Jada Bussey-Jones, MD (Host): Hello, this is Jada Bussey-Jones, the past President of the Society of General Internal Medicine, and the host of SGIM's President's podcast. We engage SGIM's former presidents, and in this case the current president, 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'm delighted to talk with Carlos Estrada. Dr. Estrada is the chief of the section of general internal medicine at Birmingham VA and a professor of medicine with tenure at Heersink School of Medicine at the University of Alabama Birmingham. He is a longstanding member of the Society of General Internal Medicine, and as I said, is the current president through 2026.

He's had lots of roles in SGIM from chairing the 2009 national meeting, serving on council, serving as deputy editor and the editorial board of the Journal of General Internal Medicine. He's also served as the president of the Association of Chiefs and Leaders of General Internal Medicine.

Outside of SGIM, Dr. Estrada has served on the National Board of Medical Examiners, USMLE Gross Anatomy and Embryology Test Material Development Committee and the USMLE committee overall. Dr. Estrada Co-directs, the Birmingham VA Medical Center Quality Scholars Fellowship, and that is known for interprofessional training, quality and safety education, as well as health services research, outcomes, and patient quality.

So thank you Carlos for your leadership over all these years, and thank you for being with us here today. I think I'd like to start off by just having you tell us a little bit about yourself. Perhaps both your personal and professional journey, how you got started in your career in medicine, and on your leadership journey.

Carlos Estrada, MD, MS: Thank you. First of all, medicine was not my first option. My dad was in the military, and I attended a high school and primary school for families of the military. So the natural thing was for people to go into the military, Army, Navy, or this or that. What happened is serendipity, I got sick. I had acute Hepatitis A, which is fairly common at the time, and the treatment at the time was complete bedrest.

So I was for a few week, few weeks in the hospital, resting, in bed. So I had a chance to meet with nurses, doctors, and that was the first exposure to medicine. And it made me curious. During my upbringing, if you were top of the class and you wanted to come ahead and I don't apologize, trying to come ahead and make a living in Peru, you choose either engineering, law or medicine.

And we chose medicine. Met my wife during med school. We are happily married with our two grown kids. And how did I get involved into general internal medicine? During residency I was so excited and passionate about doing everything ICU, I almost got and transferred into ER. And then one of the things that was very important was that the only field that allows you to do everything is general internal medicine.

Host: I love that. Well, not the part about how illness led you to your career in medicine, but I'm glad that it did. And I also felt this thing where I couldn't choose. Because I really liked all the things, and general medicine, therefore made a lot of sense. So now maybe I'll turn to your extensive leadership in SGIM.

So I'd love to hear about how you got started in SGIM? How, why did you join in the first place?

Carlos Estrada, MD, MS: Thank you. Before SGIM it was ACP during residency. ACP was fundamental and pivotal for the clinical training and education of physicians in internal medicine. And that remains the true, not only in each state, but nationally and international. So I did join ACP for a number of years. I'm still a member. I got introduced to SGIM during my fellowship years.

My fellowship director at the time, and I completed my fellowship at Henry Ford, said, Hey, Carlos, you're doing interesting work. You should attend SGIM. And it was the Midwest meeting in Chicago and I fell in love. This was the place to meet other educators, researchers, clinicians, and I do remember Gerad Rosentahl giving a workshop and I still talk to him about that. He doesn't remember that, but that's okay.

Host: I love that. And, I hear that story so often as I've been doing these podcasts, people sort of being asked by their mentors to come to the meeting. And then finding their professional home. And so I very much identify and that resonates with me personally as well. I will say that you're the first person that I've interviewed that is in the first few weeks or months of their term as president.

Everybody else I've interviewed has been past presidents. So I don't know if you have as many reflections as a past president, but as a long-term member, I'm wondering, if there are particular experiences in SGIM that you've had that you're particularly proud of, it could be whether as president or in other roles, but really any reflections that you have about your time in the organization.

Carlos Estrada, MD, MS: Thank you. And as I was thinking and preparing what to say today, one of the things that I'm most proud of is the southern region. The Southern SGIM is not anything I developed in any way, shape, or form. This was and I've been in this region for about 20, 25 years and just seeing the people grow, move up, interact, find, I mean, this is such a rich experience and this is thanks to the collective effort from everyone. From trainees, residents, students, and the faculty. To me that was a really rewarding and continues to be the most rewarding aspect as I progress during my leadership journey here at SGIM. The southern region allowed me to take some risks, volunteer, say yes to a number of things, and it was a playground to do new things and interact with people. First in the region and then at the national limit, at the national meeting.

Host: That is so great and I have to say, speaking of something that a senior person may not remember, but that you actually said yes to a mentoring program and, mentored me through a formal SGIM related mentoring program many, many years ago. And so it just sort of speaks to this gratitude first of all, and then the progression that we have over the courses of our careers and then supporting each other.

So I really very much appreciate that. I'm curious about as you think about the organization's history and we start to plan for the 50th anniversary, do you have any thoughts or advice for folks that might be come behind us, future leaders in the organization, sort of what they should be thinking about or planning or doing?

Carlos Estrada, MD, MS: Yes. I have three things. So, and this also applies not only to current leaders and upcoming leaders. So one is it's okay to say no. There is a number of workshops and this and that, that you learn how to say no or maybe, and part of that has to do with the bandwidth. We all have limited bandwidth. We all have to do other things in life, family and, developing passions. So that's an important component.

Two at the same time, how to say yes. We did a number of workshops regionally and nationally, how to say yes to professional development opportunities, and we are facing the thing at the national level in the council and that goes to my third point, and that is balance the things that you say no to and the things that you say yes to.

Right now at council, when we struggle with really important things that are happening nationally, the multiple ideas, we go back to our core values. We go back to our core values. That is one particular area that can help us define, decide when to say yes, when to say no, when to say maybe, this is an important aspect that I want everyone to hear about, that everything is important, but there are things that we may need to say yes more loudly than others at this time.

Host: I love that. Sort of understanding our why and our core values that can really help drive us both as individuals and as an organization because there are so many things that are going on or so many issues that need to be addressed, but it can really help us to prioritize. So I love that advice and that approach.

I'd like to ask a few questions about sort of getting your perspective on general internal medicine, academic general internal medicine, as a career path. What do you think have been the most important changes in this over the course of your career perhaps, and what challenges still remain?

You know, speaking of things that are potential issues, moving forward. Do you have any thoughts about that?

Carlos Estrada, MD, MS: Absolutely. Thank you. I have three things. So one is things I love. I love the physical exam. I love clinical reasoning. I just finished four weeks of inpatient attending at the VA and that was such an area to role model, to practice, and to support people in academic GIM. Whether your practice is in the inpatient setting or in the outpatient setting, or in the community. To practice that physical exam, complex decision making with all of the externalities that happen. So that's one. Foster that love. Role model that.

Two, I love the new tools that are coming our way. Few years ago it was point of care ultrasound. I still remember one of our VA quality scholars, years ago who single-handed created a curriculum, got grant funded and launched a point of care ultrasound procedure service, at least at our institution. And that has happened and has blossomed across all med schools and institutions. So I love embracing that technology in ways that can assist all of us taking care, better care of our patients.

And the last one is talking about what are the challenges for general medicine is what we all know about the leaky pipeline. The leaky pipeline for scientists, for STEM people, and for people in general internal medicine and subspecialists are also facing the same thing. I'm very excited that one of the main efforts as we move into the next 50 years for the society is how to pump the pipeline.

And that tagline is not mine. It's something that was developed organically with the group of people from council, and I'm sure it's going to have a better name and so forth. We need to pump the pipeline in terms of fostering opportunities for all of our trainees, for our junior faculty, for our senior faculty as they transition in into other opportunities, or retirement. We need to maintain that pipeline flow. I think that's such an important piece of interest and guidance for the society. Let me just go back to the new tools and new aspects and something that is really exciting to me, for the next years to come.

And that is AI and LLM, large language model. I'm excited that council decided to form a task force and a shout out to Kate Killian and Farifa Khan who have led, who are leading the task force for the next year or two. And I have already seen product from that, from the time you were president in terms of amount of work effort and workshops that were presented at the national meeting.

And I see that at the regional meetings also, when I attend.

Host: I love that. What I hear you saying is sort of continue to focus on the foundational things like physical exam and clinical reasoning, but also accept and engage around some of these new tools, but really this idea of the pipeline and maintaining careers in general internal medicine is so important; whether inpatient, hospital-based, but also primary care of course. I think it's one of the foundational things in medical care and quality. And I think there's evidence to support that. So I appreciate those insights.

Now I'd like to hear a little bit, I think perhaps easier questions, which is, if you can talk about someone as a leader in particular, that you look up to, because clearly you have been in leadership roles for a long time, so who's been your inspiration?

Carlos Estrada, MD, MS: I have to say Mike Landry. Mike Landry is a little bit junior than me, but I have known Mike Landry through the Southern Society. He's the current Editor in Chief for the SGIM forum, and I have seen Mike progress over the years and he has given me so many pointers and now he's helping me with the articles in, in Forum.

But at the same time, he's done that for other people. He has developed such a joy helping people develop to the best places that they can be. So I look up to Mike all the time.

Host: That's awesome. So maybe, I'd love to hear a little bit about you personally with all the work that you're doing at the VA clinically, as a leader with the organization. How do you find joy? What are your hobbies? What do you do for self-care? Can you share a little bit about that?

Carlos Estrada, MD, MS: So how about finding joy is primarily, there are things I do at work and there are things I do outside work. At work is what I mentioned in terms of being in love with the things I love to do in terms of physical exam, teaching, just being there one-on-one with the students, PA students and residents.

And interactions with the patients. I don't have my own practice. I practiced in clinic for about 10 years, a little while ago. I attend now three or four months a year, and I love every time I'm on service. So that brings me immense joy. So that's one perspective. From the family side, we have family dispersed in Europe, Mexico, Albuquerque, South America. So trying to travel more often, meeting together, having fun and interacting with our families. We are empty nesters. So in terms of hobbies, one of the things that I need to do is I need to find a hobby. Now at the same time, I don't apologize for not having a hobby, but there is one that I do two or three times a year that I found just so relaxing and that's flying a kite.

During your meeting in Florida, I was one of the people flying a kite outside and I'm going to visit my youngest daughter in Albuquerque, in just a couple of weeks, and we're going to go fly kite together, which is awesome.

Host: That is so awesome. So I didn't realize I was looking from above that you were one of those folks that I saw flying the, those kites. That's so awesome. So I think we're nearing the end of our time, but I just wanted to give you one final opportunity to give any thoughts or reflections or just kind of wrapping up our time together.

Is there anything that you want to say sort of in conclusion, or any final reflections or thoughts?

Carlos Estrada, MD, MS: Yeah. I think the final reflection is with these challenging times, I think it's important to go back not only to your core values, but to the things you love to do. Connect with people in your institution, connect with people in the region, connect people at the national level. So that's one. The other one is develop something that you're passionate about.

So for example, for me, I love to listen to podcasts from the business aspect and I have a number things that I do on cycle. So finding that niche that's for yourself, whether you share that information with others or not, that's absolutely wonderful.

Host: I love that. Carlos, thank you so much for joining us today. I also want to thank the SGIM staff. And Roz Bogle, our executive producer and our entire production team. Also, thank you to our listeners. You have been listening to SGIM 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 to find us. Also, look for us on the SGIM website sgim.org and follow us on X.