Michael Tarnoff, MD, FACS - Surgeon-in-Chief at Tufts Medical Center
As Tufts’ Surgeon-in-Chief and a former VP/CMO of Covidien and Medtronic, you have had a vast array of responsibilities and experiences. I’m sure that if we had this interview 10 times, we could easily talk about 10 different subjects. Is there any subject in particular that you think our Tufts’ Medical Community readers would find most interesting?
Education is wholly focused on IQ, Intellectual intelligence, traditional brain power, what you know. The world is increasingly revolving around EQ, emotional intelligence. The opposite of intellectual intelligence. Everything in medical school is pushing you and testing you on IQ and there is very little attention paid to your EQ. When you get out of medical school, your success, job satisfaction, advancement and promotion in the real world is far more dependent on EQ than IQ. Yet there is not much taught to you through college, through medical school, through residency, through fellowship that pays attention to the emotional side of all of this. EQ, meaning how well do you see yourself in the context of other relationships, talking to people, reacting to people. Do you react in overly emotional ways or thoughtful ways, how do you balance all that? The world outside of here is very much pivoting around EQ, who you are, rather than IQ, what you know. One of the best sayings I ever got from one of my HR partners in the industry was, “you will hire people for what they know, and you will fire them for who they are.” That tends to be very true of doctors. Doctors tend to know a lot, very smart, very high IQ, but I’d be willing to bet that if you did a study about EQ many physicians are well below the line of where they should be on the EQ/IQ balance. That imbalance results in tension in the clinical setting, decreased job satisfaction, burnout, high stress, lawsuits and all kinds of other things that people don’t want to be a part of. This needs a lot of attention, because as faculty we’re not spending a lot of time giving that to you guys and when you get out that is going to be a big metric of how you get assessed as a resident, a fellow and an attending.
Do you believe the EQ/IQ balance is a stable personality trait or something that you can practice and build upon?
That is a multi-million-dollar question. In fact, there are books written, can you teach people EQ? In my experience, yes you can. Some people tend to have a balanced IQ/EQ, while others tend to be higher in one than the other. The trick is to have both. So can you teach people that have high IQ and low EQ to come up on their EQ? There is a lot out there written on “can you transfer and teach EQ skills?” I think the net answer is yes. I think we all have to believe that. Right? I would like to see MedConnect think of this EQ/IQ balance as a theme. Teaching and training the emotional side of things you have to contemplate.
Can you walk us through how you got to be the Surgeon-in-Chief at Tufts?
(Editor’s note) TL;DR Unplanned adventure of followed interests! 1990s – 2008, Surgeon (Surgery + Teaching) -> 2008 – 2018, Medical Device Industry CMO/VP (Leadership + On-The-Job-Learning + Surgery) -> 2018 – present, Tufts Surgeon in Chief (Surgery + Teaching + Leadership + Teambuilding)
Twenty-five years ago, I was at your stage, hard for me to believe because I can picture myself sitting there where you guys are now. I have always enjoyed interfacing with the medical students andthe residents. Frankly it just keeps everybody young and keeps us all motivated because you guys come in and you are all enthused and excited while we are all tired, been-there-done-that, and you remind us, “oh no, this is actually a cool thing to do with your life." At your stage of the game, if you had asked me what I want to do, I would have told you I want to grow up, become a surgeon, work in an academic environment, teach the residents, do some research, have a nice balance, and that would be it. These other broader opportunities, like medical the device industry, weren’t things I was thinking about. I always had an instinct for education at a pretty young age in my career going back to my residency. I recognized some of the deficiencies in our residency down in New Jersey. I took it upon myself to get us 2 hours of dedicated educational time on Thursday mornings where I volunteered to give the lectures. I wanted to teach. Which I’ll come back to in a moment. I went on to do a minimally invasive surgery fellowship, and then came right to Tufts in June of 2001. Hired by Dr. Mackey and went on staff here and it was the dream. All went well until about 5 to 7 years down the road, the mid-2000s. I was sort of burning out at a young age. We were very busy doing a lot of clinical volume, and I was finding that other things were starting to get my attention. Still in the realm of education. But other activities were coming my way because of the platform we had here at Tufts. I was one of the early trained minimally invasive surgeons. There were surgeons in their 40s, 50 and 60s that didn’t have training in laparoscopy and wanted to learn how to do a gastric bypass, splenectomy, and donor nephrectomy laparoscopically. The medical device industry was innovating all this stuff for us enabling us to do surgeries through less invasive mechanisms. So, Surgeons from all over the country and eventually all over the world were coming to Tufts and we would teach them how to do laparoscopic surgery. While that was going on, I was beginning to get tired of the day-to-day rigor of high-volume surgery, and there were these other opportunities that I was starting to be involved in, in industry, one of which was educating the surgeons in laparoscopy.
In 2008, a company named Covidien was formed, which was spun out of Tyco International. Tyco had acquired a bunch of healthcare companies, one of which was called U.S. Surgical, a dominant early player in minimally invasive surgery that was working with us on education. They got acquired by Tyco and were put in with 7 other healthcare companies within Tyco. They called that Tyco Healthcare, and in 2008 Tyco Healthcare spun out of Tyco and became its own free-standing medical device company. That was called Covidien, which immediately became the third biggest medical device company in the world, the largest component of which was the surgical business that I was helping with. They came to me and they said, ‘We’ve gotten to know you over the years, you’ve been a good educator for us, you’ve met with our engineers, talked to our quality people, helped us frame the medical voice of our selling and manufacturing organization. Now that we’re a free-standing medical device company, we need to hire chief medical officers and bring some medical voice inside the company. Would you be interested in doing that?’
This was in late 2007, about 5 months after the company formed. I walked into this office right here that I occupy now, and I met with Dr. Mackey, my boss. I told him about this, and I thought he was going to kick me out. I thought he was going to say, ‘You’re either in or you’re out, you can’t go work for a medical device company and still be here.’ Instead, he said to me, ‘This clearly is of interest, I’ve been watching you work with them and I see what you do for them and its of value to patients. It’s of value to Tufts because they deploy you globally and you take our brand with you and you take your title with you. So, if this is what you want to do, I support it because I don’t want you to leave.’ He went to the dean of the medical school, the CEO of the hospital, and the CEO of the physician's organization. He told them I wanted to do this, and they all supported it, which was very innovative and out of the box on their part. Part of the reason I’ve been loyal to the institution as long as I have is that they were very supportive of me doing something that frankly had I been at Harvard Medical School, they would’ve told me ‘no way’. They never would’ve mixed their brand with a medical device manufacturer.
So, with all their support, we hired our fellow that year, Dr. Shah, who you guys will meet when you come through surgery next year. She’s been with us for 13 years. She took about 75% of my position, I gave up 75% practice and compensation. I stayed on staff. There was something about me that did not want to give this up. I was not ready to take off the white coat and go work for industry full time. I was given the privilege, which is how I view it, the privilege to mix my time. I worked it out so I could be here for some days of the month, for call responsibilities, and to support the department, and take care of patients, but have the lion's share of my time to go work in the industry and build what became known as medical affairs for Covidien, which was a selling and marketing organization. I ended up being asked to build a medical affairs organization. Truth be told, I had no idea what I was doing and I had no qualifications to do it outside the fact that I was a knowledgeable surgeon. They sized me up and decided that I have a balance of IQ and EQ, and this guy will figure it out.
The first thing I realized was that I needed to hire some very smart people, who knew about the components of what a medical affairs function is. Medical affairs turns out to be very different things in medical and pharmaceutical device industries, but at its essence, it is the organization within these companies that really defines the company's value proposition. If we are selling a device, what is the value proposition to the physician and the patient? Can we prove the value proposition? Can I conduct clinical research trials and partner with hospitals and physicians to prove the value of a particular product? Can I assure that the product is going to be paid for? Is it well understood by the physician community?. I was also responsible for setting up a global training organization which is that teaching passion again. That’s what it was, it was clinical research, health economics, physician education, societal interface (such as American College of Surgeons). Ultimately, I got promoted and got involved in the regulatory organizations, figuring out what hurdles the organization had to overcome to get the products approved by the FDA and other companies. I ended up going from 0 to 1,100 employees and from managing only my own bank account to managing 250 million dollars of the company’s money. It was all on the job training and learning quickly and surrounding myself with smart people.
In 2014, I got a call from the CEO to whom I reported to, who told me that we are going down a path of being acquired by the second largest device manufacturer, Medtronic. I got a front-row seat for the largest deal in medical device history. I was relied upon to justify what medical need Covidien was filling for Medtronic. Why did these two portfolios make sense? That occurred in January in 2015, and I stayed on at Medtronic for four more years.
In 2018, Dr. Mackey called me and asked if I would be interested in throwing my hat in the ring to be considered as the next chair of the department of surgery, which was never on my radar. After 12 years in the industry, I had stayed here throughout the years, always coming back to put the scrubs on and take care of patients. At my peak in Medical Device land, if anyone had asked me what I do for a living, my answer would still have been “I’m a Surgeon.” I’ve always described myself as a Surgeon, there has always been an identity that I have that is tied back to this. However, the normal pedigree of a department chair is not mine. The typical department chair is someone who has done 20 years of research and has advanced themselves in a particular area of surgery. That wasn’t me. I’m a good, safe surgeon, but I did get 12 years of some significant leadership development outside of healthcare. As I started looking at this position, I realized that the traditional pedigree of an academic chair is no longer particularly relevant.
If you look at what is going on at Tufts and Wellforce, and the relationship that we are forming with other hospitals, we are forming a rich network of hospitals, which is good for students.
We have the highest case mix index in the city of Boston, believe it or not. That means we take care of the sickest patients of any hospital in Boston, despite our size and even though our brand tends to lag that of Harvard and Brigham and Women’s and MGH. The new role of the chair is to go out, and build relationships with surgeons, with other chairmen, with CEOs, CFOs, business development people. It’s kind of one big giant integration. In Covidien and Medtronic, I had the experience of not only going through that large transaction of one company buying the other but, before Covidien was acquired, we spent about 5 billion dollars acquiring other companies. So, I had a lot of experience in going out and managing acquisitions and what has to happen when you bring people from one company into another, and the culture changes, and all of that. And that’s a lot of what this department struggles with. That’s a lot of what this department needs, and it’s a lot of these medical center struggles. The skills that I have acquired, in an unintended way, actually prepared me to do this job and set me up to be successful at it. Time will tell.
So, that’s basically the story. Now, what’s the key lesson there? No plan –– how did you become a Chief Medical Officer? Honestly, I was really good at teaching other surgeons to do what I was doing and that attracted the company’s attention, and then I answered the phone when they called, and I was approachable, and I checked my ego at the door, and then they asked me to come down and work with their quality people, and then they wanted me to talk to their legal people, and next thing you know, I had this matrix of relationships across this company. When their board said to them, “we need a CMO,” they all stood up and said, “you gotta go get that guy.” Even though I had no qualifications. There were people far more qualified than me to get that job. So it’s just sort of a follow what you’re interested in, follow your passion, follow what you like to do every day, and things will come together and good things will happen, without necessarily being really prescriptive about, “I want to be a CMO, I want to be a Chairman, I want to be a this, I want to be a that.”
So you mentioned that being a surgeon is very important to your identity, as well as your enjoyment of your profession and your work/life balance. How important do you think it was for your success as a CMO and now as a Surgeon Chief?
That’s a really good question. I think it’s very important. Can you be a Chief Medical Officer or a medical director in industry (pharmaceutical, med device, etc.) without having clinical experience? The answer is yes. There are many of them. Will you be more successful, more relevant, and more material to the company if you have clinical experience? Yes, and the more clinical experience you have, the better. So, I’ve had a few people ask me, a few medical students, actually, say to me, “you know what? I think I want to go straight to what you were doing. I don’t want to do a residency; I want to just work in industry. You can. You’d probably get hired at entry-level Medical Director, maybe a Medical Science Liaison, there are all sorts of roles now. The medical device industry has changed in the way that the traditional selling and marketing of these devices is less and less now done by sales reps, and more and more done by science-minded people who can prove the evidence and the value of the product. And so, people that have gone to medical school are qualified to do that. And if that’s the path and that’s the interest, then that can work. But if you want to rise through the ranks and be of high materiality, then having clinical knowledge and having clinical expertise and having the patient interface and understanding the way doctors think and understanding the way patients think just qualifies you more and more and more, year over year, to have that kind of an impact. So, for me, 5 - 7 years in, looking back on it, I was actually really well suited to do this, without realizing how much expertise I had built up through practice.
Today, what’s your time split in terms of surgery versus clinical versus administrative work?
Yeah, that’s been interesting. Through the course of all of the medical device work, I probably had whittled down to a couple of days a month of clinical practice. Leadership is a full time job and it takes time and focus so clinical practice has to be balanced with that. , I am really enjoying leadership at this point in my life and career. I really get a lot of enjoyment out of saying “yes” to people like you who want to come to meet. I love what you’re doing, and I want to help you! It’s as much fun for me as going to the OR and taking someone’s gallbladder out through a small incision, which, to this day, I still think is kind of cool.
Would you say you have a cohesive mission or vision for Tufts that you would like to help enact?
Yeah, I just took the surgeons through an exercise that I borrowed from my life at Covidien and Medtronic of creating a vision and a mission statement for the department. I will give you guys a copy, I have it in my office. [See: Attachment 1] We didn’t have any of this when I started. I took the surgeons to an offsite retreat the first day I started. I said to them, “it’s important for us to be a team, since we all do disparate things.” We have colorectal surgeons, we have trauma surgeons, we have surgical oncologists, transplant surgeons. Surgery’s a broad thing. But we all have some things in common as a group of surgeons, so let’s find the commonality in what we do and let’s try to put it on paper so we can always connect back to it. The vision says, “be the leaders in complex surgical care.”
I was looking at this first “Integrity and Trust” bullet point [on the department charter]. The issue of trust between physicians is very important yet under-studied. What are the components that you think contribute to improving physician-to-physician trust?
I think one of the basic things is communication. One of the things I’ve seen, in three months, is a lot of miscommunication and presumption of negative attributes. Instead of assuming positive intent, there’s a lot of assumption of negative intent and a lot of mistrust that comes from not talking to each other. It has been interesting to me because the world I am coming from at Medtronic and Covidien was global. We operated in 160 countries. I had people reporting to me from every major country in the world. I used to say that if you spin a globe and stop it blindly unless it was water, I probably had a reason to go there. We had people all over the world. For me to connect with my team and meet people, we often had to fly and coordinate across time zones. Getting together was a complex ordeal. When I was offered this position, I realized that everyone who works here is down the hall or 1-2 flights of stairs up or down. Similarly, all of my stakeholders are within a 5-minute walk. No airplanes or time zone changes! I have really appreciated that. Despite that, I think that a lot of people who are co-located don’t realize how co-located they are and don’t talk to each other. The less you talk to each other, the less you build trust, and the less you build comradery. I walk around here and see ID tags and feel like a sense of comradery with everybody else who’s here. I see it because I got the chance to go away and come back. If you see it every day and you’ve never seen anything else, you take it for granted. But there’s a real comradery about what the badge signifies, about what the hospital is, what we all do for patients. This is such a team environment and there hasn’t been a lot of work put into making people realize that they are part of a team. So, I did that to try to show a group of surgeons that they are part of a team and that they have more in common than they don't. And so, I made a big point of that. Every time I email them, I say “team” - they're all making fun of me a little “oh we’re a team now” but we are, and it’ll stick. I think it’s working.
Given that you’re managing such a large group of people, how do you measure success? How do you know that you’re doing a good job?
When I interviewed for the job, I contemplated this question. How am I going to know 90 days that I'm doing a good job (or beyond)? And I actually came up with one metric. Can anyone guess what that metric is?
MedConnect: “Patient outcomes?”
Dr. Tarnoff: “That’s a typical thought. Not a bad thought, but I’ll take you above that”
MedConnect: “Patient Satisfaction?”
I’ll go even above that. Patient satisfaction is the closest to the right answer, but I turned it around. I said physician satisfaction. if I can get high physician engagement and reduce burnout, I will get better patient outcomes, better patient satisfaction. Patient satisfaction is the right one at the end but the one that I can directly influence even in 3 months which will affect patient satisfaction is physician engagement and we had a low physician engagement coming into this.
What advice do you have for aspiring medical professionals?
Spend some time trying to figure out what really makes you tick, what gets you excited, where your passion lies, and follow that. Identify it and try to spend as much time as you can doing it because, in the end, that’s what’s going to make you happiest. It’s not about the paycheck - I’m not saying money isn’t important - but chasing big payouts, high income, titles, managing lots of people doesn’t get you anywhere if it’s not what you truly love to do. We all spend a lot of time working, and it takes a lot of people a lot of time to figure out what they really like doing.
I didn’t realize when I was going through it that I had this passion for education. When I look back on what I was able to achieve, it was my ability to excel in education that got me the opportunity to work in the medical device industry. It was that opportunity that then created the skill set that I would have needed to be considered relevant to do something like the surgeon-in-chief at Tufts. Really spend some time figuring out who you are, what you are, what makes you tick, what keeps you excited, what gets you out of bed in the morning. It may sound a little cliché, but I really believe it. And I see a lot of people get this wrong. I see a lot of people who are doing their thing, but they’re in the wrong role or the wrong place, particularly in medicine where it’s such a sacrifice - the amount of time you have to put in, the money you have to invest. Try to be true to what it is that you want to be doing.
You guys are already outliers because you’re doing this. Not everybody does MedConnect. You guys already have some other things in you that are spurring you on to do even more than wake up every day and take care of patients, so listen to that. The sooner you figure out where you fit in and what you like to do, the sooner you can serve and help influence different paths for yourself.
Attachment 1: Tufts Medical Center Department of Surgery Charter