Facets of Leadership in Pediatric Neurosurgery: A Discussion with Dr. Sandi Lam

that the people that are most respected and most wanted to be like were the neurosurgeons, who were really good surgeons and really good doctors and fundamentally cared about what they were doing and how they were helping people and really had a lot of respect and pride in their profession. Welcome everybody to the double A&S, CNS section on pediatric neurosurgery podcast series. My name is V. Jaravindra and my co-host today is Dr. Heather Spader and we have the distinct privilege of speaking with Dr. Sandy Lam. She's a professor of neurosurgery at Northwestern University and division chief of the pediatric neurosurgery team at Luri Children's Hospital in Chicago and we are really excited to talk to her today. So starting off, Sandy, thanks so much for joining us here and you know I think one thing that our listeners probably know about you or maybe they don't know is that you have a very unique history and path through pediatric neurosurgery. I actually had the opportunity to listen to a podcast that you did previously and you described yourself as a third culture kit. Can you tell us about that and how that's kind of shaped you? Thanks for having me on the podcast. This is a wonderful opportunity to talk and to share experiences together and I think it'll be a lot of fun. Regarding being a third culture kid, the way I understand it is that you grow up in a place or an environment that is different than your parents' nationality or culture. So I'm Chinese, I'm Canadian actually, but I'm Chinese and I grew up in the United States after spending some of my time in Hong Kong. So in Hong Kong, everybody looked like me, dark hair, dark eyes, Chinese ethnicity, and then we moved to the United States where very few people looked like me and English is my second language. So I don't think that is an entirely unique experience, but that is something that poses a certain set of challenges and opportunities for a child and for an adult as well. So I think it allows people to think about the world in different ways and think about the way that they relate to people in different ways. So it's not a choice as a child, right? You just roll with it. And I think that helps because a lot of things that we do in medicine and in surgery, we know our parameters and we have knowledge and a skill set and sometimes you just have to roll with it. And you do the best you can and you understand what the goals are and you do your best. And I feel like that was a lot of my childhood for growing up in a different environment, for being an athlete, for being a student and for being a daughter and a member of a community. So I think that there's a lot that we can learn from children growing up in their environment. Yeah, that's an interesting point because I think I sure probably a similar background with you in that sense and it kind of takes us back to how we learn things from our patients and our children that we take care of it at children centers. I just wanted to kind of bring things from a different perspective. So when I apply for residency and when Heather applied for residency and when you Sandy apply for residency, a lot of the leadership of the departments we probably interviewed at were a very clean cut MD, PhD physician scientist, people that ran a lab. And now if you take a look at that population, it's shifting quite a bit. And there's this kind of new age of leading that we see in neurosurgery. And I would put you in that category. And many people may not know that you have an MBA and a significant business background. How do you think things are shifting if you think they are? And how did that shape how you kind of went about going through your training and your opportunities? And actually, can I interject for a minute? I just would be curious to know for those listeners that don't know what was your background in other areas besides neurosurgery. Like if you could just briefly tell us what you've done. Sure. I was a jock in high school in college. I was a national level gymnast and a competitive tennis player. I didn't spend that much time in school. And at some point, realize that there are very few people in the world that are going to end up on a Weedies box. And you have to kind of figure out when you grow out of that phase in life, what you're going to do, are you going to use your sports background to kind of build on your adult life and your career and make sports your your life? Or are you going to use the work ethic that you learned from it? And everything else that kept me out of trouble, probably. And take that and pivot and pursue more academic pursuits and get skills and knowledge that will help really shape what you do for the next few decades of your life. And that's what I ended up doing. So I went to a school in Canada, in high school, University of Toronto schools. That was a very academically oriented and also very citizenship oriented, I think. They really taught you how to think about the world and how you're going to have an impact on the world. And I am very grateful for that experience because that school showed me a lot of possibilities. There was a lot of why that we were encouraged to ask. We could ask why. And then when we wanted to do something, a lot of our teachers and professors actually said why not go try and do it. So we didn't know that the world was full of knows. And it was a really really incredible formative experience in education and in exploration. So from high school in Canada, I went to college in the United States and through a series of serendipitous encounters, I ended up in tech transfer consulting and then running a startup where we sold high-end Japanese consumer tech. After all that, I decided to go into medical school because I was young and impressionable at that time. And I thought that I needed more meaning. And I thought that at some point if I were older and at the end of my career, whatever it was that I ended up doing, that I wanted to look back and think, you know, what have I done to make this world a better place? And I realized that wasn't going to be, I sold a lot of computers to people. So that's why I went to med school. I think my life has been full of a lot of luck and multiple under informed decisions. And I'm very grateful for some of those under informed decisions because I think that translates to what we do in medicine, right? We think we're so informed and we make spreadsheets and we think we have, you know, predictive algorithms. And then when we make personal decisions, we really, really put a lot of time and effort and analysis into it. But at the end of the day, a lot of personal decisions in life are really under informed decisions, right? And then what you do with that, what you do with those situations and how you choose to react and how you choose to make the best of those decisions is what your future state is going to be. So pediatric neurosurgery is probably the culmination of a bunch of under informed decisions. And I can't be happier and more grateful that I ended up where I am now. I matched into orthopedic surgery because I told you I'm a jock. And that was what I was going to do for my career. I was going to fix things and it was going to make a lot of sense because of my athletics. And in the course of my first two years, North Pedic Surgery Residency, I realized that I didn't want to give up being a doctor when I was fixing things. And I realized, based on some serendipitous experiences, that the people that are most respected and most wanted to be like were the neurosurgeons, who were really good surgeons and really good doctors and fundamentally cared about what they were doing and how they were helping people and really had a lot of respect and pride in their performances. profession. And also, if you had an interoperative issue, you didn't really have to call somebody to come fix it. So in orthopedic spine surgery, when there's a derotomy or a CSF leak, often, I saw the orthopedic surgeons called the neurosurgeons to come take a look and help. In training, I saw a little less of that in neurosurgery, or you could call your other colleagues to come take a look and help. But they were kind of colleagues of the same skill set, and it was more of a discussion. So I thought all of that was very interesting. And I thought if I had to spend years of my life devoted to something and being really good at something, I wanted to be like the people that that I considered my role models and the people that I really, really wanted to emulate. And I just interject because that's a really interesting path. And I, the, you know, wanted to be a complete physician definitely resonates. And then it sort of ties with what we're talking about in leadership in neurosurgery, but some of that tie is turning. And you have intensivist, you have hospitalists, you have work hour restrictions and you train fellows and you train residents. And, you know, as a leader in the field, what do you think it's going to look like and how is that going to look? And because it is different than when you first started. Yeah, that's a great question. And, you know, I think of the term leader as, you know, something that sounds a little loaded, right? I feel like now being considered a leader in the field, I embrace that because I have had a certain amount of time in the field. And I'm in a position where I can affect change and I can be a mentor and I can help people. And I'm really very glad that that I can be a leader in that way. I don't think that I have all the answers. And, you know, so I feel like I have a long way to go there and I have a lot to learn. So that's why hesitate to fully embrace the term leader because I think that that is not something that I want to make me complacent because I feel like there's so much more I need to do. And I, there's so much more the field needs to do altogether. And, and to assume that we know all the answers and to assume that we've done everything that there is to do is is not the right attitude, I think. And you're right, there's so much evolution in healthcare right now that I think it's a lot more complex than than what I thought it was. And in running a division is very different than entering into academics to trying to be an academic neurosurgeon because what it takes to succeed as a student and a medical student and a resident and a young attending is a little bit different than what it takes over time to run a team and to get promoted and then to develop multidisciplinary teams. And then to have teammates who actually function in multiple silos in healthcare and don't report to the same place or the same person or the same entity right. So if you think about nursing and pharmacy and business administrative people and other technicians and ancillary staff in the hospital, a lot of times they actually don't report to the same person. So how do you build a neurosurgery family right? How do you actually say all right we're all going to row in one direction because it's the right thing to do. It may not be how you're going to be paid and it may not be how you're going to be incentivized but we all come to work trying to help people and trying to do a great job trying to do the right thing. So there has to be a certain set of core values that we all subscribe to that we all embrace. That is actually really different than my business background where the company Iran was 12 people and really it was very centralized and the goals were very clear right. They were financial. So in healthcare now when you look at any academic medical center, there are many many many stakeholders. So it's very different and every institution actually is very different and I've worked in multiple institutions. So even thinking about how somebody's value is evaluated is a little bit different depending on the the structure of the institution. So you know for somebody who's going to be a medical student to be a resident somewhere or a resident looking at a faculty job somewhere there is you know our base kind of um you know at face value we say we want to get the right candidate right we want the best or the best we want the smartest best person with wonderful core values and a great work ethic right but when you look at the you know how that's going to play out for what that person's about what they want the environment they want the other things that they want in life it's actually really hard to put it together. I have to go back to your question sorry your question was looking at a job in a path and how that fits now because traditional grand Puba so to speak of the MD PhD academic physician scientist is maybe not what we're looking at yeah I think it's it's not you know we can with health care as a business it's just not what makes the world go round anymore you know yeah um and so I just you know while we're on the topic when did you get your MBA what was the timing of that I got my MBA as a junior attending so that sounds a little weird because I already ran a startup but that was part of the serendipity of my journey when I was starting med school I was very interested in the MD MBA combined program and I thought that would be a great thing to do and my business partner at the time said you know what do you think you're going to gain from that extra schooling besides just letters after your name because you're already running this company and I realized huh you're right maybe but at the time I thought okay well what I don't have right now is the medical knowledge you know when pursuing the MD made sense but we had just gone through a multi-year journey of building this company and establishing an office in the US and an office in Japan and actually making a very profitable business and I I pulled back from from pursuing an MBA at the time because I you know from a practical standpoint I couldn't really come up with a good reason for why I should go to business school then and then I circled back later on after going through neurosurgery training and seeing the rise of managed care seeing the the narrative get woven in to our daily lives of the choices that we should make in healthcare and and talking about what quality means and a lot bending the cost curve means and I realized a lot of those words and a lot of those narratives were coming from people who weren't doctors and not clinicians and that was actually after my training and I realized I also kind of missed it I immersed myself into neurosurgery and then the further you get along in neurosurgery the more you end up talking to neurosurgeons only right in the pursuit of the field right so then I had that kind of myopia I felt like I had kind of tunnel vision almost right or or like I got a little myopic in terms of just kind of being so into neurosurgery that that I felt like I wasn't part of the conversation for a lot of what else was going on in the world and and also with feeling like there was a lot of healthcare administration that was on the rise that was really starting to interject into clinical decisions not that point I felt like it's important to have people who are cross-trained to be able to advance the clinical needs and to be able to talk about the business of medicine and to help the whole entity come to a rational path and that rational path is really to do the right thing for patients right but but when you look at the number of physicians and the number of healthcare administrators the the rise of the number of healthcare administrators in the system is astronomical that is really becoming a very large burden on on what we do in healthcare so to a certain extent I feel like getting a business school degree was part of defending clinicians, right, defending clinical care, defending the right thing to do, and being able to have that secret handshake, if you will, for actually how to have just rationality into the system. And I already kind of, you know, I didn't feel like I got any smarter doing business school, but I did feel like it gave me an opportunity and an excuse to read and to interact with people and to really think about things in a different way, and it gave me some space, and it gave me some space to think and really gave me ability to ability to gain a network that I didn't have in neurosurgery. And I think that's really important because sometimes people ask, oh, should I get an MBA? And I say, why? I actually say, like, why do you want an MBA? And I think the timing of it really matters. I think you were at a point where you could actually contribute to the conversation with some meaning behind it, you know, versus if someone gets an MBA, let's say before they get their degree or before training or even during residency, I think it's different at each step of the way, you know, I completely agree with you that yes, it's a degree, but what you get out of it will be different because you're a different person at a different points in your life and with different accumulated experiences. So I feel like I appreciate it a lot more when I was able to do this after neurosurgery training and when I already had a job. And I think that's part of us being professional students as people going through medical school, right? We've already had so many years of schooling. And to some extent, neurosurgery training is like that, right? So there's this kind of pick me, please pick me type of mindset that you go from high school to college, you're applying and you really want, you know, to be admitted into your college of choice. And then you are applying to medical school and you really wanted to be admitted to your medical school of choice. And then you apply to residency and you're thinking, oh, please pick me. And then you apply to fellowships and you're thinking, please pick me. And you know that we just kind of are in student mode. So it would not be hard to just get another degree and you know, keep on doing school. And I think we miss a lot of the things to put life and the workings of the world into context. So I really, I really appreciate it doing business school later on. And then that's something that I see as something that I could learn from business school to contribute to the narrative now and being part of mentorship and hopefully being part of the evolution of neurosurgery is that we train people in neurosurgery. We have to think about how to have our product, right, which are, you know, surgeons who are safe and compassionate and good and have great judgment and have good hands and technical skills. And what we don't remember to do right now is a field. Sorry, what we don't do very well is actually prepare people for the workforce and for getting a job and to negotiate how they're actually going to be in in the working world. And I think that I try to be very transparent about I at this is not my first job and I feel like every time that I have moved I have learned something about what I know about negotiation and what I don't know about negotiation and what it takes really to have a successful environment. And we don't equip our residents and our fellows with the skills to say how do you evaluate a job, how do you evaluate a position. Then how do you know what to ask for? How do you know how to ask for this in a respectful way? And how do you be objective about it. And I feel like a lot of times we're not very transparent and and there's this kind of overarching expectation that we're in this noble field and noble profession so people don't talk about money as much as they really can, right. And and because we're not good about being transparent and talking about money a lot of times trainees who are entering into the job market don't go into it with eyes wide open. And I think when they're mismatched expectations is when people end up disillusioned or people realize they really weren't in the right setup and end up needing to look elsewhere. And I think we fail our trainees by equipping them only to do neurosurgery and not equipping them for life to expand on that little bit. I guess what I would love to hear is what is your advice for someone coming right out. And then there's someone that's going in to build a division like what are those things that you feel like you had you had to have in order to be successful and that you shouldn't be afraid to ask for in order to be successful, you know, I don't. It's a broad question, but I think you have that experience. I think people people would like to hear that. So as a trainee looking for a job or as a more junior neurosurgeon looking for a job, I think it's important to understand two things at least one is what you're about what you're about and what you're looking for. And that's not just as a neurosurgeon right you know you'll have your CV and you'll have your training and there will be a lot of other people who will have a similar CV and a similar training all looking at the same job. But then what is what is it that you bring to the table what value do you bring besides I'm a neurosurgeon I'm going to take call I'm going to be affable and available and able right. So you know and and that's that's important because it's important to take the time to think about what you are as a person and what you want, you know, where do you want to be what's important to you outside of neurosurgery what are your interests. And then what do you want to do in neurosurgery is it education is it clinical service is it being part of the institution and being part of the business of medicine and advancing yourself in the whole group. And it has to be something that that makes you different than than the next person because we're not commoditized right or we shouldn't be commoditized and sometimes you know health care institutions can think well you know surgeons are replaceable I kind of take a different way hopefully you know when when I recruit surgeons into our group. I consider every single person irreplaceable and I want to understand where they're going in life what's important to them where they are in their journey and is is my open position in my group a good match for that person and where they're going and are we going to get them to their goals and there's that match with the division's goals and the divisions. Culture so you know it really is about people and understanding that the group is in static and and the person is a static but understanding what that person's about and where they're going in life is going to be a much more successful venture altogether then to just look at CVs or to look at people in a commoditized way and say are they going to fit in this slot right now. And I think as a junior neurosurgeon or as a freshly minted trainee who's going to go into the workforce it's it's hard to shift that mindset because as a trainee who's just graduating residency it's you still are in that please pick me mindset right but but understanding that you're your person you you are. Somebody that a chairman or a chief is going to recruit and that you are going to be part of the team and and that your success in that team and that department is going to be predicated on what the expectations are and it's a two way street right so so even as the newest person coming into the group you need to be transparent about your expectations about what you need to be. What you need to be successful there and what you need to be happy there and what you need to thrive there because staying there and and really giving it your all to to make it a great long stint there is going to be of benefit to everybody so I think people hopefully will feel empowered to be objective about what they need to be successful and to thrive. and to thrive in a place. And that that needs to be for from a neurosurgery standpoint and also from a personal standpoint. - Where do you think this should come from? Is this something that needs to be taught as part of the neurosurgery curriculum or is this something that needs to come through self-fulfillment or is this something that needs to be sponsored by like the joint section? Because you're touching on pretty sensitive topics here in terms of how do we train neurosurgeons to function in a practice and a daily life from a business standpoint, from a personal fulfillment standpoint. These are huge issues, right? And we just, I can personally speak in my training, we had very little direction on how to get a job. And I think that would be most places. And so I just don't know what point we formalize it and go forward with it. Yeah, I don't know the right answer to that. I know that everybody who trains with me, I spend the time to share benchmarks with them and to arm them with information and with data. And these things should not be a secret, right? It's data, but that's also my entire research career is data. So I've taken negotiations classes from business school and law school professors and I've taught negotiation to start up companies and also have had workshops with our neurosurgery residents in our department. And it's not a confrontational thing. I used to think negotiation is so confrontational and it's kind of like in the TV and movies. And it's not. It's actually being a good communicator and it's actually being prepared. So it's actually having information and data that everybody can look at together and to not be shy about what it is that you are looking at that is important to you. So I feel like this shouldn't be a secret, right? And it can be taught in high school or college or residency or fellowships. And I at first thought, oh no, if I teach all of our trainees how to negotiate better, we're gonna be in a tough situation for the call schedule and the vacation schedule and pay and all that. But it's actually not. It's, I think it just sets expectations and it makes anything that you're entering into something that has fewer surprises. And we're surgeons. We don't like surprises, right? Or I don't like surprises. And we try very hard in our preparation for surgeries to try to foresee things and then to have contingency plans. So I feel like the same thing can apply. We can teach people how to negotiate. And I've actually the people that I've taught to negotiate have had good success with buying a car, you know, buying a house or negotiating for a signing bonus for their brother, right? You know, or flowers for their wedding. It's a very translatable skill and framework. So I don't think it should be a secret. - Yeah, it's interesting. I just, you know, this is how my mind works. As you're talking about negotiating and preparing for negotiations. An episode of the office comes to mind where Steve Carell actually goes to Wikipedia and prints out negotiation tactics and takes them to the meeting. And I'm sitting here thinking when you're talking, I'm like, I'm pretty sure that's what I would do if I had to do something like this. You know, so I think training in it is definitely necessary and mentorship. And maybe it is just a mentorship type of thing. Of course, your training is really benefit from that. But I'm trying to think here, Heather, did you have something 'cause I had one more question I wanted to get in before the time was up. - Well, I go ahead. - Okay, I think I've asked lots of questions. - Yeah, I know, this is great. So Sandy, you know, I think with the theme of this new age of leadership, what parting advice would you have for young pediatric neurosurgeons, either fellows or residents or even medical students who want to be a leader in their field and it doesn't have to be pediatric neurosurgery, but in general, and in your vantage point, how does that look right now? 'Cause I think it looked a lot different than it did 20 years ago. And who knows, maybe in 15, 20 years, it'll look different, I don't know. But what's your kind of advice for this current time and climate? - There are lots of ways to answer that. (laughing) - So, you know, I think there are some generational shifts and a lot of things in society exists now or are actually the norm now that weren't the norm when I was going through school and first started training, right? So when you look at the kind of the huge generational shifts that have happened are digital natives, right? That was not born a digital native. Now everybody who's coming up and training who's gonna really be the future of healthcare are digital natives. And the other is really the mindset of the importance of social responsibility and really being citizens of the world and incorporating that into our professions and what we do. So when you think about my parents' generation and also the culture that I grew up in, it, the expectation was to have one employer for life and to really get a pension from that and to provide for your family and then kind of take the path that is well-trot in and then when you look at a lot of what's happening now, it's much less expected and actually much less than norm to stay with one employer forever, right? And then when you translate that to healthcare, does that work in neurosurgery? And then that's a little bit of a weird question, right? Because we are, by definition, in a very, very conservative field, right? Medicine and surgery is typically quite conservative and it takes years to build a practice and it takes years to build credibility and it takes years to build trust, right? So it really doesn't lend itself very well to jump it around and doing like a gig economy. So how are we gonna reconcile that? I don't know yet. And so a good example is global neurosurgery, right? So and that's something that I have seen kind of from different sides, you know, from me taking vacation every year to go work with Leland Albright in Africa and then coming as a division chief saying, "Hey, this is just part of what I do. I've been going on vacation, but I recognize that this is something that is really important to me and actually really important to the field and really part of what I consider moral responsibility as a pediatric neurosurgeon that most of the population in the world that is younger than 18, that actually doesn't live in the high income countries, right? They live in the developing world and the low and middle income countries. So part of what we do as pediatric neurosurgery is something that I think that we really, you know, can do and help is actually to do knowledge and skill transfer to where we are most needed in the world, right? So, but, you know, to say to a new possible employer that this is important to me, I am not gonna be making our views when, you know, I am doing things that are important to me, but it can be very good for the institution. It aligns with the mission of the institution. There are lots of marketing aspects and donor opportunities for this. And I think it will be on our generation to actually develop a framework for how we can enable all of neurosurgery to do what we should be doing. And if something is important, we will find a way, right? Like we have to find a way. And that applies to personal and professional lives, right? If something is important to us, we will find a way to incorporate that and make it work. And I think that we need to really develop them much better framework and a more sustainable way to do that aspect. So that's just an example, right? Say like for global neurosurgery, it can't be philanthropy forever. And there are funding mechanisms like NIH, Fogridi, but we're really not there yet. And then I think, you know, when thinking about this kind of generational idea that I've been talking about, I think the idea of leadership is interesting because I do hear from the students and residents sometimes, you know, when I ask them, what is it that matters to you? What do you think you're good at? What is it that you wanna do? Sometimes I get the response, I wanna lead. And then I need to take a step back and say, okay, well, what are you gonna lead in? Because you actually need to bring something to the table, right? You need that experience. You need something where people actually, trust you and want to hear what you want, what you have to say and want to follow and want to be part of that cause. So you can't just lead. You have to be about something and have something to show and bring something to the table before you can lead. So I think that actually gets lost in the mix. And when you look at how much content there is out there now on leadership, right? You know, books, videos, social media, and just so much content that you have about leadership that I think that sometimes people forget that you really need something to be leading in and you need to build that up for yourself. And for neurosurgery, that's neurosurgery, right? And then whatever aspect of neurosurgery or whatever it is, it has to be neurosurgery plus. So when I think about this kind of new age of leadership, when I look at on paper, even though I've always felt like I didn't look like neurosurgery and I certainly didn't look like any of my mentors. My CV actually looks kind of similar to what you would expect of any division chief or academic leader in neurosurgery. You know, I have the schooling, I have the degrees, I have the years, I have the publications, I have the federal funding with PCORI. And then I have a list of people that I've mentored. So actually, if you look at kind of like the check boxes and you didn't look at how I totally don't look like an old white gentleman, you know, there's some things that you kind of can't bypass, right? Like you have to have the schooling and the licenses and the experience and kind of the accumulated experience of something that you bring to the table that shows that you have had these achievements. And the achievements aren't, you know, like awards and clapping and applause. It's actually that you have shown your 10,000 hours and your mastery of whatever it is that you have to share. And so I would, you know, I guess my advice to anybody thinking about that is, what is it that you are about and that you love and that you're super passionate about, that you're into, that you wanna spend all that time and commitment and effort to getting really good at so that you can make it better and that you can make it better than the way you found it. And, you know, whatever aspect of that is in neurosurgery, then, then, you know, go for it. Like make it better than the way you found it. And that's what I love about pediatric neurosurgery. I think we're all in it for our own reasons, but I think everybody who goes into pediatric neurosurgery like fundamentally like wants to help and wants to help kids and families and wants to make neurosurgery better to have better outcomes for kids and families. And we all come at it in different ways. So I think we need to be very cognizant of that challenge. How are you going to, how are you gonna make neurosurgery better? But also that we need to be kind and encouraging to each other in this community. It's a very tight-knit community in pediatric neurosurgery. How can we think of ways to lift each other up and how do we encourage each other and say, hey, you are in a very difficult and challenging and emotionally draining profession. And we've all sacrificed a lot to get to where we are. How are we gonna help each other make it meaningful and advance it even more? There's this perception where we always hear stories about how our teachers and our mentors walked uphill both ways in the snow, getting to and from work in residency and in neurosurgery. And I think neurosurgery is hard. We all know that, right? And life is hard. And I think that we need to be open about that and to think about how to support each other and to recognize that we are all going through the shared experience. And we need to celebrate that everybody's different and that everybody has really signed up for this challenge together. And I think being able to recognize that humanity and that experience that we have in neurosurgery together and to be able to talk about it a little bit more that it really takes a village for everybody to go through this to not just get through training, but to be able to be really good neurosurgeons and to have enough in the tank to be really good people and really good family members and really good community members and really good researchers. I think it takes a little bit more in that conversation for us to arm each other with that compassion and that time and that space and that mental space. And I don't think we do that enough in neurosurgery. And I hope that we have that incorporated into the conversation more as we trained the next generation. And even in leadership, we need to actually recognize what it takes to build a team. And building a team is not just to say we're hardcore and it's neurosurgery because it takes a lot in healthcare now. It's not just neurosurgery residents and neurosurgery attendings on your team. There are business people, there are nurses, there are advanced practice providers, there are neurosycologists, there are social workers, there's just so many more people that you need on your team all rowing in the same direction. And I think to be successful in healthcare and to be successful in neurosurgery clinically and to be successful in neurosurgery from a business standpoint and from a research standpoint, that the next generation of neurosurgeons really need to be very good communicators and very good leaders. And leaders can be on any level from a micro team, from running your operating room, to running a division or a department. - Yeah, I've thought about a little bit what you've said. And I think neurosurgeons traditionally have always been content experts and they were able to memorize large amounts of information and synthesize it and spill it out and perform. And in an era where everything's on YouTube and you can Google it, then those skills are less valuable. And you see the translation of that exactly what you're saying is that you gotta be able to function on a team. You can't just go in and yell at everybody that that world no longer exists. And because yes, we're still content experts, but it's complex and our patients do better with team care. And so it is an interesting paradigm shift because you can Google a lot of what we do. - I necessarily do, but you know. - It is, yeah. And even thinking about being a physician scientist, I think there's actually a lot of different avenues now where incorporating academics into your career is not purely in a lab or a translational sense anymore. So I'm a health services researcher, right? And I've made my MBA background actually work from learning from healthcare economists in cancer economics and translating that into health services research for pediatric neurosurgery and pediatric epilepsy and pediatric epilepsy surgery. And that's not something that I was directly taught. So that I credit to actually being able to develop relationships and work in teams to be able to learn from other fields and say how do I put that together and then understand how do you write a grant about relevance and impact and actually have that be something that is gonna make pediatric neurosurgery better and make what we do better for families. So I think a lot of, you know, what we call leadership or kind of a new way of approaching neurosurgery is really a lot of things that you would learn in business school. Or how about just things that we tend to place a little less time and effort in medical school when we're learning to be content experts for medicine or neurosurgery. We actually don't incorporate as much of the change management strategies and the business operations and kind of understanding how to navigate a lot of the synthesis of institutional workings and of life. And I think these are all things that we need to incorporate into the narrative now to be able to make sure that our next generation of neurosurgery is going to be successful at what they do. And not just successful in terms of getting a job, but being successful as neurosurgeons. Yeah, it's so important to talk about building a team and I think that's something you focused on a lot. And it's not something that we talk about, especially as I can speak to this, as someone who will be looking for a job in a year or two, you have this tendency to say, well, I want this position here or here. And in actuality, you may not know anything about that and how the team functions and how your fulfillment is part of that goal and that mission. And I think that's such a change in thought for a lot of people because you're right. It's that pick me mentality. And it's hard to get away from that because I think we've just done it for so long, you know. But I hope that people will listen to this and change the way we think about things on both sides. And maybe that will just make the world a better place, you know. So, yeah, there's a certain amount of creativity that goes into what we do. And it sounds weird, right, that in medicine, what we learn in medical school and residency, that there sometimes doesn't seem like there's a lot of space for creativity. But now a lot of what I do in team building and to set a vision for what we do for the division actually takes creativity and takes questioning and that the question is why not. And then when you think why not, then you think, okay, well, what are the steps and what are the tools that we need to get there? And when you break it down to medium schooling, huh? Exactly. So a lot of times you can say why not and you know what, you can work towards it. And part of that now is actually working with donors. And when I took this division chief job, I said one of my goals is I need to get really good at working with donors. And that does not come naturally to to a neurosurgeon, right? Or somebody who went through medical school and spent, you know, the past like two decades trying to figure out how to operate on people safely and well. And then, you know, to write papers and grant and get grants that is that there was just nowhere that did working with donors enter into the equation. So that is another skill set that actually is very important at in certain positions and at a certain stage in the career because the donor funding actually gives my team a lot of leeway and a lot of freedom to be able to think big, to be able to do the things that we want to do to really make pediatric neurosurgery better than the way we found it.