My mother, a nursing assistant, exposed me early to the healthcare profession. When I had a day off from elementary school, she would bring me to work and I would pass out graham crackers and juice to the nursing home residents.
My decision to become a doctor was not solidified until I was almost 12 years old. While in middle school, I got my first job babysitting for Peggy Sugar, a semi-retired nurse. After almost 20 years as a registered nurse, Mrs. Sugar had decided to quit her job and stay at home with her son.
One day, I shared my thoughts for a future career in medical technology. Aware of my recent acceptance into the International Baccalaureate program, Mrs. Sugar asked why I didn’t want to be a doctor. She told me that even at my age, I was smarter than some of physicians she knew, and she said that I should become a doctor. That did it for me! From that moment on, becoming a doctor became my goal.
When I tell people about the origins of my career decision, they are uniformly amazed at how one simple statement changed the course of my life. That one episode in time illustrates the power of positive belief. Mrs. Sugar believed that I could become a doctor; as a result of her belief in me, I believed that I could achieve that goal and so much more.
My subsequent undergraduate and medical school choices of Georgetown University and Johns Hopkins University School of Medicine, respectively, were firmly grounded in the belief that I could achieve great things if I aligned my thoughts and actions with my desired goal. It is important to carefully choose mentors who want the best for you, who want you to succeed, who believe that you can achieve, and who encourage you to dream big.
In the interest of fostering a relationship between medical students and faculty, all medical students at Hopkins were assigned an advisor. The four-year advisor program encouraged an active exchange between student and faculty. My advisor and mentor was Fred Brancati, an internist with a strong interest in research.
While still a medical student, I was part of clinical trial for Dr. Brancati’s Diabetes Prevention Program. Interviewing and following patients during their visits led to a desire for bedside interaction with patients, which was one of the reasons I chose to pursue a residency in internal medicine.
My work with Dr. Brancati allowed me to interact with other members of the general internal medicine faculty including Dr. Lisa Cooper, who became my role model and second mentor. Her research on racial disparities within healthcare and her work to bring greater attention to the needs of women and minorities at Hopkins inspired me to always strive to do more.
I initially contemplated fellowship training in general internal medicine, which included completion of a master’s in public health. However, the paucity of women in tenured positions in academic medicine in the mid-1990s made me reevaluate my initial decision to enter academic medicine early in my career.
Another less-spoken reason was the lack of timely and successful advancement of purely clinical physicians in academia. The research track was well-established, but the clinical track was largely unchartered. I clearly saw the gender disparity between the advancement of men and women in academic medicine.
Not to say that such disparity in position and pay did not also exist outside of academics, but I saw greater equality and growth potential in hospital medicine. I also could capitalize on the flexibility and transferability of skills if I ever chose to return to academic medicine.
At that phase in my life, I turned to colleagues and other professionals in the field for help in navigating my transition from residency to clinical practice. After talking with fellow female residents in medicine and other primary care specialties, I learned that about 30% of my third-year class of internal medicine residents decided to enter general practice, not to sub-specialize. This was a significant break from the Hopkins tradition. I chose to go into hospital medicine because of work-life balance. With a more predictable schedule I would have more time for my future family, which came five years later with the birth of my first child.
During my tenure in hospital medicine, I continued to explore my interest in academics by teaching medical students and working with administration on quality improvement projects. I collaborated with case management and other hospital ancillary departments to ensure timely patient disposition and transitions of care.
This experience exposed me to the world of administrative medicine. As medical director of a hospital medicine program, I was responsible for tracking and reporting the physicians’ adherence to core quality measures, and I developed a pay-for-performance program to achieve 100% compliance with these metrics.
After more than 11 years of practicing medicine at the bedside, I had acquired first-hand experience in caring for a forgotten portion of society: the uninsured and underinsured. I observed numerous people turning to the emergency room as their last, and often their only source for healthcare. Many individuals who had state-sponsored health plans still frequented the emergency department; their assigned physicians were often too busy with routine office visits to squeeze in urgent same-day appointments.
All too often, I witnessed the difficulties patients experience in navigating a complex system like government-sponsored healthcare. I often called personally to schedule follow-up appointments for patients before they left the hospital, especially if I knew the task would be onerous. When a young woman finally confessed to me, “It’s hard to be on Medicaid because no one wants to take your insurance,” I realized I needed to do more.
Coinciding with my desire to address the increasing social demands on my patients, I had reached a point in my career where I needed to recalibrate the work-life balance. When I returned to work following the birth of my second child, the reality of 14-hour shifts began to take a toll. So, I turned to physician executive recruiter, Dr. Deborah Shlian.
Dr. Shlian possessed an invaluable breadth of experience and perspective given her expansive background in managed care. She helped me realize that all my prior experience managing physicians’ behavior and practice patterns could easily translate into the arena of managed care. Armed with this timely advice, I welcomed the opportunity to join WellCare Health Plans, Inc., as a medical director of utilization and care management.
I transitioned from clinical practice to managed care because I wanted to focus on improving access to quality care for an entire population, not just for individuals. For several years, as I worked full-time as a managed care medical director, I continued as a hospital-based physician some weekends a month so I could still help the most vulnerable individuals negotiate the healthcare system. I believed my continued practice of clinical medicine gave me increased credibility when discussing care management issues with providers.
I was also able to voice member, provider, and hospital concerns when it came to my company’s managed care policies. In my dual role as practicing physician and health plan administrator, I could make decisions that reflected my own high standards of care. I took immense pride in knowing that countless members and providers benefited from my accumulated clinical experience.
People, especially other physicians, often ask me how I entered administrative medicine. After I describe the events of my journey, they come to realize the importance of knowing and connecting with the right people at the right time. This statement is certainly true of my relationship with Dr. Vincent Kunz, my first supervisor at WellCare.
As a general surgeon who had spent more than 17 years in practice before assuming the role as medical director over a multispecialty group, Dr. Kunz openly admitted that he entered administrative medicine late in his career. He became an ideal mentor for me because he freely provided advice and encouragement and took it upon himself to expose me to all aspects of managed care. He had an open-door policy and urged me to attend various committees and interdepartmental meetings to expand my knowledge base.
I believe the best mentors are the people who do not see the mentee’s ambition as a threat to their own professional success. I have found the best advisors among my colleagues who are well-anchored in their career or on the tail end of their career. They do not have anything to fear from my questioning and frequently welcome the opportunity to cultivate my interest.
During one of our weekly one-on-one sessions, Dr. Kunz advised me to obtain an advanced management degree since I was early in my career in administrative medicine. Never one to second-guess sage advice, I began researching executive MBA programs. As I often do, I consulted my husband, who wholeheartedly agreed that now was the time to pursue my MBA. Being in a very business-minded environment, I knew an MBA would be more easily recognized and accepted than other advanced management degrees.
With two small children at home, I sought the best program that would provide an expansive breadth of knowledge and the flexibility I needed. To achieve my professional goal of becoming an effective physician leader while allowing me to continue my administrative responsibilities without disruption, I chose Howard University’s online Executive MBA program.
During a mock interview session with my medical school mentor, I told him that my goal in life is “to run something big.” Although that statement shocked him and even caught me off guard for a moment, it appears fitting when I look at my career trajectory. I graduated with honors from a top ranked medical school, completed my internal medicine residency training at a world-renowned medical institution, and accumulated more than six years of managerial experience leading to my decision to pursue an advanced management degree at Howard University.
More advancement opportunities are now available for female physician executives in both the private and academic sectors. In the past 10 years, academic medicine has made significant strides in solidifying the succession process of several well-deserving women who are now full professors, department chairs, and hospital executives.
I am proud to say that one of my medical school mentors, Dr. Cooper, who was an assistant professor some 10 years ago, is now a full professor and the recipient of the prestigious “genius award” — the MacArthur Fellowship — for her groundbreaking work on health disparities.
Both academic institutions and private healthcare companies now realize the imperative to address the needs of the female physician executive. For me, family and personal commitments ultimately carry weight on my career choices. Female colleagues agree that maintaining flexibility in their schedule to attend school and professional conferences, fair remuneration for their skills and talent, and timely promotions are important considerations for job selection and loyalty.
With the rising costs of healthcare and increasing demands on our human and financial capital, physicians across all sectors face ever-changing priorities to deliver high-quality, efficient, and effective care for all stakeholders involved. My transition from purely clinical practice to administrative medicine was a natural progression for me as I witnessed the challenges of a hospital system as it realigned physician incentives to reflect quality performance and patient outcomes. Working in a managed-care organization I witnessed a similar paradigm shift linking fiscal growth to quality measures.
I knew that to be a successful physician executive in the healthcare industry, I needed to expand my business acumen. The business strategies and skills taught in the executive MBA program would prepare me to critically analyze current business processes to identify and eliminate areas of excess and waste and develop a more efficient workflow of evidence-based standards in care delivery.
In 2012, my journey as a physician executive was just beginning. One of the keys to my early entrance into administrative medicine was finding the right mentor at the right time. In my life and career, I have found that mentors are for a time and come in many different forms. Little did I realize that one 12-year-old’s conversation with a semi-retired nurse would translate into a blossoming career in medicine, culminating as a physician executive. The full effect of one individual’s influence on your life is usually not evident for many years, and the far-reaching effects of personal decisions made in the distant past often meld together seamlessly to form a current career trajectory.
AN END AND A BEGINNING
At the beginning of 2013, I was running the infamous rat race — working an 8 a.m. to 6 p.m. administrative medicine job, still moonlighting at local hospitals as an evening and weekend hospitalist, completing my last semester in the Executive MBA program at Howard University, and being a wife and mother with two children under the age of 6! No wonder I had lost so much weight and my hair was thinning.
Over Mother’s Day weekend, I was celebrating the completion of my Executive MBA program with my family, who had gathered in Washington, DC, for a weekend of festivities to celebrate the momentous occasion. I felt relieved to be graduating from school … again; however, when I received that call at 4:30 a.m. on July 17, several days into my younger brother’s hospital stay for uncontrolled diabetes and worsening kidney function following a trans-metatarsal amputation of his great toe, I knew instinctively that my life as I knew it would be changed forever.
I began to make an internal reflection to find my true purpose in life, an honest assessment of my present situation, and what I wanted to leave as a legacy for my children and family. I faced this daunting task in the hours and days following the unexpected death of Billy.
Losing Billy felt more like losing a child than losing a brother. My sister and I always looked out for Billy; we felt responsible for him and were so excited that he finally decided to pursue his artistic talents on the collegiate level, but when all that came to an end for him, it was a beginning for me.
Losing my brother helped me find my true, authentic, and genuine self. In the race to be everything for everyone, I fell into the trap that can plague professional and ambitious women in a male-dominated profession. I was so busy taking care of others that I failed to take care of myself. Looking at my life in retrospect, I saw Superwoman handling a multitude of responsibilities and ready to take on the next challenge, but I had essentially forgotten to put on my oxygen mask before helping others.
For me, internal reflection started with my brother’s untimely death at the age of 35. Fortunately, I was not alone in experiencing that loss and together my older sister, my mother, and I grieved. I was so blessed to reconnect with my older sister, Jackie, during this life wake-up call. She was my non-judgmental sounding board who helped me identify the areas in my life that I had neglected. She suggested that I speak with a professional who could help me deal with the loss and find my true voice. It took time and courage, but that process of internal reflection is ongoing whenever I experience a major life event, such as an impending divorce, an unforeseen job termination, or an unexpected job offer.
SOWING THE SEEDS
I can do more … I need to do more. In the years following my brother’s death, I worked to build a dynamic and diverse team of clinical and non-clinical professionals in my former role as chief medical director for medical management and external relationships at WellCare Health Plans, Inc.
I participated in various panel discussions and presentations on disparities on the local and national level. I actively engaged with the National Quality Forum through work on committees and as part of technical expert panels to share the experience as a physician executive in a managed care organization solely focused on government-sponsored health plans.
My mantra in onboarding new physicians was to make the same decision that you would make if you were at the bedside. Meaning, don’t hide behind a computer when making utilization review decisions.
I was proud to create a strong succession plan for my physician leaders and for the non-clinical team. I often held “office hours” during which doctors, nurses, and other staff could drop in to discuss work, family, school, or whatever topic they wanted advice on from Dr. Traci. As a woman, a physician, and a mother, I am constantly sowing seeds for the next generation.
Recalling that my mother took me to work with her at the nursing home as I handed out graham crackers and jelly to the residents, I routinely brought my daughter to work where I attended conference calls and video meetings. My goal is to intentionally expose her to the many facets of my day-to-day life, from observing work calls to helping me prepare for webinars by listening and critiquing my presentations.
When I came face to face with an unexpected sabbatical following the acquisition of WellCare, I finally had a moment to breathe and ultimately found my true purpose. I had time to contemplate my next career move and what I really wanted to do. I reflected upon my prior work on disparities and how many community-based organizations exist to help a wide variety of communities.
The burning question that I wanted to address directly, however, was: What happens when an organization brings all the resources into that particular zip code, effectively addressing the social determinants of health that adversely impact residents’ health outcomes, morbidity and mortality? Dr. Traci’s House was born as an answer to that very question.
I founded the non-profit organization affectionately called Dr. Traci’s House to be that organization that brings together early childhood development and education; after-hours and sick childcare; adult educational support; career development and arts education; holistic health and wellness with medical, behavioral health, pharmaceutical and dental care; nutritional support with a community garden and access to freshly prepared meals in a commercial grade kitchen; a resource center for childcare; living expense stipends for community residents seeking career certifications or job training; and most importantly, subsidized housing. (Yes, I know that is a lofty vision but my theme for 2020 was “Dream Big and Execute and Live Mindfully”!)
With the implementation of the Dr. Traci’s House community development model, a zip code once identified by a community needs assessment as an area rife with poor health outcomes and health disparities will no longer be on that list. Dr. Traci’s House provides the blueprint and building blocks to revitalize an under-resourced community and provide its residents with the tools and resources to live and thrive in their neighborhood. Dr. Traci’s House is a community-inspired approach to building a healthier community with key resources to create a sustainable model for generational health and wellness.
Dr. Traci’s House, Inc., as a 501(c)3 organization, wants to break that vicious cycle by placing the disconnected social needs together with the healthcare services in one comprehensive ecosystem of community care that is high touch, engaging care providers, residents, caregivers, and institutions in a deliberate manner to optimize health outcomes for the community. By focusing on the needs of a community utilizing published community needs assessment data, Dr. Traci’s House, Inc., will bring early childhood development, comprehensive health, and nutritional programming to the community where it is needed the most.
Serving the community takes time and collaboration. I have enlisted the support of several key stakeholders who help me realize my true purpose — service to the community. I did not get this far in my medical career alone, and I have learned an invaluable skill as a healthcare executive, the skill of delegation. I can honestly say it took years for me to be able to delegate important tasks and duties to others. Thankfully, I have nurtured a phenomenal group of women (yes, they are all women) who will usher my dream of Dr. Traci’s House into reality.
As I write this, I am embarking on a new chapter. I recently accepted a position as regional vice president for health services for Humana Florida Medicaid, thus coming full circle in my medical management journey. I started my career as a hospitalist caring for predominantly Medicaid and uninsured patients, and now I will be the chief medical officer for a growing number of Medicaid beneficiaries. This role will bring together my passion for community engagement and my purpose to serve the most vulnerable members of society.
In addition, Dr. Traci’s House is set to open its doors to the community in the upcoming months. My life has taken many turns over the years, but at each turn, I have taken time to pause, reflect, and assess. Even when things didn’t appear to go as planned or expected, my ability to reframe an experience or event has brought me peace and purpose. My hope is that my life and my service to the community will be my legacy to my children and others for generations to come.
Excerpted from Lessons Learned: Stories from Women Physician Leaders edited by Deborah M. Shlian, MD, MBA.