Margaret McKenzie, MD

Podcast Transcript

Cara King, DO:
Welcome back to Inspirations and Insights. We hope everyone is having a fantastic week. We are incredibly excited to have Dr. Margaret McKenzie, MD on our episode today, Margaret is an obstetrician and gynecologist, as well as the current president of South Pointe Hospital. She is a Past President of the WPSA (Women’s Professional Staff Association) and has numerous publications, as well as teaching awards. In this interview Margaret talks about her passion for teaching, finding your authentic self and unique barriers specific for women leaders. We hope you enjoy her wise and incredibly thoughtful words. So we are really excited to have Dr. Margaret McKenzie, MD on our Insights episode today. So Margaret welcome.

Margaret McKenzie, MD:
Thank you very much. Good to be here.

Cara King, DO:
We are so thrilled to have you too. And like I was just saying, I've been hearing your name since I interviewed here two years ago at how absolutely amazing and spectacular you are. So I'm just thrilled to have this conversation ahead of us right now.

Margaret McKenzie, MD:
Great, awesome. Happy to be here.

Cara King, DO:
So I want to start by talking about one of your really deep passions and incredible skills, which is within medical education and teaching. And I've heard you talk about how, even as a little girl, you dreamed of being a teacher, where do you think this passion came from?

Margaret McKenzie, MD:
Probably just inborn or I might've had teachers that I loved when I was growing up. I don't know, but when I was very little, I was trying to, as soon as I went to kindergarten early and I was trying to teach the chairs when I went home. I think that really, I just like to pass knowledge on. I think that it's a privilege to get knowledge and I'm always excited to share it with other people and getting them in the know.

Cara King, DO:
Knowledge is power, right?

Margaret McKenzie, MD:
Absolutely. For sure, yeah.

Cara King, DO:
I've heard you talk about not only educating medical students and residents and fellows, but also your patients. You find great pride in educating your patients as well.

Margaret McKenzie, MD:
Absolutely. Health literacy is a critical. When you're caring for patients, I view my relationship with patients as a partnership and you're not just walking in to get your tank filled, but you're also bringing something to the conversation so that, you can also take part in caring for yourself as well. I tend to be more successful that way. Yeah.

Cara King, DO:
I love that. And within medical education, what attributes do you think are most important to be an influential teacher?

Margaret McKenzie, MD:
For me, I always say the learning environment that you create has to be optimal. It's got to be psychologically safe, non-judgmental, you've got to allow people chances to not say the right thing and make it okay. And allow people to fall and to fail and not make a big deal out of it. But instead turning each one of those into an opportunity to see things from a different lens. So I tend to focus a lot on the learning environment and making it as non-judgmental as possible. The folks at Lerner (Cleveland Clinic Lerner College of Medicine) will tell you that I really strongly support a cultural feedback. I'm always looking for it for myself. I'm always asking for it. And so I tend to create environments where most of the people who find themselves in my space become like that. They start longing for feedback and using the feedback as opportunities for growth.

Cara King, DO:
What important points you make! I hear you say, create that psychologically safe space and then allowing space to struggle.

Margaret McKenzie, MD:
Yeah.

Cara King, DO:
It's so important. I know you're an OB/GYN as well, and it's such a fine line between giving space to your learners to struggle yet, letting them feel supported. And I couldn't agree more that, that space for struggle though, is really, really important.

Margaret McKenzie, MD:
It's important, I think it allows the autonomy that we're looking for, for learners to gain that in a place where we could help them out if they fall. So, that's critical.

Cara King, DO:
You make me think about one of the most important teachers I've had in the operating room. And what they used to say to me is, "If you break it, I will fix it." And for some reason, that sat with me like, give me the space to struggle, but if I don't win with this struggle, it's all going to be okay.

Margaret McKenzie, MD:
Absolutely. And that's the safe space, right?

Cara King, DO:
Very safe space.

Margaret McKenzie, MD:
You know that somebody's got your back, right?

Cara King, DO:
So true.

Margaret McKenzie, MD:
And it also promotes a lot of the autonomy I think that you need. I think that today, most people are getting out of spaces of learning without a lot of autonomy and practice. I think that when you've got a nice learning environment, by the time people are done their tenure with you, they will be very autonomous in the way that they approach problems. So, that's a good thing.

Cara King, DO:
Not building too much co-dependence. Yeah, I couldn't agree more.

Margaret McKenzie, MD:
You get it? Yeah, works for kids too.

Cara King, DO:
Oh my gosh! I need you in my life. I know I have three young kids and I'm trying to figure this out. It's so true.

Margaret McKenzie, MD:
Yeah.

Cara King, DO:
Okay, so Margaret, I want to switch and talk a bit about your tremendous position as the President of South Pointe Hospital, which is absolutely amazing accomplishment. And they say, if you can't see it, you can't be it. So I am so happy to see you in this role and absolutely killing it. So congratulations.

Margaret McKenzie, MD:
Thank you.

Cara King, DO:
And I've heard you addressed the known disparity and a number of women graduating from medical school and those actually reaching hospital leadership positions. And I'm curious, what unique barriers do you think women face during this upward climb?

Margaret McKenzie, MD:
I think that the number one challenge that we have is that most of us, when we are in the early parts of our career, we've got competing interests, competing roles. It's either your relationship, either you're trying to build one or you're in one and you're trying to create offspring, right? And those distractions leave us torn in the inside, regarding which one should I prioritize now. And that's where your values come in, because your values will help you make the right decision for that particular time in your life. And we talk a lot about on and off-ramps for women in medicine, it's actually very well written about. And that is that there are times that you might want to have your priorities be your family or your children. You're also interested five years, 10 years from now in having this big career. And so the question is learning how to prioritize things so that you could figure out how you can still keep your hands in both, but prioritizing the one that matters most right now.

And the reason for keeping your hands in both of is in the career side, you've got to maintain a little bit of visibility when you're in the off-ramp, when you're off raising kids. So you've got to keep publishing, you've got to get a national presence, and you've got to do small things around your peer environment or current environment you're in so that people would know that you actually can execute those things. And then you're not forgotten because if not, when you try to come back in, if you zoom off and then you try to come back in, most of the time, you're older and you've lost some opportunity to really excel and show people you can, you've got to start over.

Now, if you woke up one day and you found yourself not having done that perfectly, this is the United States of America. You can begin again at any time when you're ready. And I really believe that you can reinvent yourself. So if you woke up one day and you were doing something and you weren't so satisfied with it, I definitely recommend having the courage to change it. But I think that the obstacle for us is the tension, the competing interests at certain times in our lives. Beyond that, we are in an environment where many of our male colleagues might have spouses who are taking care of all of that. And also they tend to have sponsors and mentors who actually pull them onto their wings and really show them the path to getting there. And many of us women sometimes don't have that kind of mentorship and that kind of sponsorship, because that does make a difference. Those are a couple of the biggest obstacles that I see that an early career woman has got to think about and maybe even a mid-career woman.

And then thirdly then is when you, like in my generation, we didn't have a lot of role models for us to look at and say, I want to be like that. So many times you were inventing this as you go, you're looking around and you might see a woman, who's doing something close to what you want to do, and you just have to go with it. Whereas now with your generation, my goodness, you could look around and you could see people doing exactly what it is that you want to do. When we were coming through, we didn't really have that. So, definitely advantageous and less obstacle, but there's an elephant in the room.

Cara King, DO:
That was so beautifully put. You're so right. What I'm hearing you say is number one, understanding that your life is going to ebb and flow depending on outside of work things and being okay with that, but still maintaining some presence in both. And also, again, finding mentors, finding sponsors who are doing what you hope to do and keeping them close. And what I'm thinking about is how important the WPSA is just for that, right?

Margaret McKenzie, MD:
Absolutely.

Cara King, DO:
Like a whole pool of women doing exactly what you're talking about.

Margaret McKenzie, MD:
Right. And that is, I think, for our organization to support an organization like this (Women’s Professional Staff Association), I think that that's actually been really instrumental in all of the sponsorship that you see today. Many Institute chairs have been very intentional, like Dr. Falcone (Tommaso Falcone, MD, Chair Women’s Health Institute 2008-2018) was a very intentional chair. And so he made it a priority. He's in an Institute that's got close to half women, and now it's definitely more than half women, and that he had the courage to be deliberate and say, "Well, when I hire somebody, they've got to be adept in the operating room, they've got to be adept in high risk obstetrics." Well, I think that they should be having an equal seat at the table. And so I think that that intentionality is actually what has us in this particular space, because then it becomes infectious. Other people see it and they grow from it.  To get the organization, to give us a level of sponsorship that we have over the last 12 years has actually been phenomenal. So, you came at a right time, Cara.

Cara King, DO:
You are telling me? I know, I'm coming in high. I know we had Dr. Falcone and then Dr. Ridgeway, (Beri Ridgeway, MD, Chair, Women’s Health Institute 2018-2020) who was just equally as powerful and instrumental. So I know, I'm so fortunate.

Margaret McKenzie, MD:
Yeah.

Cara King, DO:
So I love the way you spoke about women kind of being going on the on-road, and I would say on-ramp, and off-ramp, kind of ebbing in flow with your career and really learning how to integrate work and home. My question is, how did you navigate that on-ramp? You're a mother, correct? You have a few kids at home, two kids…

Margaret McKenzie, MD:
Two daughters.

Cara King, DO:
Two girls. And I heard that one of your daughters just got into medical school. Is that right?

Margaret McKenzie, MD:
Both of them. The oldest one is in medical school, and then the youngest one just got into medical school.

Cara King, DO:
Oh my gosh! Congratulations, that is such a big deal.

Margaret McKenzie, MD:
Thank you.

Cara King, DO:
And that warms my heart because that just shows how influential you have been at home. They've seen your life as a physician and they're like, I want that. That's great.

Margaret McKenzie, MD:
Yeah.

Cara King, DO:
That's great. I don't know a lot about you're off and on-ramping, but I'm assuming that you maybe off-ramped a little bit when your daughters were a little bit younger. Can you talk to me about how you on-ramped again? What kind of things did you do to become more prominent when you were coming back into the workforce, a little bit more heavily?

Margaret McKenzie, MD:
I started my life in private practice for about three years. I trained at University Hospital and then I came over to the Cleveland Clinic and did private practice with the famous Dr. Iafelice (John M. Iafelice, MD) who was definitely, he's one of us and has been a great partner in terms of my growth and taking opportunity. In my off-ramps, I was having babies. And when I came back, you've heard me say, I'm a teacher, so I started teaching medical students. I won a teaching award. Then, the clerkship director went on sabbatical and I took her role. I didn't know anything about being a clerkship director and so I just reinvented the role, I joined APGO (Association of Professors of Gynecology and Obstetrics), I started to present nationally and met great colleagues within that organization and then was able to bring that back here at Cleveland Clinic and then Case (Case Western Reserve University School of Medicine) because we didn't have Lerner (Cleveland Clinic Lerner College of Medicine) yet.

And then got a chance to be on the ground floor with planning the Lerner, curriculum and assessment system, then participating in numerous ways, writing PBL cases (Problem-Based Learning), and just really getting involved in the competency-based portfolio assessment system that we have. We brought that up from a baby, okay? Gradually, doing a little bit more as time allowed and then expanding it. But it was just very deliberate, a little bit at a time. At the same time, I also took on a role in my office at Willoughby Hills as the section chief for OB/GYN, and then I became, this was in its infancy. This probably was about in 2004.

Cara King, DO:
Yeah.

Margaret McKenzie, MD:
Doing those small administrative roles, learning how to manage groups of people, and then I came back downtown to the main campus in 2007 and became the section head for general OB/GYN at the main campus. And it's from that role that I then pivoted to this current role also serving on boards nationally and also locally as well, non-profits. It sort of becomes a little nidus, for crystals to grow. All you need to do is have that little bit going and then people start finding out about you, and then they ask you to do more things. And in this organization, all you need to do to get promoted is if you show up every day and you are the best doctor that you could be in your specialty, and if there's a problem that needs to be solved rather than contributing to it or whining about it, you just solve it. Those things get you noticed.

So you're at the top of your game, clinically, as a teacher, educationally, and of course, you've got to have compassion and emotional intelligence and you've got to be fair. It can't just be you, you, you. You've got to also share with other people. They say, when you teach you learn, well, when you promote others, you get promoted.

Cara King, DO:
Wow.

Margaret McKenzie, MD:
And that's just a fact in this organization that is how you can get to the next level.

Cara King, DO:
I think those words are so powerful. Just the way you worded that, when you promote others, you get promoted. Raising everybody else up around you, raises you up, right?

Margaret McKenzie, MD:
It does.

Cara King, DO:
And I feel like oftentimes in many fields, the ego gets the best of us, where we feel like we need to push other people down to raise us up, but it's such the opposite. Isn't that true?

Margaret McKenzie, MD:
And I will invite every single person, as you walk into the door of this part of your life, honestly, the competition is over. Nobody is interested in competing with you. There is a time when you're competing because you're trying to get to the best college and then the best medical school and then the best residency and then the best fellowship, right?

Cara King, DO:
Yes.

Margaret McKenzie, MD:
And then the best practice. And then it's sort of like you're in this hollow tube where nobody really cares. And so, the bottom line is you really have to let the ego go. The ego is important, but it becomes destructive when you put it at the forefront of everything that you do. And I think that we are in the business of caring for other humans. And those other humans are not always just our patients, they're our peers and our partners and our friends. And so it's better to have friends in the workplace than somebody you feel you're having to compete with. Even if they're doing something that you want to do, go find your own thing. There are enough things out there in the world. Why do you want the thing that she has? And I just look at it totally different.

So I'm always trying to, I can't even explain it. I'm always trying to figure out how I could get somebody to do something else. And so in my space, at some point, I've actually done it by creating a physician leadership council where I groomed about 20 physicians into leaders and then gave them things to do, gave them projects to do. We try to find them protected time if we can, because it increases the engagement, I have more people to delegate things to. I know. Don't think I'm laughing now, but anyhow, but yeah, but it starts with letting go of the ego. Just like when you're with your love relationship, you've got to let the ego go. If you think you have a great capacity to do that, wait until you get a teenager. You'll start all over again. So you've got to be able to let the ego go because it'll actually hold things up and stop you from doing what's right, whatever the right thing is.

Cara King, DO:
Those words are so wise, I'm going to hold them in my heart for a very long time. Thank you so much. This is why you are president. You are just so wise. So thank you for sharing that. We really appreciate it.

Margaret McKenzie, MD:
You're welcome.

Cara King, DO:
So I want to dive a bit into how you define success and your values. And during a previous interview, I heard you say that your paradigm has to align with your own values. If you're living in that space, then you are going to choose the values that align with yours as opposed to values that align with somebody else's. And these words really struck me deeply. And my question for you is, have you ever refused any opportunities because they did not align with your values? And how did you identify this discrepancy?

Margaret McKenzie, MD:
I'm sure one day you'll be sitting there having a conversation with Dr. Falcone, and he'll tell you all the things that I said no to, because they did not align with my values. So, I think that there is a time in your life where you have to make a decision as to whether you're going to live an authentic life or not. So what do I mean by that? After a while, the competition has to end. After a while, nobody's looking to see if you're doing a Vag Hyst (Vaginal Hysterectomy) better than them or whatever it is, if you've got more articles than them or anything. You've got to go with your values, because I think life is also about joy. And if you were living in that joyous place, you've got to be real. And if not, things don't feel good in your skin. You have to be in touch with your values, you have to know what those values are.

And then when something comes along, when you get the candy offered to you, the first thing that hits you, if you wanted something bigger is, "Oh, I'll take it, I'll take it. Maybe it'll get me to the next thing." It's like being asked a really serious question about your life, and rather than just give them a quick answer, you have to go home and sort of wrestle with it. And I think that when you're home wrestling, it's all about wrestling with what aligns with your values. And for me, I like to write. I'm a two-column girl, it's one column here, one column is value oriented and aligns with mine or it doesn't. And then the one that's on the side that aligns with my values wins. When you do work, that's aligned with your value, it's joyful work.

I thank God, I should knock on wood, I don't have wood here.

Cara King, DO:
I'll do it for you.

Margaret McKenzie, MD:
Perfect, that I have never burned out. I never burned out and I've been at this for 33 years. And after that, I have a lot of gratitude, but part of it is because I dared to be true. I've lost a few opportunities, in retrospect, I'd sit back and I think, well, I could have done that, but it didn't align with the kind of life that I want it to be living. And so for me, it was the right thing and over time has proven so.

Cara King, DO:
Again, so powerful. And what I'm hearing is you're really talking about your authentic self and giving yourself the space to understand what that means for you, right?

Margaret McKenzie, MD:
Right.

Cara King, DO:
And I feel like so many times we have so many competing responsibilities that we don't actually give ourselves space to even understand what our values even are anymore. Have you ever had that happen to you? Or it sounds like you're a write-it-out type of person, but have you ever had a time in your career where you felt like you were just trying to keep up and how did you give yourself that space?

Margaret McKenzie, MD:
So, yeah. When you are younger and you first come out into practice and you're trying to build your brand, is typically when you get caught in that space. But I think that hopefully you'll wake up and say, "I feel like a rat on a treadmill. I can't continue to do this forever." Even in the hospital now as I work, when it gets like I say, really hot in there, I will walk out of the hospital and walk. We have a beautiful campus, you've been there.

Cara King, DO:
Yeah.

Margaret McKenzie, MD:
In the back in the summer, you'll see us walking out there. So in the middle of the day, when my brain is too full and there's too much going on, you have to be able to walk out and do a Walden Walk. And when you come back, you're refreshed and you can really think about things.

Margaret McKenzie, MD:
When I think that Franklin Covey spoke about that when he said, sharpen the saw. You know, the concept?

Cara King, DO:
Yes.

Margaret McKenzie, MD:
Go on, go back and find it and apply it to your life right now. It'll alter the entire course of your life. The other thing that's important is I always say, sharpen the saw, prioritize what matters most, once you figure it out, because it's got to be aligned with your values and your roles, and then have a quadrant two living. And that is, spend most of your time on the things that are important and not urgent. There are times that you have to take care of things that are urgent and important, that's our work, that's an ectopic, that's a ruptured uterus or something. Those are times when you can do that. But then as soon as that emergency is over, you have to go back into your important and not urgent quadrant.

Other than that, you're wasting life energy, and we only have so much time on this earth. We don't know how long it is. And so as you're living your life, you really want to be able to enjoy it. So in the beginning, when you're trying to find your sweet spot of practice, a lot of the times you're in this treadmill, as you're trying to do everything and be everything and be the biggest thing. And then you do wake up at some point in time because that is just not sustainable. And you've got to go and learn how to live and be creative and maintain your creativity and still produce good work and still have a great reputation and still publish and so forth. But without all of this, "I got to do it now, I got to do it now, I got to do it now." So that urgency, that sense of urgency.

Cara King, DO:
I'm pretty sure you're in my head right now. Yes, I'm feeling that so much. And I'm going to link one of your articles to this podcast where you talk about the seven key factors for success. And I'm looking at them right now, like practice self-reflection and practice self-awareness and engage in practices for creativity. So many things that you're speaking about, if you actually sit with these factors, you're right, it's going to change your life. So with that Margaret, I think it's all the time that we have today, but I cannot thank you enough for your wisdom and your time, and thank you so much for all of your tremendous work and support. It's been truly an honor to have you on our show today.

Margaret McKenzie, MD:
Yeah, and you know what else I should tell you?

Cara King, DO:
Tell me.

Margaret McKenzie, MD:
Listen to your patients.

Cara King, DO:
Yes.

Margaret McKenzie, MD:
You're going to learn so much from all of those women you care for over their lifetime. It's going to inform your entire life. And by the way, you're really good at this podcasting thing. So I think that you need to make this a regular thing. You're very good at it.

Cara King, DO:
You're so kind. Thank you.

Margaret McKenzie, MD:
No, I'm serious, you are really good at it.

Cara King, DO:
Thank you. I appreciate those words. I'm still pretty new at this, so thank you. I appreciate it.

Margaret McKenzie, MD:
Great job, take care.