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In this episode, we speak with David Danhauer, a seasoned pediatrician and former CMIO. Throughout his career, he has had the opportunity to gain a wealth of experience and knowledge, and as he approaches retirement, he reflects on his journey with gratitude. He shares his insights on what it takes to create a fulfilling and meaningful career in medicine, drawing on his experiences running his own clinic, collaborating with peers at the national level, and serving as chairperson of the HIMSS physician group. Listen in as he offers valuable advice for fellow physicians looking to make a positive impact in their profession.

David Danhauer is a pediatrician and former CMIO.

He shares his story and discusses his KevinMD article, “3 pieces of advice to create a meaningful career.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. On today’s show, we have David Danhauer. He’s a pediatrician and a former CMIO. His KevinMD article is titled “3 pieces of advice to create a meaningful career.” David, welcome to the show.

David Danhauer: Thank you very much. I’m glad to be here, and I appreciate the opportunity to be able to talk about that.

Kevin Pho: So we’ll get into the article a little bit, but first off, briefly share your story and journey to where you are today.

David Danhauer: Right, Kevin. I’ve been very blessed to have been able to work in my hometown, where I was born and raised in Western Kentucky, and to have a phenomenal career in pediatrics for 27 years. I created a great practice there with multiple partners, but I got to the point where, wow, I’d done it all. It was all done, it was really sort of stagnant, and I saw other things that I really could be doing more.

I got involved with some IT work halfway through my career, linking with the hospital, getting an EMR together, and seeing the sharing of that data, et cetera, and how important it was, and I really enjoyed it. But I also enjoyed the administrative side. Being on the hospital board, I got really excited about that, and working with administrators across the organization was very fun. So when an opportunity came up to implement a new EMR at the hospital, I jumped on it. I said, “Yeah, let’s go,” and I did it gratis. I just wanted to be there; I wanted to be engaged in it.

It came to the point where the hospital was really needing somebody more full-time, et cetera, so I jumped on it and said, “This is great, let’s go. Do you need a full-time CMIO?” And I did it. It was great, and I made that transition from a practicing pediatric primary care physician to a full-time administrator at the hospital. I did that for 10 years, and I had a great career there. I was able to travel, get out, and see what the country was doing, not just what we were doing in our little corner of the world in Kentucky. I got to network with a number of people across the country, which was very invigorating, exciting, new stuff, and bringing that back and incorporating it into our local situation was very fun.

Kevin Pho: So tell me what your day-to-day life was like as a CMIO, because a lot of CMIOs are kind of the buffer between the clinician side and the administrative side. And when it comes to implementing the EMR, I’m sure there are a lot of negative connotations from the clinician side when it comes to EMRs, right? So you’re kind of caught between those two worlds. Tell us, what was it like day to day when you were a CMIO?

David Danhauer: In the beginning, it was a lot of hand-holding. That’s exactly what my job was about. Fortunately, I had a great rapport with my physicians, and they understood and trusted me in what I was doing and where I was going, et cetera. So if I said something, it didn’t draw a lot of angst from my fellow colleagues. And there were those who weren’t comfortable with it; they really struggled with it, and so we had to help pull them along.

I found very quickly that I couldn’t do it by myself, and I developed a provider support team that the hospital embraced pretty well. It started with one individual who was phenomenal at helping with elbow-to-elbow support with my docs. We saw and showed significant improvement in physician satisfaction with those supports, and we grew that over time all the way to a five-person team. They really were the best friends of the physicians. It took us a while to gain the physicians’ comfort and ability to say, “Yeah, I need to reach out to that team,” but once they did, wow, we were their best friends. We helped them in any situation, 24 hours a day, seven days a week: “You tell me what you have a problem with in IT, and we will figure out a way to get it fixed for you.” So that buffer really helped me then be able to do bigger and more things, and that was a very good, helpful thing for our docs, but also for me to reach out and do better.

Kevin Pho: So when you’re advocating on behalf of physicians, sometimes that puts physician leaders like yourself in tension or in conflict with administration. Did that happen to you, and if it did, how did you navigate that?

David Danhauer: Right. Very early on in my career as a CMIO, I went to the CEO and said, “Tell me who I’m supposed to represent. Am I representing administration, or am I representing our docs?” He pointed down this long hallway and said, “I’ve got plenty of hospital administrators. I need you to represent the docs.” With that CEO guidance, that led me to say, “OK, I’m going to advocate only for the physicians,” and that really helped clear the way for my role in being able to challenge the administration to do better for our docs. And that’s where, again, the provider support team came in; when I came up with ideas for providers to do a better job, that rolled right through. It was very helpful. That leadership from the CEO, though, helped make that possible.

Kevin Pho: For those physicians who want to ascend a leadership ladder, I often say that they need to get into more roles like yourself, a CMIO, in order for them to have a voice. What kind of advice do you have for practicing clinicians who want to follow in your footsteps and have more of a say when it comes to administrative issues?

David Danhauer: I think the first thing they have to do is get involved with the hospital. So many physicians have really walked away from that and not wanted to be engaged with any administrative activities at the hospital, whether it’s chairing a committee, a medical committee of some sort, chief of staff, or saying, “I’d like to be on the hospital board.” They have to show some form of leadership and engagement with hospital administration before that will go, and certainly committee chairs with the medical committees are an absolute first place to go. Once you’ve shown that interest, once you show that leadership capability, administration is going to step up and say, “Oh my gosh, look at this physician. We really need to get them engaged more and more.” But the physician has to make that first step. There is no doubt they have to be engaged and willing to step out of that pure clinical role and start to take on some administrative duties.

Kevin Pho: And for those physicians who are interested in taking those leadership roles, what kind of questions should they ask themselves to make sure that they’re the right person for a job like that?

David Danhauer: Sure. I think they have to be comfortable speaking their mind, being able to stand up and say, “I feel this is right,” or “I don’t feel this is right.” For those who are rubber stampers, it’s very difficult to do anything effectively for administration. So you really have to be able to voice your opinion, communicate well, and stand up for what you truly do believe in and the why behind that.

The second piece is: Are you willing to give of that time that’s so precious as a physician? Are you willing to give up some of the time that you have for clinical work, or family, or other activities? Are you willing to spend that extra time? As I’ve spoken of in my article, do you have a passion to help make a difference and spend that energy and time that’s so rare on this particular need? You’ve got to push yourself to be able to do that. Without the passion, you’re not going to find the time, you’re not going to find the energy, and you’re not going to find the effort that makes it worthwhile for you and lets you be successful.

Kevin Pho: All right, so let’s talk about your article, titled “3 pieces of advice to create a meaningful career.” How did the article come together?

David Danhauer: Yeah, so I thought it was interesting, in retrospect, in retirement: What was it that really made me feel, as I retired, that I was successful, that I had made a difference in the lives of my patients, as well as the patients of my entire community as a CMIO? How do I improve myself and also work to improve the environment for others? Focus on what I can do better. What are my gifts, and how can I improve those for myself and for others? That drive was very important. And that’s where the true passion comes from, and knowing who you are and what your passions are is very critical. You will only be successful in being able to express what your passions are.

I think the second piece is being a good listener. I spoke to that in the article. I learned very early in my residency that if I listened to my nurses, my life was going to be much, much better. With physicians and nurses, if you have that relationship, the teamwork is so much more effective than trying to go off on your own, be by yourself, and shun the value of what nurses and others are doing. As I learned to listen to them, gosh, I was so much more successful because of that, all the way through my career.

First of all, there was listening to my families, as I mentioned in the article: listening to those who come in and say, “I think this is maybe what is going on,” rather than assuming in the first seven seconds of that patient visit that I know what’s already going on. You have to wait and really put that mindset on hold. Listen first, then start to make determinations. Even in my CMIO role, I knew who the physician was who was complaining and coming to me, and I had to really put those feelings on hold and truly listen to what they were saying before I made an assumption. I can’t tell you the number of times early in my career I got burned because I didn’t hear both sides of a story. So listening, I will come back to that again and again, and how well it worked for me in furthering my career and doing a much better job in both those careers.

Servant leader: I can’t speak to that more importantly. We hear it so many times, but if you’re not willing to do the work that the people working for you are willing to do, you’re never going to be successful. Nobody will ever listen to you; nobody’s going to be able to do that. So going back to unstopping the commode in my office when kids plugged it up with something: If I’m not willing to do that myself, I’m never going to have any of my staff be able to do that. They’re not going to be able to stand up and say, “Yeah, we need to get that done.” To show the importance of the work that has to be done to make all of that teamwork happen, you’ve got to be able to do that.

And so, dealing with that difficult physician, not just turfing that to somebody else, but absolutely saying, “That’s just as important. I need to make that impression with them. I need to step in and say something. I need to be the listener at this point and calm those anxieties and fears and work through what that next problem would be.” So really being able to do the work that others are expected to do, you’ve got to be that servant leader.

Kevin Pho: So one of the themes that comes through strongly is the importance of listening. Tell us what kind of traps physicians often fall into that keep them from being the listeners they should be. What are some red flags that physicians should look out for to improve their listening skills?

David Danhauer: So one of the scenarios: When I first started in my career, I went around to all the pediatricians in my community and introduced myself. One of the pediatricians there said, “David, if you listen to your patients, they’re going to tell you what’s wrong 80 percent of the time.” And he said, “If you really, really listen, they’re going to tell you how to treat it 50 percent of the time. Your job is so much easier if you’ll just listen.” I used that throughout my career. It was an amazing recommendation. I was green out of medical school, green out of residency, and didn’t know a thing about what I was going to be doing. It was great wisdom on his part.

But think of how many times I did that. I was at a bedside with a patient in diabetic ketoacidosis whose total body failure was occurring right in front of me, and I had every specialist that I knew in my community trying to help me save this teenager’s life. Over in the corner, one of the nurses made a suggestion of adding a pressor agent, and I thought, “Why didn’t I think of that, when I’ve got all the experts in this room?” Hello, that’s exactly what this patient needed, and that nurse saved that patient’s life. Those examples go on and on in my career, but if I hadn’t been listening, instead of being the commander of this great army, if I hadn’t listened to the troops, that patient would not have survived. Absolutely, categorically, the patient survived because of the ability to take that team and listen to what’s going on. I can’t say it enough. I mean, it’s just crazy. Listening is so, so important.

And as I mentioned, I got burned so many times when I listened just to the physician, whoever the screamer was at the time, and didn’t take into account what else was happening at the time, making a decision just off of that physician’s need or want or whatever at that time. I made bad decisions doing that. So when I stepped away from the situation, took all the data, and listened to everyone, I could then make a better decision, and actually, for the physician, it was a better decision as well. So those are some specific examples. I’ll tell you what, thank goodness I learned early on to try to listen, but it paid off greatly in my career.

Kevin Pho: We hear all the time about an increasing number of physicians who are burning out. They’re leaving medicine mid-career. They don’t have the passion for clinical care because of the bureaucracy and the fact that physicians today are just being disempowered, and they’re losing their autonomy, right? What kind of advice do you have for these physicians to regain that meaning in their life and resume their careers? What kind of immediate, actionable tips do you have for them?

David Danhauer: Well, I think they need to look at what drives them. As I mentioned, it’s the passion. If patient care is still your passion, if it’s making that difference in a patient’s life, if it means that you can actually heal someone or improve their health and welfare, if that’s truly your passion, you’ve got to look for ways where that actually does occur in your practice. Are you spending way too much time on the administrative side and not on face-to-face patient care? Are the types of patients that you’re dealing with not what’s intriguing to you, so that you need to get to a different clientele of patients, to a different subset of patients, whether it’s the clinical situation they’re dealing with, to make a difference?

When I left my pediatric practice, well over 50 percent of the patients I saw every single day were psychiatric in nature. I was not formally trained in psychiatry, but I did everything possible to do as well as I could, and I read and studied and did CME, anything and everything, whether it was ADHD, depression, anxiety, et cetera; it goes on and on. I did everything I could to train and improve my skills to help those patients. What I quickly was learning, though, was that those patients drained me significantly. It took an amazing amount of effort to try and help manage those patients. So I had to take a big look at that and say, even though I was really good at what I was doing, I knew that was not where I could extend my career and continue to keep doing it. I was going to rework something significant in my patient volumes and clientele. I was going to have to shift something to make a difference, or burnout was truly where I was headed.

So you’ve got to look at where you are, what you’re doing, what excites you, and what your passion in patient care is, and make a shift. Make a difference. Do whatever you can to protect yourself, your family, your time, your efforts, et cetera, to be able to be a much more effective physician.

Kevin Pho: So how did you go about making that shift? A lot of physicians are stuck in a rut to have a steady paycheck, and they just keep doing what they’re doing, even though they’re not passionate about it. But you actually took that next step and made a shift. You made a difference, and a lot of physicians simply can’t do that. So how did you do it?

David Danhauer: So all along in that career, I tried to develop what I felt were my gifts, whether it was leadership or administration, whatever it was. I kept trying to develop what those gifts were: What was I good at? What did I enjoy? And I kept advancing those little things. So in my own situation, because I had gone out and done things in leadership, I had established myself as a leader on multiple committees, on the hospital board, et cetera, on nonprofit organizations, leading other organizations, and in church leadership. I did all those things, and I had developed the skills that were attractive to my next employer, not knowing that’s what I was doing. But I enjoyed it, I liked it, and it was fun for me to do the administrative side, because as the practice leader, I led our practice. I did all the administrative work for our practice, the hiring, the firing, et cetera. I did all of that and hired an administrator to help me do those roles, et cetera. So I did that development of my own self, my own skills, and my own gifts, and that’s what allowed me then to go out and find other paths.

I will tell you, it was a huge shift to leave clinical work and go to the administrative side, but if I hadn’t had that prep work all along, I don’t know that I would have been able to make that transition. I was fortunate, I will tell you. I worked half-time for 18 months. Who gets to play in a new job for 18 months to decide whether they’ll like it or not, right? That was a huge thing for me, and I knew already after 18 months, I’m in it, I’m all in on that. I really enjoyed it, but I knew I couldn’t do both. I couldn’t do my clinical work in a primary care situation and be an administrator in the CMIO role. I couldn’t do both; I was failing miserably at both. I had to make a jump one way or the other and commit myself to that.

I think specialists have a little better role in that, but they don’t have that ongoing primary care relationship with patients. Specialists deal with a situation and move on, deal with the situation and move on. They don’t have that long-term relationship built up with patients as much as primary care does. Many times they are going into these roles much more easily than what you would see in some of the primary care roles.

Kevin Pho: We’re talking to David Danhauer. He’s a pediatrician and former CMIO. His KevinMD article is titled “3 pieces of advice to create a meaningful career.” David, what are some of your take-home messages that you want to leave with the KevinMD audience?

David Danhauer: Right. Again, I was blessed to know what my passions were, and I was able to follow through with those passions, and that really helped me focus on where it is I want to go in my life and my career, because of where my passions lie. From the very beginning, I was able to really enjoy being with kids. I knew I had a gift, and playing with kids all day long, what a gift that was, and I made that a career, and wow, that was it. And I knew I loved computers and the data and management and the technology associated with that. Wow, I got a career out of that. It was my passions that drove those and gave me the energy to do really well in both those careers. The bottom line is: Know what your gifts and passions are. You will always be successful, and you will always have joy in the work you do, because you’re driven by your passions.

Kevin Pho: David, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

David Danhauer: Kevin, my pleasure, always. Thank you for the opportunity.