Challenges Bring out the Best in Me, Says Njideka Udochi
Earlier in the year, Dr Njideka Udochi was named Maryland’s Family Physician of the Year 2021 by the Maryland Academy of Family Physicians in the United States. She is the first black woman to earn the honour. She has also received a major award for Covid-19 community engagement and response in Howard County, Maryland, USA. Udochi, younger sister of WTO DG Dr Ngozi Okonjo-Iweala, graduated as a doctor from the University of Nigeria at the age of 22 and proceeded to the US where she earned a Masters Degree in Public Health from the Bloomberg School of Public Health at Johns Hopkins University. She thereafter embarked on a professional career that has taken her to the heights in her chosen area of specialisation: family medicine. A Fellow of the American Academy of Family Physicians, she is certified by the American Board of Family Practice and the American Academy of HIV Medicine. In this interview, she tells Martins Ifijeh about her journey to success, highlights of her experiences as a black woman medical entrepreneur in the US, the most challenging period of her career, what she has learnt from her experiences and her new multispecialty medical practice.
ITell us a bit about your growing up years, would you say it influenced your journey significantly?
grew up in university campuses (both of my parents were academicians; my dad, a Professor of Economics and Statistics and my mom a Professor of Sociology) first at the University of Nigeria, Nsukka and then at the University of Ghana where my dad was the Director of the United Nations Regional Institute for Population Studies. So this had a major impact in my life journey. Surrounded by academicians and children of academicians, the emphasis was on academic excellence and hard work. This expectation has been the major guide as I navigated my life and career. In Ghana I also learnt the importance of tolerance and respect of all people. Since my father was working in the UN, I was fortunate to meet and interact with his colleagues’ children who were from different parts of the world and learned quickly that we are all the same and want the best for each other. The love shown me by my friends in Ghana helped mould me into who I am today.
Tell us a bit about your career journey?
My career has been very interesting. After graduating from the University of Nigeria Nsukka as a physician at the age of 22, I proceeded to the United States to study Public Health at Johns Hopkins. (My classmates remind me that I always wanted to be a public health physician working for the WHO.) I then spent a few years in Public Health first as a Research Assistant at Johns Hopkins and then at the Department of Health and Mental Hygiene rising to the position of Director of Clinical Methods for the Center for Health Program Development and Management. In that position, I was a key player in getting the High Cost User Initiative developed to target and identify high cost patients in the states Medicaid programme and develop an initiative targeting these patients to help reduce cost.
I then left public health to begin a residency at the George Washington University Hospital in Family Practice and completed a Fellowship in Geriatrics at the same hospital. After my residency and fellowship and with young children in tow, I decided to choose a job that combined both public health and clinical medicine and went to work for Mercy Hospital in Baltimore as the Medical Director of Healthcare for the Homeless in Baltimore City. After that, I pivoted into private practice and worked as a solo practitioner for 16 years and more recently with the disruption in the health space merged my practice with others to become a multispecialty practice to deliver care to patients in the DMV (Washington DC, Maryland and Virginia) area.
You come from a family of global achievers, did that put a bit of pressure on you in any way?
My parents taught my siblings and I to focus on ourselves and our talents and socialised us to celebrate one another’s achievement. My extended family has always had a high expectation for everyone so it came naturally to want to excel and do the best you can especially in service to others.
You recently opened your medical practice, what does this mean to you and for black women there?
It feels awesome. For many years working in the primary space which is very fractured, I have yearned for a more holistic and comprehensive approach to achieving better health outcomes by taking a team-based approach to care like we had at Health Care for the Homeless, caring for a very vulnerable population. So it feels wonderful to be able to finally implement this model of care with a very experienced and talented group of physicians many of whom are women.
What would your practice seek to do differently and what can patients expect from you?
Summit Medical is what we call a patient-centered medical home model. Our patients should expect us to use evidencebased medicine and a multiciliary team approach to address their health issues. Working with other partners in the community we will also focus on other social determinants of health that impact health and address this for our patients. Bridging the inequities in the health space is very dear to us as physicians of color and women in particular.
What would you say has been the most challenging moment of your career till date
The business of medicine has been the most challenging part of my career. As a physician you are trained to provide and care for patients and most physicians are good at this. But there is very little training given on how the business of medicine billing, coding, etc. And so many physicians like myself rely and contract/outsource these aspects to billing companies to provide expertise and bill for the services we provide. The problem comes when the company/companies provide you with a code which is not appropriate and then that code is used to bill for services on your behalf. This is what happened to me and to many other physicians. We outsourced our billing to companies that provided us with wrong codes for payment. As a result we were very shocked to discover that although the services were provided the codes were wrong. There is a class action lawsuit in my state Maryland by physicians who are in a similar position. Unfortunately, I and many other physicians have learnt that it is the physician or practice that gets blamed when the billing companies don’t do what is expected of them. In my own case, I decided to resolve the case without admitting any liability and we are pursuing legal action against the marketing company, the billing company and manufacturer of the device. Most physicians that go through a traumatic experience like mine will just give up. It’s highly unfair when you know you’ve done nothing wrong. It is very important to pursue legal action against the entities that wronged you. So that’s what I am doing. A lesson learnt. In life what doesn’t kill you makes you stronger. I am now a better “business physician” and have decided to improve my business knowledge by obtaining an MBA at Cornell University. I hope to use my knowledge to guide other physicians in the health space and improve the business of medicine.
As someone with experience both home and abroad, what would you say are some major differences between practicing medicine here and over there?
A big gap exists in terms of resources (medical personnel) and tools needed to manage and properly care for patients in Nigeria. You have to really admire the ingenuity of physicians in Nigeria who despite the limited resources and the practice environment have figured out a way to continue to provide the best possible care to their patients. Patients in Nigeria are very dependent on their physicians and leave all decision making to the doctors whereas in the US, patients feel more empowered and its more of a collaboration. Most patients pay out of pocket for all their care whereas in the US employers, government and patients pay for different portions of care.
As a black woman doctor, have you faced any form of profiling or discrimination?
Yes, definitely and still continue to. Its subtle in some situations and in others, totally blatant. I am not unique and other female physicians of colour have and continue to experience racism. But nothing succeeds like success so I have learnt to live with it and not let it bother me. It motivates me to do the best I can to create the best possible life for my people and myself.
How would you rate Nigeria’s health sector, is it living up to full potential?
The health sector in Nigeria is definitely below average. Nigeria has a long way to go to ensure equitable and good care is provided for all Nigerians. A healthy society can help propel technological advances and improve all sectors of the economy. This has become more evident with Covid 19.
Many doctors and other healthcare professionals are leaving Nigeria in droves; why does this trend persist?
Physicians invest a lot of years and effort to train to become doctors and deserve a living and comfortable wage to support their families and themselves. As Nigerians we are go-getters and optimists so if the wage gap is not bridged for this sector of the economy and an enabling environment provided for doctors to flourish, they will continue to leave to seek work in other countries who value their expertise.
A lot of people see medicine as a calling, is that how it feels for you?
Definitely. I love my job, really love my patients and my colleagues. You cannot imagine the sacrifices physicians face every day to do their work and save lives. Covid 19 has really underscored the importance of Medicine and physicians. My love for my profession led me to encourage my son to also go into medicine. Today he is finishing up his residency in the same hospital, George Washington University where I trained and will be beginning a fellowship in Gastroenterology.
If you weren’t a doctor, what else would you have been?
An architect. I love building and art and would have moved into that space.
In what ways can we improve Nigeria’s healthcare and access to it?
Nigeria’ s healthcare system needs special attention and an over haul. The infant and maternal mortality rate in Nigeria remains very high. We should focus on providing better training to health ex tenders especially in rural areas of the country and basic primary care services for all Nigerians. This will help improve the health status of many Nigerians. We should also improve the supply chain for pharmaceuticals and also improve the practice environment by developing and providing basic infrastructure. This will enable the use of te le medicine to help provide expertise in areas where we lackmanpower.
Living the busy life you do, how do you strike a perfect work-life balance?
There is no perfect work-life balance. I just try to ensure that I do the best I can as a mom and wife. Having a supportive spouse or partner is really important and family support is also key. My husband provides the backbone from where I have been able to pivot. He encourages me to excel at my work.