Mary K. Mulcahey, MD: Welcome everyone to the Lead Change podcast. I am so excited to have my good friend and sports medicine colleague, Dr. Ron Navarro on the podcast today. Dr. Navarro is the director for clinical affairs at the Kaiser Permanente School of Medicine, where he helps medical students and many of his practice partners in the clinical integration of their studies into the Southern California Permanente Medical Group practice via longitudinal integrated clerkships. He also has attained the academic rank of full professor in orthopedic surgery.

Mary Mulcahey: Welcome to the Lead Change podcast. I'm your host, Dr. Mary Mulcahy. I'm an orthopedic sports medicine surgeon with a huge interest in contributing to the growth and development of other leaders. On this podcast, we will share stories from many leaders in all medical specialties to understand the skills necessary to be an effective leader. We'll celebrate their success and hear about strategies to overcome hurdles. We will also highlight some of the unique challenges faced by women in medicine who are interested in pursuing leadership positions and the importance of mentorship.

Mary K. Mulcahey, MD: in the Department of Clinical Sciences at the Kaiser Permanente School of Medicine. Dr. Navarro is a proud fellow of the American Academy of Orthopedic Surgeons and is a member of the AAOS Leadership Institute Mentoring Group. He is a well-published author in shoulder and knee surgery, and he is an active member of the prestigious American Shoulder and Elbow Surgeons and its exclusive Nier Circle. He is also proudly a member of the American Orthopedic Association.

Mary Mulcahey: sponsorship, and allyship in achieving and being successful in those roles. Let's work together, build on shared experiences, learn from those before us, and use these lessons to propel us forward in our career. Let's lead change.

Mary K. Mulcahey, MD: He previously served as a member at large of the board of directors of the AOS from 2017 to 2019. He was the president of the California Orthopedic Association for the 2019-2020 year as the COVID-19 pandemic unfolded. And he helped to plan the response to the pandemic as it related to the practice across the state. He has been deputy editor for levels of evidence with the journal Bone and Joint Surgery since April, 2022. and he currently serves as the president of the American Association of Latino Orthopedic Surgeons. Ron and I have been friends for several years and we've worked together in multiple capacities through various orthopedic organizations. I always enjoy any opportunity we have to connect. Ron is optimistic, enthusiastic, engaging, and incredibly supportive of me and many of our colleagues. I'm really looking forward to talking to Ron about the experience he's gained in his many leadership roles and how he has carried that forward in his career. Ron, welcome to the podcast.

Ron Navarro: Mary, so nice to be here and thank you and all that stuff. You know, we're all fairly bashful. It's like, ⁓ you hate hearing about yourself. I just want to hear about you. you

Mary K. Mulcahey, MD: it's great. There are so many accomplishments and I'm excited for you to share a lot of your experience and really dive into some of these roles. But before we get to that, ⁓ of those leadership roles, I was hoping you can share with us a little bit about your clinical practice and just kind of highlight your areas of interest and expertise.

Ron Navarro: Sure, know, my life in Kaiser Permanente has been 28 plus years and I first came in as a sports medicine doc. So I did a lot of everything before we hired up and there's a story to kind of how the practice evolved. and, ⁓ I was doing total knees. was doing, ⁓ gosh, ankle fusions, arthroscopically crazy stuff in the beginning, but it's really settled out to be more sports medicine and a lot more shoulder surgery and arthroplasty. I have a special interest in some of the fractures from my primary training at Harbor UCLA. So sometimes I think specially about some of the more difficult shoulder fractures, the lateral or distal clavicle fractures. And I've thought through.

Mary K. Mulcahey, MD: well.

Ron Navarro: some of the solutions for that. And I'm starting to think more about solutions for things like greater tuberosity fractures, but I do a lot of shoulder, otherplasty and cuffs.

Mary K. Mulcahey, MD: Wow, yeah, I didn't know really about that evolution, but it's great to hear kind of the transition throughout your practice and over the many years and doing total knees and now focusing largely on shoulder and complex shoulder and bringing in that trauma experience. Like it's so helpful to have that background and working on trying to develop new techniques and treat these very difficult problems. So ⁓ it's great that you have that experience. You know, you have served in several very important leadership roles within and outside of your institution. As I mentioned briefly in the introduction, from 2017 to 2019, you served as a member at large for the AOS Board of Directors. So congratulations. That is amazing. That's a difficult position to get. But what were some of the main lessons you took away from serving in that role?

Ron Navarro: I found there was great complexity to the work of the Academy. ⁓ during my time, we had introduced the brand new CEO, Tom Aaron, and ⁓ the CCO came with him, DeMollis. And so ⁓ ⁓ We really felt like we were bringing them on to a certain degree. I was sort of new to the group when they came on, like just like maybe a month or two difference, but still it was really important because they brought new thinking and I found it enlightening to some degree how the AOS had been and how they would later influence to what. could be. So that was a great thing to see. I got to participate in the strategic plan of 2019, which had been the first in a long time for the Academy. It really set the Academy in a much bigger, different direction that included like a lot more inclusivity and diversity and like attention to a lot of things maybe the Academy had not been thinking about as intentionally up to that point. So I thought that was great. Not all we're happy with these changes too. So I saw some strife and ⁓ kind of ⁓ how to navigate through kind of ⁓ unhappy board members and that sort of thing.

Mary K. Mulcahey, MD: Yeah, what an interesting experience that must have been and so unique to to be there during a time when there was major leadership change, right? So to come on to be there with the transition of a CEO and a very high level leadership in the Academy must have been really interesting. with that certainly does come other changes and new vision. And so it's great that you and the others on the board at the time had the opportunity to be there and kind of help support that change.

Ron Navarro: Crazy times.

Mary K. Mulcahey, MD: And I remember, I remember that strategic plan that came out during that period of time. And that was really, I don't know, was really a lot of new ideas, a lot of great direction, big changes. So I can imagine that there were some, a little bit of strife, as you mentioned, a little bit of opposition from some, but a lot of great ideas came out of that. And it's been incredible to see how that has moved forward over these past several years. So very cool that you got to be part of that with the implementation and development of the strategic plan.

Ron Navarro: just the of like going through the exercise of a strategic plan session ⁓ and the people that were like the party vendors who came in ⁓ and helped to direct us, because none us know how to actually do the mechanics of this. You need people who are specialists in that. ⁓ And that alone was really eye opening. ⁓ I've participated in other strategic plan work with the ⁓ American Shoulder and Albo Surgeons and then with the ⁓ Latino ⁓ Association as well since then, and also some work in my own organization in Kaiser Permanente. so it really was a kind of a landmark time in it. And as you said earlier, it was one of the biggest ⁓ honors of my professional career to be a part of the the Academy's board, you know, for sure.

Mary K. Mulcahey, MD: it's ⁓ incredible, I'm sure, see the behind the scenes, like what's happening with such a major organization. You really learn a lot of the ins and outs and how the society functions and what are the priorities and to be part of the development of a strategic plan. like that is really a guiding principle for whatever the defined period of time is, a three year, a five year strategic plan. But that is what helps the organization make decisions, right? That is the organization saying, these are our priorities. And as we move through the next three to five years, this is going to be our guiding light. and incredible that you have that experience and bring those skills to ASES ⁓ to bring it to Kaiser and to like help use that to develop strategic plans in these other ⁓ areas as well.

Ron Navarro: Yeah, we don't know what we don't know. And as orthopedic surgeons, your life and my life, was, you know, four years of college, four years of med school, five years with orthopedics, maybe more if you did research and then a fellowship. None of that is a month in strategic planning. None of it. So it's really kind of a great flexes parts of your brain you've never thought of before. And then like you said, it acts as like an intentional roadmap and kind of makes you be

Mary K. Mulcahey, MD: No, exactly!

Ron Navarro: honest with your goals and really provides tools to achieve the goals. it's really great. And it's it's hard work because ⁓ some of stuff I always used to think, ⁓ it's just kind of like, you know, corporate speed. But when you finally do it, you go it's it actually works too,

Mary K. Mulcahey, MD: Yeah, it does work. And it's so, so important the time, the effort that's put in, ⁓ but we don't learn of that. We learn a lot in medical school, residency, fellowship, even being in practice. We do not learn how to do that. ⁓ And so as certainly leaders, as aspiring leaders, it is great to have that exposure and to gain that skill. ⁓ And ⁓ so that was that you were able to translate to other areas, other leadership roles.

Ron Navarro: Absolutely.

Mary K. Mulcahey, MD: Were there other things, what else from your time and your term on the board of directors has then translated and helped you in your career?

Ron Navarro: I think it ⁓ led to understand confidentiality more. There were inner workings that occurred during my board time that were critical to the board. I really to learn that we had to keep those things secret. And, you know, it's not ⁓ from the group, but just important to kind of keep what's in the room, in the room many times. We've faced heady issues. ⁓ really kind of feel like that's the way a cabinet is in a presidential term. They probably talk about a lot of things that would affect us in the country and they can't always share every single thing in the moment. Eventually you learn the directionality of things, but it was really interesting. And now I know that I'm not on those boards and there's things that are going on that I'm not privy to and I just have to accept that because that's the way it goes. On a more basic level, it really led to great other opportunities within the academy. was an instructional course book editor. ⁓ then later in concert with Matt Provencher, I know you've had him on your and we both love him. He and ideated to create this idea of orthodome when he and I both the annual meeting committee was leading and I was one of the members. And he just threw it at me and he said, Ron, ⁓ thing, we need live videos. We need to do this and that. And I said, wow, it's like the Cineramidome. And then he said, Orthodome. So that was the genesis of the funny name that it has. ⁓ so ⁓ that, he just kind of gave me the keys and let me drive.

Mary K. Mulcahey, MD: Wow.

Ron Navarro: what it might be after an initial sketch. And I kept checking in with him and the Academy staff. And then one of the AV companies that was serving the annual meeting, in concert with them, we really kind of blew that idea up. And now it's one of the most ⁓ sought after, ⁓ you know, events and learning situations at the Academy meeting. And so I'm really proud of that. And Matt and I kind of, co-creating and once again, a different kind of the to be ⁓ creative and think out of box, ⁓ big imagery, focus on the and ⁓ let folks be there. ⁓ You know, there's other things at the academy where you can learn and you have the headphones on and people walk by and say, ⁓ that guy doesn't know how to do a ladder. He's learning over there. But when you're with the teachers and you're there, you're actively learning from them how to do the latter. Jane, they're showing their view, their images, and you get to ask them questions in the moment. I think it's a more like, ⁓ fruitful and rich experience.

Mary K. Mulcahey, MD: I had no idea. I it's great to hear about these many other opportunities that have come from your experience on the board. I did not know this story about orthodome. Like, I mean, I, you know, I knew that Matt was involved in ⁓ creating that. I didn't that you guys work together. So that's amazing. ⁓ this is absolutely tremendous surgeons. This is like, This is like Disneyland. This is like seeing the surgery. You are right there. It is huge. It's like you are in a movie theater watching the surgery happen. It's right in front of you. And the surgeons doing the surgery are there. As Ron was saying, they're there. They're answering questions. They're pausing. They're walking through. They're telling you the steps. It's really an incredible learning environment. So amazing. And it has absolutely, it's taken off. It's so well received.

Ron Navarro: ⁓ the board time, really gives you some street cred organized ortho. I also say it's fleeting unless you're intentional about remaining ⁓ in that organization or other organizations. ⁓ There's always new folks coming up they want to kind of, be too. And you also have to allow others to be involved in ⁓ But, ⁓ Hey, I am a hard worker. I just want to do the work and not really bask in the power of the role or perceived power. And, ⁓ and we both know like this whole academies, large construct and specialty societies are kind of exerting their own, will we've seen that too. And I saw some of the transitions there and still yet to be determined what's going to be like the outcome of Big tent or lots of small tents and small tents becoming your own big tents. I'm a believer and we got to stay together, but that's just me.

Mary K. Mulcahey, MD: Yep. We'll see. Yeah, we're stronger together for sure. sure. So, Ron, you were elected to serve as president of the California Orthopedic Association from 2019 to 2020. so in the US we have several national orthopedic organizations. We've touched on some of these already. But each state also has their own orthopedic society or association. So, Ron, can you tell us a bit about the role of the state orthopedic societies, the association in general, and what role does that group serve?

Ron Navarro: Yeah! Yeah, you know, as a leader in my medical group, I represented over 200 orthopedic docs in Southern California, but only those who worked in Kaiser Permanente. ⁓ But once I got to be president of the COA, the California Orthopedic Association, I was really working with other leaders in the board to represent the interests of every single orthopedic physician, surgeon in all of California. And so it was an awesome experience a daunting responsibility. In a way, state societies, they're like a guild, they're really trying to vitally protect the constituents who are orthopedic surgeons in a way of life. Whereas Academy, in some ways, I see it as more of a professional org that serves even more multiple functions. State level, as you know, advocacy is really critical because it's really at the state level where most legislation that affects the practice of medicine occurs. So as a state leader, you're involved in a lot more state level advocacy but it was once again, another way of thinking and learning. Wow, especially in private practice, if we're going to allow private practice in whatever form that looks like in the future to continue, it's really at the state level that there's advocacy that goes on to protect the practitioner, the five in practice. And you're in a great city in Chicago, ⁓ you have your great academic practices and you have private practices. ⁓ in that role, I really saw myself as somebody who was trying to protect everybody. and make sure all their lives were still being fruitful. They weren't getting burned out. They were still being paid in their way of life that they had earned and that sort of thing. In that way, it is more like a guild than a professional organization, in my opinion, once again.

Mary K. Mulcahey, MD: thanks for that sort of clarification, that description. I think it's really important for people to understand the difference ⁓ in ⁓ maybe the but also ⁓ the role that state societies serve as compared to a large organization like AOS, for example. And advocacy is a huge, huge, huge part of that. Absolutely. So during your term as president, what were some of the main initiatives that actually you

Ron Navarro: Mm-hmm.

Mary K. Mulcahey, MD: hoped to move forward and were ultimately successful in doing.

Ron Navarro: we were creating more opportunities to kind of once again influence these better environments for orthopedics ⁓ and their In the first part of my term, we did a lot of work with and I don't know if qualified medical examiners who adjudicate kind of the ⁓ payment for injured worker ⁓ is big Illinois, but in California, it's really big. we, during my term, and it wasn't just me, there were lots of great... ⁓ content and thought leaders who were surgeons who were also on the board to help with this. We kind of helped ⁓ redevelop the the billing occurs and to make sure it's fair ⁓ and to sure that the workers were protected, but also to make sure that the surgeons who did this sort of work had a fair wage. And we are also working on the look of the COA. It's a weird thing, but we worked on the logo-ing and stuff. So that was kind of a fun. ⁓ you know, ⁓ a creative thing. every aspect of this from billing to environmental improvements for the state orthodox, ⁓ I really use the capable experience of our year ⁓ executive director, ⁓ Diane Shapurkowski. She's an amazing woman and probably of the best executive directors out there. She's been in the role many years and we all worry about in our presidential year, if that's the year she retires. ⁓ Because she's kind of the glue we come and go and then and she is amazing. And then as you know, and you mentioned COVID hit and suddenly I was involved in helping many orthopedic docs across the state to deal with keeping their practices afloat. The PPP program became large for orthopedic practices that really relied upon monthly billings and all of a sudden those disappeared. It was a crazy time my annual meeting, the one where I kind of oversee it was canceled. I was sad and it was going to be a nice Southern California resort. And one of my key mentors, Freddy Foo was going to be the keynote, but we were all in a different mode to ensure private practice, especially remain solvent. So it was a crazy year. What a year. Hmm

Mary K. Mulcahey, MD: in anyone's presidential year. There's a lot of demands. There's a lot of ⁓ things that can pop having to deal with a pandemic ⁓ really is unprecedented, of And so huge, huge challenges and unique things that you were facing and trying to help your ⁓ fellow orthopedic surgeons within California work through support them. ⁓ And so really challenging. But I'm sure you and everybody, your whole team took a lot away from that. I love too that you gave a shout out to the executive director, right, for the California Orthopedic Association. It's so important. And I think for any of us who have been on committees or you're working with leadership in our national organizations, you realize that the staff, that the leadership are absolutely critical to how that society functions, how the committees function, how the board functions. ⁓ It couldn't happen without them. so I... I love that you brought that, bring that to everybody's attention and really give her a shout out because you're right, she's the glue, right? And has all this perspective and has been there for many years. And as orthopedic surgeons, we're rotating, you you're there, maybe you're in the presidential line for three, four years, but they're there for 20 years. So, you know, she have a lot of memory, a lot of experience. And it's invaluable, absolutely invaluable.

Ron Navarro: Thank you. ⁓ else.

Mary K. Mulcahey, MD: So you have served in several very, very high level leadership roles and we've touched on some of them. We're gonna dive into a couple of others. But on this podcast in general, we've spoken several times about how as a leader, it is absolutely critical to understand your why or your purpose, right? What it is that drives you. And so I wonder for you, Ron, what is it that really motivates you? What is your purpose and motivation in all that you do?

Ron Navarro: I've grappled with this a lot and asked this question. I've even gotten to some of the genealogy, you know, why do I do this? My dad was a Mexican immigrant. had zero formal education. came to this country first at about 14 and then went back with some money to Mexico and had a business and felt like it was getting kind of like overrun by people who would unexpectedly try and tax him, not government officials, but kind of bad people. And so he finally came back to America and made his life, met my mom who had a high school education and her parents were from Mexico. And he had less than perfect English and had a noticeable accent. He raised five sons. I'm the youngest. have a twin brother. And with my mom, he kind of ruled with an iron fist and I think you have to when you have five boys or else it's kind of pandemonium and I respect what he did now at that time. I didn't always like it. But I told him at one point when I was ⁓ kind of becoming in high school and trying to think about jobs and the like, I just said to him, dad, I kind of want a job where as few people as possible tell me what to do.

Mary K. Mulcahey, MD: Yes.

Ron Navarro: says, mijo, I don't think you're going to find that job. ⁓ You know, but honestly, I also saw in my mom, she was a very strong woman, ⁓ Latina, but ⁓ She, when I was young, I saw her get on TV and ⁓ fight with the LA Unified School District for a new school in our district. we were in a really gritty part of Harbor area of Los Angeles. ⁓ So I just saw she was a strong woman. I saw her strength of character in high school. And then when I, she really took no prisoners. She was tough. And then when time in started, ⁓ I saw the man who hired me in Armenia and Jake Ashkenian, he was chief of the department. He asked me to become the chief of a very small department of orthodox one month after I became partner. ⁓ And it was kind of weird. would just accept it and I rebuilt it a department and that led to other KP roles. But I still ask why, you know, there's this term imposter syndrome and maybe in the beginning I felt like that. But I really tell my mentees to step up and learn ⁓ from experiences even though if they think they're not ready, because I think that's what everybody's doing. I guess that's what I was doing myself. And so I've kind of changed the term to like I found they're all imposters. Everybody's just trying the best job they can. So you're not really going to mess up. And with a couple swings at the bat, you're going to start hitting home runs. And so I just think it's important for us to do that.

Mary K. Mulcahey, MD: Yeah. ⁓ so many great Ron. ⁓ that I definitely wanted to emphasize is that whole idea of like feeling ready. Like if you wait until you feel ready, you're never going to do it. So you just have to take action, which is exactly what you said. Just do it. ⁓ Right. Do it once. ⁓ There's no There's no such thing perfect. So you just have to do it. Do it. And then you gain confidence. The more you do, the more you learn, the more confidence you gain. And so I think that is such a great point. you currently serve as president of the American Association of Latino Orthopedic Surgeons, in orthopedics we say ELOS. ⁓ Can you tell us a bit about the history of this organization? What are some of the main goals?

Ron Navarro: fresh from our strategic plan we did year, I'm so proud of what we came up And we actually use folks from the the AOS first strap plan I worked with and ⁓ them ⁓ independently work us. Our mission ⁓ is to empower orthopedic in advanced Latino musculoskeletal health. The vision, and I really love this, ⁓ is a world where the Latino community moves without pain. You know, we're small, and since I've become president, we've developed a strategic plan. We finally wrote bylaws after about 15 to 17 years of the organization. We've rebuilt our website, which is externally facing. ⁓ and we've improved our student and resident outreach. The growth of Latinos and ortho cannot be denied. There's a lot more orthopedic residents who are Latino. And I want our organization to really capitalize on this moment. You know, we take notes and we really respect the African American or Gladden Society and the women's Ruth Jackson Society, those ortho special interest groups. And I'm competitive. I want us to get to where they are. And with you talking to me, I think it'll help our continued ⁓ growth. So thank you for this. And lastly, in this time of an administration that might take umbrage with some of the sentiments I said in the mission and vision, just cause it's kind of like, that you're thinking we're singling stuff out. We're just gonna still try and do the right work, fly under the radar and also... Ask our mentees not to shrink from the idea of merit and exceptionalism. I love orthopedics beyond everything. So I want our people who are in ortho to be good or great because I love ortho and I only want the best doing it. So we're really trying to thread a needle here that's kind of tight right now, especially with some of the political climate. You know, I don't care right or left. I just want great people and they're Latino. I want you to train them because you're a great teacher and we're just going to keep trying to push this.

Mary K. Mulcahey, MD: Yeah. All right. Yeah. You're right. I think the key is right. We just want the best ⁓ and the brightest and those that are in being in this field to be able to pursue it, ⁓ to be able to have a career orthopedic surgery and to support them, promote them and help them sort of through, you know, difficult like residency is challenging, whether it's orthopedics or other specialties. It's a it's a difficult time. But ⁓ but to have an organization like ALOS to have just that support structure is huge, absolutely huge. to help support these medical students and residents going through their training and to support them as they transition into their career. And ⁓ to this, ⁓ aspect is this podcast focuses on leadership in medicine. And so as orthopedic surgeons and physicians in general, we are all leaders. Whether or not you actually have an official title that goes with it, we're leaders in the clinic, we're leaders in the operating room and in our communities. ⁓ have focused a lot in several discussions throughout the podcast on leadership skills development for practicing physicians and surgeons. And we, though, through research, through many discussions focused on leadership in the academy, in our other organizations, we realize, though, that it is critical to start developing leadership skills as early as medical school or even younger residency, right, supporting through all these stages. So can you share with us some of the leadership training opportunities that are available to medical students and residents through ALOS?

Ron Navarro: this is great. know, ⁓ felt that were some folks who could really help us. I brought on Rafael Sierra of Mayo, you know, he's a big total joint surgeon, and ⁓ he's the new leader of our programming, our board member overseeing programming. some of these ⁓ programs ⁓ existed before him, but he's really helped us to kind ⁓ find more opportunity so the very first is you can be a resident member of the board with full voting rights and we have a a resident from on a few or chris escalator is in that role right now you can be a medical student member of the board of full voting voting rights via our bylaws which should be just enacted over the beginning of last year and that's daniel herrer is that a medical college of georgia ⁓ pray that he matches ⁓

Mary K. Mulcahey, MD: Wow.

Ron Navarro: We just started because we had opened a new website and know websites really like internal to them. They're really informational places. So the external facing environment is critical. It has have the right look and we ⁓ enacted a new one it didn't have a lot of content. So we just picked two student. ⁓ Latino and Latino medical students, third year students from Ponce of the medical schools in in Puerto Rico. ⁓ And are new ⁓ and they have really improved and loaded the ⁓ content and really improved it and learned some of the inner workings of programming of a website. ⁓ It's intricate work, I don't have the time to do it, and they have done just a bang up job. It's really helpful and they get to join in the board meetings too. We also have some roles for students that lead our two programs where we bring students and residents to the Academy meeting every year, ⁓ funded by, ⁓ I can say it, Zimmer Biomed. ⁓ the Unidos is the student.

Mary K. Mulcahey, MD: Yeah.

Ron Navarro: medical student program and Alvance is the resident program. And so we need leaders to kind of help shepherd the students and residents through each of the programmatic events at the Academy meeting. Some are ALOS organized and some are the Academy's ⁓ offerings and we merge those together. And we actually do some partnerships with Nth Dimensions and GLADDIN too, where we share in some of the events with them. And then annual meeting, have student resident liaisons who kind of help with the conduct of the meeting each year. So those are just a few of ⁓ leadership opportunities. There's certainly other opportunities like research and sharing papers and being involved in other things. But those are kind of ones where at least you can put it on your CV, another line in the CV. And we know how competitive is an orthopedics to show that you're helping an organization organizationally, I hope. ⁓ gain some credence for people who are trying to get those residencies.

Mary K. Mulcahey, MD: Yeah, wow, those are tremendous opportunities. And I think actually quite rare, many or all of them with having board positions as a resident, as a medical student, like that's incredible. ⁓ Very smart to get medical students involved with helping to develop the website. Like they know way more than we do. They're very facile with that. So that is incredible. So smart. they learn, they benefit and the whole organization benefits. ⁓ And then the, mean, the programming I've seen from a distance at the Academy, but I love, mean, the number of students, how many students participate in the program? I've seen them, like, you know, large number of students. Yeah.

Ron Navarro: We'll have about 40 this year. know, ⁓ Gladden has a colored ⁓ sweater and ours, there's typically blue, ours is a green, like a Kelly green, and we switch it up each year. And we're really proud of it because then everybody can spot our students and residents. And it creates a sense of pride amongst them too.

Mary K. Mulcahey, MD: Nice.

Ron Navarro: really just of like, there goes our students right now. It's really kind of a neat thing and they're proud of it and ⁓ it's easy to find them. ⁓

Mary K. Mulcahey, MD: Yeah, I know from a logistical standpoint, but no, they are. They are so proud and it's amazing. I think that all those things that you guys are doing is supporting a lot of that leadership development, giving them that exposure to the board or to committees or to this website to involvement in social media and contributing to a large right? That is really meaningful. And I think many people, 15 years ago, didn't have as, know, 15, 20 years ago, like we didn't have that experience as medical students or as junior residents. So that's incredible that they are able to do that now. And those, that experience, those skills will serve them so well as they move through the rest of their training and into practice. So yeah,

Ron Navarro: No doubt, no doubt. Yeah, you know, I'm also honest with them. I'm like, not every medical students can become a resident and that's our goal. And we really have a lot of work to do to build up the resident ranks because they're there. They're already out there right now. And I just don't know that we have collected them all. And so we're trying to do a lot more resident outreach and still respect and value our medical students and try to grow as many of them into orthopedic residency positions as possible.

Mary K. Mulcahey, MD: Yeah. Yeah. Yeah, yeah, it's an important point. mean, we know orthopedics is very competitive, but giving them this exposure, this support definitely increases their chances and gives them a network to support them through the process. And I think for all of us, our leadership style kind of evolves as we move through our career. And it's definitely influenced by roles we've held and other leaders that we have worked with. So how would you describe your leadership style and how do you find that to be particularly effective?

Ron Navarro: My leadership style, you know, I want to kind of just be a leader who provides others with opportunity. ⁓ You know, I think I want to build a culture in all the little spaces I've been in as a leader to create like, like I want to create it so that ⁓ we show our members how much we care. want to ⁓ care by providing opportunities, course correcting gently when folks get in their own way with poor decisions. And then I also want to teach people to, like I said it before, fly below the radar. It's best to kind of just do your early leadership. you don't need a soapbox really super early on. You want to gain some street cred and then be a voice that people want to listen to ⁓ One of my biggest sources of pride, at least in my medical center team of orthopedic where I brought on younger surgeons. ⁓ I cultivated ⁓ a ⁓ culture of leadership. Many of them are so high functioning ⁓ patient centered that now they've become ⁓ leaders in their own right. in the organization. I'm really proud of that. we just created a serial culture of leadership you know, And so glad they're leading at a level beyond orthopedics even because it's hard because ⁓ do you really care about the urologists are doing or how access is going or, ⁓ know, but ⁓ these folks proven that they care about beyond themselves, they're better than I ever was.

Mary K. Mulcahey, MD: Yeah. Yeah. That's that says a lot, but right that rooting that kind of in your leadership style, but you're supporting all these people and bringing up other leaders. And then you see them contributing at an incredibly high level and contributing even broader than just to orthopedic surgery. So that, that really says a lot and about the skills that they've developed and their confidence in pursuing these other roles. So amazing to see that. And I can see how you're just so proud of them.

Ron Navarro: Mm-hmm. Right on.

Mary K. Mulcahey, MD: You know, we work with lot of leaders, some maybe we connect with better than others. So have you ever worked with leaders that maybe you didn't quite connect with or you didn't see their leadership style to be particularly effective? And if so, what did you take away from those interactions that have kind of helped shape how you are as a leader now?

Ron Navarro: I'm constantly trying to be self-aware ⁓ ⁓ check myself if I do to a point where I wanna ⁓ say, no, no, no, the answer this. ⁓ As you grow in your leadership career, you probably have more experience with what the answer might be. So it is really, tempting to just jump in and say, guys and gals, we actually know what the answer is. We've seen this 30 times and the answer is probably not that, but this. ⁓ But also, ⁓ I've leaders who rely upon 30 years ago experience to inform a leadership decision today. ⁓ And dangerous because

Mary K. Mulcahey, MD: Yeah. Yeah.

Ron Navarro: ⁓ the local milieu changes, the environment changes, and so it's best to kind of take fresh looks at things that maybe people thought were stale. And maybe it is the right time now. So the ones who don't see the folly in all of that are the ones that I've had difficulty with. When I stopped being the regional chief of orthopedics, it was my time and I really loved that job and I had to give it up because I was termed out after two six-year terms, but it was also the right time. Others have to lead. And I think leaders who don't know when it's time to give up, that's always ⁓ kind of ⁓ tough to watch. And so you have to know when your time is done and it's somebody else's time and help them.

Mary K. Mulcahey, MD: Yeah, so important. Like such great points, Ron. I mean, keep getting back to the beginning of that response, like being self aware, like being able to recognize like what am I? What? How am I responding in this case? How am I interacting with this group in this committee and this whatever this leadership moment is? So self awareness is absolutely critical and and giving the opportunity to everyone in the group to participate, to voice their opinion.

Ron Navarro: Mm-hmm.

Mary K. Mulcahey, MD: ⁓ And ⁓ and then the whole idea of terms, I know there are some institutions, I guess, Kaiser Permanente, know Mayo Clinic, there's some that have ⁓ set term limits, which is fantastic, I think, like ⁓ for all the reasons that you just too, like there is a time. to have turnover, to have new ideas, give opportunities to other people. But it is critical not everybody maybe is in line with that. And like you said, for some people it's difficult to transition out of that leadership role. ⁓ But it is, you know, it's really important to see where the value is in making that transition and how a change is good. It brings new ideas, it brings new people, it brings new perspectives. And so was great that you brought that up. ⁓ And so one of my favorite questions ask, because I'm just so curious ⁓ what people will say, but so you've on a lot of your strengths, a lot of things you've learned in your roles. What would you define, though, Ron, as your superpower? Meaning, what is one of your biggest strengths that really contributes to your success and sets you apart from others?

Ron Navarro: Right. That's right. Yeah, I think I'm tireless and I have a lot of crazy ideas. I'm a bit of a dreamer. And so it's maybe more than one super part, but it's like all goes to kind of how my self perceive me. And I don't think I can't do stuff. It all comes from the mistakes I've made along the way. I mentioned earlier, I have a twin brother and we're very supportive of one another. It's a built-in best friend besides my wife. We grew up in a really tough part of South Central Los Angeles in an environment that was really gritty. And it helped us to develop the grit, think, frankly, from fear of walking on dangerous streets that I dare say many other later generations, they don't have that sort of grit. I wish that there was more of that. And maybe that's just kind of the old guy in me. And I think people develop it in their own time. And we have to allow that to develop. But I know that both I have an internal kind of barometer of internal girded strength and also family support and also the willingness to just try new stuff. And I think I can outwork a lot of people. I'm not too smart.

Mary K. Mulcahey, MD: Yeah. That's very, and that carries you so far, but I think like absolute critical point that you made, right? That you're, there's nothing you think you can't do. And you're not saying that from an egotistical way. You're saying that, like, that you're not afraid. You're not afraid to try to do something, to learn, like that you, you do learn just by taking action. We sort of touched on earlier, but, but, but yeah, but just don't be paralyzed by fear of thinking that something's going to happen, or I'm not sure if I can do this, but.

Ron Navarro: Right. Mm-hmm.

Mary K. Mulcahey, MD: But I love that and I agree with that. I've seen that in so many things that you've done over the past several years and it is incredible then what results from that. ⁓ So I'm going to round this out with a few questions that I like to ask everyone. So this podcast is called Lead Change. And what does that mean to you, Ron?

Ron Navarro: Thanks. one of the frequent quotes I say is that the only thing we can count on is change. So in my mind, it means you got to be a leader who who is comfortable in ever changing environments and your podcast explicitly calls this out. I love it. I think we can't fear and groan about change as it's inevitable and it's possibly undefeated. Change has defeated us all from time to time. So gaining comfort in change is far more beneficial than hoping and hope isn't a strategy. Others have said that, not me. ⁓ you just can't hope that change won't find you as a leader. So lead within change, ⁓ and also lead the change you want to see.

Mary K. Mulcahey, MD: change is inevitable. It is going happen. We can't hope that it's not going to happen. That's not a plan, ⁓ as you said, right? We just have to be expect that change is going to happen. And I love it. And it's all about how we face it. ⁓ And really, the key is embrace Just embrace it, roll with it and be ready to adapt to the change. And as leaders, think we certainly have to be ready and willing to do that.

Ron Navarro: No, so true.

Mary K. Mulcahey, MD: ⁓ And so have you read any leadership books that have been particularly meaningful to you or influential?

Ron Navarro: Another orthopedic surgeon told me once Ron, don't read self-help books. Read biographies of people you admire. And so I really took to Teddy Roosevelt and I read the Edmund Morris, The Rise of Theodore Roosevelt and his sequel, Theodore Rex. He grows from like a sickly young person into a steadfast man who helped a younger America to become like a superpower. And I can kind of relate to kind of his ⁓ transition from, ⁓ this guy won't survive to he can. There's a other book that a lot of people haven't read, in California, there's the lore of this De Salle High School. ⁓ And a book called ⁓ When Game Stands Taught was made into a movie about a high school football coach in this Northern California High School De La Salle. And they have the longest winning streak of football. ⁓ And Lattiser, the coach, he brought the school out of the doldrums and they were a losing school and into this greatness of like over 140 straight high school wins.

Mary K. Mulcahey, MD: Wow. Wow.

Ron Navarro: And so I think that's a really neat thing. The last book was brought to me through a Kaiser learning and it's this the art of possibility, transforming your professional and personal life. It's by this guy who's like a conductor. He's a German conductor. And the book is a collaboration that blends the world of symphony with psychology through these practices of like leading from any chair, kind of like you were saying that you've to be a leader even if you're not stated the leader. And the chairs are referred to the symphony. And so is it the first violin leading or is it oboe leading for a moment? At different times, we all lead. So it's really neat. It's ⁓ the art of possibility. He talks about possibilities opening your mind. So

Mary K. Mulcahey, MD: First chair, yeah. So yeah, that's fantastic. And I love too that you brought up the point, like how much you can learn from other like incredible leaders, like by reading the biography. think that's such a great point to make and what you've taken away from the biographies that And then that last book, making that sort of analogy of like chairs. That's fantastic. So that that's such a great point and a great way to look at leadership. And so all great recommendations. Thank you so much for bringing those up. And the last question I to ask you is, do you any favorite quotes?

Ron Navarro: fun stuff. Yeah, you know, ⁓ the first is probably made up by Disney, but I love and especially in light of the US Olympic team winning, but back from the movie Miracle, what Herb Brooks said, the legs feed the wolf. It kind of is like a ⁓ an ode to kind of like, you've got to be conditioned to to to do the right work. And so in this case, you know, the wolf has to run fast for a long time to finally like catch its prey. But it's really it says to all of us. You're not going to get good if you don't put in the time to practice, I think, you know? And then another one, know, Wooden, I'm an LA guy and more UCLA than USC for sure. I don't know why I'm wearing this cardinal today. This one is a Wooden's quotes, talent is God given, be humble. Fame is man given, be grateful. Conceit is self given, be careful. You know, and one, two more.

Mary K. Mulcahey, MD: Yeah.

Ron Navarro: One, you have enemies. Good. That means you've stood up for something sometime in your life, Winston Churchill, just to mean that I hope you have a passion enough to speak out on something. And you're really great at that, Mary. You have, you you've both been a great scholar and a researcher. And you also have, you know, like you've thought about women in medicine and you've taken a stance. And so... ⁓ It's better to take a stance. I admire people more who like Winston Churchill, admires them that that really stood up for something that meant something that might create somebody else to say I disagree. But at least you had the you know, the internal fortitude to stand up for something. And the last one is, and the last one is from a friend, Brett Batchelor. He was a resident under me. He was my junior resident. He lost his life a few years ago to cancer, and I love Brett.

Mary K. Mulcahey, MD: Yeah. Got Yeah, fancy.

Ron Navarro: He said, earn your oxygen. It just means earn your place on this earth by good works.

Mary K. Mulcahey, MD: Yeah, such great quotes. So many like helpful and important things to take away from that. mean, right, doing the work, be willing to work hard, stand up for what you believe in. You do that too, Ron. So it's incredible. And the impact that that can have on all of those around you, the students, residents, others that you mentor, the people that you work with in your organization. And so I think that's so important for everyone listening. Take that away, right? Stand up for what you believe in ⁓ and then be willing to do the work in all these different aspects of your career. So Ron, thank you so much for being on the podcast. I have really enjoyed our conversation. I learned so much, all these things I didn't know despite the many conversations we've had. ⁓ And I know everyone listening will take a lot away from this discussion. So thank you for all that you're doing as president of the American Association of Latino Orthopedic Surgeons and your involvement in several other organizations. I look forward to many, many more opportunities to work together.

Ron Navarro: Thanks Mary, appreciate the time and thank you for all you're doing.

Mary K. Mulcahey, MD: Yeah, thank you, my pleasure.