Leadership Can Be Learned | Sandra Leal, PharmD, MPH, President of APhA

Speech to text:

Mike Koelzer: [00:00:00] Sandra for those who haven't come across you online, introduce yourself and tell our listeners what we're talking about today. My 

Sandra Leal, PharmD: name is Sandra and I'm the executive vice president, Tabula Rasa Healthcare. And I'm also the current president of the American Pharmacists Association. So today we were going to speak a little bit about my leadership journey steps I've taken, uh, within my career to be here 

Mike Koelzer: today.

I think some people, when they hear about being president of the American pharmacists association and many. Organizations that someone might be the president of, I think they're a little bit shocked when they say, oh, wait a minute, you actually have a job on top of this. The presidency is a leadership role, but it's in addition to your day job in 

Sandra Leal, PharmD: quotes, that's right.

It is. And people ask me that question all the time. Like, how are you able to handle that? And work-life balance and you have a family and then you have a real job. Um, but you know, I think one of the things that makes this possible, it makes it happen is that a lot of the work that I'm doing with APJ is very much in line with a mission and, uh, the work that I'm already doing with my current, with my current 

Mike Koelzer: employers.

But I know that in general, you have a lot of nice goals for pharmacy, but I know that on your LinkedIn about me page, or at least the hash marks we were talking about digital health and telehealth and things like that. Does the association, I mean, you don't really run on a platform necessarily. Do they encourage it?

You can bring along your flavor of what you're adding to the profession. I imagine the answer is yes. But how does that work out? Do they kind of allow your pet projects to come in and in your case may be more of the digital front versus somebody else who's maybe bringing in academia or bringing in personal nutrition or something like 

Sandra Leal, PharmD: that.

They do, you know, it's, it's funny how that happens, but so, you know, you, you first, a lot of us are on the board before we even get into the presidency position. And a lot of us represent certain sectors of the profession, some more academia, some our community, some of our health systems, some of them work for, um, like retailers, for example, or even health plans.

It's just, it's just a very diverse group of board members and all of us tend to have. Some sort of interest or passion that's gotten us to the table and something that we represent. And so for me, a lot of the work that I did historically had been working with medically underserved people. So I worked in federally qualified health centers for a long time.

And then in the progression of my career, um, I obtained a master's in public health because I was really working on value-based contracting and then doing more population health kind of work. Uh, and then, you know, when I, when I left El Rio to join tabula rasa healthcare, which was Symphonia, um, it was basically starting to use telehealth platforms and, and, and digital health platforms to be able to do more of that population, health management.

So it, so that's how I've sort of been able to evolve in my career and then also start to represent that. Being part of the president now. So interestingly enough, and everybody who's ever been president has said this to me, that I've spoken to. So I haven't spoken to all the presidents, but they always say, yeah, you'll be careful because there's going to be a wrench in the plans that you have for what you think you're going to stand for.

And then something that will totally hit you blindsided. And then you're going to have to take that on a perfect example is a pandemic. Nobody expected we'd be in a COVID pandemic during my presidential year or Michael Hogue who was right before me. And you know, it is so funny because even though that's been significant, right, there's been so much work that pharmacists have stepped into and really helped to propel.

I can still bring in the flavor of my platform, which isn't medically underserved. The people that have been. Really marginalized during this whole pandemic and still bring that to the table. And it still brings the things that I really care about, tele-health which boomed during the pandemic, but then bring in digital health, bring in all of those other things of how we had to manage patients while we were trying to also protect ourselves and protect our community.

And so it sort of feels like this situation at the time really reflects all of the things that I've had to come through in my career and like to really showcase them now. And, and it's so funny because it happened for Michael home the same way he was an immunization guy. Like he was the guy and he's a guy who hasn't.

Yeah, it's amazing. I just feel like we were the people that were meant to be here at this specific time, for whatever reason. Um, so that's, that's how it happens. That's 

Mike Koelzer: fascinating because Michael was immunizing your tele-health. Those are like right on top of each other. What are the odds of that? It's crazy.

A PHA, for example, shows how many board members there are. 

Sandra Leal, PharmD: Um, I've roughly about, gosh, I have to do the county, but. 1415, something like that. 

Mike Koelzer: Are you saying that the talents you have when [00:05:00] people, somehow, when you're voted onto that board, are looking on purpose for different gifts you bring to the table or is that by campaigning that naturally the board fills out with different gifts?

Or you say, Hey, I can bring technology to the table. I mean, it's gotta be through the election process, right? 

Sandra Leal, PharmD: I think it's more through the slating process because when we're looking for candidates for the board, they do look at things like geography, representation, they look for different fields to be represented.

So it's more in that slating process where, where some of that happens. And then definitely, you know, some people come with a lot of diversity. They've had multiple careers. Uh, and so maybe they were slated because they lived in a geography, but then, oh, by the way, they happen to represent these two or three areas.

And then, you know, by the time you get to the board, there's been the people that they're slating typically have these they're known, they have some experiences that are unique. They're very active in the profession. So, so you're, you're, you're definitely picking people that, um, tend to reflect things like entrepreneurship and things like that.

That would be unique. And that's what. Basically get something to be part of some of these processes, but the, but the slating is really where that's at. There has been this whole discussion around diversity, equity and inclusion and making sure it's balanced by gender, by diverse backgrounds. So even those things to try to become even more inclusive of an organization, it's just that next step of how to do that.

Even more, 

Mike Koelzer: Let's say the U S open golf tournament or something like that. In theory, you got every golfer can. The ranks. And in theory, you could do that through, I guess, the U S political process where you could rise up through the ranks. And I know they're slating there, but in this case, the board itself says, we're going to put certain people on the slate.

There is 

Sandra Leal, PharmD: a call though, for people to like actually either nominate themselves. So self-nominating or other people can nominate you. And then typically the way it is kind of the same process that you're talking about with a golfing, because a lot of the members, right, it really is you have to be a member, first of all, then you, there's different, uh, section interest groups that you can participate in.

So a lot of people start with those rules, they'll join a section of interest, and then they run for a position there. Then they sort of kind of go up the ranks within the different opportunities that they're slated for there. And then definitely the more people that you meet over the course of your career, as far as being a member.

It gets the people there to know you, to recognize the work that you do to see your contributions within the APA organization and then within your professional career. And so a lot of those are the same people that will nominate you and vote for you. So if you're a very active member to start and it can start as soon as you're a student, because there are student members, um, those are the people that tend to rise all the way up and then eventually sit on the board and then be president.

I took a slightly different path. I didn't go up the ranks in that same way, because I was working a lot with the APA foundation, doing project impact diabetes. And then I did some work with their three 40 B uh, pharmacy services support center. So I wasn't traditional, so you can still do it in a non-traditional way.

Because that was my experience. Um, but the more traditional path is going through the section, the sections and then kind of going up and, uh, um, ascending that way. 

Mike Koelzer: Sandra, you went back to school after you graduated from pharmacy tenure. Now one could look at you and say, well, you just wanted these skills to do this.

However, As in fonio though, you are the CEO. So it's not like you did this just to gain some skills. You went to school to rise to CEO status. Is 

Sandra Leal, PharmD: That right? It is correct. And you know, a lot of it is because when I was growing up, you know, when I was seeing people, even when I was sitting in pharmacy school, sitting in the chair, you know, in pharmacy school and in the lecture hall, I remember looking very closely at the people that would come and speak to us and they were phenomenal.

Right. They had this expertise and they were coming to lecture because they had some. Some amazing thing that got them invited to be in those positions. And so throughout the trajectory of my career, every time I would look at the people that I wanted to be, or the things that I wanted to do a lot of times they had dual degrees, like they would have an MD MPH, Hora, a Pharm D MBA or some combination.

And my passion has always been advocacy and really doing legislative policy work to change a system that's broken because we see so many people experiencing day-to-day problems. And, and it's one after the other, after the other, how do we actually fix a system? And then how do we fix a whole, you know, a whole group of, of, of situations it takes policy.

So that's, that's essentially what drove me to get my MPH that I wanted to be. In a similar position as those people that I saw as being leaders. And that's why I got my MPH. And even now I, and I always say this to my students, I'm like, [00:10:00] go and find the job that you want to do and go and look at the qualifications, right?

What are they, what are they, five years experience. It's a certificate, whatever that is and prepare yourself, go and get them because that's essentially going to give you what you need in order to apply in whatever your timeframe is. If it's five years from now, 10 years from now, you have to start investing now to do that because those positions don't just fall on your.

You have to work for them and you have to separate yourself and differentiate yourself to get there. And my wife and 

Mike Koelzer: I talk about that. I'm not near retirement age, but we always talk about what we're going to do in retirement. What kind of people are we going to be? What are we going to do? And I heard before someone say, don't look at this in some kind of a nebulous dreamlike world.

They said, pick out a couple people. You think you are doing what you might want to do and look at them, you know, look at their life, see what they're doing. Look at actual people. So you did that with the people coming, talking to you and these people usually had two 

Sandra Leal, PharmD: degrees. That's right. And I love LinkedIn now because I see I can follow people.

I could see their career path, uh, schools, the certificates, even the recommendations other people give. I mean, it's so nice. Like we never used to have that when we were growing up. Right? Like you are lucky if you got somebody's business card and then good luck finding them because people change jobs.

But now you follow people over a course of time and you see when they move to a different position and you see what certificates, what publications they have. So there's even more information now for you to be looking at, at those people that you admire or that, you know, have influence and then try to sort of position yourself in that same way to get to whatever endpoint you want to reach.

Mike Koelzer: Absolutely. I do that actually for the show when someone's gonna be on the show, I don't want to. Everything about them because that's a boring interview. So it's like someone writes a book, conventional wisdom says, make sure you read the book now, Larry King, who was a good interviewer. He said he never read the book because he wanted to be in the same position as the listeners were.

And thankfully for me, I kind of picked the lazy route out. So I'm going to pick whoever says something that's easier for me, but yeah, LinkedIn is amazing because. I'll go on there before a show, and I'll say, I'm going to get 10 points from this person. And I don't use the questions. The questions just come from our conversation, but it's amazing if you go to their history, go to where they live, and then you can go into what groups they follow, what people they follow, who or some of their connections and things like that.

You can get a really good picture of someone from, from LinkedIn. It's really amazing. 

Sandra Leal, PharmD: And I find it to be super helpful. And I used to, you know, used to think it was quite a stagnant platform when I first started to use it. But you know what I learned, this is one of the things that impressed me the most about LinkedIn, that I never knew.

So when I was working, uh, at El Rio and I moved over to a symphony, I came into the symphony as vice-president for innovation. And so that was like a title change. And I think that was like my first official title change on live. So when I did that immediately, like that afternoon, the next day I started getting all of this information and content, um, vice-president I was like, oh, wow, this is pretty interesting.

This is really helpful. And then when I moved to COO chief operating officer, then it unlocked another level. Now it's like the CEO content and it's these connections that really help you when you're a seal. And then when I moved into CEO of symphony, then boom, you hit the next level. Right? And you're now getting all this content for CEO, even new positions that people like now think you qualify for that.

You wouldn't qualify for two or three degrees down or levels down. So that's the magic to me that I didn't know existed. And I love it. And so I've had changes like I'm executive vice president, because we're part of a bigger company now. And then president of APA, you know, all these things unlock all of these new levels.

It's almost like a game, but it is. It exposes you to new people. It exposes you to new content. Groups, um, where you talk like there's a CEO chat and then you, you, you work with other CEOs and you're dealing with things about, you know, things like sustainability during COVID how to engage your employees like telework and what the new future of that is.

Like, just stuff that you didn't even know existed because you didn't even have the right, uh, Uh, a certain title and different platforms for different reasons. I love Twitter when I'm going through a meeting to a conference, phenomenal. Yeah. For work, LinkedIn for my family and keeping up with my social Facebook and then Instagram for essentially a younger population with that social aspect of it also.

So even just understanding the nuances of these different platforms, it has a big impact. 

Mike Koelzer: Social media has got a bad rap. They say it's brought out a lot of different things and people have narcissism and different stuff like that. It hasn't created stuff like narcissists and different things. It's just exposing [00:15:00] people.

People are just kind of coming out, you know? So it's a good thing. It's a really good thing. 

Sandra Leal, PharmD: Well, I think about the benefits of it. So when my father passed away, one of the things that I was really concerned about was my mom being socially isolated because of her and my dad. Like they met each other in elementary school and they spent so much time together and I was really worried about her living alone.

You know, we got her a smartphone and an apple iPad, and then connected her to cousins and all these family members. She hadn't been connected in years and it's really allowed for her to have this new, social connection and reconnect with people. So I look at that, like, I'm an, I'm an optimist by nature and I really look at ways to leverage good things.

And so for me, that's where it's really been tremendous. In fact, just yesterday, I went to dinner with a friend here and we were talking about a classmate from elementary school and we found her on Facebook and we were just like, oh my gosh, let's reconnect. She lives in Germany now, but we were so happy to just see how she was doing and I would never leave.

Never. Would you ever have had this earlier when this didn't exist? Um, so I, I love those are the good connections that can happen if you, if you use these tools effectively. When you 

Mike Koelzer: become CEO, do you lie there in your bed at night and say, I'm CEO. Now I know you didn't abuse your power trip as CEO, but did you have feelings of like, I'm awesome now fess up.

Sandra Leal, PharmD: So this is an interesting question. I think every position I've ever been at has always been like a position I never even expected to have. Like I came to, I came to the symphony and VP for innovation and then because of need, cause it was a growing company that was a startup became COO, which I never imagined I was going to do.

And then eventually CEO. And I think what you think of when you're in these roles, at least for me, and maybe not the same for other people. Yeah. Like a tremendous amount of, uh, overwhelming responsibility for the people that work with you. And just to try to maintain, uh, you know, positions that are satisfying, that, that you connect with with all of these people.

Like you always imagine, oh, if I was CEO, I could do all these things. Well, the reality is, first of all, we all have a bus. Everybody has a bus. Even the CEO, everybody has a bus, it's either a board or it's whoever it is. There's always another boss. So as much as you think you're in power or you have some sort of thing, there's always somebody that you always at the end of the day, half their response to.

So that's a very much, I think people truly need to know that even the president, right. They have the people that vote for them that they have to respond to and all of these things. So you're never truly ultimately in charge of anything except maybe yourself. Right, but I mean, it's cool. Right? It's cool to get to a position like that, that you just didn't even realize that you had an opportunity for, especially when we go into healthcare professions, I never thought I'd be working in administration.

First of all, I thought I was going to be working in clinical care, seeing patients. And then just because of the trajectory of my career and then trying to replicate these models to help more patients, I just found that I could do it more effectively doing program designs and policy and all that, that it took me in an administrative route.

Um, and so it was interesting to wake up and say, Hey, yeah, I'm CEO, but I, at the same time, I don't know. Sometimes it is so much on your shoulders and there's so much stress. I really like, I, I emphasize for people that are in these positions where they have to make these very critical decisions. And even right now, Even more concerning.

Imagine all of those, uh, people that had to make determinations about essential workers, like who they continue to employ. Even the decisions about coming back in a, getting your employees to come back in a safe way. All of these are things that really land on your shoulder. And so there's a lot of stress and aging that comes when you're in those positions trying to make the right decision.

And I hope I'm a good, you know, a good person, enough to think about the considerations of every single person on the line. And, you know, I don't know about every other company, but those are the things that keep me up at night in this position. And it's not always fun. It's just a lot of responsibility.

Mike Koelzer: Well, I think the problem is, and this is what was. Demonstrated to me on a very small level. When I first became the president of our family business, I was really in a bad spot because I had the responsibility to, to lead and do it right. Button. All the authority now I do. But what I'm thinking of, when I hear you talk about that, of having all the people you're responsible for still as CEO, then you've got a crap load on your plate, but you can't just snap your finger and say, everything's going to happen.

That I want to happen because you've got your other bosses too. So you're really in a tough spot. Sometimes it seems 

Sandra Leal, PharmD: you made the same point, right? Like sometimes you have all the [00:20:00] authority, but not necessarily all of the ability to do what you need to do because there's all these other competing factors.

So it's almost. What you think it is, and then the reality of what it is. And it's always, uh, you know, be careful what you wish for, because you might get it. And then, then you realize, oh my gosh, absolutely. Then you start understanding why, why the CEO gets paid a little bit more and then sometimes it's gross, right?

Like, I absolutely don't agree with this differential between like the employee, but truly the level of responsibility, like not sleeping at night. The concern about the finances, you have a lot of people's lives, um, in your hand because of, you know, it's their job, it's her livelihood. It's the things that you want to make sure they're successful, uh, and that your company is successful so that these people stay employed.

Those are things that just, you, people don't even think about as being part of those responsibilities, uh, that are very, very critical. And then like right now, especially with COVID again, I just go and think about, you know, Do it right. How to make sure you still have, um, a sustainable organization during this very incredible pandemic and then come out.

Okay. On the other side and hopefully have, have made sure that all of those employees were taken care of, uh, we're healthcare providers. We need to take care of ourselves so we can take care of others, making sure that those individuals, um, are being taken care of appropriately and correctly so that they can be effective.

Mike Koelzer: All right, Sandra. So when you went from CEO and then your company kind of merged. 

Sandra Leal, PharmD: We were, yeah, we were bought by tabula rasa healthcare. And then, um, I was then the lead for this division, which is, um, it's symphony a cell, but it was, um, the health plan and payers division is what they call us within this new, how many people were you CEO over?

Um, for symphony of about anywhere from like six 50 to 750 employees because of this, we have contracts across the country with different colleges of pharmacy. So there were a lot of, uh, FTEs as a result of that. So about, say about seven 50, then you go 

Mike Koelzer: to Tableau or rasa and how many people in that company.

Sandra Leal, PharmD: So altogether the company is about right now, roughly about 1500. So we, we brought in a huge amount of FTEs when we joined, just because of the way that we were doing the work that we were doing and your executive 

Mike Koelzer: vice-president now correct. Executive vice presidents are there. And then is there like a CEO right above you 

Sandra Leal, PharmD: now?

Yeah. Yes. And actually everything's in transition. We're actually merging because they acquired other companies, not just Symphonia they acquired, uh, prescribed wellness is another company. There's a company out of Australia. So when you look at the strategy for tabula rasa, healthcare is really medication optimization.

Uh, On a variety of things. And really the CEO that we all report to now is Cal Knowlton. Who's a pharmacist and his wife, Ursula, Knowlton. They were the founders of tabula, rasa healthcare. And so it's really great because there are a lot of pharmacists within this organization. So we all have that mission, right.

Which is to really advance the work that pharmacists do, address medication safety, make sure people are taking the medication in an optimal way. And then there's a different division. So the different vice presidents are for the different divisions, which have been the companies that have been acquired.

And then we're actually now merging divisions together because it's so synergistic merging them together versus keeping them, um, siloed. So, uh, so that's sort of the evolution of where the organization is at right now, doing that, that integration. 

Mike Koelzer: When you found out you were emerging and you are no longer going to have that CEO designation where you moping around the house and depressed because of.

Label got taken from your name? 

Sandra Leal, PharmD: I wasn't, um, no, not at all because honestly it's so it's different like levels, right? So it's, again, it sorta goes back to that level analogy. 

Mike Koelzer: I know you're still the CEO. I mean, you're still the head of that thing. It's just that, that label's not 

Sandra Leal, PharmD: there though. Yeah, no. And it's, to me, okay.

Because then you start understanding the structure. Like you could be the CEO of your consulting firm and it's an N of one, right? Right. Or you could be a CEO of a company of 10. So the titles get less as the company gets bigger. So like now you're talking about an Amazon, right? So many different titles, there's only one CEO.

So you can't have 16 CEOs within an organization. It just doesn't make any sense. So within a, you might have a lesser title, but it's a bigger company. And so that title might even carry more weight and more responsibility than the CEO of a 10% shop. So those are kind of like, just even just in the, you know, the evolution of my career and the titles as they change, you really have to look at what the scope is of what your responsibility is, what the organization is, where they fall within, you know, the company's like, is it a top 10 fortune 500?

Or is it, you know, in just a really tiny company that's local. And then I always look at things like that. Is it the local impact, which is [00:25:00] important. There's nothing. Um, I mean, that's really critical, right? Local state, federal world. Do you have international implications for the work that you do? And so at all of those levels, those different titles mean different things and there's different responsibilities.

So it didn't bother me not to be CEO. Uh, what I loved more is having, you know, More resources and then actually the ability to collaborate and to bring in new solutions as you have. Access to them because you now have new, um, you know, new partners that you didn't have access to before. And I think that was one of the really great things about how it just, again, in my career, I started seeing one patient at a time and then trying to do more population health, and then trying to figure out how to scale and with, with all of that comes new resources that you can utilize to do the work that you want to do more effectively.

And you're not having to do everything yourself because when you first started off, I remember very clearly I was doing some clerical work because I didn't have somebody to take, um, you know, certain things appointments, make appointments for me. Like I had to start doing that. When you get into these other new positions, now you've got executive assistants and you've got, you know, these new technology tools and all these things that weren't available to you before 

Mike Koelzer: You find, when you raise up the ranks with different leaders, do you ever talk to another leader or someone from another company and just shake your head and say, how the hell did they get that?

Well through whatever nepotism or politics or something, or are you finding that the people in these spots are always pretty sharp because they've been sifted pretty well to get up there. 

Sandra Leal, PharmD: I'm very surprised about what I found out coming up the rags, you know, I'm um, let's go. Yeah, no, I mean, you know, yes.

I have found that some people I'm like, I don't know why you're in the position that you're in, maybe luck, maybe whatever it is. Um, I do find, I mean, for me specifically, like my, my situation is so unique, I'm a woman, so I don't see a lot of other women. Right. It's still not equally balanced from that. I'm Hispanic.

When you look at, when you look at, uh, Latino women, I mean, it's less than 1%. I mean, it's crazy. So I come up and I bring a totally different worldview sometimes when I'm sitting around a boardroom and, and then I see, you know, then not a lot of diversity sometimes. And so then I wonder, I'm like why, why them and not somebody else.

And I know so many other more qualified people, even, you know, you look at, uh, and I've sat on a lot of boards and I sat on, um, a lot of groups and looking around the table. And like, I find that it's surprising that, um, some people are where they're at, that is absolutely, absolutely an observation that I've had.

And some people are phenomenal. Some people absolutely no doubt deserve the position that they're in. But a lot of times, uh, there are definitely more qualified people that should probably be sitting there that are not, and I know 

Mike Koelzer: that you're a positive person and I try to approach things positively, but it's more fun to get the dirt.

All right. So here's the question. What traits do you think are missing? As you go around this imaginary room, what are some traits that there are some people in leadership that, and again, we're not trying to pump yourself up. We're just chit-chatting here. But what are some traits that some of the people in this position you think are missing?

Like how are they missing that skill? What kind of skills are they? 

Sandra Leal, PharmD: I think just understanding of the work that they're leading. Right. A lot of times. And I have always, like, I've been concerned about, I never want to lose because I've been in an administrative role so far removed from the actual work that you represent, that you don't even know what you're talking about.

That's the biggest surprise for me. I'm like, you know, wow, you don't even know what we do. You don't know what we sell. You don't know that that's pretty big to me when 

Mike Koelzer: they're talking, you know, that they're missing something because you know enough about even their 

Sandra Leal, PharmD: frontline workers yeah. About frontline workers or the organization or whatever that you're talking about.

Right. Or even just staying abreast of the changes that are coming in. I think one of the things that we always have to do is stay ahead of the curve, like read and write. Keep up with the administrations, whoever that is, understand what the changing politics are. Um, you know, and I think we do this as a profession too.

We go back to what we thought it should be or what it was versus what we need to be doing to be able to adapt. And that's hard. I get it. Like I change is so hard for people. They'll just stay here, like look up and like, look to see what the world is around you. And cause I see this all the time with pharmacists, right?

Pharmacists like, well, it's frustrating, frustrating, but I'm like, have you talked to a doctor lately? They are super frustrated too. They have the same problems. Now they have to report everything. Value-based, you know, they have the same, they have to see X number of patients. Now they have to do RVU.

I've been a medical director, which is unique for a pharmacist still to get the perspective of what the medical site is dealing with, which is very, there's a lot of similarities to the challenges that the pharmacists are facing too. They're facing [00:30:00] consolidation all the time too. There's not as many.

Doctor practices are there used to be, there's not a lot of small independence. Like there used to be, they're getting bought up. I mean, there's a lot of parallels. So instead of like, kind of like living these parallel lives, if you actually spoke to each other, and got together and advocated for these changes that are frustrating, you might be more effective versus not even understanding that it's also happening to them.

And a lot of times we're putting more of an oppositional point of view or like AMA doesn't support us or this or APH, um, like we actually have more similarities and differences and yes, there are going to be issues that maybe we don't fully agree on. But at the end of the day, a lot of us have the same priorities.

Like we all went to school to be. Providers to help people, right? Like none of us went to school to be rich. I mean, there, people get rich in the process, but I don't think that one buddy thought like they wanted to be respected. They wanted to take care of people. They wanted to make a difference. Uh, and it's just all of these other factors that end up causing the friction where you could actually be collaborating more than, than being antagonistic 

Mike Koelzer: going around this imaginary room.

Sandra Leal, PharmD: How do you think people lose that touch? They've stopped talking to the frontline workers. How do they lose touch? 

Mike Koelzer: In this example, you're 

Sandra Leal, PharmD: giving You pick up more responsibility. It gets harder for sure. It gets harder to try to go back and do some of that work. You're busy, right? You're busy. So you don't. tend to Maybe talk to the people that you used to talk to and you start getting into these other things, but I think you should always make the time to go back to the roots, right?

To talk to patients, do focus groups, like all of those things that end up getting you reconnected even with your own experience. And this always happens, right? People that, um, don't realize how complicated the healthcare system is until they personally have to live through it, or they have a family member. And it's not just for this issue of healthcare it's for any issue.

Right? If you, if you never had, um, an experience, sometimes you don't even know what it's like to live that experience. Because you never had the experience, but you don't put yourself in those other individual's shoes until you have it personally happen to you. And so a lot of it is just trying to be open to what the possibility is for somebody else to experience that, that doesn't have to happen to you for you to actually have empathy towards that individual.

And to try to, you know, see a point of view that might be different from yours. And that's hard. That's hard. 

Mike Koelzer: That's something that as the leader, you could say, Hey, I want a focus group, or I want to see a sampling of the reviews that the patients are. These workers are giving each other or whatever there's ways to do it.

Especially now in talking about technology, there's a lot of ways to get a standard. Of what's 

Sandra Leal, PharmD: happening well. Yeah. And some of it is even being driven by some of the changes in the administration and how payers are covering. Like, I'll bring up an example, like social determinants of health, right?

Everybody's like finally starting to have that conversation. Um, my whole career has been about social determinants of health with El Rio. And it's, I'm glad today we're starting to see players talk about issues that impact patients, things like transportation affordability, but it's taken a long time to get there.

Uh, I'm glad we're getting there. It's taken a little bit too long. Um, and then some things like the pandemic have exposed Cigna. Uh, social decisions are for some people more than others. Uh, but it is, it is to your point, like you could actually have already seen that experience that you could have been in a practice.

You could ask people that are living this every day. You could do a survey. Um, you can ask your neighbor, you know, what their experience is. They're not pharmacists, they're not CEOs. They might be a blue collar person. That's experiencing challenges and learning from that and then figuring out, oh, wow. I didn't even realize that was the situation.

Mike Koelzer: And they're not giving you bullshit answers to try to please you, you're just going out and finding these. Correct. So we're going around this room. That person might be a little bit out of touch. What's another trait that might be missing from someone that you shake your head and say, how'd that person get there?

I 

Sandra Leal, PharmD: I think one of the things that always surprises me. That a lot of people just simply don't know how to manage. They either haven't had management experience or they don't let their leaders or the expertise that they've brought to the table just do their job, right? Like you either micromanage or get in their way or not let the people that are actually the qualified individuals do their job.

You, you make it harder for them. How'd they 

Mike Koelzer: get there then? How are they in this spot that let's say they've had to raise up through four or five 

Sandra Leal, PharmD: jobs for many reasons. Sometimes it's so, you know, you know, sometimes I always say, I like, I think equal opportunity is really important, but I don't think it's applied like that.

Like, I don't know if you've experienced that when you just go in and randomly apply for a position. I feel like a lot of times they already have somebody in mind for these positions or like, you know, there's somebody internal, so it's really hard to break in if you're an external candidate. Um, so a lot of it is truly like who, you know, or, you know, what, you know, [00:35:00] relationships you've had in the past 

Mike Koelzer: nepotism, right.

Going all the way 

Sandra Leal, PharmD: back. So that's the thing. So if you have those kinds of things and you don't actually do an equal review or an equal opportunity, or actually judge people for their actual qualifications, or even when you're in those positions actually doing evaluations right. And performance assessments, um, in a way, cause you know, you, performance assessments are very interesting.

We all think we do. Um, and, but then when you actually go and sit and do a performance review, I don't know what your experience has been, but you know, in the past, for me, it's sort of seemed like an exercise and not really actually sitting in really doing a really good, um, performance review where you talk to people and you do.

Feedback. And then you actually try to align skills. And if there's a gap, you actually empower that person to get whatever that skill training is to increase their ability to do that role or whatever it is. It takes a lot of work to actually get somebody to be at that point where, where they have had training, would they have had feedback, you know, like an executive coach or some of those things actually get people.

Cause I don't think anybody starts, they're like natural leaders, but it takes work and you have to always be a learner, like a lifelong learner to build on those skills because I know I've taken a lot of them. Um, classes to help me be a better person. I've taken media training to be able to communicate better.

I've been, I've read leadership books. Um, I've, you know, I read a lot just in general to try to stay up with things. I, I, I definitely try to empower and mentor people. And then I also try to know individuals where strengths are and where weaknesses are, and then pair people up so that they can be better together.

Right? Like I know what my weaknesses are and if I have a weakness, I try to find somebody who's better at that than me. And then try to make sure that I'm working with them to actually make us better together. So those are the kinds of things I think that just helped to build better leaders in 

Mike Koelzer: general.

I'm sure if I had a weakness, I would know what it was. Sandra. I'm the boss, screw everybody. Now I've spent years answering things and now it's my own little kingdom. I'm the benevolent dictator. And I get to do 

Sandra Leal, PharmD: what I want. Yeah. Well, and, you know, I mean sometimes when you have entrepreneurs, like sometimes they 're the person's personality and that's what gets them to be, um, where they're at.

So you also have to like, understand how some people get there. It's the point you made earlier about, uh, people that are narcissistic. They were narcissistic before social media, um, that's something maybe a strength that drove them to be in this position to create a position, a job, a new company, whatever.

So you do have to know how to work with these people. Now there's maybe nothing wrong with that. Just figuring out how to leverage the good things and then, you know, figure out a way to navigate the things that are not the good things and be successful with 

Mike Koelzer: that. Yeah. It could be that, you know, somebody is maybe an entrepreneur and then they get to a level.

Where, all of a sudden they're on this board or something like that, they haven't been used to that before now. They got to work things out with eight people where before they were kind of their lone cowboy or 

Sandra Leal, PharmD: cowgirl, and that's hard. I mean, it's really hard. Every single job I've had, it sort of started off small, like El Rio was small when I first joined it and it became a huge organization.

Same thing for the company here. The boards I've sat in the smaller organizations that grew to be bigger. Um, you know, being president of a PHA. So I've seen these kinds of things in different situations, startups, non startups, profit, not for profit. So, and that to me has been the biggest education personally, like having sat around the table.

And I remember like one of my first boards was with the national center for farmworker health. All of this, all of the board members were either C O CFOs, um, uh, chief medical officers. And. Uh, pharmacist. So I had none of these chief titles, but I sat there and I took that as an opportunity to learn from these individuals who were living these very, you know, complicated positions and working with underserved populations that struggled.

I learned a lot from them. I learned so much from them that it, like, I feel like because of my exposure and sitting at around that table, that's what led me to my own CEO role. It was like, uh, like I was in a free college classroom, getting the expertise from these people and that at the same time, what I was giving to them was.

All of these services that pharmacists could bring to their health centers, to their clinics. We were talking about three 40 B and how to maximize, you know, using that to help more people. And like, I brought so much information and knowledge to them and some of them didn't even have an in-house pharmacy when we first started and they started an in-house pharmacy because they are like, oh wow, I hadn't even considered that.

So those are the things to me that when you go and join a new group or a new situation, like, what are you going to take from that? What are you trying to give and take? Right? What's like the, the reward and the, and the give back and pay forward for that. And so I'm still part of that group. And I still still find so much value in speaking [00:40:00] to them because they show me the world of, of the finances, sustainability of the medical officers, all of those that are as challenged as pharmacists are.

And then again, try to look at the bigger picture of healthcare and know that we're not the only ones that are struggling in certain aspects, but how can we work together to have better solutions? We're 

Mike Koelzer: imagining a board that's filled with, maybe not the people that we would like sitting there. One of them has lost touch.

Another one, maybe doesn't manage as well. If you could pick a third person to say, how did that person get there? What skill would they be lacking? 

Sandra Leal, PharmD: I think just effective communication and transparency. Sometimes it is like, um, you know, people want to hold turn information or they. Don't share. I've always been very transparent and I love to over communicate.

Uh, and you know, obviously you gotta be careful with some of the things that you share, but I truly find that if you're more transparent and like you, you share the real, the real picture and give people more insight about why you have to make decisions, then there's a lot more understanding. And sometimes decisions are made in that you have no idea and people take a lot of things personally, or they internalize it, or they think it's their fault.

They make up the worst picture. Correct. They, they take, they take it to an extreme. And then when you actually find out the real reason, it's so far removed from what you thought. And so that really matters, right? It helps morale and all of these things. So for me, communication and transparency are very key.

And then if you don't have that, then there's like that mistrust that can, that can occur. Um, so I do find that sometimes people aren't fully transparent, uh, where it would help them instead of being a detriment, they might think. 

Mike Koelzer: Lessen their advantage or lessen their power or something like that. When in fact they might've been stung before, but if they do it right, you can probably pick up quite a bit of trust and cooperation from that.

Absolutely. So let's take these three of losing touch, managing, and communication people aren't born and put in the corporate table. You know, they've spent years getting up there. These are skills that can be learned. 

Sandra Leal, PharmD: I think so. I mean, I think if you look at, you know, you probably looked at your own leaders that you've worked under, what kind of aspects about them?

It sort of goes back to the same discussion we had earlier. What qualifications do they have and what do you want to see in yourself and learn from those people that you've, uh, seen to have been great leaders and those that haven't been as effective and try to pick up those traits or like, you know, buff up your, your skill set for those things that you admire.

Um, but you do have to have exposure though. Sometimes we do end up coming into our little world and we kind of keep our heads down and we're not looking up or, or. You know, doing the kind of things that it takes more work like board board work. For example, I have sat on a number of boards. It's a lot of work to be on a board.

It's volunteer time. It's all of this extra effort that nobody pays you to do, but you do it. Why? Because there's these other things that you're gaining, you're gaining the networking, you're getting the exposure, you're getting opportunities to learn new things or new ideas, but you have to go out and seek that.

And then you have to go out and do that. It doesn't just come to you. Uh, so I, I, again, I mentioned that because sometimes people are frustrated about their situation and how they don't have opportunities and things like that. But again, they don't just come to your door, you have to go out and seek them sometimes.

And, and then get that exposure because the more opportunities like that you have, you'll get to meet some of those people that have these skills that you really admire, and then hopefully even ask them to be a mentor or, um, to help you out and, and just give you their life experience, how they got there, what they learned, uh, what, you know, what worked, what didn't work, and then see what you can apply to your own expense.

Mike Koelzer: It's unfortunate because sometimes you'll get people that are, while you're working for an organization, let's just say a pharmacy or let's say a mid-size hospital or something. And if there's a negative culture there, that's running through the business. You're just not even exposed to real leaders sometimes.

And boy, that's one thing I loved about the, uh, or I loved, I've been off the board now for a few years, but I was on our county pharmacy board, just part of the state board. And then, you know, a part of the APJ. I was in that for 20 some years. And I loved going to those meetings because it just gets you out of your cocoon and you run into some local leaders who are really good leaders and some of them have gone on to do other things, but that's an important statement you made there about getting out and just seeing some good leaders, if not.

At least reading them. And now we've got the benefit of YouTube. I was just on my walk this morning and I'd put on some business leaders and just at conferences and stuff where they've talked and it's really cool. You can get in touch with some good leaders, even though maybe you're stuck in one building or you're performing in one building [00:45:00] for years 

Sandra Leal, PharmD: and years.

Agreed. Yeah, absolutely. Like they have all these TEDx talks, right? Like all these ways that you could hear about people's experiences. You know, some, some quick podcasts and it's phenomenal what you learn. Um, but you have to do that work and I always get inspired, but you do, you have competing priorities.

Like I wish I could sit and read a book all day long and, and, and have that luxury of that time. But whatever, you know, whatever time you can carve out, invest in, in yourself and then figure out how to get exposure. Cause I just might, my biggest, I feel like sad for people that went to school for such a long time.

And then they're not professionally satisfied by the career that they picked. And we see that a lot now, especially when there's burnout, there's frustration. They, it wasn't what they thought it was going to be. Uh, but truly you, you truly have the power to make it different. You know, you don't have to be stuck with what you think is a status quo.

Um, the only thing that's keeping you from making a change is as your own self and you know what you want to do. And, uh, I always love education. I think education has given me so many opportunities. I've been, I always say I've been getting a degree. You know, trying to get a degree, a decade to, to be able to do that.

And I thought, oh wow. I'm in this decade. I haven't gotten a new degree. Um, so, and I have thought about it. I'm like, oh wow. Maybe I should. I, like, I thought I would love to do law because I love why I thought that was one of the other degrees I considered when I was doing my MPH MBA, because I've been working a lot with contracts and business kind of things.

But one area that is fascinated with it right now is just like the whole hit, you know, health information, software development, um, All of that right now is go coding apps, all of that kind of stuff. Cause there's so much use in application in healthcare. And if you think about electronic health records and how we're communicated remote monitoring with patients, to me, that's just this whole new arena that wasn't even available when I was first like stepping out of pharmacy school that are now new opportunities for, uh, for our profession to just really enhance what we do.

But just with that new technology footprint. 

Mike Koelzer: I know you didn't say you were going to 

Sandra Leal, PharmD: do them, you know, not a degree, but I get a certificate cause I've even looked at, you know, Google has like six months. I was just 

Mike Koelzer: going to mention that that's going to start bursting some of these colleges, but yeah, they've got that six month thing.

It's like 600 bucks or something and you get a Google 

Sandra Leal, PharmD: degree. Yeah. It's so reasonable. Honestly, like me, I've been recommending that to students. I'm like, man, if you didn't get your residency that you want to go and get one of these certificates, you're going to be super valuable. Personally. I literally 50% of the people that we work with here are people.

So I've learned a lot, uh, around the language of change management, you know, agile software development, security, my goodness, everything around cyber security, all of that's really critical and important. Um, so I've had to sort of like learn all of that as I've been going and doing this work. And I just find that it's so incredible when we have somebody who understands health.

Delivery model and then the it, and then marries both of them to be able to do it more effectively. 

Mike Koelzer: For sure. Well, you're bilingual in Spanish. Was that from birth? Pretty much. Sandra. Were you bilingual? I mean, was that spoken in the home or do you have to learn one 

Sandra Leal, PharmD: of those? So I had to learn English.

My first language is Spanish and my parents still to this day don't speak English because we grew up in the border town of Nogales. And so we like the community itself, even though we're on the American side, I'd say 95% of the population only spoke Spanish. The town has no gala. Sonora Nogales, Arizona, we were on the Arizona side, but my parents were from Sonoda from Mexico.

And I would remember when I was younger. In elementary. I thought I was going to forget my English in the summer, like when we would finish school. Because we didn't speak English at home. You could go to government buildings anywhere. You would say something in English, you would, people would respond in Spanish.

And I think that's still pretty much the experience to this day. So, uh, I was probably late elementary before I learned how to speak English. Yeah. So, uh, elementary late like fifth, fifth grade. Yeah. All right. So 

the 

Mike Koelzer: The point I'm making here and you're a good example of the point is that I think some people don't want to learn programming.

They think. What am I going to learn Ruby on rails or C plus plus or something? I'm going to get stuck in that? I think the argument against that is like, no, learn it. You're going to learn so much in one language. Like you're learning a second language. I'm sure you could learn a third and a fourth, much easier than I could learn one language because your mind now has two separate language pathways.

I just think it's easier. And I think the same with computers. I think that if you got something like that, I'm not sure how specific Google's is, but I think if you got that, you'd learn so much else besides maybe one language they're focusing on. 

Sandra Leal, PharmD: Absolutely. I actually put my own daughter in an immersion school to learn Spanish, learn it really well, not just conversational.

Uh, and it's like I told her this. Greatest gift I will give to you is for you to be bilingual. Because for [00:50:00] me, my first, like in my career at the federally qualified health center, I would spend 75% of my day speaking in Spanish to the patients that I work with. And even now, even till this day, I still get tapped about helping with translation.

In fact, I was at the APA board meeting this past week, and I was asked to do a video on vaccine hesitancy for, um, the department of health and human services. And I recorded three videos in English and three videos in Spanish, and they were so happy to have a healthcare provider that could speak in Spanish to like, be able to do this recording.

And then again, it goes back to what I was mentioning before helping underserved populations. It was going to be used for. Agricultural workers, this national center for farmworker health. So it's like literally all of these things coming together, uh, language, helping underserved populations speaking in, in both languages, uh, and creating these videos.

It just is such a gift to be able to do that. And I've always found it such an incredible tool. Um, and my, my favorite story, and this happened about three weeks ago. Four weeks ago, I volunteered for a COVID clinic here in Tucson, and it's called COVID after dark. So it was, um, uh, I volunteered as nonmedical, so I didn't want to, you know, try the medical route.

Cause I want you to try the nonmedical, which the role for that was to stand on the sidewalk and just welcome people to get the vaccine in, in a popular area in Tucson. I stood on the sidewalk and I just would talk to people say, Hey, come and get the vaccine it's here. You don't have to make an appointment.

All of that. But one of the best stories of that night was this, uh, this woman that was walking by selling, um, she was a street seller, selling little trinkets on her car. She didn't speak English and I'm like, Hey, you know, in Spanish, come and get your ex. And she's like, I don't, I don't have insurance.

It's okay. You don't have to have insurance. I don't, I can't read. I'm like, it's okay. I'll and this is all in Spanish. I said, I will read with you, you know, I will help you fill out your paperwork. It's like, well, I don't have an ID. Like you don't have to have an ID. So by the end of our conversation, she got her vaccine and she's like, thank you for, you know, like convincing me to do this.

I never thought ever that I was going to get the vaccine just cause I didn't have all the, all of these things. So I felt like I had to be at that place at that time. And, and to help this woman. Absolutely one of the most professionally satisfying, um, experiences that I've had. And it goes back to all the things, again, all the things that I've worked up to in my life and being bilingual and being able to do that was just, uh, a wonderful experience to, to do 

Mike Koelzer: that.

We were talking earlier about how you were kind of enamored by people that had two degrees. And then just recently you were talking right now, and you were saying that the power of bringing two professions together in yourself or having someone skilled in two different things. That's a really cool thing.

There's a lot of power in seeing how powerful things are, whether it's law or computers or language or something that's powerful. 

Sandra Leal, PharmD: It is, it does, it opens up just new opportunities and, uh, just a different level. That is, uh, it's unlocking, like I said, it's like unlocking this new level for you.

Mike Koelzer: Speaking of leadership, does the APHL have any struggle? Leaders in terms of the lower entry people. For example, I was on the marketing committee or something for my state association. And I got on that basically because I put my name in the hat. Does the APH a half. Fight off people because there's too many people that want to be uncertain committees and so on.

Is that like an old let's call it a prestigious position or is there any challenge trying to find people? It can 

Sandra Leal, PharmD: be a little bit of both. So sometimes they have more interest in certain positions, more than others, and then sometimes they do, they need more volunteers and are willing to run. So sometimes you'll see, you know, maybe a position that is not staged by even two individuals.

Maybe it's just one individual. And I think that's the same for a lot of different groups in general. My impression has been that, you know, a lot of these positions, like anything else, require more work, so it it's. It's hard because people do have a job, right? Like they have their professional job. Uh, but at the same time, people also understand if I do these roles that maybe it will give me more of the opportunities I want to do for the kind of job that I want.

So you end up seeing, depending on the different positions, that there might be more interest in one area versus another. Um, sometimes it could be seasonal too. Maybe like this year we have 10 candidates for one slot and then the following year, for whatever reason, maybe you only have a couple for one slot.

So it changes with time. It changes with different priorities. It changes with different needs. And so, and so sometimes we'll find that, that does happen in both ways. So there's a lot of interest and then sometimes there's not enough interest. Uh, but I think consistently, like if you're part of the organization and you want a leadership [00:55:00] position, I, I really feel like there's always room to be able to have a leadership role.

And a leadership role is not just a title either, right? Or not just like an office that you won or that you held. It could be a project that you start. It's networking. We have an engagement platform. For example, a lot of my actual opportunities that I got through EPHA was because I was doing a building code in my practice and I was piloting it.

And then I shared that and then others were like, oh, how'd you do that? Can I learn from you? Tell me how you did this, what kind of policies and procedures. So that ended up becoming like a leadership role. And then my expertise ended up being in building ambulatory care services and then billing an FQHC.

And then my own personal passion was diabetes. So I became like a leader in that area. And I started an accreditation program. So it wasn't because I was president or, you know, SIG, you know, section, it was because I was doing these things, uh, and these unique, uh, innovative types of practice models that then others wanted to learn about.

And so then I was doing webinars and I was doing, you know, education around that. So leadership comes in many ways and it doesn't always have to be because of a title. 

Mike Koelzer: I was in a service club, it was Quantis, but similar rotary and lions club and things like that. But one of the requirements was that like within the first year or two, you had to join a committee.

It was remarkable how just joining a committee, how that takes off. Because even though it's almost like a leadership role, you're actually, it's a service role, which builds a leadership role. There's a nice combination 

Sandra Leal, PharmD: there. No, it's true. I mean, it's, it's absolutely true what you're saying there, because it is, it's like if you join a group and then they see you're active, then guess what, then there's another opportunity and then another opportunity and then it can take a life of its own.

And then you're president of APJ. So that's basically what happened. Right? I joined one group. I volunteered. I said, yes, and this, and here I am sitting on the sand. That's how it happened. It was just a committee that I started or volunteered on that led, uh, me for more opening of doors and more opportunities to walk through those doors.

Mike Koelzer: You're on this board with all these misfits, not APH, I'm talking to this imaginary board of the misfits that are around there, you're on this bar with the people that see. Didn't seem to be up where they should be or could be for great collaboration. If you could get a hold of, let's say young pharmacy students, and you could do a Ted talk to them.

For example, what three points would you like to get across to young pharmacy students? 

Sandra Leal, PharmD: Stay involved, no matter how hard or complicated, even if it's, even if you can't be super active, but just stay connected because that connection will really lead to opportunities later on. And then hopefully, uh, you won't feel that isolation sometimes that you feel when you're kind of doing your own thing.

So, that entire aspect of staying in a leadership organization, either your local pharmacy association, your state I'm in both, right. I'm in the Arizona pharmacists association. I've been in it since basically I was a student and then a professional organization, which is, it could be a PHA. I'm in a number of them.

I'm not just in APJ. And then, you know, try to get outside of the pharmacy too. That's a very key message. I can't stress that enough because we do, we get stuck and we talk to just the pharmacist when we should really be talking to others to know the value that we bring. And I think there's been more power in me doing that and explaining what pharmacists do versus letting us know what we do.

We definitely know what we do. It's not to say don't get involved in. Profession, but. But how do you actually like to take that outside of pharmacy and amplify that to the rest of the world, your neighbors, your, all of that, because it really makes a difference. Um, well then I would just say, you know, definitely investing yourself, you know, that's another key thing, continue to learn, continue to pursue passions that you have, and it doesn't even have to be a formal education.

It could be something like, if you care about, you know, some hobby that you like to invest in, because that brings so much joy. Um, you know, I do so many other things that I really like to do. I love to travel so much. Like I love spending time with my family. Uh, and all of that brings me, uh, it brings me education.

I take a lot from that. Like I've even traveled to Cuba, one of my bucket list items. And I went there to learn about the healthcare system and I learned so much about how they manage effective primary care. Uh, so even that travel piece, connecting that in some way to like bring back. To my own day-to-day experience so I can invest in this.

And so combining some of your passions together makes a big difference in how happy you will be, that you ended up doing what you decided to do. 

Mike Koelzer: When you talk about getting involved, expanding your pharmacy life and so on to other professions to hear from others. How would you do that? Let's say you're putting in your time at a community pharmacy, and you feel like your life [01:00:00] is involved there.

What would be a recommendation of reaching out to another profession? 

Sandra Leal, PharmD: Well, right now, I think it's really interesting right now. Like I actually signed up, I told you earlier about them at nonmedical volunteering. A lot of public health departments have a lot of call-out right now for volunteers to help with COVID testing, education, medical non medical.

So partnering with your local public health department, even, you know, like. Even your school, like your PTA. If you have kids in school, there's always so many opportunities to sit on the PTA and there's, um, opportunities to kind of bring your skill sets in a different way there. Uh there's you know, I mean, I love like I'm a, I love politics.

I really do there's precinct committees that you can join. There's homeowners associations that you can join. All of these kinds of things expose you to how to run a meeting of Robert's rules. Like I never even knew how to do before I started all of this and, um, you know, sitting at AP. At the boardroom running my first live meeting with a hybrid with Robert's rules.

And I was just like, wow, this is crazy. Uh, but had I not had some of those earlier experiences in my careers, I would be lost. So, but it starts a lot with some of those, um, opportunities. It doesn't have to be anything big. It could be volunteering within, like I said, your homeowners to something more formal, um, or just even volunteering for your school, your, your kid's school for all of these different things.

There's a lot of not-for-profits out there locally, also looking for board members all the time. Like they're looking for some skillset, some representation, a lot of them want people to help fundraise for, you know, a charity ADA American heart association. So there's tons of opportunities there. So I would say like, if there's a certain area that you have passion for.

Go and seek, um, air go and seek those groups out and see what help they need. And sometimes it's as simple as picking up the phone and calling and asking the question. Um, one of the, my favorite stories that I'll never forget is I was reading a journal one day and it was called insulin journal. And I remember just even opening the front page and looking at all of the editors and all of one more MDs, every single one of them.

And I'm like, wow, I'm surprised they don't even have a pharm D like for, you know, diabetes and insulin. It's such a heavy condition. Why don't they have a pharmacist on? And I literally picked up the phone and I called the editor and I said, Hey, how come you don't have a pharmacist? And he's like, oh, wow.

I hadn't even considered that. Do you know somebody who would be interested? And I'm like, I would. I would love to do this. He's like, well, send me your CV. And that's all it took. I took a cold call and asked a question and I was on the editorial board for the insulin journal after that. So it's surprising that sometimes it's not this huge effort, but it just was simply asking a question that nobody asked her.

Nobody volunteered for that and ended up leading to an opportunity that, that, that, that happened. So that was just an example of something that happened very, very quickly. 

Mike Koelzer: Sandra, you really put your money where your mouth is on LinkedIn and go and see people being involved in. So on one of the areas that I don't usually see a lot of people, but I saw in yours is you've got like 150 million publications that you've done along with.

And I opened them up and there's other authors and things like that that you've worked with. And so on. So you're not blowing smoke here. When you say you work with people and you get things done and your teamwork and, and things like that, not to dismiss leadership. Sometimes when you say a team worker, you forget that they're also great leaders, but you've got a lot of.

Crap you do. When I look at you and I look at me, I kind of feel a little lazy. 

Sandra Leal, PharmD: I dunno what to say about that. I know I have been very lucky in my career to, you know, publish it so funny. I never actually, I never worked in academia for, I've been a preceptor and an adjunct faculty, and I've published a lot, which is surprising because not a lot of people publish that are not in academia, where it's a requirement for your position for like tenure and non tenure.

Uh, but it is, it's about sharing, right? It's about sharing the experiences, what worked, what didn't work, what I learned from. And I always thought that again, it goes to that whole thing about amplifying the voice in the rule for pharmacists. If we share that we've published. And if you look, a lot of those journals are not, not pharmacy journals, only annals of internal medicine.

There's been the American diabetes association, clinical diabetes. More because I want to show the other groups of other professionals where those are published, that pharmacists do a lot, and we do it in so many different ways. So that's, again, it just goes to the mission of, of the work that I've always tried to do is to amplify the voice for pharmacists and get others to really understand the value that we bring to the healthcare team.

So, one thing that I hopefully am is very consistent with my messaging and I repeat myself and that message several times. So people know. We've got 

Mike Koelzer: the right person at the head of this. Thanks Sandra, for everything you're 

Sandra Leal, PharmD: doing well, I, again appreciate the opportunity and I think everybody I've ever worked with who's, you know, definitely had a little piece, um, to do with my success because it's taken a lot of people and a lot of [01:05:00] collaboration to get 

Mike Koelzer: here.

We're all behind you. And the great things that APA is doing. It's exciting. Opening the LinkedIn feed every day and seeing what's new there. It's really fascinating. So thanks 

Sandra Leal, PharmD: for everything you're doing. I appreciate it. And thank you for what you're doing. I love the messaging that you're getting out and all the people that you're interviewing, it contributes to that excitement.

Hopefully people see this and hear this and then want to do something more. 

Mike Koelzer: I hope they do. All right, Sandra, we'll be in touch.