As CSA's new President, I have made it an objective to dedicate a new monthly column to our blog called "Head of the Table". It is modeled after the New York Times’s Corner Office, to spotlight physician anesthesiologists and the incredible work they do whether it be in the CSA, academia, private practice, or research.
I hope you enjoy this new column and look forward to sharing the extraordinary stories and expertise of fellow physicians.
Shalini Shah, MD, on Managing the Many Roles as a Physician
As Chief of the Division of Pain Medicine and Director of Pain Services at UC Irvine as well as the Vice-Chair, Pain Medicine of the Department of Anesthesiology, it’s fair to say that Dr. Shah wears many hats.
Last August, she was appointed Director of Pain Management which propelled her into an administrative role that has her dividing her time between her clinical role, research, and running the division of pain medicine. Dr. Shah is also the founding chair of the Committee on Pain Medicine at the California Society of Anesthesiologists. Although it may seem like a great deal of responsibility, Dr. Shah believes that anesthesiologists are multitaskers by nature which helps her when juggling all of her responsibilities.
When Dr. Shah isn’t in her administrative or clinical roles, you can find her at the forefront of a groundbreaking study, researching the effectiveness of Botox on pediatric migraine pain. The study received national attention by NBC News and TIME. Her hope is that Botox can be effective, so other sedating medications can be minimized, and patients can have better control of their migraine symptoms. The overarching goal of the study is to change the FDA labeling status, so it can be offered as a validated treatment.
This interview, which was condensed and edited for clarity, was conducted by CSA President Sam Wald, MD, MBA, FASA.
How do you divide your time between your administrative role and your clinical role?
The best way I can describe it is that I’m clinical two days out of the week and three days I’m in the administrative role.
Did you struggle with making the transition into the administrative role and giving up time in your clinical role?
I knew when I accepted the position last July that it would involve quite a bit of administrative time. What I really had to deal with was giving up OR anesthesia. In order to balance my time clinically, I made the conscious decision to make the clinical commitment to pain, because that is the specialty I enjoy practicing the most. I enjoy the administrative job so much that it doesn’t feel like work—problem solving and the challenges that go along with it. For example, in this past year we were challenged with the national opioid shortage. Putting together teams to create practical solutions is what I enjoy. I will make the caveat that I am early in my practice, and I wasn’t ready to give up clinical practice altogether—even though my superiors such as my Chair and those in the C-Suite highly suggested that I come out of clinical practice to fulfill all my obligations.
Did they encourage you to come out of clinical practice completely?
Not completely. They did ask me how much time it would take, and I gave them an honest answer. I do, however, think I underestimated the amount of time that it would take me to complete all the tasks involved in my duties. I think that is the issue with females in general – that we underestimate to others how the time commitment a certain job takes to do it well.
You mentioned being female in an administrative position. Do you think there is a difference in your path versus a male physician?
The short answer is no. I am conscious of when we talk about women in medicine or women in leadership roles. I don’t like to differentiate based on gender because this makes no difference in my role as a physician or administrator. However, I will say that in my role specifically, it is very rare to see a female as a Division Chief of Pain. I am the only female division chief of pain in the state of California, and there are probably only a handful nationally. Women remain persistently underrepresented in pain medicine.
What was your first experience with leadership?
My first experience was when I finished my fellowship, which consisted of half pediatric pain and half adult pain. The adult portion was at the Brigham and Women’s and Beth Israel Deaconess hospitals and the pediatric portion was at the Boston Children’s hospital. When I completed my fellowship, I was recruited to start a pediatric pain service at UC Irvine, and I had no idea how to start a division or how to start a service line for a hospital. It was my first foray into starting something that didn’t exist, and it was very trial and error.
How do you manage your time? Do you have a best practice?
I am horrible with structured time management and feel that when one decides to take on a project one must give it their all. My approach has been simply less about structure and more focused about being open to opportunities. Whether that requires you to work eight hours a day, 12 hours a day, or 16 hours a day. I don’t like to quantify time, so I don’t use time management very well. My mentality has always been that if you see an opportunity, jump in wholeheartedly. Some physicians say, ‘Why should I take this on if I’m not being compensated?’—that type of mentality should be put on the backburner.
Would you encourage people to take an opportunity that is offered to them?
Of course. My advice would be not to have a specific career goal in mind but rather see where the journey takes you and enjoy the education. One thing I realize in medicine is that hard work never goes unrewarded. Not today, not tomorrow, maybe not even a year from now, but somewhere down the line, the effort you put in today will be realized in the future. Don’t only look for short-term gains—always have a long-term vision, because you never know where life will lead you.
Physicians tend to be individual contributors. How do you figure out delegating certain activities?
This is actually something that I have been struggling with—I am a poor delegator. If I take on a task, I end up doing it myself, because I fear that delegating it to someone else might result in the work not being done to the standard that I expect it to be. I am learning the importance of having a support system, along with the right people, to whom you can confidently delegate tasks.
I assume the hospital pays for your time away from patient care. Is that right?
How did you navigate negotiating them to do that?
There were two factors. First, I had an extremely supportive Chair who knew the time commitment that would be required and the appropriate compensation for my time. Second, I learned to negotiate my own self-worth. I, and I think many young physicians, especially women, tend to underestimate their own self-worth. But then as we get more and more entrenched in our roles, we realize how much time and effort we actually spend and how much we bring to the table. I’m proud that this is something my Chair and I believe in-- supporting and teaching women to ask for things up front and to be confident in the value that they bring.
You have talked about the value you bring as a physician to your administrative role. How do you go about showing that value to C-Suite?
If any physician is looking to move into an administrative role, I think you first must demonstrate that you are a good physician first and foremost. If you’re not clinically competent, you really have no foundation to stand on. I produce a great deal of RVUs. I try to stay as clinically relevant and clinically productive as possible, so that when I do start to negotiate for items for the division or practice, I stand on my own two feet. I think that is very important.
How do you convince the C-Suite you have value to them when you’re not producing RVUs?
The value I would say would be the understanding of healthcare economics from a physician perspective in the front lines. Physician value doesn’t always have to come from holding a stethoscope—there is value in experience, there is value in education, there’s value in vision. There’s a great sense of enjoyment to building and expanding service lines alongside with the C-suite—building a new ambulatory site, solving the delivery of care issues and figuring out how to make the product better. There is also value in opening the road to make sure other physicians can do their job well and make sure they’re happy, satisfied, and engaged.
Can you give me an example?
Healthcare is ultimately two things – it is comprised of the patient and comprised of the physician care team. Anything that comes in between creates a further divide between patient and clinical care. It’s very important for non-physician administrators to have a sense from the physician, which represents such a large part of the healthcare dynamic, how to steer the role of healthcare delivery for their patients. No matter how many healthcare organizations you’ve led as an administrator, if you’re not a clinician, it will be very difficult to obtain buy-in for your initiatives without physician collaboration and engagement. I think that is where physician anesthesiologists can step in. It comes down to being an involved physician influencing the trajectory of your future practice and healthcare.