As an early career electrophysiologist, Richard I. Fogel, MD, learned to raise his hand when projects needed a captain. Now he’s CEO of the St. Vincent Medical Group in Indianapolis and president of the Heart Rhythm Society (HRS). His formula? Listen, ask good questions, surround yourself with talented people and let them do their jobs, he explains in a Q&A with Cardiovascular Business.

How do you balance your clinical and executive duties?

The thing to remember is that I like both sets of duties. I got my MD in 1986, and I really like being a doctor and taking care of patients. I have been in the administrative world since around 2000 and I find that very challenging and stimulating. It gives me an opportunity to engage a different part of my brain.

You have to be disciplined. You have to say, ‘Here is the time I am going to be clinical and here’s the time I am going to be administrative.’ You have to protect the clinical time.

How do you go about doing that?

You schedule yourself for those clinical hours. If I am in the office, I know I am in the office from 8:30 a.m. to 12:30 p.m. That is my dedicated office time. Unless there is some administrative emergency then that is my time with patients, and I stay focused on that time.

Sometimes when I am in the administrative world and there is a patient emergency I will come out of the administrative world to deal with the patient emergency. Fundamentally, patients will always come first.

What was your earliest leadership position?

I don’t know the answer to my earliest one. The one that comes to mind in my modern day would be when I was elected to the board of the cardiology group that I joined out of my training called the Care Group. That was an independent cardiology group. In 1997 I was elected to the board of managers of that group. That was my first taste of leadership and management in my adult life.

You have held many management positions. Is there one lesson you learned that you applied in each of these roles?

The best lesson you can learn as a leader is to be a good listener. In any management enterprise, you need to be a good listener and when you take care of patients, you have to be a good listener. And when you are president of the Heart Rhythm Society, you have to be a good listener. You have to not only listen to what is being said, you have to listen for how it is being said and look for the nonverbal cues. There is a lot of information being transmitted. It is helpful to listen and ask questions and try to get the stakeholders, or the patient, to express their views in a way you understand.

Does being president of HRS have similarities to your role as CEO?

The similarities are in process and execution. In both circumstances, you have to focus on being a good listener. Whether I am in a meeting at St. Vincent Medical Group or at the board meeting, listening and asking good questions is critically important. It also is important as a leader to surround yourself with really good people who are very knowledgeable and very good leaders in and of themselves. Then empower them to do their job and let them do their job.

The best piece of advice I ever got as a leader was to surround yourself with good people and then get out of their way.

Is variety a consideration in cardiology management meetings?

At a meeting, it is always good to have people with different perspectives, backgrounds and points of view to challenge me and the other people in the group. Only that way can you explore all the possibilities. I encourage diversity of thought.

For example?

In 2009, I was still part of the Care Group. We had been in discussions about joining St. Vincent Health and becoming the St. Vincent Medical Group. St. Vincent Health is part of Ascension Health, which is the nation’s largest Catholic, not-for-profit health system. We had about 90 cardiologists and 40 internists, and I was the CEO. There were a lot of changes going on in cardiology [in 2009]. We had to make the decision of whether to be integrated into St. Vincent Health.

There were 130 partners. Everyone comes from a different place in that decision. There is a potential loss of autonomy when you move from partner to employee. There is a sense of security that can be developed when you move from a large independent group to a large system. There were many different opinions about that.

The discussion at the executive committee of the Care Group, at the board of the Care Group and ultimately all the partners of the Care Group were some of the most interesting discussions I have ever been in. Subsequently, we decided we should become integrated into St. Vincent Health and form the St. Vincent Medical Group.

What advice would you give to an early career cardiologist who aspires to be a physician leader?

You really have to know yourself and know what you want. If you want to be involved in leadership, then you need to start asking questions and getting yourself involved. Approach the people who are more senior to you [about] opportunities and indicate your interest. When they ask you to do something, you need to do it in a very timely way and do it very well. In general, you need to learn how to say yes. 

If you do a good job, they will ask you to do something else and eventually you will be asked to do bigger and bigger projects and you will lead bigger and bigger initiatives.

At the same time, you also have to increase your knowledge base through reading, observing or whatever opportunity you have to learn more. Physicians typically are not taught the skills to be good business leaders. You have to go out and get those skills and knowledge. 

Dr. Fogel is CEO of the St. Vincent Medical Group and was CEO of the Care Group. He has served in many leadership positions at HRS and is the society’s current president. This interview was edited for brevity.