The IAP Young Physician Leaders (YPL) Program with Jo Ivey Boufford, MD

This transcript of their discussion has been edited for clarity and length.

Mike Sacopulos: As the 19th century Austrian politician, Klemens von Metternich, famously said, "When Paris sneezes Europe catches a cold." After two years of a pandemic, we hardly need proof of the interdependency of public health. What we do need is collaboration and strong leadership. To answer this need steps forward the IAP Young Physician Leaders Program. By selecting young physicians from around the globe and focusing upon developing their leadership potential, countless people benefit. Our guide for this important topic is Dr. Jo Ivey Boufford. Dr. Boufford explains both the program and those institutions like ESMT in Berlin and The World Health Summit that support it.

My guest today is Dr. Jo Ivey Boufford. Dr. Boufford is Clinical Professor of Global Health at New York University's School of Global Public Health, and she is Clinical Professor of Pediatrics at NYU School of Medicine. She has held leadership positions at Health and Human Services and more professional executive titles than I can recite. It is my honor to welcome Dr. Boufford to Sound Practice.

Dr. Jo Ivey Boufford: Thanks very much, my pleasure to be here.

Sacopulos: I’m very interested in your involvement with the IAP Young Physician Program that trains young physicians from around the world and links and networks them together. Can you tell me a bit about the history of the program and the current strategic plan for it?

Dr. Jo Ivey Boufford: This program was launched in 2011 by a global organization called the InterAcademy Partnership. It's a network of national academies of science and medicine worldwide. It has 149 member academies with four regional networks, and represents 30,000-plus scientists around the world in more than 100 countries. So, the group that focuses on health, now called IAP Health, decided in partnership with the World Health Summit, which is an annual meeting in Berlin in October every year, created to bring attention to health issues globally.

It's also sponsored by the M8 Alliance, which is a group of academic health centers and medical universities worldwide, to really look at how we could create a leadership training program for physicians under 40. We wanted to get young leaders that had longer careers ahead of them. And in looking at the opportunities for physicians at that stage in their careers, at a global level to get exposed to people in other countries in a systematic way. It was largely if you were a researcher.

And we thought it was really important to offer such an opportunity to physicians that might have a different career track in mind like clinical practice or education or health policy and management, or public health services research. So, we got some funding, I always want to give credit to the donors, from The Tides Foundation and the buyer, a pharmaceutical company actually, was very interested in this regionally and globally, their education fund, to start the program in 2011. And it's been going annually since then except for last year obviously, with COVID, because it's a kind of program that has to be done in person. So that gives you a sense of how we started, and I am happy to go into more detail on who the folks are and where they're from if that's of interest.

Sacopulos: It certainly will be, but could you give our audience the flavor for the type of topics that are most interesting or of most interest to the young physicians?

Boufford: The program that we've been running is really focused on them learning leadership. They come from multiple specialties of medicine. They come from very different clinical backgrounds, some are researchers, educators, clinicians. So, we emphasize leadership. These folks in this program are picked because they have shown evidence of leadership behavior or leadership activities in their special area, and they have to write a little essay on a leadership role they've taken in their own societies to improve health in their countries. It's a pretty specialized group.

When you ask about their interests, obviously they wouldn't have tried to get nominated for this program or been nominated if the focus wasn't the fact that they see themselves as leaders in their own areas of choice in medicine, whether it's clinical or education, or policy. In their professional roles, their day jobs as we say, they focus on anything from cardiovascular research to neurosurgery to developing NGOs to have less expensive prostheses in low-income countries, it just runs the gamut. But they want to be better leaders to take forward the areas they're interested in or within their own specialty area.

Sacopulos: Let's step back a moment and talk a little bit about your career as a physician leader. Could you share some highlights of your career?

Boufford: I don't want to go back too far but I actually was a Psych major in undergraduate and was interested in applying to medical school, but it was during a period in the '70s when it was very bio medically oriented. So, I applied to the University of Michigan, got in, it was one of those, "You're the kind of student we want if you can make it," kind of conversations. I've never really quite been the typical medical student or physician. I got interested very early in management and policy, primary care, and community health. These were not the mainstream career tracks in medicine during my career. So, I've had this values commitment to working with underserved populations and dealing with health equity and inequities for my whole career. But I'd say the path has been a bit zigzagged.

I ran a residency-training program at Montefiore Hospital in the Bronx for five years. I was a Robert Wood Johnson Health Policy Fellow for a year, and then came back to New York, went to work for the Health and Hospitals Corporation and was there, this is the largest public hospital in New York City, was there for seven and a half years, was president for four and a half years. And then I went to Europe which was very atypical. Everybody told me it would be a career-ender, but I was interested in it anyway.

I went to work at the King's Fund College in London, and I worked as a consultant there with organizational development at a time when Margaret Thatcher had just announced a major reform about the National Health Service, which was a bit of a surprise to all the people leading the National Health Service. It was done at a news conference on a Saturday night, and everybody was trying to figure out what that meant exactly. But the following two years was fascinating because it really was developing many of the structures that from a U.S. perspective looked like, quote, unquote, “privatizing the national health service,” but of course it wasn't at any level. So, I got a really good exposure to that.

Then I was chosen to lead the King's Fund College for two and a half years. Then came back to the U.S. in the Clinton administration as Principal Deputy for Health for four and a half years. Back to New York as a dean of the Robert F. Wagner School of Public Service, which had a Health Policy and Management track but was not largely health, it was urban planning and public administration. I was super interested in all of those areas. Then ran a non-profit, the New York Academy of Medicine, I was president for 10 years then.

Now back at NYU, but in the School of Global Public Health, teaching global health, doing global health pretty much all the time which has always been my hobby and my secret passion but now I'm able to do it full-time and teaching with young people, and working with urban health globally, so that's the root.

Sacopulos: And that, I assume, is what attracted you to the IAP Young Physician Program?

Boufford: Exactly, because I had, in my experience, felt that physicians who were attracted to the kind of career path I was taking initially were not very well supported. I think that physicians going into management in the United States has really evolved dramatically in the last 20 or 30 years. But initially it was a very strange choice and not a lot of support. And so, in my experience, I've always tried to encourage young physicians. People send me the, what I call, quote, unquote, “deviant physicians,” the ones who are not going into biomedical research or a traditional career. I try to encourage them to hang in there and stay with it. And it's gotten much easier over the years because I think organizations like physician executive groups and others in the United States have become quite supportive. And interestingly, in Europe there has been a good bit more support for physicians seeking management and leadership roles in policy than there was initially.

This program really reflects that feeling of wanting young physician leaders from around the world to meet each other and realize that they're not alone in their journey, and then hopefully stay together in a alumni network, provide peer support for each other and then be able to lead next-generation physicians in their own countries.

Sacopulos: You've told me that your constituency members are under 40 and come from different countries around the world. Roughly, how many are admitted into this program on an annual basis?

Boufford: We have admitted between 20 and 25 young physicians. They are nominated by their national academies of science or medicine and the members of this M8 university academic medical center/medical university group. They are vetted by experts from the InterAcademy partnership who are not involved in their nomination, and selected in that way.

But up to now it's 213, globally, from 50 countries. And 140 of those 213 are from low and middle-income countries, 21 different low and middle-income countries, which is very exciting for us and an amazing opportunity for the young physician leaders to really meet physicians from around the globe. And we're also very happy that 41% of the fellows are women and 59% are male. So, it's a really terrific representation and diversity experience that they have in their classes.

Sacopulos: Does a specific fellow or two stick out in your mind, an interesting story to give our audience a little more feel for the type of individuals that are joining these fellows?

Boufford: There are a few stories that are interesting. I think it's important to remember that as physicians under 40, even ten years out, a lot of these folks are still in an early mid-career or mid-career. So, we imagine even more great things will come of it. But one of our physicians is a neurosurgeon who was in our 2015 class from Macedonia. He came and is now, I believe, still the Health Minister of North Macedonia. So that's a quick leap, he went from this program about three years later as an active neurosurgeon in Macedonia to this particular position.

Another of our young physician leaders from Turkey, a woman physician, was chosen by her peers to present to this global meeting of the World Urban Forum. And although she's now working as a faculty member at the Earth Institute at Columbia, she was chosen to be on the Lancet COVID Commission and has been on Global Health Commission, very involved in something called Global Happiness Commission. Which there's a lot of researchers looking at happiness embassies. And she's particularly interested in vulnerable populations. She's a real star and I think we'll hear a lot more from her.

And then a couple of others just from different parts of the world, we have a young woman from Malaysia, from Kuala Lumpur who is an epidemiologist and a public health physician, social activist, who has been doing a field study on COVID-19 in the Ravingh community in Kuala Lumpur and is part of a regional network of equity-initiative fellows that are really young physicians and public health workers looking at equity issues in the health system.

And just for something really different, Helene Rossinot, who is one of our 2015 fellows is a public health physician in France. And she started her own NGO called Jump for Health which is working on caregivers in France. She's recently published a book which is in French, it hasn't been translated yet, called Caregivers: The Invisibles. And she's really committed to raising the profile of caregivers worldwide. She's a very accomplished public speaker, ran for office as a young physician in the first Macron election. She was not elected but it gives you a flavor for the level of her activism. So, it's a really broad group and they're all just doing really exciting things. On our website there's alumni profiles and most of them keep them up, which is great, so that we can track them.

Sacopulos: It must be exciting to work with such a group. Can you tell us a little bit about the annual meetings, the type of sessions and how all that works?

Boufford: The World Health Summit was created by colleagues from Charite, which is a major teaching hospital in Germany, in Berlin that made it through as a, if you will, bipartisan healthcare institution during the division of Germany and then post-war. And they were celebrating their 300th anniversary and wanted to have the equivalent of a, if you will, Davos for health. The meeting is held in Berlin every October. It's co-sponsored by the President of France and President Chancellor of Germany, and has become a real magnet, I think, experience conference for a private-sector individual.

A lot of companies are very involved, international UN agencies as well as health professionals in education, clinical professionals from medical universities and healthcare delivery systems worldwide who are interested in global health and global context for their work. It lasts about three days. It's curated by the Charite secretariat and represents everything from announcements of world importance from WHO or UN agencies to spotlighting public/ private partnerships.

For example, the Nova Artist Foundation has been involved in upstream cardiovascular prevention with cities around the world for a number of years. Novo Nordisk has been involved in diabetes prevention work. They present their initiatives at this meeting. And thanks to the Charite philosophy, a lot of young health professionals, physicians, especially from Germany and from the European region are encouraged to participate. It usually brings in over a thousand people every year. So, it's a different kind but it's very focused on health systems management, medical education, health professions education and institutions that have a connection-global footprint.

Sacopulos: Dr. Boufford, can you walk me through the process by which someone would apply to become a fellow?

Boufford: We put out a call for applications. The call is really sent to the leaders of these 149 national academies, which are now national academies of science and medicine and are members of IAP, and to the members of the so-called M8 Alliance. Obviously, it's many more than 8 institutions at this point in time. It's more in the 20 to 30 range. It's on the public website. A lot of alumni we know contact their colleagues and say, "Go to your academy, get nominated." They're not able to self-nominate as yet but they're through these institutional nominations.

Then once they are nominated there's a form that they all fill out and a letter is written in support by the nominating organization. And then those are reviewed over the summer and the fellows that are chosen are notified usually in August, early August, late July, of their nomination. And then the funding allows us to bring them to Berlin for this, essentially, six-day experience. Three days is very much leadership development training and then three days as presenters and participants in the World Urban Summit. Which it follows immediately upon the leadership development workshop that we conduct.

Sacopulos: That's fabulous. Now you mentioned that the class of fellows is, I think you said, north of 40% female. And certainly, we're seeing an increase in women physicians around the world and women applying to medical school. Are there particular skills that young women physician leaders need?

Boufford: I think the real issue that is expressed by many of the women is they feel they don't necessarily have the opportunities or visibility of their male colleagues in their respective countries. I think the issue for them is how do they establish themselves? How do they create networks? How do they identify mentors that can really support, sponsor, and champion their movement within their careers? They don't need any skills that are unique to women.

I think the interesting part that we take up in the workshop is the fact that so many of the skills in the literature that women leaders, and I would say leaders with feminine characteristics, because many men have so-called feminine leadership traits, they are very focused on open communication, on nurturing their teams, on sharing information on flatter organizations, which are really marks of many flexible and successful organizations going forward, much less command and control than traditional healthcare organizations have been. But some of those leadership skills often disappeared within the traditional models of top-down leadership.

We talk about that a lot, and I think a number of the men who are inclined towards more of an emotional-intelligence-led leadership, with developing themselves, developing their own capabilities with other people in addition to the technical and conceptual skills that they want to learn, find it very rewarding to hear about these conversations. And then for many men, especially Asian men in parts of the world, they do feel very strongly the stereotypes of being opaque, being passive, relatively passive, et cetera. So, these are all areas that are seen as, they certainly aren't, but they hinder their advancement into executive position. So, these are terrifically rich conversations because they are happening with young physicians at the same career stage across the world.

Sacopulos: Fascinating. As we close out our time together, is there anything else that you'd like to share related to your philosophy of physician leadership or anything else about the IAP Young Physician program?

Boufford: I think one of the really strong requests from those physician leaders, and I know it's been important in my career, is the importance of mentorship. All of them mention that, especially being mentored by physicians who are in leadership roles and value this next generation, giving them that experience and giving them that support in what for many of them may be a more challenging journey than following the usual path in research or in clinical practice or in medical education. And I'm only speaking about physicians here.

I think that would be a message that those colleagues that have really assumed clinical leadership roles, leaderships in medical education, leaderships in social change, really, public health, health services research, keep an eye out for young physicians that have that same career path or seeking it. Take the time to tell them about your journey, provide them support for their own. I think that would be a message from this experience and from my own experience.

Sacopulos: Dr. Boufford, thank you so much for being on SoundPractice. This has been very, very interesting.

Boufford: Thanks for inviting me. I look forward to other people getting more active globally, as well, in a leadership role. Thanks so much.

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For more information on the YPL program:

https://www.interacademies.org/project/young-physician-leaders-ypl

https://www.worldhealthsummit.org/initiatives/young-physician-leaders.html