Interview with Dr. Rachel George
In today’s interview, we'll hear from another great physician executive who graduated from the University of Tennessee Physician Executive MBA program. Dr. Rachel George explains how she was able to apply her expertise in quality improvement, and strategic and operational skills as a physician leader.
Dr. Rachel George obtained her medical degree from J. J. M. Medical College in Davangere, India. And she completed an internal medicine residency at Mercy Hospital in Chicago Illinois. She started part-time in management as the medical director of the Hospital Medicine Program where she started her career following residency.
From Medical Manager to Great Physician Executive
While in that role, Rachel completed her MBA at the Haslam College of Business at the University of Tennessee. Two years later, she went on to become regional medical director for a national hospital medicine company. She stayed with them for nine years and grew with them to become President of a Business Unit.
From there, she moved to a health system to be part of its population health strategy team. And then 4 years ago, she became Executive VP and Chief Medical Officer of a national physician services company.
Our Sponsor
We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.
The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.
By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.
Combining QI Expertise with Strategic and Operational Skills
During our interview, Rachel explains what it was like to work in a variety of business settings. And she provides her advice on how to become a great physician executive.
I was asked to be the medical director. And then I went back and got my MBA because I thought that if I'm going to do the job, I need to get the skills that I need to do it well.
Advancing Your Career
Her top three recommendations for advancing your career are:
- Get involved in committees and projects at whatever institution you are affiliated with.
- Keep learning topics that interest you and that might be helpful to your career. Rachel focused on quality improvement, strategic planning, and other management skills.
- Take advantage of networking with old and new colleagues and at professional society meetings such as the ACHE and AAPL.
SUMMARY
Not long after beginning her work as a full-time hospitalist, Rachel's employer recruited her to a management role. She found that she enjoyed it and that it opened up possibilities for advancing her career. Subsequently, she decided that an advanced business degree would help her situation. So, she explored her options and matriculated at one that was designed exclusively for physicians. This led to continued career advancement and opportunities in great physician executive positions.
Remember this week to please go to nonclinicalphysicians.com/voicemessage and tell us about something on the podcast that has inspired or helped you, and the positive impact it had. Add a shout-out to a particular guest, if you like. And optionally, include your name and mention your website, if you have one.
NOTE: Look below for a transcript of today's episode that you can download or read.
Links for Today's Episode:
- Dr. Rachel George's LinkedIn Profile
- University of Tennessee Physician Executive MBA Program
- Interview with Dr. Kate Atchley, Executive Director at the Haslam College of Business
- How to Emerge as an Awesome Physician Executive – 093
- 5 Steps I Took to Be a Hospital Executive – 175
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Transcription - PNC Episode 198
How a Great Physician Executive Combines QI Expertise with Strategic and Operational Skills
John: Today's guest is a great example of a physician executive who's worked in multiple settings. She did work in a hospital setting for several years, but she has a lot of experience outside the hospital setting as an executive VP and CMO. So, I really want to give a warm welcome to Dr. Rachel George. Hello.
Dr. Rachel George: Hey, John. How are you?
John: I am great. I'm so glad we could get together. You were referred to me by our sponsor, the UT PEMBA. So, that's another reason I wanted to connect with you. We'll talk about that in a minute. But yeah, what we usually do is start out with having our guests, just tell us a little bit about how they started out clinically and then walk us through what happened that led you into your management career.
Dr. Rachel George: Yeah, absolutely. So, I am an internal medicine background by physician and after finishing my residency, I was not really sure what I wanted to do when I grew up. I found a job that I really based it on geography because my husband had a job. He really liked it. I didn't want to ask him to move when I didn't know what I really wanted to do. And it was a great group of people.
So, I found myself in a hospitalist job, thinking, "Hey, I'll figure this, I'll do this for a year or two and then figure out what I want to do next". And I ended up actually really loving hospital medicine. And then shortly after I got there, I was asked to be the medical director of the group. I mean, honestly, for no other reason that I was the only person standing. We had a saying in hospital medicine back then that there were no gray-haired hospitalists, and there were not just a lot of people with experience.
So, I was asked to be the medical director, and then I went back and got my MBA because I thought that if I'm going to do the job, I need to get the skills that I need to do it well. So, I got an MBA. I grew the program there. We were very successful with the program. It continues to this day and it is a very successful program. And I was recruited to a national healthcare company, national hospital medicine company, which at the time was the largest privately held hospital medicine company VC backed, venture capital backed.
And I started as a regional medical director. I stayed there for about nine years and over the course of nine years, the organization grew and I grew with the organization. And so, by the time I left, I was president of one of their business units and managed $250 million in revenue, about 20-25 program, something like that over 12 or 15 states, somewhere in that range.
And then I left and went to a health system, where I was their senior vice president over emergency medicine, hospital medicine, for all of their 12 facilities, as part of their population health strategy. Lots of stuff happened as things happen in health systems. And I didn't stay there for very long as a new CEO came and the strategy changed and the position was eliminated. And I went to another national company as their CMO of hospital medicine, another national. This was an emergency medicine hospital medicine company, again, VC backed, privately held to lead hospital medicine. And so, those are some of the things that I've done over the last 15, 20 years of my career.
John: Okay. That's a good overview. I love it. Because I'm going to go back to some questions I have, and I didn't want to interrupt, but that's a good overview of a process. You didn't change jobs all that often. You were in an organization a couple of times there where you really grew within the organization, correct?
Dr. Rachel George: That's correct. Yeah. Especially in my first job, I was there for about five years before I was recruited away. And that was really where I started my administrative journey. It was in a hospital. I started as a medical director. I used to joke that when I first started, I was a hundred percent clinical and I did my administrative stuff on the side. And then that morphed to the point where I was a hundred percent administrative and I did my clinical stuff on the side when I got the chance.
But I really started a hundred percent clinical and doing the administrative stuff above and beyond that. A lot of committees, I can't even count the number of committees that I've been on in terms of code blue committee and the pharmacy and therapeutics committee and credentials. I was on the medic deck of the hospital. I just really took advantage of all of the leadership opportunities that were given to me at the hospital. I really took advantage of all of them.
John: Let me ask you this before you get into that next employer. Were there certain committees that you felt provided you more exposure? I found the MEC for a hospital, the medical executive committee was a good one, or I don't know, there are certain committees that seem to involve a little more learning of how to run, can you become the chair, do you run the meeting? What can you learn about the finances of the hospital? What do you think?
Dr. Rachel George: Yeah, so I think it's important to start wherever you can get a start. So you're never going to be able to start as a member of the medical executive committee. That's just not going to happen. Very rarely happens. So, what you want to do is you want to start wherever there is a need, and show your value. And they're also not going to make you chair of the committee at your first go. They're going to make you a member of the committee. So, be a member, be an active member, participate.
And as you get the opportunity, I think everybody knows what the BfR committees in the hospital are, P&T is one, credentials is another one. If there's a quality and oversight committee, that's another great one.
So, wherever you have the opportunity to be in some of these kinds of BfR committees, take the opportunity, take the opportunity to lead them, but then you have to be present. You have to be present. You have to be active, you have to participate. You can't just be there in membership only.
John: All right. And one other clarification, when you were working at that first hospital, that was a hospital-based group that you were in. It wasn't the one that was being staffed by an outside organization.
Dr. Rachel George: That's correct.
John: Although, it probably wouldn't make much difference. Because if you're a hospitalist there, whether you're employed directly or whether you're with a larger group, you're going to be involved in many of those committees, I would think.
Dr. Rachel George: Yeah. I mean, it really doesn't matter who your employer is because quite frankly, as in the hospital, you're a member of the medical staff. It doesn't matter if you're independent. It doesn't matter if you're employed by somebody else or by the hospital. You're a member of the medical staff. And as a member of the medical staff, you have all the rights as any other members of the medical staff, including the ability and truly it's an expectation that none of us kind of really fulfill, or the majority of us don't fulfill to be a member of committees and to help improve the quality of what's happening at the hospital.
John: Okay. Then you mentioned earlier that you decided to pursue an MBA and my listeners know the University of Tennessee, just because they've been a sponsor for a while, but in the sponsorship, we don't really talk about the program per se, in terms of what it's like to be in it. So, can you tell us a little bit? You said why you did it, but what were the challenges and what are you looking back on? How did you feel about that?
Dr. Rachel George: So, I'll just go through my journey just a little bit. And regardless of sponsorship, I think I would have this conversation. So, I went through and I looked at all of the executive MBAs, and living in Chicago, I had lots of options locally. And so, there were at the time only a small handful that were really focused on physicians. And so, the program at PEMBA, I really liked it at the University of Tennessee in Knoxville, for a couple of reasons.
One, it's fully accredited. And there's no question about accreditation or any concern around that. The second reason I liked it is because it's all physicians. And that's good for two reasons. You're not sitting next to a CFO as you're doing some kind of finance and accounting. I mean, starting from the same level, which is a nice place to be at.
And also, when you're talking about finance, there's a focus on healthcare finance. And they're not talking about just marketing in general. When you're talking about queuing theory, we're not talking about how you build widgets in a warehouse, you're talking about ED throughput, which is where queuing theory is incredibly relevant in the hospital. So, everything becomes very hospital, healthcare focused, which is really nice.
The other nice thing about it is the network you develop. I think the latest statistic is they have like 700 graduates or something. You have no idea how many times I call someone and they're like, "Hey, I'm a PEMBA graduate. I know what it's like". It's really nice to have that network of physicians.
John: Yeah, I had someone ask me this question. I think I might've even done a podcast episode on this. But one of the things I listed, because it's come up so many times in the past is this idea of having this cohort of people you've gone through the program with, usually you're going to stay in touch with them, but then you can also really access a lot of the graduates going through, from what I understand. And that's true of all MBAs, really. I mean, usually you're working on projects, you get to know some of the other team members and then those things last beyond your graduation from the program.
Dr. Rachel George: The other thing I liked about the UTK program more than the others, any of the others. I feel like you can do anything for a year. I mean, I'm one of these people, I think so myself for a year. And I think most physicians can do really hard stuff for a year. And I don't want to fool anybody. It was hard. They're not taking any shortcuts. It was a really, really, really hard year. But it was a year. I can do it for a year. And so, that was okay.
John: So, then you did that, you made it through this, your time there at the hospital, and then you moved on to this large national organization. And what was that transition like? I mean, that had to be a different kind of job. Did it take you very long to start to feel like part of the team? We would like to hear about that.
Dr. Rachel George: Yeah. I think the two biggest challenges that I faced as I was transitioning over was one, I was no longer in one place and just managing a team in one location. One of my mentors used to call it managing by walking around. It was what you do generally when you're in a hospital or you're in a clinic or in one setting. I was overseeing people in multiple facilities in another state. And so, now you're managing from a distance and you're managing multiple people from a distance. That is a skill that is actually quite challenging to learn. You can be given a lot of clues on some things to do to make it easier. I can certainly give you some tips on how to do that a little bit better, but it's still hard to do. You just have to learn how to figure that out. And so that was one challenge.
And I think the other challenge is going from a not-for-profit healthcare system to a for profit VC backed, venture capital backed organization. And the organizations are very different. Not in terms of the fact that we're trying to make money because gosh, you've all heard, every good healthcare organization league has told you that without margin, there's no mission, right? If you don't make a buck, you don't have a mission anymore. And so, everybody wants to make sure that they're financially viable, without a doubt.
But when you are in a privately held organization, it moves things a lot faster. You have to be a lot more agile. You have to be willing to fail fast. There's no time or patience for committees to sit around and decide if that's the right thing to do. You make decisions and you move forward.
And so, that culture is very different and it worked well for me because personally I'm like that. I like to make decisions quickly. I like to move quickly. I don't particularly like to sit in a committee for too long. I think that's why I like hospital medicine more than primary care. It's instant gratification, right? You take care of people. You get them better and get them out the door as opposed to the long game of primary care. Both are important. Both are really relevant. You just have to figure out what's the better fit for you, as an individual.
John: It seems when you're in that situation and you're making decisions and you're managing teams that are remote, I don't know, I have to imagine you would have to do a fair number of hiring and firing, because if you don't have the right team, they're not going to implement and you're not there looking over their shoulders. So, that must have been a little bit of a challenge, I would think.
Dr. Rachel George: Yeah, it is. It's always a challenge. You do want to make those decisions, because if you don't think they're the right person for the job, then they're probably not happy. So, it's really making sure people are in the right positions that are best for them. And you're doing everyone a favor by doing it sooner rather than dragging it out because the rest of your team also gets bogged down, right? Because they feel this person is not pulling their weight or whatever the case may be, and they see nothing happening about it and it makes them have a harder time as well. I will say though that the day that firing somebody becomes easy is a day you need to take a very, very, very long vacation. Because that's crazy and it should never be.
John: It's the end of your rope. And it's like, everybody's going. No, that's not good. Hopefully that doesn't happen too often. You were there for a fair length of time. What is the difference between being a regional let's say CMO and a central business unit president? What does that even mean?
Dr. Rachel George: It's a lot about how much responsibility you have, and what are those responsibilities. So, they morph into being responsible for growth and strategy as well, and not just day to day operations, not just quality, because you're always responsible for that. And then kind of strategic partnerships conversations.
So, I moved from having conversations with my hospital CEOs and C-suite to system CEOs and C-suites. Kind of morphed into a more strategic type of thinking. So, that's more long-term and larger as opposed to the individual program.
When you're a medical director, you're worried about your program, your physicians and how to ensure that you're taking great quality care of all of your patients. And then you move up and you do something a little bit more and you're worried not only about that and the individuals, you're worried about the medical director, making sure that they are providing great leadership for their team. But then you're also worried about how's the relationship with the C-suite. You're worried about helping the hospital executives achieve their goals. And then as you move up, you're worried about how do you expand your organization? How do you expand your footprint? How do you ensure that you have strategic connections with systems?
John: Yeah, that sounds like a good distinction between what someone might say the difference between management and leadership in that kind of setting is more strategy, more about the mission, the vision and that sort of thing, as opposed to making sure that this unit's open tomorrow or someone shows up for work.
Dr. Rachel George: That's right. That's right. In some ways it's easier and in some ways it's harder. Dealing with the one-to-one individual that doesn't have that really high management skill set is harder than dealing with the people who have really high management skillsets to begin with. But then it's a bigger challenge.
John: Bigger challenge and responsibility. And if you get the strategy wrong, it's going to take a long time to reverse or shift gears then if you just hire the wrong person or maybe do something on a unit that it doesn't work for a few days, you just redo it.
Dr. Rachel George: The mistakes are a lot bigger. Oh, yeah.
John: So, then you move from that organization. Are you doing similar things in what your role is now? Explain more about what you're doing with the current organization.
Dr. Rachel George: Actually, I'm in transition right now. But my most recent organization, my title was CMO, but it was very operational. The title CMO varies very much from organization to organization. Some of them are very much just focused on quality. Some of them are focused on relations and community relations, and some of them are focused more on operations and strategy. And there's a mix of them. So, it's how CMO actually means a lot. Chief medical officer, at least. Not chief marketing officer, chief medical officer.
John: Right.
Dr. Rachel George: And so, where I was, it was operations and strategy and things like that. And so, really working with the hospital medicine team, turning it around. It was losing quite a bit of money when I got to the organization. And so, we were able to turn that around. Really moving from a strategy perspective, we moved into value-based care, brought in new technology and did tele-health and tele-nocturnists. So, a lot of larger big picture strategic types of things and a bigger footprint.
John: Okay. Well, I think just by virtue of what you've told us from your story, it's very inspirational. But let's go back to those that are really early in the process and they're thinking, "Okay, this sounds like it might be fun. I may or may not need to get that MBA right away". But maybe you can tell us what in your experience are like two or three of the major steps or strategies or tactics that someone might take, if they really think they want to pursue a similar career in the future.
Dr. Rachel George: Yeah. So, a couple of things that I would say is, wherever you are, whatever you're doing, get involved. I've had conversations several times with other physicians' executives and we all get frustrated with the same thing, which every once in a while, we have someone come up to us who may have a tremendous amount of experience as a clinician and it's probably a spectacular clinician, but who wants to jump into leadership and usually wants to be the CMO of the hospital.
I mean, they don't want to start for less than that. And you ask them what they've done. And the fact is that they've done nothing in terms of truly objective leadership. There's a lot of subjective stuff. You are kind of the unspoken leader and all of that kind of stuff, and that's important as well, but really objectively, what are you doing?
And so, that's why I'll say in your hospital, get involved in committees, chair committees. I promise you they will be happy to have you, and have you on a committee. They're always looking for people. If you're a member of a medical group, what can you do in your medical group to provide leadership, and what are the opportunities there. And whether it's quality or making the schedule or whatever the case may be, let's find opportunities for leadership there.
As you do that, think about what it is that really interests you. Because we were talking about the different roles that CMOs have. You can take a quality track. You can take if you're focused on operations, if you're focused on strategy. I mean, what is it that you really enjoy doing? And trying to really focus on that and hone in on that and get good at that. So, if your focus is on quality, then make sure that you understand and educate yourself on what is happening nationally in quality. What are the metrics that you should be looking at?
So, start educating yourself on whatever it is that you want to be doing. And my way of doing that was to go get an MBA, but that is certainly not the only way to do that. So, educate yourself whether formally or informally on whatever it is that you're interested in. That would be two.
The third thing I would say is start networking. Three or four of the jobs I've gotten were all because of my network. I was rarely out looking for a position and my network contacted me and said, "Hey, this is something we think you might be interested in". And so, network. Go to professional society meetings, think about the American Association of Physician Leadership, AAPL. Become members there. Become a member of your specialty.
So, I was a member of the society of hospital medicine or the American cardiology society, or the American society of critical care medicine. Whatever your specialty is, become involved there. Become involved in committees at those organizations. Again, they're always looking for people to participate. Become involved, show your leadership and start networking. And so, network, network, network, network, network, meet people, go to meetings, go to local meetings, go to chapter meetings, meet people, put yourself out there and volunteer for leadership. Don't expect to get paid at the beginning. You're not going to, but what you're doing is building up the network of people, but also the experience that will help you get to the next level. So, lots of committees, do a lot of things, educate yourself, and network. So those are the three.
John: I think those are great bits of advice. I think people forget that whether it's your state medical society, your professional society at the state or national level, they all have committees. They all have things they're trying to do. They need input and pay. There are 10 other doctors on the committee. Why shouldn't you be the chair after a couple of years? And that's really where you're going to get the nitty gritty experience I would think, then just sort of showing up on a Zoom call or showing up at a live meeting for an hour and then going home.
All right. Well, that is very interesting and instructive. The networking. When we think about networking, we're like, "Oh, we're going to go to a meeting or to stand around a table with a drink at the end", which is like, I couldn't do it. I'm just such an introvert. But you're talking about really just staying in touch with people that you meet, that you run into, particularly on these committees and these organizations. Can you think of some of the people that you got their jobs from? What was their relationship to you? Just to get a little insight into that.
Dr. Rachel George: Yeah. So first of all, let me just say, most people have left me because I've learned to be personable and in crowds, but I am very much an introvert and nothing stresses me more than going into a room full of people that I don't know and trying to make conversation. And I think about it. So, if any of you see me at a meeting, come up to me and talk to me, I will be grateful for life because I am standing in a corner just shivering because I hate it. So, I get it, all right? Which is why committees are a good thing to do because you're automatically thrown into a small group where we all focus on the same thing.
But one of the first opportunities that I got was because I was involved with the society of hospital medicine. I attended one of their leadership conferences, which was a much smaller group. And I went off to someone there and I spoke to several people that I got to meet there. And I said, "Hey, I'm looking for new opportunities. And so, if you hear anything, this is what I've done. This is who I am, this is what I've done". And by then I had my MBA too. I said "I have my MBA and this is what I've done".
And honestly, I got a call. It was months later. I got a call months later. And I honestly thought it was some committee work that I was working on with them. I thought they were calling me about a committee. They said, "Hey, I have a job offer for you". And I remember I was in the car having this conversation because literally I thought it was about committee work. "It's not that important. I'll just take the call in the car, no big deal". I almost drove off the road because I was so surprised. And it wasn't somebody that I knew well. I have come to know them incredibly well over the years, but at the time I spoke to them half a dozen times in all around the staff. Other than that conversation that I've had initially, it was all around stuff that was very specific to stuff that we were doing together with in committees. And so, networking is just so important.
John: Well, you're probably not going to tell us this, but probably in that interaction about those committees, you were always on time, you were doing work, you were making them satisfied. They were seeing your work ethic. And so, it's not just you just show up, but actually perform.
Dr. Rachel George: That goes without saying. Don't plan to be anywhere late ever. That's just a non-starter. And you can't just show up at the Zoom meeting. You have to be there, you have to participate, you have to volunteer, and then you have to fulfill your commitment to keep saying that you're going to research something and get back to the team, research and get back to the team.
John: I suppose the networking could go both ways if you're given different responsibilities and you blow them off and you don't show up and you don't call, it's going to definitely work to the negative in that case.
Dr. Rachel George: Absolutely. Absolutely. And we all know those people too. Right? We all know those people. Don't give them that task if you know they're not going to get it done and they don't follow up. So, don't be one of them.
John: All right. Well, that has been very fun to listen to and hear your story and what you've learned and shared with us. We could probably go on for another hour or two, but I got to respect your time. So, we're going to end here in a minute, but any last words of advice or encouragement for our listeners that might be thinking about doing something like this.
Dr. Rachel George: Yeah. I will say that right now is probably a really difficult time in healthcare. There are a lot of people looking to get out of clinical medicine for all of the challenges that we faced in the last year and to go into things that are outside of clinical medicine. So, some things that I'll say is don't be discouraged. Because as many people are looking outside of medicine, there are just as many opportunities that are opening up.
Really explore what it is that you want to do. There is so much out in the world, out there outside of the hospital. Healthcare technology, if you are interested in tech is just booming right now. And every single organization needs clinical expertise. Be willing to volunteer your time if necessary, or be willing to do something part-time or to act as an advisor. To get the experience, get your foot in the door, and start meeting people.
John: All right. Thank you for that. Rachel, this has been fun. I really appreciate you being with us today. And I guess at this point with that, I'll say goodbye.
Dr. Rachel George: Bye-bye. Thank you so much.
John: It's been my pleasure.
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Transcription - PNC Episode 198
How a Great Physician Executive Combines QI Expertise with Strategic and Operational Skills
John: Today's guest is a great example of a physician executive who's worked in multiple settings. She did work in a hospital setting for several years, but she has a lot of experience outside the hospital setting as an executive VP and CMO. So, I really want to give a warm welcome to Dr. Rachel George. Hello.
Dr. Rachel George: Hey, John. How are you?
John: I am great. I'm so glad we could get together. You were referred to me by our sponsor, the UT PEMBA. So, that's another reason I wanted to connect with you. We'll talk about that in a minute. But yeah, what we usually do is start out with having our guests, just tell us a little bit about how they started out clinically and then walk us through what happened that led you into your management career.
Dr. Rachel George: Yeah, absolutely. So, I am an internal medicine background by physician and after finishing my residency, I was not really sure what I wanted to do when I grew up. I found a job that I really based it on geography because my husband had a job. He really liked it. I didn't want to ask him to move when I didn't know what I really wanted to do. And it was a great group of people.
So, I found myself in a hospitalist job, thinking, "Hey, I'll figure this, I'll do this for a year or two and then figure out what I want to do next". And I ended up actually really loving hospital medicine. And then shortly after I got there, I was asked to be the medical director of the group. I mean, honestly, for no other reason that I was the only person standing. We had a saying in hospital medicine back then that there were no gray-haired hospitalists, and there were not just a lot of people with experience.
So, I was asked to be the medical director, and then I went back and got my MBA because I thought that if I'm going to do the job, I need to get the skills that I need to do it well. So, I got an MBA. I grew the program there. We were very successful with the program. It continues to this day and it is a very successful program. And I was recruited to a national healthcare company, national hospital medicine company, which at the time was the largest privately held hospital medicine company VC backed, venture capital backed.
And I started as a regional medical director. I stayed there for about nine years and over the course of nine years, the organization grew and I grew with the organization. And so, by the time I left, I was president of one of their business units and managed $250 million in revenue, about 20-25 program, something like that over 12 or 15 states, somewhere in that range.
And then I left and went to a health system, where I was their senior vice president over emergency medicine, hospital medicine, for all of their 12 facilities, as part of their population health strategy. Lots of stuff happened as things happen in health systems. And I didn't stay there for very long as a new CEO came and the strategy changed and the position was eliminated. And I went to another national company as their CMO of hospital medicine, another national. This was an emergency medicine hospital medicine company, again, VC backed, privately held to lead hospital medicine. And so, those are some of the things that I've done over the last 15, 20 years of my career.
John: Okay. That's a good overview. I love it. Because I'm going to go back to some questions I have, and I didn't want to interrupt, but that's a good overview of a process. You didn't change jobs all that often. You were in an organization a couple of times there where you really grew within the organization, correct?
Dr. Rachel George: That's correct. Yeah. Especially in my first job, I was there for about five years before I was recruited away. And that was really where I started my administrative journey. It was in a hospital. I started as a medical director. I used to joke that when I first started, I was a hundred percent clinical and I did my administrative stuff on the side. And then that morphed to the point where I was a hundred percent administrative and I did my clinical stuff on the side when I got the chance.
But I really started a hundred percent clinical and doing the administrative stuff above and beyond that. A lot of committees, I can't even count the number of committees that I've been on in terms of code blue committee and the pharmacy and therapeutics committee and credentials. I was on the medic deck of the hospital. I just really took advantage of all of the leadership opportunities that were given to me at the hospital. I really took advantage of all of them.
John: Let me ask you this before you get into that next employer. Were there certain committees that you felt provided you more exposure? I found the MEC for a hospital, the medical executive committee was a good one, or I don't know, there are certain committees that seem to involve a little more learning of how to run, can you become the chair, do you run the meeting? What can you learn about the finances of the hospital? What do you think?
Dr. Rachel George: Yeah, so I think it's important to start wherever you can get a start. So you're never going to be able to start as a member of the medical executive committee. That's just not going to happen. Very rarely happens. So, what you want to do is you want to start wherever there is a need, and show your value. And they're also not going to make you chair of the committee at your first go. They're going to make you a member of the committee. So, be a member, be an active member, participate.
And as you get the opportunity, I think everybody knows what the BfR committees in the hospital are, P&T is one, credentials is another one. If there's a quality and oversight committee, that's another great one.
So, wherever you have the opportunity to be in some of these kinds of BfR committees, take the opportunity, take the opportunity to lead them, but then you have to be present. You have to be present. You have to be active, you have to participate. You can't just be there in membership only.
John: All right. And one other clarification, when you were working at that first hospital, that was a hospital-based group that you were in. It wasn't the one that was being staffed by an outside organization.
Dr. Rachel George: That's correct.
John: Although, it probably wouldn't make much difference. Because if you're a hospitalist there, whether you're employed directly or whether you're with a larger group, you're going to be involved in many of those committees, I would think.
Dr. Rachel George: Yeah. I mean, it really doesn't matter who your employer is because quite frankly, as in the hospital, you're a member of the medical staff. It doesn't matter if you're independent. It doesn't matter if you're employed by somebody else or by the hospital. You're a member of the medical staff. And as a member of the medical staff, you have all the rights as any other members of the medical staff, including the ability and truly it's an expectation that none of us kind of really fulfill, or the majority of us don't fulfill to be a member of committees and to help improve the quality of what's happening at the hospital.
John: Okay. Then you mentioned earlier that you decided to pursue an MBA and my listeners know the University of Tennessee, just because they've been a sponsor for a while, but in the sponsorship, we don't really talk about the program per se, in terms of what it's like to be in it. So, can you tell us a little bit? You said why you did it, but what were the challenges and what are you looking back on? How did you feel about that?
Dr. Rachel George: So, I'll just go through my journey just a little bit. And regardless of sponsorship, I think I would have this conversation. So, I went through and I looked at all of the executive MBAs, and living in Chicago, I had lots of options locally. And so, there were at the time only a small handful that were really focused on physicians. And so, the program at PEMBA, I really liked it at the University of Tennessee in Knoxville, for a couple of reasons.
One, it's fully accredited. And there's no question about accreditation or any concern around that. The second reason I liked it is because it's all physicians. And that's good for two reasons. You're not sitting next to a CFO as you're doing some kind of finance and accounting. I mean, starting from the same level, which is a nice place to be at.
And also, when you're talking about finance, there's a focus on healthcare finance. And they're not talking about just marketing in general. When you're talking about queuing theory, we're not talking about how you build widgets in a warehouse, you're talking about ED throughput, which is where queuing theory is incredibly relevant in the hospital. So, everything becomes very hospital, healthcare focused, which is really nice.
The other nice thing about it is the network you develop. I think the latest statistic is they have like 700 graduates or something. You have no idea how many times I call someone and they're like, "Hey, I'm a PEMBA graduate. I know what it's like". It's really nice to have that network of physicians.
John: Yeah, I had someone ask me this question. I think I might've even done a podcast episode on this. But one of the things I listed, because it's come up so many times in the past is this idea of having this cohort of people you've gone through the program with, usually you're going to stay in touch with them, but then you can also really access a lot of the graduates going through, from what I understand. And that's true of all MBAs, really. I mean, usually you're working on projects, you get to know some of the other team members and then those things last beyond your graduation from the program.
Dr. Rachel George: The other thing I liked about the UTK program more than the others, any of the others. I feel like you can do anything for a year. I mean, I'm one of these people, I think so myself for a year. And I think most physicians can do really hard stuff for a year. And I don't want to fool anybody. It was hard. They're not taking any shortcuts. It was a really, really, really hard year. But it was a year. I can do it for a year. And so, that was okay.
John: So, then you did that, you made it through this, your time there at the hospital, and then you moved on to this large national organization. And what was that transition like? I mean, that had to be a different kind of job. Did it take you very long to start to feel like part of the team? We would like to hear about that.
Dr. Rachel George: Yeah. I think the two biggest challenges that I faced as I was transitioning over was one, I was no longer in one place and just managing a team in one location. One of my mentors used to call it managing by walking around. It was what you do generally when you're in a hospital or you're in a clinic or in one setting. I was overseeing people in multiple facilities in another state. And so, now you're managing from a distance and you're managing multiple people from a distance. That is a skill that is actually quite challenging to learn. You can be given a lot of clues on some things to do to make it easier. I can certainly give you some tips on how to do that a little bit better, but it's still hard to do. You just have to learn how to figure that out. And so that was one challenge.
And I think the other challenge is going from a not-for-profit healthcare system to a for profit VC backed, venture capital backed organization. And the organizations are very different. Not in terms of the fact that we're trying to make money because gosh, you've all heard, every good healthcare organization league has told you that without margin, there's no mission, right? If you don't make a buck, you don't have a mission anymore. And so, everybody wants to make sure that they're financially viable, without a doubt.
But when you are in a privately held organization, it moves things a lot faster. You have to be a lot more agile. You have to be willing to fail fast. There's no time or patience for committees to sit around and decide if that's the right thing to do. You make decisions and you move forward.
And so, that culture is very different and it worked well for me because personally I'm like that. I like to make decisions quickly. I like to move quickly. I don't particularly like to sit in a committee for too long. I think that's why I like hospital medicine more than primary care. It's instant gratification, right? You take care of people. You get them better and get them out the door as opposed to the long game of primary care. Both are important. Both are really relevant. You just have to figure out what's the better fit for you, as an individual.
John: It seems when you're in that situation and you're making decisions and you're managing teams that are remote, I don't know, I have to imagine you would have to do a fair number of hiring and firing, because if you don't have the right team, they're not going to implement and you're not there looking over their shoulders. So, that must have been a little bit of a challenge, I would think.
Dr. Rachel George: Yeah, it is. It's always a challenge. You do want to make those decisions, because if you don't think they're the right person for the job, then they're probably not happy. So, it's really making sure people are in the right positions that are best for them. And you're doing everyone a favor by doing it sooner rather than dragging it out because the rest of your team also gets bogged down, right? Because they feel this person is not pulling their weight or whatever the case may be, and they see nothing happening about it and it makes them have a harder time as well. I will say though that the day that firing somebody becomes easy is a day you need to take a very, very, very long vacation. Because that's crazy and it should never be.
John: It's the end of your rope. And it's like, everybody's going. No, that's not good. Hopefully that doesn't happen too often. You were there for a fair length of time. What is the difference between being a regional let's say CMO and a central business unit president? What does that even mean?
Dr. Rachel George: It's a lot about how much responsibility you have, and what are those responsibilities. So, they morph into being responsible for growth and strategy as well, and not just day to day operations, not just quality, because you're always responsible for that. And then kind of strategic partnerships conversations.
So, I moved from having conversations with my hospital CEOs and C-suite to system CEOs and C-suites. Kind of morphed into a more strategic type of thinking. So, that's more long-term and larger as opposed to the individual program.
When you're a medical director, you're worried about your program, your physicians and how to ensure that you're taking great quality care of all of your patients. And then you move up and you do something a little bit more and you're worried not only about that and the individuals, you're worried about the medical director, making sure that they are providing great leadership for their team. But then you're also worried about how's the relationship with the C-suite. You're worried about helping the hospital executives achieve their goals. And then as you move up, you're worried about how do you expand your organization? How do you expand your footprint? How do you ensure that you have strategic connections with systems?
John: Yeah, that sounds like a good distinction between what someone might say the difference between management and leadership in that kind of setting is more strategy, more about the mission, the vision and that sort of thing, as opposed to making sure that this unit's open tomorrow or someone shows up for work.
Dr. Rachel George: That's right. That's right. In some ways it's easier and in some ways it's harder. Dealing with the one-to-one individual that doesn't have that really high management skill set is harder than dealing with the people who have really high management skillsets to begin with. But then it's a bigger challenge.
John: Bigger challenge and responsibility. And if you get the strategy wrong, it's going to take a long time to reverse or shift gears then if you just hire the wrong person or maybe do something on a unit that it doesn't work for a few days, you just redo it.
Dr. Rachel George: The mistakes are a lot bigger. Oh, yeah.
John: So, then you move from that organization. Are you doing similar things in what your role is now? Explain more about what you're doing with the current organization.
Dr. Rachel George: Actually, I'm in transition right now. But my most recent organization, my title was CMO, but it was very operational. The title CMO varies very much from organization to organization. Some of them are very much just focused on quality. Some of them are focused on relations and community relations, and some of them are focused more on operations and strategy. And there's a mix of them. So, it's how CMO actually means a lot. Chief medical officer, at least. Not chief marketing officer, chief medical officer.
John: Right.
Dr. Rachel George: And so, where I was, it was operations and strategy and things like that. And so, really working with the hospital medicine team, turning it around. It was losing quite a bit of money when I got to the organization. And so, we were able to turn that around. Really moving from a strategy perspective, we moved into value-based care, brought in new technology and did tele-health and tele-nocturnists. So, a lot of larger big picture strategic types of things and a bigger footprint.
John: Okay. Well, I think just by virtue of what you've told us from your story, it's very inspirational. But let's go back to those that are really early in the process and they're thinking, "Okay, this sounds like it might be fun. I may or may not need to get that MBA right away". But maybe you can tell us what in your experience are like two or three of the major steps or strategies or tactics that someone might take, if they really think they want to pursue a similar career in the future.
Dr. Rachel George: Yeah. So, a couple of things that I would say is, wherever you are, whatever you're doing, get involved. I've had conversations several times with other physicians' executives and we all get frustrated with the same thing, which every once in a while, we have someone come up to us who may have a tremendous amount of experience as a clinician and it's probably a spectacular clinician, but who wants to jump into leadership and usually wants to be the CMO of the hospital.
I mean, they don't want to start for less than that. And you ask them what they've done. And the fact is that they've done nothing in terms of truly objective leadership. There's a lot of subjective stuff. You are kind of the unspoken leader and all of that kind of stuff, and that's important as well, but really objectively, what are you doing?
And so, that's why I'll say in your hospital, get involved in committees, chair committees. I promise you they will be happy to have you, and have you on a committee. They're always looking for people. If you're a member of a medical group, what can you do in your medical group to provide leadership, and what are the opportunities there. And whether it's quality or making the schedule or whatever the case may be, let's find opportunities for leadership there.
As you do that, think about what it is that really interests you. Because we were talking about the different roles that CMOs have. You can take a quality track. You can take if you're focused on operations, if you're focused on strategy. I mean, what is it that you really enjoy doing? And trying to really focus on that and hone in on that and get good at that. So, if your focus is on quality, then make sure that you understand and educate yourself on what is happening nationally in quality. What are the metrics that you should be looking at?
So, start educating yourself on whatever it is that you want to be doing. And my way of doing that was to go get an MBA, but that is certainly not the only way to do that. So, educate yourself whether formally or informally on whatever it is that you're interested in. That would be two.
The third thing I would say is start networking. Three or four of the jobs I've gotten were all because of my network. I was rarely out looking for a position and my network contacted me and said, "Hey, this is something we think you might be interested in". And so, network. Go to professional society meetings, think about the American Association of Physician Leadership, AAPL. Become members there. Become a member of your specialty.
So, I was a member of the society of hospital medicine or the American cardiology society, or the American society of critical care medicine. Whatever your specialty is, become involved there. Become involved in committees at those organizations. Again, they're always looking for people to participate. Become involved, show your leadership and start networking. And so, network, network, network, network, network, meet people, go to meetings, go to local meetings, go to chapter meetings, meet people, put yourself out there and volunteer for leadership. Don't expect to get paid at the beginning. You're not going to, but what you're doing is building up the network of people, but also the experience that will help you get to the next level. So, lots of committees, do a lot of things, educate yourself, and network. So those are the three.
John: I think those are great bits of advice. I think people forget that whether it's your state medical society, your professional society at the state or national level, they all have committees. They all have things they're trying to do. They need input and pay. There are 10 other doctors on the committee. Why shouldn't you be the chair after a couple of years? And that's really where you're going to get the nitty gritty experience I would think, then just sort of showing up on a Zoom call or showing up at a live meeting for an hour and then going home.
All right. Well, that is very interesting and instructive. The networking. When we think about networking, we're like, "Oh, we're going to go to a meeting or to stand around a table with a drink at the end", which is like, I couldn't do it. I'm just such an introvert. But you're talking about really just staying in touch with people that you meet, that you run into, particularly on these committees and these organizations. Can you think of some of the people that you got their jobs from? What was their relationship to you? Just to get a little insight into that.
Dr. Rachel George: Yeah. So first of all, let me just say, most people have left me because I've learned to be personable and in crowds, but I am very much an introvert and nothing stresses me more than going into a room full of people that I don't know and trying to make conversation. And I think about it. So, if any of you see me at a meeting, come up to me and talk to me, I will be grateful for life because I am standing in a corner just shivering because I hate it. So, I get it, all right? Which is why committees are a good thing to do because you're automatically thrown into a small group where we all focus on the same thing.
But one of the first opportunities that I got was because I was involved with the society of hospital medicine. I attended one of their leadership conferences, which was a much smaller group. And I went off to someone there and I spoke to several people that I got to meet there. And I said, "Hey, I'm looking for new opportunities. And so, if you hear anything, this is what I've done. This is who I am, this is what I've done". And by then I had my MBA too. I said "I have my MBA and this is what I've done".
And honestly, I got a call. It was months later. I got a call months later. And I honestly thought it was some committee work that I was working on with them. I thought they were calling me about a committee. They said, "Hey, I have a job offer for you". And I remember I was in the car having this conversation because literally I thought it was about committee work. "It's not that important. I'll just take the call in the car, no big deal". I almost drove off the road because I was so surprised. And it wasn't somebody that I knew well. I have come to know them incredibly well over the years, but at the time I spoke to them half a dozen times in all around the staff. Other than that conversation that I've had initially, it was all around stuff that was very specific to stuff that we were doing together with in committees. And so, networking is just so important.
John: Well, you're probably not going to tell us this, but probably in that interaction about those committees, you were always on time, you were doing work, you were making them satisfied. They were seeing your work ethic. And so, it's not just you just show up, but actually perform.
Dr. Rachel George: That goes without saying. Don't plan to be anywhere late ever. That's just a non-starter. And you can't just show up at the Zoom meeting. You have to be there, you have to participate, you have to volunteer, and then you have to fulfill your commitment to keep saying that you're going to research something and get back to the team, research and get back to the team.
John: I suppose the networking could go both ways if you're given different responsibilities and you blow them off and you don't show up and you don't call, it's going to definitely work to the negative in that case.
Dr. Rachel George: Absolutely. Absolutely. And we all know those people too. Right? We all know those people. Don't give them that task if you know they're not going to get it done and they don't follow up. So, don't be one of them.
John: All right. Well, that has been very fun to listen to and hear your story and what you've learned and shared with us. We could probably go on for another hour or two, but I got to respect your time. So, we're going to end here in a minute, but any last words of advice or encouragement for our listeners that might be thinking about doing something like this.
Dr. Rachel George: Yeah. I will say that right now is probably a really difficult time in healthcare. There are a lot of people looking to get out of clinical medicine for all of the challenges that we faced in the last year and to go into things that are outside of clinical medicine. So, some things that I'll say is don't be discouraged. Because as many people are looking outside of medicine, there are just as many opportunities that are opening up.
Really explore what it is that you want to do. There is so much out in the world, out there outside of the hospital. Healthcare technology, if you are interested in tech is just booming right now. And every single organization needs clinical expertise. Be willing to volunteer your time if necessary, or be willing to do something part-time or to act as an advisor. To get the experience, get your foot in the door, and start meeting people.
John: All right. Thank you for that. Rachel, this has been fun. I really appreciate you being with us today. And I guess at this point with that, I'll say goodbye.
Dr. Rachel George: Bye-bye. Thank you so much.
John: It's been my pleasure.
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