Given all that is happening in health care, it is more important than ever for physicians to voice their opinions, whether conversations are taking place within politics, health care organizations, or communities. The Kansas City Medical Society is asking physician leaders within our community how others can follow in their footsteps and become inspiring leaders.
This week’s discussion is with Dr. Joshua Mammen Surgical Oncologist at the University of Kansas, Vice-Chair, Division Chief of Surgical Oncology, Associate Program Director of the General Surgery Residency and the Kansas City Medical Society Board Chair.
After growing up in Kaplan, Louisiana, Mammen completed his undergraduate and medical training at Boston University. After completing his General Surgery Residency at the University of Cincinnati, he went on to a clinical fellowship in Surgical Oncology at the University of Texas M.D. Anderson Cancer Center. During this time, he also completed a PhD in Molecular and Cellular Physiology at the University of Cincinnati. He is board certified by the American Board of Surgery, a Fellow of the American College of Surgeons, and a member of the Society for Surgical Oncology.
The Chair of the Kansas City Medical Society Board of Directors, Mammen is also the State Chair for Kansas for the Commission on Cancer, the Chair of KUMC’s Cancer Committee, and Chair of the Kansas Cancer Partnership Early Diagnosis and Detection Committee.
What has driven you to take leadership roles?
I grew up around the time when C. Everett Koop was the surgeon general. He was a pediatric surgeon, but his impact is probably not the surgeries that he did on all those kids. The reality is it’s probably his advocacy on issues like cigarette smoking – that’s probably what has saved the most lives.
So for me, my role in advocacy and physician leadership has been in regards in trying to educate individuals about the dangers of ultraviolet light exposure, in particular, self-induced ultraviolet light exposure by sunlamp devices.
The other part is, health care is changing rapidly, that is an old cliché phrase, but the reality is exactly that. Often when changes happen, they don’t happen in a very thoughtful manner with patients’ care in mind. Physicians have a unique perspective. They see patients on a daily basis, and they realize what changes, even small changes, can have in terms of the care they are able to provide patients.
What do you like about leadership roles?
By the very nature of the profession, physicians have to be leaders in all sorts of situations, and leadership does not mean you are the person that necessarily gets to be the only voice that’s heard, but you can certainly facilitate others to have a voice or guide the direction in concert with others. Some of the most important leadership roles I play – they don’t have a title. I’m a surgeon in the operating room working with my colleagues – anesthesiologists, nurses, technicians – and I have a leadership role to play there, and my leadership role might be collaborative, but sometimes there is a time, if something is essential to the care of my patient, where I have to take a different role in terms of leadership.
You have testified before the Kansas Legislature. Please explain how that came about?
I am the state chair for the Commission on Cancer for Kansas. The Commission on Cancer is a national organization which encompasses many different medical societies. I testified in that capacity on a proposed ban on tanning beds for minors. Unfortunately, the ban did not pass this year. I think it’s only a matter of time, and hopefully we will be able to make some progress. Freedom is very important, and I certainly understand the concerns about this infringing on freedom. It is just simply like whether we should allow kids to smoke or should we have car seats for kids – very simple things like that.
Are there any resources you have relied upon to become a leader, books or anything like that?
What has allowed me to really develop my leadership skills the most is showing up, and I think that really is sometimes underestimated. You have to actually show up, whether that’s a staff meeting or it’s at a local medical society meeting or whatever opportunity there is, and that’s hard sometimes. The Department of Surgery here has been tremendously generous as well as the hospital. I went through the leadership training course here put on by the School of Medicine. Additionally, my chair sent me to the American College of Surgeons “Surgeons as Leaders” workshop, a four-day workshop in Chicago. Those are all opportunities that have helped to enhance my leadership skills, and I learned a tremendous amount there, but having actual opportunities to lead is where I learned the most.
So much of what happens in healthcare today happens outside of the doctor’s office, with all this emphasis on wellness and that type of thing. Do you think it’s important for physicians to take a leadership role in this arena, such as on a municipal board or commission? And if so, how do they make the time?
I do think it is important. The biggest gains we have had in terms of health care in the last century have been sanitation, for example. Those have very real implications on our patients, and I think, again, since physicians often see the consequences of any behaviors that are anti-social behaviors or impacted by outside influences, I think they can provide a unique perspective that can really help guide policies by having those stories from their patients, you know – “I would love to walk five miles a day, but you know, the reality is, I don’t have any sidewalks where I am.” Or, “I’d like to bike to work but I can’t do it safely.”
The talk in healthcare today is about mergers, the creation of mega-systems, and more and more physicians becoming employees of these systems. How can physicians learn to speak up and ensure administrators hear the medical voice?
We as physicians have to realize that some of these benefits are not going to be short-term gains. That is hard sometimes. When I do a surgery to remove cancer, it’s gone – right away, but some of these leadership opportunities take quite some time. We have been working out policies and changes, for example, for the last five years that are just now coming to fruition.
What are those?
I helped put together a new surgical checklist, like pilots do prior to starting an airplane, so before we start an operation there is a checklist. That revision has been going on for the last year and a half. It never seems like it will see the light of day, but it will – it’s probably going to get started in the next couple months. And the tanning bed legislation – certainly everyone I have spoken to in the legislative arena have not been at all surprised that it failed in its first year and usually they mention it is a three or four-year project.
You have been a physician for 15 years, so you are not new to the profession, but you are still relatively early in your career. How can physicians of your age and experience adapt to the emerging model, where leadership is going to mean more collaboration?
In isolation, a physician has very limited opportunity to really help his or her patients. It requires a collaborative effort, and that may be a medical society, it may be a committee at a hospital, it may be a national organization, but rarely are you able to accomplish what you really need to do to improve your patients just as an individual. I think we have to engage a team, and it could be things like me discussing the operation prior to starting it with my team to make sure everyone is on the same page, but I think that working more broadly as a leader, working with those larger groups is important.
You grew up in an age before Twitter and all the social media, but still, do you think your generation might be more open to collaboration than older physicians?
The image of a physician as a lone individual by themselves is really not common among my generation or younger generations. Now that being said, I think one of the things we need to preserve from the previous system is an emphasis on personal responsibility. It is easy for the pendulum to swing to the opposite extreme when it’s all about the team or the system that made the mistake and the individual didn’t make any mistakes. So I do think there should be that balance, that you still have a responsibility to your patients, they still do have a relationship with you, as an individual.