42 episodes

Join host Patty Fahy, MD as she shares the evidence for why physicians must lead healthcare and lead us out of the current healthcare system morass. Patty has twenty years of experience working with leaders in healthcare—as a member of an executive team, founder of a successful coaching and consulting firm, and as a committed physician advocate. This podcast is for you if you want expert physician leaders at the helm of U.S. healthcare systems and if you want practical advice and critical conversations about honing the leadership skills of physicians.

The Licensed to Lead Podcast offers new angles on the neuroscience of leadership, challenges a “burnout industry” that is profiting from physician burnout, and offers a no-holds-barred investigation into the business school mindset that puts profits over patients. Patty and her guests provide provocative and clear recommendations for changing the business of medicine so that it fulfills the professional obligations of medicine.

The physician identity is deeply rooted in doing the right thing for patients. It is time for the financial preoccupation that arises from a business school mindset to be subordinated to the professional obligations we have to patients. Find out more about Patty and Fahy Consulting at LicensedtoLeadPodcast.com.

Licensed to Lead Patty Fahy, MD

    • Health & Fitness
    • 5.0 • 20 Ratings

Join host Patty Fahy, MD as she shares the evidence for why physicians must lead healthcare and lead us out of the current healthcare system morass. Patty has twenty years of experience working with leaders in healthcare—as a member of an executive team, founder of a successful coaching and consulting firm, and as a committed physician advocate. This podcast is for you if you want expert physician leaders at the helm of U.S. healthcare systems and if you want practical advice and critical conversations about honing the leadership skills of physicians.

The Licensed to Lead Podcast offers new angles on the neuroscience of leadership, challenges a “burnout industry” that is profiting from physician burnout, and offers a no-holds-barred investigation into the business school mindset that puts profits over patients. Patty and her guests provide provocative and clear recommendations for changing the business of medicine so that it fulfills the professional obligations of medicine.

The physician identity is deeply rooted in doing the right thing for patients. It is time for the financial preoccupation that arises from a business school mindset to be subordinated to the professional obligations we have to patients. Find out more about Patty and Fahy Consulting at LicensedtoLeadPodcast.com.

    042 - Dr. Susan Rogers Tells Senate: Don’t Hand Medicare to the Profiteers

    042 - Dr. Susan Rogers Tells Senate: Don’t Hand Medicare to the Profiteers

    Community, connection, purpose: these values are almost palpable even in a virtual conversation with Dr. Susan Rogers. Dr. Rogers is an internist, educator, and activist on behalf of those who suffer when profit motives bulldoze the institutions that are meant to serve the public. A neon example of a public good which has been targeted by profiteers is traditional Medicare. As president of Physicians for a National Health Program, Dr. Rogers is fighting back against the shape-shifting strategies launched by insurance companies and private equity firms to cash in on Medicare. She fills us in on the importance of preserving the choice of traditional Medicare, and talks about her work to inform the public and Congress about the “predatory DCEs” or Direct Contracting Entities.

    She was shaped by growing up in a uniquely integrated community in Chicago as well as by the activism of the 1960s. When she was in middle school, her mom took her to a march led by Martin Luther King, Jr. protesting the state of the public schools in Chicago. She trained at Cook County Hospital in Chicago and then went on to hold leadership and teaching positions there as an attending. While she did defect temporarily to work in other settings in Chicago, she missed the camaraderie and like-minded passion of her Cook County colleagues. She emphasizes the importance of community with colleagues and the significance of a physician’s long-term relationships with patients.

    Dr. Rogers is exasperated at the privatization of healthcare by people who know nothing about the practice and profession of medicine. She describes the total disconnect when decisions are made by financially-driven business people: “There should be no role for them.”

    “Resources aren’t placed where they’re needed—
    they’re placed where they can generate more money.”

    She compares the inroads of private equity firms in healthcare to the debacle of private equity firms and charter schools siphoning funds away from public schools in poor communities. As in healthcare, the motives are not to provide the needed services to the public—but to amass profits for investors. Rural hospitals that are acquired and then closed by large healthcare systems are another example of decision-making by those seeking to maximize profit, not community benefit.

    Dr. Rogers and other representatives from Physicians for a National Health Program had success on Capitol Hill when they petitioned Congress and HHS to reject DCEs. While PNHP’s efforts were influential regarding DCEs, she describes how it didn’t take long for a new acronym and strategy to emerge. “Same shirt, different color,” she says about ACO REACH (ACO Realizing Equity, Access, and Community Health). She emphasizes the remarkable lack of oversight by Congress for this program that can be hoisted on patients without patients realizing that their traditional Medicare decision has been overruled.

    Also in this episode:
    •The powerful impact of a high school biology teacher
    •Activism in the time of role model Angela Davis
    •A Tuskegee airman who exemplified the bond between physician and patient
    •She was able to see patients as people: “They shared their lives with me”
    •“Are you going to open your own office?” a question rarely posed to medical students now that 70%+ physicians are employed
    •Burgeoning full-service hospitals arising in close proximity are as logical as putting a town’s four fire stations on facing corners.

    Meet Susan Rogers, MD
    Dr. Susan Rogers is president of Physicians for a National Health Program, a national organization with over 23,000 physician members, whose mission is to advocate for Single Payer/Medicare for All.

    Dr. Rogers received her medical degree from the University of Illinois College of Medicine and completed her residency in Internal Medicine at Cook County Hospital in Chicago. She spent...

    • 51 min
    041 - Mining Mintzberg for Management Gold

    041 - Mining Mintzberg for Management Gold

    McGill Business Professor Henry Mintzberg is the author of 20 books on management, creator of two revolutionary international management programs, and the recipient of a mountain of accolades and honors for his thought leadership in the business world. Mintzberg minces no words in his pointed criticism of current approaches to management training and the behavior of those in management and leadership positions. In this interview, Professor Mintzberg comments on the value of an MBA in providing management skills:

    “Anybody who comes out of a business school should have a stamp on his or her forehead—like a skull and crossbones—that says Warning! Not Prepared to Manage.”

    He explains how managers get distorted during traditional business education. Management is a practice where art, craft and science intersect. Because the art and craft cannot be taught in a business school setting, the “science” has become the focus of graduate business education. Thus, MBAs emerge with skills in marketing, finance, and accounting but lack the very “essence” of management—the art and the craft.
    He explains why “remote control managers” are dangerous. These are people who manage by the numbers, with monitoring and measuring substituting for actually knowing what’s going on in the business. This lack of understanding has implications for the success and capacity of the organization and disconnection from the ground floor of the organization impairs innovation.
    Professor Mintzberg says healthcare should not be run like a business. In fact, he states, “most businesses should not be run like a business.” He makes it clear that this is especially true in professions and in services like medicine and healthcare. Healthcare is not a business, it’s a calling.
    Professor Mintzberg points to the pros and cons of various groups such as physicians, nurses, MBAs, accountants and others who seek to lead healthcare institutions. He believes managers must know and understand the services being offered, be unequivocally collaborative, and humble enough to learn. Physicians who succeed in business are those who collaborate and build relationships.
    Mintzberg, an internationally recognized iconoclast, believes jail is the most appropriate destination for board members who approve super-sized CEO salaries and for the executives who accept them. He states that huge salaries are dysfunctional nonsense and the opposite of leadership that leads to “a kind of narcissism.” When asked about incentives for physicians, Professor Mintzberg exudes enthusiasm. “Yes! A patient whose life has been saved and who is appreciative is a terrific incentive!” But treating physicians like caged pigeons and giving them little rewards for their work is just silliness.
    Professor Mintzberg talks about the structure, purpose, and successes of the International Masters for Health Leadership program which he co-founded. And he shares a high level overview of his important work focused on the need to rebalance society. An imbalance in three sectors, the public, private and what he calls the plural sector, are at the root of many of society’s most harmful and dysfunctional patterns. This is so relevant to healthcare, which is being destroyed by inroads by the profit-driven private sector.
    In this episode:
    •Why Professor Mintzberg’s quadruple bypass cost $2.50
    •How beaver artists find gallery space
    •The Supreme Court legalized bribery in the Citizens United decision
    •Mintzberg’s Masters Program, Ebola Virus, and Doctors Without Borders
    •Dulcie and the Infinite List of Positive Characteristics

    Meet Henry Mintzberg
    Henry Mintzberg, PhD, is a professor in the Desautels Faculty of Management at McGill University in Montreal. He sits in the Cleghorn Chair of Management Studies and has had extensive visiting professorships at INSEAD in France and the London Business School in England.
    As an...

    • 54 min
    040 - Stanford Physician Writes the Book on Wellbeing

    040 - Stanford Physician Writes the Book on Wellbeing

    Author and certified lifestyle medicine physician, Iris Schrijver, MD, describes a fulfilling and fast-paced academic career at Stanford as a full professor of pathology and director of a molecular genetics research lab. A few years ago, in an unlikely turn of events, an opportunity to design a leadership project ignited her long simmering interest in wellbeing.

    That project culminated in a 2016 research article An Exploration of Key Issues and Potential Solutions that Impact Physician Wellbeing and Professional Fulfilment at an Academic Center. I give you the details here because this is the article that led me to reach out to Dr. Schrijver. I had read everything and everyone with a scholarly approach to physician burnout in preparation for several podcasts. Dr. Schrijver’s article was one of the most outstanding and useful of the scores of articles I read. In our conversation, she describes how important it was for her to have the credibility of being a physician as she interviewed her colleagues about the underpinnings of burnout. She also describes how extrinsic factors, such as restricted autonomy, dominated the findings which contributed to physician burnout.

    She and her husband, an astrophysicist, decided there was more they wanted to accomplish and experience beyond their fulfilling but all-consuming careers. The magnificent Oregon landscape was pulling them away.

    Dr. Schrijver describes how she consciously made changes to create the life she wanted. She decided to pursue a certificate in lifestyle medicine, write a book on wellbeing, and contribute to medicine and patients in a different way. They moved to Clackamas County, Oregon, and she began volunteer work at the Clackamas Volunteers in Medicine Clinic—including a stint as medical director and a board member. Now she is developing a lifestyle medicine service for the Clinic. She finds the work remarkably rewarding. As she says, “Poverty is not a crime, and it is a privilege to provide good medical care for this population.” She continues to serve as adjunct pathology faculty at Stanford.

    Dr. Schrijver describes an interaction with a mentor early in her career who gave her a pointed introduction to her leadership accountabilities as a physician. It served her well. She has served in academic and national leadership roles, including as the President of the Association for Molecular Pathology.

    She connects the scientific method, physician leadership, and physician wellbeing to the important task of promulgating accurate and useful information to the public. Dr. Schrijver makes a compelling case in her book and in our conversation that we can take steps to improve wellbeing. We can envision and create a more fulfilling life for ourselves and guide our patients to greater wellbeing as well.
    Also in this episode:
    •The Six Principles of Lifestyle Medicine
    •Mentoring advice to physicians making their first career move
    •Does Press Ganey turn doctors into Nordstrom clerks?
    •How alliances can serve physicians in attaining wellbeing
    •Seeking resilience is aiming too low—aim to thrive
    Meet Iris Schrijver, MD
    Iris Schrijver is a certified lifestyle medicine physician, also specialized in clinical pathology and molecular genetics. She is an adjunct clinical professor of pathology at the Stanford University School of Medicine and a past president of the Association for Molecular Pathology. Dr. Schrijver served as medical director of Clackamas Volunteers in Medicine, and is now developing a lifestyle medicine service there, because she believes that healthcare is a basic human right.
    Her dedication to patients and to medical progress through science has resulted in the publication of many original research articles, book chapters, and books. Together with her husband, an astrophysicist, she wrote “Living with the Stars”, a popular science book about connections between the...

    • 46 min
    039 - Attorney Drops Truth Bombs about Physician Employment Contracts

    039 - Attorney Drops Truth Bombs about Physician Employment Contracts

    Attorney and author Dennis Hursh helps physicians navigate their employment contracts. He describes his shock early on in his career when he saw the lopsided language in the contracts offered to his highly trained physician clients. He points out that no hospital executive would ever agree to such contractual language for themselves.
    A sampling of items Mr. Hursh considers “insane”:

    - 24 hour call shifts (and by the way, you will work the next day, too)
    - The employer will decide if you’re disabled and has the right to terminate you if you can’t do the job
    - No paycheck for you if you can’t navigate their complex credentialing process by your start date AND they reserve the right to terminate you if you aren’t fully credentialed by your start date
    - Punitive non-compete clauses (a.k.a., restrictive covenants) that wreak professional and personal havoc rather than simply limit the loss of patients who might follow you when you leave
    - “Brutal” provisions in the contract that the administration promises they won’t enforce (but nonetheless they won’t remove the language)
    - Low starting pay with a promise (but no contractual language) of partnership to come
    - “Integration” documents that provide explanations and promises related to the formal contract (but alas, they are not enforceable unless they are in the formal contract)

    In this episode, Mr. Hursh exposes the risks lurking in several areas typically included in physician employment contracts (beware if these points are not explicitly addressed!):

    CREDENTIALING: Flexibility can be built into the contract to allow a physician to begin a narrower scope of work if certain hospital credentials or other privileges are still delayed at the start date.

    RESTRICTIVE COVENANTS (noncompete clauses): This refers to contractual language that prohibits a departing physician from practicing within a specified distance of the former employer for some period of time. Mr. Hursh draws attention to several issues regarding the distance that is specified and what is being measured: Is it the distance between the physician’s previous office and the office with the future employer? From a specific hospital or the organizational headquarters? Or from any of the employer’s sites anywhere?

    MALPRACTICE INSURANCE: He describes the critical difference between Occurrence vs. Claims-Made insurance policies. Red alert if the contract simply says “malpractice insurance is provided.” If you don’t know the difference you could be saddled with expensive “tail insurance” when you hightail it out of there.

    COMPENSATION, CALL, DUTY HOURS and LOCATION: Ambiguity is not the physician’s friend when it comes to an employment contract. Exquisite clarity about compensation and call is critical. If your future employer thinks full-time means 40 jam-packed patient-contact hours then, in reality, you could end up with a 60-hour workweek. Similarly, it’s critical to have clarity and security about your office and hospital location.

    Mr. Hursh advises physicians to hire an attorney who has experience working with physician agreements and who has the needed resources (e.g., MGMA database, up-to-date Stark regulations). An advantage of hiring an attorney is that shelling out the money for an attorney signals that the physician is taking the offer seriously. Also, contractual challenges can be raised by the attorney so that the physician doesn’t have to directly challenge a potential employer.

    Also in this episode:
    •We discuss my guest’s article “Are Hospitals Evil? A Physician Contract Attorney Explains”
    •How hospitals protect themselves while circumventing the bans on Corporate Practice of Medicine
    •The Business School Mindset (BSM) and its many manifestations in healthcare systems
    •How disdain for physicians leaks out in the language, action, and inaction of management br...

    • 1 hr
    038 - Physician Leaders Ask about Influence and Incentives

    038 - Physician Leaders Ask about Influence and Incentives

    In response to listener questions and comments, we dive into two topics in this episode. The first is influence, especially when managing “up” or when dealing with a high profile colleague. The second topic is incentives. Podcast episode #35 featured Alfie Kohn who surprised listeners when he described the negative impact of incentives on intrinsic motivation.
    We discuss a model of influence from the work of Jay Conger, who wrote extensively on the topic of influence including his bestselling book Winning ‘Em Over. Linked below is a worksheet that we use in our leadership programs. Conger describes four components of influence that can be useful when trying to persuade an audience to align with your point of view:
    • Credibility
    • Compelling Evidence
    • Common Ground
    • Connecting Emotionally

    In this episode, as in our leadership programs, we zero in on Credibility as an important foundation for influence. It is comprised of two components: your expertise as perceived by the other party (or your audience) as well as the relationships you have already built with those you are seeking to influence.

    Of the other three elements of influence, one that physicians may be tempted to overuse is Compelling Evidence or bringing data to the conversation. Finding Common Ground means walking in the shoes of your audience for a spell. The last one is Connecting Emotionally by appealing to someone’s values and leaning in with your own heart. Unlike the use of logic, emotional connection is often evoked by stories and has a lasting effect.

    After we wrap up the influence section, we turn to feedback about the podcast conversation with Alfie Kohn (#35). Based on the questions and comments we received, this incentives episode had an unsettling effect on listeners. We discuss the misguided use of incentives in healthcare and the use of incentives in mundane and repetitive tasks. We raise the possibility that steering away from incentives might steer us into better outcomes and more empowering approaches to leadership. And Lynn makes the point that we must not confuse incentives with an important and often overlooked leadership behavior: the expression of genuine appreciation.

    •Influence Worksheet: https://bit.ly/InfluenceWorksheet
    •Jay A. Conger, Winning ‘Em Over: A New Model for Management in the Age of Persuasion
    •SIGN UP FOR OUR NEWSLETTER: https://bit.ly/LicensedToLeadSignup

    • 16 min
    037 - Physician Ownership and Group Wisdom Prevail Through Crises

    037 - Physician Ownership and Group Wisdom Prevail Through Crises

    Christopher Obetz, MD, is the CEO of an organization which started with a handful of physicians 30 years ago, and now they have over 150 physicians and APPs. The group staffs nine emergency rooms in the Minneapolis St. Paul area. One year ago, Dr. Obetz was my guest on Episode #15 (Title: Emergency Care Consultants CEO: The Incalculable Value of Physician Careers). At the time, the ECC leader and his organization were faced with a trio of crises:
    •The Covid pandemic and sequelae in Emergency Medicine
    •Unexpected closure of a hospital with resultant overstaffing
    •The George Floyd murder devastated the community around ECC’s flagship hospital

    Patient volumes dropped by 40-50% during the early months of the pandemic as patients stayed clear of hospitals in order to avoid infection by Covid. ECC, which was already generously staffed, faced overstaffing as a result of reduced volumes and the hospital closure. When I spoke to Dr. Obetz last year, he wasn’t sure if the values of the organization or even the organization itself would survive. Could they get through an unprecedented nosedive in income? Could they honor the employment agreements with physicians scheduled to start in the spring of 2021? And in the aftermath of George Floyd’s death, could they examine their own biases and emerge as a trusted source of care in their stricken community?
    Dr. Obetz describes how the impact of the pandemic evolved: from the initial emptied-out emergency departments to a swelling tide of patients overwhelming their EDs. The current “boarding crisis” resulted from greatly increased demand for ED visits and inpatient beds. One reason is the pent-up demand and more advanced disease because care was delayed for typical medical conditions. The second is prolonged hospital stays for critically ill patients suffering from Covid. Patients are “boarded” when there is no ICU or regular hospital beds available and they end up receiving critical care, sometimes for days, in the emergency department. The effect on doctors and nurses and others is “bruising” as they scramble to care for patients on ventilators or crowded in the hallways, still working behind N-95 masks, gloves, and gowns.
    The organization has navigated through two years of an unpredictable and seemingly unending pandemic. Dr. Obetz describes the strategy that has underpinned their success: “We are democratic to a fault.” In fact, hiring decisions include an assessment of whether a physician will embrace the hard work, time investment, and collaborative nature of participative decision-making. Listen in as Dr. Obetz specifies how their three core values, their principles, have served the large emergency medicine group. And when it comes to the importance of physician ownership and physician leadership, Dr. Obetz is a believer.
    In this episode:
    •The expertise of previous podcast guest Alfie Kohn is invoked
    •ECC’s prime directive is the overriding priority of outstanding patient care
    •The importance of physician expertise in decision-making echoes the research of “friend of the podcast” and two-time guest, Dr. Amanda Goodall
    •The real meaning of Shift Nirvana is spelled out
    •Do ECC physicians defect to work for competitors? “It has never happened”

    Meet Christopher Obetz, MD:
    Dr. Christopher Obetz, an emergency medicine physician, is the President and CEO of Emergency Care Consultants (ECC) in Minneapolis, Minnesota. ECC is a “physician-owned, independent, and democratic” organization responsible for both outstanding emergency care and outstanding emergency medicine careers in nine hospitals in the Twin Cities area. Dr. Obetz has been leading ECC for the last decade, a period marked by significant organizational growth.
    The organization is known for its consistent high quality care and service, excellent business outcomes and sustained high satisfaction among physicians and staff. Innovation is...

    • 54 min

Customer Reviews

5.0 out of 5
20 Ratings

20 Ratings

Harvardmom ,

Excellent for everyone

I am not a medical professional, but I love this show. It’s like peeking behind the curtain of how the world of medicine really works. Who knew there was so much sneaking around? Thank you for enlightening and educating me!

Spinone-Speak ,

Authentic Content

Patty Fahy MD, offers authentic content, rarely heard in healthcare.

Zalaha4949 ,

A voice in the wilderness

Patty Fahy is a voice in the wilderness for physician leadership. Corporate MBA’s have overtaken health care in America to its detriment. The loss of autonomy for physicians has led to increased burnout and compromised patient care. Dr. Fahy presents a compelling case for the return of physician leadership. Anyone interested in the future of healthcare would be wise to listen to her words.

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