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It's Not About the Brain - It's About the Heart
Charles Saltzman, chair of orthopaedics, believes that academic practice is about passion, not just intelligence. He tells Accelerate about what he’s learned while training and leading some of the most talented physicians in the country. There’s a common thread among the greats: They are drawn to academic work because they feel they can make a difference.

#1: Academic medicine is about the heart


cademic medicine appeals to different types of people. I didn’t really see myself becoming an academic physician when I started. I found myself enjoying the environment of questioning. The goal in academics is to question the standard of care, improve it, and establish new and better standards of care.

It’s exciting–there’s a continuous exchange of information and questioning of dogma. In academic medicine, you get the opportunity to focus on making the field better. You also get the opportunity to not only improve the care for patients in front of you, but also around the world if you’re doing it right.

It is not just a matter of basic intelligence that pulls people toward academics. I’ve had the opportunity to train some of the smartest people from some of the best medical schools, and it’s something about their heart that drives them into academics. They come into academic medicine because they feel they can make a difference. It’s not about the brain, it’s about the heart.

#2: Leadership isn’t about the limelight

Leadership is getting out of the limelight and helping others. I spent 14 years at the University of Iowa moving up through the academic ranks in three departments with a dynamic interdisciplinary research program, and that trajectory was really fun. I looked at where I was and where I was going, though, and I realized that if I was going to have a bigger impact, I had to leverage myself through others.

As a chair, my job is about trying to attract faculty and provide them with the resources to be successful. It’s about supporting people. Part of the job involves conflict—getting the right people on the bus and the right people off the bus. But getting people off the bus—telling them that they’d be happier somewhere else, or that you’re not happy with their behavior, or that they’ve disappointed the department—is not easy but it is at least as important as who you add. Ultimately, it’s not about you.

I try to lead a culture in Orthopaedics that people want to be a part of. Our culture is mutually supportive, intellectually curious, patient-focused, ethical, hard-working, and safe. I want to build a place where people want to be. Together, we’ve built a great department, as good as any orthopaedic department in the country or in the world.

As an institution, we’re uniquely collaborative and extremely well-organized at delivering high-quality patient care. There are so many people at all levels of our system—hospital administration, physicians, nurses—who are so engaged and informed about doing the right thing. It’s not “them” and “us”—it’s the fundamental culture of openness that we have at Utah. Our institutional culture allows for high-reliability process improvement.

#3: Our foundation is solid and the future exciting

The University of Utah Health is regularly ranked as the best in the nation. There's no question that the patient care here is as good as anywhere. A friend of mine was in our surgical ICU (SICU) for a week last summer. I sat in the ICU as his patient advocate, but I didn't have to advocate that much because the quality of the care was so exceptional.

That’s because of the strength of our teams. Value improvement, or appropriateness of care, is the answer. I’m excited about the foundations we’ve laid in value, in patient-reported outcomes and in our clinical care systems.

The next game changer is what it means to do “well” after a surgery, and then predict whether a particular patient will have this outcome. Ultimately, we’ll be able to predict how a patient is going to do and understand the risks and benefits at a granular level. It’s a bit of a different definition of personalized medicine. Individuals are a constellation of social, emotional, physical, cultural factors. We’ll eventually get to a point where we can help patients figure out, given those factors, their age, and their comorbidities, what is their likely outcome? We can have conversations about whether that matches their expectations.


Charles Saltzman

Chair, Department of Orthopaedics, University of Utah Health

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