What does it take to become the Anthony Fauci of the University of Michigan? When COVID-19 hit, Dr. Rob Ernst was tapped to lead the school’s response. As the Chief Health Officer for the university, he prioritized maintaining core critical operations in order to provide healthcare for the whole region. For Dr. Ernst, commitment to caring for his community is key. Dr. Ernst chats with Breaking Schemas co-host John Branch about how mentorship and the courage to take non-traditional paths have shaped his career, his approach to navigating the school’s pandemic response, and how he views commitment as a disruptor. *Breaking Schemas is a production of the Yaffe Digital Media Initiative at Michigan Ross and is produced by University FM.*
What does it take to become the Anthony Fauci of the University of Michigan?
When COVID-19 hit, Dr. Rob Ernst was tapped to lead the school’s response. As the Chief Health Officer for the university, he prioritized maintaining core critical operations in order to provide healthcare for the whole region. For Dr. Ernst, commitment to caring for his community is key.
Dr. Ernst chats with Breaking Schemas co-host John Branch about how mentorship and the courage to take non-traditional paths have shaped his career, his approach to navigating the school’s pandemic response, and how he views commitment as a disruptor.
*Breaking Schemas is a production of the Yaffe Digital Media Initiative at Michigan Ross and is produced by University FM.*
A mentor’s wisdom: Take the chance, even when you feel unready
07:36 My belief is that if you've got a really great opportunity and you don't feel like you're ready for it, take it. So, I don't know if he was talking about that more generally or about he was just trying to say that I was actually more ready than I thought I was, but I actually have behaved that way in a number of other capacities throughout and tried to not be afraid to try to blaze a new pathway even if it seems like a non-traditional pathway.
Making tough calls during the COVID pandemic
16:07: As a trained general internist, I think, compared to many, I have a much higher comfort level with uncertainty, and even making hard decisions with incomplete information is what we do in medicine, right? I mean, you gather information, you do some deeper digging with some tests or studies, or something. And then, you don't know exactly what you're up against most of the time or often. And you still make some decisions about, let's try this, whether it's some kind of procedure or medicine or some non-pharmacologic treatment, and then get back together and see how it's going. Maybe there's some new information and you shift and things like that. And we don't blame ourselves for not having been able to see the future with incomplete information. And we just trust our experience and our judgment, weighing its risks and benefits. And that's just how we behave. And I have a really high comfort level, and practicing that way and that was the course through COVID.
How Bob Quinn’s writings shaped Dr. Rob Ernst’s leadership style
27:29: The temptation for us as humans is to tinker with problems and add here, reclassify that position, move that person's blah, blah, blah, as opposed to just saying, "If we were trying to solve this problem from scratch, how would we do it?" And then, just oftentimes, it's a completely different approach.
(Transcripts may contain a few typographical errors due to audio quality during the podcast recording.)
[00:00:00] Intro: Welcome to Breaking Schemas, a podcast that explores the dynamic changes of contemporary business through the lenses of the disruptors who’ve not only navigated the changes but have also rewritten the rules of the game. We’ll be sitting down with business leaders across a wide spectrum of industries to discuss their victories, their failures, and the biggest lessons they’ve experienced throughout their career to prepare tomorrow’s leaders — that’s you — for an ever-changing marketplace.
I’m Marcus Collins, marketing professor here at the Ross School of Business University of Michigan. I’ll be your host, along with my co-conspirator, Professor John Branch. Now, let’s get into it.
[00:00:00] John: Hello, listeners. This is Professor John Branch from Michigan Ross, coming to you for another episode of Breaking Schemas, where we unpack disruption. What is it? And how does it affect the world around us?
Missing today, unfortunately, is my co-pilot, my co-conspirator, and my co-host, Professor Marcus Collins. However, we have a special guest with us today. We have Dr. Rob Ernst, an alumnus of the University of Michigan and also an employee of the University of Michigan.
We're so delighted to have you here, Rob. Welcome!
[00:01:21] Rob: Thank you, John. I'm delighted to be here.
[00:01:23] John: Rob, I know that you did your undergraduate degree at the University of Notre Dame in sciences with the goal of becoming a physician. Say a little bit more about that.
[00:01:32] Rob: Yeah, I didn't know there was such a thing as first-gen college kids when I went through the process, but, kind of, identify with that now with some imposter stuff and probably compensated a lot by just studying a lot and reading a lot and trying to outdo my expectations, which weren't that super high, quite frankly. But got really fortunate when I was at Notre Dame, which was a dream of my mother, coming from a big Catholic family, to get at least one of her kids to Notre Dame was, sort of, mission accomplished for her.
But while I was there, I had a really influential faculty person take interest in me. He was science professor, chemistry professor, and also a dean of the freshman year of studies. And he noticed me, which was something that hadn't really happened to me before, and asked to meet with me, which was intimidating at first, but turned out to be really transformative for me.
And got curious about me, understood some of my insecurities, and helped simplify my decision making, you know, basically, helped me understand that my curiosity about science and people would be a good fit and that I would be well-prepared for medical school if that's something that I wanted to do. And being from Michigan at that time, he basically said, “Don't overthink this. Go to Michigan.” And it really helped me, you know, to just boil it down to a path that seemed doable. And I know there were probably resources available, but first-generation college kids, I think, are famous for not engaging a little bit. So, it really was very, very fortunate for me to get some mentorship early on by an interested faculty person, which I'm really grateful for.
[00:03:27] John: I want to continue in a bit about your incredible career at Michigan, not only medical school, but then as a faculty member. And most recently, if I can use this term, the Anthony Fauci of the University of Michigan. But first, I want to go back to this idea of mentorship. You know, I wish that Marcus were here, because Marcus, in grade seven, flew off to Sweden. Now, for those of you who don't know, Marcus is African American from inner city Detroit. And I asked him, how does this kid from inner city Detroit end up flying for a one-month stay in Sweden? And he said almost exactly the same thing as you. Robby said, somebody took an interest in me. Somebody believed in me. Somebody encouraged me. And somebody even said, “You can do it,” when I suppose he had never heard that before in his career. And it made such a difference in his trajectory. And high school, he then had another mentor who, who sent him off to Japan, which he said was incredible to be an African American wandering around the streets of Tokyo.
So, can you expand a little bit more on that, that notion of mentorship? Because clearly, it was instrumental in where you are today.
[00:04:37] Rob: Oh, that, you know, it is something that I've attended to, you know, a lot and tried to give back a little bit, too, but, you know, I had some anxieties also about possibilities, you know, getting through med school and residency and things like that. Again, kind of, overcompensated by this working really hard and studying even harder and…
But I also was keen on watching certain people that I wanted to, sort of, be like, you know. And whether they were formal mentors… knew that they were mentors or not, I was just watching a lot of people. There were a couple of my co-residents who I was really respectful of in terms of their poise, their ability, their compassion and care. And, you know, there were certain aspects about the way they conducted themselves that I would try to be like, you know, that was, sort of, an informal way of being a mentor.
My next real strong mentor is somebody who's still here at the University of Michigan, who was my residency program director at the time, Joe Kolars. He's now in a leadership role in global health and has been in the dean's office at the med school here after an extraordinary set of experiences outside the university in China and at the Gates Foundation and at the Mayo Clinic.
But Joe also was someone who I think, I use the term “noticing” a lot. I sat in on lecture at Ross, actually, one of your colleagues, talked about empathy can only occur when you just notice first, you know, we have to, kind of, get out of ourselves and get curious, you know, about other people. So, it's something I try to do myself.
But Joe did that with me also. And I remember there was a time when he observed some things in me that he didn't think was great. You know, it was at a time when I just finished residency and was just working as a clinical instructor, doing some clinical teaching, trying to hone my skills clinically, make some money, pay off my loans. That was the plan. And you know, at the time, the leadership was turning over, and there was a real interest in bolstering the research investigator pathway, and there was a number of incentives in place for writing grants and things like that. That wasn't what I was doing. And there was a cohort of some of us who got really bunchy about that, and vocal, and, you know, I found myself, sort of, gravitating towards that. And Joe, kind of, saw that and said he wanted to have a meeting with me. And I was so appreciative of this. He said, “You know, you don't seem yourself. You ought to try to be a little different than what you're seeing out there.” And I got it right away, you know. And then later there was a time when he left soon after that and set me up in residency in a leadership role at the residency program. And I had only been out of the residency myself for about a year and a half, had a lot of insecurities about that. And he said, well, here's another little bit of advice. And I'll never forget this, is that he said, “You know, my belief is that, if you've got a really great opportunity and you don't feel like you're ready for it, take it, you know.
So, I don't know if he was talking about that more generally or about he was just trying to say that I was actually more ready than I thought I was, but I actually have, kind of, behaved that way in a number of other capacities throughout and tried to not be afraid to try to blaze a new pathway, even if it seems like a non-traditional pathway.
And Joe was really candid with me about his pathway has been, sort of, non-traditional. His pathway through promotion at the medical school wasn't, you know, the traditional basic science and was pretty candid about feeling like he needed to, sort of, or wanted to push to be recognized for his contributions, not just for traditional scholarly work, but to also, you know, value education and teaching, you know. So, he really helped me, yeah, with that.
[00:08:42] John: You know, this really resonates with me because we often talk about the University of Michigan as being, you know, a multidisciplinary university, leaders and best, yada, yada, yada. But what I've discovered is that the university has been, for me, flexible enough to allow me to be a leader and the best without, you know, hemming me into a very, very traditional pathway.
It's also big enough that it allows people like you to make these quite massive career shifts without you having to leave and go to another, another university.
[00:09:19] Rob: Yeah. And, you know, the university is, oftentimes, described as being so decentralized, you know, and almost as if that's not great or, you know, something like undesirable would be siloed. I actually think, for a university to be as large and diverse as it is, it's understandable that it's decentralized, and that makes sense.
Now, certain things that I think are more overarching and, sort of, applicable to the broader community, like when COVID hit, you know. Then, it became more of an imperative for us to break down some of those silos, start working with some non-traditional partners in service to, sort of, a, kind of, overarching thing.
[00:10:05] John: Yeah. So, you raised COVID, so we might as well jump there. Tell me about when you got the call before you lost all your hair and it went gray.
[00:10:17] Rob: Well, look who's talking. Yeah, you know, after a 12-year run as medical director of the health service, I had gone back to the hospital for a few years in a really intriguing role at the medical school. But when the, you know, the vice president of student life reorganized the health and wellness units within student life, she was able to convince me to come back in a new role as AVP for health and wellness. And in that capacity, I did supervise the health service, the counseling center, disability services, sexual assault awareness and prevention, but stayed really present at the health service.
In the spring of 2020, you know, it was a curious thing where our very early spring break really put us at, sort of, a heightened risk compared to many of our peer institutions. So, our campus basically emptied out the last week of February. Students and affiliates all over the world were returning, just as things were heating up, not just in China, but in Europe and other places.
And it became pretty clear that, to me, you know, we had to get ready for, perhaps, people coming back from spring break, that, you know, we, we might be seeing cases. We likely would be seeing cases. And what was fresh in my mind was that, you know, if this was, this second generation of SARS, you know, we remembered in healthcare, you know, how devastating that was, not just the people, but the caregivers, you know, were at significant risks.
So, I know that, that institutional leaders were talking about what we might want to do and things like that. But as those conversations were going on, we had cases, you know. And I, I think that there was a bit of a disconnect between what some people thought was planning while some of us here were actually in response mode. And it was really frightening when we had a young lady from a student who had been in Italy who was in our health service on a Tuesday night, you know, behind a door that we were talking to her on a phone, you know, and working with the health department. There was, of course, no testing or anything available. And coordinated with campus security and housing to find an alternate arrangement on the fly. We were there all night, taking care of it. And the next morning, I had been part of the emergency operations center when they were still talking, kind of, planning. And I was like, “This is happening,” you know. And based on what we know, you know, if the incubation period's, you know, 10 to 14 days, and oh, by the way, next week is St. Patrick's Day, I mean, this could really be crazy.
So, there were some people there who said, “You need to send this message up.” And I got dragged, basically, from the EOC into a meeting with people who, in my career, I never would have imagined I would have ever been in meetings with. So, at the leadership meeting, you know, there was a, a call for consensus on some of these much, what I would consider more modest plans. And I, I just, sort of, raised my hand and said, “You know, I would love to be wrong on this, but I think we ought to just send everybody home before we have a potential disaster this weekend.” And I said, I wasn't even, I don't know why I'm even here, but you just put out a call. If everybody agrees, I said, I just don't agree, but that's fine.
And luckily, I believe there was someone from the executive officer group there who said, “I'm changing my mind based on what Rob just said. And I think we should send everyone home and figure out how to teach remotely. And, you know, let's figure that out.” And she said, “I hope I'd be wrong, and I would love to be criticized for being, like, overly cautious here.”
So, it was only after that, that that was what led to the 48-hour, sort of, pause and instruction and got everybody home and had to get things started. And it was the next week that things were starting to organize with bigger committees and things were taking some time. And the president, at some point, called me and said, “Rob, I need you to just make some things happen.” And I said, “Well, I don't even ever really met the president before.” He's like, “Just tell me what you need and you can have all the people you need. We just, you know…” he, he was, I actually think, really concerned that the really big committee structures would not possibly get enough things in place for us to, you know, repopulate the campus and do some things.
And he was actually really good about saying, you know, “I'm going to set this up as an 18-month appointment for you,” which at the time sounded so long, but of course, didn't even seem long enough now. But we organized a team of folks who are really quite committed. And, you know, we were meeting twice weekly and all, you know, and a bunch of other times. And, and the group really stayed together, and we still have almost the same team that we started with. It's been remarkable through that, widely represented across academic affairs groups and infrastructure units, regional campuses, hospital infection prevention.
We've, we've really pulled together non-traditional partners who have been quite impressive in what they've been able to do, not that we did everything right.
[00:15:41] John: I'll pick up on that last sentence there. If you had to grade yourself, what would you say?
[00:15:45] Rob: Well, it depends on what the, you know, what the outcomes were, right? And I think that's where we, I think, a lot of people disagreed, right? I think that, in this setting… and it's something that the, the leadership at the time, and I used to talk about, in terms of my role in COVID and I kept reflecting on the fact that, as a trained general internist, I think, compared to many, I have a much higher comfort level with uncertainty, you know. And, and even making hard decisions with incomplete information is what we do in medicine, right? I mean, you gather information, you do some deeper digging with some tests or studies or something. And then, you don't know exactly what you're up against, most of the time or often. And you still make some decisions about, “Let's try this,” whether it's some kind of procedure or medicine or some, you know, non-pharmacologic treatment, and then get back together and see how it's going. Maybe there's some new information and you shift and things like that.
And we don’t, we don't blame ourselves for, you know, not having been able to see the future with incomplete information. And we just trust our experience and our judgment, weighing, sort of, risks and benefits. And that's just how we behave. And I've, I have a really high comfort level in, you know, practicing that way. And that was the, the course through COVID. And yet, other people were just craving certainty and, you know, latching on to outcomes like, you know, how many cases versus how many tests we were doing and a bunch of other things.
But for me, really, the most important thing, always, was super clear to me. It's still clear to me to this day, is that I believe that what the university does is really, really important work. And that's, you know, world-class education. That's cutting-edge research. That's service to our community. That's providing healthcare to the whole region. And as long as we were able to maintain continuity of those critical functions, that was the most important thing to me.
So, that's what I felt like our public health practice, our infrastructure that we put up, was not, in and of itself, trying to win any contests for doing the most tests or having the fewest number of cases or finding every single case of COVID. It was maintaining the core critical operations and really hoping that we didn't have, you know, very serious clinical outcomes or at least minimize those.
[00:18:28] John: Yeah, yeah. You know, you're not the only alumnus of the medical school who has gone on to do non… let's call it non-traditional medical career, like not doctoring all day long, you know. Rather famous alumnus, Sanjay Gupta, comes to mind whom the world knows, right, as, as Mr. Medicine.
[00:18:48] Rob: He was in my wife's med school class.
[00:18:50] John: Yes, indeed. What do you think it was? What was that tipping point? If you could point to one thing that got you out of a traditional clinical or, in this case, clinical academic scholarly track and into health, you know, health behaviors and student life and student health and, now, wellness for, for the entire university?
[00:19:15] Rob: Yeah, I wish I could say it was, you know, this goal+oriented, you know, striving for this my whole life. It was… that really wasn't the case. You know, I, I just mentioned, you know, my wife is also in, in medicine and I have four children, one who is really profound intellectual disabilities. And to balance everything, I've had to, you know, make some decisions. And, you know, I'm not saying any one thing is any easier than anything else, but, you know, my wife and I have both made significant changes early on in our career, just to, sort of, make space for each other and each other's careers and our children's needs.
So, that's, you know, all that work-life balance now. And we were doing some of that early on. And, particularly, with, you know, our daughter has really bad seizure disorders. So, we found that it actually became almost impossible for us to manage that while we were both seeing patients at the same time, you know, because the one thing we don't shut down is, is our clinical work, unless we really have to, but the last thing that we would shut down would be our clinical work. I understand how we're both very respectful of, of our patients’ time and our commitment to showing up there.
And so, we, we tried to come up with a model. You know, this is pretty, you know, close to the ground. It doesn't sound super purposeful from a professional standpoint. But, you know, our early on goal was not being in-clinic at the same time, you know. So, we had this very, sort of, complex grid that basically made it easy for us when the schools called and said that our daughter was having a seizure, who was going to be the, you know, break away and get there as fast as they could, because you always cancel a meeting, but you can't, you know, walk away from patient care as easily.
[00:21:05] John: Yeah, yeah. We're going to do a looking back and then a looking forward. Looking back, what's been the most rewarding position in your multi-position career?
[00:21:14] Rob: You know, I get asked that, you know, sometimes, even when at the height of the pandemic, you know, it was so, so challenging. And I continued to see patients during that time. I still see patients now. I maintain a clinical practice, even as I'm, sort of, redefining what it means to be the chief health officer and, you know, building out this wellbeing collective and trying to tighten up our continuum of care for the campus and things like that.
So, I've got a lot of things that I'm working on, but I still continue to see patients. And even at the height of the pandemic, people, even my patients would ask me because they all knew that I was getting just overwhelmed with, you know, the COVID situation. And they're like, “I can't believe you're, like, breaking away and seeing me.” And I'm like, “Oh, you’re kidding me. This is my favorite four hours of the week, you know, were, actually, everybody who comes to see me, actually, you know, wants my opinion, you know.” I really treasure my clinical work. And of all my, sort of, identities that I've had professionally, my clinical work as a primary care physician is the most rewarding part of all of it. It is such a privilege to be charged with the care of a person and their family and just trusted with deeply personal and, you know, challenging issues. I just can't get over the responsibility and the privilege of that. And like I said, when people would ask me, “What would you give up?” I'd say, “Well, actually, I, kind of, love the balance. I love all the different aspects and the variety of my practice, but, you know, my, my most valued identity professionally is as a primary care physician.”
[00:22:57] John: This brings us to the end. And Marcus and I always try to capture blank as disrupter, try to, try to, you know, thematize what we've just done. And I wrote down three, but they've changed over the course of the conversation. So, I started out as emulation as the disruptor. I thought it very, very insightful how you said that, that you began your career and career and early academic career emulating others and that helped, perhaps, disrupt your own career trajectory. So, emulation as the disruptor.
Then, I loved what you said about noticing or observation as the disruptor. Marcus and I often use a phrase that things are only obvious when somebody points them out to you, right? That there really is a skill in noticing. We also like to joke that we think that some of the best anthropologists, some of the best noticers, observers, are stand-up comedians, right? Because they've, they identify these little things in life and then they say them and we go, “Yeah, yeah, yeah, that's it, exactly. That's, that's how it happens to me.”
Then, I absolutely love your career, the way you’ve jumped around, and I don't mean that in a derogatory way, but you've jumped around pursuing things which were important for you, for your family, for the university. So, I had another one. It's variety as the disruptor. But you know what? I think I want to use a different one. And here it is, and see if you like it. Commitment as the disruptor. Because it seems to me that, throughout your career, for your family, for this university, for yourself, at the end of the day, what holds all of these experiences together is your commitment. And when you decided to commit to something new, which was important to your family, to, to your wife, to, to your career, it was about commitment, including this most recent, very, very important and very impactful aspect, which is health and wellness at the University of Michigan. So, I'm going to, I'm going to call it, it's commitment as the disruptor. What do you think?
[00:25:10] Rob: Well, I think you're right, as I have evolved, no question. And, you know, I've had, early on, navigated my, what I now see as a first-gen kind of experience through noticing. And then I got lucky with some great mentors.
You know, I'll actually give credit to my, sort of, more recent leadership to one of your colleagues, you know, Bob Quinn, through executive education. You know, I'm a voracious reader. And, you know, in terms of studying leadership, I actually don't believe there are born leaders or natural leaders or any one even natural leadership style or better leadership style. I think, effective leaders, you know, become capable of providing the type of leadership that is called for in a given situation. And I learned through some readings of Bob Quinn that there is some fundamental properties of leadership, and I'll get to, sort of, disruption as part of this at the end, if that's okay.
[00:26:10] John: Mm-hmm.
[00:26:10] Rob: But, you know, being other-focused and purpose-driven is really, really important. And I really think about that a lot. So, that is part of the commitment part that's really prominent in my leadership, I think — make it about other people, not myself. And then really being flexible with plans and being able to, you know, receive input from a range of different sources. And then, as he would say, build the bridge as you walk on it. Know where you're going, but, you know, not be committed to any one kind of pathway.
And then the part that I really… and that's been really helpful for me, that building the bridge as you walk on it notion and the fundamental state of leadership that he articulates in his writings. But I also really identify a lot with his book, Deep Change, where, if you're trying to solve a problem, an incrementalist approach to complex problems is oftentimes exactly the wrong thing to do. And to have the team around you who you can build the sort of capacity and the resiliency enough to just do something dramatically different to solve a complex problem is a really important, you know, skill set, I believe, in leadership. And I learned that from Bob Quinn's writings.
And I, I, kind of, bring that with me in saying, you know, the temptation for us as humans is to tinker with problems and, you know, “Add here, add here, reclassify that position, you know, move that person's, you know, blah, blah, blah,” as opposed to just saying, “If we were trying to solve this problem from scratch, how would we do it?” And then, just oftentimes, it's a completely different approach, which is why, if you think of some of these jobs that I've taken over the years, John, most of my administrative positions have been new positions. You know, when I took on the AVP for health and wellness, actually, the associate division chief in general medicine to oversee primary care, we didn't even talk about that was a new position to try and address some very real hard stressors on people doing primary care work, the clinical people doing that work.
And it was a hard new job and, you know, took that on. And then, of course, the COVID job and, now, this revised chief health officer job. It, oftentimes, needs something completely different than what we've had before to try and take on complex problems. And I think that's, sort of, inherent in my, in my leadership.
[00:28:32] John: Wonderful! Well, dear audience members, thank you for joining me, Professor John Branch from Michigan Ross, for another Breaking Schemas episode, this time with a dear friend, a wonderful colleague, an alumnus of the medical school here at the University of Michigan, Dr. Rob Ernst.
Thank you so much for spending time with us today.
[00:28:55] Rob: Oh, it was, it was my pleasure, John. This was really fun. And I really enjoyed it. Thank you.
[00:28:59] John: Thanks, everybody. And we'll see you on the next one. Until then, take care! Bye-bye!
[00:29:07] Outro: Breaking Schemas is a Michigan Ross podcast powered by the Yaffe Digital Media Initiative and produced by University FM. Go Blue!