Mentorship, Women Physicians, and Leadership with Kathleen Neuzil, MD, MPH

Kathleen Neuzil, MD, MPH, is the Myron M. Levine MD, DTPH professor in vaccinology, professor of medicine and pediatrics, and is the director for the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine.

Host Mike Sacopulos speaks with Neuzil about her chapter in the book, Lessons Learned: Stories from Women Physician Leaders, her work for a non-profit, and her work in academic medicine. Throughout her career the power of mentorship, both as beneficiary and as benefactor, has been an inspiration to her. But what makes a good mentor?  How do women find role models who balance a family and a successful career? How has the aftermath of the COVID-19 pandemic had an impact on women and young families advancing in their healthcare careers?

Neuzil’s leadership story is inspirational. She shares how small acts of kindness, via mentorship, can result in tremendous returns. Her clinical and policy talent, anchored on the bedrock of science, has benefited countless people around the globe.

This transcript of the discussion has been edited for clarity and length.

Mike Sacopulos: I've been thinking lately about mentors. It started at my son's graduation. He had several professors that were nothing less than transformative. We can all think back to a person whose words or actions helped us. Often, they were professional educators, but no one is completely disqualified from being a mentor to someone else.

My guest today knows the power of mentorship. She has been both the beneficiary and the benefactor of mentorship. We are all the better for this. Prepare to see how small acts of kindness result in tremendous returns next on SoundPractice.

Kathleen Neuzil, welcome to SoundPractice.

Dr. Kathleen Neuzil: Thank you. Happy to be here.

Sacopulos: As you know this is the podcast of the American Association for Physician Leadership, and I'm interested in your path as a physician leader. Can you give me an overview?

Neuzil: Sure. Nobody in my family was in medicine. There were certainly no physicians, nurses, or others, and really it was my interest in science that sent me to medical school. I was quite fortunate to land at Johns Hopkins University School of Medicine which really prides itself on training future leaders in medicine. And I can tell you as a 22-year-old I didn't have much of an idea of what that meant, but again, was certainly surrounded by many inspirational people. And I think that theme continued throughout my career. I was able to train at top institutions, Vanderbilt University, the University of Washington, and again, continuously inspired and challenged by others that I worked with.

Sacopulos: In your chapter in Lessons Learned you give thanks and appreciation to your mentors. Most people describe mentors in their professional career, but I was interested to see the first mentor you mentioned was a high school teacher. Who was the high school teacher, and what did he or she help you think about?

Neuzil: Yes, I think there are maybe a few answers to that, and perhaps I may have described it in the singular, but I am sure there is more than one.

Certainly, it was my biology teacher who inspired me to be interested in science, and I would say also challenged us very specifically. I went to an all-girls school, and it was true back when I was in school that there was not as much emphasis on science and math in the girls’ schools as in the boy schools. For example, if you wanted to take calculus you had to go to the boys’ school to take calculus, it wasn't offered at my school.

So certainly, my biology teacher, who was Sister Irene, and I would also say my principal, Sister Ann Magner, who really said "Kathy, why don't you think a little higher here? You know, you have potential, you don't need to follow what then was a traditional path,” and just really encouraged me to apply to colleges and medical schools more broadly, and to, again, push myself in a way that I would not have even had the awareness that some of these opportunities were there.

Sacopulos: Well, how nice. What do you think makes for a good mentor?

Neuzil: Yes, that is a really good question. I think it is somebody who certainly models a behavior that you strive for. And so, when I think about my mentors, I absolutely think of them as role models, and you are pointing to some aspect of them and saying, "I want to be like him or her." It may not be every part, right? You are not trying to clone that person and become that person, but there is some aspect that resonates with you, whether it is their leadership skills or their scientific skills. For me, it was the many women early on who balanced a family and a successful career that allowed them to be a role model for me.

And then I think it is somebody who cares and puts your needs as a priority. Simple things. You ask them to read something or to comment on something and they get back to you quickly, they are giving you advice that benefits you. Most of the time it may also benefit them, but when it doesn't, they can step back, they can look at it from your perspective, and again, give you the best advice.

And then perhaps another important characteristic for me were mentors who gave me opportunities or introduced me to people, right? They said, "I need to connect you with this person." So, recognize that they are not the end-all and be-all for my career, and again, helped me network and find others who could compliment their own mentorship.

Sacopulos: Excellent. In your chapter in Lessons Learned, you write as a young girl of reading biographies of famous women. I think role models and heroes are important. In the time of cancel culture, should I be concerned?

Neuzil: I am not sure that I can get that profound. Role models are important. What worries me a little bit about today, and whether it is cancel culture or another word for it, is we know so much about everyone. And even some of my role models, you find out that they were imperfect humans, and we are all imperfect humans. But again, I was reading biographies from first grade. In first grade I just wanted to believe that Clara Barton and Abigail Adams were doing the right thing. And if they were flawed humans, I am not sure I could grasp that at that time anyway. So again, as we get older, perhaps we realize that, again, some of our heroes were flawed, but in the same way that with our personal mentors, they are people, there are aspects that can still inspire us, and I still think it is important to have those role models.

Sacopulos: Definitely. Lessons Learned looks at women in medicine. How has the profession of medicine changed, if at all, for women during your career?

Neuzil: Yes, I think it has changed tremendously. Again, when I was in medical school, we had a pretty good number of women actually. We had about a third in the class who were women, there were still many subspecialties for which there were not a lot of women. Now at our medical school, here at the University of Maryland School of Medicine, and others, more than 50% are women. So just the sheer numbers have changed dramatically in a relatively short period of time. Now there are still rooms and committees that I am on where you may be the only woman in a leadership position, but we are definitely seeing more and more deans of medical schools, chairs of departments, women leaders as well. Again, a little catching up to do there, but just the sheer numbers have dramatically changed during my career.

Sacopulos: You described in your writing that the time in a female academician's career when she has young children is, "one of the most tenuous times for female faculty." Is this changing?

Neuzil: I would like to say it is changing; however, I believe the COVID-19 pandemic set us back. And I say that because as difficult as it was for me with three young children and trying to keep up with academics, when you put on top of that what some of these both young mothers and fathers went through in these last three years where schools were closing, daycares were closing, they were trying to juggle working from home, and children, and remote learning. And I think we took a big step back during COVID-19, and we have to recognize that the stress and the pressures on young parents were really tremendous. So, I think we need to claw our way back out of that a bit, and again, I think it is still stressful, but hopefully we can continue to make progress.

Sacopulos: Good. I am interested in leadership and business practices that you learned while you worked at PATH. You indicate that these were not skills or things that came to you through an academic environment. And so, could you talk about the different employment environments and how they impact leadership skills?

Neuzil: Sure. And again, there may be people in academics who gain these leadership skills in different ways, but I think there are a number of important lessons and skills that I learned working for a not-for-profit for 10 years.

One is really how you are incentivized. And in academics, at least in the earlier part of our career, we have to prove our individual worth. We have to prove our scientific contributions in whatever way we might do, and that may be through getting grants or publications. When I was at the not-for-profit, the incentivizing was different. It was collaboration, it was more team-based, right? And it was achieving a certain team-based public health goal. So again, the skills that you might use to get to those, what might be similar, but different pathways to get there, I believe are important.

So, when I moved to the global health not-for-profit it was the first time that I had formal leadership training. Again, this is done more commonly now in academics, but was not done earlier in my career where I actually sat down with professionals, and a group of professionals, and learned techniques, learned how to approach difficult situations, how maybe to give feedback that is not easy to give, how to deal with, it is rare, but how to deal with the difficult employee. So yes, there were a number of skills and a number of ways that I learned those skills that were different in the nonprofit world.

Sacopulos: Very interesting. I think people would be fascinated to know a little bit about your service at the nonprofit organization, PATH. Could you just give us a 30,000-foot view?

Neuzil: Sure. PATH is a global health not-for-profit, and I worked in the vaccine group, so our goal was to accelerate the introduction of vaccines in low-resource countries. And it was really a wonderful decade of my life where I felt like I could take the scientific, the trial design, the clinical and policy skills that I had learned in academics, and apply those to broader populations, and apply those specifically to populations in low-resource countries.

And again, it was putting the science in the context of the larger public health goal. So, we still had to do rigorous science, but you learn that just proving a vaccine works or just developing a vaccine is not enough. We need to be able to communicate the benefits of that vaccine. We need to be able to generate political will. We need, and we all learned this the hard way many times, we need to have a business case for that vaccine and a market for that vaccine, right? If countries can't afford it, they are not going to use it. If the use is not sustainable then a manufacturer is not going to make it. So, all of these other aspects that surrounded the science of vaccinology, which was really my focus in academics, were part of the broader perspective at PATH.

Sacopulos: Very interesting. And your answer just brought up the political dimension to vaccines, and I think few would argue that there is a political dimension to vaccines, both recently and going back a number of years. We don't really see that in other areas of medicine. Why do you think that is?

Neuzil: Yes, it is a great question. And as you have said, we could give examples through the decades. You can go back to the original smallpox vaccines a hundred or more years ago, and there have been cases that went all the way to the Supreme Court testing the individual rights of my being able to get or refuse a vaccine versus the public health mandate, that we have an outbreak of a very deadly disease. That is not new. I think what is new is the pervasiveness of it, right now, is what has really changed. It used to be a minority, but in the '50s and '60s we had moms and parents lining up with their children because we finally had a polio vaccine and children were not going to be paralyzed by swimming at the public pool in the summer. We finally had a measles vaccine, a very deadly, and still one of the deadliest infectious diseases known. And again, except for a small minority, vaccines were seen as very positive.

So again, the pervasiveness of it, the number of people with doubts about vaccines has increased over time, which to me is a great irony because we know so much more about the science now than we did 50 years ago. We know precisely how these vaccines are working, precisely the immune response to these vaccines. We can measure safety and adverse events to the one per million metric. So really, we should have more confidence in vaccines right now and yet we are seeing the opposite.

Sacopulos: You brought up historically, I think you mentioned smallpox, and I live in a small town in Indiana. In the early 1850s, residents were required to be vaccinated for smallpox, lest they be expelled or jailed, right? So, can you imagine a scenario where such a mandate is possible today, and does this really mean that medicine is a victim of its own success?

Neuzil: Yes, I think there are two aspects of that. We have medical professionals and the Centers for Disease Control who recommend vaccination, and then it is really at the state level how you require and enforce that vaccination.

So, while I can't comment on 1850's Indiana, school laws, for example, are set and enforced at the state level, not by medical professionals. And again, it is this attempt at balance between the individual rights, but also recognizing that there are parents of five-year-olds with cancer, and they are not going to respond to that vaccine. And if we can surround them with other five-year-olds at recess who are vaccinated, we are going to protect that vulnerable child. And we can give many, many examples of this. An infant is another example. When we all go to visit infants, when we go to visit people in nursing homes, we do have some obligation to them and to protect them. So no, I can't imagine people currently being thrown in jail, but it is this idea of what obligation do I have to my fellow community here to keep them safe, in the same way that I stop at a red light even if it is at 2:00 in the morning. So again, it's that obligation to community in my opinion.

Sacopulos: And so, do you think that this is a communication issue more than a science issue, when it comes to the politicalization of vaccines?

Neuzil: I think part of it is communication, I think part of it is that it has become a political issue, which, again, is probably what is most disappointing and upsetting to me personally. That if we think back of other outbreaks in history, it has been really when politicians have come together to support a similar cause. I do not understand why it is political, but unfortunately, it has become more political.

And then I think it is a function of social media. If you Google vaccine, your top 10 hits may be something horrible, right? But absolutely not reliable sources. So, I think we in medicine and vaccinology have not kept up with communications, to your point about communications. And it is not just me standing there as a physician saying, "Everybody should do this," but recognizing that people's sources of information have changed dramatically.

All of that being said, if you look at studies, you are always, again, going to have a minority of people that you are not going to change their mind, but people will still listen to their trusted source. So, their own personal healthcare provider. If you have ever heard, "Progress moves at the speed of trust," and I think that is similar for vaccination and public health programs. The faster we want to move, the more trust we have to engender.

Sacopulos: Excellent point. Well, as our time together ends, I am interested in what is next for you. What projects are you working on?

Neuzil: Yes, I am working on a lot of different projects. I do want to make the statement that I was talking about how much I loved working for the global health not-for-profit, and I am really very, very fortunate that even though I have moved back into academics that I am still able to work with many of the low-resource communities. We are currently working on a big typhoid vaccine project to try to get that vaccine out there. But really my motivation for moving back was this is where you are going to mentor people. You are going to mentor people in an academic center.

And while we all mentor people all our lives, it really is concentrated. The common denominator for any of us in this field is we must go through our academic training phase, and then we may go off to a not-for-profit, or we may go off to a pharmaceutical company, and that is great, but I really had such great mentors that a big part of my job, and at this phase in my career, I really want to help that next generation of leaders and ensure, again, that maybe those women that are feeling a little bit vulnerable because it has been a bad week at home, either have a role model or a little extra help that can get them through. Because we want these people as leaders, and we need these people as leaders.

Sacopulos: My guest has been Dr. Kathleen Neuzil. Dr. Neuzil, thank you so much for your time.

Neuzil: Yes, this was a lot of fun. Thank you for having me.

Listen to this episode of SoundPractice.