best for your patients and building programs that work for everybody.

So that was something I think very, very early on that's been consistent throughout my whole career. I've always felt that I had a mission, and the mission was to make things better, whatever it might have been. You know, sometimes you're successful, sometimes you're not. I mean, right now, for example, I'm working with a very interesting, group of people, very eclectic, from disciplines that are way outside of medicine, but who are interested in trying to maybe even create a new type of organization to help healthcare for the future. We're in the infant stage of that, but that's, I find it motivating and sustaining, to have that in the back of my mind to do that.

I'm a senior advisor for the Center for Women in Academic Medicine and Science. I get a couple advisees every year, and working with women to get them into senior, help them get into senior leadership positions, I find that very fulfilling and meaningful. And I've also reached a stage of life where I like to write memoirs.

You get to a certain point, you want to write memoir. So I did write a memoir that was published by the way, in the same journal that the AI paper came on in about what happened to me in Belgrade. And how my whole career changed. I called it Tito's Moon about how that all happened.

I have another one coming out in a little while about what happened to me in Indonesia. So I find that at this stage, writing memoirs is very meaningful and fulfilling. And then I've got my granddaughters, and you know, unfortunately they don't live close to me, but, um, we see a lot of each other and, um, I want to make a better world for them.

And it's very challenging to even think about that right now. But that's extremely motivating and gives me joy every time I see them.

Host: Well, thank you so much Steven. I, I've learned a lot today about leadership and, um, not just sort of individual leadership in academic medicine, but also leadership of an organization and how we might make our way forward. I really appreciated, uh, thinking about inward reflection, um, and that journey as well as kind of also supporting others and um, and making that be the central thing and then being a part of a great team.

So, um, I really, again appreciate your time and for our listeners, I want to say thank you all for joining us today. I want to thank our SGIM staff. And, um, you have been listening as, uh, to the SGIM 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 social media.