Healthcare Rebel Alliance: Q&A with Michael Soman, MD

Nick Soman, Decent: When did you decide to become a doctor, and why?

Michael Soman: I'd flirted with the idea because my girlfriend in high school’s older sister ended up marrying a guy who was an intern in pediatrics in the LA area, and one day I went and picked him up at LA County Hospital. I'd really never been in a hospital except to have my tonsils out, and nobody in my family was ever a doctor, and I just sort of looked around and went, well, this looks kind of cool.

But then after college, I spent a year hitchhiking around the world and I actually, at one point, slept outside for seven months in a row in southern Europe and in Africa. And something about seeing particularly in Africa, the people and the level of need and how a lot of what they needed was really simple stuff convinced me that I wanted to go back and really, you know, explore healthcare and a career there.

So I applied and went to medical school at UC Davis, and worked with a faculty member who was running free clinics in Davis. I worked with migrant farm workers and enjoyed the content of medicine enough—though that isn't what I was in love with—but as I got further along and ended up having a sense that I might actually have some skills, some competence, then it was how you can actually be around people the set of skills just like a plumber would have set of skills and really kind of help them and be valued by them in times in their lives that were often emotionally charged and difficult for them. And that really appealed to me.

Nick Soman, Decent: Is that what you would say you loved most?

Michael Soman: Well, I went through stages. That was one stage. But what was always true was that it was always about the relationship with the patients. By virtue of having gone to medical school and gone down this path, I really felt blessed to be given essentially a ticket to be in situations with people at charged times of their lives.

Then there was a realization about how much heroism there is in behaviors by normal people. We read in the papers about athletes and movie stars and politicians and famous people and some of them did amazing things. But I was struck how maybe the last patient I saw, you know, has not been out of their house for three weeks because they are afraid of seeing other people, and that getting dressed and coming to see me was a big deal. Or they have a skin condition and are afraid of their skin being seen, and I realized both the drama of everyday life for a lot of people and the heroism of everyday life. Some of these people who came out of bed to go to see me were showing as much courage as whoever climbed Mount Everest.

Nick Soman, Decent: Were you born that way? Or is that something that you cultivated over time?

Michael Soman: My dad, my dad loved people. I cultivated it by watching him.

You knew Grandpa Bob. One of the things in that book you gave me to read was she talks about always trying to have the most generous interpretation when somebody has a behavior. Like you could think, “They're awful.” But you could also say, you know, he's, “He's really suffering today.” And my dad always gave the most generous interpretation. He loved people. He would help everybody that he could, from strangers to people he knew. He would always take the side of the underdog, whether it be in sports or like fights in Brooklyn. And he sometimes got chumped by being too open to somebody who was maybe trying to use him, but I could see that the upside of being open to loving people and receiving and giving love was way more important than the downside of getting chumped every now and then, so that became conscious in my life.

Nick Soman

That resonates a lot. I want to ask you about another part of your personality. And I think I can ask you these things because I know how much both of these things fueled your work in healthcare.

You know, you were also the high school valedictorian who spit on a letter sent to you from then California governor Ronald Reagan and sent it back to the governor's mansion with a note that said “I just wanted to see if your signature was as fake as you are.”

I have at times associated that in my own life with class rage, which is goofy, given that I had a really nice upbringing. Is that what it was for you, or what drives those sort of sharp edges? Where do those come from? Is that your mom?

Michael Soman

Maybe a little bit of my mom, you know, she definitely had a lot of righteous indignation about everything.

But my dad, when I said he always stood up for the underdog, I mean in my mind, Ronald Reagan and Donald Trump and lots of people between them have been selfishly doing harmful things to others for their own greed. And you've got to remember, when I did that with the award that Mr. Reagan had sent me, he had sent the National Guard into People's Park in Berkeley. He had taken over college campuses with National Guardsmen. He had really been a force in my mind for fascism.

And I didn't really know that he was phony. I don't to this day know that he was phony. He may have been completely true to his values and principles. But I also had a part of me that enjoyed, you know, rocking the boat and, you know, rebelling. And I think the specific words I chose were about that.

Nick Soman

Yep. I want to take it back to healthcare, because that resonates sometimes more than I would like it to for me.

Nick Soman, Decent: How and why did you go into executive leadership in healthcare? You were a really good doctor. Why didn’t you just keep doing that?

Michael Soman: Okay. I practiced for about 20 years. I enjoyed it, enjoyed the staff I worked with, and I enjoyed the patients. Then I had the opportunity to be the Chief Medical Director of a clinic that I started from really small to it grew quite a lot so I could handpick the people who joined us to work and have a lot to do with how the culture was because of the people I hired and because of what I modeled.

I had some beliefs about how we could work together to create wonderful, compassionate, professional healthcare and also support each other and love each other as staff members. I didn't make all the right decisions, and I learned some things the hard way. But that was what I was trying to do, and it worked honestly better than I ever would have thought it did in a small clinic.

Nick Soman

There's still something that isn't clear to me. You could want all those things, but you could say, those are some things that I want and I'm going to try to behave in my day to day job as a doctor in consistency with those things, but you decided instead you wanted to be the leader of the clinic and sort of build that. What was that decision like?

Michael Soman

Well, I think I had a lot of righteous indignation, which probably did come from my mom, but also I had a pretty strong feeling of put up or shut up. If you don’t like how something is being done, see if you can do any better. And if you can't, stop whining about other people, and if you can, good on you. And so, I didn't feel it as a burden. I felt it as a wonderful opportunity to see what we could create together.

And I hired a bunch of wonderful people, probably all of which you know. And in the context of hiring, we would talk about what I was hoping to create for them to be part of. From the beginning, it was an overt and conscious decision to try to create the best clinic in the northwest. And honestly, think we did. And then somewhere I became aware that, you know, larger healthcare was quite broken, and starting from the national level. The health care system in the United States of America was very broken and is very broken.

But within my own organization, which was actually much more progressive and much more forward and much more advanced than American health care system was generally, I became frustrated with the leaders above me that if I could be part of making this wonderful transition at my little clinic, why can't you make more positive change at a bigger level?

And what I've often found in my life is when I get really frustrated like that, I have a choice.

I either have to leave or I have to jump in and see if I can do any better. Because it has never been a choice for me to just sit back and talk about how screwed up everything is and enjoy the fact that I didn't do it and be smug. That really was not a way that my parents taught me or that I wanted to be.

So I decided I would give leadership one year. And I had a mentor who for a long time had been saying, “Mike, you need to do this at a different level and I'll hire you. I'll give you different jobs.” And I'd say no, and I'd actually make fun of him for even asking because I knew that, you know, administrators were lower than snails. So why would he even have the nerve to ask me? But I did decide at that moment, you know, I need to give it a year and see how it goes. And I went to him, actually, because he was the big boss then, and I said, look, I want to take you up on that, but I have one condition. You have to have dinner with me once a month and teach me everything you know. And he knew a lot. And he was generous and kind and said yes. That's a very, you know, progressive and selfless thing for a leader to do. Yeah, I'll have a meal with you once a month and teach you things.

And I was doing it for a year to see what I felt about it. At the end of the year, I learned, wow, I like it. I mean, I'm enjoying this. I'm enjoying the growth opportunities. It's very different from being a doctor, where you get kind of pat on the back constantly by your patients if you're any good, and kids hug you, and “Oh God, you helped me so much.” And as a leader of physicians, who's a little different, you get a lot of, I want this, I want that. But it gives you an opportunity to kind of look at your soul and see what's important and really bring your values forward. Anyway, that's how I got beyond leading at one small clinic and into larger parts of the organization and ultimately the whole medical system.

And it was wonderful. It was not pleasant all the time, but it was truly a growth experience.

Nick Soman, Decent: What's your least favorite thing about being a leader? And you can be just as honest with me on camera as you would be if I asked you this privately.

Michael Soman: Well, sometimes the politics are really unpleasant. I think some people think that as you go up the hierarchy of leadership, eventually you have all the freedom to do whatever you want if you're the top dog. But actually, in some ways, you get less and less freedom because you have more and more critics and more and more people who want you to do things a different way and are diametrically opposed to other ways. And then also egos of people get kind of big and nasty and power grabbing becomes a bigger deal at the higher levels. And so definitely the ugliest part was some of the politics.

Nick Soman, Decent: If you could find yourself back sleeping outside in Africa and kind of give yourself some advice for the career that you had ahead of you, what would you say?

Michael Soman: You know, I don't regret anything I did in my career, and I believe I had two wonderful careers. And one of the things I was very much into was just the study of leadership and applying it to healthcare, because there's a giant knowledge base that you can either read through leadership books or through books about people like Lincoln or F.D.R.

I taught all the leaders in the medical group for a long time. And one of the key questions that I would ask young leaders was, would you rather be right, or would you rather be effective?

And I tried to ask that to both of my kids too. And you know one of my kids really well.

Nick Soman

I like to think I know both. But I don't know if I internalized that lesson as well as I could have.

Michael Soman

Both of these were lessons that even though I knew them intellectually, I personally couldn't have internalized them probably until I was in my 50s.

And the second one was, and I believe this, by far the most important tool in leadership is listening. Now, I learned those both somewhere, and I'm sure I tried to teach them to others before I really believed them myself all the way. Because we are so darn trained to defend our position and, you know, be right and get the last word that it takes decades, I think, for most leaders, and I'm going to say, maybe I'm wrong about this, but I notice it more in males than female leaders, to say, leave the ego at the door, and doesn't mean be egoless, but leave the ego at the door, use your ears more than your mouth.

Be really curious about what you're hearing, and ask yourself the question a lot, am I trying to be right, or am I trying to be effective?

And I had several people that I was teaching who would get back to me years later, in one case decades later, and say, you know, I brought that home to my marriage, and it made a huge difference.

So back to sleeping outside in Africa, what I would ask myself, it's not so much tell, it's how can you facilitate those two things so they happen faster, so you don’t have to wait 20 or 30 years to incorporate them into your everyday practice?

Nick Soman, Decent: Do you want to be right, or do you want to be effective, and the most important tool in leadership is listening.

Michael Soman: Yeah. I had a wonderful coach at one point, and he taught me a technique that helps you incorporate both of those lessons that’s called “Up on the balcony.” When you're in a discussion and your buttons are being pushed, have your other self go up to the balcony and look down on the conversation that's going on and just notice what your role is in the conversation. What am I doing right here?