Podcast: Preparing the next generation of physician leaders

Ted O’Connell, MD, and Lindia Willies-Jacobo, MD, offer insights into advancing medical education

Health systems across the country are navigating clinician shortages, which include a pressing need for more physicians. Data from the Association of American Medical Colleges shows that the U.S. could see a deficit of up to 124,000 physicians across all specialties by 2034. A recent health worker survey shows that due in part to COVID-related stress, 1 in 5 physicians plan to leave their practice within 2 years. 

Amid this backdrop, preparing the next generation of physician leaders is more important than ever. Innovation and transformation in medical education that trains early-career doctors for the modern workforce is essential to ensure that the practice of high-quality, integrated care remains strong. 

In this episode of the Permanente Medicine Podcast, Chris Grant welcomes 2 Permanente physician authorities on medical education. They survey the landscape of physician recruitment and retention, as well as share how Kaiser Permanente is working to address the clinician shortage. 

Ted O’Connell, MD, is director of medical education for Kaiser Permanente Northern California and a family medicine doctor for The Permanente Medical Group. Joining him is Lindia Willies-Jacobo, MD, senior associate dean for Admissions and Equity, Inclusion, and Diversity, and professor at the Kaiser Permanente Bernard J. Tyson School of Medicine in Southern California. 

Related story: Maria Ansari, MD, shares health care innovations to address the physician shortage 

Drs. O’Connell and Willies-Jacobo speak to how medical education and residency programs are evolving to align with increasing complexities in the practice of medicine and patient needs. They also offer a glimpse into the unique experience Kaiser Permanente offers physicians who are just beginning their careers. 

Ensuring that the physician workforce is diverse requires intentionality.

– Lindia Willies-Jacobo, MD 

“Our training programs take a personalized approach to medical education to train the best physicians possible while also encouraging leadership in medicine,” says Dr. O’Connell. “We promote diversity and inclusive learning environments with an intent to develop a physician workforce that represents the communities we serve.” 

Drs. O’Connell and Willies-Jacobo share expert insights on how to support a robust and engaged physician workforce through nurturing education programs and providing mentorship opportunities. Additionally, they speak to the vital importance of building equity, inclusion, and diversity in the physician workforce.   

We need to be expanding the pool of people who potentially see themselves as future health care practitioners.

– Ted O’Connell, MD 

“Equity, inclusion, and diversity are deeply embedded in everything that we do,” says Dr. Willies-Jacobo. “We are ensuring that the entire community feels supported while attracting students to the school who themselves are from diverse backgrounds.”  

Related story: Leong Koh, MD, speaks on the importance of recruiting and retaining primary care physicians 

In this episode 

2:39: Paths to becoming Permanente education leaders 

6:21 Evolution and adaptation at the Kaiser Permanente School of Medicine 

9:52 Kaiser Permanente’s unique approach to residency programs 

13:29 Addressing clinician shortages and maintaining a strong physician pipeline 

18:46 Fostering equity, inclusion, and diversity in medical education 

 21:59 Advice for medical students and doctors starting on their career path 

Connect with Chris Grant by following him on X (formerly Twitter) at @cmgrant or LinkedIn.  

Follow us: Subscribe to the Permanente Medicine Podcast on your favorite streaming platform.  

Podcast transcript 

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.  

Lindia Willies-Jacobo (00:03): 

For me, ensuring that the physician workforce is diverse requires a lot of intentionality as well as knowing the data because I think it’s really important to know where one could potentially put resources and maximize output from that. 

Ted O’Connell (00:23): 

In my mind, we need to be thinking about physicians and we also need to be thinking about the rest of the U.S. health care workforce because there are real shortages in nursing and in all the other allied healthcare fields. 

Chris Grant (00:39): 

Hello, and thank you for tuning in to another episode of the Permanente Medicine Podcast. I’m your host, Chris Grant, chief operating officer and executive vice president Kaiser Permanente, The Permanente Federation. Today’s episode looks at how we’re training the next generation of doctors for success, as well as what’s being done to address the current physician shortage facing health care. I’m grateful to have two guests joining me who are front and center in recruiting and training the next generation of physicians and setting an exceptional example for advancing medical education in the process. Dr. Lindia Willies-Jacobo is senior associate dean for Admissions and Equity, Inclusion and Diversity, and professor at the Kaiser Permanente Bernard J. Tyson School of Medicine in Southern California. She’s also a professor of pediatrics at University of California, San Diego since 1996, where she held the role of assistant dean for Diversity and Community Partnerships and director of the program in Medical Education Health Equity. Also on the program is Dr. Ted O’Connell, who serves as director of Medical Education for Kaiser Permanente Northern California, overseeing the residency and fellowship programs as well as medical student rotations and pathway programs into health care. Dr. O’Connell practices family medicine for The Permanente Medical Group (TPMG) in Northern California and is also the author of 18 medical textbooks and numerous peer-reviewed journals. Welcome to the show, Lindia and Ted, I’m so glad to have you both here sharing your expertise on a timely topic that many members of the medical community are paying close attention to right now. 

Lindia Willies-Jacobo (02:25): 

Thank you so, so much, Chris. It’s an absolute privilege to be here alongside you, as well as alongside Ted. 

Ted O’Connell (02:32): 

Yes, thank you for the invitation to join you on this podcast, Chris. I’m really looking forward to this conversation with the three of us. 

Personal and professional pursuits 

Chris Grant (02:39): 

Terrific. We’re going to have a lot of fun and hopefully we’ll share some important information to our listeners. Why don’t we start off by sharing just a little bit more about yourselves and your specialty with our audience. Lindia, can you tell us about your role at the Kaiser Permanente School of Medicine and the path that led you to becoming a leader in medical education? 

Lindia Willies-Jacobo (03:00): 

Yeah, I’m absolutely happy to do so. I always believe that it’s important for me to first start by talking a little bit about my own identity. I’m of Afro-Caribbean descent. I was born and raised in Panama, and I came to the United States in 1983 at around the age of 18. I attended UC San Diego School of Medicine for the entirety of my training, and I really thought I was going to finish out everything there. And as it turns out, when this opportunity arose to come to Kaiser Permanente Bernard J. Tyson School of Medicine, I jumped at it immediately. I’ve been here since 2018 and I’ll say that I was drawn to this role primarily as a direct result of its mission, vision, and core values, as well as the core values of Kaiser Permanente. I’m also a practicing pediatrician. I have the privilege of practicing what we call Permanente Medicine, so it’s a privilege again to be here with you. 

Chris Grant (03:55): 

That’s terrific. We’re lucky because the organization has you both as a leader in our School of Medicine and our members and patients have the benefit of you as their pediatrician. Before we started recording, I was telling Lindia that I was at the first shoveling of the first block of dirt in the construction of the School of Medicine. And for our listeners, if you ever have the opportunity to come visit, it’s one of the most advanced, one of the most spectacular medical education campuses around. Ted, you also are a tremendous leader and advocate for physician education and residency programs, and I’m just in awe of what you oversee on behalf of The Permanente Medical Group. Could you speak to your current role and journey overseeing the space for Kaiser Permanente? 

Ted O’Connell (04:42): 

Absolutely, Chris. As you mentioned at the outset, my current role is director of Medical Education for Kaiser Permanente in Northern California. I oversee our 21 residency programs and 15 fellowship programs as well as the approximately 1,100 residents who rotate with us every year from our affiliates at institutions such as Stanford University, UC San Francisco, and UC Davis. And they really come to Kaiser Permanente because of the clinical excellence and the great training provided by our medical centers, which is the real draw for those university partners. I also oversee the clinical rotations for about 450 medical students who rotate in our facilities each year, as well as our many pipeline programs that support students on their journey into careers in health care. And we have a particular focus on those who are from backgrounds that are underrepresented in medicine. I also lead our CME (continuing medical education) portfolio, which provides over 5,000 individual CME programs annually for TPMG’S 10,000-plus physicians. I realized during medical school and then into residency that I really enjoyed teaching and wanted to be involved in medical education and I began my career with the Southern California Permanente Medical Group, where I became a residency program director and served on the board of directors there. And then in 2012 was recruited to TPMG to establish the first family medicine residency training program for Kaiser Permanente Northern California. I helped to develop three other programs in a community medicine fellowship and then took on this current role. 

Evolution in medical education 

Chris Grant (06:21): 

What an exciting journey and wealth of experience. Since the Kaiser Permanente School of Medicine opened its doors in the summer of 2020, and I want our listeners to imagine this right in the midst and in the middle of the pandemic. A lot has changed in the practice of medicine and how we train future physicians. Lindia, I’m wondering if you could speak to what it’s been like overseeing admissions at the school during really one of the most transformative times in medicine, and how has the program adapted and where do you see it evolving? 

Lindia Willies-Jacobo (06:53): 

Yeah, so thanks for that, Chris. And I should point out as well that I oversee both admissions and our equity, inclusion, and diversity office. I’m actually responsible for development and execution of both of our admissions and our EID strategies here at the school. Just always ensuring that equity is at the forefront of all that we do here at the institution. And with that, I will say that working in the admission space has been incredibly exciting. It moves, as you can imagine, at a really rapid pace, and we formally actually started recruiting students for the school in early 2019. It was right after we received our preliminary accreditation. And we’ve been incredibly intentional with our outreach efforts, including reviewing candidates through a holistic approach.  

I think for us here at the school, you mentioned Chris, how our pedagogy is a little bit different. We’ve definitely utilized and leveraged that in our own recruitment and retention of a diverse class, all of whom our mission aligned. Keeping equity at the forefront, 41% I will say of our students come from backgrounds underrepresented in and historically excluded from medicine. And so I think because of the mission, vision, core values and all of the innovation here at the school, we freely had the opportunity to attract as students here who are incredibly bright, very curious, and deeply determined and committed and passionate about advocacy and leadership. They actually enjoy being here alongside us in these transformative spaces. And they’re always finding ways to innovate, to co-create the curriculum.  

And we’ve been fortunate, of course, to have the support of Kaiser Permanente as our parent organization in providing all students in the first five classes with free tuition for their first four years or their four years with us here. And so, I think as it pertains to transformation, et cetera, it’s important to remember that our class who will matriculate in 2024 will be the ones who are going to be last to benefit from that very generous funding that we’ve received from Kaiser Permanente. And we’re now seeking out philanthropic efforts to ensure that we are in fact able to continue to support our students financially, especially those who are coming to us with the least resources. 

The residency experience at Kaiser Permanente 

Chris Grant (09:29): 

Yeah, that’s really quite impressive. Ted, you’re very familiar with our more than 40 residency programs offered by the Permanente Medical Groups. In fact, you’ve led the way on so many of them. Could you give a glimpse into what residency looks like at Kaiser Permanente and how this experience is so unique for young physicians who are just starting out on their careers? 

Ted O’Connell (09:52): 

Sure, Chris. I really appreciate the sequencing here and the opportunity to take the baton from Dr. Willies-Jacobo, as we think about the continuum going from medical school and then into residency and fellowship. Our residents receive their training under the direct guidance of practicing physicians who are known for their clinical excellence and in many cases are nationally known experts in their field. Residents learn about Kaiser Permanente’s integrated health model, both by receiving their training embedded in this model and then also by being taught about what makes Kaiser Permanente unique. And this includes our approaches to innovation technology, continuous quality improvement, inreach and outreach and engagement with our community partners. Our training programs really take a personalized approach to medical education to train the best physicians possible, while also encouraging leadership in medicine. We promote diversity and inclusive learning environments with an intent to develop a physician workforce that represents the communities we serve. And we do all of this while promoting physician well-being and fostering essential wellness habits so that a long career in medicine can be sustained. The bottom line is we’re really proud of our graduates who we think blend a warm bedside manner with the best in cutting-edge medicine. 

Chris Grant (11:19): 

I love the focus, Dr. O’Connell, that you have on physician well-being. It’s a difficult pathway to go through medical school and residency and all of the demands that come with it. And you’re teaching skills on how to care for yourself as you’re taking on the demands of caring for many others. 

Ted O’Connell (11:36): 

Absolutely. 

Supporting a strong future for medicine 

Chris Grant (11:37): 

Many health systems are navigating clinician shortages right now, including the need for more physicians. Data from the Association of American Medical Colleges, the AAMC, shows that the U.S. could see a shortage of up to 124,000 across all specialties by 2034. I’d love to hear from both of you on this, how do you think we can address the issue and keep the physician pipeline strong? Lindia, why don’t we start with you here? 

Lindia Willies-Jacobo (12:08): 

Yeah, thanks Chris. And I was going to say, before responding to that, just listening to Dr. O’Connell and hearing the importance of physician well-being as our students potentially transition into residencies at Kaiser Permanente was really important to know that here also at the school well-being is also at the forefront of what we are trying to do with our curriculum and our co-curricular spaces. So that level of intentionality was just wonderful to hear about as well. And one of the things I would say, I spend a lot of time thinking about the physician workforce, especially through an inequity and inclusivity lens. And I will say for me, ensuring that the physician workforce is diverse requires a lot of intentionality as well as knowing the data. Because I think it’s really important to know where one could potentially put resources and maximize output from that. So I’ll just share one data point that I think you’re likely familiar with, and that is that about 12% of the U.S. population are Black, yet nationally only about 5% of physicians are Black. 

And I think when you start to disaggregate those numbers, it’s even more stark if one looks at the trend of Black men applying to and matriculating into medical schools. So recently the Association of American Medical Colleges considered this a national crisis, especially in the context of recognizing that there has not been a whole lot of change in about 35 years, and in fact, in some cases, a bit of a decline. So I think the way I think about it through my EID lens is that as far upstream as we can place our efforts, I think the better off we will be downstream. What I mean by that is ensuring that part of our strategy is exposing kids as young as possible to the thought of becoming doctors. I think it’s pretty cliched, but we often say it’s hard to be what you can’t see. And I’ll say here at Kaiser Permanente Bernard J. Tyson School of Medicine, a lot of our pathway efforts are in doing just that. And when I was at UC San Diego, many of our efforts was ensuring that we were providing support throughout the entirety of the educational journey, but remembering that a lot of this begins quite early. So looking at how to engage middle schoolers and high schoolers into the field of medicine or health professions is going to be important to addressing these shortages. 

Chris Grant (15:06): 

Ted, I’m interested in your thoughts on both the criticality of this outreach to diverse populations for future physician workforce, but also how the heck do we solve for this 124,000 physician shortage that’s predicted? 

Ted O’Connell (15:22): 

Well, Chris, it’s a really big problem to try to tackle. And in addition to what we’re talking about here, it’s also going to take approaches around health policy and advocacy efforts to really address it. I think the core of my answer echoes and maybe builds on a bit of what Lindia had to say, and that’s really recognizing the value of starting really early in the process and thinking about what the potential pool of future health care practitioners looks like. In my mind, we need to be thinking about physicians, and we also need to be thinking about the rest of the U.S. health care workforce because there are real shortages in nursing and in all the other allied health care fields. And I really believe we need to be expanding the pool of people who potentially see them[selves] as future health care practitioners. And that means nurturing pipeline programs and providing mentorship and support to students who might not otherwise have this exposure to health care in their lives and might not otherwise imagine themselves as future physicians, which gets to Lindia’s point about you’re not going to become what you don’t see. 

And so really trying to provide exposure and mentorship, especially for students who are from backgrounds that are underrepresented in medicine. And then it’s important to really nurture these relationships and continue to support the students on their educational journey because there are lots of opportunities to drop out of that, so-called pipeline without adequate support. So we need to be thinking about that. And then on the other end of the continuum, I think it’s important to engage in health policy and to push for residency expansion, as this is where one of the current bottlenecks in the U.S. health care system exists. We’re getting to a pinch point where there just aren’t enough residency training programs to train the number of physicians that we need. And then there are other mechanisms that probably need to be evaluated as well to address the workforce shortage, and that includes potential pathways for international medical graduates to enter into our system, to create incentives for individuals to work in physician shortage areas, and a number of other policy measures that I think can be addressed. 

Chris Grant (17:41): 

Really thoughtful insight. Lindia? 

Lindia Willies-Jacobo (17:44): 

Yeah, I was going to say, Ted, that so resonates. I think that last comment around the importance of expanding residency slots. I know that we, every couple years or every year, there are a couple new medical schools that are emerging, right? And our residency programs are not keeping pace with that, so I think that’s such an important point as well. 

Ted O’Connell (18:08): 

Yeah, the medical school seats are expanding at a rate greater than residency seats. 

Championing equity, inclusion, and diversity  

Chris Grant (18:15): 

Yeah, such great insight. I want to expand a little bit on this theme. So one vital part of supporting strong physician pipeline is building this diversity, equity, and inclusion in the medical workforce. Lindia, your work supporting equity, inclusion, and diversity efforts for the Kaiser Permanente School of Medicine and for the program in Medical Education Health Equity at UC San Diego, I’m interested in what are some of the ways in which you are working to foster this approach? 

Lindia Willies-Jacobo (18:46): 

I think one of the benefits of our school is that equity, inclusion, and diversity — EID as we call it here — is really deeply embedded in everything that we do. So the framework we utilize in our office of EID is that we are ensuring that the entire community feels supported as it pertains to medical students specifically and attracting students to the school who themselves are from diverse backgrounds. I think for us it’s been important to ensure that our medical school curricula are covering and have topics of equity, anti-racism, bias mitigation, health disparities and inequities, deeply embedded. We’re fortunate here to have a health system site, a department which we partner with to address a lot of these issues. I think if you look at the literature, it really suggests that groups who are historically excluded from medicine are more likely to enroll, and even staff and faculty are much more likely to come to medical schools that are boldly addressing these issues head on. 

I think, again, venturing back to that student piece, ensuring that students and others in our physician workforce are feeling well-supported financially, with appropriate growth opportunities, paying attention to their well-being, and ensuring that community building is central to the work, where all who occupy our spaces have the opportunity to feel that deep sense of belonging. So I would argue that much of what we’ve spent our time doing at the school through an equity lens has been with intentionality and ensuring that we are constructing spaces across the school whereby it’s who we are. And so that’s been wonderful to see. 

Chris Grant (20:44): 

Actions speak louder than words, right? Ted, I know building diversity, equity, and inclusion and medical workforce is central to the work that you’re leading. What else do you think needs to be done to influence positive change in this area? 

Ted O’Connell (21:00): 

For this, Chris, I’m going to go back to our previous thought about expanding the pool of potential applicants. And one of the things that really just needs to happen is some real opportunities for mentorship so that these initial relationships that we develop at events like this are followed up with continuous relationship building, mentorship support for these students, and then going along further holistic review of applications into medical schools and into residency training programs. And then, as Lindia mentioned, it’s not just support and recruitment on the front end, but once these students and young physicians have joined our organizations, really trying to ensure that we’ve created an inclusive, supportive environment for them to be in so that it feels welcoming, feels supportive, and provides the infrastructure that’s really needed to ensure success. 

Words of wisdom for early-career physicians 

Chris Grant (21:59): 

That’s wonderful. I’d like to wrap up with a final question for both of you, and this is my [most fun] question of all. It’s such a critical time for physicians to be entering the workforce, and it’s a great period of change. We have a lot of listeners that are hoping to go to medical school or are in the midst of medical school or their residency program, and they need mentors, luminaries, such as both of you. If you could give one piece of advice to medical students or doctors just starting out on their career path right now, with all the knowledge and experience and wisdom that you’ve assembled over your careers, what would it be? Ted, why don’t we go ahead and start with you first. 

Ted O’Connell (22:45): 

Thanks, Chris. I think I’m going to go broad with my answer and say, make sure that you’re pursuing something that you really love doing, whether it’s medicine or anything else, because having a passion for your career I think is really critical to having both success and well-being over the long term. 

Chris Grant (23:05): 

Isn’t that the truth in everything? What’s the old saying? That if you love what you do, you never work a day in your life. Lindia, I would love your words of wisdom. 

Lindia Willies-Jacobo (23:15): 

Yeah, I would point out the journey is long, right? And it is not without its twists and turns and it’s not always going to be easy, but I often remind folks to not be discouraged. I think finding good mentorship is going to be important along the way, and I think the journey is well worth it. 

Chris Grant (23:34): 

That’s great advice, and it is a circuitous pathway. I’m the dad of a doctor that’s finishing residency and headed into fellowship this year, and so I’ve had firsthand experience to watch that pathway and it’s anything but a direct line. It’s a very circuitous pathway, but one that also has so many rewards and learning opportunities and gratifying moments along the way.  

It’s been really inspiring speaking with both of you and I could continue this conversation for hours, but I’m feeling really excited about the future of medicine after hearing both of your insights and your words of wisdom today. I hope that there’s future students and current doctors within our system that are listening to this and feeling as energized as I am. So I want to thank you for joining us today. Ted and Lindia, our future physicians are in great hands with the two of you leading the way.  

Lindia Willies-Jacobo (24:30): 

It was truly a privilege. Chris, I really enjoyed this time with you and Ted. 

Ted O’Connell (24:34): 

And Chris, thank you for what you’re doing with this podcast and the opportunity to come on and talk about what we’re doing in medical education within the organization. And I appreciated the opportunity to meet Lindia for the first time and have this conversation together. 

Chris Grant (24:50): 

Thank you both and onward to the future of medicine, and I want to thank once again our listeners for tuning in. If you enjoyed this episode, please take a moment to subscribe or share a review. We’ll see you next time. The opinions expressed on this podcast are those of the speakers and are not necessarily the views of Kaiser Permanente, the Permanente Medical Groups, or The Permanente Federation.