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    A conversation with David J. Skorton, MD

    The new president and CEO of the AAMC talks about increasing the diversity of the health care workforce, embracing the arts and humanities, and what it’s been like to perform with Billy Joel and Wynton Marsalis.

    David J. Skorton, MD sitting on a chair

    This week, David J. Skorton, MD, became the 5th president and CEO of the AAMC, joining a prominent list of medical educators and physicians to lead the organization that represents America’s medical schools, teaching hospitals, and academic medicine societies.

    Skorton, who most recently served as the Secretary of the Smithsonian, has enjoyed a distinguished career spanning the halls of medicine, higher education, and government. A cardiologist by training, he was on the faculty of the University of Iowa College of Medicine and College of Engineering for over 20 years before becoming president of the University of Iowa and later president of Cornell University, where he was professor in medicine, pediatrics and engineering. In 2015, he was tapped to serve as the 13th Secretary of the Smithsonian, where he oversaw 19 museums, 21 libraries, the National Zoo, and numerous research centers and education programs.

    In a wide-ranging interview, Skorton talked to AAMCNews about academic medicine’s biggest challenges, the role of the arts and humanities in science and medicine, choosing medicine over music — and the times he played the flute with Wynton Marsalis.

    What made you decide to leave the Smithsonian to become president and CEO of the AAMC?

    I was extremely honored and excited to be asked to be Secretary of the Smithsonian, a true national treasure with unparalleled collections and enormously talented and passionate people. I’ve learned more about America than I ever knew in terms of history and culture. I’ve learned more about the world of art and many areas of science. It’s been a fabulous experience. When I was contacted about the AAMC position, I was thinking about the fact that my years at the Smithsonian were the only time since I graduated from medical school that I have not been involved in some fashion in the world of health care. When I was president at the University of Iowa, I still maintained my regular clinic, and when I was at Cornell, I did much less but I still had the opportunity to do a little teaching and saw patients in my specialty area, which is congenital heart disease in adolescents and adults. And so when the AAMC opportunity came up, I realized three things: how much I missed the world of health care, how much I enjoyed my experience on the AAMC board a few years ago, and that I believe there are things to be reexamined and perhaps changed in the American health care system that the AAMC is really well qualified to be a part of changing.

    What would you say are the biggest challenges facing academic medicine?

    We want to make sure that people have access to health care, that the health care is affordable, and that it is of high and consistent quality. We have work to do in all three areas. The Affordable Care Act greatly increased access but we still have farther to go. Even when there is the attempt to broaden access, the financial aspects are the first things to come up. That’s because U.S. health care, which is excellent in many ways, is also expensive.

    Drilling down a little bit more, one of the things that makes any endeavor high quality is when the team performing the endeavor is a more diverse team. There are social justice reasons to support diversity and of course those are very important. We want to do the right thing. But there’s also a growing body of research that shows diverse teams do better work. I believe that we will do an even better job of caring for patients, an even better job of understanding people’s circumstances and cultures, if the health care workforce is diverse, not just among physicians but among nurses, physician assistants, pharmacists, dentists, and others.

    What needs to happen to ensure that these underrepresented groups think about a career in health care?

    In any area in which underrepresented groups are trying to enter a field, a number of things have to happen. One is that ideally they have role models from their own cultures whose paths they can emulate. Then, they need to be able to see themselves in that profession, and that requires familiarity with the profession and self-confidence and the ability to project oneself into a future that’s different from the present. In order to make those things happen, we have to begin at early ages. We can’t start worrying about this when students are juniors in college. It’s way too late. We can’t even start thinking about it when they’re juniors in high school. As early as middle school, we want to enable young people to begin to imagine themselves in a profession or doing activities that would lead to a profession. Finally, even more than having a role model and projecting oneself into a profession, when entering the pipeline, the climate has to be conducive to success and provide a feeling of safety. It’s not enough to recruit someone either to a position of employment or a pipeline program; the atmosphere has to be such that the person feels that success is a likelihood.

    During your tenure at the Smithsonian, more than two-thirds of the hires at the director level or above were women or people of color. How would you change the culture in academic medicine to prioritize this issue?

    When hiring, one has to be able to see people different from oneself as probably successful in the job. If you can only see someone with your own background as being successful, then it’s going to be very hard to make diverse hires, even when there are options in the candidate pool. What’s more, when you’re looking at a pool of candidates for a job or a pool of candidates for promotion or a pool of candidates for an award, you have to make yourself aware of microbiases, or biases that are not easy to recognize. Unfortunately, the climate for people of color and for women in many of our great organizations has been negative and troubling. So I think it’s important to face the issues, face squarely our own individual biases, and then try to do this exercise in seeing each candidate as potentially successful. That’s something that has to be cultivated and doesn’t always come easily but it can be done.

    You’ve spoken often about the importance of the arts and humanities in medicine. What is it about the arts that is useful for a young doctor to know?

    When I was teaching med students, I used to give them copies of The Complete Adventures of Sherlock Holmes. Sir Arthur Conan Doyle was a physician and the model for Sherlock Holmes is said to have been Joseph Bell, his surgery professor at the University of Edinburgh. The Sherlock Holmes method of solving crimes is the medical diagnostic method or, if you will, the scientific method. You notice something, you posit a hypothesis about what might have caused that phenomenon, you gather more data, and if the data does not line up with the hypothesis, you develop a different hypothesis. That’s just one example of how a great work of literature could help us understand medicine better.

    I chaired a National Academies report that came out about a year ago called Branches from the Same Tree. It’s about reintegrating the arts and humanities with the STEMM disciplines including medicine, and it includes over 200 examples of programs and curricula aimed at integrating STEMM with the arts and humanities. One medical education example that’s well-known is exposing Harvard med students to works of art in the Museum of Fine Arts in Boston. The educators had the students look at works of art closely to improve their powers of observation and it turns out that they were better clinical observers afterwards.

    I understand you wanted to be a musician, rather than a doctor. How did you wind up in medicine?

    We moved to Los Angeles, California, from Milwaukee, Wisconsin, when I was nine and I fell in love with that music scene, including the career path to becoming a studio musician. I wanted to be a musician when I was a kid, big time. But my dad convinced me that I would have a more stable life if I had a profession, so I went to college. When I was in college at Northwestern, one of my roommates was a drum player in a rhythm and blues band in Chicago, Illinois. He came to me one night, said the sax player had to quit the group and asked whether I thought I was good enough to play with the band. I said, “Give me a shot,” and I played with them for the whole time I was in college. It was really, really, really fun.

    I did apply to medical school and I did get in. I was still in Chicago and I was still tempted to play with the band. It turned out that med school was pretty demanding and I had to work too, so I couldn’t hang on to the band experience anymore.

    In med school, I had a professor who taught me how to do a physical exam and especially how to examine the heart. And as corny as this sounds, it had a rhythm to it and it had a certain percussive sense that was musical to me.

    Fast forward to my cardiology fellowship at the University of California, Los Angeles. The day that I started my fellowship was the day that the late professor, Joseph Perloff, started his professorship there. He was a towering figure and one of the pioneers of the study of congenital heart disease in adults and he was a humanist at heart. I not only followed him into the corridors of cardiology but I followed him into the corridors of the humanities.

    But you’ve never stopped playing music. I hear you’ve even played with some of the greats?

    Well first, I wouldn’t exaggerate my musical skills. If I was a really great musician, you wouldn’t be talking with me for this article. You’d be buying tickets and streaming my stuff. So no false modesty there. But I’ve had the opportunity to perform with some amazing people. Before I tell you about this, it’s not that these people woke up one day and said, “My career is going to be better if Dave Skorton performed with me.” No. What happened is they performed at a college campus and somebody told their staff that the college president was sort of a musician, and they had me perform with them. I performed with Billy Joel at a college concert, and I performed three times with Wynton Marsalis. The last time I performed with Wynton, he said, ‘Your tone is getting better, but please learn your harmonies!” He must have lost my cell phone number because he hasn’t called me to go on tour with him, nor has Billy Joel. Oh well.