Latest / Becker’s Healthcare Podcast / Leading Through Uncertainty in Academic Medicine

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Leading Through Uncertainty in Academic Medicine · Becker’s Healthcare Podcast

• 0:02
  - The playbook for running a successful ASC in
• 0:04
  - 2026
• 0:06
  - looks almost nothing like it did a few
• 0:07
  - years ago.
• 0:08
  - And the one for 2029
• 0:10
  - probably won't look like this one either.
• 0:12
  - Case complexity is increasing. Payer models are shifting.
• 0:16
  - Technology is creating new possibilities
• 0:19
  - and new cost pressures at the same time.
• 0:21
  - The spine and orthopedic leaders who are staying
• 0:24
  - ahead aren't just keeping up with the changes.
• 0:27
  - They are in rooms where the changes get
• 0:29
  - talked about honestly. Becker's twenty third annual Spine
• 0:29
  - Orthopedic and Pain honestly.
• 0:31
  - Becker's twenty third annual Spine Orthopedic and Pain
• 0:33
  - Management Driven ASC Conference is such a space.
• 0:37
  - More than 1,000 attendees,
• 0:39
  - 275
• 0:40
  - plus physician and ASC speakers, three days of
• 0:43
  - programming across the clinical,
• 0:45
  - operational, and strategic
• 0:47
  - with CME credits available.
• 0:49
  - Join us June eleventh through the thirteenth. For
• 0:52
  - the agenda and event details, visit Becker's hospital
• 0:55
  - review and click on the events tab in
• 0:57
  - the upper right.
• 0:59
  - This is Gracelyn Keller with the Becker's Healthcare
• 1:01
  - Podcast, and we are recording live at the
• 1:03
  - twenty third annual Spine Orthopedic and Pain Management
• 1:06
  - Driven ASC Conference.
• 1:08
  - I'm joined currently by doctor William Levine, who
• 1:11
  - is
• 1:12
  - a Frank E Stinchfield professor and chair at
• 1:14
  - the orthopedic surgery department at New York Presbyterian
• 1:17
  - Columbia University Medical Center. So Doctor. Levine, thank
• 1:21
  - you for being here and I'll have you
• 1:23
  - briefly introduce yourself a little bit further. Tell
• 1:25
  - us more about your different roles and the
• 1:27
  - organizations you work with.
• 1:29
  - And then let's talk about what's currently commanding
• 1:31
  - most of your attention as a leader right
• 1:33
  - now.
• 1:33
  - Well, thanks so much for having me, and,
• 1:35
  - it's great to be here at the, at
• 1:38
  - this meeting.
• 1:39
  - So I am, the chairman of orthopedics
• 1:42
  - at New York Presbyterian
• 1:43
  - and Columbia Orthopedics, and that's a job I
• 1:45
  - have, that title I've held since 2014.
• 1:50
  - I'm also the chief of the shoulder service,
• 1:52
  - which is the oldest shoulder service in the
• 1:55
  - world. It's actually started in 1970,
• 1:58
  - '5. We're gonna be or it's 1975,
• 2:01
  - '76. We're gonna be celebrating our fiftieth year
• 2:03
  - anniversary,
• 2:04
  - coming up, so it's pretty exciting.
• 2:07
  - And,
• 2:08
  - I serve as the fellowship director for the
• 2:10
  - for our fellowship,
• 2:11
  - and,
• 2:13
  - I guess most of the things that I
• 2:15
  - spend my time on now well, first of
• 2:17
  - all, I'm still a very busy clinician, and
• 2:19
  - I love being a doctor. So that's the
• 2:20
  - most important thing because I never went into
• 2:23
  - leadership thinking that I would be one of
• 2:25
  - those leaders in the Ivory Tower and kind
• 2:27
  - of,
• 2:29
  - I guess, telling people what to do from
• 2:31
  - above and not really knowing what was happening
• 2:33
  - down on the on the at the grassroots
• 2:34
  - level. And I think as a surgical chair,
• 2:37
  - that's very different than if you're in internal
• 2:39
  - medicine or some of the the,
• 2:41
  - less procedural
• 2:42
  - oriented specialties,
• 2:45
  - because I don't think you can really lead
• 2:47
  - in surgery if you don't know what's happening
• 2:49
  - in the Operating Rooms. And furthermore, I I
• 2:52
  - love being an orthopedic surgeon.
• 2:54
  - So I spend a lot of my time
• 2:56
  - still practicing,
• 2:58
  - orthopedics every day and and operating. And then
• 3:01
  - what I've done in my leadership
• 3:03
  - style is I've condensed
• 3:05
  - my clinical practice
• 3:07
  - into
• 3:08
  - smaller parts, but I haven't condensed the volume
• 3:12
  - of medicine that I perform. You're supposed to
• 3:14
  - reduce
• 3:15
  - your clinical practice by about 30 to 40%,
• 3:17
  - they say, and I chose not to do
• 3:19
  - that.
• 3:20
  - And it helps because I don't sleep.
• 3:23
  - And so,
• 3:24
  - I I literally only sleep about four hours,
• 3:26
  - at night.
• 3:27
  - And so,
• 3:29
  - the things that really keep me up at
• 3:30
  - night, when I am up and not sleeping,
• 3:34
  - I think that we're in a really challenging
• 3:36
  - time right now in health care.
• 3:38
  - Academic medical centers are no different than the
• 3:41
  - rest of, I think health care, but are
• 3:43
  - are feeling a specific
• 3:45
  - squeeze that perhaps
• 3:47
  - others aren't. And especially if you happen to
• 3:49
  - be in a blue state and New York
• 3:51
  - is about as blue as it gets in
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  - some fashions, there's a lot of red around.
• 3:55
  - But in Manhattan, obviously, it's very blue.
• 3:58
  - And from a political standpoint, it's blue. And
• 4:01
  - so that has really caused a lot of
• 4:03
  - consternation,
• 4:05
  - for our our political leaders and for our
• 4:07
  - health care organizations because a lot of decisions,
• 4:10
  - as you know, from last year,
• 4:12
  - when the, the administration at the White House
• 4:14
  - decided to,
• 4:16
  - hold federal grants,
• 4:18
  - back,
• 4:19
  - that was to the tune of about $450,000,000
• 4:22
  - at Columbia specifically.
• 4:24
  - That shut down labs that took people who
• 4:27
  - were here from around the world to do
• 4:29
  - their PhDs or do their postdocs or to
• 4:31
  - do their master's programs, and literally, they had
• 4:34
  - to leave. So people don't understand the personal
• 4:37
  - toil. It wasn't just a a political move
• 4:40
  - that was a very personal and professional tool.
• 4:42
  - So so that was, you know, an unbelievable
• 4:45
  - challenge.
• 4:47
  - We just came away from the New York,
• 4:49
  - NYSNA, the New York's, State Nursing Association,
• 4:52
  - had the longest strike in the history
• 4:55
  - of nursing strikes, forty four days,
• 4:58
  - which really they tried to bring the the
• 5:00
  - hospital system down to its knees, and, thankfully,
• 5:03
  - that didn't happen. But it was, you know,
• 5:05
  - both politically and professionally and personally very challenging
• 5:09
  - for all of us. So I think one
• 5:11
  - of the things that happens in leadership is
• 5:13
  - that you never know
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  - what crisis
• 5:16
  - is just around the corner.
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  - And if you think about the, you know,
• 5:19
  - the twelve years I've been chair, we had
• 5:21
  - COVID. We've had the nurses strike. We've had
• 5:24
  - now all of the things happening in Washington.
• 5:25
  - So I think that's the thing that you
• 5:27
  - probably can never really be prepared for.
• 5:30
  - And it it it is I guess the
• 5:33
  - bottom line is I think you have to
• 5:35
  - be facile,
• 5:37
  - and you have to really understand that you
• 5:39
  - can't just look at it like this is
• 5:41
  - the way I'm going to do things, and
• 5:43
  - that's gonna work
• 5:44
  - irrespective of what's happening around us.
• 5:47
  - So I think that's probably the my biggest
• 5:48
  - take home message for people interested in leadership
• 5:51
  - is,
• 5:52
  - make sure that you have the wherewithal and
• 5:54
  - have the background to be able to understand
• 5:57
  - that, you know, what we're doing in two
• 5:59
  - months may be very different than what we're
• 6:01
  - doing today, but we need to keep moving
• 6:03
  - the the organization forward.
• 6:06
  - And you touched on it a bit just
• 6:08
  - now, but I'd love to know that in
• 6:10
  - a year marked by rapid change,
• 6:12
  - what recent decisions or pivots you've had to
• 6:15
  - make that required the most leadership conviction,
• 6:18
  - particularly when it came to aligning people, resources,
• 6:21
  - and capabilities?
• 6:22
  - Well, we're in a unique situation right now.
• 6:25
  - You know, I I live in an organization
• 6:27
  - that has a hospital system, New York Presbyterian,
• 6:30
  - which is extremely
• 6:32
  - successful, extremely powerful,
• 6:34
  - system in New York City and New York
• 6:36
  - State and, frankly, internationally as well. And then
• 6:39
  - I have my other parents being Columbia University
• 6:41
  - and the the medical center.
• 6:44
  - And
• 6:45
  - because the leadership is different and because the
• 6:47
  - histories are different and sometimes because the goals
• 6:50
  - aren't necessarily
• 6:51
  - aligned perfectly,
• 6:53
  - there has been,
• 6:54
  - frankly, some,
• 6:56
  - conflict,
• 6:57
  - between the two parents, if you will, over
• 7:00
  - the years. And so as a department chair
• 7:02
  - and as the clinical departments, we are sometimes
• 7:05
  - in the middle of that Venn diagram.
• 7:07
  - And, so that's been probably my biggest challenge
• 7:10
  - is how to figure out how to navigate
• 7:14
  - both parents
• 7:15
  - who ultimately do want success for their children,
• 7:18
  - but they have different views and different,
• 7:21
  - perspectives on how to get there.
• 7:23
  - And so I think it's been a a
• 7:25
  - a particular challenge in the days where everything
• 7:28
  - was wonderful and there was huge margin
• 7:31
  - and the finances were going. You know, if
• 7:33
  - you lost a few million here, it didn't
• 7:35
  - matter that much because there was so much
• 7:38
  - cushion, if you will.
• 7:40
  - And those days are are coming close to
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  - behind us now, and so the margins are
• 7:45
  - narrower.
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  - You know, as a quaternary,
• 7:48
  - referral
• 7:49
  - major academic medical center like New York Presbyterian
• 7:52
  - Columbia,
• 7:53
  - we focused on inpatient surgical
• 7:55
  - patients. That's where the bread and butter was.
• 7:58
  - As it turns out, that strategy does not
• 8:00
  - work today.
• 8:02
  - And so have not having a powerful ambulatory
• 8:05
  - surgery,
• 8:06
  - network, not having a super powerful
• 8:09
  - and integrated primary care referral network
• 8:12
  - has really made it challenging. So as one
• 8:15
  - of the surgical leaders,
• 8:16
  - honestly, it's been a a lot of what
• 8:19
  - we've been dealing with is how can we,
• 8:22
  - take what our all the strengths that we
• 8:25
  - have, but understand that those strengths are not
• 8:28
  - they're not enough for us to continue to
• 8:30
  - succeed. And for us to succeed, to thrive,
• 8:33
  - to get better, we've had to pivot. And
• 8:36
  - so that means building a brand new beautiful
• 8:38
  - 50,000 square foot ambulatory surgery center, not just
• 8:42
  - surgery, but an outpatient center,
• 8:45
  - in Westchester.
• 8:46
  - It's called The One. It was just opened,
• 8:49
  - in January or,
• 8:51
  - in September. Excuse me. And, you know, that
• 8:54
  - has been a major change. And so I
• 8:56
  - think
• 8:56
  - those are the things that we are constantly
• 8:59
  - looking at. How do we continue to evolve
• 9:01
  - and change? And I think as leaders,
• 9:03
  - we have to we as the clinicians
• 9:06
  - need to make sure that we are not
• 9:08
  - just sitting back and acquiescing to what
• 9:12
  - administration says because,
• 9:15
  - our our voice and our perspective are critical
• 9:19
  - to the ultimate success of the organization.
• 9:21
  - Yeah. That's,
• 9:22
  - some excellent points there. And I'd love to
• 9:25
  - know going off of that how those types
• 9:27
  - of moments challenge your assumptions
• 9:30
  - and how they change
• 9:32
  - or what they change about how you approach
• 9:34
  - decision making, talent, or organizational
• 9:36
  - readiness.
• 9:38
  - Yeah. I think that we've you know,
• 9:40
  - you learn a lot about people during stressful
• 9:43
  - situations, and we've had a lot of stressful
• 9:45
  - situations. So I've seen some leaders,
• 9:47
  - frankly, who have, flourished, and I think they
• 9:50
  - relish those challenges.
• 9:52
  - And I've seen other leaders,
• 9:55
  - who have not flourished,
• 9:57
  - and that's been a real challenge as a
• 9:59
  - chair in the department because we need to
• 10:01
  - I have to be able to navigate both
• 10:03
  - of those scenarios.
• 10:05
  - And so I would say it's been a
• 10:07
  - from
• 10:09
  - a interpersonal
• 10:10
  - standpoint and from a leadership standpoint,
• 10:12
  - understanding the people that you're dealing with and
• 10:15
  - how do you,
• 10:17
  - you know, get what I need for the
• 10:18
  - department of orthopedic surgery,
• 10:21
  - which sometimes comes at a personal cost because
• 10:23
  - I'm going to advocate for my, you know,
• 10:26
  - myopic needs for the department,
• 10:29
  - but recognize that I am one of 17
• 10:31
  - clinical departments.
• 10:33
  - And so, ultimately, the success of the entire
• 10:35
  - organization
• 10:36
  - does rely on all of us being successful.
• 10:39
  - But, again, the surgical departments
• 10:42
  - in general
• 10:43
  - do drive the ship because that's where the
• 10:46
  - the biggest margin comes in. It doesn't come
• 10:48
  - in neurology. It doesn't come in endocrinology.
• 10:51
  - It still comes from our surgical volume, at
• 10:53
  - least for now.
• 10:54
  - That may well change, you know, over the
• 10:56
  - next five to ten years. But for now,
• 10:58
  - we still have a a major,
• 11:00
  - say in what the finances of the organization
• 11:03
  - look like.
• 11:04
  - And shifting gears a little bit, when you
• 11:06
  - think about the forces reshaping health care right
• 11:08
  - now, where do you believe leaders need to
• 11:10
  - be more decisive,
• 11:12
  - especially when balancing speed, risk, and having the
• 11:14
  - right teams in place?
• 11:17
  - Well, I think we face a number of
• 11:19
  - challenges that we've never faced in the past.
• 11:23
  - And and honestly, a lot of them come
• 11:25
  - down to the financial
• 11:27
  - forces.
• 11:28
  - Again, when you had a bigger cushion and
• 11:31
  - a bigger margin, it just afforded
• 11:34
  - everybody
• 11:35
  - more latitude than what we have now.
• 11:37
  - We have private equity that's, you know, infiltrated
• 11:41
  - private practice,
• 11:42
  - orthopedics.
• 11:44
  - I don't think personally for the better, but
• 11:46
  - I think that's happening. And I think a
• 11:48
  - lot of the groups that have gone down
• 11:50
  - that pathway, at least from the people I've
• 11:53
  - spoken to and watching from a kind of
• 11:55
  - a national perspective,
• 11:57
  - aren't so sure that that's been beneficial other
• 11:59
  - than the initial boost, of course. So I
• 12:02
  - think that's a challenge that, remains to be
• 12:04
  - seen on on how that's going to play
• 12:06
  - out. I think what the role of an
• 12:08
  - academic medical center
• 12:10
  - is going to be in the future is
• 12:12
  - still very unclear.
• 12:14
  - If I'm if I look at this and
• 12:16
  - say, well,
• 12:17
  - what's gonna happen to these major academic medical
• 12:19
  - centers in the next decade? You see this
• 12:22
  - race to increase. Right? So all of the
• 12:25
  - major health care organizations in New York are
• 12:28
  - trying to go into every borough
• 12:30
  - of the five boroughs in New York, going
• 12:32
  - into Connecticut, going into New Jersey, going into
• 12:34
  - Florida.
• 12:35
  - And so it's just this,
• 12:37
  - constant push
• 12:38
  - to try to increase.
• 12:41
  - And that makes it challenging, you know, for
• 12:42
  - us as as leaders, you know, as the
• 12:45
  - department chair. When I took the job,
• 12:48
  - we had three hospitals
• 12:50
  - all within
• 12:51
  - the same campus.
• 12:52
  - Now I have nine
• 12:54
  - under the kind of the auspices of worth
• 12:57
  - of Columbia Orthopedics.
• 12:59
  - So that's challenging because that means that we're
• 13:01
  - much more spread out. We're much more
• 13:03
  - we we don't have that human touch connectivity
• 13:07
  - that I think is so critical to the
• 13:09
  - success of any organization.
• 13:11
  - I think this is a challenge for all
• 13:13
  - of medicine right now. This is a natural
• 13:16
  - byproduct, and I think COVID escalated
• 13:18
  - kind of everything in this regard, telehealth
• 13:21
  - visits,
• 13:22
  - no longer coming back to the Mecca for
• 13:24
  - rounds or for conferences and doing it by
• 13:27
  - electronic means.
• 13:29
  - It makes sense, but it does come at
• 13:31
  - a cost. And the cost has been well
• 13:33
  - shown in a lot of sociological
• 13:35
  - studies that the psychology
• 13:37
  - is different.
• 13:38
  - The connectivity
• 13:39
  - to
• 13:40
  - people is different. If you don't see people
• 13:43
  - other than on the little Zoom box,
• 13:45
  - it's just not the same. So I I
• 13:47
  - those are challenges that we continually
• 13:49
  - are striving to figure out answers to. Having,
• 13:52
  - you know, journal clubs
• 13:54
  - in person, having dinners, having social events. I
• 13:58
  - host a pickleball tournament for the department. We
• 14:00
  - have a my wife and I host a
• 14:02
  - huge,
• 14:04
  - event every August,
• 14:06
  - at a place out in Long Island.
• 14:08
  - And I rent a bus and we have,
• 14:10
  - you know, residents and fellows and students and
• 14:12
  - faculty come,
• 14:14
  - just to try to continue to maintain that
• 14:17
  - family feel that frankly we have been very
• 14:19
  - proud of in our department for so long,
• 14:22
  - but it's an ongoing challenge.
• 14:24
  - Certainly.
• 14:25
  - And wrapping up our conversation,
• 14:27
  - as uncertainty has become the norm, what leadership
• 14:30
  - habits or mindsets have been the most critical
• 14:34
  - in keeping your organization and your people moving
• 14:36
  - forward?
• 14:37
  - Well, as you know, there's you know, if
• 14:39
  - you I think last time I looked when
• 14:41
  - I googled leadership, there was about 3,500
• 14:43
  - books on on on Amazon, Google Books.
• 14:47
  - So there's no shortage of of references.
• 14:50
  - And you can drive yourself crazy if you're
• 14:52
  - inter if you're interested in becoming a leader,
• 14:54
  - you can drive yourself crazy. But
• 14:56
  - there are a lot of different leadership styles,
• 14:59
  - but what I have learned is
• 15:01
  - the most effective leaders who I've modeled myself
• 15:04
  - after and just from my own personal experience
• 15:08
  - are those that do not,
• 15:10
  - prescribe
• 15:11
  - to or subscribe to one leadership style.
• 15:15
  - If you are an autocratic leader and that's
• 15:17
  - the only way you are, you're gonna have
• 15:19
  - a problem. If you're a servant leader and
• 15:21
  - that's the only way you look at the
• 15:23
  - world, you're gonna run into problems. And so
• 15:26
  - I would say within one day of my
• 15:28
  - life,
• 15:29
  - I may have
• 15:31
  - to demonstrate three or four different leadership styles
• 15:33
  - depending upon the problem that I'm facing.
• 15:37
  - And so that can be a little bit
• 15:38
  - taxing, obviously, like, oh, is this the right
• 15:41
  - style for this problem?
• 15:42
  - But I think that's what you have to
• 15:44
  - do to understand that
• 15:47
  - as long as you continue to have
• 15:50
  - your essential
• 15:52
  - kind of prime goals and objectives
• 15:54
  - at the at the core of why you
• 15:57
  - are making decisions,
• 15:58
  - which is what I've always tried to do,
• 16:00
  - then I think
• 16:01
  - recognizing that how you make those decisions and
• 16:04
  - what style of leadership you use, as long
• 16:07
  - as from my perspective, what I've always tried
• 16:09
  - to do is tell my team, I'm gonna
• 16:11
  - be fair. I'm gonna be transparent.
• 16:14
  - I am gonna explain why when I can,
• 16:16
  - why the decisions I've made. And you're gonna
• 16:18
  - have to respect and understand that the decision
• 16:21
  - I make today
• 16:23
  - might not be in your best interest,
• 16:25
  - but it's in the best interest of the
• 16:26
  - group overall. But the decision I make tomorrow
• 16:29
  - might be in bettering your interest, but someone
• 16:32
  - else might feel the same so that the
• 16:35
  - the sum and substance of all of those
• 16:37
  - decisions are hopefully
• 16:39
  - that I'm I'm doing things for the betterment
• 16:41
  - of the department
• 16:42
  - and for the people
• 16:43
  - in this family that we call Columbia Orthopedics.
• 16:47
  - Wonderful. Well, doctor Levine, thanks so much for
• 16:49
  - joining me today on the Becker's Healthcare podcast
• 16:51
  - to share these thoughts and insights. And, again,
• 16:53
  - we are recording live at the twenty third
• 16:55
  - annual Spine Orthopedic and Pain Management Driven ASC
• 16:58
  - Conference.
• 16:59
  - Thanks so much for having me.