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The Neurologist as National Health Care Leader: Mayo Clinic's John H. Noseworthy, MD, FAAN

Shaw, Gina

doi: 10.1097/01.NT.0000512944.07862.48
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John H. Noseworthy, MD, discusses his pathway from a passion in multiple sclerosis research and clinical practice to heading up the Mayo Clinic enterprise as its president and chief executive officer.

Today, the world of health care knows John H. Noseworthy, MD, FAAN, as the influential president and chief executive officer (CEO) of the Mayo Clinic. But the world of neurology, and of multiple sclerosis (MS) research, might be very different today had Dr. Noseworthy elected to pursue the medical specialty he had originally planned on: cardiology. In fact, Dr. Noseworthy had already been accepted into a cardiology fellowship when he began his final rotation in internal medicine, studying neurology with the eminent Thomas John “Jock” Murray, MD, at Dalhousie University in Halifax, Nova Scotia. Dr. Murray founded and then directed the Dalhousie MS Research Unit for more than 20 years, and under his tutelage, Dr. Noseworthy discovered a passion for neurology.

“One of the things that intrigued me was the importance of the history and the examination, and the ability to help other physicians solve problems that they didn't know how to solve,” Dr. Noseworthy said in a telephone interview with Neurology Today. “I was impressed with the elegance and precision of the nervous system, and I saw the neurologist as being very useful in the practice of medicine because we were seeing cases where the referring physicians were lost, and we were able to help.”

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As he completed his neurology training at Dalhousie and the University of Western Ontario, in London, it was the first time Dr. Noseworthy was exposed to the true “science of medicine.” A history major as an undergraduate, he had not followed a classic scientific path. Working under the mentorship of two other well-known neurologists — stroke specialist Henry Barnett, MD, who chaired the department of clinical neurological sciences at Western Ontario, and George C. Ebers, MD, a noted MS expert who would go on to establish the Canadian Collaborative Project on Genetic Susceptibility to MS — Dr. Noseworthy became captivated by research. “Dr. Ebers was the first person I saw running an actual wet lab,’” he recalled.

Dr. Ebers' patients struck a chord with the young neurologist. In his late 20s at the time, he looked into the faces of young people with MS, and saw individuals who were sick through no fault of their own. “These young people who were very ill with a frightening disease, faced an uncertain future,” he said. “I thought that if this was an immune-mediated disorder with a genetic component, then in my lifetime there should be some advances in not just diagnosis but treatment. I committed my career to trying to help them.”

After postdoctoral training at Harvard Medical School, Dr. Noseworthy realized that his first love lay with clinical medicine. He decided not to pursue discovery science, but instead move into clinical research and develop a career in designing, conducting, and analyzing clinical trials in MS.

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In 1990, he was recruited to join the faculty at the Mayo Clinic in Rochester, MN, where he has spent his entire career since. As he began his career at Mayo, Dr. Noseworthy found two new mentors: Jasper R. Daube, MD, FAAN, then the institution's chair of neurology, and Moses Rodriguez, MD, FAAN, a noted clinician-scientist whose research focuses on determining the mechanisms of demyelination and remyelination in diseases such as MS.

“I think the most important contributions from our work have been providing definitive answers as to what works, and what doesn't work, in altering the natural history of MS,” he said. “To be blunt, the clinical trials that we did basically demonstrated that while a number of leads have received a lot of attention, when you put them through the rigor of a randomized, double-blind, placebo-controlled trial, placebos did just as well most of the time. These were disappointments, but they were important, because they contributed to our understanding of the importance of scientific design. There are no shortcuts if you are going to be using complex and potentially dangerous therapies in treating neurologic disease.”

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He credits much of his success to lessons learned from his two early mentors, Dr. Ebers and Dr. Barnett. “Dr. Barnett taught me the importance of knowing the right question to ask, while Dr. Ebers taught me to make sure you get the truth from a study. You don't have to be first, but you do have to get it right. It sounds simple when you say it, looking back on a career, but learning those two key questions and devoting my academic career to using those principles in the work I did were critical factors in my career.”

As his career progressed, Dr. Noseworthy began to recognize that the same skills that had helped him to understand what kind of clinical trials were needed in the field, and to be able to develop an outstanding network to design, conduct, and analyze those trials, were skills that translated well into institutional leadership. “I realized that I was particularly good at identifying areas that I wanted to pursue, and encouraging really smart people to go along with me,” he said. He quickly climbed the ladder within Mayo's department of neurology, and was named department chair in 1997.

The same skills that propelled him to the department's top spot also led him to publish the first neurological therapeutics textbook. “It occurred to me that there was an awful lot of information about neurological therapeutics that had never been put down in one place,” he says. “And as the chair of the AAN's Science Committee, I got to know many wonderful colleagues across the disciplines. So I called on some 400 of my friends to put together the first definitive neurologic therapeutics textbook.” First published as a two-volume set in 2003, Neurological Therapeutics: Principles and Practice (CRC Press) expanded to three volumes in its 2006 second edition. “I never did a third edition because my job got in the way,” Dr. Noseworthy confessed.

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After stepping down as chair of neurology at Mayo in 2006, Dr. Noseworthy was recruited for a new leadership post: editor-in-chief of Neurology. “Steve Ringel called and asked me to apply for the position. Dr. Berch Griggs, a renaissance man of enormous talent, had been editor for some time. I wasn't sure if it was right for me, so I did what I always do: I asked people smarter than me,” he said. “I called all the journal editors I knew, and they said it was the best job in the world, working with thoughtful leaders and moving the field forward.”

During his three-year tenure as Neurology's editor-in-chief, Dr. Noseworthy once again used his model of setting a vision, hiring like-minded people, and then getting out of their way to move the journal forward. Neurology went from a monthly journal to a weekly, as he built a team of associate editors, “industrialized” the process with a database of the best reviewers, and added weekly products like podcasts. “It's like the African proverb: If you want to go fast, go alone. If you want to go far, go with others.”

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When the opportunity to take on the top spot at Mayo — president and CEO of the entire enterprise — was presented to him in 2009, Dr. Noseworthy said it meant “walking away from the highlight of my academic career” to leave Neurology. But after years of growing leadership responsibility, not just as department chair but also as chair of the Rochester campus' capital campaign (which raised $1.3 billion) and then of a group charged with positioning Mayo for 2020, taking on this position seemed to make sense.

Because of the previous leadership positions he had held, making the transition to president and CEO from practicing neurologist was not as big a leap as it might have been. And, Dr. Noseworthy added, he got some help from Mayo's “special sauce.”

“Although Mayo is physician-led, every physician leader is paired with an administrator who's every bit as good as they are,” he said. “In some organizations they want physicians to get an MBA to take on leadership roles. Mayo has chosen a different route: You will become savvy at business, but not on day one. By the time I became president and CEO, I had had probably 12 years of experience working with able administrators who helped me understand business, development, fund raising, and so on.”

The greatest challenge he has faced, Dr. Noseworthy said, is change management. “It's great to have a strategy and know the direction you want to go, but you have to bring 68,000 people along with you. I've made every mistake you can make, of course,” he confessed. “I've found that the most important thing a physician leader can do is to listen respectfully, pull out the best ideas, share those ideas, give credit where it's due, and build that common vision together.”

Sometimes that means not jumping ahead of his team. “In a fast-moving world, it's easy to get ahead of people. People you trust will say, ‘Back off a bit, you haven't got the team with you, let's back up a bit and listen, and try to bring folks along.’ You can't change their world too fast.”

Under Dr. Noseworthy's leadership, Mayo has taken its highly recognized brand worldwide, by establishing affiliation agreements with other hospitals through its Mayo Clinic Care Network, which now includes more than 40 health care organizations across the US as well as in Puerto Rico, Mexico, the Philippines, Singapore, and the United Arab Emirates. He has also spearheaded what is likely to become Minnesota's largest development project, a $6 billion investment to turn downtown Rochester into a “Destination Medical Center.” On December 29, he was one of four leading health care executives to meet with president-elect Donald J. Trump to “discuss the Mayo Model of Care and Mayo Model of Research as potential roadmaps to excellence in all of American health care and share Mayo Clinic's views on critical success factors needed to solve our nation's most pressing and complex health challenges.”

For a time, Dr. Noseworthy tried to balance the position of president and CEO with continuing to practice neurology, his first love. But one day his other first love helped him understand that it was time for a change.

“I came home one day and said to my wife Pat, ‘Oh, I was with patients all day and had a great day in clinic.’ There was a pause, and she said, ‘John, it's time.’ I asked, ‘Time for what?’ She told me it was time to give up my practice,” he recalled. “She said, ‘You have another job now. You're never there, and patients travel from out of state to see you and often they're disappointed because you're gone.’ I said, ‘But I love being a neurologist. I've spent my whole life caring for patients.’ She replied, ‘Oh, it's all about you, is it? I thought it was supposed to be all about the patients?’ I knew she was right. That's what someone you love dearly can tell you.”

Today, Dr. Noseworthy still reads neurology journals every week. “Not cover to cover, but I sit down and read the things I want to read in one sitting. Clinical neurology was my plan A, and I rode it as long as I could. But for many people, plan B is actually better than plan A. You have to be open and let the world impact you. Be open to change. There might be an opportunity for you to make a greater contribution and be more fulfilled.”

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•. Why Mayo Clinic's CEO wants to serve 200 million patients— and how he plans to do it. Lessons from the C-Suite: Dr. John Noseworthy, CEO of Mayo Clinic. The Daily Briefing 2014.
    •. Interview with Dr. John H. Noseworthy. Modern Healthcare. September 24, 2016.
      © 2017 American Academy of Neurology