The 2023 Joseph W. St Geme, Jr Leadership Award Address: The Magic of Yes

The following is an address given by the 2023 recipient of the Joseph W. St Geme, Jr Leadership Award, presented by the Federation of Pediatric Organizations at the Pediatric Academic Societies meeting on April 28, 2023.

I’m deeply honored to receive the 2023 Joseph W. St Geme, Jr Leadership award. Thank you, Federation of Pediatric Organizations, for this great honor.

Each year, we celebrate Dr St Geme’s vision, dedication, and commitment to excellence. Although I never had the opportunity to know him, I believe there are only 2 degrees of separation between us. First, I have known his namesake, Dr Joe St Geme III, a distinguished leader in Pediatrics, for many years and always enjoyed seeing Mrs Monica St Geme at this event. Second, I am connected to Dr St Geme through Dr Larry Shapiro, my mentor and former chair. Dr Shapiro was mentored by Dr St Geme when Dr Shapiro was a junior faculty member in the Department of Pediatrics at Harbor-UCLA. Even now, Dr Shapiro remembers the valuable advice he received from Dr St Geme during the early phase of his career. Finally, I count among my friends and treasured colleagues many previous St Geme awardees.

The St Geme honoree is recognized for their commitment to and impact on pediatrics. Although I’m proud of my career, I’m deeply humbled to consider that I’ve had an influence on our profession and would like to offer some reflections on my career and lessons learned.

Every day, we are asked questions, respond to requests, and make decisions. Although we want to believe that we have autonomy when we make decisions, there are times when it’s difficult to say no. Some requests fall outside of our assigned scope of responsibility and declining might seem like the obvious choice. I would suggest that in academic medicine we are expected to engage in myriad roles and tasks that fall outside the scope of our assigned scope of work and for which yes is an appropriate response. For example, we are expected to demonstrate that we have a regional, national, or international reputation, which requires engaging in efforts that are, by definition, above and beyond our daily responsibilities.

When faced with a request or a decision and you respond affirmatively, your “yes” response might have different meanings. For example, there’s the automatic yes, the conditional yes, which involves some negotiation, the reluctant yes, the enthusiastic yes, and the unsolicited yes.

In academic medicine, however, I would argue that we are trained to question, push back, explore alternatives, and most of us are inclined to say no when we’re presented with a request! To test my hypothesis that in academic medicine we’re generally more inclined to say no than yes, I conducted a PubMed literature search, using the phrases “saying yes” and “saying no.” Using only those phrases, I retrieved 10 articles with the phrase “saying yes” and more than 3000 with the phrase “saying no!” Even without further analysis, I hope you agree that my hypothesis, that we are more likely to say no than say yes, was supported by the literature.

As my family, friends and colleagues know, I am someone who generally says yes! That response may not always be the most strategic but I will share some reflections on why saying “yes” has been good, even magical, for my career.

Looking back, I admit that many of my affirmative responses were naive and based on a desire to contribute to our profession, learn about interesting issues, and expand my professional network. My first formal organizational opportunity came from the American Academy of Pediatrics. After dipping my toe into the water as a founding member of the Academy’s Resident Section, in 1994 I was appointed to the Academy’s Task Force on Minority Children’s Access to Pediatric Care. This assignment may have sealed my fate as an organizational contributor because our task force was a wonderful, diverse group, chaired by Dr Bob Johnson. We engaged in deep reflection and robust, far-ranging discussions that culminated in 66 recommendations related to access to care. This opportunity, which came during an early, formative phase of my career, taught me how to engage in productive, sometimes heated discussion, how to marshal ideas and passion into actionable steps, and the joy of working with and learning from people with whom I share a commitment to children and their wellbeing.

Over the years, I’ve said “yes” countless times, attended interesting conferences, and met wonderful people. I served on the Council of the National Institute for Child Health and Human Development (NICHD) during the early 2000s, the glory days of the doubling of the National Institutes of Health budget. As a Council member, I learned important leadership lessons from NICHD Director Duane Alexander and Deputy Director Yvonne Maddox, such as how to invite feedback, balance competing priorities, and make thoughtful decisions regarding the allocation of resources. These lessons made a big impact on my professional development and have been useful in many ways.

In 2000 I was elected to the Council of the Society for Pediatric Research and my perspective on the breadth and depth of pediatric research expanded. Equally important, I formed friendships that have enriched my life. Several years later, when I was elected President, I learned how challenging it is to set an agenda and fulfill Presidential promises during a short year! Once again, I had the privilege of working with talented, committed, wonderful colleagues.

In 2012 I was elected to the Council of the American Pediatric Society and joined a new group of accomplished and inspiring colleagues. The year I served as President was very special because we had engaged in a lengthy strategic planning process and presented our updated plan during the Pediatric Academic Societies meeting. I’m very proud of the American Pediatric Society’s contributions to diversity, equity, and inclusion, which began in 2011, when President Bruder Stapleton asked me to develop a program for the Society. I’m thrilled to witness the expansion of diversity, equity, and inclusion programming at the Pediatric Academic Societies’ meeting.

Despite the remarkable increase among women in medicine, we are not as well represented at the leadership level. The year 2017 to 2018 I served as President of the American Pediatric Society, which was a special year because Dr Colleen Kraft was President of the American Academy of Pediatrics, Dr Sue Bostwick was President of the Academic Pediatric Association, and Dr Michelle Gill was President of the Society for Pediatric Research. Throughout the year, we emphasized synergy and collaboration across our societies and it was very special to be a member of this all-female leadership group.

For 10 years I’ve served on the National Advisory Council of the Academic Pediatric Association’s Research in Academic Pediatrics Initiative on Diversity program, led by my friends, Drs Glenn Flores and Fernando Mendoza. This program supports the early career development of underrepresented pediatricians and other health professionals and I’ve had the opportunity to mentor inspiring young people. It’s a special pleasure to celebrate my longstanding friendship with Dr Mendoza, who I was honored to introduce last year, when he received the 2022 St Geme Leadership Award.

Editorial board service represents another opportunity to support our profession through the publication and dissemination of worthy scientific work. I met Drs Cynthia Bearer and Eleanor Molloy when I served on the Council of the American Pediatric Society and was honored when they invited me to join the editorial board for Pediatric Research. In addition to Pediatric Research, I’m honored to serve on the editorial boards of the Journal of Pediatrics, JAMA Pediatrics, and the Milbank Quarterly, and have served other organizations during my career. In each case, I’ve learned something valuable, met interesting and inspiring people, and tried to make a lasting contribution.

Although I have an inherent interest in leadership roles, I was deeply influenced by my Fellowship in the Executive Leadership in Academic Medicine (ELAM) program, which is based at Drexel University. The ELAM program is centered on learning communities and my life changed for the better when Dr Devaskar and I were assigned to the same learning community. Dr Diana Bianchi, Director of the National Institute on Child Health and Human Development, promised me that ELAM would be life-changing, and she was right!

By now, you probably have the impression that I say yes whenever I’m asked and I’m guessing that my husband would agree! When Dr Nancy Spector, the Director of ELAM, asked me to return to the program as a Learning Community Advisor, she didn’t have to twist my arm very much. Just as I benefitted from the mentoring of Dr Archie Chatterjee, who served as my Learning Community Advisor, I was excited by the opportunity to mentor a diverse group of ELAM fellows. I’ve been privileged to mentor several learning communities and can unequivocally state that I’ve received much more than I’ve contributed. The ELAM fellows have taught me lessons in resilience, kindness, and creating community.

In addition to the standard types of yeses I already mentioned, I’d like to introduce 2 other types of yes responses. The covert yes is a yes from which you benefitted but of which you were unaware. I’d like to give an example of an “accelerator” yes, which is a yes response that changes something in a profound and lasting way.

My story of an accelerator yes is based on 2 individuals with whom I served on the National Advisory Committee of the Robert Wood Johnson Foundation’s Clinical Scholars Program, Drs Renée Jenkins and Kathe Nelson. They are distinguished members of our profession and Dr Jenkins received the St Geme Leadership award 10 years ago. During our Advisory Committee meetings, we took a walk every morning to jump start the day. One day, Kathe asked Renée about the Institute of Medicine’s newly defined priority on electing younger members. Renée confirmed that there was a call for nominating younger individuals, and Kathe said “Renée, why don’t you nominate Elena?” Renée agreed, although she may have felt pressured to agree, since I was standing right there, but that conversation changed the trajectory of my career. Dr Jenkins and my former chair, Dr Mel Grumbach, nominated me for membership and I was astonished when I was notified of my election. In a classic case of imposter syndrome, I was convinced that my notification e-mail was erroneous and would be quickly followed by a retraction, like an erroneous college acceptance! I have been immersed in the National Academy of Medicine, including serving on and leading the Membership Committee, the Diversity Committee, consensus committees, and am deeply privileged to serve as Home Secretary.

But why, you may wonder, have I chosen to be engaged in so many organizations? Why have I said yes so many times? Once, when I was packing for a trip, my husband Peter asked if the trip was really necessary, if it was important or necessary for my job. From his perspective, as an engineer who worked in the private sector, it seemed optional.

With the benefit of hindsight, these opportunities were a way for me to influence child health, Latino health, immigrant health, and outcomes for underrepresented women and children, the priorities that have driven my scholarship. For example, on NICHD Council we debated the institute’s research priorities and on editorial boards we discussed how to balance various forms of research. Over time, I have come to apply an additional lens to my engagement in these opportunities. I have tried to represent our field, since Pediatrics is often marginalized, to represent academic generalists who may be overlooked in an increasingly specialized field, to represent Latinas in medicine, and represent physician mothers.

Another immensely rewarding and magical aspect of my yeses has been the friendships I’ve formed. The year I served as President of the Society for Pediatric Research coincided with Dr Tina Cheng’s Presidency of the Academic Pediatric Association. We’ve been friends since internship, and I could not have imagined that we’d be simultaneously leading professional societies 20 years after our chief residency!

During his 2014 St Geme lecture, Dr Lewis First encouraged us to move out of our provincial corners and embrace all members of our profession.¹  For me, the Pediatric Academic Societies’ meeting and our individual societies have been marvelous opportunities to make new friends and deepen longstanding friendships, all of which have enriched my engagement in academic pediatrics.

Of course, none of us works in a vacuum. I’m grateful to my parents and my sisters, who created my foundation. My husband, Peter, has supported me throughout this journey, even when he was asking if I really had to travel or participate in a conference, and our sons and new daughter-in-law keep me looking forward.

Dr Mark Schuster’s 2018 St Geme address highlighted the importance of mentorship,²  and I have benefited immeasurably from a large, diverse group of mentors, including my mentors at the University of California, San Francisco, my mentors at other institutions, and my peer mentors. More recently, as I accept and embrace my status as a “senior” member of our profession, I have reveled in the opportunity to mentor and support the career development of others. Each year, at the Pediatric Academic Societies meeting, I connect with colleagues, and I relish the privilege of mentoring them by offering advice and encouragement.

My colleagues in the Department of Pediatrics at Zuckerberg San Francisco General Hospital, the Office of Academic Affairs in the School of Medicine, and the Dean’s office at Zuckerberg San Francisco General have supported me so I could pursue activities outside of our institution.

Taking a page from Dr First’s memorable “leadiatrics” St Geme address,¹  I would like to offer some words of encouragement, another aspect of the magic of yes, using YES as an acronym (Table 1). Y represents you because you can make a difference. As stated by Margaret Mead, “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”³  E reminds us to engage with others. The sage advice of the proverb attributed to Africa resonates deeply with me: “If you want to go fast, go alone. If you want to go far, go together.”⁴  Finally, S represents speaking up. We need to SPEAK up for our patients, our trainees, our research, and our profession! Dr St Geme himself said “Let’s stand up, pediatricians. Let’s consider the legacy for not only our patients but also the young people who will follow us in our professional careers.”⁵ 

For me, saying yes over the course of my career has brought magic as well as joy. I’d like to close with the words of Rabindranath Tagore, “I slept and dreamt that life was joy. I awoke and saw that life was service. I acted and behold, service was joy.”⁶ 

Thank you for this immense honor.