Saying Yes to What’s Around the Next Corner (Podcast)

Hospital president followed his instincts to new opportunities

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When Neil Smith, DO, was in school, he was told that he probably didn’t have high enough chemistry or biology scores to study medicine – but he went to med school anyway. When he was in private practice and was offered a chance to buy an urgent care facility, at first it didn’t look like a great idea from a financial standpoint. He turned it into one. And when he was approached by Cleveland Clinic to take a leadership role, he didn’t imagine himself ready for that, either.

In a conversation with Brian Bolwell, MD, for the “Beyond Leadership” podcast, Dr. Smith described the path he took to become president of Cleveland Clinic Fairview Hospital. Taking advantage of unforeseen opportunities is a common theme.


Dr. Bolwell: Can you share a little bit about how you started your career as a physician and ultimately became president of Fairview?

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Dr. Smith: Sure. It was kind of a circuitous route. I went to undergrad in St. Louis at St. Louis University, and I got a job afterward working at a hospital in St. Louis called the Jewish Hospital. It’s now part of Barnes Jewish. And I was taking grad-level classes and I got a job as an orderly in an emergency room. And I worked the third shift from 11 at night to 7 in the morning. And my major duties were just stocking the rooms and transporting patients here and there.

But the emergency room was run by residents, both surgical and medicine residents. And the one thing that residents like more than free food is sleep. We had call rooms off of the emergency room, and it’d be in the middle of the night, and a patient would walk in, and the nurses would put them in the room, and then they didn’t want to wake up the residents because they were generally in a pretty surly mood. So they would say for me to go wake up the residents.

I would knock on the door, and they would ask me, “What’s going on?” And I’d say, “We’ve got a patient here.” They said, “What are they here for, Neil?” I said, “Well, I don’t know.” He said, “Well, go back and find out.” And the reason they were doing this was to just give them more time to sleep.

And after a period of time, they would finally come out and talk to the patient and then start ordering tests. But I would listen to them asking questions to the patients, the timing, when did the shortness of breath start? What makes it better, what makes it worse? And pretty soon I could see that the really good ones could get these patients to tell them exactly what was going on. And I thought that was fascinating.

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I did this for two years. I would see more and more cases come through, and they would actually show me what a chest x-ray looked like that was abnormal, or an EKG, or blood work. And I got fascinated by the puzzles of medicine.

I was told in high school that I wasn’t all that good in chemistry or biology. I could never go into medicine. But I realized pretty quickly that even though that has something to do with medicine, if you listen to the patient and you like figuring out what’s going on and what their problems could be, that’s really kind of what it was about. So that inspired me to take more classes and finally apply to med school and get in.