Chiefs of Cardiology Q&A

 How do you manage time differently as a chief prior to becoming chief, specifically managing the massive increase of email requests? (Vincent L. Sorrell, MD, FACP (honorary), FACC, FASE, FSCCT, FSCMR, Anthony N. DeMaria Professor of Medicine, Acting Chief, Division of Cardiovascular Medicine)
 

"If you are operating at a high level, you need to acknowledge the fact that you are going to miss an email. Personally, I used to spend my evenings and weekends getting all caught up but recently stopped doing this because it is incredibly unhealthy to work all the time. We all know there is a lot of burnout in this field, and I as anyone, am susceptible to it, especially during the pandemic. In turn, prioritizing your own health over human health is incredibly important.

When I took this job initially, I started in the September/October timeframe. This means I very soon after attended the American Heart Association sessions that November. When I was there, I went to one of the big clinical trial sessions, showing up a half an hour early with a sandwich to get a good seat. As I walked into this enormous hall, I randomly picked a section to sit in and made a beeline straight to that place. As I was getting settled, I noticed someone sitting in the very same row. As it turns out, two seats over from me, was Dr. Eugene Brown Wells. As we know, Dr. Brown is the grandfather of cardiology, and he was also my chair of medicine at the Brigham, residing as the chief of cardiology before that. Dr. Brown is a brilliant man, and a leader for decades and decades in cardiology. Then, out of luck, he was sitting right there in front of me, early, eating a sandwich too. I took this opportunity to say hello and luckily talked to him for the next 25 minutes. He ended up mentoring me on being the chief of cardiology. That time was amazing and completely priceless. To this day, one thing he told me that really stuck was 'eight hours in a day is not enough. 24 hours in a day is not enough. You can’t do it all, so you just have to put it down at some point, then pick up where you left off the next day.' He was right. 24 hours in a day is not enough, you just can’t keep it up. "

- Nancy K. Sweitzer, MD, PhD, is director of the University of Arizona Sarver Heart Center, Professor of Medicine and Chief of the Division of Cardiology in the U-Arizona College of Medicine - Tucson

"I personally create administrative days. On Monday's and Friday's, I block out time to handle these issues.  Then, on top of that, I try to push things down. For example, if one of my electrophysiologists reaches out to me, I almost always ask if they mind reviewing that matter with the section chief. With that, I try to be proactive in making sure that our leadership team knows where they speak from by having monthly meetings with section chiefs and our admin team. When you come from a standpoint of mentoring, talking about the headaches, hassles and positives, that gives everyone the ability to see what problems they need to handle."

- James Chen-tson Fang, M.D., Chief of Cardiovascular Medicine at the University of Utah School of Medicine, Director of the Cardiovascular Service Line at University of Utah Health Care

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How much clinical work do you unload as a chief? What is a feasible expectation, especially when you first step into this role? (Vincent L. Sorrell, MD, FACP (honorary), FACC, FASE, FSCCT, FSCMR, Anthony N. DeMaria Professor of Medicine, Acting Chief, Division of Cardiovascular Medicine)
 

"That's pretty highly variable. Most of us do somewhere between two and four months a year of clinical work when you add it up. For me, my clinical load is extremely heavy, as I’m doing twice as much as I am supposed to do... In the end, you must be honest with yourself about how much time it's going to take you to do the things that are expected of you. You need to be thoughtful about the clinical roles and responsibilities you accept, and how that those roles are going to interact with your other faculties. To some extent, one of the problems as chief is that you can get very out of touch as the last person to know…then you don’t know the stuff that's bubbling up. I find clinical work can be helpful for that. It gives you a presence, and the visibility."

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- Nancy K. Sweitzer, MD, PhD, is director of the University of Arizona Sarver Heart Center, Professor of Medicine and Chief of the Division of Cardiology in the U-Arizona College of Medicine - Tucson

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"That’s a good question. You know, I'm a clinician educator. Most of my portfolio is not from extramural funding. So, in result, it's part of who I am, I do a lot of clinical work. The clinical side is the most difficult side but without it, I think it's hard to have any credibility. Unless you're in the trenches, it just doesn't resonate. You just don't understand unless you feel what they're going through. So, you must be in those similar situations for you understand the frustrations. Personally, I'm a heart failure transplant guy. I do anywhere between four to six weeks of inpatient work, two half days a week in clinic and day a week in the Cath lab. So on paper, it adds up to 40% (some years ranging to 50%). In the end, they selected you to lead, not to be in the trenches. Whether you generate one RVU, or a million, it impacts the efficiency of your vision, the expectation of leadership, and frankly, your faculty to have the time to do the things that you need to do. The question is, what percentage of time allows you to have enough visibility that people know what it’s like?" 

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- James Chen-tson Fang, M.D., Chief of Cardiovascular Medicine at the University of Utah School of Medicine, Director of the Cardiovascular Service Line at University of Utah Health Care

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Suddenly, your peers become your responsibility for performance evaluations, how do you deal with this transition? (Vincent L. Sorrell, MD, FACP (honorary), FACC, FASE, FSCCT, FSCMR, Anthony N. DeMaria Professor of Medicine, Acting Chief, Division of Cardiovascular Medicine)

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"You lose all your friends when you become the chief. You’re one of the faculty, you’re best friends, and then suddenly, you're the boss. While people are still nice to you, and they like you, they are not your buddy anymore because that power relationship has shifted. You know, people warned me before I took this job that it was lonely. I was glad they told me that because then I wasn't surprised when I found that out…. When it comes to review, I do try to structure performance by having as much data as possible to back up what I want to say. Knowing what you want to say if you're unhappy with someone's performance is incredibly important because you need to approach them in a way that says 'I'm not happy with your performance, I need to see x, y and z from you, let's brainstorm how we can accomplish that together.' Cardiologists are hardworking, thoughtful, smart people. I've been impressed with my faculty that they respond to these conversations, however, some of them will get away with whatever they can get away with. When you sit them down and say something isn't acceptable, they usually respond and do it. Then, if it's a conversation happening repeatedly, typically they'll quit, which is probably what needs to happen. So, in the end, it's important to have these conversations, it's important to have them as rapidly as possible after an event, or as the situation's evolving as you can to nip it in the bud. You can't let it sit even though it's more comfortable to let it sit. Then additionally, one thing I learned very painfully in my chief role is that you don't want to be too harsh. Everyone wants to be praised. Even if you think performance is as expected, saying 'as expected' is bad. You want to tell them that they are performing superbly. You need to shower them with praise or more so, focus all your energy on correcting unacceptable behavior and praising acceptable and better behavior."

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- Nancy K. Sweitzer, MD, PhD, is director of the University of Arizona Sarver Heart Center, Professor of Medicine and Chief of the Division of Cardiology in the U-Arizona College of Medicine - Tucson

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"We have to have a written performance evaluation on all faculty annually. I do these individually with everybody. We have a standard form that every person fills out (including myself and the chair). Along with this, I always separated performance review from compensation. Inevitable, people want to talk about their compensation. In return, I always tell people I do not talk about comp at the performance review. They're in my opinion, associated issues…you're trying to promote a career, not promote their salary. I also ask the section chief to provide me with few sentences about what they think in the past year this person has done along the three axes. Then, I incorporate that into the performance review, and then I structure the performance for them along the three domains."

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- James Chen-tson Fang, M.D., Chief of Cardiovascular Medicine at the University of Utah School of Medicine, Director of the Cardiovascular Service Line at University of Utah Health Care

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How do you rate the needs of a division with the request of the DLM in hospital? What is the role DA, and how much responsibility do you leave with the individual versus your own? (Vincent L. Sorrell, MD, FACP (honorary), FACC, FASE, FSCCT, FSCMR, Anthony N. DeMaria Professor of Medicine, Acting Chief, Division of Cardiovascular Medicine)

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"I'm a big delegator, I give everything to the division administrator that I can give to her. Absolutely everything. Then, if she rises to the occasion, I give her more. She can plan faculty meetings, prepare all the data prepare monthly report, ex…. So, I think you must get somebody competent and helpful, who's an ally and an asset in that role. Then if they can't do that, you need to change that person. Additionally, it’s helpful, particularly as a new chief, to find the win wins. If something you want to accomplish is going to make your chair look good… everyone's going to be happy with you. Then that task is worth spending time on. All in all, you need to choose your battles, choose your battles, choose your battles. Then, if you're thinking about a battle, and you're not sure, get that peer network out, and talk it through with them before you head into battle, because you can really hurt yourself by fighting on something you're never going to win. There are a lot of those things and it's hard because they may be very important to you. But if you're not going to win, you're not going to win."

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- Nancy K. Sweitzer, MD, PhD, is director of the University of Arizona Sarver Heart Center, Professor of Medicine and Chief of the Division of Cardiology in the U-Arizona College of Medicine - Tucson

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"Utah, the divisional administrator, arguably, is hired by the DLM Senior administrator. We overlay knowledge, which puts our administrators in a very awkward role, as they are repeating their reporting to masters, and they’ve got either a dotted or solid line to the senior administrator medicine, and then of course, a solid line to you. In turn, we have two people to help manage us. One that really is the data person and then another person who, frankly, is more of a manager, not only with the staff, but in interpersonal relationships with faculty. While this cost money because it's two people…you don't want to run someone out of town because unlike you and me, they're not addicted to their job. When you are trying to deal with a large group of people, complex issues, and trying to make sure that the finances and etc, are, are solid, we have found it better to have two people in these roles."

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- James Chen-tson Fang, M.D., Chief of Cardiovascular Medicine at the University of Utah School of Medicine, Director of the Cardiovascular Service Line at University of Utah Health Care

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What is your approach to faculty recruitment? (Vincent L. Sorrell, MD, FACP (honorary), FACC, FASE, FSCCT, FSCMR, Anthony N. DeMaria Professor of Medicine, Acting Chief, Division of Cardiovascular Medicine)
 

"My key to success, particularly, has been that our divisions understaffed, so we have a lot of needs. In turn, one of the questions I ask prospective faculty is for them to tell me their dream job, and how they would like to spend their days. I then try to get as close to that as I can while still meeting our needs. And I can do that well, because we have so many needs. And that really helps because I think a lot of these young, particularly young candidates are going out and doing job interviews, and the chiefs are telling them, 'I need somebody who's going to do this three days a week, this one day a week, and this half a day a week.' Then, that candidate only ends up getting one half day a week to do what you want. While it might end up being the exact same job, it is just framing that conversation in a way that isn’t simply just telling them exactly what they need otherwise they can’t have a job there. "

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- Nancy K. Sweitzer, MD, PhD, is director of the University of Arizona Sarver Heart Center, Professor of Medicine and Chief of the Division of Cardiology in the U-Arizona College of Medicine - Tucson

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"I generally don’t use recruiting companies as they don’t help much for the money. I personally start with ads and networking. I involve everybody.  Now, you may have faculties that feel that this is your job so why are they participating in it? I think that's a little myopic because to be fair, this candidate will not just be working for you, but they will be working with them. So, you want them to have arguably a say in it because getting involved is in their best interest. Additionally, I’m a big believer in just getting good people. I mean, sometimes you just do need certain job descriptions. But to be fair, I think I'd rather get just fantastic person and we'll figure it out later."

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- James Chen-tson Fang, M.D., Chief of Cardiovascular Medicine at the University of Utah School of Medicine, Director of the Cardiovascular Service Line at University of Utah Health Care

 

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