Honoring Excellence: Q and A with John B. Waits, MD, CPE, FAAFP

February 16, 2024
2024 Courage to Lead Awardee John B. Waits, MD, CPE, FAAFP

This interview is one in a series of interviews with recipients of the 2024 ACGME Awards. The awardees join an outstanding group of previous honorees whose work and contributions to graduate medical education (GME) represent the best in the field. They will be honored at the ACGME Annual Educational Conference, taking place March 7-9, 2024, in Orlando, Florida.

Dr. John Waits is a recipient of the 2024 Parker J. Palmer Courage to Lead Award. Dr. Waits is a family medicine physician and currently serves as designated institutional official (DIO) and program director for the Cahaba Medical Care/University of Alabama (UAB) family medicine residency programs, as well as chief executive officer for Cahaba Medical Care. He reflected on his calling to a career in medicine and the joy and satisfaction he finds in his leadership role.

ACGME: How did you become involved in medicine, and in academic medicine specifically?

Dr. Waits: My father is a general surgeon, but despite this, I initially sought a different path for myself and did not pursue a pre-med major. However, about halfway through college, I experienced what aligns with my faith tradition's concept of a calling. Inspired in part by my father’s commitment to serving people and his community, I began contemplating how I wanted to contribute to the world and realized that following in my father’s footsteps was a familiar and meaningful choice. So I switched to pre-med, and I went to medical school thinking I would probably do surgery. While I loved procedures, throughout my clinical experiences in my third year of medical school, I discovered that I enjoyed every aspect of medicine; thus, family medicine emerged as an appealing choice because it offered a versatile opportunity to do a little bit of everything.

As for how I got into academic medicine, for as long as I can remember, I have enjoyed sharing knowledge and teaching others; seeing people who wanted me to teach them be able to make progress as a result of my guidance has consistently brought me joy. The progression of medical education and training necessitates an automatic “trial run” in the role of “teacher,” where fourth years teach third years, and interns teach students, and upper-level residents are responsible for so much of the educational experience. For me, this was enough to light the spark of interest in formal teaching, so when I was offered a faculty job at the University of Alabama School of Medicine after my obstetrics fellowship, I jumped at the chance to have the formal opportunity in clinical teaching. Over the subsequent two years, I was invited to become the family medicine clerkship director, then a family medicine residency director, and I felt I had found my niche.

ACGME: What does this award mean to you? 

Waits: The more I learn about this award, the more incredibly honored I am, not only to have been chosen from amongst my peers and colleagues throughout the country but also for the thoughtfulness of my teammates who submitted the nomination. This recognition holds a special place in my heart, as it symbolizes a major milestone in my career in academic medicine. During my tenure at the University of Alabama, we pioneered the establishment of Alabama's first rural track at Cahaba Medical Care, a safety net clinic that I founded. However, in the dynamic landscape of academia, projects come and go, funding fluctuates, and leadership changes. Our rural track faced challenges and eventually phased out, but this setback presented us with the opportunity to start fresh, giving rise to the development of a community health center and a family medicine residency program, then initiating four family medicine tracks and introducing multiple fellowships. Creating things has a very intimate, personal aspect to it, so it’s sometimes hard to ascertain success objectively. That is why our overtly positive outcomes, such as increased resident retention and a higher number of residents entering underserved and rural medicine, have been immensely satisfying. This award serves as another source of validation and gratification, affirming that our endeavors to invest in these creations have indeed made a meaningful impact to GME and the broader health care landscape.

ACGME: What do you feel is the most important “job” that’s part of your role as a designated institutional official?

Waits: I feel that my most important job as a DIO is to ensure the seamless management of crucial educational compliance tasks outlined by both the ACGME and the Review Committee and to make sure that much of the burden of handling these responsibilities falls on me and the GME office in order to alleviate the workload and provide more bandwidth for the associate and assistant directors, faculty members, chief residents, and other staff members. While I have found surprising satisfaction in my administrative career, many of the compliance aspects wouldn’t be considered my “favorite” tasks; yet I view them as an integral part of my role as the “keeper of the springs,” working to optimize the time our faculty members spend on teaching, curricular development, and other meaningful aspects of their roles, rather than being excessively consumed by educational compliance tasks. My goal is to provide them with more bandwidth, reduce burnout, and enhance job satisfaction. I believe that by facilitating a more fulfilling and less burdensome work environment for our team, we ultimately contribute to a positive cascade effect where the well-being and contentment of our faculty members directly influence the residents.

ACGME: What is the most rewarding part of the job?

Waits: Long-term close friendships seem to be a rare thing; thus, having the immense privilege of co-founding and leading the Cahaba Medical Care Foundation, a Community Health Center in central Alabama, as well as the Cahaba+UAB family medicine residency with my practice partner and long-time friend, Dr. Lacy Smith, would have to rank at the top of any list.

Witnessing faculty members flourish and excel in their work, observing the continued growth and commitment of residents, receiving feedback from alumni who credit our institution for their excellent education and training… just seeing the overall impact on individuals and their professional journeys is also meaningful and rewarding.

Additionally, I find great joy in the creative process of establishing systems and structures that not only function effectively but also fulfill their intended purposes. Crafting solutions and frameworks that work seamlessly contributes to the overall success and efficiency of our operations. This interplay between the human element and the dynamic, problem-solving aspects of the job adds a layer of fulfillment to the job for me. I feel incredibly lucky to be able to do what I do every day.

ACGME: What is the most challenging?

Waits: It's hard to name the most challenging part of the job because I love challenges. I thrive on problem-solving and embracing challenges and obstacles as opportunities for growth. However, I think the most challenging part of this job is the lack of adequate and consistent funding for initiatives, that, based on past experience, would be effective and have great potential to yield positive results. Navigating the complexities of securing funding for such initiatives becomes especially daunting when resources are subject to political maneuvering. The uncertainty and volatility in our current overly partisan political environment presents obstacles that demand innovative communication and advocacy approaches. I remain hopeful that, collectively, we can move towards a more collaborative and successful trajectory, ideally achieving positive outcomes in the years to come.

ACGME: What advice do you have to give residents and fellows who may be interested in pursuing a career in academic medicine?

Waits: My father always said, “You don’t practice at a higher level than your training.” To me, this means actively seeking excellent training, not necessarily in the most prestigious residency but by taking agency over your own education and having the integrity to own your career pathway. Be assertive and fully commit to the responsibilities at hand. If you’re on call, be on call. Don’t hope for an easy night so that you can get back to the call room and watch Netflix or play PlayStation. Instead, go “all in” when you’re at work, be fully present and engaged, and ask questions. Even as a second- or third-year resident gaining confidence, maintain the humility to ask good questions. These inquiries, even if you believe you know the answer, provide insight into the attending’s style and nuances. In GME, there comes a point where one might feel smart enough to coast without asking questions. However, the key is to go beyond and pose the next-level, post-graduate questions that can open the door for advanced teaching and deeper insights from experienced professionals. If you’re interested in academic medicine, you’ve got to extract every bit of knowledge from every attending you work with. There are no poor historians, only poor history takers. It’s the same way with attendings. The key to success lies in being a skilled information gatherer who can extract valuable knowledge by asking the right insightful questions.

ACGME: Is there anything else you would like to add we haven’t asked about? 

Waits: There are a couple of pieces of advice that I believe would have significantly benefited me had I more completely incorporated them into my collegiate, doctoral, and post-graduate life:

  1. Adopting a growth mindset over a fixed mindset is crucial. Learning to receive feedback, even when it may be delivered in a less-than-ideal manner, is a skill that can profoundly impact personal and professional growth. It's important not to take criticism personally and to assiduously resist the urge to become defensive. Instead, “gamify” criticism – find the nugget of wisdom or the opportunity to improve with every critique.
  2. Giving people the benefit of the doubt is another powerful mindset shift. Avoid assuming that others are intentionally trying to harm or hinder you. Instead, embrace the idea of assuming positive intent. This perspective can prevent unnecessary conflicts and misunderstandings. Learning this lesson took me some time, but it has proven to be a valuable principle in fostering better relationships and collaborative interactions.

Learn more about the ACGME’s
Parker J. Palmer Courage to Lead Award and nominate a DIO for the 2025 Award – nominations are due by March 27, 2024. Registration is still open for the 2024 ACGME Annual Educational Conference – learn more and register today on the conference website.