Startup Physicians

From ER to Executive: Scaling Startups and Redefining Physician Leadership with Dr. Pam Sullivan

• Alison Curfman, M.D. • Season 1 • Episode 20

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In this episode of the Startup Physicians podcast, Dr. Pam Sullivan shares her unique journey from physical therapy to emergency medicine and ultimately to leadership roles in healthcare startups. She discusses the challenges and opportunities she faced as a woman in medicine, her transition into leadership, and her pivotal experiences in scaling operations at Landmark. Dr. Sullivan emphasizes the importance of mentorship, the need for adaptability in startups, and offers valuable advice for physicians considering career changes.

Episode Highlights

[00:00] - Introduction to Startup Dynamics
[02:24] - Pam Sullivan's Unique Career Path
[07:37] - Transitioning to Leadership Roles
[12:57] - The Journey into Startups
[16:50] - Scaling Operations in Startups
[20:23] - Lessons from the Urgent Care Experience
[26:45] - Advice for Physicians Considering Career Changes

Pam Sullivan:

The first is determining why you want to make a change, and is it an emotional response to a bad day or a bad week or a bad month, or is it something you truly want to do? And then, if it's something you truly want to do, why haven't you done it? As you think about where you want to go, you need to look at your personality, style, your values, what's going to align well with what you want to do.

Alison Curfman:

Welcome to StartUp Physicians. Please Like and follow our show to join our community of physicians who are reimagining healthcare delivery. Hi everyone. Welcome back to startup physicians podcast. I am so excited today to be joined by Dr Pam Sullivan. She is an engaging and vibrant physician leader who is going to really dive into an entirely different area of startups that we really haven't covered yet in this podcast, which is the later stage startups, so operations, growing and scaling. You know, when you're working for a startup that's really, really starting to take off and maybe taking on a lot more people and playbooks and responsibilities. And I'm really excited for her to share her story on how she crossed over into this field and what sort of, you know, opportunities it gave her so PM, thank you so much for joining me today. Thank

Unknown:

you so much for having me. Alison, I'm excited to partake in this discussion. Yes,

Alison Curfman:

so I know we were connected by a colleague, and pm was a very integral part of the scaling of a company called landmark, which was founded by the same person that recruited me to Nashville to start imagine so our companies are like, I guess cousin companies or something. I always have been so inspired by the story of landmark and how they took a really challenging problem of chronically ill seniors. They were one of the first ones to identify ways to take take risk and create value based contracts and really create a system for home based care for adults with medical complexity. When we started imagine it was a lot of trying to decide, like, how do we make landmark for kids? And so I feel a lot of camaraderie with the company that Pam helped to scale. So Pam, I would love if you could just walk us through a little bit about your career path, going back as long as you need to to share about you know how you ended up in this place. Yes, thank

Unknown:

you. So my career path was incredibly atypical from your classic position. I started my career as a physical therapist, mostly because at my you know, the time that I grew up, if you were smart, you became a lawyer or a doctor. And I never felt that I had that sense of smarts to become either one. And I was very involved with gymnastics, and I decided to go into physical therapy, but I never recognized that physical therapy was just as difficult as medical school, and it's a really tough career path. So I initially became a physical therapist, and my sister, who was a physician, convinced me to become a physician. So I took some prereq classes, not many, because most of them already covered through my physical therapy background and applied to med school. And fortunately, I was accepted to med school, and at the end of that, there was no doubt my mind I was going to be an orthopedic surgeon. Then I recognized, well, I don't know medicine, and I want to care for a whole patient, so I decided to do a residency in Internal Medicine. And then while waiting to apply for orthopedic residencies, I took a one year position in the emergency department, and I ended up staying there over 20 years. I ranked very few programs in ortho because at that point I was engaged, so I wanted it to be the perfect match. And I never really recognized in my career a lot of the adversity that women faced. To me, you just it was so resilient. I just kept going. And it wasn't until now that I'm writing a book and doing other things that I can retrospectively look back. But I did have a number of programs. I had two programs, actually, that called me up and said, Hey, why don't you rank us. We need a skirt in the program. Oh

Alison Curfman:

my gosh, yeah. What? What decade was this?

Unknown:

This was the end of the 80s. Okay,

Alison Curfman:

okay, yeah, yeah. I know that medicine and training has changed a lot in the past, you know, few decades. So it's always interesting to hear these stories.

Unknown:

Yeah, it would have been the early 1990s because I was done with my internal med residency at that point or in it.

Alison Curfman:

So they wanted a skirt. In their program. Wanted a skirt. Yeah?

Unknown:

And, you know, they were things in the interviews I had to do that the men didn't have to do one. One made me bench press in a suit. Yes, one made me take an kind of spatial relations exam that the men didn't have to take. So any rate, we get through that, and I decided to stay in the emergency room for over 20 years. And I loved it. I loved the organized chaos of an emergency room. The shift work worked for me, and at that point we got married and had two children, so I was able to be there for my kids, be there for my husband. I actually switched to working straight night shift for 15 years so that I could be there for all of our kids events. And that worked great for us. We put my husband, I kind of put our relationship on hold, because for us, the right thing was to put our kids first. My husband was a stay at home dad, but he never stopped working. He built our homes, and I told him he needed to write a cookbook on the quick five minute meal that's healthy. Yeah. Anyway,

Alison Curfman:

I already am hearing a little bit of like willingness to pivot in your career. I know that some trainees listen to this, and I was also dead set on a surgical training, and went pretty far down that path before I realized that instead of being a pediatric surgeon, I just it was the kids that I was really excited about. And I too, wanted to, you know, have a family. And obviously, a number of, like, phenomenal women surgeons make it work to have a family and be a surgeon. But I also had, like, a pretty dramatic pivot. And I think that when you have those moments where you you have to be willing to stop and question the life path that you're on at at any point, and be willing and open to the fact that there's actually, like, a multitude of pathways ahead of you, and you don't have to stay on the same one just because you made that decision before. So I just wanted to throw that out there as you're getting started on your journey, and

Unknown:

I'm so glad you brought that up, because I think I was naive, like I just kept going because it's what I had to do. And I think I was naive to taking a step back and looking at where I was and the decisions I was making and how they were going to impact me later on. I feel, in retrospect, I wouldn't change a thing that I did, but I don't think I was as Cognizant to those decisions at the time that I was making them. It was just, this is what I'm going to do next. This is the right thing to do for me, my family, my husband and just did it. So I'm glad I did that, but I think that there were times I wish I was a little more present in the moment. It all worked out, and something worked out for the right reasons. So, yeah. So

Alison Curfman:

yeah, it sounds like you had developed a ton of clinical experience. This is more of a traditional pathway at this point, 15, right, 20 years in the ER, what? What came next? And how did you pivot into startups? Well,

Unknown:

next I wanted to get into leadership, and because I was an emergency medicine trained, I was told I couldn't do leadership. They also thought it was cute. As a four foot 11 woman, I wanted to do leadership, and I'd be patted on the head or the backside and told that that was cute. I asked for mentors because I did not have the emotional EQ I needed. I made a lot of mistakes early on as a leader, a lot, and I wasn't given that opportunity. So I really developed a bit of imposter syndrome. Fortunately, again, that resilience had me keep pushing through, and I found back doors. So I became one of eight physicians on the medical and dental staff board of 1200 and I did that for eight years. Did a lot of different things and and actually the CEO of the hospital later down my career path, we're talking 15 years later, he was kind enough to help mentor me, but they were also doing a change in the hospital, of moving on anyone that had been there for a long time. And I saw the writing on the wall for myself. I took another position in emergency room, but there I was going to get pushed out by Ed trained. I was just there temporarily, and I had kids getting ready to go to college, and I needed financial stability. I was fortunate that Dr Greg Daniels opened a door for me. He ran a company that staffed emergency rooms, urgent care centers, hospitalist programs. So he gave me my first opportunity as a medical director, and we launched an Urgent Care Center in Rochester, New York, and he already had a number going, but this one exceeded all expectations, way ahead of schedule, and from there, I won a trip. Because of this work, myself and my dyad partner, we won a trip to the annual Urgent Care Association meeting. From there, I met some board members who asked me to run for the board, and very quickly, I was on that board ahead of people that had been trying for years. And I was very What do you

Alison Curfman:

think? I contributed to your success on joining a board, and what was that like? And did you feel, you know, nervous at all about the liability.

Unknown:

I was not again. I think I was just so naive to it. We did have situations that came up when I was on the board that we did get legal representation, but I didn't think about it at the time. I was just thinking about, wow, new experiences, this is going to help me grow. And it was because I was so involved with the American College of Physicians, which is a professional organization. This one was a trade organization, so it really opened my mind to business and how competitors can work together for the good of everyone. So it was really, it took me a while to wrap my mind around that this board was also made up of very, very successful business owners, and I was, I wasn't an owner or an operator. I was a medical director. So I was very objective. When I was on the board, I wasn't there for any secondary gains, and I'm not saying the other board members were, but I didn't bring any bias into it. It was all about what's the best thing for our membership. And when I ran for the board, it was interesting, because someone much higher up in my company, in this division was running, and there were eight of us running, and I was the only female, and Margaret Thatcher had just passed away. So I was kind of bold in this group of men, but when I gave my kind of elevator speech as to why me in front of the whole group at a lunch presentation, I quoted Margaret Thatcher, and I said, if you want something said, ask a man. If you want something done, ask a woman. And I had some people stand up and I, you know, clap for it. And people told me, I can't believe you said that in front of a group of men, but I was elected on so I was, you know, very fortunate from there and during this part, not only was I Medical Director of the urgent care center, but for a lot of reasons. They needed help in the emergency room. I needed some increased income because we had to split our hours in the urgent care waiting to open up another one. And I took a position just in an emergency room, just helping out. It was about an hour and a half from home, so I'd pick up some shifts there. And the CEO of that hospital asked that I become the medical director, and he was threatening to pull the contract if they didn't do it, we were looking to sell to another company. So, long story short, I took that position for about six months to stabilize. Learned a lot as the ED Medical Director, because I was always told you couldn't do it, and when I was asked to do it again. Someone in the company, when I told them, Look, I'm not Ed trained, that I'm probably not who you want, he said you're exactly who I want. I don't want the best trained emergency room physician. I want the best trained leader for this company and to lead this department. So that really gave me another perspective on things. So I was supposed to do that for six months. I did that for four years. I'm still on the board. And then I dropped being the Medical Director of the urban care because I decided to get my MBA. And I looked at this as I thought I knew what I needed to do to run these departments, run these companies, but I recognized I needed a lot more of the vocabulary understanding and be able to be a part of this executive team. So I went and received my MBA from the University of Tennessee, the physician Executive MBA Program, which changed my life. This was clearly pivotal for me. I my colleagues were so like minded, and we were just the bonds that I formed with these people 10 years ago. We still talk. We still support each other. If I don't talk to one of them at least once a month, something's wrong, and it was just phenomenal for me. So I did that, and then I decided where I wanted to go in my career. At the same time, I became the first and only female president of the Urgent Care Association. So I just gained tremendous experience there. I also then said, Okay, what's my next steps? What do I want to do? And I ultimately came down to two career options. One was a CEO of an urgent care company that wanted to go national, and the other one was working for landmark as a medical director. And actually, what they were offering me, or what we looked at, changed so many times because it's a startup. So their needs are constantly changing. How they're going to organize. Things are constantly changing, waiting for new contracts gets delayed tremendously, and that was a huge learning experience for me too, because I interviewed with them, but it took a year to finally get the right position with them. And

Alison Curfman:

where were they in their growth curve? Was Rochester one of their first markets?

Unknown:

No, actually, that was. Later market. They had already launched in Buffalo Albany, Pennsylvania and Massachusetts. And the last two markets, I think, were relatively new, so they were only two years in. I think I started interviewing them when they were just a year into it. And later is when I interviewed for the CEO position. And I remember standing at a restaurant in Erie, Pennsylvania called landmark, and I was trying to decide which company to work for. I hadn't been offered either position yet, but both were getting close. I had already been flown down to the CEO job, taken around with realtors to look at hers, and we were at the final stages, and I just said, You know what your heart is with the going with landmark, their mission speaks to you. Their culture totally speaks to you. That's where you want to go. That's what you want to do. So do it. And again, I didn't recognize the risk I was taking with a startup. I didn't recognize this company. Could be gone tomorrow. I didn't appreciate any of that, because I just said, this is where my heart is, and this is what I want to do. And I figured, I'm going to join that won't be the culture. The culture was exactly what I thought it was, and it was just phenomenal. And we were all family, all working toward common goals, and it was great. So I was initially brought on as the medical director for new market implementations. It was a Diane model, where on one half we had an operator on the east and an operator on the west, and then I was the clinician serving both. And it was great because there was no job description. There was

Alison Curfman:

no that's not a typical in a in a startup, my fluid job description, one that might be changing frequently,

Unknown:

exactly, and I call the startup. So I've kind of titled this one. I give talks about startups and value based care. We had Tasmanian level leadership, meaning you have limited resources when you start up a company and everybody's doing everything because it's what you need to do, and everybody's willing to step up. But as you get into that growth phase in a more mature company, you need to start really defining what each person's role is, and the company grows, and you're bringing in more people to focus on different portions of the business. So you have to go from this Tasmanian level leadership to a more focused, organized leadership, and there's a lot of challenges with that. I can talk before I were just on the challenges with that. So when I came in, I did what had to be done. I stepped into another area of the business line that we were trialing, and we ended up closing that business line, but I helped out there when we first, first days that we launched, because we didn't have physicians to go into these long term care facilities. The next thing you know, I came up with a whole what is the clinical pathway for new hires? We restructured the whole recruiting process because we were putting people through way too many interviews, and we were having way too many people have to approve a new hire, and it's it was just a lot of excess waste. So we really define the processes as to how we're going to go from we've signed a contract to launching the market. I develop processes for our client partner relationships, and what's the right number of touch points before we launch. And how do you not promise the world you want to you know you don't want to over promise and under deliver. So how do we develop that trusting relationship between our new client partner? How do we make sure we're not having excess in what the client's delivering to the patients and what we're delivering to the patients? So there was so many factors to this. How do you train all these new hires in a brand new market where they nobody knows their job, nobody understands the workflows, yet you're training everybody all at once, so you're not efficient. And one of the things that I started, that I'm really super proud of, was what we call the Delta team. The Delta team was a travel team that was initially designed for new market implementations, whether it was, you know, the providers that went out to we hired enough providers, whether it was training the new providers, and then we had a different group that would train some of the nurses and other roles. By the time I left landmark six, seven years later, we had a huge team. I believe we were up to 70 something budgeted positions on this team, and we were a mobile market, and we didn't just manage a new market, but if we had any areas where we had contracts at risk, where we had difficult to staff areas in markets, if we had multiple vacancies, whether it was fmlas or. Other issues. If we needed to train large groups of people, whatever the issue was, this team would go in and help those markets and help the company. And they had their own vision and value statement that we developed that continued throughout all of landmark and we had only one regrettable turnover in five years, which was phenomenal. So that was kind of my initial role at Landmark, yeah,

Alison Curfman:

so it sounds like your MBA training was very pivotal for you when you moved into more of like an operator role at a startup. I think that makes sense. I really encourage physicians frequently that you don't have to have an MBA to work with startups. You don't have to know everything about business, especially earlier stage companies. But it sounds like a lot of what you were doing was really building a lot of the scaling mechanisms and the operational programs to help this company grow from five markets to however many, how many did it have when you, when you finished that job, you know,

Unknown:

I don't even know, because we're integrating another company. I know we were in over 40 states, yeah.

Alison Curfman:

So huge, huge growth. I certainly have been through the growing pains of moving from that, you know, very right, organic and fluid level of leadership, where everyone is doing everything to having to, like, really get into structured swim lanes, definitely a hard phase to move through. How, how do you feel like you as a physician, had a unique, you know, perspective or background or specific value to lend to that transition. Yeah. So

Unknown:

I think being on both sides of the coin, then I understood clinical, but then I also understood ops and business. And fortunately, our company always had the patient as a North Star, which is my personal values, so I was able to kind of mold both of those together. And there were a couple pieces of feedback that were given to me that I really appreciate it. One came from one of the executive directors in our markets who later became the CEO of the company, and he said, Pam, what I love about you is that, and I'm paraphrasing because I don't remember the exact words, but it was, I don't have this kick and punt mentality, or I don't have this excitement, like I see a problem and I want to fix it, and, yeah, I'm excited about fixing it, but I don't come in and change everything that we're working on and change all the priorities and get everybody all excited, and then two weeks later, I get another great idea In the shower and come in and, you know, do around what we were working on to go for something else. He said, You really look at the whole picture, the impacts and where you're going to go. And then the other story was, I was training one of my VPS, and we were, you know, going through a lot of new skill sets. I'm like budgeting, how to we had to reorganize this team so many times. And you know how you do what's best for the company, and looking at the company needs and figuring out that org structure before you put names with the jobs. So we were going through all of this. And she said to me again, I never really realized I was doing this. She's like, what I love is you are always looking about how this is going to impact a year from now, three years from now, five years from now, so that we're not backing ourselves into a corner, backing ourselves into a hole. Because I would let her figure out what to do, but she said, then you would bring to my attention that if I do this next year, I'm gonna face these challenges where, if we do it differently, we don't have those challenges. So I never kind of recognized I'm doing it, and now I'm a lot more mindful as I do things to say, Yeah, you are doing that, or I see where you're doing that. So I think that just kind of came into play. I think the other thing that really helped when I was working, especially with a lot of the ops side of the house, and the person that referred me to you, she was different because she was a nurse practitioner in OPS, but for the most part, most of our operational people were not clinicians. So if a gap needed to be filled. I'm not saying the solution is to fill the gap, because sometimes, if you step out of your role and you always fill that clinical gap, that becomes an expectation, and it doesn't allow you to do your day job. But part of my role when launching these new markets early on was that I served as a medical director. I actually took call for the whole first year that I was at Landmark call virtual or there would be a first call and I was backup call, but I would fly in and do weekend calls and things like that. The Ops, I couldn't do that. And by being that person in the market, by being someone that would occasionally step in and see patients. Applications with collaborative practice agreements I would do ride along visits with our providers. I saw where the challenges were, I saw where things went right, where we had issues, and I was able to address those. The other real important piece in all of this was my job. Allowed me to be in multiple different markets, and as I launched markets, we set a standard as to what is best practice. So this market over here is doing this thing great. How do we bring that to the other markets? But what we learned in the training is that people would train in other markets, and they would bring quote, unquote bad habits. They would bring non standardized ways, and then our team would go into these established markets and find out they were doing things way different. So standardization became a real big issue, and it was hard to get rid of old, outdated training documents and house everything in one place. It was difficult to set these standardized workflows. So now, when I work with startup companies, I really push that right from the beginning. You might not have the resources to do everything a certain way, but let's make sure, before we go into market two, that we're deciding what best practice is, and if market one or market two comes up with something better, the whole company changes, and we still have to adapt. There's a book team of teams which really showed this idea of you can be standardized, but you need to adapt. So what you do in rural Mississippi is very different from Central New York City and Manhattan. So

Alison Curfman:

yeah. Well, those are great lessons. If you had to give a piece of advice for physicians who are in more of a traditional practice background but are interested in branching out, what? What sort of advice would you give them?

Unknown:

Oh, gosh, well, I'm laughing, because this is what I'm writing. My book is, is going to be on career What's

Alison Curfman:

your book going to be called? And we may

Unknown:

change the title, but right now, it's a prescriptive guide to position career advancement or change? Awesome, but yeah, the publisher may change the title. We're hoping it'll be launched in November. So congratulations, right? Thank you. But it goes through all of this, and I'm going to hit just some key points. The first is determining why you want to make a change, and is it an emotional response to a bad day or a bad week or a bad month, or is it something you truly want to do? And then, if it's something you truly want to do, why haven't you done it? What are the barriers that are in your way, and do you need to stick with these barriers? Let's say you've got a spouse who's doing a residency, and they don't finish for two years, and you've got a family and you all want to move together somewhere. So you know what? What are your barriers? What are the workarounds to those barriers? And looking at all of that as you think about where you want to go, you need to look at your personality, style, your values, what's going to align well with what you want to do. And then I don't get into it, but there's so many career options, whether you want to get on the health plan side, whether you want to be an industry pharma instrument development, whether you want to stay on clinical pathways, whether you want to become an author in medicine, there's just it's unlimited what you can do. And then when you decide what you want to do. What are the skill sets I need to do that? And what are the skills? Where are my gaps? And how am I going to fill that gaps, and who are the right mentors for me? Do I need to get an MBA? Do I need a master's in public health? Like, where do I need to fill those gaps so that I can get myself from point A to point B? And then we go through the whole idea of having the right resume and how you interview and how you go through the process, how you negotiate contracts, and what happens if you don't get that job. And I've been through this a lot in the last year or so, and that's okay. You learn from all of it. And so we go through every bit of that. There's a lot of other kind of key takeaways in the book, but those are some of the big ones that that are really important. Because it's not just saying I want to make a change, but what's the right fit for you, and where are you going to be happy? Because you don't want this arrival fallacy where you get somewhere thinking it's going to be great and it's no different.

Alison Curfman:

That's such great advice. Well, I have loved hearing more about your story and your journey and all the amazing things that you've been able to do. I think that if anybody wants to reach out to Dr Pam Sullivan, is LinkedIn, the best way to connect with you LinkedIn is great, yeah. And then if you follow her on LinkedIn, I'm sure you can also get updates on when her book is coming out. So we will, we will look for that. So thank you so much for joining me today, and for everyone listening, I appreciate you tuning in. I'd love if you have any feedback. You can leave a comment. Um. Um, like, follow and share. So thank you so much for joining us and have a great day.

Unknown:

Thank you for listening to Startup Physicians. Don't forget to like, follow and share. You.