Jada Bussey-Jones, MD (Host): Hello, This is Jada Bussy Jones, the past president of the Society of Journal Internal Medicine And the host of S'S President's podcast. We engage S'S former presidents who are leaders across healthcare, public health. Policy and academia. As we lead up to the organization's 50th anniversary, we hope to capture insights from our national thought leaders so that our organization, our members, and healthcare and society broadly, are in a stronger position to grow, innovate, and meet the health challenges of our time.

So to our listeners. We say thank you so much for joining us today. I'm delighted to talk with Dr. Seth Land Field. previously he served as the chair of the Department of Medicine for the University of Alabama Birmingham, and physician in chief of UAB Medicine, where during his tenure tenure he grew NIH funded research.

Over 70% to rank among the top 20 of US departments. He is a fellow at the Center for Advanced Study in Behavioral Sciences, And in addition to being the past president of SGIM, where the organization awarded them their highest recognition for achievement, the Glazer Award, he has also led many other organizations, including as the director of the American Board of Internal Medicine And the President-Elect of the Association of Professors of Medicine.

Dr. Land Field has received numerous recognitions. He has won multiple Teaching Excellence awards at UAB, and he is an elected member of the American Society for Clinical Investigation And the Association of American Physicians, and is also a master of the American College of Physicians. Dr. Fel also serves on many boards of directors, including the Board of Directors for UAB Health System And the University of Alabama Health Services Foundation, And the Alliance for Academic Internal Medicine.

His discoveries have improved outcomes for seriously ill older people. Specifically, he is the creator of the ACE unit model that's been shown to reduce functional decline, shorten hospital stays, and improve satisfaction among older adults. As always, I'm so thrilled to talk with someone from your background and your leadership, especially, the connection with our, mutual organization.

And I really appreciate you coming today, Seth. So I, am looking forward to this conversation and I was wondering if you might start by. Just telling me a little bit about yourself, and I noticed when I was reading your background story that you had received degrees in history from Harvard and philosophy And the theology from Oxford, when you were serving as a Rhode Scholar.

So I was curious about how you, went from those degrees in that education to establishing career in medicine. So I'd love to hear a little bit about you broadly, but then also how you came to medicine.

Seth Landefeld, MD: Well, Jada, thanks very much. It's really a delight to be here and to join our SGIM members. but one of the themes that will come through is that SGIM has been an extraordinary home for me And the community that we have that, welcomes us, challenges us, and, nurtures us is just tremendous.

So it's wonderful to join the members. how did I come to medicine? we all figure that we had some choice in these things and you look back and you say, gee, how much choice did I really have? My mother made me do it. not really, but it's like, were on a shoot.

for me, I think it was really incredibly influenced by the fact that when I was, four years old, I got sick, and I developed wellness's tumor. it was metastatic. This was a time when, that killed everybody. and I was growing up in Cleveland and, my. primary pediatrician, mentioned to my parents, a guy named Sidney Farber in Boston, And that I ended up meeting him and, benefiting from actin d and My memories of that time when I was four and five are that you wonder what your memory suppresses.

But I remember This is, wow, This is really exciting. These are really neat people. And so love that. And as I ended up growing up, going to school, I always love people and I love science. and so that in the back of my mind was that, Medicine is a great way to combine those things.

but going off to college, I didn't want to come to premature closure. I love reading history And the history of science and had a chance to do that And then started medical school, before going to Oxford and, got far enough in medical school that I realized. Uh, I believe that, theology, religion, philosophy are foundational for our lives.

And once I was in medicine, I wasn't gonna have a lot of time to develop this learning at all. So I took advantage of that as well. And. It, it's also, I think, why I'm a general internist, that it gives us a chance in a very rigorous way to weave together many of the important things in life.

the intellectual approaches to problem solving And the relational, interpersonal, foundation of people. And to me, happiness. So that's, that's what brought me to Madison.

Jada Bussey-Jones, MD (Host): That is so awesome. I mean, I think sort of having these formative experiences at such an early age within the healthcare center, system, is really remarkable. and really described also. So how you've come to general medicine. I'm also wondering about leadership, so clearly you've had a lot of leadership responsibilities.

getting into medicine is one thing. how did you get into leadership? Is it something that you sort of thought about intentionally or did it, I've been talking to a lot of people who it sort of seems like they fell into it or got an opportunity. so I was just curious about your path to leadership.

Seth Landefeld, MD: I, think it relates a lot to liking people. and it also relates a lot to liking some degree of control, and, it has. Been incredibly important to me, whom I'm working for. can I learn from them? Can do I respect them? am I happy working with those folks? And some of the things in leadership have come along because, well, the folks I could work for weren't always.

Inspiring to me, and I wanted to take up the ball myself and run with it. probably my first exposure to real leadership was. when I was a kid on Outward Bound and, this was camping in the wintertime and it was around based on, sort of a logging, kind of thing.

And I end up the other folks, like me, their straw boss to, lead this group of 15 folks or so. I mean, in many ways. And then, going into medicine, who were the best doctors you ever knew? they were your chief residents. and, they were way better than the faculty.

And, they knew a lot and they taught a lot, and they were, really, I wanna emulate them. So, I, love, the opportunity to be a chief resident, and. to keep learning and keep working with other folks. As I got into general internal medicine, it, I think if you like teaching and you like mentoring.

and you like building things then, I mean, you can't help but being, a leader of people. and for me the most incredibly rewarding thing was working with, folks who were, they were always a little bit younger than me. They were always a good bit smarter than me. and I learned a lot, working with them and helping them develop.

So I think that was really. the path to leadership. I think about, as I was, thinking about our conversation today, I was wondering, what are the best, almost. 40, years in medicine would've been the best parts of that. And, one part I loved the, being a early assistant professor, it was a very different era then.

It was a kinder, gentler world. and I was, aiming towards developing research and I had incredible freedom to just learn all sorts of things from people that I'd never run into before. And then to implement them in trying to improve clinical care. I love that. And then the other job that I really love the most, I've really liked everything I've done, but I love being chair of a department.

and again, it took me back to a place. There were so many people who knew so much interesting stuff that I didn't know, And that I could learn from them. and when I was a chair, I said, the big power that I had was that nobody would do what I told 'em to do, but they would come to a meeting, and they would talk with me and they would teach me.

So, I mean, that was just, I loved doing that. And, I think hopefully, making things better for our faculty and patient's and learners and, uh, also having a lot of fun doing it. So that was sort of my path to leadership.

Jada Bussey-Jones, MD (Host): It sounds like your leadership journey also started during your formative youth, right? That, oh, those outbound experiences, but also that you were able to, to really learn and, and have an impact and, and, and I can say too that I. It's one of the things that I enjoy as a leader.

I'm curious as a former chair, when you think about the trajectory of academic journal, internal medicine, or even academic medicine broadly as a career path, what have been some of the most important changes that you saw over the tenure of your leadership? are there challenges that still remain? And what should we be thinking about when, in our academic spaces.

Seth Landefeld, MD: Yeah, I think there are absolutely huge challenges. and, I guess. A lot of them don't make me very happy. but they also, part of the good part of it is it means there's a lot of work to do, a lot of work for important work for people in SGIM to do, one challenge that, has troubled me as a general internist is, don't, there's no fighting the world on this.

I would, there's a lot less general, in general internal medicine than there used to be. and when I was in training, we really, ran the inpatient side, ran the outpatient side, ran the emergency room, your goal was to be a great physician who could handle almost any situation, either acute or chronic.

Now, we weren't trained to handle many chronic diseases. nearly as well as we do now. we didn't recognize what we didn't know. and I think Those are really, things that we've gotten much better at. But there's a lot less general, in general internal medicine. and the fact that very few inpatient physicians see people outside of the hospital that very few people who are taking care of patient's.

while they're still walking at home or in the clinic, see them in the hospital. that loss of relationship, loss of continuity, I think it's a loss. it allows us to do other things in medicine. I think the part that worries me the most is what I would call the increasing corporatization.

Medicine, And the increasing focus on the bottom line from a corporate point of view. And on the one hand it has, has something to do with making the extraordinary advances in medicine available to us. I mean, you think about the diseases that we can manage well, sometimes even cure now, that we couldn't even dream of curing, 30 years ago.

and absolutely wonderful. But we're doing it in a world where I think our academic health systems have become increasingly focused on being. High functioning corporations and often not so much about either their patient's or the people who work in them. And we need to, we need to keep that culture of caring for each other, of really caring for our patient's very much alive.

that's one challenge. I think it's a challenge. That as physicians, we in general internal medicine, it's a place where we can make a real difference. 'cause we live in that space. We can become those leaders. And that you, don't have, the power to make it all happen, but you have incredible power to be engaged and actively changing things.

the last year I think. Who talk about things that are surprising, who would believe that we'd be, dealing, with, a secretary of DHS who wants to turn the whole world of, vaccinations and what's good for nutrition, what's good for your body, in many ways upside down and inside out.

and. not to mention, a federal hierarchy that treats a whole bunch of people, in very inhumane ways, And that Those are. Challenges that we can address as citizens. But you know, as they, they're not directly in our, line of sight, control wise as physicians, I think they are very much in our line of sight as, our responsibilities to people in our population.

so I think, and question I ask myself that I don't have a good answer to is. what can I do to change that? and it's gotta be more than, simply, hold your nose for another year or another three years or something. We have to take much more active approaches.

But, I think the, corporatization, the focus on, profit in medicine And the. higher level federal changes have been, very troubling to me. the good news is that we have incredible diagnostic and therapeutic modalities. And we have, the reason I've stayed in medicine and loved it for so long is the people we get to work with are wonderful people.

and, you know, the students coming in are. As every bit as dedicated as we were in their, every bit is smart, in many cases, smarter, and they know all sorts of things about how to use, technology and to work with people that I had no idea of at their age.

So it's really, I think Those are the real positives, that we have with us.

Jada Bussey-Jones, MD (Host): Yeah, you've brought up so many really wonderful points. I think, I'm of the timeframe where we did, it's still. Always, GIM has been Whole Person Care, but in both ambulatory and inpatient settings And in many cases academic medicine has been immune, you know, where we can still do practice in both settings, but even that, I think has become, at-risk.

And to your point, more academic medical centers are becoming more corporate and. monetized not to mention some of the political, wins as well. I appreciate the challenges, but also the really wonderful, people that we get to work with every day. Not, to mention our patient's, but our learners and colleagues.

it sort of us, keeps us at this, So, you've talked a lot about, leadership and your role as chair and some of the challenges in internal medicine, and medicine broadly. I'd like to narrow the conversation to SGIM, a bit and as you think about your engagement with the organization, society of Journal, internal Medicine, I wanna understand how did you even hear about it?

How did you join, how did you get started in the organization?

Seth Landefeld, MD: The first SGIM meeting I went to. Was the first one that was held in San Francisco where I was a resident at the time, and probably the third year of the organization? and I think my First, attending was, Steve Schroeder, whom you've probably spoken with and, was an early president of SGIM.

And I knew that, this guy did really interesting stuff and, uh, so he had told me about it and at the time I was applying for. A, uh, fellowship, and had spoken with Lee Goldman, who was at the Brigham at the time, and he said, well, let's talk at the SJM meeting in San Francisco.

It's gonna be in your backyard. So that's what. Brought me to it, and it was really teeny. And that at that time it was, you know, society for Research and Education and primary care, internal medicine. And the things that appealed to me were this broad, holistic view of medicine and of people, And the people who were coming together were.

now some people might say, oh, we were all elitist, you know, but they were really curious. academically driven people who also believed in caring for people and, really doing the best that you could, for your patient's as a physician. So, it was that combination that So, it was real, it was people who shared values and shared an approach to, very.

Thoughtful approach to life that was very appealing, appealing to me. that's what really brought me to it. And then when I was a fellow in Boston, we would, I guess five or six of us as fellows would go to the es I guess still disruption meetings together. and it was, a bigger tent in Washington.

but it was still, it had an intimacy, where you felt you could really connect with. Your colleagues and, that part of what I loved working with people who were writing the articles that you read in Annals or New England Journal or jama, this was before the days of JJM, and, who were really addressing the questions that came up on rounds or came up in the clinic.

so being part of that, both caring environment as well as well, let's get some answers, some to questions that'll really help us do better as physicians. that was very, very appealing to me.

Jada Bussey-Jones, MD (Host): First, can I just tell you how impressed I am that you can remember the, words for the acronym? That's very impressive. But second, I'm wondering 'cause you've clearly been a part and even leading other organizations, how do you feel like this organization is different, from your other profess? Societies and organizations.

Seth Landefeld, MD: Most other organizations are very, I'll say subspecialty focused. and I was as a general internist, if you're in academic general medicine for 30 years, you're going to end up getting more specialized in one thing than another. I mean, that's just the way life happens, you know? So we do have you like developing that expertise, but the.

Most other organizations. have a parochialism to them, that SGIM does not. now maybe that parochialism is part of their secret sauce, you know, that they're able to generate more resources or more power or something. But, I, love that, generalist. Comprehensive, let's take it all on and try to really understand the complexity of the world and do something about it, That is inherent in SGIM.

And I think, even I'm also a geriatrician, as many general internists are, and I love geriatrics. I love taking care of old folks. I. love working with geriatricians. But A GS even, even though it's got a generalist view, in some ways it feels more, parochial than SGIM. You know, SGM is the only place you can go where you're gonna be speaking to people in, rural practice, people in inner city clinics, people in the hospital, people are still doing, acute intensive care.

people who are teaching, people who are developing the new approaches to teaching people who are making incredible discoveries. there's something about that, that has a, a j quo that's very, very appealing, to me anyway. Uh.

Jada Bussey-Jones, MD (Host): I. and I'm wondering, as we think about our organization's history and plan for celebrating our 50th anniversary, do you have any thoughts or reflections that you wanna share? Any advice for, our current or future leaders of the organization? if you could offer any.

Seth Landefeld, MD: the, downside of this broad view in these broad interest, what I call the curse of the generalist. I've got it up the wazoo. There are too many things that are really interesting And that can be very diversionary. On the one hand, you don't want to DEET deny the complexity of the context in which we live.

and yet to achieve things of importance, have to have a focus and achieve, focus on, one or two or maybe three things. And really advancing that and asking ourselves in SGIM, What are those top three priorities? and, what can we do about them as, really an academically focused organization of general internists, and.

for example, many political and policy issues are critically important. and by and large, you know, we're not the organization that's gonna have a lot of throwaway there. Individual members will have incredible throwaway because they're the intellects. That are often driving things. But that's an area where I think we need to work with partners, and really collaborate.

But when it comes to, what are the new ideas that are going to really shape the future of medicine and how it's practiced, I think. We as an organization can lead that both in, education, and thinking about, what is the role for education has not done as good a job of generating evidence as, many other parts of medicine.

It's doing a much better job now than it did, 30 years ago. How can we play, a really creative role in that And also, practice for so many people, the practice of office-based medicine has lost its joy. And what, how can we redesign how that works to give people the chance to really connect with their patient's, to connect with each other, and.

restructure the system. I think, I think There are people in GIM, general, SGIM who have all sorts of really creative ideas about how to do that. none of us knows what AI is going to bring. it's, going to bring abilities, I think for us to really extend what we can do.

And we need to be. Leading that and, really becoming expert ourselves so that we can think about how better to, to use that to care for people, including, folks who are not getting enough care, enough care now. So I think having SGIM focus on what are those top priorities that where we can make a special difference and really trying to do that, I think is very important.

Jada Bussey-Jones, MD (Host): I think you're absolutely right. We have so many wonderful, leaders and innovative thinkers, And so where we can be at the front, the forefront of these innovative ideas that bring, What you said, I love joy in medicine and you know, trying to figure out, figure out those issues both for our current practicing folks, but also our future, the next generation, so to speak.

So, thanks so much for, for sharing those thoughts. I think it's really important. maybe I'm gonna turn a bit to some lighter questions. I'd love to hear a little bit about, what you are reading or listening to right now.

Seth Landefeld, MD: Sure. been carrying around, William Carlos Williams, doctor Stories, which I never read when I was younger. I can't believe it. They're so relevant and they're very relevant to, some of what we're speaking about now. and they're just, they're so much about people. I just, have loved, making my way, through those over the last, couple months.

In terms of what I'm listening to, when I was in Birmingham, my wife was in Nashville. I spent a lot of time in Nashville. the food's better in Birmingham, but the, the music is unbelievable in Nashville. And, didn't know Steve Earl before going there. and I love, his song, listening to him, Pilgrim is my favorite one.

and John Prine was still alive when we got there and, died during COVID. But, I could listen to, John Prine, and I just cement all day. I just cement all day. But, my favorites are, how lucky can one man get? Which I, That's my mantra. I feel so blessed to be able to have done, what I've done and a really important song for me now is, he sings another guy's song That he heard in Amarillo, called Clay Pigeons.

where it's all about, I never knew how to say y'all before being in Birmingham, but You know, it's all about y all, it's all about, how to get back in the game. and, that incredible spirit and, the joy that, people who sing like that bring to their life and their work is, very, very inspiring to me.

Jada Bussey-Jones, MD (Host): That is so awesome. I love that you have, That is, things that you're listening to in addition to what you're reading and listening to. I know we talked earlier about grandkids, but I'm curious about other hobbies or things that you do for self-care. I mean, like, after years of being so productive and busy, how do you take care of yourself?

Seth Landefeld, MD: I am working on that. I haven't gotten the paycheck for a year now. so I've been retired for a year and I gee it was a whole lot easier working. one of the myths, and This is a danger of medicine, is we believe And we are told that everything we're doing is always so important.

and it's not, so we get tied up in all sorts of things that are really not all that important. And so been able to reflect and discern and, read people like David Foster Wallace to think about, how do you apply? How can you be free to really. Decide what is important and how you wanna make a difference in the world.

So having the time to do those things and to do it in a disciplined manner is really, really good to take care of myself. my wife and I pretty much swim every day and, that's, I hate jumping in and I feel so much better afterwards. You know? So it's like, keeps me, going.

And we're back in California with, all three of our kids and all of our grandkids are now within an hour and a half for the first-time in, a long, long time, so being able to really. Have time with family, to reconnect with, people, build relationships. I think, building relationships, learning the world with, my best friend and my wife is just really, really extraordinary.

So you're saying geriatrics, you know, keep moving.

Jada Bussey-Jones, MD (Host): I love it. I think Those are great words of advice for all of us. and maybe, in addition to thanking you, I'll give you maybe one last opportunity to offer any final words or reflection as we, as we wrap up our time together today. Any, any last thoughts or reflection either about, medicine, personal, you know, sort of, you talked about thinking about what you wanted to do or accomplish in the, in the world, but any final reflections.

Seth Landefeld, MD: Sure. It's, really about the incredible joy that we have in medicine. And in life and was listening to a friend and colleague yesterday, bill Curry, who is a very wise, general internist at UAB. and he spoke about secret sauce of enchantment, and allow yourself to find the enchantment in what you're doing, in medicine or in anything else.

And. I think really thinking about that, where's the awe, where's the wonderment? Where's the enchantment? And how can I keep that alive and how can I share that with other people? I think that what will keep general internal medicine going is our excitement about what we do, the things that we are trying to make better, that we address how we care for people, and sharing that with our young colleagues.

there are so many really, really, good people who want to make a difference in the world, and there's no, there's no better way to do that than as a, general internist. So sharing that with folks I think is really, really important.

Jada Bussey-Jones, MD (Host): I love it. Awe, wonderment, and excitement. So Seth, I really wanna thank you again for. Joining us today. I also wanna thank the SGIM staff and Roz Bogle, our executive producer and our entire production team. Also, thank you to our listeners. You have been listening to SGIM President's Podcast.

If you like what you've heard, please rate us and leave a comment wherever you listen to podcasts. It helps other's to find us. Also, look for us on the SGIM website sgim.org and follow us on x.