Beyond the Title is a series of Q&As with alumni of Madison365’s Most Influential lists. Join many of our Most Influential at the 365 Leadership Summit on November 3!
Dr. Nestor Rodriguez (Wisconsin’s Most Influential Latino Leaders, 2020) is a board-certified emergency medicine physician and the medical director and co-owner of Carbon World Health in Madison. He emigrated from El Salvador to the inner city of South Central Los Angeles at the age of 7. After graduating with honors from Yale, Dr. Rodriguez followed his dream to study medicine, which he did at the University of Wisconsin School of Medicine and Public Health, where he found a passion for sports medicine, cosmetic procedures, and emergency medicine. Thereafter, he was part of the inaugural class of the University of Wisconsin emergency medicine residency program. Dr. Rodriguez is currently the Medical Director of Emergency Services at Watertown Regional Medical Center. In addition, Dr. Rodriguez and his significant other, Ashley Greer, created Carbon World Health, a one-stop-shop for fitness, health, and beauty. In 2016, he was awarded the “Impact Award” by the Urban League of Greater Madison for his work in developing young professionals in the Greater Madison Area. In 2018, Dr. Rodriguez was awarded the “Entrepreneur of the Year” by the Latino Chamber of Commerce of Dane County.
What does presence before performance mean to you – and how do you stay grounded when the pressure to perform is high?
For me, “presence before performance” means remembering that people come before outcomes. I’m an emergency physician and a founder. In the ER, a monitor can be screaming and ten things need doing—but the human in front of me needs me to arrive before I act. At Carbon World Health, it’s the same: clients don’t just need protocols; they need a person who’s fully there. Presence is the discipline of letting purpose drive speed, not adrenaline.
How I stay grounded when the pressure spikes:
Breathe & name the moment. I use a 60–90 second reset: slow nasal inhale, long exhale, and I quietly name what’s happening—“This is a high-stakes airway,” or “This is a pivotal conversation.” Naming replaces panic with clarity.
Serve the one in front of you. I narrow my focus to the next right action for the person, not the whole chaos. In medicine, that’s airway/breathing/circulation. In business, it’s the one decision that moves the mission.
Purpose cue. I ask, “Why am I here?” My answer is consistent: protect life, restore dignity, build people. That reorders my priorities—ego down, service up.
Body check. Shoulders down, jaw unclenched, feet grounded. It’s amazing how fast your nervous system follows your posture.
Faith & gratitude. A short prayer—“God, use me”—and one grateful thought. Gratitude shrinks fear and expands capacity.
Team voice. I invite collaboration: “Here’s the plan—anything I’m missing?” Presence isn’t solo heroics; it’s coordinated excellence.
I’ve learned this through wins, losses, and even injury and rehab. Performance matters, but the best performance is a byproduct of presence—calm mind, open heart, steady hands, clear next step. That’s how I try to show up for my patients, my team, my family, and my community.
What’s the best advice you’ve received from a mentor?
A mentor once told me, “Decide who you’re becoming before you decide what you’re doing.”
That line changed how I lead in the ER, how I build Carbon World Health, and how I show up for my family.
When pressure hits, tactics multiply. This advice forces me to slow down and run every big decision through a simple identity filter:
Does it serve people first?
If the patient, client, or teammate isn’t better because of this move, it’s the wrong move—no matter how impressive it looks on paper.
Does it align with my purpose?
My purpose is to protect life, restore dignity, and build people. If a project pulls me away from that, I pass—even if it’s shiny.
Will it compound over time?
I choose systems over splashes: protocols, training, and partnerships that make the right thing the easy thing six months from now.
That counsel helped me say “no” to good opportunities so I could say “yes” to the right ones instead of chasing headlines.
So the best advice? Lead from identity, not urgency.
When who you are is clear, what you do gets a lot simpler—and a lot more powerful.
Tell us about a time you had to lead before there was consensus – when you were the only one who saw it, believed it or were willing to act. What gave you the courage to move anyway?
This year as President of my local Medical Society, there was energy to launch a bunch of visible initiatives—big statements, big events. Instead, I proposed something unpopular: a strategic pause. No splash. Look inward. Fix the foundation—governance, budget clarity, member value, and a real pipeline for future leaders.
Early feedback was…polite. Some worried it would look like we were doing “nothing.” I believed the opposite: if we didn’t recalibrate, any headline would be a sugar high.
We mapped three moves:
Assess honestly—what programs actually deliver value vs. what’s just tradition.
Build playbooks—how we govern, spend, recruit, and communicate so success doesn’t depend on personalities.
Re-ignite engagement—invite fresh nominees, especially mid-career physicians and trainees, into real responsibility.
It took months before anyone could see the payoff. Then it landed: for the first time in years we had a full slate of Board nominations, cleaner financials, clearer roles, and a bench of members leaning in because they knew where we were going. The society is stronger today not because we were louder, but because we got truer and tighter.
Where did the courage come from?
ER muscle memory: In emergency medicine, you act on first principles before the room agrees—airway, breathing, circulation. Purpose drives speed, not applause.
Data over drama: I had enough evidence to believe the foundation was the constraint. When the diagnosis is clear, the treatment is easier to defend.
People-first compass: My job was to leave the organization better than I found it, not better looking in the moment.
Faith and mentors: A quiet prayer—“use me for the work that matters”—and mentors who reminded me, “Decide who you’re becoming before what you’re doing.”
Leadership before consensus is lonely for a while. But if your purpose is clear and your prep is solid, results create the consensus you didn’t have at the start.
What’s one question every new leader should ask during their first 100 days and why?
“What is the one promise we must keep—every time—to the people we serve, and where are we currently breaking it?”
Why does this question matter in the first 100 days?
Clarifies purpose fast. It forces a crisp definition of who you serve (patients, members, staff) and the non-negotiable outcome they expect.
Surfaces reality, not slides. Asking “where do we break it?” pulls out the friction points you won’t see in dashboards—handoffs, wait times, communication gaps, billing surprises, etc.
Creates trustworthy early wins. Fixing broken promises (the “moments of truth”) earns credibility faster than launching shiny new projects.
Aligns culture and operations. A promise you keep consistently becomes your operating system: hiring, training, metrics, and budgets start serving that promise.
How to use it (practical playbook)?
Ask it at every level—patients/clients, frontline staff, supervisors, execs. Collect stories, not just opinions.
Map the journey and mark the top 3 “break points” (e.g., first contact, first appointment, first bill).
Name one standard per break point (the behavior that keeps the promise).
Build a simple scorecard: measure the promise weekly; share results openly.
Close the loop—tell people what you heard and what you fixed in 30/60/90 days.
Ask the promise question early, listen hard, fix the breaks. Do that, and your first 100 days will build the kind of trust that powers the next 1,000.
Who’s in your “corner” – that voice of wisdom you trust when things get tough? How do you build and protect that circle?
My corner is small and intentional. It’s a personal board of directors across the key arenas of my life:
Faith & family: First, I turn to God intentionally—prayer, Scripture, and quiet space to ask for His guidance and the courage to do what He wants me to do. Then my wife, Ashley, is my first call. She knows the mission and isn’t impressed by titles—she’ll ask, “Is this aligned with who you said you want to be?”
Medicine: Two colleagues who’ve lived the highs and lows of the ER and have led teams through both medical and strategic growth during challenging periods. They ground me in first principles and scalable leadership—not just today’s crisis.
Business/Leadership: A couple of seasoned operators/mentors from mastermind groups I have joined who challenge the model, not just the mood.
Community/Service: My Bible Study Fellowship circles—people who hold me to Scripture, prayer, and obedience over ego.
How I built it (filters I use):
Character over charisma. If they won’t tell me the hard truth, they’re not in the circle.
Complement, don’t clone. I want different disciplines and temperaments—clinician, operator, strategist, and a “soul friend.”
No agenda. They’re for me, not for my deals. If our relationship depends on a transaction, it’s not counsel—it’s sales.
Receipts. Lived experience beats theory. Have they navigated failure and come back better?
How we operate (rhythms & rules):
Cadence: Quick texts anytime; a monthly 30-minute check-in; a quarterly deep dive where I bring a one-page brief: context, options, risks, decision date.
Red-team rule: Someone is assigned to argue the opposite case—pressure-test the plan before the world does.
“Identity first” question: We start with “Who are you becoming?” before “What are you doing?” It resets ego and urgency.
Truth with tenderness: Radical candor, zero contempt. We critique decisions, not dignity.
Confidentiality is sacred. What’s said there stays there. Psychological safety fuels honest counsel.
How I protect the circle:
Boundaries: I don’t bring every crisis to everyone. I match the problem to the person so I don’t burn the well.
Reciprocity: I serve them back—make introductions, show up for their big days, celebrate their wins.
Pruning: Seasons change. If a voice becomes consistently cynical, conflicted, or transactional, I bless it—and step back.
Gratitude rituals: Quick “here’s what your advice changed” notes. Gratitude tightens trust.
What it gives me:
When pressure spikes—at the bedside, on stage, or in the boardroom—this circle brings clarity, courage, and calibration. They remind me to choose presence over performance, purpose over applause, and long-term health over short-term hype. That’s the corner I want when the bell rings.
Leadership can be exhausting. What practices or boundaries help you avoid burnout and stay aligned with your purpose?
I organize my approach into seven categories. Each exists to solve a specific burnout driver.
Presence Rituals
Why they matter: Burnout starts when your mind lives in the next meeting while your body is in this one. Brief, repeatable rituals train attention. They quiet noise, restore agency, and ensure I lead from intention rather than adrenaline.
Non-Negotiable Health
Why they matter: Physiology is the foundation of psychology. Sleep, strength, nutrition, and recovery aren’t “nice to have”; they are the power supply for judgment, empathy, and resilience. If the power is unstable, everything flickers.
Boundaries That Protect the Mission
Why they matter: If everything is urgent, nothing is important. Time and communication guardrails convert priorities into reality. Boundaries create margin; margin creates the space where strategy, creativity, and compassion can actually occur.
Team Systems (So You’re Not the Bottleneck)
Why they matter: Leaders burn out when they carry decisions others could own. Clear delegation frameworks and decision guardrails distribute thinking, build leaders around you, and keep you focused on high-leverage work.
Early-Warning Dashboard
Why they matter: Burnout is rarely a surprise; it’s a trend. Simple, periodic self-checks turn vague overwhelm into a readable signal. When you can see load rising, you can course-correct before you’re underwater.
Relational Anchors
Why they matter: Isolation accelerates exhaustion. A trusted circle—faith, family, and a few seasoned peers—replaces ego with accountability and fear with perspective. Wise counsel shortens hard seasons and protects character.
Purpose Audits
Why they matter: Misalignment—not volume—is often the real drain. Regularly testing work against your core promise to the people you serve keeps efforts coherent. When purpose is clear, tradeoffs get simpler and energy returns.
Put together, these categories create a rhythm: presence → power → protection → partnership → perception → people → purpose. That rhythm doesn’t eliminate pressure; it makes you strong enough—and centered enough—to carry it without losing who you are.
Clout fades. Calling lasts. How do you stay anchored in impact over recognition?
I anchor to calling with a simple hierarchy: purpose → people → process → proof. Recognition isn’t on the list.
Purpose. I start with why: protect life, restore dignity, build people. I ask God for guidance, then check every big decision against that purpose. If it serves the mission, I’m in—even if no one’s watching.
People. Faces beat metrics. In the ER and at Carbon World Health, I picture one patient, one family, one staff member. If this action measurably helps them, it’s the right action. Impact is personal before it’s public.
Process. Systems outlast applause. I choose to build playbooks, train teams, and improve handoffs. Quiet process work isn’t glamorous, but it compounds. If I left tomorrow, would the good continue? That’s my scoreboard.
Proof. I measure what matters: safety, access, outcomes, retention, stories of changed lives. Data keeps me honest; stories keep me human. Likes and headlines are not proof—results are.
To keep that hierarchy intact, I hold a few disciplines:
Identity check: “Who am I becoming?” precedes “What am I doing?” If the work is growing my character smaller than my platform, I course-correct.
Credit discipline: Share wins, own misses. Praise by name, protect in public, coach in private. Recognition flows outward.
Obscurity reps: Do meaningful work no one will see—mentor quietly, prep thoroughly, serve without posting. It immunizes me against approval addiction.
Time with truth-tellers: My wife, my inner circle, and my Bible Study Fellowship circle can pull me back to center fast.
Finish-line test: “If this never had my name on it, would I still do it?” If yes, that’s calling. If no, it’s clout.
Clout asks, “How did it look?”
Calling asks, “Who was served—and what will endure?”
I try to live in that second question, every day.
What’s a leadership value you refuse to compromise even when its inconvenient?
Truth with compassion.
I won’t trade honesty for optics. In the ER, in business, and in community work, people deserve the real picture—what’s working, what isn’t, and what we’ll do next—delivered with dignity.
Why it’s non-negotiable:
Trust > tempo. Speed without truth just gets you lost faster.
Safety & stewardship. In medicine and leadership, reality saves lives and resources.
Character alignment. My faith calls me to speak truth in love; if I lose that, the win isn’t worth it.
How I practice it under pressure:
Name the reality, own my part, set the next step. No spin, no blame-shifting.
Measure what matters. Data keeps me honest; stories keep me human.
Protect people, not egos. Praise publicly, coach privately, never weaponize the facts.
Keep promises—or reset them clearly. If we can’t deliver, we say so and renegotiate the plan.
It’s not always convenient, but it’s always clarifying—and clarity is a form of care.
What book, quote, lyric or even scripture captures how you lead or how you live?
I carry four anchors:
“I’m not saying I’m gonna change the world, but I guarantee that I will spark the brain that will change the world.” —Tupac Shakur
That’s my leadership lens: light a spark in someone else—patient, teammate, student—and let the ripple do the heavy lifting.
E + R = O (Event + Response = Outcome)
I don’t control every event; I do control my response. That equation keeps me out of victim mode in the ER, in business, and at home. When pressure hits, I focus on the R: values-first choices, clear communication, next right step.
“In their hearts humans plan their course, but the Lord establishes their steps.” —Proverbs 16:9
I dream big, plan diligently, and then submit the path to God. It keeps ambition from becoming idolatry and re-anchors me in calling over clout.
“Begin with the end in mind.” —Stephen R. Covey
Know the target, then reverse-engineer the path. I’m explicit about outcomes (health, access, dignity), define the milestones, and build systems so the right thing becomes the easy thing—over and over.
Put together, this is my operating code: spark people → own your response → let God direct the steps → reverse-engineer the work. That’s how I try to lead in the trauma bay, at Carbon World Health, and in my community.
When life gets heavy or leadership feels overwhelming, what’s something you turn to: music, travel or cultural connection that helps you feel like yourself again?
I come back to center through music, movement, and meeting with God—each one resets me in a different way.
Music. I start with hip-hop to shake off the stress—then lean into my cultural roots: Spanish music, salsa, reggaetón—Marc Anthony, Bad Bunny, Camilo. And lately I’ve realized gospel has some “club bangers,” too—tracks that move your body and lift your spirit at the same time. Ten minutes with headphones can flip the whole day.
Movement. I’ll be honest: I don’t always want to. But my wife reminds me—“go work out.” She’s right. As a physician, I know this: physiology drives psychology. A lift, a brisk walk, cryotherapy session or red light session—nothing heroic—changes my chemistry and gets me back into problem-solving instead of problem-spinning.
Meeting with God. I connect intentionally—prayer as a real conversation, talking to Him like a close friend. I lay out the anxiety and the fear, and I let it fade, knowing He’s got my back. That reorders everything: identity before urgency, calling before clout.
When I stack those—music, movement, and meeting with God—I come back more me: grounded, grateful, and ready to serve.
Who is your favorite sports team?
Los Angeles Dodgers & Lakers; Barcelona Soccer Club
What is your favorite holiday and why?
The Fourth of July.
As a first-generation immigrant, Independence Day captures what I love about America: the ideas of freedom and opportunity—and the responsibility to contribute. It’s the one day I feel the arc of my family’s story and this country’s promise at the same time. I’m proud to build a life here, serve patients, create jobs, and give back to the community that opened its doors to me.
I also love the rituals—neighbors in the park, kids with sparklers, flags on porches, a grill going. And yes, the fireworks: that magnificent burst of color against a dark sky reminds me of God’s grandeur and the beauty He’s given us to enjoy. It feels like a prayer of gratitude in light and sound.
For me, July 4th is a celebration and a recommitment: be grateful, be useful, and keep doing the work that makes the promise of this country more real for more people.
