Sono Hot Seat with Chris Fox: On Departmental Leadership

J. Chris Fox MD, FACEP, University of California – Irvine

Questions posed by Stephen Alerhand, MD

Q: What experiences, encounters, or mindset led you towards falling into or seeking departmental leadership?

A: Department chair was never on my radar. In fact it wasn’t really on anyone’s radar that I would end up in this role. I know because people tell me that all the time (in the nicest possible way). I never wanted to be the boss of anyone. I loved being with my sonotribe and serving my department as vice-chair. That way I still had a hand in helping shape the course of the department, but it was never my hide that was on the line in case things went the wrong way. That’s essentially the main problem with being a chair. You have so much accountability and if someone in your department does something really bad - the chair takes the heat for it. My leadership journey officially began when I was an ultrasound director and a fellowship director which led to my role as director of ultrasound in medical education. After spending more time with medical students, I was offered the position of assistant dean of student affairs. I didn’t even know what that meant and actually had to google it. But it was clear I needed some leadership skills so the vice-dean put me through a two-year leadership course at AAMC called LEAD, and that got me reading and thinking all about what my own leadership style would be like should I ever find myself in that unfortunate position. Then I became a vice-chair and was put through more leadership courses. I did SAEM’s Chair Development Program, a year-long course which was 51 hours of in-person classroom exercises. I wrote a list of 10 reasons why I wouldn’t want to be a department chair and was very happy vice-chairing under a wonderful chair that I hoped would never leave. But after 3 short years, he moved on and told the Dean I should be next chair. The Dean made me interim chair for 18 months and put me through Harvard’s 2-week in person Program for Chairs of Clinical Departments course at TH Chan School of Public Health. This was very rigorous with 50 other department chairs in my cohort, me being the only emergency physician. And it was 16 hours a day and a lot of old school socratic method action I wasn’t used to. But I learned a ton about my biggest leadership flat spot: finances. So it’s been 5 years now in my role and I’m feeling more comfortable in my skin and having more fun with it!

Q: What pearls of wisdom would you provide to someone seeking to advance their portfolio beyond academic US?

A: None of us are born leaders as some would like to believe. Leadership is something that occurs over time with lots of lessons, mentors, and training along the way. Having a combination of on the job training in those fellowship director, ultrasound director, associate program director, associate medical director or assistant dean roles helps get the leadership engine started. Combine that with some really good coursework and others start to notice your behavior and ability to work well with a team. Then it depends on whether you want to stay at your own institution, or consider a migration. Either way it helps to keep your linkedin profile up to date to let those who might be considering you for a position know what you’ve been up to. They might take a peek at that before requesting a CV or a meeting.

Q: What do you consider the most important qualities (or tenets to keep in mind) that have allowed you to pursue and succeed in this route?

A: All the leadership mumbo jumbo books will tell you to be vulnerable, be authentic, be present, stay positive, keep your emotions in check, and use appropriate sense of humor. All that is true and somewhat natural for most people. But it’s that last part that continues to be a big struggle for me. We use humor in emergency medicine with our nursing colleagues and our residents to make it through a stressful situation. In leadership there are no shortage of stressful events and I think humorous thoughts all the time, but they aren’t always appropriate. [Shout out to Vicki Noble for always being willing to laugh with me]. So in my 18 months as interim chair I really had to dial back my personality and with very few exceptions - only when I read the situation very carefully - did I let the jokes out. After all leaders are serious and professional people and turns out humor (like the kind we normally use in the ED) in heavy situations isn’t always welcomed. But whenever working in small breakout groups, humor helps make that type of work go by faster. And speaking of presentations…there are a LOT of talks that I give to the folks I report up to. All those years of teaching and navigating the politics of ultrasound helped me feel comfortable in explaining operational or financial things in a more clear and engaging way. Usually someone else makes me a powerpoint, and then I change it all around to reflect my own style.

Q: What do you miss the most about academic ultrasound?

A: Naturally I miss the research. This was what I was afraid of too. It was the number one reason on my top ten. But I’m proud of what I did for the first 15 years of my career. I still have a bunch of protocols going on and meet weekly with my team. As I continue to cultivate that team and I’m hopeful we’ll be back to the machine we once were. I also miss being able to attend an ultrasound conference and not be distracted by my zoom life.

Q: How involved are you in the current UCI Ultrasound Division? What are the most important aspects or qualities that you seek to foster within it from slightly more afar?

A: So as I write this, I’m still the ultrasound fellowship director. With the help of Dasia Esener and my prior fellow Matt Whited, I was able to navigate my way into a three-year accreditation cycle. Then I took the sono-boards and despite my teenage son getting in my head about why a supposed ultrasound expert is studying so hard for an ultrasound test, I passed that thing! I meet with my fellows once per week for 5 hours and this year’s fellows (number 39 and 40) are hired to start in July! So Edmund Hsu will be the ultrasound director, and Megan Guy will be the associate ultrasound fellowship director. I will always remain a sono-junkie at heart and I’m super pumped to be the incoming President of Society of Ultrasound in Medical Education! I don’t really see myself ever being “afar” when it comes to ultrasound at UCI. If anything the time I spend with my ultrasound team charges my batteries back up!

Q: What advice would you have for an ultrasound fellow starting their journey today in the year 2023?

A: Since we are talking leadership, my advice is to make ultrasound the conduit by which you develop relationships throughout your institution. Seek out the naysayers and foster alliances with them. Be engaged, curious, energetic, and close the loop on any project assigned to you. Be accountable even for stuff that’s totally out of your control as other leaders will immediately identify that as a rare trait and will think of you when opportunities arise. Maintain low entitlement and high vulnerability. Okay some of this stuff sounds like I drank the leadership Kool-Aid and I’m sorry if it comes across that way, but this helped me avoid blind spots and when I did mess up, my bosses have granted me that grace I needed to get past it.

Q: To this day, what has been your favorite POCUS experience or memory? A specific case, specific conference, manuscript, experience?

A: The best part of my career has been watching my mentees succeed in all their various roles!