Stephen Wilson Interview

I’m Steven Wilson. I’m a Professor of Pediatrics at UCSF, where I practice clinical pediatrics, and I’m also the Associate Chief Strategist at UCSF.

Interviewer: What initially drew you to pediatrics, and when did you realize it was the right path for you?

Response: Pediatrics wasn’t my original plan. I started in bench research and expected to spend my career in a lab. I was in an MD-PhD program, and after finishing the PhD portion I entered the clinical environment and liked it far more than I expected. When I reached pediatrics rotations, it was a surprisingly good fit. I met people who cared about the same things I cared about, and it felt like I had found my people.

Interviewer: How has MD-PhD training shaped how you think and operate today, even if you’re not doing basic research now?

Response: I stopped doing basic research years ago, but the training still shapes how I think. I’m analytical and skeptical in the way a science person is. In clinical medicine, people often accept things on faith, and “common knowledge” changes over time. My default is to ask, “How do we know that?” and “Where does that evidence come from?” That skepticism can annoy people, but it tends to make me more effective in the long run.

Interviewer: What led you to stay in academic medicine instead of moving fully into private practice?

Response: I actually tried non-academic settings. I worked three years at Kaiser and three years at a private children’s hospital in Central California. The clinical work was good in both, but I didn’t feel as connected to the professional environment. My tendency to ask “why” landed better in academic medicine. After two similar three-year stints, I realized it wasn’t going to click for me, so I returned to UCSF.

Interviewer: How long have you been at UCSF?

Response: I did residency at UCSF. If you don’t count residency, I returned in 2001 and have been here since.

Interviewer: How has working in pain medicine changed the way you treat children, especially when standard approaches fall short?

Response: It broadened my view of what care actually is. It’s not just diagnosis and prescriptions. It’s a child and a family having an experience, with fear, uncertainty, and stress layered into everything. As a pain consultant, I’m often not the person driving diagnosis, so my role becomes helping the patient tolerate what’s happening and regain some control. That includes medication sometimes, but also mind-body approaches like mindfulness, hypnosis, guided imagery, and similar tools that reduce anxiety and catastrophizing. Pain medicine pushed me to see the person in front of me, not just the patient.

Interviewer: Before pain medicine, what kind of clinical work did you do?

Response: I practiced hospital medicine for about 20 years. That’s general pediatrics in the hospital setting. Outpatient pediatricians mostly see well children. In the hospital, by definition, kids are sick, often complex, and they may need multiple specialists. The hospitalist coordinates all of that and makes final decisions when recommendations conflict.

Interviewer: From a strategy perspective, what are the biggest challenges pediatric hospitals face right now?

Response: The first challenge is money. Costs keep rising, insurers resist paying, public funding is under pressure, and hospitals get squeezed. The job becomes delivering the care you’d want for your own family without blowing up the financial model. The second challenge is identity and positioning. At a place like UCSF, we thrive on being cutting-edge and university-based. But if you become too specialized, you narrow your business base. If you become too general, you lose the academic identity that attracts talent. The hard part is finding the balance.

Interviewer: Have you seen more misinformation or distrust from patients and families in recent years?

Response: Yes, but I associate the shift more with COVID than with politics. COVID pushed people into a strange mindset around healthcare. Since then, I see more suspicion and fear: people questioning motives, worrying they’re being experimented on, or assuming something shady is happening. It’s not everyone, but it comes up regularly, and social media is not helping.

Interviewer: Looking back, are there career decisions you would make differently?

Response: I wouldn’t change the big arc. Starting with research and then shifting clinical was right for me. The research training still helps how I think, and clinical medicine has been great long-term. I’m proud of the clinical leadership roles I’ve had across hospital medicine and pain medicine. If I’m being honest, the only thing I might change is timing around administration. I’m a bit burned out on the business side because so much of it is money conversations, and I may have stayed in that lane longer than I should have. I’m likely ready to shift back toward clinical work.

Interviewer: What’s the most valuable advice you’ve gotten from a mentor that you still use?

Response: In hard decisions, do the right thing. Don’t optimize for politics, convenience, cost, or who gets mad. Choose the ethically right path. You may pay a short-term price, but it tends to work out better over time. It sounds simple, but it’s hard when pressure is coming from all directions, especially from people who care more about dollars than doing the right thing.

Interviewer: What skills or mindset are most important for physicians who want to move into leadership?

Response: Listening is underrated. Leaders often enter a room with a plan and a conclusion already formed, and halfway through delivering it they realize they misunderstood the situation. That creates anger and loss of trust. The better approach is humility and genuine curiosity: ask real questions, gather information, and understand how the decision will affect the people doing the work. In leadership roles, what you know is often filtered into thin bullet points. If you don’t slow down and learn the detail, you’ll make bad decisions.

Interviewer: Late in your career, how do you hope to influence the next generation of pediatricians and healthcare leaders?

Response: I’m trying to shape my next chapter around mentoring. I want to support people early in their careers: med students, residents, or early attendings who haven’t found their direction yet. A lot of the value isn’t “wisdom” so much as helping people trust their own thinking. Early on, people often know what they want but worry it’s the wrong choice, too risky, or will disappoint someone. Having someone further down the road say, “This is survivable, your path can weave, you don’t need a perfect plan” can give people confidence and courage.