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The Choices We Make That Determine Our Path with Dr. Robert Gabbay

Podcast, by Jen Barna MD, Physician Coaching

Tune in to hear more about Dr. Robert Gabbay’s journey in medicine and how he balances it all. Dr. Gabbay also talks about the importance that mentors have had in his life and how they helped to shape him. 

“For me, the beauty of diabetes was that it was the anchor but it allowed me to explore so many different areas of research and interest.” -Robert A. Gabbay, MD, PhD

In episode 158 of the podcast, we welcome Dr. Robert Gabbay. Dr. Gabbay is Chief Scientific and Medical Officer of the American Diabetes Association and Associate Professor at Harvard Medical School. DocWorking Founder and CEO, Dr. Jen Barna talks with Dr. Gabbay about how it all started for him, his journey in medicine, how he balances it all and what advice he was given and what advice he would give to his younger self. He speaks about difficult decisions he made that affected the direction of his career. Dr. Gabbay also talks about the importance that mentors have had in his life and how they helped to shape him. 

Robert A. Gabbay, MD, PhD is Chief Scientific and Medical Officer of the American Diabetes Association and Associate Professor at Harvard Medical School. His research focuses on innovative models of diabetes care to improve diabetes outcomes and the lives of people with diabetes. Throughout his vibrant career he has had many accomplishments as a basic science researcher, developer of patient communication tools, creator of the first broad scale diabetes registry, designer of care management training programs, and leader of one of the largest primary care transformation efforts in the US around the Patient Centered Medical Home. The reach of his work has been recognized through leadership roles around the world to transform diabetes care including leading the International Diabetes Federation BRIDGES program that implements evidence based translational research to low resource global settings. Dr. Gabbay has received funding from the National Institute of Health Diabetes, Digestive and Kidneys Diseases (NIDDK), the Agency for Healthcare Research and Quality (AHRQ), and the Center for Medicare and Medicaid Innovation for his care transformation work. Along with an extensive peer reviewed publication record, his views have appeared in popular press such as the New York Times, CNN, the Washington Post, People, Oprah, and National Public Radio. Formerly, he held the role of Chief Medical Officer at Joslin Diabetes Center.

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Podcast produced by: Amanda Taran

Please enjoy the full transcript below

Dr. Robert: For me, the beauty of diabetes was that it was the anchor, but it allowed me to explore so many different areas of research and interest.

 

[DocWorking theme]

 

Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna and I’m excited to have you here with me today. Thank you for joining me for this conversation with Dr. Robert Gabbay. Dr. Robert Gabbay is Chief Scientific and Medical Officer of the American Diabetes Association and Associate Professor at Harvard Medical School. His research focuses on innovative models of diabetes care to improve diabetes outcomes and the lives of people with diabetes. His vibrant career includes many accomplishments and you can see those in our show notes. I’m very thrilled to have Dr. Gabbay here to discuss with me his personal journey, a little bit about his life, and some insights that he shares with us about physician wellness, and how to integrate work and life. So, Dr. Robert Gabbay, welcome to DocWorking: The Whole Physician Podcast.

 

Dr. Robert: Thanks so much, Jen. I’m looking forward to this.

 

Jen: I’m so excited to have you here, because you’ve had great success, and you’ve made such a difference in so many lives across the globe in your career, and I really am interested in hearing about your journey. So, just going all the way back, how would you describe yourself as a pre-med and medical student? Let’s start at the beginning.

 

Dr. Robert: Okay. I would start by saying my intention was not to practice medicine. I started as a basic scientist and got a PhD in biochemistry. My interest was really to be a researcher. With that, during my PhD and I did it the long way, PhD first and then went to medical school. My experience doing research was the first paper was this amazing thing. I literally had a big party celebrating with my friends that I published my first paper, and I was so excited, and then, the second one was a little less, and the third, a little less, and the fourth, a little less, and I realized that, I went into this in a sense to help people. As a scientist, I felt I was too distal to actually impact people. Of course, science is critical to all the discoveries we’ve made, but I wouldn’t be a little bit closer. 

 

I literally went to medical school to learn more physiology and then, go back to the lab. As a pre-med, it wasn’t a pre-med, I was a scientist. Then, in medical school, really the first couple of years were doing the coursework and I was really focused on learning that information, but not really focused on the practice of medicine. Then, the aha happened in the third year of medical school, that magical year, where you try a little bit of this and that and I was like, “Wow, this is really cool.” So, I kept on reenlisting in the clinical world and things went on from there. [chuckles] 

 

Jen: That is so interesting. We actually have that in common. I started out to do research as well and realized partly into my PhD that I wanted to be on the more clinical side of things. The basic research can be so specific and so narrow and yet so critical to ultimately making a difference in the lives of clinical medicine of patients. But it can be very difficult when you’re focusing on such a small piece of that to see the big picture and difficult to explain to other people what you’re doing.

 

Dr. Robert: Yeah, I think it’s true. I think every person has their niche in the journey and I guess I realized that it took me a while, because even after doing residency, I carved out six months in my residency to do research. Then, when I started my fellowship of my three years, I actually started the first year, plus doing research and not doing clinical. I kept going back to that. It was only that last phase, where during my fellowship, I did my research time and it was probably a year and year and a half of the three years. I wrote a grant, and then, I went back to doing clinical stuff, and I missed the clinical time, and I really enjoyed doing that. The funny thing is, I actually, the grant, it’s what they call a K award, that’s a five-year foundational thing for your career. I found out part of the way in that clinical time and endocrinology fellowship that I got the grant, which is like, “Wow, five year, cover 80% your salary.” It’s as good as it gets in that phase of one’s career. 

 

I came to this thing of, “I don’t really want to do that.” I had to go to my mentor and he’s like, “Bob, this is fantastic. You’re well on your way.” I’m like, “Yeah, I’m sorry, but I think I’m going to turn it down.” He’s like, “What?” I was very nervous to tell him because– But we had a great relationship, I had great respect for him, and I was really nervous, and he was like, “Bob, you gotta do what you wanted to.” He was fine with it, of course. He turns out to be this incredible person. I’ve been fortunate to have so many wonderful mentors. He actually eventually became the Dean of Harvard Medical School and he was an important person in my life. I’ve had several wonderful mentors historically. They’ve really shaped who I am and my way of giving back is a really big believer in mentorship, such an important thing that we do and medicine has a great tradition of that.

 

Jen: You bring up a couple of points that I would love to hear more about. To even so early in your career, and you were so accomplished to receive this honor of this award, and then to have the wherewithal to be able to step away a little bit, and recognize that that wasn’t the direction that you wanted to go, rather than let that push you in a direction. That had to take a lot of self-awareness and courage to be able to do that at that early stage in your career. Kudos to you for realizing that and to your mentor for supporting you in that decision. What did you do from there and then, I also am very interested in hearing about mentorship, because I do agree with you that that’s such a critical part of success and guidance, especially in a medical career?

 

Dr. Robert: Yeah, it’s interesting. I’ve had several points of my career, where I’ve had those forks in the road. I’d love to say, I was super reflective and analyzed all the pros and cons. To some degree, I did, because I tend to be that kind of person. But there are probably like a half dozen crucial decisions that shaped who I am. That was one of those choices. Again, getting my PhD, and not going to a lab and being a researcher, and following that path was another fork point and I’m going to go to medical school. But I remember my parents thought I was crazy. “You already got a job, got the PhD. Why are you going back to school?” [laughs] In any case, it all worked itself out.

 

Jen: I can imagine the difficulty explaining that to others is such a long road, the MD, PhD, especially.

 

Dr. Robert: Yeah. “You already have a career, why you starting a new one?”

 

Jen: Speaking of your career and all of the achievements that you’ve made in the field of diabetes and treatment of diabetes, is there something that happened in your life or was there anything in particular that drew you to that illness, specifically?

 

Dr. Robert: Yeah, that’s a good question. It was somewhat serendipitous to some degree. When I was choosing a mentor in my PhD program to do my research with, I had someone in mind and also, another one of those in this pantheon of mentors, Henry Lardy. His lab was looking at metabolism and understanding it, what my project was was how insulin signaled. In those days, they really didn’t know any of the tyrosine kinase or any of the things that we later understood. I worked on that, but honestly, I didn’t even and this seems crazy. I was speaking of the narrow world. I didn’t really equate that to diabetes at all. I was like, “Oh, here’s this hormone and they don’t know how it works.” I’m like, “Oh, that’s an interesting problem.” I just went deep into that. As I got into medical school, then, I obviously saw the connection to diabetes and I think what has been great professionally in the world of diabetes it’s the gateway to so many different things. Because it’s endocrinology, certainly, but it’s cardiology. It is neuropathy, it is renal disease, it is population health, it is one of the most costly chronic diseases. 

 

Chronic disease management as that evolved. I got interested in primary care, because that’s where most people get their care and that took me on a journey to a patient-centered medical home and a bunch of work in that area. It’s about behavior change and understanding what works there. That’s another area that I dove deep into for a number of years. It’s health economics. One in five healthcare dollars spent on diabetes, prevention, lifestyle. So, for me, the beauty of diabetes was, that was the anchor, but allowed me to explore so many different areas of research and interest. So, yeah.

 

Jen: Beautifully said. I can imagine how many opportunities there are and it must be difficult to even focus within one, especially an illness as broad as diabetes.

 

Dr. Robert: Well, the interesting thing is, I got advice earlier or back here at my first faculty job that I did not heed. That was, “Bob, you need to focus. You need to pick one area and just like that’s your thing. Not diabetes, but a much more narrow one aspect of diabetes.” That has actually not been the way I’ve done things, because as I described, I’ve had different periods of time, where I got into behavior change, and projects around that, and then patient-centered medical home, and population health, and digital health, and a whole bunch of different things. Yeah, so, you don’t have to listen to all the advice you get. [laughs] 

 

Jen: Yeah, and that’s great advice in and of itself.

 

Dr. Robert: Yeah, right. You got a process and what feels right. For whatever reason, maybe, it’s a little bit of my ADD, just got excited about the next cool thing. If I think about it, some of it was really trying to solve problems like the behavior change piece was clearly something that I realized that so much of diabetes was what people did, and I didn’t really know how to help people change their behavior, and I certainly didn’t learn any of that in my training. Because in those days, that was not– Now, fortunately, some of that is in the curriculum. My daughter is at medical school and so, I get to hear what it’s all through her in any case. Yeah, it was following different areas that clinically made sense, because I saw patients, I needed to help dealing with them.

 

Jen: Speaking of seeing patients, how do you divide your time between being Chief Scientific and Medical Officer at the American Diabetes Association, and Associate Professor at Harvard Medical School, and seeing patients?

 

Dr. Robert: First of all, I mentioned, I’m a little ADD. The opportunity to do lots of different things is extremely appealing to me. As I became a physician and really devoted myself to that, it’s an incredibly rewarding activity, and it’s a great motivator for me, and it was not something I wanted to give up. I started, obviously my training was mostly all clinical. My first faculty job, I probably was maybe 50% clinical and 50% other research teaching leadership roles. That kept narrowing because that’s the career path that many of us do, we are more on the research or leadership side of things. But I never wanted to give it up. When I came here to the American Diabetes Association, it was a precondition. I want to be able to continue to do that and they were like, “Sure.” How do I juggle it? It’s not easy. It’s busy and it may be something I can’t always do. We’ll see, but it recharges my batteries each time I go and it reminds me why all the things we do are important.

 

Jen: You mentioned being a dad as well, how do you integrate your life outside of work with all of these many things and I’m sure I really barely scratched the surface in naming those three [giggles] categories. You’re involved internationally with programs, such as the International Diabetes Federation, Bridges program, and etc. So, how do you integrate in your life outside of work with all of the work you do in your career?

 

Dr. Robert: That’s a great question. I started doing some things that have really helped me in terms of managing the stress of it, finding the balance. Maybe, balance isn’t the right word, because certainly, it’s not a 50-50 in the medical world. I stopped working at a certain time of the day and that may vary. But then I’m done. Unless, if I’m on call or something, obviously, urgent things come up. But generally, I try not to look at emails anymore, I don’t do anything till the next morning. I have that little carved out time. As much as I can, I try to do as much as I can during the week. My weekends are mostly free. Not always things spill over, but I go in with that intention to ensure that I have time and it took me a while to realize that checking a few emails at a random time in the evening, I think, “Ah, it’s easy, no, it takes my mind somewhere else and I’m not the precedent, I’m not as relaxed. So, it helps me to have sequestered time, where I do not unless special circumstances being workload and that really helps.

 

Jen: That’s wonderful advice. My last question, really is what you may advise yourself as a younger person? What would be one piece of advice that you would give to yourself?

 

Dr. Robert: Oh, boy. Wow, that’s a tough one. I think I have faith that it’ll all work itself out. Trust yourself and stay curious. I think that’s been another part of my journey is that curiosity has taken me into lots of different things. Now, I have a role, where being a jack of many trades is particularly valuable, because I deal with the research side, and the clinical side, so many different aspects.

 

Jen: Wonderful. I look forward to talking with you further about your ideas, about physician wellness, and I know that you’ve done some work in relation to that, and I love hearing your insights there, and I appreciate you coming on the podcast and talking with us. We’re so thrilled to have you Dr. Bob Gabbay. Thank you, again, for coming on DocWorking: The Whole Physician Podcast.

 

Dr. Robert: Thanks so much, Jen. This was great and I look forward to more.

 

[music]

 

Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you so much for listening. Please don’t forget to like and subscribe and head over to docworking.com to see all we have to offer.



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