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Alumni Profile: Dean Jeffrey Balser, M.D., Ph.D. (‘90)

Posted by on Friday, February 2, 2018 in Alumni.

by Ayesha Muhammad (M2) and Maggie Axelrod (G1)

Medical Center North, which still evokes the sense of being an antique building, boasts the title of being the “original” Vanderbilt Hospital. Deep in the corners of the third floor however, it sports a wood-paneled side corridor, which seems out of place as compared to the rest of the building. Here lies the office where the most important decisions about the medical center are made, the office of the Chief Executive Officer (CEO) of Vanderbilt University Medical Center (VUMC) and Dean of Vanderbilt University School of Medicine (VUSM), Dr. Jeffrey Balser (PhD ‘88, MD ‘90).

His office hides behind a giant gargoyle — which used to be a water spout on top of Kirkland Hall — named Galen after the ancient Greek physician. Dean Balser, with a glimmer in his eyes, is quick to point out that the office has housed the Dean from the beginning of VUSM-times. His furniture is a tour of VUSM history: His desk belonged to Dean Canby Robinson, who is given credit for the original design of Medical Center North and eponym of Robinson college; his chairs belonged to Dr. Ike Robinson, Vice Chancellor for Health Affairs, with authority over all of Vanderbilt’s programs in health from 1981 to 1997; his decorations include a pair of wooden elephants from the World War I era. Personal to Dean Balser is a plaque commemorating his 2002 Nature paper about how calcium levels affect cardiac excitability. But what catches our eye, among all the Vanderbilt history, is a seemingly anachronous stuffed chicken toy. The toy squawks if you strangle it, and Dean Balser remarks how it helped the senior leadership at VUMC through some challenging times. The office is a good metaphor for Vanderbilt and Dean Balser’s vision for it: a healthy respect for the past and a committed vision toward the future, with a dash of fun and personality.

From Vanderbilt MSTP Class of 1990 to Dean of VUSM and CEO of VUMC
What initially appealed to Dean Balser during his physician-scientist training was the idea of having multiple career skills. “I really liked having a portfolio of activities that was broad… I tend to feel confined if I am just doing one thing,” Balser said. “So I loved the notion of being in research part of the time, training people part of the time, and in clinical care part of the time.” It was this combination of multiple avenues that attracted him to a career in an academic medical center.

Dean Balser graduated from the Vanderbilt MSTP in 1990, a time he recalls quite fondly. “I have this vision in my head of it being three days before graduation and [being in the south elevator lobby of Light Hall]; it looks exactly the same today as it did in 1990, and I remember standing there and looking around and thinking I really don’t want to leave this place and I bet I come back someday. I remember that vividly because I was so happy here.” After graduation, Dean Balser left for Johns Hopkins to complete his residency and fellowship training in cardiac anesthesiology and critical care. At Johns Hopkins, he also started his first faculty position, focused on growing his research lab and obtaining his first R01. He made the conscious decision to establish his research career before attempting to move to another institution, something he suggests current trainees should consider as well.  

In 1998, Dean Balser was recruited back to Vanderbilt to help with physician-scientist development at a junior faculty level, and he leapt at the offer to return. While personally this opportunity allowed him to “dab his toes” into an administrative role, it also benefited Vanderbilt: the current Harrison and Newman societies, development programs for residents and junior faculty respectively, are modelled after his efforts. Initially, his administrative responsibilities were just an extension of his traditional physician-scientist career path.

As he thought of moving up the administrative ladder, the Chair of Anesthesiology at Vanderbilt retired, and Dean Balser was offered the position: “I had no idea what I was getting into. I didn’t understand business. I didn’t understand finance. I didn’t understand HR. The list of things I needed to know and didn’t understand was a mile long… It was almost like I needed to go to medical school again to understand it.” He compares taking on the chair role to being in the ICU with eight patients coding at once, and not having the training to handle it. As to how he was able to stay afloat, he stated, “I was not afraid to ask for help … I attribute my ability to succeed in that position — that I was wholly unprepared for — largely as a reflection of the institution’s culture and the way we are about supporting each other here [at Vanderbilt].” He was able to ask Dr. John Sergent, Chief Medical Officer at the time, for help with unfamiliar administrative tasks, only a few years after Dr. Sergent had read Dean Balser’s name at his own VUSM graduation. He also got a professional coach, as advised by his mentor at Hopkins and at Vanderbilt, Dr. Charles Beattie, who was chair of Anesthesiology at Vanderbilt from 1994 to 2001.

Once Dean Balser got more comfortable as a department chair and realized he enjoyed administrative roles, another opportunity presented itself: the head of research, as Dr. Lee Limbird stepped down. “This [job] was just all science and building big science and that was just a wonderful experience for a physician-scientist… We got to envision the beginnings of what personalized medicine would look like. BioVU: we got that started.”

Then in 2007, when Dean Steven Gabbe left Vanderbilt, Dean Balser was asked to serve as Interim Dean. “I really wanted the job at that point and was so thrilled when I was selected,” Dean Balser said of starting the Dean’s job.  He was appointed Vice Chancellor for Health Affairs nine months later in the wake of the 2008 national financial collapse in an effort not to “separate the faculty and the health system at the top… It is a lot more fun actually than having the organization split… When we are creating a clinical program in the hospital we are also thinking about how it serves residents, how it serves students and how it serves the research enterprise… to be able to think about all that at once is really the power of an academic medical center. By having unified governance, people aren’t developing separate infrastructures [in competition with each other]. The whole infrastructure of the medical center [was redesigned] so that we have everybody at the table when we are talking about new programs.” Through a legal and financial separation with Vanderbilt University, Balser was appointed President and CEO of VUMC in May 2016.

Using MSTP training to transition from clinician-scientist to full-time administrator
When asked about the transition from clinician-scientist to administration, Dean Balser said, “You know how in the lab you do an experiment, you see a result; you take care of a patient, you see they get better, a lot of that is really short-term feelings of success… Little infusions of a grant being funded, a paper being published, and a patient responding. Administrative life is not like that. Going home at night having had 16 meetings and having made slightly measurable incremental progress on fifteen things is like a huge day … [and] developing what I call executive patience… takes doctors and physician-scientists a while to get comfortable with… Once I was feeling emotional satisfaction from an administration leadership role it was easier for me to think okay time to give up the lab.” While he maintained an active lab until his appointment as Dean, he gradually down-sized as his administrative duties increased. “The degree to which I was more and more comfortable giving that [the lab] up, as well as clinical practice, was directly correlated to how much I was enjoying the other piece.”

“There are some aspects [of seeing patients and running a lab] that I miss, but I am immensely happy because there are things you get out of this job that are equally gratifying and in some ways similar. So for example, I get tons of people stuff in this job. I meet new people everyday. I am hearing about people’s problems [and] helping them find solutions. I mentor people… Honestly, I get to think creatively about science in this job. It’s just big science: what should the next version of personalized medicine at Vanderbilt look like? How will artificial intelligence change that? Those are the kinds of questions I love and I do actually spend time thinking about that.” In this role, Dean Balser says that he uses the same approach to problems that he did in the lab, except instead of focusing on molecular arrhythmias, now he is working on what are the highest potential things Vanderbilt University Medical Center can do. “I wouldn’t be as happy if this job did not include the research enterprise. The fact that we have a $600 million research enterprise inside this medical center is one of the reasons this is such a great job and requires the leader to be a physician-scientist.  But every now and then I really do miss putting a breathing tube into somebody,” he said.

When asked how MSTP training helped him navigate his career transitions, Dean Balser replied, “The beauty of MSTP training is that you are given a world-class-level problem to solve. That is what a PhD is. And you get a PhD if you solve it. And there are rough expectations around how long that might take but they are rough and it could take forever. That kind of challenge is an unprecedented opportunity to gain confidence in solving hard problems. When I got into administrative roles and I didn’t really understand the substrate, I had this inkling that I would probably be able to figure it out. And I think a lot of that confidence came from doing a PhD.”

Advice to current students: “Strap on your rollerblades,” pick “selfless” mentors, “have a good reason to move”
When asked about picking mentors, Dean Balser answered readily, “The number one criterion I have is measuring whether people are unselfish. I don’t pick arrogant people as my go-to people. I don’t care how smart they are. You want people who place a value on helping other people.” Dean Balser said he applied this philosophy to picking his graduate school mentor, Dan Roden, and this was why he chose to be Dr. Roden’s first graduate student. “Dan is a very selfless individual. You can always find smart people who know stuff. The real difference is people that really care and have a value system for helping other people, including an MSTP student. I have been very, very fortunate to have those people in my life. My career is really a reflection of those people.”

When asked about the decision to move away from Vanderbilt for residency, he was quick to respond that he wouldn’t necessarily make the same choice today. “In those days the prevailing wisdom was, ‘you need to move around.’ Honestly, I don’t think that’s the prevailing wisdom anymore,” giving the example of Dr. Josh Denny, who started at Vanderbilt as an undergraduate, stayed through medical school, residency, fellowship, and an M.S. in bioinformatics, and is now a PI on one of the nation’s largest grants. “You ought to move if the program you really want to train in is the best program and it’s not here, but increasingly we would like to just keep our people…Honestly, I think we do a better job than almost any place of mentoring young physician-scientists, so if we can demonstrate to you that you can train in a Vanderbilt program…frankly you lose time by moving. When we get to be… MSTP students, we are not quite as young as we once were and so we are thinking about families and we are thinking about our lives in a broader context and I think moving is just harder. So, I wouldn’t discourage people from moving, but you ought to have a really good reason to move.”

When asked what advice he would give to current Vanderbilt physician-scientist trainees, his immediate answer is, “Strap on your rollerblades.” After thinking for a moment, he elucidates, “You aren’t as challenged to learn content. You are challenged to learn how to think about rapidly changing paradigms, information use and management… there is too much content to know and that problem is just getting worse. Having an attitude that I am trying to work on my game around learning… it’s the metacognitive piece. The better you become at learning as an MSTP student, the more successful you will be in the future… that is what you are here to learn. Whatever you do your PhD on, I guarantee you that by time you are running a lab, it [your PhD project] will be like a fossil. So when we recruit medical students, I don’t care what their major is. I actually think the pre-med requirements honestly are a waste of time: I think what we want is people who can think really well, and have the right culture and personality.”

With the pace of science, it is becoming easier to connect the clinical realm and the research realm. “Before, it felt like two careers. Now, it doesn’t feel like two careers anymore. That is very exciting but it also requires a different attitude about the process.”

Passion for Vanderbilt, its culture and his job
“My biggest job is managing the culture of the place…It’s all about the culture and I think because we are growing so fast and so large that is an even bigger deal… I have this weekend rule for recruiting department chairs. I tell [search committees] that unless the candidate is someone that they not only want to take home for dinner, but would love to have them live in their house for an entire weekend, don’t bring them to me. Academic medical centers have not had that value system, historically. They haven’t valued the qualities of the person nearly enough in choosing leaders. Department chairs set the tone for an entire faculty… Having chairs [and other senior leaders] that reflect that [our] value system is the most important thing I can do… We have 22,000 people here. I can’t get to 22,000 people, but [by] making sure the people we recruit into leadership positions have those values is the way I primarily influence the culture of the place…It is easy to find smart people, and accomplished people. But finding ones that really have your value system, that’s the challenge.”

His enthusiasm for his job leaves very little interest in (and time for) other hobbies. “I don’t have very many other hobbies,” he says. “I think it is largely because the nature of a career in academic medicine is very stimulating. I spend a lot of time at things that are work-related, not because I have to, but because I enjoy them. So I am not looking for time to play golf because I am just as happy thinking about what the research enterprise should do next year. I find all that enormously intellectually stimulating and satisfying… People are always disappointed that I don’t have some kind of hobby.” He does acknowledge that he loves the restaurant scene in Nashville, and to compensate for his love of eating, he exercises most mornings.

His job isn’t without challenges, and Dean Balser shared with us the hardest part of his: “Giving people the bad news that they can’t stay with us… It is almost always because they don’t actually satisfy our cultural requirements. It is rarely because they are not smart enough to do the job… I am often in the position of having to ask them to step down and I always lose sleep over that and often feel like I have the flu. I just hate that. I do it because you have to. Maintaining the culture of the place requires that bad stuff too.”

Having now emphasized the culture of Vanderbilt multiple times, we asked him to define it more concretely. “Maybe I could describe it this way. Some places you go in America when you pass somebody on the street, they don’t look at you, and some places in America… they hiss at you. Then there are places in America where they don’t look at you unless you say something to them and then they will look over and say, ‘Oh, hi.’ And then there are places in America where as you are coming toward them they look at you and engage you and make you feel welcome… That’s a value system around the importance of people. Vanderbilt is the [last] place. Most places in academic medicine fall into one of the other categories…  it is all around having a value around human interaction and people that is not just an afterthought… It is a little bit unusual, actually. I think it’s our secret sauce…There is no question it’s our most valuable asset, because it makes everything else just so much better. When we went through this horrible thing with the economic problems we had back in 2012 and ‘13, we had to take 8% out of our cost structure. We had to do layoffs. It was a nightmare. Our culture is the reason we survived… The beauty of the culture isn’t just that it makes us stronger in good times, it also makes us resilient in tough times.”

“I can’t say enough about [the culture]. It was here when I was a student and it’s still here and really strong. And you [MSTP students] are the beneficiaries and the promulgators.”