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Zach Klaassen: Hello, and thank you for joining us for the UroToday discussion. We're at the AUA 2023 in Chicago. My name is Zach Klaassen. I'm a urologic oncologist at the Georgia Cancer Center in Augusta, Georgia. And with me today is Dr. Kirsten Greene, who is the chair and professor of the UVA Department of Urology. It's great to have you here. Thanks for joining us.

Kirsten Greene: Thank you so much for having me. It's great to be here.

Zach Klaassen: I'm excited to talk about leadership and what that means to you. And I think just high level, what does leadership mean to you and why are you passionate about it?

Kirsten Greene: I think it can mean a lot of different things. A leader can be someone who's inspirational or innovative. It can be a thought leader or it can be somebody who tackles tough problems and has the courage to speak up and say, hey, that's not right, or let's go on a different path, or change people's minds. So I'm passionate about it, I think because I've had great leaders in my career and I'm here because of them.

Zach Klaassen: Name some of those people. Who's been influential to your career?

Kirsten Greene: There's so many. So Peter Carroll, Jack McAninch, Marshall Stoller, Lou Kavoussi. And it's people from all over who have helped me. Alan Partin. That's just to name a few. My Dean, Melina Kibbe. It doesn't have to just be in urology, it doesn't have to just be in oncology as we are. It can be people who've touched you for your entire life to help you get where you are. My mom.

Zach Klaassen: Yeah, that's a good answer. I mean, there is some intersection I think between leadership and mentorship. Would you agree with that?

Kirsten Greene: Yes.

Zach Klaassen: And it seems like these people you mentioned are also mentors as well. Is there a significant interaction or intersection with that? How would you describe that?

Kirsten Greene: I think so, but as you're saying this, it makes me think mentors can be peers as well. And so someone who really helped me, who's junior to me is Sima Porten. And Angie Smith, people who said, you know what? We want you to try for that job. Even if you don't get it, somebody's got to do it. And we need somebody to look up to. I think mentors can introduce you to new people. Their sponsorship is an element of it, but then there's also role modeling. Who do you want to be? And it doesn't have to be someone who looks just like you or is just like you, it can be someone who maybe embodies different elements that you aspire to professionally or personally as well.

Zach Klaassen: I've heard you talk about your application process going for the UVA chair job, and it's very inspiring. And I think there's probably people out there that are maybe thinking about doing that process. They've got promoted to associate professor and at that point in their career where they just have to take that step. Maybe break that down for the listeners a little further.

Kirsten Greene: Well, I would say if you're thinking about doing it, try it. Just try it because I have spoken with so many men and women who say, well, I want to do that someday, but I'm not qualified yet, or I just can't get that job. And the truth is, when you put yourself out there, it's scary. It's a risk. And you have to face that rejection at a time where you're not getting a lot of rejection in your career, but just trying, it makes people think about you differently. It makes people say, oh, I didn't know she was interested in that or, wow, I never realized that he wasn't perfectly happy with exactly what he did and wanted to take this next step. So it is hard, but just try. No one's going to know. I think I was always afraid people would look at it and laugh and be like, ugh, who does she think she is? She is so unqualified, but no one's going to do that. That's not how it works. So just give it a try.

Zach Klaassen: Urology is a small community, obviously, and so I think people, correct me if I'm wrong, they're respected. They see that you're motivated to take that step. And at least in my mind, it would be surprising if people wouldn't see that as a positive. Right?

Kirsten Greene: Yeah.

Zach Klaassen: You've been chair now for several years at UVA. Talk to us about how you develop leadership in your junior faculty, your residents, even your medical students that are coming through. What's sort of your process at UVA?

Kirsten Greene: I think, well, first of all, all of our students and residents and faculty are amazing.

Zach Klaassen: Yes, we have great colleagues around us. Don't we?

Kirsten Greene: We do because we have the best students who go into urology and that just continues on. So pretty much everybody I work with has the potential to be an unbelievable leader. And I think especially starting at a very young age with the medical students, making them know your opinion's important, your voice is important through the SAU, there's a lot of different things I work on. And so getting their input, what do you think about this? How would you do it? Same with residents. Anytime there's an opportunity in the health system for someone to be involved, I want my faculty to do it. And I'm trying to get them out of that idea of I'm too junior, I'm not ready for that yet. It's like, no, get on this committee. Tell them what you think. You're a frontline physician. You have to get out there and share your thoughts. So I think just helping everybody get involved at all levels and overcome that fear we all have that we're not quite good enough yet to do it. 

Zach Klaassen: Yep. Absolutely. You mentioned a few minutes ago sponsorship. Describe what sponsorship is and some examples of how you've integrated that into your department.

Kirsten Greene: Sponsorship is, to me, when someone gives you an opportunity or helps you get a seat at the table. And it's different from mentorship, right?

Zach Klaassen: Yes.

Kirsten Greene: The sponsor can be someone, as an example, here's a great example actually. Chris Kane, who's wonderful and I worked with when I was at UCSF, and he's been incredibly successful. He's the reason I got into the SAU. I still remember he nominated me. I wasn't even in the room. He's like, "I'm going to nominate you for an at-large member," and now I'm SAU president. And it's because years ago, Chris Kane thought of me and was like, I'm going to nominate her. So he got me in the door and a seat at the table. And that's what sponsors do. They try to help you. They say, maybe he wants to do it, maybe he doesn't, but let's ask him instead of always asking the same people. So that's sponsorship. And I think it's just as important as mentorship.

Zach Klaassen: I totally agree. I mean, I think it's the ultimate altruism. I mean, you or me, we could have an opportunity to do this, but we maybe have 16 other things going on. Or really, it's truly, no, we should see if we can get the junior person in to either be on that committee or give that talk. I think that's important. I mean, I think when we look about building up the next generation, the workforce, the diversity of it, that's important. Correct?

Kirsten Greene: That is correct. Yeah. And there's so much work to do to your point. I mean, how many abstract committees are there? And then how many unbelievable junior faculty would love to get a start on the abstract committee?

Zach Klaassen: That's right.

Kirsten Greene: Because you read the abstract, it sparks an idea. Maybe you actually reach out to them to say, hey, I read your abstract. It was awesome. Let's collaborate. So that's how you make everything stronger. And I don't need to read the abstracts, you don't need to read the abstracts, but there are people who are dying for this chance, so let's spread the wealth. Right?

Zach Klaassen: Let's give it to them.

Kirsten Greene: Yeah.

Zach Klaassen: As a program director at our institution, I often think about is there books that we should have the residents reading? We don't want to add extra workload to them, but is there certain books or podcasts where you say, listen, if you have time, this is really something that would be helpful for all of us to listen to. Do you have go-tos?

Kirsten Greene: I mean, that's a really good question. I kind of feel like I start a little bit of a lot of different podcasts. There's one that was Givers, Takers and Splitters. I think that was really good. Just learning about different people to identify in your life. Who's going to just kind of give and give? Who's going to take and take? Who do you put your time into? I've heard Good to Great is terrific.

Zach Klaassen: That's also very good, yeah.

Kirsten Greene: Getting to Yes, I think. But a lot of people have this instinctive idea about EQ and that you can't have everything that you try for. So you have to give a little bit.

Zach Klaassen: What's your philosophy in terms of, there's always a saying there's natural born leaders. Can people develop to be leaders? Or do you think there's, what component of it is just sort of natural burning within a person soul?

Kirsten Greene: I think you can develop it.

Zach Klaassen: I agree.

Kirsten Greene: Yeah. I think there are people who naturally do the work. There are people who naturally figure out the problems or have an operations strategy kind of mindset. But yeah, I think you absolutely can learn it and you can be going down one path in your life and things can change in usually a bad way, and you have to step up and do something. Yeah, I think you can absolutely learn it.

Zach Klaassen: At my institution, one of the first female chairs of a department, Dr. Martha Terris.

Kirsten Greene: She's amazing.

Zach Klaassen: And I know you are now in that seat. You don't have to name names, but just give some examples of situations where people have reached out to you now and say, hey, you're in this spot. How can I do that?

Kirsten Greene: I think people ask that all the time. And maybe because I am a little different than other chairs. Maybe because I kind of got here through a different path. I didn't have an RO1 lab and all these different things. I hope that it helps my success seem more approachable. I got here because a lot of people helped me get here, and I am absolutely willing to help anybody.

Zach Klaassen: That's great.

Kirsten Greene: So I'm hoping that people who have questions can feel more comfortable reaching out. Maybe because I'm not such a big deal. I'm going to help anybody, everybody helped me get here. But what I've liked about it is that sometimes it's a student saying, I'm in a program and I don't have anybody to mentor me. Or it's a faculty member saying, I kind of feel stuck. And I know you made a big change and how did you think about the problem? And then just other female chairs, it's kind of natural for us to stick together a little bit. Or new chairs. That's the other thing.

Zach Klaassen: Absolutely.

Kirsten Greene: A lot of new chairs, we have a little support group, I won't name the names, but we have a little new chair support group that we meet quarterly.

Zach Klaassen: That's awesome.

Kirsten Greene: And it's not all women, but we all have the same problems.

Zach Klaassen: I think too you mentioned a good point. We don't take ourselves too seriously now. We have the best job in the world. We get to train the next generation of urologists. We get to take care of patients. And then we have these extra responsibilities of whether it be chair of a department or residency program director. If we take a high level view, it really is a lot of fun and it's all aspects of that. So it's been a great discussion. Can you give our listeners, say two or three, just take home messages with regards to leadership and anything maybe we didn't touch on that you want to mention?

Kirsten Greene: Yeah. I've been thinking about this a lot lately. I think humility is incredibly important.

Zach Klaassen: Yeah. Good one.

Kirsten Greene: Just remember, we're all lucky to be where we are. If you're in a place of position or power, you better be grateful to be there. And you better remember what it was like when you weren't.

Zach Klaassen: Yeah, because we're all replaceable, right?

Kirsten Greene: We're all replaceable and we're so lucky to have this job. That's a good point. I think remember, you're not too good for anything. I will do any job. I will wheel a patient down the hallway. I will bring them a glass of water. I will take their trash out of their room because it all comes back to the patients. I think as a leader, you have to remember that everyone's job is just as important as yours. So that's the second thing. And then I guess the last is it really is all about the patient. They're the center of everything we do. They're why we have a training program.

Zach Klaassen: That's right.

Kirsten Greene: Or a hospital or a department or research. So just be a really good doctor.

Zach Klaassen: Yeah. That's great advice. I really enjoyed it. Thanks so much for joining us, Dr. Greene, and thank you for listening.

Kirsten Greene: Thank you.