speaker-0: Welcome to Beyond the White Coat. I'm your host, Dr. Zwade Marshall. ⁓ once again, folks, this podcast exists because medicine trains us exceptionally well to care for patients, but it really prepares us for leadership, policy, systems-level impact. Yet many physicians feel called to do more, to shape how healthcare is delivered, how teams function, and how decisions are made beyond the bedside. Beyond the White Coat is a space for honest conversations about how physicians actually build influence and what that path really looks like, the pivots, the risks, and the lessons along the way. Today's guest embodies that journey. I'm joined by my good friend, Dr. Josh Lumley, a practicing physician of over 15 years, an early Doctor Doc investor, actually the earliest, and a healthcare executive whose career reflects the idea that clinical training is. beyond a starting point. It's n it's it's just the way to get started, not the ceiling. Josh holds a master's degree in business operational excellence from the Ohio State University. He served as a fellow of the American Association for the Advancement of Science, informing congressional health policy, and has held senior leadership roles, including Chief Medical Officer and now National Chief Quality Officer at North Star. where he oversees quality outcomes and CMS reporting at scale. Josh, that's a mouthful, brother. Like I like I'm like, I have friends in important places. Welcome to the show and I'm really glad you're here.
speaker-1: Two kinds Wadi. I'm really glad to be here with you.
speaker-0: So, Josh, you're incredibly accomplished, man, and and you've built a career that spans clinical medicine, policy, and executive leadership. But I always like to rewind before we fast forward. ⁓ tell me about Josh before the titles and the leadership roles. I'm curious, did did young Josh imagine this kind of career at all? Where did you grow up and ⁓ what first sparked your interest in medicine?
speaker-1: Yeah, I mean I grew up in ⁓ in central Texas in a little suburb ⁓ north of Austin. Of course now it's part of Austin, town called Floogerville. My mom was a ⁓ my mom was a school teacher there, taught third grade for 40 years, and ⁓ before retiring. And as the child of a school teacher who you knew you were gonna she was gonna find out if I stepped out of line, I needed to be on the straight and arrow from Did you go to her school? I I did, I did through elementary school. Yes, I did. And so I knew if if I ⁓ if I stepped out of line at all, it was going straight to Mary Lumley. And ⁓ and so, you know, ⁓ she poured a lot into me. But you know, my parents are still married. My dad did as well. My dad traveled a lot for work, so so really I was largely spent most of my time with my mom. ⁓ she dumped a ton of of energy into me and ⁓ and really set the bar high for me to be successful. And I had sort of this inherent drive ⁓ to to be that way. ⁓ in terms of like I I think like decision making of wanting to pursue medicine, it really was ⁓ I had a couple like sort of formative events. I ran track in high school ⁓ track in college. I loved physiology. and I really, you know, had a mind for science. And so when I went to undergrad from the get-go, I was pre-med and thank God I wasn't one of the ones that that sort of fell to the wayside during organic chemistry my sophomore year. I still very clearly remember though, ⁓ the, you know, how how difficult that time was. And sort of one thing just led to another. And I was fortunate enough to ⁓ ⁓ to get accepted into medical school back in Texas and and then, you know, here we are.
speaker-0: It's funny how without real intention, sometimes we we follow the path of those early influences, right? And it's funny to hear you say that your dad traveled a lot, your mom's a school teacher, my mom's a school teacher. And I know right now you're sitting in a hotel room. Yes ⁓ because you're traveling for work and we'll we'll kind of evolve the story of what your day to day work looks like. But you're clearly a parent like your dad in the sense of work travel. And I know that you've got ⁓ two daughters at home and your wife Katie's a huge supporter of your career. What's it like to be in the road as much as you you are? And how do you think about how young Josh experienced dad and what's similar and different about how your girls experience you?
speaker-1: Yeah, it's a great question. You know, I when I stepped into my role that required a lot of travel as an executive, ⁓ you know, an executive clinical leader doing startups for anesthesia practices around the country, I was attracted to it because of sort of the direction it was going to take me career wise. But I was trying to identify, have a moment with my dad where I said, you know, it's interesting that. I'm traveling so much for work in a very similar way that you did for me. And hey, listen, I want you to know that I never feel like I never felt like I missed out on you as a parent, ⁓ being gone so much. But you also like impacted me a ton, knowing that for you, ⁓ work was very important. And without you, I would not be where I am today. And he stopped me for a moment and he said, Well, I I appreciate you saying that, but I sometimes have some guilt about it myself. ⁓ in missing track meets and missing sporting events, et cetera. And ⁓ and I'm kind of, you know, if I'm completely honest, in a moment of vulnerability, I'm sort of going through that a little bit right now. I've got a, you know, 13-year-old daughter who is athletically gifted, academically gifted, a 10-year-old who's stepping into middle middle school. And there are moments where you struggle with your capacity to be present. as much as you need. And I I wonder, you know, sometimes you do have this internal struggle of, am I doing the right thing? Am I not? ⁓ are am I personally going to have regrets down the road? Are they going to have regrets down the road? ⁓ but I'm fortunate enough, you know, I've got a great partner in Katie who I can bounce these thoughts around and say, am I, you know, I I need you to I need you to exactly exactly Right, are things out of balance in terms of career, personal life, health and wellness, et cetera? Is one of them re getting too much attention and focus? And do I need to reset?
speaker-0: Sure. I know I think all of us, all of us are challenged by exactly that. ⁓ and it's just hard to know when sometimes you can't tell, you know. And at other times you'll feel it acutely, especially when you know you're missing something. ⁓ and I don't think any of the guests that we've had in this ⁓ podcast ⁓ has not mentioned that as something that they're acutely aware of as a an area of emphasis to to do better. Because we're all in this continuum of trying to get ⁓ the right balance in very demanding clinical and then, you know, academic and professional careers, ⁓ while also ⁓ you know, balancing that we're doing it for these people we love, this is taking us away from them.
speaker-1: Exactly. Correct. One of the things I th I have personally kind of found a little bit valuable is like envisioning there's this pie that's cut into five slices. You can call each of the five slices whatever you want to. But you know, one would be, you know, ⁓ spirituality, one would be career, one would be finances, one would be family, one would be health and wellness. And each of those pie each of those pieces is numbered one, two, three, four, five. If you score five on all of them, you get a perfectly round big pie. If you score one, you got a really small pie. It means you're not doing good on any of them. But if any one of them is like, hey, I'm one on health and wellness, but I'm five across the board, it's like a wheel that just doesn't roll. and so you know, the dream scenario is that your fives around the world, ⁓ across the board. ⁓ but if any one of them is out of balance, it's pretty obvious from, you know, a visual perspective of like, geez, I need to, I'm definitely, I'm crushing this area of life. This one here, I'm falling ⁓ to the wayside on.
speaker-0: I hear you. At some point in time though, I think ⁓ many of us start to notice that there are questions that go beyond the exam room. So we're we're balancing life, but we have we've got these curiosities and we have questions about systems, about policy, about how healthcare actually works at scale. And you're the embodiment of someone who had those questions and then ⁓ chose a career path that allowed you to scratch all of those itches, you know. ⁓ Was there a moment or a series of experiences for you in your clinical career that sparked that curiosity about policy? And how do you navigate the tension between being a practicing anesthesiologist? We traded the same program at Harvard, the Harvard Hospital Bringham and Women's. And you were a star there, chief resident. You're someone whose name rung out ⁓ after you left. ⁓ I heard of the Josh Lumley. ⁓ and ⁓ and and you you you cu you had built this. this reputation for clinical excellence and rigor. And you also chose to become a leader, an administrator, someone who thinks bigger about impact at scale. How did you navigate that tension and and and how do you balance it now?
speaker-1: Yeah, ⁓ it's it's a great question. ⁓ and I will say I am not an expert or ⁓ at balancing it. having said all of that, like for me, policy and politics had been very important from sort of day one. I I'm an only child. My mom is an educator. My dad is an educational consultant. He worked, ⁓ he would write grants and proposals for low-income school districts in Texas, Louisiana, Arkansas, Oklahoma, New Mexico. And my mom also being a public school teacher in a very middle, lower class ⁓ sort of part of of central Texas, we would have a lot of conversations around. you know, what life was like, how can we make life or or where are areas that we felt like the government could maybe help out populations ⁓ that were underserved, or what could be the impact ⁓ within public education. So policy had always been something that we talked about at the dinner table. When I was at the Brigham and the opportunity availed itself to be a congressional fellow, I was like, I am absolutely throwing my hat in the ring. And definitely want apply for this. ⁓ it was 2007, 2008. ⁓ and ⁓ so you know, there was gonna be a change in the presidency. ⁓ didn't know who it was gonna be. ⁓ there was definitely going to be a ⁓ you know, probably a change in who controlled the ⁓ House and the Senate. It was a prime opportunity to do so. And I was young, we didn't have kids, ⁓ and so I approached the, you know. my residency program of director and said, I want to apply for this. And he encouraged me to do so. And lo and behold, I was selected. And so there's not a question. We definitely said, We're out for a year. We're going to DC, ⁓ and you're going to work on the hill for a year. and ⁓ you know, and my wife ⁓ worked as a school teacher at the at the Smithsonian. And it was just, it was an incredible year for us. It was just incredible.
speaker-0: It's so funny how like the same events in history ⁓ impact all of us in different ways and then some of us in similar ways, right? So at that same time that you were considering doing the fellowship, I was in medical school thinking about an MBA. And my the lead professor for health policy at Emory, where I went to medical school, Ken Thorpe, was an advisor to the Obama campaign. And so the Affordable Care Act was being formulated in the classroom. Right. And I had this rich opportunity to say, look, I'm gonna get an MBA because if healthcare is being changed in such interesting ways, if you're not at the table, you're gonna be in the menu, is what they say. Yeah. And ⁓ and I I had the curiosity, like you did at the time, to kinda go deeper. And it was so funny to be in the classroom with Ken, Professor Thorpe, on a Tuesday. And they'd be we'd be tossing around the ideas around ⁓ single payer coverage, what Medicaid reimbursement looks like compared to Medicare reimbursement. And then I'll see him on the news on Thursday espousing the same themes that we had in the classroom on Tuesday. Yeah. And so I had a front row seat to this massive legislation. And the MBA for me was my conduit to get access to understand how the economy of medicine kind of runs. ⁓ and that's really why I got the NBA because it was in that two thousand six to seven era when the Affordable Care Act was being formulated.
speaker-1: Yeah, and you know, for me, ⁓ I was slightly before that, but it was just a conversation around y so Zwade, this is crazy. But at one one time charts were paper and people would have to write notes ⁓ like H and Ps and soap notes and you would have to like handwrite labs and things like that in order
speaker-0: Maybe they'll call someone on a telephone that had a c a cord attached to the wall, right?
speaker-1: It was and it was not an EMR and it and it was and it was like less than twenty years ago was that was the world. And so the debates that were going on were how do we create an IT system that communicates with another IT system? So that if a person ends up with a broken ankle in California on vacation and they're on this multitude of medications, like how do we communicate with the their home hospital? ⁓ It it was it's crazy, but my ⁓ after my intern year, I went to the Brigham and Katrina hit New Orleans and it was a huge population that was displaced from New Orleans to Houston. And the people that and the people that did the best were the folks that were that came from the VA because the VA already had an EMR and those folks they knew, you know. They were on their co-reg for their, you know, significant CHF and they could just continue that medication. But if you have somebody that just shows up to the Bentov emergency room with a bag full of drugs and I was like, this is, you know, I just brought it with me, you know, from New Orleans, I've been displaced here. Like that was the world that we lived in at that time. So so what we worked on extensively in the office that that I was in was ⁓ you know, we worked on energy and commerce. ⁓ committee was all around health information technology, making it interoperable. and how do we implement this new ⁓ bill that has just been passed called HIPAA. ⁓ and ⁓ it was fascinating. It was really just incredible.
speaker-0: Yeah, I I can only imagine, especially at a time in in disaster and crisis, right? Like so we've also lived through a series of, you know, once in a lifetime crises and ⁓ you know, like we we we just went through COVID what feels like yesterday. and we saw the impact of having immature health systems and what it means for population health. And so it we can underscore how important it is to have the best and brightest amongst us as clinicians be a part of policy totally and administration and legislation as well. The your titles, SVP and National Chief Quality Officer and CMO, they can all they can feel abstract to the to the ⁓ to the doctors that don't really know what that means from a practice perspective. Tell us more about what your actual day-to-day means to oversee CMS quality reporting on an enterprise level performance. What does that look like?
speaker-1: So my elevator pitch ⁓ about my role as chief quality officer is I have three overriding sort of jobs that I undertake. Number one is reporting quality every single anesthetic that's performed within our organization. So a million and a half anesthetics a year. Every single anesthetic we need to report quality metrics ⁓ to CMS and third party payers. That's everything from a cataract and a carpal tunnel. Up to circa rest, aortic arch repair, and everything in between. There are quality metrics whereby you know you should be able to say, is my department of anesthesia doing the right things? Are they good? Are they taking great care of patients? ⁓ so reporting those out. ⁓ being an anesthesia-specific patient safety organization. So for every so you know, we did receive ⁓ accreditation as an anesthesia PSO. And so Every single, you know, continuous improvement in our clinical performance, driving and pushing the needle forward in terms of patient safety. And then last but not least, ⁓ and this is a very sort of B school ⁓ type, you know, terminology, but just implementing standardized clinical techniques so that you know, you know, if you're having a total knee done in this part of the country. For the most part, the anesthetic techniques that are performed there are going to be the same anesthetic techniques that are performed in another part of the country, 1,500 miles away, and the outcomes are going to be largely replicable. So that is sort of the effort that we're trying to drive within the OCQ. ⁓ along with that, you know, education, ⁓ continuous, you know, you're not in academic department anymore, but how do we make sure that you're continuing to learn? ⁓ new and novel techniques and the best ways to take care of patients. ⁓ and then of course I have a a balance of my, you know, ⁓ of my FTE allocation that's still with taking care of patients day in and day out. Yeah. Yeah.
speaker-0: Hence you're in a hotel room right now.
speaker-1: There you go. Tomorrow. Exactly. Yeah.
speaker-0: What it what what was it about you ⁓ as a clinician at NordStar that allowed management to see you as someone that can be in this leadership role? ⁓ and what kind of guidance can you give to others who are mostly clinical but aspire to be in leadership?
speaker-1: So the first thing is is I think you have to make a decision early on in your career that leadership is something that you would like to pursue. Because every decision that you make builds upon that. And you may or may not have that opportunity, say, in your 30s and 40s, maybe even your 50s, the opportunity to be a department lead, a chair, an SVP. may not avail itself, but it is really important that those decisions you're making incrementally early in your career sort of set you up ⁓ experientially with an opportunity to lead down the road. So that is early on, stepping up and looking for mentorship in your department department or in the broader ⁓ college of medicine. That is volunteering to serve on committees where feasible. Of course you've got to be A really good clinician if you're going to be a leader because people are going to look to you and hold you to a higher standard. ⁓ but you've got to make incremental decisions early on your c in your career to build upon and sort of set yourself set yourself up for when the for that opportunity that might avail itself in your late 30s and your 40s and your 50s. And that I think it's also important to know that opportunity may not come. but you gotta be in the right position to be able to take it ⁓ when it does when it does come. So, you know, part of that also is is like, you know, you sometimes feel feel p hear about people that are like, I want to peel back my FTE or I'd like a no-call position, ⁓ or or I I really don't want to have a life outside of clinical care that unfortunately doesn't really lend itself. ⁓ to being a leader. part of it is being the first to volunteer ⁓ for those sorts of things ⁓ you know really day in and day out early on in your career. I guess the last part is it that I want to say about this is every person that's listening to this ⁓ podcast, every person that has gone through medical school, has gone through residency, is now a junior attendee, whatever, wherever you are and you're ⁓ sort of spectrum of of clinical training. You're a type A person and you've been used to like climbing the food chain. You have this impression of like my career is this very linear ⁓ one step over, one step north type of, you know, of slope. And that is not how your professional career is. It it may be Flat for a long period of a plateau and then very, very abrupt increases, and then flat periods of plateaus. And so there is a lot of patience involved in that process of learning, like, you know, it's not always this. ⁓ and it, and it certainly is not that as you get farther in your career where those opportunities to go from, say, a, you know, director to a managing director to a VP to an S V P to an E V P to a C suite position. ⁓ those those opportunities are fewer and farther between and it takes a lot a lot longer to get there.
speaker-0: That's that's really helpful. I think there there are many that could be frustrated, right? They think that ⁓ they're doing their part in demonstrating leadership locally. They're division director or their team lead scheduler, but they're just not getting that that nod for the title up. Yes. ⁓ and I think sometimes having the ⁓ the perspective that it may take time and that role may not appear where you are. And it's of also ⁓ I think I think good to put your C V out there, to also speak with headhunters and recruiters, ⁓ because the role that you're aspiring to may not be at your current organization. ⁓ and it may re and it may mean that you're you're going somewhere else to climb the ladder. ⁓ 'cause it's tough to promote from within sometimes when the person in the role that you aspire to is doing well in that role and not leaving anytime soon.
speaker-1: 100%. And I think the last part is sometimes people that are around you are uncomfortable in saying, like, hey, Josh, you talk too much. Or you need, you know, you're a little bit unprofessional when you present ⁓ at at this. So they may be, you know, that's constructive feedback that you need to get. And they may be uncomfortable doing that. But I promise you, a headhunter, they'll be when they see the whole picture and they interview, they'll say, look, you're lacking in this, you're lacking in this. I got concerns about how you're gonna interview on this. And you probably need to work on this to get this position down the road. Cause that's what they do day in and day out. And sometimes that is really the most valuable thing that you can get is somebody who's who just tells it to you straight about where you need to up your game.
speaker-0: And it's free advice. It doesn't cost you anything to talk to them. ⁓ and you may knock it out the park and now they've got your profile in their system to say, Hey, I see a chief role coming up at this hospital, you'll be great for it. And then you get the call as well. Exactly. So put yourself out there, folks. Yep. Agreed. ⁓ we're coming up in closing here, Josh. And I just gotta ask, what was it that made you and Katie say yes? To investing in Doc to Doc. this was a napkin idea now seven years ago. And ⁓ you were one of the smartest people that I know. And I called you, ⁓ you're one of the first phone calls that I made. ⁓ and I remember telling you the idea of what we were hoping to do with making capital more affordable, democratizing access to money for docs who were early in their careers, especially, who are struggling to get approvals because of low FICO, low income, ⁓ and just having a ton of student debt, right? ⁓ over the course of the last decade, that problem has been e even greater because there's a a depression in reimbursement for doctors, medical education has gone up even higher, and the burdens on our credit profiles have gotten worse. All that being said, your initial response to the question of what do you think about the idea was Not only do I love it, but I'll invest. Why?
speaker-1: So ⁓ so the first part was it had been something that I had always had in the back of my mind, less so on the trainee front, but in my role of managing a variety of practices prior to quality and doing, you know, vice chief medical officer, CMO work, you know, I take over I would be managing practices and you know, you occasionally would get a call. On say a Friday afternoon on payday or maybe Thursday, ⁓ I'd find out, you know, gosh, something happened on ⁓ on accounts payable and ⁓ we weren't short on cash. But for whatever reason, there was not gonna be a paycheck on that Friday, but it was gonna we were gonna cut a check independently and it was gonna hit the account on Monday. And I remember, you know, talking with an anesthesiologist making buo money, who was who said, No, no, no, no. It's you gotta pay me on Friday. And so, you know, no questions asked. Yes, we cut a check ⁓ and have the the funds wired. But in the back of my mind, I'm thinking, wow, you know, you're making a lot of cash and what you you have zero liquidity to be able to handle this bump in the road. Second example of just, you know, transitioning a practice, you know, a person whose child got into Stanford and didn't have the money saved and was taking a loan out to their 401k that then required a balloon payment at the end. And I just thought for both of these people, regardless of their life circumstances, whatever brought them to where they are, this is crazy that they're that short. So when I'd speak, ⁓ when I had the opportunity to speak with with you and Kenton, I was like, no questions asked. Absolutely. This has been in the back of my mind. Not only should we be doing this for Residents and fellows, but you should be doing this for in practice stocks, ⁓ because life happens for for them as well. And I think just the second part of this was it energized me. ⁓ and the opportunity to maybe dump some personal effort into it was very exciting, enjoyable for me, and gave me ⁓ a little bit of like, you know, ⁓ professional energy. to be able to be doing something else outside of medicine that that I was really personally very vested and interested in.
speaker-0: Well, I'll I'll say thank you again ⁓ for believing in the idea and for all the effort that you invest. effort, ⁓ time and and and coin, right? I think it's important that the ecosystem of folks that benefit from our product understand that the people that are behind constructing it did so with this mission ⁓ in mind to be helpful to our peers. ⁓ and ⁓ and you embody that. This has been a really meaningful conversation, Josh. ⁓ what stands out to me, and I hope our our listeners can can see is that your journey reinforced reinforces a simple but powerful idea that clinical training doesn't limit us, it equips us. ⁓ and you've shown that stepping into leadership, into quality and systems level work isn't leaving medicine behind, it's expanding its reach. So the takeaway here is your white coat can be the foundation, not the finish line. There's so many ways to influence to create impact beyond the bedside. If you're willing to stay curious and say yes to growth. Yeah. Thanks for your perspective, Josh. And to our listeners, thank you for joining us on Beyond the White Coat. Until next time, keep asking bigger questions and don't be afraid to step beyond the white coat. Thank you all.
speaker-1: Two kinds Wadi. I'm really glad to be here with you.
speaker-0: So, Josh, you're incredibly accomplished, man, and and you've built a career that spans clinical medicine, policy, and executive leadership. But I always like to rewind before we fast forward. ⁓ tell me about Josh before the titles and the leadership roles. I'm curious, did did young Josh imagine this kind of career at all? Where did you grow up and ⁓ what first sparked your interest in medicine?
speaker-1: Yeah, I mean I grew up in ⁓ in central Texas in a little suburb ⁓ north of Austin. Of course now it's part of Austin, town called Floogerville. My mom was a ⁓ my mom was a school teacher there, taught third grade for 40 years, and ⁓ before retiring. And as the child of a school teacher who you knew you were gonna she was gonna find out if I stepped out of line, I needed to be on the straight and arrow from Did you go to her school? I I did, I did through elementary school. Yes, I did. And so I knew if if I ⁓ if I stepped out of line at all, it was going straight to Mary Lumley. And ⁓ and so, you know, ⁓ she poured a lot into me. But you know, my parents are still married. My dad did as well. My dad traveled a lot for work, so so really I was largely spent most of my time with my mom. ⁓ she dumped a ton of of energy into me and ⁓ and really set the bar high for me to be successful. And I had sort of this inherent drive ⁓ to to be that way. ⁓ in terms of like I I think like decision making of wanting to pursue medicine, it really was ⁓ I had a couple like sort of formative events. I ran track in high school ⁓ track in college. I loved physiology. and I really, you know, had a mind for science. And so when I went to undergrad from the get-go, I was pre-med and thank God I wasn't one of the ones that that sort of fell to the wayside during organic chemistry my sophomore year. I still very clearly remember though, ⁓ the, you know, how how difficult that time was. And sort of one thing just led to another. And I was fortunate enough to ⁓ ⁓ to get accepted into medical school back in Texas and and then, you know, here we are.
speaker-0: It's funny how without real intention, sometimes we we follow the path of those early influences, right? And it's funny to hear you say that your dad traveled a lot, your mom's a school teacher, my mom's a school teacher. And I know right now you're sitting in a hotel room. Yes ⁓ because you're traveling for work and we'll we'll kind of evolve the story of what your day to day work looks like. But you're clearly a parent like your dad in the sense of work travel. And I know that you've got ⁓ two daughters at home and your wife Katie's a huge supporter of your career. What's it like to be in the road as much as you you are? And how do you think about how young Josh experienced dad and what's similar and different about how your girls experience you?
speaker-1: Yeah, it's a great question. You know, I when I stepped into my role that required a lot of travel as an executive, ⁓ you know, an executive clinical leader doing startups for anesthesia practices around the country, I was attracted to it because of sort of the direction it was going to take me career wise. But I was trying to identify, have a moment with my dad where I said, you know, it's interesting that. I'm traveling so much for work in a very similar way that you did for me. And hey, listen, I want you to know that I never feel like I never felt like I missed out on you as a parent, ⁓ being gone so much. But you also like impacted me a ton, knowing that for you, ⁓ work was very important. And without you, I would not be where I am today. And he stopped me for a moment and he said, Well, I I appreciate you saying that, but I sometimes have some guilt about it myself. ⁓ in missing track meets and missing sporting events, et cetera. And ⁓ and I'm kind of, you know, if I'm completely honest, in a moment of vulnerability, I'm sort of going through that a little bit right now. I've got a, you know, 13-year-old daughter who is athletically gifted, academically gifted, a 10-year-old who's stepping into middle middle school. And there are moments where you struggle with your capacity to be present. as much as you need. And I I wonder, you know, sometimes you do have this internal struggle of, am I doing the right thing? Am I not? ⁓ are am I personally going to have regrets down the road? Are they going to have regrets down the road? ⁓ but I'm fortunate enough, you know, I've got a great partner in Katie who I can bounce these thoughts around and say, am I, you know, I I need you to I need you to exactly exactly Right, are things out of balance in terms of career, personal life, health and wellness, et cetera? Is one of them re getting too much attention and focus? And do I need to reset?
speaker-0: Sure. I know I think all of us, all of us are challenged by exactly that. ⁓ and it's just hard to know when sometimes you can't tell, you know. And at other times you'll feel it acutely, especially when you know you're missing something. ⁓ and I don't think any of the guests that we've had in this ⁓ podcast ⁓ has not mentioned that as something that they're acutely aware of as a an area of emphasis to to do better. Because we're all in this continuum of trying to get ⁓ the right balance in very demanding clinical and then, you know, academic and professional careers, ⁓ while also ⁓ you know, balancing that we're doing it for these people we love, this is taking us away from them.
speaker-1: Exactly. Correct. One of the things I th I have personally kind of found a little bit valuable is like envisioning there's this pie that's cut into five slices. You can call each of the five slices whatever you want to. But you know, one would be, you know, ⁓ spirituality, one would be career, one would be finances, one would be family, one would be health and wellness. And each of those pie each of those pieces is numbered one, two, three, four, five. If you score five on all of them, you get a perfectly round big pie. If you score one, you got a really small pie. It means you're not doing good on any of them. But if any one of them is like, hey, I'm one on health and wellness, but I'm five across the board, it's like a wheel that just doesn't roll. and so you know, the dream scenario is that your fives around the world, ⁓ across the board. ⁓ but if any one of them is out of balance, it's pretty obvious from, you know, a visual perspective of like, geez, I need to, I'm definitely, I'm crushing this area of life. This one here, I'm falling ⁓ to the wayside on.
speaker-0: I hear you. At some point in time though, I think ⁓ many of us start to notice that there are questions that go beyond the exam room. So we're we're balancing life, but we have we've got these curiosities and we have questions about systems, about policy, about how healthcare actually works at scale. And you're the embodiment of someone who had those questions and then ⁓ chose a career path that allowed you to scratch all of those itches, you know. ⁓ Was there a moment or a series of experiences for you in your clinical career that sparked that curiosity about policy? And how do you navigate the tension between being a practicing anesthesiologist? We traded the same program at Harvard, the Harvard Hospital Bringham and Women's. And you were a star there, chief resident. You're someone whose name rung out ⁓ after you left. ⁓ I heard of the Josh Lumley. ⁓ and ⁓ and and you you you cu you had built this. this reputation for clinical excellence and rigor. And you also chose to become a leader, an administrator, someone who thinks bigger about impact at scale. How did you navigate that tension and and and how do you balance it now?
speaker-1: Yeah, ⁓ it's it's a great question. ⁓ and I will say I am not an expert or ⁓ at balancing it. having said all of that, like for me, policy and politics had been very important from sort of day one. I I'm an only child. My mom is an educator. My dad is an educational consultant. He worked, ⁓ he would write grants and proposals for low-income school districts in Texas, Louisiana, Arkansas, Oklahoma, New Mexico. And my mom also being a public school teacher in a very middle, lower class ⁓ sort of part of of central Texas, we would have a lot of conversations around. you know, what life was like, how can we make life or or where are areas that we felt like the government could maybe help out populations ⁓ that were underserved, or what could be the impact ⁓ within public education. So policy had always been something that we talked about at the dinner table. When I was at the Brigham and the opportunity availed itself to be a congressional fellow, I was like, I am absolutely throwing my hat in the ring. And definitely want apply for this. ⁓ it was 2007, 2008. ⁓ and ⁓ so you know, there was gonna be a change in the presidency. ⁓ didn't know who it was gonna be. ⁓ there was definitely going to be a ⁓ you know, probably a change in who controlled the ⁓ House and the Senate. It was a prime opportunity to do so. And I was young, we didn't have kids, ⁓ and so I approached the, you know. my residency program of director and said, I want to apply for this. And he encouraged me to do so. And lo and behold, I was selected. And so there's not a question. We definitely said, We're out for a year. We're going to DC, ⁓ and you're going to work on the hill for a year. and ⁓ you know, and my wife ⁓ worked as a school teacher at the at the Smithsonian. And it was just, it was an incredible year for us. It was just incredible.
speaker-0: It's so funny how like the same events in history ⁓ impact all of us in different ways and then some of us in similar ways, right? So at that same time that you were considering doing the fellowship, I was in medical school thinking about an MBA. And my the lead professor for health policy at Emory, where I went to medical school, Ken Thorpe, was an advisor to the Obama campaign. And so the Affordable Care Act was being formulated in the classroom. Right. And I had this rich opportunity to say, look, I'm gonna get an MBA because if healthcare is being changed in such interesting ways, if you're not at the table, you're gonna be in the menu, is what they say. Yeah. And ⁓ and I I had the curiosity, like you did at the time, to kinda go deeper. And it was so funny to be in the classroom with Ken, Professor Thorpe, on a Tuesday. And they'd be we'd be tossing around the ideas around ⁓ single payer coverage, what Medicaid reimbursement looks like compared to Medicare reimbursement. And then I'll see him on the news on Thursday espousing the same themes that we had in the classroom on Tuesday. Yeah. And so I had a front row seat to this massive legislation. And the MBA for me was my conduit to get access to understand how the economy of medicine kind of runs. ⁓ and that's really why I got the NBA because it was in that two thousand six to seven era when the Affordable Care Act was being formulated.
speaker-1: Yeah, and you know, for me, ⁓ I was slightly before that, but it was just a conversation around y so Zwade, this is crazy. But at one one time charts were paper and people would have to write notes ⁓ like H and Ps and soap notes and you would have to like handwrite labs and things like that in order
speaker-0: Maybe they'll call someone on a telephone that had a c a cord attached to the wall, right?
speaker-1: It was and it was not an EMR and it and it was and it was like less than twenty years ago was that was the world. And so the debates that were going on were how do we create an IT system that communicates with another IT system? So that if a person ends up with a broken ankle in California on vacation and they're on this multitude of medications, like how do we communicate with the their home hospital? ⁓ It it was it's crazy, but my ⁓ after my intern year, I went to the Brigham and Katrina hit New Orleans and it was a huge population that was displaced from New Orleans to Houston. And the people that and the people that did the best were the folks that were that came from the VA because the VA already had an EMR and those folks they knew, you know. They were on their co-reg for their, you know, significant CHF and they could just continue that medication. But if you have somebody that just shows up to the Bentov emergency room with a bag full of drugs and I was like, this is, you know, I just brought it with me, you know, from New Orleans, I've been displaced here. Like that was the world that we lived in at that time. So so what we worked on extensively in the office that that I was in was ⁓ you know, we worked on energy and commerce. ⁓ committee was all around health information technology, making it interoperable. and how do we implement this new ⁓ bill that has just been passed called HIPAA. ⁓ and ⁓ it was fascinating. It was really just incredible.
speaker-0: Yeah, I I can only imagine, especially at a time in in disaster and crisis, right? Like so we've also lived through a series of, you know, once in a lifetime crises and ⁓ you know, like we we we just went through COVID what feels like yesterday. and we saw the impact of having immature health systems and what it means for population health. And so it we can underscore how important it is to have the best and brightest amongst us as clinicians be a part of policy totally and administration and legislation as well. The your titles, SVP and National Chief Quality Officer and CMO, they can all they can feel abstract to the to the ⁓ to the doctors that don't really know what that means from a practice perspective. Tell us more about what your actual day-to-day means to oversee CMS quality reporting on an enterprise level performance. What does that look like?
speaker-1: So my elevator pitch ⁓ about my role as chief quality officer is I have three overriding sort of jobs that I undertake. Number one is reporting quality every single anesthetic that's performed within our organization. So a million and a half anesthetics a year. Every single anesthetic we need to report quality metrics ⁓ to CMS and third party payers. That's everything from a cataract and a carpal tunnel. Up to circa rest, aortic arch repair, and everything in between. There are quality metrics whereby you know you should be able to say, is my department of anesthesia doing the right things? Are they good? Are they taking great care of patients? ⁓ so reporting those out. ⁓ being an anesthesia-specific patient safety organization. So for every so you know, we did receive ⁓ accreditation as an anesthesia PSO. And so Every single, you know, continuous improvement in our clinical performance, driving and pushing the needle forward in terms of patient safety. And then last but not least, ⁓ and this is a very sort of B school ⁓ type, you know, terminology, but just implementing standardized clinical techniques so that you know, you know, if you're having a total knee done in this part of the country. For the most part, the anesthetic techniques that are performed there are going to be the same anesthetic techniques that are performed in another part of the country, 1,500 miles away, and the outcomes are going to be largely replicable. So that is sort of the effort that we're trying to drive within the OCQ. ⁓ along with that, you know, education, ⁓ continuous, you know, you're not in academic department anymore, but how do we make sure that you're continuing to learn? ⁓ new and novel techniques and the best ways to take care of patients. ⁓ and then of course I have a a balance of my, you know, ⁓ of my FTE allocation that's still with taking care of patients day in and day out. Yeah. Yeah.
speaker-0: Hence you're in a hotel room right now.
speaker-1: There you go. Tomorrow. Exactly. Yeah.
speaker-0: What it what what was it about you ⁓ as a clinician at NordStar that allowed management to see you as someone that can be in this leadership role? ⁓ and what kind of guidance can you give to others who are mostly clinical but aspire to be in leadership?
speaker-1: So the first thing is is I think you have to make a decision early on in your career that leadership is something that you would like to pursue. Because every decision that you make builds upon that. And you may or may not have that opportunity, say, in your 30s and 40s, maybe even your 50s, the opportunity to be a department lead, a chair, an SVP. may not avail itself, but it is really important that those decisions you're making incrementally early in your career sort of set you up ⁓ experientially with an opportunity to lead down the road. So that is early on, stepping up and looking for mentorship in your department department or in the broader ⁓ college of medicine. That is volunteering to serve on committees where feasible. Of course you've got to be A really good clinician if you're going to be a leader because people are going to look to you and hold you to a higher standard. ⁓ but you've got to make incremental decisions early on your c in your career to build upon and sort of set yourself set yourself up for when the for that opportunity that might avail itself in your late 30s and your 40s and your 50s. And that I think it's also important to know that opportunity may not come. but you gotta be in the right position to be able to take it ⁓ when it does when it does come. So, you know, part of that also is is like, you know, you sometimes feel feel p hear about people that are like, I want to peel back my FTE or I'd like a no-call position, ⁓ or or I I really don't want to have a life outside of clinical care that unfortunately doesn't really lend itself. ⁓ to being a leader. part of it is being the first to volunteer ⁓ for those sorts of things ⁓ you know really day in and day out early on in your career. I guess the last part is it that I want to say about this is every person that's listening to this ⁓ podcast, every person that has gone through medical school, has gone through residency, is now a junior attendee, whatever, wherever you are and you're ⁓ sort of spectrum of of clinical training. You're a type A person and you've been used to like climbing the food chain. You have this impression of like my career is this very linear ⁓ one step over, one step north type of, you know, of slope. And that is not how your professional career is. It it may be Flat for a long period of a plateau and then very, very abrupt increases, and then flat periods of plateaus. And so there is a lot of patience involved in that process of learning, like, you know, it's not always this. ⁓ and it, and it certainly is not that as you get farther in your career where those opportunities to go from, say, a, you know, director to a managing director to a VP to an S V P to an E V P to a C suite position. ⁓ those those opportunities are fewer and farther between and it takes a lot a lot longer to get there.
speaker-0: That's that's really helpful. I think there there are many that could be frustrated, right? They think that ⁓ they're doing their part in demonstrating leadership locally. They're division director or their team lead scheduler, but they're just not getting that that nod for the title up. Yes. ⁓ and I think sometimes having the ⁓ the perspective that it may take time and that role may not appear where you are. And it's of also ⁓ I think I think good to put your C V out there, to also speak with headhunters and recruiters, ⁓ because the role that you're aspiring to may not be at your current organization. ⁓ and it may re and it may mean that you're you're going somewhere else to climb the ladder. ⁓ 'cause it's tough to promote from within sometimes when the person in the role that you aspire to is doing well in that role and not leaving anytime soon.
speaker-1: 100%. And I think the last part is sometimes people that are around you are uncomfortable in saying, like, hey, Josh, you talk too much. Or you need, you know, you're a little bit unprofessional when you present ⁓ at at this. So they may be, you know, that's constructive feedback that you need to get. And they may be uncomfortable doing that. But I promise you, a headhunter, they'll be when they see the whole picture and they interview, they'll say, look, you're lacking in this, you're lacking in this. I got concerns about how you're gonna interview on this. And you probably need to work on this to get this position down the road. Cause that's what they do day in and day out. And sometimes that is really the most valuable thing that you can get is somebody who's who just tells it to you straight about where you need to up your game.
speaker-0: And it's free advice. It doesn't cost you anything to talk to them. ⁓ and you may knock it out the park and now they've got your profile in their system to say, Hey, I see a chief role coming up at this hospital, you'll be great for it. And then you get the call as well. Exactly. So put yourself out there, folks. Yep. Agreed. ⁓ we're coming up in closing here, Josh. And I just gotta ask, what was it that made you and Katie say yes? To investing in Doc to Doc. this was a napkin idea now seven years ago. And ⁓ you were one of the smartest people that I know. And I called you, ⁓ you're one of the first phone calls that I made. ⁓ and I remember telling you the idea of what we were hoping to do with making capital more affordable, democratizing access to money for docs who were early in their careers, especially, who are struggling to get approvals because of low FICO, low income, ⁓ and just having a ton of student debt, right? ⁓ over the course of the last decade, that problem has been e even greater because there's a a depression in reimbursement for doctors, medical education has gone up even higher, and the burdens on our credit profiles have gotten worse. All that being said, your initial response to the question of what do you think about the idea was Not only do I love it, but I'll invest. Why?
speaker-1: So ⁓ so the first part was it had been something that I had always had in the back of my mind, less so on the trainee front, but in my role of managing a variety of practices prior to quality and doing, you know, vice chief medical officer, CMO work, you know, I take over I would be managing practices and you know, you occasionally would get a call. On say a Friday afternoon on payday or maybe Thursday, ⁓ I'd find out, you know, gosh, something happened on ⁓ on accounts payable and ⁓ we weren't short on cash. But for whatever reason, there was not gonna be a paycheck on that Friday, but it was gonna we were gonna cut a check independently and it was gonna hit the account on Monday. And I remember, you know, talking with an anesthesiologist making buo money, who was who said, No, no, no, no. It's you gotta pay me on Friday. And so, you know, no questions asked. Yes, we cut a check ⁓ and have the the funds wired. But in the back of my mind, I'm thinking, wow, you know, you're making a lot of cash and what you you have zero liquidity to be able to handle this bump in the road. Second example of just, you know, transitioning a practice, you know, a person whose child got into Stanford and didn't have the money saved and was taking a loan out to their 401k that then required a balloon payment at the end. And I just thought for both of these people, regardless of their life circumstances, whatever brought them to where they are, this is crazy that they're that short. So when I'd speak, ⁓ when I had the opportunity to speak with with you and Kenton, I was like, no questions asked. Absolutely. This has been in the back of my mind. Not only should we be doing this for Residents and fellows, but you should be doing this for in practice stocks, ⁓ because life happens for for them as well. And I think just the second part of this was it energized me. ⁓ and the opportunity to maybe dump some personal effort into it was very exciting, enjoyable for me, and gave me ⁓ a little bit of like, you know, ⁓ professional energy. to be able to be doing something else outside of medicine that that I was really personally very vested and interested in.
speaker-0: Well, I'll I'll say thank you again ⁓ for believing in the idea and for all the effort that you invest. effort, ⁓ time and and and coin, right? I think it's important that the ecosystem of folks that benefit from our product understand that the people that are behind constructing it did so with this mission ⁓ in mind to be helpful to our peers. ⁓ and ⁓ and you embody that. This has been a really meaningful conversation, Josh. ⁓ what stands out to me, and I hope our our listeners can can see is that your journey reinforced reinforces a simple but powerful idea that clinical training doesn't limit us, it equips us. ⁓ and you've shown that stepping into leadership, into quality and systems level work isn't leaving medicine behind, it's expanding its reach. So the takeaway here is your white coat can be the foundation, not the finish line. There's so many ways to influence to create impact beyond the bedside. If you're willing to stay curious and say yes to growth. Yeah. Thanks for your perspective, Josh. And to our listeners, thank you for joining us on Beyond the White Coat. Until next time, keep asking bigger questions and don't be afraid to step beyond the white coat. Thank you all.
