Episode Overview

Podcast: Advancing Health
Episode: You Can’t Buy Trust: Social Capital and the Physician Leader
Host: Dr. Chris Durienzo (B)
Guest: Dr. Tom Lee (C), Chief Medical Officer of Press Ganey, Editor-in-Chief of NEJM Catalyst
Date: December 3, 2025

This episode centers on the essential role of social capital in elevating physician leaders and bridging the know-how gap between clinical expertise and healthcare leadership. Dr. Tom Lee shares insights from his decades of experience, discussing why trust, teamwork, and relationships are irreplaceable assets for physician leaders—assets that cannot be purchased or outsourced, but must be intentionally built and maintained.

Key Discussion Points & Insights

The Physician Leadership Gap

• Bridging Two Skill Sets:
  There’s a delineated gap between the skill set of an outstanding clinician and that of an effective physician leader. Excelling at the bedside does not automatically translate to success in leadership roles.
  "We have to actually deal with those situations where working hard is not enough, where it's not clear exactly what we should do. How do you figure out what we should do and how do we do it? That is the nature of the jobs of being a physician leader today."
  — Dr. Tom Lee [01:51]

Defining and Developing Social Capital

• What is Social Capital?
  Unlike financial or human capital, social capital comprises the relationships, trust, and shared norms that make a team or organization function more effectively.
  "Social capital is how those people work with each other and with their infrastructure that enables you to do things you couldn't otherwise do. Social capital is based upon currencies like trust and respect and teamwork."
  — Dr. Tom Lee [02:44]

• Intentional Approach:
  Building social capital requires the same intentionality and rigor as financial management.
  "Building them, as opposed to just being grateful when we have them... getting tough minded like the CFO is about financial capital and building teamwork and trust and high reliability."
  — Dr. Tom Lee [03:27]

• Not Just a By-product:
  Outcomes such as teamwork and high reliability flow from robust social capital, not directly from trying harder.
  "You describe teamwork and high reliability as secondary effects of high functioning social capital. Am I getting that right?"
  — Dr. Chris Durienzo [04:21]
  "Very much so... It takes sacrifice... having norms, behavioral norms, and enforcement mechanisms."
  — Dr. Tom Lee [04:44]

Changing Physician Leadership Mindsets

• Shifting Away from Heroism:
  Medicine traditionally encourages "heroic" individual action. In leadership, the focus shifts to distributed expertise, feedback, and enforcing team norms.
  "We may be an expert in the things in which we are expert, but that doesn't make us an expert in everything."
  — Dr. Chris Durienzo [06:37]

• From Pyramid to Network:
  The mental model should move from hierarchies (pyramids) to networks (webs of relationships), enhancing connectivity, shared values, and team effectiveness.
  "Think about social network diagrams... making connections real among everyone and making them compelling."
  — Dr. Tom Lee [06:50]

Practical Examples of Social Capital in Action

• Learning Across Disciplines:
  Dr. Durienzo shares how his CFO mentored him on financial concepts, illustrating that real-world leadership develops through exposure and experience, not just knowledge.
  "My CFO was a node in that network who was willing to sit down and share with me enough... to be a competent operator. ... That is a outcome of social capital."
  — Dr. Chris Durienzo [08:34]

• Depictions in Media and Real Life:
  Dr. Lee points to TV dramas like "The Pit" as examples of how social capital builds over time through shared experiences and informal bonds.
  "They're actually building social capital, including the part where they're sitting on a park bench sharing beer from a cooler..."
  — Dr. Tom Lee [09:31]

Challenges at the Leadership Level

• Camaraderie in the C-Suite:
  The transition from clinical teams to executive roles can feel isolating.
  "It's a different kind of a team. When you're sitting around the health system CEOs table, ... it takes a different degree of intentionality to find ways to connect"
  — Dr. Chris Durienzo [10:31]

• Clinician Mindset in Management:
  The iterative, adaptive mindset of clinicians is well-suited to tackling complex management challenges, such as overcrowded hospitals, where solutions are not always clear-cut.
  "Thinking like a clinician... may be more the right thing for complex problems... we need to do that more in our management life, too."
  — Dr. Tom Lee [11:41]

Notable Quotes & Memorable Moments

• On Social Capital’s Strategic Value:
  "You can go to the bank to borrow money, but there is nowhere to go to borrow. Trust, teamwork, reliability, and the desire to innovate and improve."
  — Dr. Tom Lee [12:42] (Original quote from NEJM, revisited)

• On What Sets Healthcare Organizations Apart:
  "Our organizations are not going to differentiate themselves... on the basis of who can borrow the most money... where we'll differentiate ourselves is how we work together."
  — Dr. Tom Lee [13:22]

• On the Non-negotiable Human Element:
  "Healthcare is and will always be a uniquely human experience. ... You can buy things, but you can't buy trust. You've got to build it."
  — Dr. Chris Durienzo [14:05]

Important Timestamps

• 00:28 – 01:51: Introduction of Dr. Lee and framing the gap between clinical and leadership expertise.
• 02:44 – 03:55: Defining social capital and its businesslike approach.
• 04:21 – 05:51: Outcomes of social capital; intentional building of teamwork and norms.
• 06:37 – 07:44: Mindset shift from pyramid leadership to network model.
• 08:34 – 09:02: Personal anecdote of learning from a CFO—crossing exposure and experience gaps.
• 09:31 – 10:11: Media representation of social capital and informal team-building.
• 10:31 – 11:41: The challenge of building capital at leadership levels; bringing clinician thinking into management.
• 12:42 – 13:22: Quoting the enduring importance of social capital over financial capital.
• 14:05: Closing thoughts on trust as an unbuyable asset.

Summary Takeaways

• Social capital—trust, teamwork, and shared norms—is as critical as (or more than) financial or technical prowess for effective physician leadership.
• Physician leaders must intentionally cultivate networks and feedback cultures, overcoming the isolating tendencies of traditional hierarchies.
• Adapting clinician mindsets—iterative, data-driven, and collaborative—to leadership and management drives better outcomes for organizations and patients.
• You can’t buy trust; it is an asset built from the inside, fundamental for lasting organizational success.