Beth Garner, MD, MPH, on Physician Leadership, Careers in Industry, and Advocacy for Women’s Health

Host Mike Sacopulos interviews Elizabeth (Beth) Garner, MD, MPH, who contributed her life and career story to the AAPL book, published in 2022, Lessons Learned: Stories from Women Physician Leaders.

Garner is chief scientific officer of Ferring Pharmaceuticals, and president of the American Medical Women’s Association (AMWA). She received joint MD and MPH degrees from the Harvard Medical and Public Health Schools and trained in obstetrics and gynecology at Brigham and Women’s (BWH)/Massachusetts General Hospitals. She was a 2019 awardee of the PharmaVoice 100 Most Inspiring Individuals in the life sciences industry and received the 2022 Women in Science Award from AMWA.

Physicians working to improve our healthcare system give us hope. Prepare to meet one of those extraordinary physician leaders. Garner’s story and career trajectory should inspire other physicians, other women.

This transcript has been edited for clarity and length.

Mike Sacopulos: My guest today is Elizabeth Garner, MD, MPH. She is the chief scientific officer of Ferring Pharmaceuticals and also president of the American Medical Women's Association (AMWA). Dr. Garner, welcome to SoundPractice.

Dr. Elizabeth Garner: Thank you so much.

Sacopulos: It is a pleasure to have you as a guest. By anyone's estimation, you are a physician leader. Could you describe your career path?

Garner: Sure, of course. So, from a pretty young age, I was interested in the medical field. I had a fantastic pediatrician that was really a role model for me. So, I definitely saw myself as a physician by the age of 12. Other than thinking about being a pilot, that was the other option, I went to medical school straight out of college. My mother was a Peace Corps volunteer and a very strong advocate for women. I went to her alma mater, Mount Holyoke, which is a women's college. So, by the time I hit medical school, I was already thinking about women's health and aware as a woman myself, but also as someone who was born and raised in Nigeria, very much aware of the many unmet needs in women's health. So, for me, going to medical school and becoming a doctor, I knew I had a great opportunity to make a difference.

I never expected, though, to end up being in the pharmaceutical industry as a physician leader. That was not on the radar at all for me. When I entered medical school, and even several years post medical school, I went through OBGYN training. I did a fellowship in GYN oncology. So, I think at that point I saw myself as being a clinician for the rest of my career, but realized fairly quickly, actually, once I was done with my training, that there were a lot of unanswered questions. It's a good example; I was frustrated in the ovarian cancer realm, which is where I spent a lot of my time as a GYN oncologist, that we just didn't have adequate treatments. So, I found myself doing all these surgeries, doing these really big operations on women with ovarian cancer, and then it would come right back despite my perfect operation.

I thought, "This is not okay. We need better treatments. We need targeted treatments," which I was already thinking about, interestingly enough, way back then before targeted therapy became a thing in oncology, but I wasn't necessarily doing anything about it. And then I got an email from Merck basically saying, "Hey, we're looking for a GYN oncologist, would you be interested?" So that was the turning point, going to Merck, interviewing, and realizing, "Wow. This is where all the really interesting research is happening." So, I made that leap into industry about 16 years ago. And then I think I also realized fairly early on in industry that I recognized some of the leadership qualities I didn't even realize I had but was very interested from the get-go that I really wanted to climb up that ladder and be one of the people making big decisions.

So, in order to do that, I realized that a company as large as Merck, that is years of waiting around if you want to work your way up. I'm now on company number six in my 16 years. And in this role that you described as the chief scientific officer, being involved in a lot of decision making and strategy and being one of the people that directs where we are going as a company. So that has been the journey. I think it has been amazing. I don't think I'm done yet. I don't know, but I think there's more to do, especially in the women's health space. There are so many, I'm sure we'll talk about this, huge unmet needs in this area. I would love to have more opportunities to get down into the science and figure these things out for women.

Sacopulos: As you know, this is the podcast of the American Association for Physician Leadership. What changes have you seen in physician leaders over your career?

Garner: That is a very interesting one. Unfortunately, I think that physician leaders, at least at the moment, are feeling disempowered in many ways. If I think back to medical school, we didn't really get taught anything about leadership. That was not a part of the curriculum at all. It was all about just learning the diseases and the medicines, and that was really the focus. And for me, what that has led to is that as physicians move up, if you want to call it that, they haven't been able to maintain the decision-making on how medicine is here, how medicine is done, how it is conducted.

So, you will see there used to be so many more, say, private physicians who had their own private practices, and we are seeing fewer and fewer of those as they get eaten up by these bigger corporations. And I feel that physicians, as I said, have been very much disempowered. We don't see, I think as many as we should in those top leadership roles. What I will say though, the positive side of that is I think that what that has led to is physicians realizing they need to be leaders if they want to influence how medicine is conducted in the United States. So, what that is leading to is, for instance, organizations like the American Medical Women's Association is really focused now on, we have to get leadership training. We have to do this in medical school, in residency, much earlier in the career path.

Unfortunately, I feel like all that had to happen in order for physicians to realize how important leadership is. So, I feel like the good news is, within AMWA for sure, that is where I'm spending most of my time with other physicians. I'm seeing that change happening. What I'm seeing is younger physicians who are, for instance, doing MBAs, we're seeing a lot of those combination degrees. The most people were doing in terms of combination degrees when I was training was an MD and an MPH, for instance, which I did. But that's not leadership. We're seeing more and more of the younger generation coming up and realizing, wait, we need to figure out this leadership type of thing. So, I'm very optimistic, I guess, as to where things are going for physicians.

Sacopulos: Well, that ends the question on a high note, which makes me feel good. Maybe you could tell us briefly about the American Medical Women's Association. I think our audience would be interested in how people could become members and so forth.

Garner: AMWA has been around for over 100 years now. We are the oldest women's physician group in the country, maybe even in the world. And we focus on women physicians' lives, improving their lives, not only as it relates to their careers, but also the other aspects of life, their mental health. We spend a lot of time thinking about that. And basically overall, how do we make the lives of women physicians better? So that is a real pillar for AMWA. We, of course, are also very interested in equity. And if there is a topic that is timely right now, it is all about health equity and how the pandemic exposed many issues around health equity, not only related to gender, but race. So AMWA is very focused on that. That's another pillar, basically, of the organization.

And then we are also very focused on women's health, so improving the lives of women as well from a health standpoint. So not just physicians, but also patients. It is really those main components. There is a lot of other stuff that AMWA does. We have a really powerful, very active advocacy committee that does a lot of advocacies related to some of the questions you were asking around, talking about Dobbs and all those other things and what is happening in the reproductive health space and the threats I think that we have, AMWA is very focused on that. So, our advocacy team is really incredible. They are quick to jump on new legislation or things that are coming out. And really, we have a presence there. Actually, at the beginning of this year, we received a letter straight from Joe Biden, congratulating AMWA for the work that it is doing in that area.

And then members, we are very open in terms of membership. There are really no requirements necessarily. We have members who are not physicians. We of course are very open. We have a very large pre-med division. So, these are people who are thinking about going into medicine, a very large medical student division that is very active, and we have a residency division that is not as active because they're so busy being residents, and then of course the established physicians. So, a lot of pieces to the organization. But all in all, I think that these are passionate women. I think one thing I was very excited about when I joined AMWA was the connections that women physicians are able to make with each other as members of AMWA. So just a great organization. We have a fantastic executive director, Eliza Lo Chin, you may have spoken to, who's been with AMWA for many years. She is actually my classmate from medical school, so we go way back. But her passion and her dedication to the organization I think is one of the things that really makes it great.

Sacopulos: Very nice. Dr. Garner, you wrote a chapter in the book Lessons Learned: Stories from Women Physician Leaders that was published by the AAPL last year. Can you tell us how you became involved in the project and a little bit about the book?

Garner: This book I think was fascinating. It was just a wonderful collection of physician leaders from all the various aspects of medicine. So, folks like me who are in industry as well as of course, practicing physicians as well as a nice age range of people from earlier in their careers to later in their careers. And basically, I got involved through AMWA. I think it was Eliza that I just mentioned, the executive director that was asked to think about physician leaders and asked me to participate. And I was excited about it because I think traditionally when people think about physician leaders, naturally they think about people who are actively practicing medicine. And one of the things I am trying to do even within AMWA, is broaden that definition.

We have physicians who are doing all kinds of things all the way from being in the insurance industry or working for CVS, being the medical director or chief medical officer for large pharmacies, and even physicians who work for sports teams. I mean, there are physicians everywhere. And I think we don't necessarily think about that when we think about the definition of a physician. So, one of the things I liked about the book was that it included a wide range of individuals and their stories. I mean, I think what was so great about the authoring of the book was just really helping those of us who contributed to really think very broadly across our entire career, and to think about what were those early influences that led us to decisions we have made or the path that we have taken. So yes, it is an amazing book and I know there will be more of these coming, so I am excited to see what comes next.

Sacopulos: In the book, Lessons Learned, you write about a childhood of world travel. Does international travel impact the practice of medicine?

Garner: Well, I would say I think so, yes. I think it is easy for us to get very focused, and not just in the United States, but our little piece of wherever it is that we work. So, what we see, what the patterns are, and what the unmet needs are too. If you live in Montclair, New Jersey, let's say, and you are a reasonably wealthy corporate, whatever it might be, you are going to have a very different view of what medicine is about. When you go to see, say your primary care doctor, and you are someone who lives in Tennessee for instance, in a rural area, where you barely have access to a physician for miles and miles. There's going to be a very different view on health because naturally in those environments, you are going to have different problems.

It is in those places, remote areas, areas that are underserved, where we in the United States actually look worse in many ways than the developing world, sadly. But I think it is being able to get around the world and see what the issues are, how medicine is delivered, that really helps you to understand and put into perspective, I think, what we have here in the United States positively, but also some of the negatives. Around the world, most people have coverage, just the citizens of countries, and we don't have that here. That is, for me, a major difference as to how people interact with the medical system. So yes, absolutely. I think that traveling around the world and seeing how things are done differently impacts the way physicians think.

Sacopulos: Are there more leadership opportunities available to female physicians in non-clinical settings?

Garner: That is a great question. I just gave a talk about a month and a half ago around leadership. And what I think is there is a need for more women, not just physicians, just all women, but for more women to be at the top. So, from a corporate perspective, but also an academic perspective as well, because at the end of the day, somebody has to be the final decision maker. Whether it is an investment. You might have a woman who is at a certain level that sees a company that has what she thinks is a great investment, but then takes it up to the top and no, it doesn't happen because the guy at the top may not know the first thing about women's health and why there's such an unmet need.

So, I talked about the need for women in all parts of the industry, and that is to your question, we need leaders in investment. We need women leaders in pharmaceutical companies. And I am talking at the very top. CEOs, basically. We need a lot more women who are heads of boards of pharmaceutical companies. I would say from the research that I did, I think to a degree, yes, there are more opportunities, I believe for women to be in leadership. There is not a huge difference though, if you look at the very top. The CEOs and the heads of academic medical centers, there is still not many women at the top. So, when you are talking about the top leadership positions, I would say it is probably not that different for clinical versus non-clinical. We are still struggling, I guess, is what I would say.

Sacopulos: Let's shift gears a little bit. Last summer, the United States Supreme Court released its decision in the Dobbs case, the decision impacts the practice of medicine in many states. We have also seen state legislatures pass laws impacting how physicians practice. Are we seeing an erosion of physician authority and autonomy?

Garner: Yes, I would say that we are. It is really troubling to see legislators, many of whom know very little to nothing about women's health and certainly very little to nothing about women's reproductive health specifically, making decisions and making very broad decisions that in my mind, don't necessarily think about or take the time to think about what the ratifications are of the decisions they are making. So, it is after these decisions are made that complicated situations arise, and they say wait, we didn't think about that. What happens with a 10-year-old, for instance, who was raped. How do we manage that? So, it is very concerning to me.

And yes, I think the fact that legislators believe that they should be the ones to make these decisions without that critical background is very concerning. And I do think it erodes the power of physicians. Now, this is where I think organizations like AMWA come in. We need to advocate; we need to really be active in these discussions and push back. And it is not a fight in my mind, it is a discussion. Let's talk about this with legislators, let's talk it through. And that is where I think that we definitely need physicians to step up and take back, I think some of that decision making power.

Sacopulos: We mentioned earlier that you are the chief scientific officer for Ferring Pharmaceuticals. Can you tell us about Ferring and your work there?

Garner: Sure. Ferring is a global company, headquartered in Geneva. It's a privately held company as well. So, unlike many pharmaceutical companies that are public or publicly traded, Ferring is private and actually has a single owner. It is the family that founded Ferring over 70 years ago, that generation of the family that continued to own the company. So that makes it, at least for me, having been with those six companies that I mentioned earlier that I have worked for, Ferring is the first company that is privately held. I'm used to public companies where everything that happens has to be a press release and all that pressure. So, one of the nice things I think about Ferring is the fact that it is privately held and that not everything needs to be, "Oh my gosh, we need to let the investors know." So that is a big difference.

The global aspect of Ferring I think is really interesting as well, because we all need to work together. And I think Ferring does that well. It is a growing company though, so of course, as with any company that is growing quickly, there can be challenges. But as it goes, I think the understanding that it is a global company and the fact that we need to work together is, I think, a great thing. It is very interesting because as we talked about earlier, international health is different. So, for my colleagues in Copenhagen, that is where a lot of the research and development happens, where they have healthcare, they have health insurance, they are covered. They don't see some of the unmet needs that we see here in the United States. So those discussions are always really interesting, right around what the priorities are for the company. And I think I love those discussions. I love the strategic decision making.

Ferring is very focused on reproductive health. That is really, I would say, the core business, that is what Ferring is known for. If you were to poll physicians in the United States, most of them, if they know Ferring, they will know it for the reproductive side of things. Infertility mainly, that is where most of our products are. And then we also have products in the gastrointestinal space as well as orthopedics. And then those are marketed products.

And then most recently, what has been super exciting for me in this first year of being in the company, is we had two FDA approvals at the end of 2022. In November, our microbiome product called Rebyota was approved. This is a product that is to be used for prevention of recurrent, what we call Clostridium difficile, which is a terrible abdominal infection. So that was super exciting, and it is really to prevent the recurrence.

And then the other product that was approved in December, so a month later, amazing, is a product for the treatment of bladder cancer. So, we have these really different areas that we are working in, which can be a challenge. Sometimes it is easier to have one focus, and that is what you are good at. But I think what is really exciting about these new products is that it is a great opportunity for folks at Ferring to learn about these new areas and develop expertise as we go through. It is a very fast-moving company and really growing. It is an exciting time.

Sacopulos: Well, congratulations on the approvals. As our time together comes to an end, I would like to have you give advice to physicians based off of your career and your leadership. For new physicians that may be listening to this podcast, any words of wisdom?

Garner: Certainly. I'm a big believer in following your passion. There is no doubt I have done that throughout my career. And what it does mean is at times having to make changes to follow that passion. But I have been very lucky that I have been able to stay focused in the women's health space through all these years. Over 16 years in the industry as well as obviously my clinical work. It has been really great to recognize that passion, find out what it is, and then follow it. I think change is a huge one for me. I have been willing to make changes to take the risk in many instances actually. So, I switched residency programs way back. That is almost unheard of. People start in a residency. I started in internal medicine; I switched over to OBGYN. That was a really tough thing to do. It was risky but I did it because I realized my passion there was to focus on women's health.

So yes, be willing to take risks, make changes. Speaking up, I think is critical. And that can be hard to do as physicians, especially women physicians. I think it can be hard to speak up, say what you think. Let your opinions be known. I think for younger physicians, that can be tough. When you are in training, you feel like I shouldn't really say anything. I encourage younger women physicians in particular to speak up when they see things that perhaps they believe shouldn't be happening for instance. Advocate for yourself. I think it is really important to pull others up.

I get, as you might imagine, a lot of requests to speak to people about their careers and if they want to make a move. And although it can be challenging to fit that in, I really try to, to be able to give advice on careers. I think we owe it to the folks coming behind us to do that. And I want to go back, I think for me it is all about my passion. I really think about it all the time and I try to make sure that whatever I'm doing, whether it is being the president of AMWA, as you said, I want to be sure that it is what I'm doing and what I'm doing to help the organization is focused on what are my passions? Where do I think the unmet needs are? I think those would be the major points of interest and advice.

Sacopulos: Great advice. My guest is Dr. Elizabeth Garner. Dr. Garner, thank you for being on SoundPractice.

Garner: Thank you. This was so much fun. I appreciate it.

Listen to this episode of SoundPractice.