Physician Leadership in the Time of COVID-19 with Dr. Anthony Fauci

In this episode of SoundPractice, Mike Sacopulos and Dr. Peter Angood interview Dr. Anthony Fauci on the nuances of physician leadership during a pandemic.

As the Director of the National Institute of Allergy and Infectious Diseases, Dr. Fauci, who has been a physician leader and in the forefront of medicine since the 1980s, will explain how he navigated the balance of clinical issues and political situations through seven presidential administrations, his take on both courage and humility for physician leaders, and his clarion call for vaccinations and the role of physician leadership in getting ahead of this pandemic.

Dr. Angood discusses the tactical side of skill and competency building for physician leaders, physician leadership at this unprecedented time, and initiatives that the American Association for Physician Leadership (AAPL) is undertaking on the Global scene.

As a bonus, Dr. Fauci shares his opinion on the best resources for physicians to access to stay abreast of news related to COVID-19.

Michael Sacopulos: SoundPractice is the business podcast for physicians and healthcare leaders from the American Association for Physician Leadership. I'm your host, Mike Sacopulos. Today, my guests are Dr. Anthony Fauci and Dr. Peter Angood. Our topic, “Physician Leadership in the Time of COVID-19.” Dr. Fauci is Director of the National Institute of Allergy and Infectious Disease. Dr. Angood has led the AAPL since 2011.

Dr. Fauci, Dr. Angood, welcome to SoundPractice.

Dr. Anthony Fauci: Thank you very much. It's good to be with you.

Dr. Peter Angood: Dr. Fauci, our Association is really about physician leadership, and my personal philosophy is that at some level, all physicians are leaders. We provide support and solidarity for all physicians, as well as for the places where they work. And, during this critical time of the pandemic, from your perspective, what's the best message we can give physician leaders? Just keep trusting the science? Better leverage their influences to help individuals get vaccinated? Or, how else can physicians help that scope of the profession?

Dr. Anthony Fauci: Well, I think you've mentioned the important messages there. Certainly, this is an evolving situation. And this is what confuses people, for example, the recommendations that come from the CDC. These are based on information as it evolves. As you get a dynamic epidemic, a pandemic as we have right now, things change. We now have a dominant Delta variant. It's very different from the time when we had the Alpha variant, particularly among vaccinated people.

So, physicians are steeped in science and truth. The public interact with their physicians much more closely than with public health officials at the national level. Patients often count on their physicians, the people that they trust. Whenever we talk about trusted messages in the community, right at the top of the list are physicians and healthcare providers. These individuals are trusted so much more than national figures.

So, I believe, it is within the purview and the power of physicians to translate the data and the truth to their patients in a way that's understandable, particularly the issue of getting vaccinated. We know right now that we have highly effective, safe and available vaccines. It would be tragic if we continue to have the amount of infection, hospitalizations, and deaths despite having these vaccines. Now, over 625,000 people in America have died from this outbreak, which makes it the worst pandemic of a respiratory disease in over 102 years. And yet, we have, fortunately, highly effective vaccines that are safe. So, we've got to get people vaccinated.

So, the message to the physicians who might be listening is that you really can help greatly to promote the health, not only of your individual patients, but for the country in general.

Dr. Peter Angood: Absolutely. Healthcare is an inherently complex industry, as we know, and yet that patient/physician relationship is the most critical and still that driving force in healthcare in so many ways. But, in terms of leadership, it takes a lot of courage for these physicians to kind of recognize to some degree they have a responsibility of leadership in any variety of ways.

Our constituency of this Association is international, and we have many large-scale health system CEOs, chief medical officers, and a whole variety of other administrative roles. And yet this is unprecedented times for them, and so they must be courageous as they try to take a stand on several issues -- mandatory masking, vaccines for all staff, hospital visitors, supply chain issues, and complex issues like triaging care, and end of life care. Again, from a leadership perspective, what would be some of your guidance for those physicians who are, again, thrust into these unique roles?

Dr. Anthony Fauci: What I would advise physicians, is to really try and stay up attuned to the information upon which things are based. For example, you mentioned the idea about mandates for vaccines and for masks. That's a very sensitive subject, because there are many people in this country who feel that their individual liberties are encroached upon when you mandate anything. But, I think, as you say, you used the word, “courage,” which I think is a very appropriate description. I would hope physicians analyze the entire situation and realize that we really do need to get to the end game of getting most people in this country vaccinated. If we don't, this thing is going to linger with us, literally indefinitely, because it'll continue to circulate, it'll continue to mutate. And when it mutates, you'll get new variants and new variants may evade and be elusive to the protection of the vaccines.

So that the unvaccinated people who don't like mandates should realize, and with the help and the leadership of the medical community, is that if they don't get vaccinated, they're not only endangering themselves and their family and their community, but they're really providing an opportunity for the virus to continue to evade everything, even the vaccines.

So there comes a time when you must make the difficult decision, and this is where the idea of what you mentioned, Peter, regarding courage. It is time to step up and say it is controversial. It is. But with our role as physicians and as leaders in the arena of public health, we have to stand behind those decisions in which the primary goal is to promote and preserve the public health.

So, that's what I would recommend to physicians. You must sometimes, take a difficult stand where people may get upset with you. I would rather have an upset and alive patient, than a patient who thinks I'm a great guy and winds up getting to the ICU and dying.

Dr. Peter Angood: Yes. I was noticing one of the factoids on my feeds this morning, just slightly less than 10% of small-to-intermediate sized businesses are mandating vaccine. So, it's going to continue to be highly controversial for some time, as you say. So, thank you.

Michael Sacopulos: Dr. Fauci, in your answer, you alluded to physicians keeping abreast of certain types of information. Can you provide our listeners with some trusted sources? Can you point them to resources for the ever-evolving epidemiology and progress on COVID-19?

Dr. Anthony Fauci: An easily accessible source is the website of the CDC, www.cdc.gov. It comes up; they have a search engine. You click on COVID-19, and every aspect of the pandemic includes detailed information. On the NIH website, where I work as an Institute Director, there is information on the scientific aspects of the pandemic. What we've done over the last eight months, from the time that President Biden was sworn in, was to have at least two and sometimes three, but at least two times a week, press conferences that are very unlike the press conferences from last year.

The current press conferences are structured like this: We have the CDC Director give about five minutes or so of update on what's important epidemiologically. She's followed by me who gives about five minutes on what the latest scientific advances in regarding vaccine efficacy, therapy efficacy, things like that. And then you have the rest of the time where the press ask questions. That whole thing lasts about 30-40 minutes. For those who have the time and the interest, it's not a bad idea for physicians to just tune in. It's usually covered by CNN and some of the other networks. But the easiest thing to save time, rather than listening to a press conference, just go to www.cdc.gov and just ask the question in the Q's and A's, area and you'll get the answers you need.

Dr. Peter Angood: Thank you. And I have popped into a couple of those news conferences, and they are very, very informational. And yet, I think our constituents still are reassured to hear, just go to the CDC still. That's our main federal bureau of authority on this. So, thank you for that and that reassurance.

Dr. Fauci, we're curious about your own leadership journey. As a globally recognized physician leader, quite influential over the course of your career, would you care to share the two or three experiences for you that confirmed your leadership? Where you recognized for yourself that you could create a larger scale of influence. I ask this type of question because so many of the folks that interface with us, here at AAPL, are always fascinated by those stories of how physician leaders have structured their careers.

Dr. Anthony Fauci: Well, thank you for that question, Peter. It's a bit of a complicated answer, but I think I could simplify it by some fundamental principles. I found myself in the position where I had the opportunity and the privilege to advise seven presidents about areas of domestic and global health. In the beginning I advised President Reagan. This was in the very early years of the HIV/AIDS pandemic, and it was a very sensitive and difficult situation. The White House, at the time, did not feel it important to come out and use the bully pulpit of the White House to get people aware of the danger of the emerging outbreak, at that time among young gay men. I had a principle that I've always had, which is to stick by the data, evidence, and facts and be consistent in everything you do.

The lesson I think that says it all, is when I went in for the first time to the White House, into the West Wing, because President Reagan asked me to come in and talk a little bit about HIV. This was the early 1980s.

Remember, he wasn't talking about HIV very much at all at the time. A very wise person (who became came a very good friend of mine) and who had been in the Nixon White House for about five or six years, gave me advice. I hope and I think I would have thought about this anyway, even if he didn't suggest the advice to me, but he really confirmed it.

He said, “Whenever you walk into the White House to brief the President or people at the highest levels, tell yourself that this may be the last time I'm ever going to do this. If you go into it feeling like you want to get asked back, because it's such a haughty and heady experience to go into the White House, you may wind up hesitant to tell the President something that he might not want to hear, but a truth that's inconvenient for him. So, you've always got to stick by the facts, stick by the truth, and don't ever veer from that even if it means you're not going to get asked back again.” I've lived by that, and I've gotten asked back for seven presidents. So, it seems to have worked.

If you really want to maintain leadership capability, you've got to be consistent, you've got to be based fundamentally on fact, and you've got to live by example. I think the example of what you do, your fairness, your consistency, is what people look for when they look for leaders. They don't like inconsistencies. You've got to articulate what your goals are.

As the Director of the Institute, one of the things I pride myself as the Director of NAID, is that there is no doubt in anybody's mind what my goals are, what my vision is. If you want to be a leader, you can’t keep people guessing about your direction. You’ve got to be very articulate in saying, this is the institution I'm the leader of. This is where we want to go. These are the principles upon which we're going to operate. So, we've all got to be pulling together to get to the common goal. That's what people really want in a leader. They don't want vagueness. They don't want inconsistencies.

Michael Sacopulos: Also in their physicians, correct? The public looks for similar characteristics in their physicians.

Dr. Anthony Fauci: Absolutely.

Dr. Peter Angood: In our AAPL membership and our constituency overall, a couple of the White House physicians continuing to be our members. And I have had the privilege of going into the White House a couple of times, and I remember meeting President Obama very briefly. As I watched him move through his meeting, I noticed the humility that he demonstrated with his support staff. That focus, that strategic direction that you provide to people is very important, but that underpinning of humility is crucial, at least in my opinion.

Dr. Anthony Fauci: No, you're absolutely right. That is a quality that I've seen in many presidents, but certainly President Obama had that. He's a brilliant mind, usually the smartest person in the room, but he never acted that way. He always wanted to hear what people had to say.

Dr. Peter Angood: Well, and you yourself, sir, have been demonstrating that humility to the nation and to the rest of the world. Last year was complicated with a different administration. It's perhaps a little bit simpler this time. Yet, we're still dealing with this incredible pandemic that's challenging us in so, so many ways. So, we very much look forward to your ongoing leadership.

We very much appreciate your spending some time with us today, and for that combination of pearls on the pandemic. But also, your pearls on leadership. So, thank you so much for your time today. And the best of luck as we all continue to do our best to manage this pandemic.

Dr. Anthony Fauci: Thank you very much, Peter. It was a pleasure to be with you. Thank you for having me.

Michael Sacopulos: Doctor, thank you.

Dr. Anthony Fauci: Thank you, Mike.

Michael Sacopulos: Thank you. My guests have been Dr. Anthony Fauci and Dr. Peter Angood. Thank you so much for being on SoundPractice.

Listen to the podcast on SoundPractice.

Dr. Anthony Fauci https://www.niaid.nih.gov/about/director

Dr. Peter Angood https://www.physicianleaders.org/about/executive-management-bios/peter-angood