AAPL Member and Author, Non-Fiction and Fiction Writer

Can you please provide us with an overview of Lessons Learned: Stories from Women Physician Leaders?

Ten years ago, the American College of Physician Executives (now the American Association for Physician Leadership) asked me to update a monograph I’d written in 1995 titled Women in Medicine and Management: A Mentoring Guide.

At the time I wrote that 1995 monograph, I was one of a very few women in ACPE. Only about 19% of physicians in the U.S. were women (up from 8% in 1970) so I had great difficulty finding more than a few women physicians who held low or mid-management positions and almost none in top management. That was true across the entire healthcare system.

I’ve always believed that the narrative form is a powerful way to engage people. We remember stories more than we remember data. So after months of searching, I selected 17 representative women physicians and asked them to write their personal stories, including how they chose medicine, why and how they transitioned from clinical medicine to management, and what obstacles they encountered along the way.

Most of them were primary care physicians in middle management or just beginning to transition from clinical medicine to leadership. It was clear from their narratives that for the majority, leadership positions had been unplanned and that few had found role models or mentors to help guide their career paths. There also was consensus that a thick glass ceiling existed within healthcare that was thwarting their ability to move into more senior positions.

When I agreed to update the original monograph 17 years later, I expected the situation to be significantly improved. After all, women have been entering medicine in increasing numbers since 1995; in 2013, 50% or more of the students enrolled in many medical schools (including my alma mater) were female.

Unfortunately, as I researched the latest statistics for that book, I discovered that women physicians were still underrepresented and underutilized in positions of power — especially at the most senior levels. No more than about 16% of the top leadership positions in any area of the healthcare system were held by women doctors.

For the updated book, I repeated the format I’d used in the original monograph. This time, I was able to find 24 exceptional female physicians who had defied the odds by rising to top management posts. The title of the updated book was Lessons Learned: Stories from Women in Medical Management. In it, these women shared their career paths from clinical medicine to leadership within healthcare, including the obstacles and challenges faced in balancing work, family, and personal life. The hope was that their experiences could serve as guides for younger women physicians aspiring to executive roles within medicine.

In 2021, 26 years after the original monograph and a decade after the first update, I was asked to do yet another update that included as many of the original women as possible to answer the question “Where are they now?”

This latest version updates the stories of 23 of the women in the 2013 version and adds nine more, including two young women — one a senior medical student and one a second year resident who was about to be chief resident — who had leadership training in medical school and aspire to leadership roles in the future.

The women in this book have found success in many different areas of medical management. They include corporate medical directors, managed care executives, managers within government, the pharmaceutical industry, academic leaders, hospital executives, and entrepreneurs.

In the overview chapter, I discuss the current situation vis-a-vis women physicians in leadership within all aspects of healthcare. Bottom line: Almost three decades since the original monograph, women physicians continue to represent a relatively small group of senior physician leaders.

What was the process for compiling the contents and editing the book?

In the latest version, Lessons Learned: Stories from Women Physician Leaders, I followed the same format as the two previous versions: I asked each contributor to tell their own story, which I edited as needed. Because I had worked with many physician leaders in my role as an executive search consultant, I was able to choose representative women for the book.

Originally I did interview them, but later decided that having them tell their personal stories in their own words would be more authentic. The process was iterative, as many of the chapters went through several revisions. Many of the contributors later said that this was the first time they had actually sat down to consider the various obstacles and challenges they faced in their career journeys. I especially urged them to share how they were able to balance their professional and personal lives.

Are there one or two stories that stand out?

While I think every one of the women profiled are outstanding. Here are three:

Mona Hanna-Attisha, MD, MPH

Mona Hanna-Attisha’s family is Iraqi. She was born in England, then moved to Detroit, where her father, who was an engineer, worked for General Motors.

Board certified in pediatrics with a master’s in public health, “Dr. Mona,” as we’ve come to call her, is best known as the whistleblower who exposed the dangerous blood lead levels in the children of Flint, Michigan. Risking her job to raise awareness of this scandal, Dr. Mona’s advocacy eventually resulted in $100 million in federal and $250 million in state funding to address the problem.

She was named one of the Time magazine’s Most Influential People in 2016, but to get that moniker she had to fight the powers that be and almost lose her job.

When she heard about the possibility of lead in the water, she began a research study using data available in electronic medical records and found an unacceptably high level of lead in the blood of Flint children. Because of the public health implications, she revealed her findings publicly and advocated for action at a press conference in 2015 before her research was scientifically peer reviewed.

The next day, Flint issued a health advisory for residents, particularly children, to minimize exposure to Flint tap water. Hanna-Attisha’s research and findings were criticized by the spokesperson for the State of Michigan’s Department of Environmental Quality, who accused her of being an “unfortunate researcher,” “splicing and dicing numbers,” and causing “near hysteria.” About 10 days later, after the Detroit Free Press published its own findings consistent with hers, the State of Michigan backed down and concurred with her findings.

Later, at a press conference in which the State of Michigan acknowledged the lead-in-water crisis, Department of Environmental Quality officials apologized to her.

Elizabeth Garner, MD, MPH

Elizabeth Garner holds a medical degree from Harvard Medical School and has practiced in obstetrics, gynecology, gynecologic oncology, and internal medicine at Brigham and Women’s Hospital and Massachusetts General Hospital. In addition, she holds a master’s degree in public health from Harvard’s T.H. Chan School of Public Health and a bachelor’s degree from Mount Holyoke College in Massachusetts.

Garner is a recognized leader in her field, helping to develop new treatments for endometriosis. But what makes her success so fantastic is her “back story.” She was a war refugee. She shares her life journey in Lessons Learned. Here’s an excerpt:

“My identity as a physician who works toward leading change comes directly from the foundation of my formative years. My mother is a white American born in Huntington, Long Island. As a fresh graduate of Mount Holyoke College, she started immediately on her way to life as a change maker by joining the Peace Corps. She was dispatched to teach German in Nigeria, a fledgling country that had just won independence from Great Britain two years earlier. My father was born in rural eastern Nigeria to proud Igbo parents and worked his way up to a degree in electrical engineering and economics from Leeds University in England.”

She was literally “born a crime,” since interracial marriage was illegal in 1964. As a result, she spent her young years in Nigeria living in a remote Igbo village while a civil war was raging. Eventually she, her mother, and older brother escaped to Portugal where her maternal grandparents were living, and then to Cincinnati, Ohio, where her aunt lived. Her father remained in Biafra to oversee the electricity grid and the airports. As a single white woman with two mixed race kids, her mother had trouble finding a landlord who would rent her an apartment. In 1970, they returned to Nigeria to reconnect with her father.

Laura Esserman, MD, MBA

Laura Esserman is a world-renowned breast cancer surgeon and advocate for changing how women are screened for breast cancer. Named one of Time magazine’s 100 Most Influential People in the World in 2016, Esserman attended college at Harvard University and completed medical school and a general surgery residency at Stanford University. After finishing a postdoctoral fellowship in breast oncology there and earning a master’s degree at the Stanford Graduate School of Business, she joined the faculty at UCSF Medical Center in 1993.

Known as the “singing surgeon” for singing to her patients as they go under anesthesia, Esserman is the director of the Carol Franc Buck Breast Care Center. She believes that some patients with a type of breast cancer, ductal carcinoma in situ (DCIS), should be placed on active surveillance instead of undergoing mastectomy or lumpectomy, radiation, and endocrine therapy.

She is one of the most vocal proponents of the idea that breast cancer screening brings with it overdiagnosis and over treatment. To that end, she is currently conducting the WISDOM study. Her goal is to bring together 100,000 women from across the U.S. to find the safest and most effective way to detect breast cancer for every woman. More than 70,000 women are currently enrolled in the program.

You are an accomplished writer, both fiction and nonfiction. How did you learn to write? Do you find it difficult?

I wanted to be a physician from the time I was in grade school. My dad was an old-fashioned internist. Until I was a teenager, his office was in the basement of our house. I often went on house-calls with him and he sometimes took me on hospital rounds. I got to see how grateful his patients were for his care. He was a hands-on doctor who spent time listening to his patients. He was my role model.

But while I planned to be a doctor, I also loved to write. I started a neighborhood newspaper called The Chatterbox when I was in sixth grade, I wrote plays in summer camp, I was on the high school and college newspapers. In college I majored in zoology and minored in English.

When I discussed my interest in being a writer, my father told me that as a writer, I might not make a living, but as a doctor, I could always write as an avocation. So that’s what I did. After medical school in Baltimore, my husband and I moved to Los Angeles to finish our residencies, then joined a large multispecialty group called Kaiser-Permanente, where we worked in side-by-side offices for a decade.

Along the way, we taught medical students and residents at UCLA, wrote medical research articles and nonfiction books and articles on medicine-related topics for the public. We developed a reputation for writing about healthcare issues in an understandable way. If you remember Art Ulene, one of the first doctors on The Today Show we even helped write some of his copy.

I was happy practicing medicine, teaching, and consulting, but you know you can’t live in Los Angeles very long without getting bitten by the Hollywood bug. Everyone you meet is something else on the side: your dentist is a producer, your lawyer is an agent, and of course, every waitress is an actress. I was especially influenced by Robin Cook’s novel Coma, which I think is still one of the best medical mysteries. He’s really the father of that genre. And then a few years later, Michael Crichton, also a doctor and writer, adapted the book as a screenplay.

I had an idea for a novel based on something that happened at my hospital and decided to give fiction a try. I convinced my husband to co-write it. That book was called Double Illusion. We ended up writing two more books together — Wednesday’s Child and Rabbit in the Moon — before my husband decided he preferred photography to writing, even though Rabbit garnered a number of literary awards, including the Gold Medal for the Florida Book Award and the Silver for Mystery of the Year.

Coincidentally, Linda Reid, a pediatrician with whom I had worked at UCLA Student Health Service, emailed me about writing something together. The result of our collaboration was three books in a series starring radio talk show host Sammy Greene, an outspoken, brash, native New Yorker, and Gus Pappajohn, an ex-New York policeman who end up teaming up to solve murders. The first book takes place on a college campus in Vermont, the second in Los Angeles, and the third in Greece.

People say you should write what you know. So it’s not a surprise that because I am a physician, all of my novels so far have some kind of medically related theme. As a family physician, I have had an opportunity to get to know so many different individuals over the years, to learn about their lives from a kind of intimate perspective that is quite unique. That has given me a breadth of experiences from which to draw my characters and situations.

Even though some people call my books medical mystery/thrillers, I have tried very hard not to write the same book each time out; each one is different. My latest novel, Silent Survivor, is about a drug developed by a rogue subdivision of the Army that ends up having some terrible side effects.

What does the future hold for you?

I have several projects I am interested in — one, of course, is to help promote a new book, Lessons Learned: Stories from Women Leaders in STEM. I feel more strongly than ever that we need to expose young girls (and boys) to science as early as possible. I recently met a parent of a 9-year-old who told me that her daughter loved math, but just this year had a teacher who actually told her math was not a career for girls!

So I am looking for opportunities to be a mentor to some young people. I am also interested in the possibility of writing a book with male role models for young boys.

Linda Reid, the co-author of our Sammy Greene series, is anxious to write books No. 4 and No. 5 so that is also on the drawing board.

To suggest an AAPL member for this ongoing series, email us at journal@physicianleaders.org.