The Architect: Addison May, MD, MBA, FACS, FCCM

Transcript

[0:00] I didn’t really push the way I should have. And I remember vividly interviewing and meeting with a dean at a med school, and he mentioned my grades.
And I mentioned something about, gee, I thought it was very important to be engaged in, extracurricular activities that are important in governance and other things.
And he just said, well, I guess you were wrong.

[0:39] Music.

[1:02] Dr. Randy Cook Hello everyone, and welcome to Prescription for Success.
I’m Dr. Randy Cook, your host for the podcast, a production of MD Coaches, providing leadership and executive coaching for physicians by physicians to overcome burnout, transition your career, career, develop as a leader or whatever your goal might be, visit MD Coaches on the web, at mymdcoaches.com because you’re not in this alone.
And don’t forget that CME credit is available when you listen with us.
Just look for CMFI in the show notes to learn how.
My guest today is chief of acute care surgery for the Atrium Health System and Carolina’s Medical Center in Charlotte, North Carolina. Previously, he was chairman for surgical sciences and professor of surgery and anesthesiology at Vanderbilt University Medical Center, where he, was director of surgical critical care and program director of Vanderbilt’s surgical critical care and Acute Care Surgery Fellowship for 17 years.
So let’s hear my conversation with Dr. Addison May.

[2:18] Well, I’m really excited today to be speaking with a fellow surgeon, something that I don’t often get to do. Dr. Addison May is with us from Charlotte. You are in Charlotte, are you not, Addison? That’s correct. And welcome to Prescription for Success. I’m really excited to have you here. Well, it’s my pleasure to be here. Well, let’s get right down to business. As we always do, Addison, I like to start at the beginning of the story with your origins.
I know that you did your early training in Virginia. Are you a Virginia native or did you grow up someplace else?
Addison Miller Actually, I grew up here in Charlotte many years ago. I did and had been gone from Charlotte for probably 40 years, went away to college and didn’t move back.
Family always been in the area.
And then my wife always said, is there a reason you’d want to move back to Charlotte?

[3:18] And there weren’t positions at any of those times that really attracted me, but was recruited back four years ago and it’s been nice to move back home.
Yeah, sounds like you’re glad to be back home again. That’s great.
And I’m also interested in how our guests happen to find their way into the medical profession.
There’s so many stories.
How about you? Was it something that you dreamed of as a five year old or was it later?
Well, my father was a physician. He was an OBGYN here in town.
Uh, I’m the youngest of five. I’m the only one that, that actually went into medicine. Really?
And I, I don’t know that I actually ever, ever really thought I would do anything.
Different. Went away to college and just assumed that I probably would become a doctor and that probably led to one of my life’s biggest lessons.
I’m not sure I accepted it so much I’m not sure I put enough energy directly towards it and.

[4:21] Probably rightly so I was not accepted to med school the first time I applied and, that was probably the best lesson that ever happened to me at that time I then recognized that I would never, never let sort of being undirected or a lack of energy, limit what I would do going forward, that I would always put my best foot forward.
So to me that was a good thing. I would love to hear you talk about that some more because I was one of those guys that it took me two applications to get in medical school.
And it is truly a bit of a, I don’t know if it’s a life-changing moment, but it certainly is, or it was for me, a time of profound self-reflection.
And I’d like to know a little bit more about what was in your head at that time.
Well, I went undergraduate to University of Virginia and I was very actively involved in some of the student self-governance and a number of committees and perceived that as being very important to me and important sort of globally.

[5:34] And my grades were okay. I just didn’t really push the way I should have.
And I remember vividly interviewing and meeting with a dean at a med school and he mentioned my grades and I mentioned something about, gee, I thought it was very important, to be engaged in extracurricular activities.
Are important in governance and other things. And he, and he just said, well, I guess you were wrong.

[6:07] Did he really? And I’m like, whoa, okay. Uh, and you know, but again, I, that led to a period of me thinking, okay, well, you know, I work a couple jobs and study hard and worked in sort of actually worked in a microbiology lab.
I was a biology graduate, degree undergrad, and had a fabulous time working in a clinical micro lab in a hospital and redoing, studying for MCATs and did another job.
And I just said, okay, well, if I apply myself, I think I can get in.
And then I wasn’t gonna let a lack of energy limit my academic performance going forward.
I did chill like.
You know, you ought to learn things to be the best doctor, not to necessarily do well on the test.
But my theory was that if you learn to be the best doctor, you do well on the test too.
Dr. Darrell Bock You bet.
Dr. John Baxter So all that worked out for the best in the end.
Dr. Darrell Bock Yeah. And you wound up in Charleston, at Medical University of South Carolina, was on that second round of applications.

[7:18] Was that your only choice, or were there other choices? I’m really interested in the rest of the the story?
Well, you know, when I, when I didn’t get into medical school, I looked at thinking about, okay, where, where could I work in a research lab?
Where can I do things like that? And that was the period when the Reagan cutbacks were just put into place and.

[7:40] Everybody was short on money and it really wasn’t a lot of opportunity and, uh, had, some connections in, in Charleston and looked at, uh, in a position there.
And the gentleman that ran the hospital at the Charleston Memorial Hospital, ran the path lab and the micro lab and all gave me an opportunity to work in the micro lab, and also do phlebotomy.
And that’s sort of a jack of all trades actually.
And it was fabulous, fabulous experience, but gave me the opportunity to meet local people there and opportunity to take time to, I hadn’t really worked to study for my MCATs the first time either, so was able to put those at a pretty high level and was able to get into med school.
And so when you went back for interviews, I would imagine that that gave you an opportunity to say, you know, I really thought this over and I’ve done some hard work in the interim and I think I’m probably a better candidate than a lot of these guys that are just coming out of colleges.
Am I in the right ballpark? Yeah, I think so.
I mean, I guess I always, it’s always hard for me to put myself up against somebody else.
I could tell him why I thought.

[8:57] I would be a good physician and why I would do well and that I knew I could put great energy towards it.
And they also offered the opportunity after I got in, you could start early and take anatomy.
They offered some people, I guess the whole class, but there was only limited spots that you could start during the summer.
Since I had been out, I decided to do that. And that really enabled me to get started well on the right foot and finish the top of the anatomy class.
And then you could tutor during the semester. So, that ended up being quite good.
I do vividly remember there was a student that had finished, I think, third in their class at Duke, who was in our class.
And had the highest MCAT score I’d ever heard, and got into school and did basically what I did.

[9:58] In undergrad, didn’t really apply themself, just assumed that they were gonna do well.
And they got a very bad, flunked the first test and got a very, did not do well.
And you could tell for this individual that it was the first time that they had ever failed and doubted.
And it took that individual probably the first two clinical years to get back on solid footing and then sort of turn it around.
So you know, failing when you’re younger and coming back from it is a great lesson and a great thing.
So again, failing before getting to med school is probably better than failing during med school.
I really appreciate you sharing that with us because it is such an important lesson, I think. I’m interested to know that once you got underway at…
In Charleston at MUSC. Did you find the labor of being a medical student.

[11:03] Was it really difficult or were you of such a mindset that you knew what you had to do and got it done?
What was your state of mind at that point? For me it was, I mean I think you worked hard, but I was used to working hard.
To me it was fun because you were learning to do what you wanted to do and the body and human physiology, and all is just so fascinating and such a wonderful thing.
That for me, putting all that together was fun.

[11:38] One of the good thing, the easy thing is that if you surround yourself by people who are working hard, it’s easy to do that.
It’s difficult to surround yourself by people who aren’t in mid school who are able to go out every night.
You’re gonna be miserable if you do that.
But I trained during the time when in residency we were every other night call and I look back on it and would not have changed any of my education and enjoyed the whole part of my training.
So to me, it’s all how you frame it.

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[13:32] Music.

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[15:46] Music.

[15:51] That’s a good segue into the postdoctoral training. Moved on to University of Virginia for that phase of your training.
And I didn’t actually ask you if you did any serious thinking during medical school about whether it was going to be surgery from the beginning or was it a later decision.
But in any case, you used it. It was a very late decision.
I wasn’t sure what I wanted to do. I liked everything so much that actually.

[16:21] Back at that time, the application deadline was much earlier in the year before you could complete all your extra rotation.
So I ended up applying in medicine and surgery and OBGYN because I wasn’t sure which I really wanted until I redid a second rotation in the fourth year.
And then I look back, I’m like, how could I have ever thought I wanted to do that?
But to me, Yeah.
Yeah, liking a lot is better than only liking small area medicine.
Absolutely. So you moved on to Virginia for a surgery residency.
And did you feel like you were in the right spot from the beginning, or were there ever any second thoughts?
Oh, no, I thought I was at the right spot. I applied to residencies all over the country.
I had done a fourth-year rotation in Seattle and applied in Seattle and Colorado and UCSF and Stanford.
But really the program director at the University of Virginia is really the reason when I loved the program and loved how they ran the program and really sort of put self-governance to the residents on how we were going to get things done.
And he gave out responsibility and authority. As long as you met your responsibility, you were going to keep your authority.
And it was just a great place to train.

[17:44] The chairman was just such a fabulous man. So I Clearly would not have done anything differently.

[17:52] And the other thing that’s really interesting to me about your CV Addison is you know a lot of people get into their residency and it’s pretty grueling and.

[18:00] The biggest thing on their mind is getting it over with you actually took a pause in the middle to do Research fellowship you want to tell us about that? Yeah, I did two years of research in an area of sort of of surgical infections, happened to align with my micro interest and one of my mentors there was a, I didn’t think he could be boarded in as many things he was boarded in.
He was boarded in medicine and surgery, transplant and ID and critical care because you could grandfather in critical care.
So I think he had five boards, just a brilliant man and ran a great lab and had some very productive residents who were the year ahead of me in the lab, and I’d always had interest in microbiology and infections, So that worked quite well.

[18:49] For me, I don’t know that I thought about it prospectively, but after you do it and you look back, I think even if you never do research again, the period of deep research does help you mature and understand really complex process and understand that anecdote doesn’t necessarily shouldn’t drive clinical decision making.
And it was a fabulous experience and has substantially altered sort of my pathway through medicine throughout the rest of my life.
Dr. Darrell Bock Yeah, I bet it has. As I reflect on my own career, if I were armed with what I know now, that is exactly what I would like to do is spend some more time in those academic institutions.
Once you finished up at Virginia, you decided that you were going to do some more training in this time in trauma and surgical critical care.
How’d you come to that decision? Similar to my approach the first time, I like sort of everything when I went through, but I realized that I like complexity and I like sort of full systems of care.

[20:02] Came for a long time, transplant was also of interest to me.
Similar in that, hey, to really provide the highest level of care, you have to interface in systems. And so I liked taking patients who were really sick and trying to make them better, I think, is probably what appealed to me the most.
Dr. Darrell Bock No better place to do that than with trauma, man. I’m telling you. You sort of do everything that there is to do. And after finishing up with your fellowship.
Well, I can’t really tell from looking at this CV. Did you?
Was it on completion of your fellowship that you went to UAB or later?
That’s correct. That was my first academic position was at UAB. Spent four years in Birmingham. It was a great opportunity and great first job.

[20:54] How’d you pick them? Well, that’s a good story. I was in Philadelphia, University of Pennsylvania doing my fellowship.
At the time, the finances of healthcare was going through one of those big mergers and then places going belly up with some frequency and thinking about jobs in the Northeast.
I’m not from the Northeast, though my wife’s epicenter is closer to the Northeast.
And I looked at positions and I wanted to be in a busy place, but not a place that already He had a tremendous number of faculty.
And UAB was a great place and busy. And I would join an established but not a big group.
And it also provided the opportunity to do research. Now, I mentioned my wife’s epicenter is probably further north than that. She grew up outside Washington.
But her family’s from Massachusetts originally. And she spent a lot of time in Massachusetts.
And I came home and said, hey, dear, I’m thinking about a job in Birmingham.
And she goes, Birmingham?
I’ll move to England. And I said, England? No, Alabama. She goes, Alabama. What?

[22:11] So, uh, but she’s a, she’s a great sport and we had a great time in, in Birmingham.
It’s great. I’m glad to hear that.
Yeah. UAB is actually where I went to medical school.
And at the time, uh, uh, the great John Kirkland was there. The people that wanted a surgery residency there were just too numerous to count, which is why I elected not to.
But it was a great research center back then, and I think it was probably in those years as well.
But yet, apparently along came an opportunity to be a faculty member at Vanderbilt, and I’d like to hear about that.
Yeah, I got recruited to Vanderbilt. I actually went to a – I wasn’t looking.
I went to a talk in Birmingham put on about a surgical infectious disease topic, and the The speaker happened to be from Vanderbilt.

[23:02] She had actually quoted a couple of studies that I had done when I was in residency.
And my wife went up to her and said, hey, you mentioned a couple of things, quoted my husband a bit.
And I met her and she said, well, oh, you know, by the way, we’re looking to recruit someone to run our surgical critical care at Vanderbilt.
You should come look at it. So I did.
And, uh, it was a great opportunity and it was a great move for us.
And, uh, we loved Nashville. It’s a great town. And, uh, you’re there for a good while.
So, uh, you must have really felt like you had landed in exactly the right place.
You want to tell us about some of the things that you did and some of the ways that you grew while you were there?
Yeah. Um, well, you know, uh, you talk about things being the right place, right?
We were there 17 years and it was fabulous. Our daughters were raised there. But you know.

[23:59] One of the things that you learn doesn’t matter whether it’s surgery or private practice or industry or academic surgery, you know, there are always challenges and always politics and always everything. You know, and figuring out how to navigate those things, maybe it’s easy in retrospect, never easy when you’re in the middle of it. Vanderbilt was a fabulous opportunity and felt like things were growing and moving forward throughout the time. But there were clearly politics and things that you felt threatened and learned lessons along the way on getting things done and maneuvering and surviving politics. So, you know, I think that’s just part and parcel to everything that we do. That is kind of the nature of academic medicine, I think it is the nature of academic medicine for sure.

[24:54] In our organization some the organization Leadership on the physician side doing a great job to try and hey, We want this to be a great place to work and they put out a survey on what can we do?
And you know, it’s probably Might speak to some of this later health care has become big and complex And it’s so complex that you really have to change your approach to how you solve problems because it’s not easy and straightforward to just get problems solved because you’re now in big organizations.
So I think a lot of, if I’m in private practice in a group of X number, you can probably solve problems pretty quickly.
Now that things have merged and become bigger and bigger and bigger organizations, you really have to be able to sort of reset your rheostat, I think, to put pressure over time.
And as long as you’re moving things forward, that’s a good thing.
And you can achieve really fabulous things if you’re willing to do pressure over time.
But most of these changes and frustrations that you have aren’t going to be settled.

[26:16] Easily because it’s just it’s become so complex. It’s not the same world that most of us joined.
You know, if you joined over 20 years ago, it’s way different.
And those changes and frustrations, it sounds to me, and I want you to speak to the subject if you’re willing, is that what brought about the move back to North Carolina?
William Irwin Well, the move to North Carolina, I think, really was driven by opportunity. Vanderbilt at the time, it just pulled separate from the undergraduate institution at a big price tag, and so didn’t have, wasn’t in a position to be a system. Atrium Health, Carolina’s medical system at the time, had become a system, and so the opportunity was to have an impact on a much larger patient care footprint for predominantly the greater Charlotte region, which is a big area. At the time, there were few other hospitals aligned outside that area, but systems much bigger now.

[27:32] But that’s what attracted me because the position was not only division chief over the flagship hospital here, acute care surgery division at Carolinas Medical Center, but also to advance integration for acute care surgery across our system in the greater Charlotte market.
And that was an interesting challenge. a lot of patience that you can, if you do it right, you’re making a big impact.
Well, that’s a great story. So it sounds like you’re very satisfied with the move back to North Carolina. What’s on the radar looking forward? How many more years you’re going to practice? Well I’m 62 now going on 63 my suspicion is it’s probably another five.

[28:19] Years before the things that I’m trying to create would be enduring You know be able to outlive my just stepping away from it I suspect that’s the length of time so I’ll probably do what I’m doing for another five years, Though, you know one one reason the way I got to know you is in five years I saw my father just do his clinical work until he retired, and that transition to retirement, I don’t think was that easy because he didn’t have anything that kept him engaged.
And I’d like to remain engaged, but that’s not an easy, it sounds easy, but figuring out how to, we all put too much time into our primary job.
So figuring out what that pivot will be is not always straightforward.
Can you name some of those things that you have left to do? Yeah, here, it’s really probably creating a structure within the organization that allows integration of care for the patient care condition.
So when I joined, they said, we’re an integrated sort of hospital system, and we need you to advance this.
But in fact, if you’re a hospital system that has been independent hospitals.

[29:47] You may or may not have a structure that allows you to be efficient and effective across a region and have synergy for patient care conditions.
So we have a good number of hospitals, at least nine hospitals in this region.

[30:05] That do some component of acute care surgery. You know, that’s 40 to 50,000 patients a year with emergency general surgery, critical care and trauma.
So it’s a large group.
And there’s an opportunity to have that same sort of synergy actually go across the enterprise.
So that would be my goal to move the structure forward enough where we can measure how we’re doing, we can leverage successes across the organization and continuously increase the value of care that we’re offering.
Well, Addison, I think you’re the very definition of a professional life well spent.
And I appreciate you sharing with us and I’m looking forward to kind of keeping track of you and seeing how these last few years of ambition work out for you, I bet it’s gonna be fabulous.
We have arrived at the part of the program that I think most people come for, and that is when I get out of the way and allow the guests to speak on their own.
So we’re gonna do that. And audience, I’m gonna close my mic.
Dr. Addison May is gonna share his personal prescriptions for success.

[31:28] Well, thank you. This has been quite a joy and a privilege to be on today.
I felt challenged to be able to narrow it to three, but I’ll give three prescriptions that have been, I think, most important for me.
The first one I would throw out is.

[31:46] Read initiate a reading program for me this includes a mixture of genres that include.

[31:57] Performance change management leadership self help books mixed in with history and a little bit of fiction my program didn’t really start until after my daughter’s talk man to getting an ipad mini and downloading on Kindle on the Mini.
I’ve been amazed at how much reading I can get done walking from place to place or at the gym.
And I never did that prior to having that device. For me, it’s sort of what I call repetitive reading.
Serves sort of as a coaching mechanism for me, reading areas that I feel like I could or should improve or areas which I feel stressed.
And then even with history, you learn, and it supports your own performance.
The data is strong that most of the top performing CEOs in the country do a lot of independent reading.
So that would probably be my first.
The program really enabled me to react to stress and challenges in ways that without it, I probably would not have been able to change how I approach things or learned how to survive through some of those challenges.
The second thing I would throw out is, Throw Your Life a Curve.

[33:25] That title comes from an HBR, Harvard Business Review, summary that comes across emails.
This great little article, and what I mean by that is give yourself multiple areas of engagement to create the opportunity for several acquisition curves.
Humans by far and away are happiest when they feel as if they are on a steep part of an acquisition curve.
And I felt that way. I was always on a steep part of an acquisition curve in my job, and I put 99% of my life towards my job.

[34:06] Out of your control things can occur that all of a sudden you feel like individuals are a lot in grenades under your car or something happens that is beyond your control that you’re no longer on that acquisition curve.
If that’s the only thing you’re putting your energy to, you don’t have resilience.
Life typically, if that’s all you’re putting your energy to, is not particularly enjoyable at that time.
I remember vividly people saying, oh, you should be more balanced, you should be X.
And I’m like, yeah, yeah, yeah, no, I like what I’m doing.
And it took me a long time to recognize that being resilient means you need some balance in activities.
That way you can pivot to things that are going well and tread water in the things that you need to just tread water and let circumstances change where you can get back to an acquisition curve. So if I would have done that much sooner in my career had I been wise enough to do so. The third prescription I would say is is just advance the needle.
And in my discussion with Randy Cook, maybe inferred a little bit of this.

[35:27] When I say just advance the needle, I mean changing your framework in your mind.
As long as what you’re putting your energy to is advancing, you’re not moving backwards.
And that’s a success. And you should envision that as a success.
Many of my colleagues that are frustrated, you know, surgeons are, for the most part, fairly compulsive individuals. Acute care surgeons like to put a lot of energy to a problem, fix it and be gone. That’s great for resuscitating a critically ill or injured patient. It doesn’t work in complex organizations. It’s really how you frame the problem.
To solve problems and make things better you need to be able to step back and say well is my energy advancing the needle and if it is you’re moving the needle forward and being able to maintain sustained.
Pressure over time is really the only way to achieve problem solving.

[36:37] In complex settings, particularly in complex organizations. So those are the three things that, if I had been able to do it 20 or 25 years ago, I’d probably be much further along and had much less stress in my career over time.
So with that, I’ll end my prescriptions for success.
Well, Dr. Addison May, that’s a pretty good recipe.

[37:06] Read, throw yourself a curve, and just advance the needle. And no doubt if we had the capacity to understand those things when we were young, we probably would be more effective.
But that’s part of getting to where you know that these are the things we’re supposed to think about. Dr. Darrell Bock Exactly.
You don’t learn by being right. Dr. Regan No, you don’t. Actually, this has been a lot of fun.
Before we go, I want you to share with us as much information as you would like to about how people can find you and contact you, whether it’s email addresses or books coming up or speeches you’re going to be giving. What have you got for us?
Dr. John Axelrod Well, folks are always welcome to email me.
My email address is addison.may at atriumhealth.org.

[37:56] Be delighted for anyone to reach out to me. Most of my books and publications are probably fairly esoteric for the audience, so I’m happy for people to reach out to me and happy to help share things in any way that I can.
So this has been my pleasure and a lot of fun.
Dr. Darrell Bock Well, I’m glad you enjoyed it. I certainly have.
And once again, thank you so much for being here, Dr. Addison Maye.
Thank you so much for listening with us today.
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And remember, be sure to fill your prescription for success with my next episode.

[39:19] Music.