When Julia Arnsten, MD, MPH, professor of medicine, epidemiology and population health, and psychiatry and behavioral sciences, began her career at Montefiore Einstein as a faculty member in 1998, she never imagined she would not only go on to help found a new division, but to lead it for 20 years. In 2004, she became the inaugural chief of the division of general internal medicine, and she remains at its helm today. She has shepherded the division’s growth into a research powerhouse, while adding consistency and rigor to its educational offerings and supporting its clinicians. Here, she looks back at her career and talks about her approach.

An innate problem-solver: “When I was a little girl, I wanted to be a judge. I thought I was going to go to law school. I always wanted to think through difficult problems and try to come up with solutions that work for everybody. At some point my interests shifted to medicine. But that is the essence of my role as division chief.

Asking for what you want: I grew up in the Bronx, so I had always been aware of Montefiore Einstein and its mission. When it was time to join an institution as a faculty member, this was where I wanted to be. There was a lot of pressure to have a clinical practice and teach, but I was upfront about wanting to devote 50 percent of my time to research, and my leadership supported me in this.

Building a community: At the same time, I was active in the Society for General Internal Medicine (SGIM). Some of the most prestigious academic medical centers were forming divisions around internal medicine to better support research while also integrating clinicians and educators. The idea was that creating a stronger community within a larger institution could help everyone. People who choose academic medicine want to feel like they're part of a community and are continually learning from their peers. Divisions provide a smaller home for doctors, where somebody is representing them at the table. They become a collective voice, not a sole voice, and that is critical.

Taking a leap: The chair of medicine at the time wanted to start a division of general internal medicine. From the beginning I had a strong vision of what that could be, but I didn’t initially see myself in the role of chief. There was a team from SGIM offering consultations at academic institutions about how to create a division, and they came here and talked to people. I didn’t know it, but they recommended me to lead it. At that point I had been focused on my research and, outside of work, on caring for my two young children. But I also believed I could help our faculty, our department, and our institution to be successful, and I accepted the job.

People in my division know that I hold their successes to be more important than my own. That's really the secret sauce.

Dr. Julia Arnsten, chief of the division of general internal medicine

Helping others shine: My crucial advice for anyone who aspires to a leadership role, is that if you're not more excited by the successes of the people you're leading than you are by your own achievements, then it's not fun. Leadership positions are often given to people who are very, very successful in their own careers. But that's not what leadership needs. Leadership needs the leader to be more concerned with the success of others. If you are interested in becoming a leader, be radically honest with yourself and figure out which kind of person you are. The thing of which I'm most proud, other than my kids, is that the people in my division know that I hold their successes to be more important than my own. That's really the secret sauce.

Waiting, and working: Even when there were obstacles, I stuck it out because I knew the time would come when I could shape the division in the way I thought it could be most successful, integrating the research and clinical sides, and eventually we got there. Looking back, I got through that period by investing hugely in research, both my own and others’. I knew there was one currency that was going to be valuable, and that was getting grants. And I knew that I could write successful grant proposals, and teach other people how to do the same. I also put in place structures for peer mentoring. I supported people to go to academic meetings. I made everybody present their abstracts and posters ahead of time, and rehearse what they were going to say. For any grant that was submitted from our division, I read every word. I read budget justifications. I read letters of support. I read bio sketches. Nothing left the division without my eyes on it. We got larger and larger grants. People started to pay attention to us, and we were the division with the most grant funding in the department of medicine for many years. We really are a powerhouse in terms of the research that we do and the amount of NIH funding we bring in. We punch above our weight in comparison with other institutions.

What not to do: So I just worked, worked, worked. I did all of these things in the research arena that were very rigorous, and that took time. My time was the thing that I had complete control over. But that approach took a toll. For 20 years, I checked my email and responded around the clock. I wouldn’t advise people to do what I did. Now as a leader I’m concerned with, how can we allow people to be successful in academia while still turning off their computers at night, taking time to recharge and being present for their loved ones?

Keep your eyes on the goal, and help others do the same: A few other hallmarks of how I lead: From the beginning, I had a goal, and every decision I made was informed by that goal. And I try to help others figure out what their goals are, and then give them the support they need to reach them. I mentor the people I can help, based on my own expertise, and find the right mentors for the others. I’m always on the lookout for opportunities that could be a great fit for this person or that. Another part of being a leader is knowing who knows what, who's good at what, and not giving people things to do that they're not good at.

On the horizon: Our healthcare system in the U.S. has made it very hard for physicians to stay in primary care fields. I think we will be replaced to a large degree by nurse practitioners and physician assistants. Physicians will be in supervisory roles, working with non-physicians who will provide most of the direct care. There's a challenge in that, that we will need to isolate and articulate, and it has to do with patients who have chronic disease and need a physician who is managing their care with the help of subspecialists, versus patients who are generally healthy and need health maintenance. Helping our academic general internists carve out that niche is something that I want to think about more in the coming years.

Lifting everyone up: Women have made a lot of strides in occupying positions of leadership in academic medicine, but we're still a small minority, and that's very frustrating. I don’t have a solution and I know there are many people actively thinking about this. One issue I think is related, is that there are a lot of competing pressures in our professional lives. All these things have to get done, but we don't have a good system for figuring out how much time they're going to take and what someone won't do while they are chairing a committee, managing a new program, mentoring someone, or reimagining a core competency or a curriculum. Finding ways to better define people’s roles and responsibilities might help everyone find the right balance.”