This transcript of the discussion has been edited for clarity and length.
Mike Sacopulos: My guest today is Dr. Michael Gardner, Vice President and Administrator of Women’s and Children’s Hospital at University Health in San Antonio, Texas. Dr. Gardner is board certified in obstetrics and gynecology as well as maternal fetal medicine. He is a Certified Physician Executive and in 2025 became a Fellow of the American Association for Physician Leadership. Dr. Gardner, welcome to SoundPractice.
Michael Gardner, MD: Thank you, Mike. It’s great to be here.
Sacopulos: Before we dive into strategic thinking, could you tell me about your path to becoming a physician leader?
Gardner: My journey has been quite varied. I’ve held diverse leadership roles throughout my career, including Director of Quality for Harris Health in Houston, Chief of OB/GYN at Grady Hospital in Atlanta, and Executive Vice President for Ambulatory Care at Harris Health. I also served as Vice Dean of Clinical Affairs at the University of Nevada Las Vegas and held various academic department chair positions. I’ve been involved with AAPL since 1997 and earned my Certified Physician Executive credential through the organization’s partnership with the University of Southern California’s Master of Medical Management program. Each of these experiences built upon the previous one and helped me develop the strategic thinking skills that are so essential for physician leadership today.
Sacopulos: Let’s talk about strategic thinking. Why is this skill particularly important for physicians in leadership roles?
Gardner: Physicians bring a unique perspective that’s essential for improving American healthcare. We’re dealing with a situation where healthcare consumes roughly 20% of the GDP, and our outcomes lag behind other developed nations. That’s a significant problem. Physician leaders must actively participate in strategic decision-making rather than exclude themselves from these conversations. We can’t just focus on the clinical side and leave the strategic planning to administrators. Our perspective is crucial for shaping the future of healthcare in a way that truly serves patients and improves outcomes.
Sacopulos: How would you distinguish strategic thinking from clinical thinking? Aren’t they related?
Gardner: They are related, but there are important differences. Clinical thinking focuses on immediate patient care with narrow attention to detail. When you’re treating a patient, you’re focused on their specific condition, their immediate needs, and the interventions that will help them right now. Strategic thinking, on the other hand, requires a broader view of internal and external environments, long-term organizational goals, and the ability to embrace foresight and ambiguity.
The key difference lies in scope and timeline. Strategic thinking means planning months and years ahead. You’re looking at where the organization needs to be, what forces are shaping the healthcare landscape, and how to position your institution for success in an uncertain future. Clinical thinking is more concrete and immediate, while strategic thinking involves navigating ambiguity and making decisions with incomplete information.
Sacopulos: Some physicians seem naturally drawn to strategic thinking while others struggle with it. Is strategic thinking something that can be learned, or is it more of an innate ability?
Gardner: That’s an excellent question. Although some physicians may naturally gravitate toward systems-level thinking, strategic thinking is absolutely a skill that can be developed through mentorship, education, practice, and progressive leadership experiences. It’s not something you either have or you don’t.
I’ve seen many physicians develop strong strategic thinking capabilities over time. The key is starting with smaller leadership roles and building confidence. Maybe you begin by leading a committee or a small quality improvement project. As you gain experience and see how organizational decisions play out, you develop the ability to think more strategically. Progressive leadership experiences prepare physicians for larger strategic challenges. Education and mentorship are also crucial. Having someone guide you through strategic frameworks and help you understand how to analyze complex organizational issues makes a tremendous difference.
Sacopulos: We’re hearing a lot about artificial intelligence in healthcare. How do you see AI impacting strategic thinking for physician leaders?
Gardner: AI is going to be a game changer, but not in the way some people might think. Artificial intelligence will enhance strategic thinking by accelerating data gathering and scenario analysis. Imagine being able to quickly analyze multiple strategic scenarios, understand market trends, or assess the potential impact of different decisions. AI can do that kind of heavy lifting much faster than humans can.
However — and this is critical — it won’t replace the human judgment required for strategic leadership. AI should be viewed as a powerful tool that requires verification and human oversight. You still need experienced leaders who understand the nuances of healthcare, the culture of their organization, and the complexities of patient care. AI can give you data and even suggest options, but it can’t make the final strategic decisions that require balancing competing priorities, understanding organizational culture, and exercising wisdom gained from experience.
Sacopulos: Physician leaders often need to work closely with administrators who come from business backgrounds. How important is it for physicians to understand business concepts, and how deep does that understanding need to go?
Gardner: This is really about being translators. Successful physician leaders must learn to speak both clinical and business languages. Now, you don’t need to match your CFO’s financial expertise or your COO’s operational knowledge. That’s not realistic or necessary. But you must understand enough to communicate effectively with your administrative colleagues.
For example, you need to understand basic financial statements, how revenue cycle works, what drives costs in healthcare operations, and how strategic investments are evaluated. You need to be able to discuss market share, competitive positioning, and operational efficiency. At the same time, you need to translate strategic concepts back to medical staff in language they understand and in ways that connect to patient care and clinical quality.
The physicians who struggle in leadership often are those who either refuse to learn the business side — thinking it’s somehow beneath them or not relevant — or those who can’t translate back to their physician colleagues. You’re sitting in the middle, bridging two worlds, and you need to be fluent enough in both.
Sacopulos: What would you say to a physician who’s interested in developing their strategic thinking skills but doesn’t know where to start?
Gardner: Start small and be intentional about your development. Look for opportunities to participate in strategic initiatives at your organization, even in a supporting role. Volunteer for committees that are working on strategic planning or major organizational initiatives. That exposure is invaluable.
Seek out mentorship from physician leaders who are strong strategic thinkers. Watch how they approach problems, ask them questions, and learn from their experience. Formal education also helps tremendously. Programs such as those offered by AAPL provide structured frameworks for thinking strategically and give you tools you can apply immediately.
Also, practice thinking strategically even in your current role. When your organization makes a decision, think about the strategic rationale behind it. What environmental factors influenced that choice? What are the long-term implications? How does it fit with the organization’s overall direction? Training yourself to think this way builds the muscle memory for strategic thinking.
Sacopulos: You and your colleague Dr. Mark Guadagnoli are developing strategic thinking courses for AAPL. Can you tell us about those?
Gardner: Absolutely. We’re developing a comprehensive course series that addresses strategic thinking and planning from multiple angles. We’re creating an online strategic thinking course that physicians can complete at their own pace, learning the fundamental frameworks and concepts. We’re also offering a “The Who, What, Where, and When of Strategic Planning” course that goes deeper into the mechanics of actually creating strategic plans.
The most exciting part is our hybrid strategic planning workshop planned for 2026. This won’t be just theoretical — participants will actually create strategic plans for real challenges they’re facing, with ongoing guidance and feedback from us throughout the process. We want people to leave with something they can immediately implement.
Sacopulos: Tell me a bit about Dr. Guadagnoli. What does he bring to this work?
Gardner: Mark is fascinating. He holds two PhDs — one in sports performance and one in neurosciences — and serves as Senior Associate Dean for Faculty Affairs at UNLV. He’s also an executive coach, consultant, and mental performance coach for the UNLV golf team and PGA professionals.
He brings this unique perspective on how people learn and perform under pressure, which is incredibly relevant for strategic thinking. He has an upcoming book on “challenge point learning” that explores the optimal learning zone — where individuals are pushed enough to improve without being overwhelmed. That concept applies perfectly to developing strategic thinking skills. You need to be challenged beyond your comfort zone, but not so far that you freeze up or become paralyzed by the complexity.
Sacopulos: As we wrap up, what final advice would you give to physician leaders who want to strengthen their strategic thinking capabilities?
Gardner: I’d say embrace the ambiguity and uncertainty that comes with strategic thinking. As physicians, we’re trained to seek definitive answers, clear diagnoses, and evidence-based treatments. Strategic thinking often requires making decisions without complete information, and that can be uncomfortable. But it’s essential.
Also, remember that strategic thinking isn’t about having all the answers yourself. It’s about asking the right questions, gathering diverse perspectives, and creating processes that lead to sound decisions. Build relationships across your organization. The best strategic thinkers I know are those who can tap into expertise from finance, operations, clinical areas, and even patients and community members.
Finally, commit to continuous learning. Healthcare is changing rapidly, and the strategic challenges we face today will be different from those we face five years from now. Stay curious, stay engaged, and keep developing your skills. The future of healthcare needs physician leaders who can think strategically and help guide our organizations and our profession in the right direction.
Sacopulos: Dr. Gardner, this has been a fascinating conversation. Thank you for sharing your insights on strategic thinking in healthcare leadership.
Gardner: Thank you, Mike. It was a pleasure.
Sacopulos: My guest has been Dr. Michael Gardner, Vice President and Administrator of Women’s and Children’s Hospital at University Health in San Antonio, Texas. For more information about AAPL’s strategic thinking courses, visit the American Association for Physician Leadership website.