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Hey guys, welcome to another edition of Bootstrap MD, the podcast for physician and healthcare entrepreneurs. Really excited about my next interview. You know, from time to time, I really like to spotlight physicians who are in the trenches and are helping other physicians, other people in not necessarily going away from their their current vocation, but just exploring different ways that you can use your expertise as a physician in different ways.

and I'm super excited to bring to you one of the founders and president of Critical Endeavors LLC and his website is functional mentoring.com. He has a decorated career as an Army critical care physician. So, we're going to talk about how he transitioned into this journey into coaching others. So, I'd like to welcome to the program Dr.

Christopher Columbo. Christopher, how are you today, my friend? Good, Mike. Thanks so much for having me.

I really appreciate it. Awesome. Okay. So, I didn't really do your bio justice.

I know you had a long career in this. So, tell us about your start to how you got into medicine and what brought you up to this point now in coaching and mentoring other physicians. Yeah, it's one of those things where, you know, I probably decided I wanted to be a doctor sometime around elementary school because it was just one of those family nudges. nothing forced, but you know, it seemed to be a good mix of a kid with a science aptitude and kind of a people person and just kept that focus through college, premed, medical school, and when deciding what career path to pick, internal medicine and specifically critical care medicine were kind of what called to me.

I had joined the army to pay for medical school. So I was in the reserves during school and going to officer basic and other leadership experiences and clinical experiences. Went on active duty for my residency training fellowship and career and served 20 years active. So 24 total including deployments, leadership experiences, department chief was program director, things like that.

And then when I retired, somebody asked me, "What are you going to do?" And I at that point after 24 years of full-time employment for the US Army, I said, "I'm not going to do anything. I'm going to sit and build Lego for a little while." And they said, "No, seriously." I said, "I'm being 100% serious. I think I just need a break." I picked up some part-time clinical work.

It's pretty easy to find a night shift in an ICU. So, I had been doing that. And a friend of mine had transitioned to retirement a year after I did. we had shared an office for a good part of our career together and she got into executive coaching and at first I looked kind of crosseyed at her and I said what's that all about and as we talked more about it it occurred to me that you know that was a huge part of my life and my career for 20 years we didn't call it coaching at the time it was leader development professional development and it was just an expectation we joked that it was additional duty as assigned in the army it was just an expectation of what you did and when looking back and thinking about the parts of my career that were enjoyable.

Obviously, clinical practice was something that really called to me and still does, but the mentorship aspect and the development and coaching aspect was something I was missing out on as I transitioned. So I underwent executive coach training and then as I started to go through that and you know get counseledled hey build your niche figure out what you're passionate about where you can do good I thought about my own challenges in my career in the army and as a leader and what would I have benefited the most from and my challenges really came personally from those areas that overlap between the personal and the professional. You know many physicians will do this.

I certainly was guilty of it of overcompartmentalizing and then getting frustrated that you're good at one domain of your life or with a skill in one domain but it doesn't translate to the other and you stay frustrated and trying to figure out why that is and the key of first place to look is the common denominator between the two domains and that's you. So I went beyond executive coach training and also undertook training as a positive psychology coach with the idea being you know what would I have benefited from and it would have been somebody that could have helped and mentor me both in those executive skills and how to be a leader and time management feedback communication and also how to align what I wanted to do professionally with how I was living my life personally so that you know wherever I was always being authentically was the colleague was that was he also a physician who got into executive coaching. Yes.

Yeah. Another critical care physician. We we were in fellowship together and then the army bounces you around a little bit but ended up sharing an office for the last three years of our career together. Wonderful.

And so are you completely out of medicine? Are you still doing part-time? No, I I still do part-time clinical. In fact, this past weekend I just did three night shifts back to back to back.

And you know, everybody asks, "Aren't you going to burn out doing night shifts?" So, I'm like, absolutely not. That's the part that I loved the most was being in the thick of it, focusing on patient care, shoulder-to-shoulder with the nurses. If someone's going to page me at 3:30 in the morning in the ICU, they mean it. I should definitely be up and doing something with that.

So, I still do that. But in terms of the organizational leadership, I stay connected to that by coaching other folks instead of having taken on a full-time position at a large practice or a hospital or an academic institution. Yeah, I'm trying to think and forgive my naivity. There doesn't seem to be a lot of overlap in your clinical work and then when you're doing coaching or is there?

Honestly, it depends on who I'm coaching. I I find it important in coaching physicians to maintain that credibility of still being a clinician. It's kind of unifying for a lot of different specialties to deal with an intensivist. It doesn't really matter what flavor of physician you are.

If your patient is getting very critically ill, you're going to be calling one of me or my colleagues. And it's interesting how that's translated to a baseline trust and credibility in coaching of okay well if I was going to call you because somebody's dying I can certainly call you because of this particular challenge or helping me get unstuck in my life. So I agree it doesn't seem like there's a lot of overlap but there's some synergy between the two.

Yeah, I do want to as a son of a physician who was in the Air Force reserves as well as in the National Guard again thank you and thank you for your service and you know I definitely saw through my own father who passed away a few years ago how did the military service shaped his views on medicine and how did it affect you in terms of medicine and what did it teach you about leadership and what did it teach you about resilience? Wow, in so many ways. Yeah, exactly.

That's a lot to unpack. I mean, honestly, the amount of opportunity to flex your resilience muscle and rely on it in the services is enough on its own. When you add in being in the medical in the service and deployed experience in a combat support hospital, the overlap between those two professions and all of the different ways in which stress has come, whether it's something specific with the patient, whether it's being away from home, whether it's both of those things at the same time, the surprises within and the unexpected that comes with service in the military.

Those are just some of the obvious ones of how the experience shapes your ability to use resilience and understanding the absolute necessity of being trained in resilience. What's interesting specifically about the army is that the positive psychology folks at I believe it's University of Pennsylvania, Barbara Frederickson and company, they developed a resilience program for the military and it was adopted lockstock and barrel for the army at least. I remember going through it myself and I remember all of the different techniques of finding your personal values and figuring out where priorities were and also catastrophizing versus when you're initially assessing your emotional response to uncertainty and news.

I remember going through all of that training and then I remember thinking as I went through my own positive psychology training, I'm like this is not applied to the best benefit of the service member. And unfortunately in many ways did the same thing that happens in large organizations. This is not a shot on the Department of Defense by any means. It happens often in healthcare training, corporate training that rather than focus on the goal of the training and getting the most out of it to build that skill and support the mission, it becomes its own end and you just get through it and check the box and make the spreadsheet green so to speak.

I was amazed to find out how much depth there really was to the positive psychology literature in terms of techniques to build resilience, but more so when I revisited it in my personal training than what I saw when I was in service. We've talked before and you've worked primarily with physicians who are stepping into that leadership role. So, what do you say is like the most common challenges they face into that transition?

Yeah. Yeah. And that's, you know, kind of inspired to help those folks because really that was my challenge was stepping into a leadership role and realizing at the end of it when it wasn't going well for the first time that we rise to positions as a physician and we're always focused on that next step. It just becomes cultural.

When you're in high school, you're trying to get into college. When you're in college, you're prepping for the MCATs and trying to get into medical school. Then you're studying for your boards to try to get into residency. Then you're studying for your inservice to pass your boards and get into fellowship and the next one and the next one and it never seems to end.

And a natural progression for a physician beyond their clinical work is obviously to become a leader in their practice, in their hospital, at their academic institution. And the trouble becomes when we transition to those roles, we expect that we're going to be as competent at that next role as we have been at all the previous ones. The difference is all of those roles, premed to med school, med school to residency, residency to fellowship, fellowship to practice, we're all intentionally preparing you for that next step as a culmination.

As a leader, we're grossly underprepared and we don't know it until we get there. And most folks that are unprepared are frustrated. And I think this is a huge source of burnout for new physician leaders because they don't understand why they can't effectuate change and policy and performance. And it's because it's a completely new set of skills.

they haven't been prepared for it, but they were selected for it because they had credibility. They had trust at the bedside. And you know, in my instance, I was an intensivist. If I said something in the ICU, everybody listened and we just figured out how to get it done.

There might be some input from the team and pointing out data that I might need to understand, situational awareness, and it was all to help the mission. And there wasn't any personal agenda going on at the bedside of a critically ill patient. Everybody was on same team and on same mission. And as I moved to a leadership position, thinking, well, I can run this meeting.

It's a meeting. What stakes could there possibly be at this meeting that would connect with a shock or a cardiac arrest or anything like that? And yet, I couldn't effectively get a team of folks on board for an agenda. even selecting the agenda would sometimes be a struggle.

And I'm like, what is it that I I'm not demonstrating that I have no credibility in this new environment, in this new realm versus my day job. There aren't a lot of questions being asked and I'm doing things that are way higher stakes. And it was because I did not have the commenurate skill and training and experience to leadership that would have matched up with my clinical.

So there's a big disconnect in the pathway to physician leadership for many in that we're selected for it because of our clinical competence and the credibility and the trust that we engender and then we get to that situation and none of what we bring is the coin of the realm and we wonder why we can't get things done. We're selected for leadership positions as physicians often because of our clinical competence. And the expectation is that we'll have the same credibility and the same level of trust and benefit of the doubt when we make a decision or make a call in a leadership position.

And it just doesn't work that way. The coin of the realm, so to speak, is experience as a leader and trust by everybody that's not clinical. And we haven't earned that. And we haven't been trained for it.

And we go in assuming that we're going to be good at it because well, we were selected because we were good clinically. People believe in us and trust our opinions clinically. And then it just doesn't translate. And it's a great degree of frustration.

And I see actually a lot of burnout from rising physician leaders. And when you break it down, it's one of two things. They didn't know what they were getting into. And now the question if they back up becomes now that I know what being a leader is, do I really want to do this?

And that was an experience that I had as a program director in graduate medical education. Many of the things that I did that got me considered for that position, being a mentor, being a great teacher, being a good researcher, really didn't translate once I got into the leadership position. mentoring individuals and focusing on their, you know, research and doing projects with them. It looks like you're playing favorites.

You can't do that anymore. Like I was a mentor that had to be, you know, restricted in the number of people that I could mentor cuz I was sought after. Once I became the program director, what had been a positive yesterday was now seen as a negative. And I didn't react to that.

Well, I've learned a bit since then. My next fora into leadership was much more successful. But what I'd love to spare people is that school of hard knocks where you have to fail at a leadership position to learn your lessons and then come back again with resilience better, stronger, smarter. If you go into it with eyes wide open of this is what you may have to sacrifice to be effective as a leader.

This is what the job actually entails. This is what the expectations are and you still want that. Great. It's the same as choosing medicine.

Honestly, if somebody grabbed an undergrad and actually explained to them what medical school was going to require, what residency was going to require, what the life of a physician while you're paying your dues in order to be able to get to a point in your career where you can have some control, do some job crafting and some career selection as I have. If that was all explained ahead of time, I think we'd have a much different set of folks that were trying to enter medical school. It's very similar for us as leaders.

I think it's just that natural progression of chasing the next thing and becoming the next level and achieving the next job and I think it would be beneficial for everybody involved organization and potential physician leaders to have your eyes wide open as you pursue those positions and then if you are to be developed and mentored into them instead of okay you've got it and then you end up as the dog who caught the car you don't know what to do with it. You know, it reminds me of this doctor who started up his own practice and I was overseeing him. I was doing some practice growth on it and he kept saying to me, "Mike, you know, I don't know what's wrong with these nurse practitioners or these physicians assistants or the RNs or the medical assistants.

They don't train them as they used to." And he would be the type of person that would go, every employee wouldn't stay that long. And he could have realized that maybe it's not them. Common denominator in this situation is Exactly. And as you were saying, there are many physicians who excel clinically but struggle with the people side of leadership.

So how do you help them bridge that gap? It doesn't seem easy. It is not. It's work.

But again, I'm dealing with a population of folks and I point this out to them when they say, "This is hard. I've never done this before." And I said, "Great. Think back over the last 15 years of your education and career. It seems to me that you're well qualified to do hard things and to have learned things.

And what requires a little bit of convincing is that leadership, including, as you point out, the people side, emotional intelligence, social skill, communication, feedback techniques, these are all learnable skills. None of this is magic. All of these things are as learnable as the physical exam or placing a central line or adjusting a ventilator or prescribing the right antibiotic. It's just that we're 15 years in and the expectation is that we should be good at these things.

And then should becomes that red flag word of okay, well that's a gap between expectations and reality. Which of those things do you have control over when it's yourself? You may be able to affect that reality, but that's going to be the journey and the work where you have to bridge that skill gap. If it's another kind of should where it's an external reality, you need to manage your expectations.

And it's those kind of conversations that help reframe for folks just getting grounded in reality. I'm a huge fan of the concept of humility, but not in the way that most people use it. Most people will use humility as a synonym for modesty. And the actual Greek root of humility is grounded, meaning grounded in reality.

So it avoids false modesty, right? For someone to say, I'm a great clinician and a lousy leader. I need to work on that. Is very different than them saying, you know, I'm not that great a clinician and thus I am humble and modest and you'll like me better as a leader.

I don't think so. If you really are a good clinician, to say that you aren't, right, engenders some insincerity. The idea of humility as being grounded is really what the original Greek root for that is. It's not modesty.

Modesty is important. I think when it's sincere, if you say, you know, I'm a great clinician, that's not braggadocious if you are a great clinician. But understanding that being a great clinician does not translate to being a great leader and saying, you know what, I'm a leader that is in need of some skill development, some mentoring, some practice. That's being humble in a useful way to say I'm not that great a leader or I'm not that great a clinician.

And thinking that modesty, which is frankly false modesty, gives you some credibility as a leader, really engenders a feeling of insincerity in people that hear you say something they know to not be true. They observe that the opposite of what you're saying is the case. So that doesn't help you become a better leader. But really embracing reality, right?

It's not a bad thing to say. I'm not any good at this. That's the first step in figuring out why you aren't any good at it, what you need to do to be good at it, and pursuing a plan to get good at it. Whether that's a training course, a mentor, or a coach, as a trusted adviser giving you feedback.

There's a lot of different ways to get there. But if you don't embrace reality at the beginning and be humble in being grounded in that reality, then you're missing a key first step. Now most of my audience knows what executive coaching is and which you're certified in but you're also certified in and you made reference to this positive psychology coaching. So tell us a bit about that and how does that approach you know complement each other in your coaching practice.

I have to do this explanation a lot because most people don't put those two together. You know they think of positive psychology coaching as oh that's a life coach that's not what I want. I want an executive coach. I could talk about positive psychology your entire podcast.

So the notion of clinical psychology as distinct from positive. So clinical psychology will look at pathology right. So human dysfunction and just like any disease model will try to fix the problem and return the person to a neutral state. Okay?

So on a number line think of it as somebody is in their level of function is at a neg3 or a neg4 and clinical psychology will get them to zero. What about all the folks that are at zero or one and want to be at a plus three or a plus4? Clinical psychology doesn't have an answer for them. We fixed the glitch and that's the end of it.

Positive psychology takes the tack of okay, you are coach, you're competent, you're resourceful, and you're whole, but you are not optimal. You're not as good as you could be. You have potential that's untapped. And the goal for positive psychology is to make the most of that potential.

and allow a human being to flourish in their life. which when I frame it that way, if I'm able to combine that with the executive coaching, executive skills, leadership skills, communication, all of the kind of nuts and bolts that go into being an effective leader, and even the bigger picture things like strategic thinking and planning, but I'm able to connect that with your underlying value, your principles, your character strengths, what motivates you, what stage of change you're at, and how to affect effect moving on to the next stage, how to stay motivated because this is a journey. So that was why I put those together cuz I had plenty of people trying to explain to me when I was a failing leader what I needed to do better.

Not trained executive coaches. Again, it was the army. We didn't have that sort of thing. We just had older leaders that had been there.

But in terms of being able to bridge that personal gap, u he's my partner at functionalmentoring.com. Paul Micho as another army physician. He sort of hit me with a cognitive frying pan uh you know during my leadership crisis and he said look do you want to be right or do you want to be effective and that is not an executive skill that is very much a positive psychology approach and the idea of doesn't matter if I'm right if nobody listens nobody does it nobody follows me how do I become effective and what that appealed to was not my sense of you know you're terrible this do it better because I said so which is the approach taken by other leader developers and mentors that I had encountered.

It was what is important to Chris? What makes him tick? Competence, excellence. Right?

These were underlying principles and values that I had. I wanted to be excellent at things. And this was somebody pointing out to me, okay, you're so focused on winning, you're not focused on what's really important to you actually, which is being effective and being competent and being excellent at this new skill of being a leader, just like you would for all your clinical. And you know, talk about a wakeup call.

So I was going to say that's g that punch. Yeah. Yeah. And that's why I still work with the guy, right?

So I mean, looking back, what mix of skills would help me make those kind of breakthroughs with other struggling leaders? And that's why I pursued both the executive coaching side and positive psychology because if you've got those skills that you can impart to folks and train them on as well as that underlying psychology to keep people motivated through that painful journey and change, right? You got a much better chance of being able to help them.

So let's say a physician is listening to this right now and maybe they just accepted a leadership role. So, what's like one practical mindset shift that they can do right away to make it as most effective as possible? I think probably one of the most important is to start by acknowledging emotions and relationships, which are two things that we're taught to suppress as physicians. I think embracing how important those are as a leader.

Again, my partner points out to me all the time, if the relationship is right, you can say anything. And if the relationship is wrong, there isn't a damn thing you can say. So, making sure that you understand people on that personal level and that they get you and understanding why you do what you do so you can communicate that to your team. understanding why they do so that you can frame whatever part of the mission is theirs in line with their personal why as well as how it supports that mission that you're trying to lead them to.

And equally important is control over your emotions. As physicians, we get a lot of latitude on what constitutes acceptable management of emotions because what we do is so important in the outcome that even if we do it with a lousy personality, we're probably going to get cut a bunch more slack than other people would in other jobs. And that is very hampering when you get to be a leader where you do not have that slack anymore.

Just because you're the boss, just because you're in charge of the meeting does not mean anyone is going to tolerate your emotions. Being anything other than in check and under control. So acknowledging that they're there and building the skill of whatever your initial emotional response, that is your very primitive brain, right? You get a stimulus, you get an emotional response first.

And we evolved a cortex to tell stories to explain that emotion and put it in context. And you can either try to put out that fire with gasoline or you can pour water on it and try to get control of it. So I just had this conversation with a client. I said, think of an obvious example just to understand the metaphor is, you know, road rage.

Someone cuts you off in traffic and immediately because of fight or flight and fear, you lash out and start swearing in the car and making hand signals and all the rest of it. And then if you stop and tell yourself, what story did you tell yourself to justify that response? Do you really think that person woke up, twirled their mustache, opened up their smartphone, and got a picture of you and your car and an exact notification of where you would be at what speed in what lane on what road, and then they planned to cut you off.

You say it like that, it's insane. If you stop and tell yourself the story, look, that person is probably just as in a hurry, just as distracted, and just as humanly fallible as I am. Okay, I got cut off. Let me make sure we're safe in this car.

And then I'll remind me to check my blind spot twice cuz maybe they only check theirs once and you drive on without that violent and dangerous emotional response. That kind of thing in micro happens throughout the day. Whether you're reading an email, here's a practical tip, right? Because all that sounds theoretical.

You receive an email and if you don't read email and see red occasionally, you're probably just not reading it. Okay? But everyone's gotten an email in a leadership setting or even before you were a leader. You get an email and you just go rage response.

My advice is type the response to that email. Whatever comes to mind initially. Do not send it. Okay?

Erase the twoline when you replied and send it to yourself. Here's a practical example to put all that theory in. Road rage sounds like a very obvious example and it's there to illustrate the metaphor, but here's an example that it happens daily. You get email and you probably have a rage response to that email depending on what kind of day you're having.

Happens to the best of us. If you're not mad at your email every once in a while, you're just not reading it. Your initial response is probably to type out some sort of flame response. My advice is, as a technique, hit the reply button, erase the address of the person you're replying to, put in your own address, and type whatever you want.

Type the most emotionally irrational response that you can possibly come up with. And as long as you checked that address again and it's to yourself, hit send. And then get up, go somewhere, get a cup of coffee, go get some sunshine, take a breath, take a walk, find something that calms you, right? Pictures of your dog, Instagram video, I don't care what it is, something to distract you.

And then come back to your desk and read your response. And then be grateful that you did not send that. And then give yourself a chance to sit down and think and respond to that email. If it even bears a response, someone else to deal with it.

Exactly. Delegation is a great way to deal with that emotional response, but getting control of that initial I mean, how many of us have just replied and hit send and then unfortunately there's no regret button to pull them back. This has been great. So, where can they go?

Tell us about functional mentoring. Where can they go to get more information about this? What do you do? And tell us about your coaching company.

Great. Yeah. So, www.functionalmentoring.com. functionalmentoring.com all one word.

So that is mine and Paul's blog. We do thought leadership on we call them the ships mentorship, relationship, friendship and leadership. And our motto is we got to get all of your ships sailing true. So if you want one of his kind of short form pathy things, like I said, he hit me right in the head with that cognitive frying pan of do you want to be a writer?

Do you want to be effective? And his blog posts sort of follow that theme of being short and piffy and punchy. I'm a little more verbose. I go for the long form.

But I'll tackle some of these topics like resilience, a growth mindset, emotional control. I did a series called the seven dirty words. Why should always, never, must, accept, only just are cognitive traps that you can recognize and what to do about them. So, we love to have subscribers and readers stop by at functionalmentoring.com and see what you think of our contribution to the positive psychology, mentorship, and leadership space.

We're both available. There's a contact button there. Contact at functional mentoring, Chris at functional mentoring or paul of functionalmentoring.com. You can subscribe.

You can reach out. You can actually book a 45minute cognitive sparring session with me for that. no charge, just a nononsense thought partner to help prevent you from being stuck and help you figure out why you're stuck. And if I can offer you one insight in 45 minutes, I think that's time well worth spent for both of us.

So functionalmentoring.com and free to come and go and reach out to us if you think you like what we do. All right. And we'll also leave a link over into the show notes. Christopher, this has been very enlightening.

Any last minute thoughts before we end the call today? No, I really appreciate the time, Mike, and also the work you do with spotlighting physician coaches. It's a good move in our profession that we start taking care of each other and that we get some training and some education on how to do that effectively. It's a learnable skill set like any other.

I would love to see physician leaders flourish in their first job in the way that I didn't. I've had many teachers and I'm proud to say that they set the example of me that a teacher or a mentor's fondest wish is that their protege surpassed them. And if I could get folks to be able to surpass me in how they handled their first leadership assignment or their first leadership opportunity, nothing would warm my heart more.

We'll end with those great words there. Again, thank you Christopher and also thank you for listening. As a physician entrepreneur, you're going to have your ups and downs. Do a little something each day to get you closer to your goal and keep brewing forward.