Episode 68

Advancing Military Medicine

with Joseph Caravalho, Jr., M.D., MG, U.S. Army, (Ret.)

June 16, 2022

Joseph Caravalho, Jr., M.D., MG, U.S. Army, (Ret.)
President and CEO, Henry M. Jackson Foundation for the Advancement of Military Medicine

Dr. Caravalho is responsible for the guidance and leadership of HJF. He sets strategic goals and guides HJF in advancing military and civilian medicine. 

Prior to joining HJF, Dr. Caravalho served as the Joint Staff Surgeon at the Pentagon in Washington, D.C. He was the Chief Medical Adviser to the Chairman of the Joint Chiefs of Staff, providing recommendations to the Chairman, the Joint Staff and Combatant Commanders on a wide range of medical and readiness issues.

Before becoming Joint Staff Surgeon, he was Army Deputy Surgeon General and Deputy Commanding General (Support) of the U.S. Army Medical Command. Clinically, Dr. Caravalho held positions as a staff internist, nuclear medicine physician and cardiologist.

Dr. Caravalho graduated with a M.D. from the Uniformed Services University of the Health Sciences School of Medicine in 1983. He also has a B.A. in math from Gonzaga University, and a master’s degree in Strategic Studies from the Army War College. In 2019 he received an honorary doctor of laws from Gonzaga University. 

For more than 30 years, he has served the U.S. Army in various leadership positions, including Commanding General of the Southern Regional Medical Command and Brooke Army Medical Center, the Northern Regional Medical Command, and the Army Medical Research and Materiel Command at Fort Detrick in Maryland.


Leadership is not an innate skill. It's a learned skill.

Joseph Caravalho, Jr., M.D., MG, U.S. Army, (Ret.) Tweet



[00:00:06] Gary Bisbee, Ph.D.: General Joe Caravalho had a distinguished leadership career in the military, retiring as a Major General from the Medical Corps of the US Army. He now serves as the CEO of the Henry M. Jackson Foundation for the Advancement of Military Medicine, known as HJF. Dr. Caravalho walks us through leadership lessons learned from his military career, including his role as advisor to the Chairman of the Joint Chiefs of Staff. He discusses the opportunity in the military for leaders to unite many distinct groups around a common vision. He notes that, intrinsic to leadership, is humility, compassion, and integrity. General Carvalho describes the HJF and the role it plays in research to advance the medical goals of the Department of Defense. Recent focus includes vaccines and epidemic prevention. For young leaders, General Caravalho advises thinking about leadership early in your career and building a foundation of technical expertise. As you rise through the ranks, people skills will become more important. The abilities and skills that get you to one level won’t be enough for the next.

Well, good afternoon, General Caravalho. Good to have you here.

[00:01:22] Joseph Caravalho, Jr., M.D., MG, U.S. Army, (Ret.): Ah, thank you, Gary. I’m happy to join you today.

[00:01:25] Dr. Gary Bisbee: We’re pleased to have you at this microphone and we appreciate your service. This show is about healthcare leadership, and you’ve certainly had a very distinguished career as a healthcare leader. We’d like to explore your thoughts about leadership and your time as an army surgeon. We’d also like to learn more about your current posting, which is the CEO of the Henry M. Jackson Foundation for the Advancement of military medicine, which we’ll refer to going forward as HJF .Can you describe HJF for us, please?

[00:01:58] Dr. Joseph Caravalho: So it’s a civilian not-for-profit organization that was authorized by Congress. So Congress put into law that they wanted a not-for-profit created. We are the result of that. And the reason they wanted it created was to partner, at that time, with the Uniform Services University of the Health Sciences. And the reason for that is the congressional are typically one year at a time types of funding for research. It is two year funding. Senator Jackson and the other proponents of this knew that one couldn’t do world-class research in one year blocks or two year blocks. So they needed an entity that was outside of the military to partner with the military to then facilitate multi-year studies and larger programs. And thus the creation of HJF. Unfortunately, there’s the word, foundation, in our title, which makes people think that we are like other nonprofit foundations, which generally raise funds and then either grants those funds out for other causes going forward. We are primarily an implementing partner for research that the DOD does, and we do raise funds, but we also do other things that are under the umbrella of advancing military medicine.

[00:03:18] Dr. Gary Bisbee: What are your top priorities, just to allow us to understand a little bit better the sort of work that HJF is doing?

[00:03:26] Dr. Joseph Caravalho: So our priorities are the priorities of the Department of Defense. And as you can imagine, that’s dynamic. The challenges that the DOD, and therefore DOD medicine, changes over time. So we were in a certain type of war. So there were priorities early on for how to manage burn casualties, how to resuscitate in the field,a and then how to manage brain health, whether psychological health or concussive injuries going forward and how to pull all of that together, are examples of things that were of high priority to them. Coming out of those wars, there’s a sense that we may be in a conflict in the future against folks where we may not have air superiority. We may not be able to pull a casualty out right away. Well, when you can’t do that, you must be able to care for them until it is safe to evacuate them. So that prolonged field care is a priority nowadays, going forward, how you manage individuals under those settings. It is still a military trauma, still brain health, still risks to the individuals who have post-traumatic stress that is not well managed. Those are the highest priorities. Certainly, troops that the president can put anywhere in the world that needs to operate on day one, the focus is on vaccine or the prevention of endemic diseases in that area more than the treatment. So there’s a high focus, strong focus, on vaccine work, which continues to this day.

[00:04:58] Dr. Gary Bisbee: Well, what about COVID? How did COVID affect HJF priorities?

[00:05:03] Dr. Joseph Caravalho: So we were lockstep with the military and what happened, and everyone is aware of what Moderna and Pfizer and AstraZeneca and everyone was working on. But the DOD had a big part in research as well. So what happened, at a moment’s notice, all this research DOD put out, I want that to stop. I want all COVID related research to start up or expand and grow. Because we were that partner that I described, we were able to take our laboratorians that were supporting these researchers and then pull them and shift them, and then start on this other research project. And as you can imagine, one can’t just enter military facilities from the civilian world in, so we already had the right ID cards and the capabilities. That proved very helpful. And the focus of the DOD was on detection, protection, treatment and care. So across the board, there was strong research in that regard. We’ve been nonstop during the height of the pandemic and throughout working on this. And there’s some great breakthroughs and continued research on some vaccines that, if successful, will be very helpful going forward.

[00:06:12] Dr. Gary Bisbee: Any thought about a annual sort of vaccine for COVID? I hear this discussion all the time, but I don’t know if we’re really very close to it. What’s your view of that, Joe?

[00:06:24] Dr. Joseph Caravalho: So it’s really fun to have our scientist s embedded with the DOD scientists. And we have very high level scientists that have been asked to be co-chairs and helping with the government. So we have special programs that allow us to do that. And so we get to hear about what the government is thinking about going forward.

And just personally, I think, we are talking about boosters going forward. At some point I think we’re going to have to figure out what is the right regimen? So what is the initial vaccine regimen and then what is the appropriate booster? Unfortunately, for all of us, it’s a little frustrating, because we’re trying to figure this out. But at some point we’re going to find the right, what I call battle rhythm on what the right frequency is. It would be easiest if it was annual. And then if you could get your flu vaccine and your coronavirus vaccine at the same time, I think we’ll be in a good pattern going forward, especially if we do that before the winter months, when people come in and the risk of transmitting that, even when you’re infectious to others, would be helpful.

[00:07:27] Dr. Gary Bisbee: Over the last 20, 25 years, what’s been funding for medical research in the military? I expect, when the military doesn’t get as big an increase, then research doesn’t grow that much, but what’s been the characteristics of that over the last 20 or 25 years?

[00:07:45] Dr. Joseph Caravalho: Well there’s a steady level of research funding and I applaud DOD for doing that, but they’re conducting research across the board and medical is just a small part of it and it’s what’s called requirements driven research. And so it has to help a war fighter on the battlefield. So it would not be typically studying a disease state, like cardiology research or diabetes research per se. But it might be, how can we make this soldier, sailor, airman, Marine, more agile, resilient, survivable going forward? And even when it’s basic science, there has to be a thought of, what am I doing this for? If this works out, where am I taking this, so that I end up with a product, equipment, drug, knowledge product, policy going forward to help the individual. Well, as you can imagine, when we’re at the height of the war and the congressional supplementals that kept going up year after year, even if the percentage didn’t change, there was more and more that was applied to research going forward. And some of it was indirectly medical in that, how do you make vehicles safer, body armor, and things like that. And some were more typical medical in that treatment care protection, that aspects. Well coming out of this war, DOD is saying, I haven’t modernized, I haven’t re-equipped I haven’t done, we’ve just been fighting a war. So I have to reset. I have to think about readiness. I have to think about lethality going forward. So the impact on that is, they’ll say, more funds here. What happens at these periods of time is medical funding might take a backseat. Now that doesn’t mean that the warfighters are less important. But when you have limited funds, those decisions are made. The good news, I believe, is that, when I say our priorities are DOD priorities, even though they’re talking about requirements and research, they’re talking about, typically, an adult human. So if you’re doing something that studies will make an adult human better, safer what have you, then it can be really in or out of uniform. So whatever we do whatever is focused on the military, many times, can be translatable to the civilian population. And in that study, the example of vaccines, it’s translatable from military health to global health. And that’s very rewarding for folks who are in our space. So I believe, even though funding might be challenged within DO, my strong hope is that there can be some public private partnerships with academia, with industry corporations, even with individuals, to help pull together efforts to maybe power studies more appropriately or have larger studies and more directed studies to know that product A for the military may be ruggedized, or what have you, but that same product has a commercial use and is helpful then for the general public in many examples of that. And I hope that’s where where we can go going forward.

[00:10:49] Dr. Gary Bisbee: So how would that work? Could HJF kind of lead in that kind of public private partnership, or does that need to be a DOD led effort with HJF coming along with it?

[00:11:02] Dr. Joseph Caravalho: We’re hoping that, because of the congressional language and the fact that we’re a civilian not-for-profit, that we can serve as a connective tissue bringing the two together. So it is not uncommon when I know DOD priority and then I know a scientist at university X, Y, or Z, and we pull investigators together that may not have come together going forward is a typical thing that we’re doing. We’re talking to venture capital groups that are in the medical research space to see if we can introduce them to what the military is looking at so that their efforts can be a dual benefit. And I found that many of them feel good about that, that there’s a dual purpose on their success for something commercializable and helpful to those in the military.

[00:11:46] Dr. Gary Bisbee: So why don’t we get to know you a bit and, in so doing, what was your life like growing up, Joe?

[00:11:54] Dr. Joseph Caravalho: Well, I was born in Hawaii and I’m old enough that I was born in Hawaii when it was still a territory of the United States. And to your listeners, Hawaii may seem idyllic, a popular tourist destination. But for me, it was just simply home. My parents, I had a very blue collar experience. My father was a policeman. My mom was a, what we called at that time waitress, hotel, maid, and then a pantry cook. Five children. Just blue collar family growing up in Hawaii.

[00:12:26] Dr. Gary Bisbee: What was a young Joe like? Did you think at all about leadership or did you observe perhaps your father as a leader or your mother?

[00:12:35] Dr. Joseph Caravalho: Well, so nuclear family. I thought about being a policeman. Really that was about it. I didn’t have a lot of role models to think about growing up. I do now more fully recognize that my folks made a great sacrifice to send all five of us through a Catholic education from kindergarten through high school. But I was not science minded and I was not military minded. I really didn’t think about the military growing up, even though my folks both experienced the Pearl Harbor attack and there’s every branch of service in Hawaii, that just wasn’t on my radar.

[00:13:12] Dr. Gary Bisbee: Sure. What led you to Gonzaga?

[00:13:14] Dr. Joseph Caravalho: I definitely was one of those kids that wanted to leave home. So even though I was from Hawaii, I wanted to get away. I figured I’d be on the west coast somewhere. I wanted a small school in a place that had snow and mountains and trains and lakes. And since it was going to be small, it was probably going to be denominational. So I just looked at Catholic universities and luckily fell into this Jesuit university, Gonzaga University, in Spokane, Washington.

[00:13:39] Dr. Gary Bisbee: So what did you think about medicine at all? When did medicine enter into your thinking?

[00:13:46] Dr. Joseph Caravalho: So when I was a junior in high school and there was a Marianist brother, I went to a Marianist school, and he got my attention for the probably for another story for another time. But he asked me rhetorically if I knew that I could be anything I wanted to be in this world. Maybe I was just ready to hear that at the time. But that got me thinking of, what could it be? And I started to think outside the realm of what my parents talked about or what I saw. I knew I wanted to help people and I just thought, well, why don’t I become a physician? And that was the start of it.

[00:14:23] Dr. Gary Bisbee: And then how about the Army? When did you become involved in terms of thinking about an Army?

[00:14:28] Dr. Joseph Caravalho: So my folks were kind enough to allow me to go away to school. I really wasn’t sure that we could afford it. I saved every penny from my summer job before college. And that was at the Dole Pineapple Cannery. I think I saved something like $1,200 working the graveyard shift, et cetera, et cetera. I got to Spokane and I realized quickly that my $1,200 just paid for room and board for one semester. And I quickly realized there’s no way my family and I are going to be able to pull this off. During orientation, there was an Army ROTC barbecue. They probably do this for that very reason. I checked it out and they talked about the potential of getting a scholarship if I worked hard for the last three years. And then that introduced me to the idea that, hey, I could pay for school on my own by an investment of time after college. And I wouldn’t have to do work study. And in my mind, I thought I really have to completely focus on studying to get into medical school. This would be a delayed payment by serving in the military going forward.

[00:15:31] Dr. Gary Bisbee: So when you joined the military was your thinking that you could go to the military version of the medical school?

[00:15:38] Dr. Joseph Caravalho: I am an alumnus of USU, but I was in the fourth class. I really didn’t even know about that. So, medical school was still in the abstract for me. I had not thought about the combining of two noble professions, reconciling physician and military. So it was very abstract. I just thought I could be in the military and, for your listeners who are Catholic or know Catholics, very regimented and it didn’t take but a second for me to just really identify with the discipline thought that went into being in the military. And then I thought, boy, I really want to be an Army officer. I want to lead troops Maybe I’ll get into medical school, but it kind of switched. I wanted to be an Army officer. I jumped in with both feet into the deep end of the pool there.

[00:16:19] Dr. Gary Bisbee: Okay, well, what was the sequence then when you realized that you could go to UHS and actually get your medical degree?

[00:16:28] Dr. Joseph Caravalho: Well, I applied, like many kids, I applied to law schools. I ended up getting into Georgetown and USU. I knew that I was going to be a career officer. I had committed in my heart to do a full career. And both schools are in the national capital region. One was a great tradition, to be a Hoya, to finish my education in Catholic education, versus to be at the start of a military tradition, get paid as an officer to do it. I knew I was going to be in anyway. So the payback of one versus the other didn’t matter to me. so I went with USU and never looked back, really.

[00:17:04] Dr. Gary Bisbee: So at what point did you decide you wanted to make the military your career?

[00:17:10] Dr. Joseph Caravalho: It was really in ROTC that I loved it enough. I liked the idea that 20 years would be a career. Really, as a young guy, I didn’t think too much about it, except that I loved it. It was not a prison term for me. I’ve since met a lot of folks say, I’ll do it and see how it goes. I was all in. And that’s what probably helped me along the way is, I was committed. It was never a, I’ll do it as long as you keep me happy, I was committed to be an Army officer.

[00:17:37] Dr. Gary Bisbee: So, if you think about your various commands during your time as a military surgeon, can you give us a feel for the sort of commands that you had during your career?

[00:17:48] Dr. Joseph Caravalho: To be in the Medical Corps is a branch of the Army, for your listeners who don’t know. And to be in the Medical Corps, you have to be a physician or a surgeon, so an MD or a DO. And so at the beginning of my career, it was like, I was a civilian in that I did an internship and a residency. And later I did a fellowship, a couple of fellowships. But in the military, you don’t have to do everything right away so that you can hang your shingle and get started. Because, I told you, I wanted to be an Army officer, I did what I needed to then be able to go out. And after internship, I went to Okinawa and I was a special forces battalion surgeon, which meant I was a military advisor to a special forces battalion. And it was probably the coolest thing I’ve done as a young officer, to be on a staff of infantry or special forces type of unit. And I really got a good feel for what our special forces do every day for national security, without anyone in the country knowing about it. And while I was there, I got to be a flight surgeon. I got to go to scuba school. I even went to the special forces school. So I am a Green Beret by training along with special forces folks. And then I did my training. I did medicine and then I went back. I wanted to go back and be with the infantry. So I spent, all told, nine years or so with special operations units. But after my initial training, I was with the ranger regiment. And then while I was there, I got to go to ranger school. So I’m also ranger qualified. I went back and forth between clinical and what I’m describing as operational medicine. Ended up doing cardiology. So I’m an invasive cardiologist tied in with my nuclear medicine training. I moved along and then I commanded a combat support hospital, which is the first time I got to be a commander with young troops and taking care of them to ensure that they were safe and protected and developed and trained and equipped and well led. And that was a great feeling that brought back my ROTC training. That is the coolest thing. And that’s where I got to bond with the idea that I am now the old Colonel and I’m dealing with 20 year olds that are prepared to lay down their lives as they engage the enemy, if you will, even though we were medical, a medical unit. I made General soon thereafter, and then I was in what I would call executive medicine types of jobs. I led Brooke Army Medical Center with armies only burn center. And I did that after coming out of Iraq, which was also a cool assignment where I worked with the Iraqi Minister of Health in developing their health system. But at Brooke, I managed the care there in the region. I did another region on the east coast. And then I led a medical research command, which was at that time, $1.1 billion of research conducted across the globe. I moved on to be the Deputy Surgeon General. Each one of these jobs were awesome. And then I culminated my career as the medical advisor to the Chairman of the Joint Chiefs of Staff at the Pentagon. So, all wonderful experiences that I never would have imagined as a young man.

[00:20:58] Dr. Gary Bisbee: I mean, it’s just a great, great story for sure. Was there one of the commands along the line that you felt was more important to you from a learning about leadership standpoint than any other, or was it just, sequentially, you just learned as you went along?

[00:21:16] Dr. Joseph Caravalho: It got progressively more difficult and that’s how the Army is, right? It keeps giving you more and more and more. And so you build on it. But when I had command at Brooke Army Medical Center, coming out of Iraq, where we were in combat, to then take on a center that was receiving the casualties and the care that we provided for them. To then help with their recovery, and then their re-integration, I think was very fulfilling. From a leadership standpoint the added degree of difficulty of being a commander is you’re leading leaders, right? So physician to lead physicians is a little more challenging when people feel like they know what to do and what’s right. And how do you get everyone on board, right? So I told you, I was a physician, to now lead surgeons was also a bit of a challenge. So that’s probably where I got to encapsulate it all and to kind of get people singularly focused when, stereotypically, within their own little sections, how could I bring them together to think through the organization moving in one direction?

[00:22:17] Dr. Gary Bisbee: Well, your appointment as the advisor to the Chairman of the Joint Chiefs of Staff must’ve been pretty interesting. Any story coming out of that, Joe? Anything that surprised you a bit, or you weren’t aware of until you got into that role?

[00:22:33] Dr. Joseph Caravalho: It was very humbling to be that individual. So the Chairman’s job is to provide the best military advice to the President. And my job is to provide the best military medical advice to the Chairman. And so that’s a heavy thing to think about. Under the chairman are all the cobatant commands and then they all have their own surgeons. So I got to think about the globe. I got to think about, as we moved out of the Iraqi and Afghanistan theaters of combat that we were in at the time and how we were then going to manage terrorist networks in other parts of the globe. Very, very interesting to think through how to leverage very limited assets that the three services has as forced providers for use by the joint task forces, the combatant commanders to get after it in widely dispersed regions. So, whoever has these jobs has the complex problem set going forward regardless. And how you get at it, there is no textbook answer. It is managing a complex problem set. So, if that scares you, you get paralyzed. If you take it as a challenge that must be overcome, you stay at it. And when it does come together, it is very fulfilling. And to see the professionals coming together to get after a problem set is also very rewarding professionally.

[00:23:56] Dr. Gary Bisbee: When you’re working with young up and coming leaders, Joe, what are the main characteristics that you’re looking for that you can perhaps help them develop?

[00:24:06] Dr. Joseph Caravalho: Well, so I tell folks that, with regards to one’s character, that’s probably developed and imprinted in them by the age of four, right? So, if they have a bad character, it is just going to get more complex as they get older. So that part is kind of already done. But I tell folks that leadership is not an innate skill. That’s a learned skill. But what, at that point, should be second nature is humility and compassion. And when I talk to young folks and I ask them who wants to be, and in my former world, a senior leader, the representative term is general officer. So I say, who wants to be a general officer? But don’t answer that. Don’t raise your hand because people, that’s kind of a foreign idea. But I say, what I’m really asking you is, who wants to be a senior leader? And I said, when you’re young, you’re not thinking about being a senior leader. But what’s important when you are a senior leader is to have technical expertise. I said, so go back and develop that expertise. So you have that Screen Actors Guild card, that union card, that says at one point I was an expert in whatever field you have. And then as you move along and you progress from expert to supervisor, to manager, to leader, to senior leader. All those skills that gets you to the next level, you set aside and you learn new skills. So I start to introduce that idea to them and then speak to what I’m looking for going forward basically is integrity, which is a combination of this technical expertise I was talking about, trustworthiness, and competence as a leader, and then humility and compassion. And it’s a combination of all that I think makes for a successful individual going forward. But if you don’t know that early on, you don’t get to just invent that when you’re ready to be that senior leader. So I do like to talk to young folks to think about that and start building that while their focus is on developing their expertise.

[00:26:04] Dr. Gary Bisbee: In terms of mentors, I’ve always thought of the military as understanding the role of a mentor and developing mentors. Was there one mentor during your career that kind of stands out in terms of influencing your development as a leader, Joe?

[00:26:21] Dr. Joseph Caravalho: What I didn’t mention before, my mom is Chinese heritage. My dad’s Puerto Rican heritage. So influenced more by my mom. Typical Asian experiences being very deferential. The downside to that is, I didn’t seek mentors throughout my career. There was a big focus on humility, just do your job, and don’t schmooze, don’t brag. So I never asked for help. And you kind of moved along and the thinking is good effort would be recognized. So I chugged along and it was relatively successful. And then I ran into, at the time, Brigadier General Elder Granger. And we are friends to this day. But he was a General and I was a Colonel and we were in combat together. And I remember that he asked me a question. So what would you do in this setting? And so I told him what I would do. And then I answered it and kind of continued along. And later he asked me, what would you do in this setting? And as I answered, I thought, gee, boy, this general asked me a lot of questions. Doesn’t he know what to do? And then I was like, oh, he’s mentoring me. He knows what to do. He’s asking me so that I think it through, on what I would do and then listening to it and then adjusting off of that. And that’s when I realized the value of mentorship, even though I was the reluctant protege or mentee. So I am all about mentorship now going forward. I’m very helpful going down. I was not very helpful growing up. So I spend a lot of time telling people, don’t be like me if you’re an introvert and be hesitant to ask for mentorship. We are all hardwired to help each other. So just go out there and ask.

[00:28:07] Dr. Gary Bisbee: Well, we’ve had General Granger on this show and it was a terrific interview. And I’m not surprised that he was a stalwart mentor for you. You know, the military is highly diverse. Your own background is diverse. How do you ensure that all these voices are heard?

[00:28:26] Dr. Joseph Caravalho: That’s the beauty of the military is, we are a cross section of America. And to me, growing in Hawaii, I had never seen groups of people until I joined the military. The greatest thing about having served in the military is I can vouch that there are good people from everywhere in this country, from everywhere in the world. And I got to exchange ideas with them. As a commander, we’re very hierarchical in distribution, right? So I’ve heard someone say, we defend democracy, but we don’t practice democracy. So the commander can just make the decisions and move out. And you can get away with that without asking for a lot of input from folks. So if you don’t watch it, you’re not best informed getting the diverse perspectives going forward. So I knew that was a risk. So the way one does it as a general officer is, you will hear from the seniors and then you stop and then you ask the juniors. In many cases, the diverse thought is junior to senior different. So I’d ask the non-commissioned officers, what do they think? Early on, it was like, whoa, I thought I was just to be silent in this case. But after I keep doing it, I would hear perspective. And so many times, much more enriching than what I would hear from the officers. And then other things I would do is pull aside the very junior folks and talk to them, whether they’re. Our privates or our young lieutenants. And then the last thing I would do is what I started to do before I retired was I would bring in our female officers and our female non-commissioned officers and get a sense from them, how things are going from their perspective. And I learned an awful lot that wasn’t even on my radar of how we were leading and how we were misfiring on so many fronts. And so, in my civilian world now, I do the same by talking to different groups and try to. Sometimes I need to separate them from other groups so that they feel emboldened to speak. They’re not next to someone else. I make sure that they’re small and focused. Then I say a couple of things to make sure that they feel a freedom to speak to me. And I try to take action on that. I am best informed with diverse thought, and I think organizations are best functional with diverse thought.

[00:30:40] Dr. Gary Bisbee: Joe, what are some of the differences between growing up in the military as a physician, as you did, and being a civilian physician? What are some of the differences between the two that come to mind?

[00:30:53] Dr. Joseph Caravalho: So let me just say, in all fairness, I was never a civilian physician. So the way I think about it is, in my experience of what tangentially or from afar, or looking over the transcript at the civilian world. But I always felt that military medicine was team medicine. It is, everyone had the same weight that, if you’re on the team, everyone’s a safety officer. Everyone can say what’s best for the patient. It wasn’t a, oh well, the principle, in the way I would imagine, is a physician said this. Don’t second guess a physician, which kind of can set you up for going the wrong path if a wrong decision is made and no one ever said says to undo it. So I like this team medicine approach to it. And the other thing that I liked is, no wallet biopsy going in. It was, what’s the right thing to do and we just get it done. One can say, well, you don’t get paid more for this or that, so therefore you can be lazy. But I’ve never seen laziness in military medicine. But I have seen, I don’t believe you need this procedure, this operation, this cath, and you got to know, when I say that, I’m not making more money or less money based on this decision. I really feel this is the right thing for you and my recommendation to you. I felt that our patients could feel empowered by that. It didn’t make a difference one way or the other on what was the best thing to do. We would just tell them what was the best thing. I’m very proud of being part of military medicine in that regard.

[00:32:27] Dr. Gary Bisbee: Joe, this has been a terrific interview. I have two questions, if I could ask, just to wrap it up. The first is, what advice do you give for a young person that comes to you and says, General, I may be interested in the military. What advice do you give that kind of person?

[00:32:45] Dr. Joseph Caravalho: Well, so, I’m kind of a living example of someone who really didn’t know anything about the military. I would say, embrace the military as your military, right? Don’t let it be someone else’s military, some city’s military. This is part of your being a citizen. It is not a prison term. Don’t be afraid of wearing the uniform. Don’t be afraid that someone’s going to tell you what to do. Embrace the opportunities that the military is going to teach you discipline, leadership, is going to give you a skillset, is going to give you the chance to tell the world, henceforth, that you’re a Patriot and you served your country. And there are all kinds of opportunities, right? We talked a lot about military medical research. So we have individuals in uniform whose career is spent doing research. We’re not all infantry men or paratroopers or whatever. So there’s room for everyone to be able to contribute in the defense of our nation. So embrace it, check it out. See what’s available. You may be like me and fall in love with it and stay in for 38 years.

[00:33:56] Dr. Gary Bisbee: Yeah, well said. Second question, anf the last question of the day, is kind of similar, but it’s more about leadership. So when young people come to you and say, I’m really interested in leadership, I’m kind of on the way up, what kind of advice do you provide someone like that, Joe?

[00:34:17] Dr. Joseph Caravalho: I tell them that no matter what field they’re in, at the end of the day, leadership is how you manage people. So if they’re very junior, as I mentioned before, establish their expertise so that they can say, I understand this field. I have been successful in this field. And then it’s a matter of finding a mentor that makes most sense going forward. Embrace education and reading and development. And then keep an eye up while they’re keeping an eye forward and see how people lead them and develop a little checklist of, this is how I would like to be going forward. And then one other thing I tell folks is, as they move up, remember that what got them there won’t get them to the next level. Skill sets keep changing going forward. It is challenging to lead, but it is probably the best experience to help develop folks behind them.

[00:35:08] Dr. Gary Bisbee: Well, Oh, this is a good place to land. That’s a terrific thought. So General Caravalho, it’s been a pleasure to have you with us today. Thank you for your time.

[00:35:18] Dr. Joseph Caravalho: You’re quite welcome, Gary. Thank you very much.

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