Podcast Summary

Podcast: Becker’s Healthcare Podcast
Episode: Todd Smith, MD, Chief Physician Executive at Sutter Medical Center
Date: October 27, 2025
Host: Erica Carbajal (Editor, Becker's Hospital Review)
Guest: Dr. Todd Smith, SVP and Chief Physician Executive, Sutter Health

Episode Overview

This episode features Dr. Todd Smith, the Senior Vice President and Chief Physician Executive at Sutter Health, discussing Sutter’s clinical and operational priorities as the year wraps up. Topics include physician onboarding at scale, challenges of ambulatory expansion, strategies for clinical integration and standardization, and the evolution of the Chief Physician Executive role. Dr. Smith draws on recent experiences and insights from leading a large, multi-county system during a period of significant growth.

Key Discussion Points & Insights

1. Sutter's Year-End Priorities: Growth & Access

• Sutter has rapidly grown its clinician base, adding 1,500–2,000 new clinicians over 2 years. The focus is now on onboarding, operational integration, and expanding ambulatory care.
• Ambulatory expansion remains a top priority. Sutter has opened about 17 new ambulatory sites in 2025, with several more planned.
• The double focus: Improve patient access and experience while also creating a good working environment for clinicians.

Notable quote:

"Once you hire them, now you need to actually get them onboarded operationally and up to speed...a lot of work really around that clinical base to try and improve our access and experience for the patients."
(Dr. Todd Smith, 01:35)

2. Physician & Clinician Onboarding at Scale

• Onboarding involves significant complexity, with Sutter encompassing eight medical groups across 26 counties.
• Joint Ownership: Partnering between medical groups, physician services, and operations teams.
• Multi-stage Orientation: System-wide orientation, group-specific onboarding, and local clinic level acclimatization.
• Ongoing process—"a journey," not a one-time event.

Notable quote:

"Onboarding is a journey—it doesn’t start the day they start, and it doesn’t stop the day they start...It's jointly owned by the medical groups as well as our foundation counterparts."
(Dr. Todd Smith, 04:20)

3. Ambulatory Growth & Clinical Integration

• Sutter is in the midst of a $1 billion ambulatory expansion.
• Consistency of Care: Establishing an “operating rhythm” of communication from clinic to system level, focusing on quality metrics.
• Addressing different skills needed in ambulatory vs. acute (inpatient) settings, especially with procedural training and onboarding.

Notable quote:

"One of the biggest things that we've done...is to really create an operating rhythm...so that there's a clarity of conversation and a clarity of metrics."
(Dr. Todd Smith, 06:20)

4. Impact on Inpatient Care Models & Staffing

• As more care moves outpatient, inpatient settings are seeing higher acuity patients.
• Emerging Technologies: Predictive modeling to anticipate patient deterioration is being explored and implemented.
• Virtual Sitting: Digital options are being used to monitor patients, freeing up staff for higher-value tasks and enhancing safety.

Notable quote:

“We are beginning to see changes in our case mix index...how do we leverage technology so individuals can be doing things that only individuals can do?”
(Dr. Todd Smith, 08:25)

5. System-wide Clinical Standardization

• Standardization is critical but complicated by Sutter’s scale and diversity.
• Clinician Involvement: Leaders at local and system levels help design and improve evidence-based pathways.
• Establishing regular operating calendars and touchpoints allows for learning and sharing.
• Best Practice Sharing: Successes are celebrated at system level, and teams are deployed to accelerate improvements across sites.

Notable quote:

"Scale is helpful at times and at other times actually can get in the way...celebrating best practices and sharing those out accelerates improvement."
(Dr. Todd Smith, 12:00)

6. The Evolving Chief Physician Executive Role

• The modern CMO must now blend clinical expertise with operational leadership.
• Broadened Scope: Responsibilities now include clinic throughput, supply chain, hiring strategy, and integration of new organizations.
• Collaboration: The CMO is a vital partner to the COO, bringing a clinical lens to operational decisions.
• Future Success: Clinical acumen plus operational fluency will define high-performing physician executives.

Notable quote:

“The successful chief physician executive [of the future will] be well-grounded in all the clinical pieces, be well grounded in the quality pieces, but also much more well-versed in the operational pieces... It's a different skill set than many physician leaders have had over the years.”
(Dr. Todd Smith, 15:30)

Memorable Moments & Quotes

• "Onboarding is a journey—it doesn’t start the day they start, and it doesn’t stop the day they start...It's jointly owned by the medical groups as well as our foundation counterparts." (04:20)
• “One of the biggest things...is to really create an operating rhythm...so that there's a clarity of conversation and a clarity of metrics.” (06:20)
• “We are beginning to see changes in our case mix index...how do we leverage technology so individuals can be doing things that only individuals can do?” (08:25)
• "Scale is helpful at times and at other times actually can get in the way...celebrating best practices and sharing those out accelerates improvement.” (12:00)
• “The successful chief physician executive [of the future will] be well-grounded in all the clinical pieces, be well grounded in the quality pieces, but also much more well-versed in the operational pieces...” (15:30)

Timestamps for Key Segments

• [01:17] Dr. Smith outlines Sutter’s current top priorities: onboarding clinicians and expanding ambulatory care
• [04:00] Deep dive on volume and complexity of the onboarding process across the organization
• [06:02] Approaches to maintaining care quality and continuity during rapid ambulatory expansion
• [08:20] Implications for inpatient care and use of predictive technology/virtual sitting models
• [10:23] Strategies for system-wide clinical standardization; celebrating and sharing best practices
• [13:58] The changing nature and necessary skill set of the modern Chief Physician Executive

Conclusion

This conversation with Dr. Todd Smith provides an insider’s perspective on the complexities of scaling care delivery, integrating new clinicians, adapting to ambulatory trends, and leading system-wide standardization. Dr. Smith’s insights illustrate the evolving and increasingly hybrid nature of executive physician leadership in large integrated health systems—where clinical, operational, and strategic acumen must intersect for both present stability and future growth.