Hello friends 👋
In this special episode of The Incubator Podcast, done in collaboration with the California Association of Neonatologists for the upcoming Cool Topics in Neonatology conference, Ben and Daphna welcome Dr. Robin Steinhorn, a leader in neonatal medicine, alongside Dr. Denise Suttner. Dr. Steinhorn, the keynote speaker for Cool Topics 2025, shares insights from her storied career, reflecting on the highs, lows, and lessons that have shaped her journey. From groundbreaking research in nitric oxide therapy to leadership in neonatology, she offers a candid discussion on navigating challenges, fostering collaboration, and embracing opportunities beyond predefined career paths.The conversation also delves into pressing issues in pediatrics, including workforce shortages in subspecialties, gender disparities in medicine, and innovative workplace policies supporting women and families in healthcare. Dr. Steinhorn’s wisdom extends to mentorship, career adaptability, and the future of neonatal care.
Additionally, Dr. Suttner provides an exciting preview of Cool Topics 2025, highlighting discussions on neonatal legal challenges, probiotic use, and emerging fentanyl-related neonatal conditions. Listeners can register for Cool Topics (March 5-7, 2025, in San Diego) using code INCUBATOR for a $50 discount. Tune in for an inspiring episode packed with leadership, innovation, and the future of neonatology!
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Short Bios :
Dr. Robin H. Steinhorn: Robin H. Steinhorn, MD, is Professor and Vice Dean for Children’s Clinical Services at UC San Diego. She also President of Children’s Specialists of San Diego and Senior Vice President for Rady Children’s Specialists of San Diego where she oversees more than 500 pediatric medical and surgical specialists. She is a neonatologist with a particular interest in pulmonary vascular biology and respiratory diseases of the newborn infant. She is an elected member of the Council of the American Pediatric Society and a member of the board of directors for the American Board of Pediatrics.
Dr. Denise Suttner: Dr. Denise Suttner is the clinical director of neonatal services for Rady Children’s Hospital NICU’s. Professor of Pediatrics at UCSD She has been a full-time neonatologist at Rady Children's and helping patients, including premature infants, with medical care since 1998. In addition to her clinical duties involving neonatal care, she is director of the San Diego Regional ECMO (Extracorporeal Membrane Oxygenation) Program and a professor of pediatrics at UC San Diego.
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The transcript of today's episode can be found below 👇
Ben Courchia (00:00.878):
Hello everybody, welcome back to the Incubator podcast. We are back this Sunday with another interview. We have a special guest this morning. Daphna, how you doing?
Daphna Yasova Barbeau (00:09.198):
I'm doing very well. I'm excited to hear from our special guests to talk about Cool Topics. I had the pleasure of attending Cool Topics last year and it was such a great conference. So we can't wait to hear more.
Ben Courchia (00:22.36):
Absolutely. We are joined today by Dr. Robin Steinhorn. Robin, welcome to the show.
Robin Steinhorn (00:27.706):
It's a real pleasure to be here. Thanks for having me.
Ben Courchia (00:30.795):
We are also joined by Dr. Denise Sutner. Welcome to the podcast, Denise.
Denise Suttner (00:39.099):
Thank you so much for having us.
Ben Courchia (00:42.15):
People definitely know who you are, Dr. Steinhorn. You're a professor and vice dean for Children's Clinical Services at UC San Diego. You're also the president of Children's Specialists of San Diego and the Senior Vice President for Rady Children's Specialists of San Diego. Denise, you are the clinical director of Neonatal Services for Rady Children's Hospital and you're also a professor of pediatrics at UCSD. We're doing this episode in collaboration with the California Association of Neonatologists.
Denise was mentioning just a second ago that there's a change that has been voted. It will now become the California Association of Neonatology in order to include more of the providers that are caring for newborns, nurse practitioners, PAs, and so on. We're doing this episode in collaboration with CAN for the upcoming Cool Topics in Neonatology and Improvement Palooza 2025, which will take place March 5 to March 7, 2025 in San Diego, California.
If you are not yet registered for the conference, please do so. And you can use the code “incubator” for a $50 discount at checkout. Dr. Steinhorn, you're going to be the keynote speaker for this year's edition of Cool Topics. And the talk that you are scheduled to give is called “A Neonatologist's Path, the Highs, Lows, and the Road Ahead.” My first question to you is, what made you want to give this particular talk?
Robin Steinhorn (02:09.298):
I wrestled with the idea of even being asked to give a keynote address. It's incredibly flattering. And there are so many brilliant neonatologists out of there that Dr. Sutner could have asked. And so I thought about what I could contribute through a talk. I've heard a number of these talks. They're always very inspirational.
What I thought I could contribute was reflecting on my own path as a neonatologist, which has been filled with more blessings than I ever could have imagined. I've been so fortunate to be at the bedside, to be with families as they go through the worst time of their lives.
I've been able to help families very directly that way. And I've had the good fortune to be involved in investigative work that has led to therapies being developed and improved, to help many, many babies.
Now in my current position, I support a lot of physicians, hundreds of physicians, but always close to my heart are those neonatologists. I think neonatology is on the cusp of really having more definition around who we are, who we are as critical care specialists on that continuum, supporting those neonatologists as we move past the old ways of thinking about neonatology, and moving into a new era of how neonatologists practice and are supported.
Ben Courchia (04:22.37):
Thank you for that introduction. I was quite puzzled by the title of your talk because I was considering your papers, your accomplishments. I would have expected it would have been the highs, the highs, and more highs. So, can you tell us a little bit about what are some of these experiences? When you're looking at your path, as you call it, what were the highs? What were the lows? And my follow-up question is, were you aware of these being highs or lows as you were going through them, or is it only today as you reflect that you're able to see them in this context?
Robin Steinhorn (05:03.026):
What a great question. I would say in the moment, the lows feel lower than they do when you look back on them. All the lows that I had, I now look back at with more perspective. I realize those lows are how I have learned and been able to bring some wisdom to the work I do.
When I think about highs, think about being in the laboratory, there is nothing more exhilarating than seeing something for the first time. Those are the moments that just are seared into my brain. I remember when I was in Chicago, and we were doing a lot of work on nitric oxide and
I was working with the brilliant Satyan Lakshminrusimha on a lamb work and I flew out right before Thanksgiving. And we did our first work looking at mitigating the effect of reactive oxygen species. So we were giving superoxide dismutase into trachea, with and without nitric oxide.
And watching the physiology unfold for the first time – we were the first people to have done this, to see the effect it had on the transitional vasculature. It was just one of the best days of my career. We went late into the night. We kept repeating the experiments.
And then I went back to my hotel and was socked in by a snowstorm. I did get home for Thanksgiving dinner. Thanksgiving's a big deal to me. I'm always the one who cooks. My husband muddled through. He bravely put Thanksgiving on the dinner. I walked in literally as we were serving Thanksgiving dinner. And so that moment was definitely a career high. That paper got a lot of attention. It launched a lot of investigation, a lot of funding. It was a cover girl for the American Journal of Respiratory and Critical Care Medicine.
The lows though associated with that were trying to take that to the bedside. That's where my heart always is. Trying to take this to the bedside, I couldn't think of a good reason why it wouldn't work, but encountering the challenges of translating a laboratory experiment to the clinical arena is much harder than I ever expected. I worked on that with John Kinsella.
We had quite a bit of funding to do it, and we just couldn't get the patients enrolled in that study. We ended up having the NIH ask us to close the study because we were only able to enroll five patients. That was a real low for me.
But it has only inspired me to become more involved in clinical research, which to this day is something I advise, support, and participate in. And figuring out how can we help parents understand the benefits to them, as well as to all children, by participating in clinical research.
Daphna Yasova Barbeau (09:22.604):
I love those highlights, lowlights, the stories. I think we learn so much from hearing about how other people have encountered challenges. We think that the greats in neonatology have only had, like Ben said, highs, but it's really the overcoming of challenges that is the only way for a lifelong career. I think given the breadth and the depth of your research, people will think that you were in the lab starting in high school or something. But I read somewhere that you actually didn't start in a lab right out of fellowship. I think that is an early challenge that a lot of people face, but maybe you can tell us a little bit how you came back to research to create all of this amazing work.
Robin Steinhorn (10:14.77):
That's a great question. And it's kind of a funny answer. I was a clinical neonatologist through and through. I trained at the University of Minnesota, which is where I met my husband. This weekend we'll have our 39th anniversary. My husband came home one day and said, “Robin, I think we're moving to Buffalo.”
And I said, “Help me understand here. I don't think I understand why ‘we’ and ‘Buffalo’ are in the same sentence.” It was a very exciting opportunity for him, and so off to Buffalo we went.
There I had one of the real good fortunes of my career - I met a number of really brilliant investigators, including Rick Moran, who became one of the most influential mentors of my career. Now, Rick was, and I'm sure is, a high energy innovator. He was in the process of really understanding how oxygen affects the transition. He had a very large laboratory in the Department of Physiology at SUNY Buffalo. And he graciously accepted me into the division because I was trailing my husband. I obviously needed a job.
He asked if I could set up an ECMO program. I was three years out of fellowship, but, you know, gamely said, yes, I can do that, which we did. I said the one thing I want in return is a chance to see if I can cut it as an investigator. And he said yes. So I went and interviewed a lot of people. One thing that was true about me then, that is still true today: when everybody is zigging, I like to zag. So I did not go into Rick's lab. I went into a PhD's lab by the name of Jim Russell and learned how to evaluate how vessels relax and contract in a very different system than Rick was using. And that's how things got started. That's where I learned the power of what a physician brings and how to combine that with what a PhD scientist brings. We physicians often discount the power of the knowledge that we have or understand where the important questions are. A PhD scientist really, really values that. And in turn, most of them are so generous with sharing their knowledge. So that's how that all got started.
Daphna Yasova Barbeau (14:01.942):
I love this idea about saying yes to where the journey takes you, and you find a way to reinvent yourself wherever you're planted. And I especially like this concept of collaboration, which sounds like over and over again, is a part of your career journey. There's so much value, like you said, in research going out of our disciplines and cross-pollinating to create something new with people who have expertise in different areas. And it sounds like that's happened many times in your career.
Robin Steinhorn (14:43.206):
Collaboration to me has been such a core principle. We can do so much more through collaborating than any of us can do individually. That has proven true for me again and again, both in the clinical realm and in the research realm.
In Chicago, for instance, the work we were able to do to really start to dig into the bigger questions about how oxygen affects vascular behavior, I could not have done that without Paul Schumacher, for instance.
That is where I derive a lot of the joy of investigation, through that sense of collaboration.
Daphna Yasova Barbeau (15:46.87):
I love that. When we started this, you were telling us about some of the challenges, and how they go from one to the other, the highs and the lows. I wonder if you have any advice for people about how to temper the lows. Maybe that's in research, maybe that's in clinic, maybe that's in life. But we will all encounter them, but some of us seem to come out of them, in one way or another, stronger than others, and I hope you can share how you've been able to do that.
Robin Steinhorn (16:18.874):
It's one of the things I will share during my talk. One of the biggest lows of my career was being unable to navigate a collaboration. And that was back at Lurie Children's. This was right as cardiac intensive care was becoming really a thing. Cardiac intensivists were differentiating from pediatric intensivists, and building stand-alone units. That was just happening at Lurie Children's. I'm a collaborative person by nature, and I thought we had it. I thought we were dialed into this. We even went out and looked at Phoenix Children's, which had a NICU piece to their CTICU. We built that in, and I really thought that's the path we were on. Then we hit a pretty big roadblock because it turned out the surgeon didn't want it at all. The surgeon wanted really a cardiac intensivist team, and really did not want a neonatologist there at all. And I was not sophisticated enough at that point in my career to see the signals coming and to navigate them.
The low was pretty low for me. I smarted over that failure, what I felt was a failure for quite some time. But for me, the lesson was, you have to learn from those lows. It took me a while to process it and it wasn't something that, a week later, I had it figured out. It was over a period of years. It's really sparked my interest in how one negotiates, how one develops a mutual understanding. Frankly, I think that low in my career helped me build the administrative positions I have today and has inspired me to gain a lot of tools in negotiating some very, very difficult situations. Is everything rosy all the time? No, it is not. Those are hard things to do, they are often bumpy. But that experience really, really helped me become a stronger, wiser leader.
Ben Courchia (19:48.716):
What's very interesting in the stories you're telling us today, is that in contrast to what is being asked of young graduates, young career neonatologists today, we want to know, what do they want to do? What are their areas of interest? We really try to put them in a box. But what you're describing is that you were always open to new opportunities.
You seized on new opportunities, and for many of them, they ended up being almost career-defining. Can you tell us a little bit about this mindset? How should it be fostered in the newer generation of neonatologists to jump at the opportunity to take on a new challenge, even if it is not exactly, for example, in the lane that I had defined for myself when I applied for this particular job?
Robin Steinhorn (20:34.478):
Great question, and not an easy one because as I told you before, when people are going in one way, I always want to know about the other. It's what drove me as a scientist, as a clinician, and as a person. So, putting me in a box is
just not okay with me. I really think this comes back to making sure people understand, as fellows, that there's a world of opportunity that is open to you as a physician and as a neonatologist. It's one of the reasons neonatology is the best specialty ever. There are so many opportunities. It's really a whole field in itself. So, keeping yourself open to those opportunities and figuring out what is exciting to you is what I would encourage people to do. People don't have to do that, but they should be in touch with, do I love what I'm doing? Are there other things I might love as much or even more?
Daphna Yasova Barbeau (22:13.742):
I think a lot of people end up in a lane that isn't what they love doing. But it really sounds like even when that happened to you, you found the joy. You were able to find something about the situation that you could build off of. How can we foster that skill in our learners?
Robin Steinhorn (22:37.906):
I have a couple of things. Another brilliant neonatologist in San Diego is Gail Knight. And Gail has a little saying that you have to lean into conflict. And of course, conflict is inherent. In our jobs, we do that every day. But people who tend to thrive and grow, figure that out through their careers. Figure it out at the bedside. If a family is the so-called “difficult family,” instead of avoiding that parent, how do you learn to lean into that and be with that parent? If you're having conflict with other specialties, with other people in your division, or with your division chief, be fearless about approaching and tackling that conflict. It really is fear of conflict that holds us back. So how do we then teach people that you don't have to do that?
You learn a mistake is a mistake. You learn from it, and you move on. Bad conversation is a bad conversation. You learn from it. You go back and talk to that person, and you move on. So, I would say it's learning to shed that fear, and it's being optimistic about the future. When I was little my dad told me, “Robin, there's two ways a kid can be. And you can figure it out by walking that kid into a barn full of horse manure. The first kid will walk in and say, ‘it just smells bad. I don't want to be here. Get me out of here.’ And the second kid will walk in, look around and say, ‘I know there's a pony in here somewhere.’” So, it's that mentality about finding the pony that allows you to shed that fear, be optimistic about the future.
Daphna Yasova Barbeau (25:23.042):
It's obvious that you bring a real positive approach to everything that you do. I can tell that mentorship has been a big part of your career; obviously you've been a tremendous mentor. You've had a lot of opportunity to mentor others, but it sounds like it started with you being a good mentee, really taking in the lessons, and being open to feedback.
Can you highlight some of those skills about being a good mentee and then subsequently being a good mentor?
Robin Steinhorn (25:56.722):
Thank you so much for that. I tell this to all my mentees – you only get as much out of it as you put into it. For me, that was absolutely a core principle when I was young and had mentors. Y
ou have to add value to the relationship. Recognize that it takes time. These are people who are busy people. So for me, thinking about Jim Russell, Rick Morin, Paul Schumacher, and many others, delivering everything I said I would – and even more – was a core principle for me.
I will also say, we're in an era where there's a big gap, a void of mentorship. People are hungry for mentorship and searching for it. I see a lot of mentorship programs where there's matching that occurs. I view mentorship a lot like any relationship. Sometimes it works. There are marriages that are created through matching people together, and sometimes that works great. But generally matching works best when there's chemistry. So if it's somebody that you really feel a connection with and that's mutual, those are the mentorship relationships for me that have just stood the test of time. Now, being a good mentor, I think those same principles apply. I love talking to people. I love figuring out what they're about. I really love talking to early career people. They have such an important perspective.
Those are always the best conversations I have, hearing somebody's goals and aspirations. Those relationships blossom when I have something they need. Sometimes it's just not the right time. I don't have what they need at that time, but can check in every so often. And then there might be a time that comes where I can provide mentoring in a more intensive way. You have to have something they need, you have to be generous with your time, you have to have the time to do it, and I think you have to really enjoy it to be a good mentor.
Daphna Yasova Barbeau (29:33.13):
I love that blueprint. Thank you. It seems like almost as an extension of your mentorship: you have had this ability to see opportunities for structural change. You're part of another session during Cool Topics talking about healthcare economics and pediatrics. Your perspective is still an extension of your other talk, “What's the future? Projecting the future concerning trends in the pediatric subspecialty workforce.” What is our obligation to support the future of pediatrics and neonatology?
Robin Steinhorn (30:10.876):
I think pediatrics is in a real tough moment. It's something that keeps me up at night. The overall healthcare, the funding of healthcare, and the funding of physicians is a rocky road right now, and I predict a rocky road ahead. That road is all the harder for pediatrics. It's no secret we are not funded as well. And it's the rockiest for pediatric subspecialists. The people that we as neonatologists count on – endocrinology, infectious disease, pulmonary, nephrology – these are people who spend just as much time as we do gaining those extra skills, only to make less money than general pediatrician. That keeps me up at night. As I said at the beginning, the traditional model of supporting those specialties has been at a departmental level, using your fund to subsidize endocrinology, nephrology, etc. in that fashion. I don't think we can continue to do that. I think neonatology, because of the 24-7 hours and the rigors of the field, really needs to be funded as a standalone entity. At the same time, we have to figure out all of those colleagues that we need so desperately to deliver care to, as consultants to us in the NICU, but for years and years beyond that. The kids are really counting on it. We're going to have a significant shortage of some of these key specialties within the next 10 years if we don't figure this out.
Ben Courchia (32:29.41):
I feel a bit awkward asking this question, but I'm curious to hear your thoughts on your message for women in medicine. Satyan [Lakshminrusimha], who came to speak to us at the Delphi conference, mentioned a statistic that was absolutely mind boggling to me. Specialties that used to be dominated by male physicians, and are now dominated by female physicians, end up seeing a decrease in their wages.
That to me is just incomprehensible. I'm just curious if you have any advice for women who are in the field of neonatology or pediatrics, and how they should use their voice and their wits to effectuate change.
Robin Steinhorn (33:20.414):
They also need sponsors and mentors, I would add to that list, Ben. This is one of those topics that is clearly very personal to me. I have a daughter who's an anesthesiologist, so it's personal to me as an individual and as a leader.
There are many reasons for it. We need to combat some of the inequities through not allowing compensation systems to be based on who simply comes in and talks a better negotiation game during the initial recruitment. You have to level that playing field. Advances in compensation need to be
systematic rather than based on who's able to better negotiate a raise. We have to figure out how to make sure that women advance in the academic system, because that holds women back. That's a powerful factor.
And the last thing I'll say is, we have to figure out how to support women who are going to have the additional responsibilities of birthing and raising children. How do we support them through that, and not penalize them financially?
These are complicated and interrelated topics.
One of the privileges that I have is launching a Women In Medicine Council at Rady Children's. These women have that fearlessness I talked about before. They raise the hard questions,
and it allows us to tackle them head on. It's something that I spend a lot of time thinking about. So thank you for the question.
Ben Courchia (35:53.996):
It's a topic that has been near and dear to the podcast as well. I am the spouse of a physician as well. And we've taken on this topic on many occasions with multiple guests because it definitely is a priority.
Daphna Yasova Barbeau (36:10.316):
You've just not covered that in your words, but really in your actions. You've spearheaded a number of workplace initiatives that, on face value, impact women in medicine, but they really impact families in medicine. I'd love to hear about some of those initiatives, so that some of our other colleagues might take up the charge. It can be done.
I know you had a program RVU's for lactating moms and in-house call stipends. We'd love to hear about these initiatives.
Robin Steinhorn (36:43.398):
Lactation credit is something that we launched in the last year. I'm extremely proud of this program. It was a suggestion during one of our Women in Medicine Council meetings. I
t's one of those things you look at it, and you see it, and you can't unsee it after that. We're taking it step-by-step. Right now, the program is primarily for our ambulatory physicians because if you pump during clinic, you can't see a patient.
If you're compensated at all through productivity, your productivity gets hit and you aren't paid as much. It's been extremely popular and it's taught us a lot of lessons. It's taught us that women really value that prioritization of their time. It is
just as important as the financial benefits. So those are lessons we're going to be able to take to our inpatient divisions. We've also learned about some of the financial penalties that women pay during their pregnancy leave.
That's a shared duty that doesn't just fall on the shoulders of the woman. That is something we all need to prioritize and handle together, rather than just that one individual.
Daphna Yasova Barbeau (38:54.158):
I love that. To your point, I think it will impact the whole workforce, not just the individual person, not just women in medicine. Thank you for leading the charge with that.
Robin Steinhorn (39:07.25):
Thank you for saying that. Getting that kind of reaction just fuels my motivation to keep working on this.
Daphna Yasova Barbeau (39:19.406):
That's great. Well, when we first started, you said this talk that you're giving for Cool Topics is really a reflection on your career thus far. We're excited to see what comes next for you. Tell me a little bit about this practice of reflection. Is that something that's been a part of your life? How can we all benefit from taking the time to be a little introspective about our lives?
Robin Steinhorn (39:48.014):
Yeah, I think it's something that has always been how I process things. I spend more time reflecting on the lows than I do the highs, because that's how you learn. It's through those resuscitations that didn't go quite as you hoped. For me, it’s that patient conversation that didn't go as well as it could have. Learning is a core value for me, so learning from those is how I reflect. I'm so lucky in my marriage because my husband has always been that sounding board, and I'm lucky with my friends as well.
My friends are people that I've been able to process those moments that were tough and to get their support, which helps as you're wrestling with it, when reflecting on something you don't feel good about. It’s how you move past not feeling good and thinking, okay, what's next? How can I take this and turn it into a better Robin, a better outcome next time?
Ben Courchia (41:32.962):
Thank you, Robin, for sharing that. It is such a powerful message.
I wanted to take the last few minutes to bring in Denise and talk a little bit about the upcoming Cool Topics in Neonatology and Improvement Palooza conference that's going to be taking place March 5th to 7th in San Diego, California. Denise, if you are not already excited about this conference listening to our keynote speaker, can you tell us a little bit about what else people can look forward to at the upcoming Cool Topics Conference?
Denise Suttner (42:07.873):
Sure. First, I think you guys can easily see why it was clear to me who should be the keynote speaker. I'm sitting on the edge of my seat. I get to spend a lot of time with Robin already, which is delightful. I think that the steering committee came together and said, what are other topics that we want to hear about? We have an innovation session, which will be terrific. But we're also going to address some of the legal matters that have come forward for neonatologists, about these formula lawsuits. We have Jonathan Fanaroff who's coming to help neonatologists navigate the legal landscape that comes with the work that we do. We have Joe [Josef] Neu coming to talk to us about probiotics and how do we implement those.
The FDA obviously has weighed in heavily on that, but there's many units that still feel like a great value add. In California, as I suspect many other places, we are dealing with fentanyl addiction in our mothers, which we haven't seen in the past. We now have a new fentanyl phenotype that we are seeing, causing morphologic changes. In addition, treating these babies has become very, challenging for many of us. So these are some of the things that we're just really looking forward to hearing from experts.
Ben Courchia (43:36.398):
Very current topics for sure. If you are not yet registered for the conference, please make sure to use the code “incubator” at checkout for a $50 discount. We are looking forward to the great content that will be coming out of Cool Topics this year. Robin and Denise, thank you. Thank you so much for making the time to be on the podcast with us this morning. Thank you, Dr. Steinhorn, for sharing all these valuable pearls in your experiences. Thank you.
Robin Steinhorn (44:02.044):
Such a pleasure.
Denise Suttner (44:03.569):
Thank you.
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