‘A woman has to put in twice as much ef­fort as a man’

Dr. Halee Fis­cher-Wright has been a chief med­i­cal of­fi­cer at a large health sys­tem, owned her own med­i­cal prac­tice and worked as a con­sul­tant. Now, as CEO of the Med­i­cal Group Man­age­ment As­so­ci­a­tion, she leads the na­tion’s largest as­so­ci­a­tion for med­i­cal

Modern Healthcare - - Q & A -

Mod­ern Health­care: Are things bet­ter or worse or both for women in health­care now as op­posed to when you first were start­ing out?

Dr. Halee Fis­cher-Wright: Def­i­nitely bet­ter, but not where we want it to be, and I think we would al­most uni­ver­sally all agree with that. I started in health­care over 20 years ago as a gen­eral pe­di­a­tri­cian. Women were nurses and men were physi­cians, so I was prob­a­bly the sec­ond gen­er­a­tion, but my med­i­cal school class was 50/50. That gen­er­a­tional dif­fer­en­tial had taken root, but it hadn’t played out as far as prac­tice goes. If you looked at the per­cent­ages that were out in prac­tice, it was still male over fe­male. That led to a lot of chal­lenges in re­gards to nav­i­gat­ing com­mit­tees in the hos­pi­tal. I re­mem­ber go­ing to my first com­mit­tee meet­ings dur­ing my res­i­dency and them say­ing, “Well, you know, we need to wait un­til the doc­tor is here to start the meet­ing.” “I am the doc­tor,” I said. “Oh, sorry.”

You kind of ex­pected that, but what you don’t know when that hap­pens is how it erodes at your au­thor­ity and it makes it hard for you to be ef­fec­tive in your role. You don’t rec­og­nize from a cul­tural per­spec­tive how much ex­tra ef­fort you have to put in to get things ac­com­plished; a woman has to put in twice as much ef­fort as a man. There were def­i­nitely times when I was thought­ful and in­ten­tional of how I can work so hard so they don’t see me as a woman but they see me as a col­league, and that is a sense of be­ing in­ten­tional that I’ve al­ways had. It’s never been an as­set to be a woman in ex­ec­u­tive ranks. Some­times it’s not been a detri­ment, but it’s never been an as­set.

I was in a salary ne­go­ti­a­tion for a very high-level po­si­tion prior to this one. I had the mar­ket data—MGMA mar­ket data, may I add—on what that po­si­tion should pay. They of­fered me 30% less than 50th per­centile, and I said, “I know it; I did my home­work.” They said, “Well, your hus­band is a physi­cian, so you’re not the pri­mary bread­win­ner.” I was told this at a job in­ter­view. And I re­sponded, “If that’s your logic be­hind it, I prob­a­bly shouldn’t take the job. This is not go­ing to work out well for ei­ther one of us.”

As I’ve got­ten fur­ther in my ca­reer, and as women have got­ten into those roles, they’re con­scious about it, and they drive or­ga­ni­za­tions and they set be­hav­iors and they role-model the kind of be­hav­ior that we should see. That’s why I view my role as re­ally a role model not just for women but also from a di­ver­sity stand­point. All of our or­ga­ni­za­tions will thrive and do bet­ter with a di­verse em­ployee tal­ent base.

MH: So, look­ing more broadly at the or­ga­ni­za­tional cul­ture, what shifts do you see hap­pen­ing now, whether it’s with con­sumers or providers?

Fis­cher-Wright: Health­care is lag­ging be­hind, and we have such great role mod­els in other in­dus­tries on how to do things bet­ter that we have not nec­es­sar­ily availed our­selves. We all em­braced the Six Sigma method­ol­ogy. We were

“It’s never been an as­set to be a woman in ex­ec­u­tive ranks. Some­times it’s not been a detri­ment, but it’s never been an as­set.”

“There’s a model around women’s health that we saw in Port­land, Ore., where they did some­thing re­ally amaz­ingly rev­o­lu­tion­ary: They asked their pa­tients what they wanted, and they built a prac­tice around that.”

all on board with that, and that went re­ally well. That was process im­prove­ment. But as far as or­ga­ni­za­tional trans­for­ma­tion, we haven’t seen a lot of that in health­care.

You brought up con­sumerism. There’s an in­ter­sec­tion of things go­ing on. We have to de­crease costs; we need to in­crease ser­vice, and those things are ab­so­lutely in con­flict.

I tend to look at Sil­i­con Val­ley for in­no­va­tors be­cause they specif­i­cally look for dis­rup­tive in­no­va­tion. That’s what we need in health­care. We’ve been fo­cused on in­cre­men­tal im­prove­ments for the past 20 years. In­cre­men­tal im­prove­ments are not go­ing to get us to where we need to be. We need ac­tual in­no­va­tion. Get out of the mind­set of Six Sigma. I think we’ve Six Sigma’ d to the point where we just don’t even know where to go any longer. Where is the lead­er­ship? You can look at other in­dus­tries, the tech in­dus­try, for ex­am­ple, where their mind­set is what can we do to dis­rupt our­selves.

MH: What role do you think tech­nol­ogy will play in health­care?

Fis­cher-Wright: Tech­nol­ogy has, and will con­tinue to have, a pro­found in­flu­ence in health­care. I think we see peo­ple in Sil­i­con Val­ley ad­vo­cat­ing for the day where we don’t have doc­tor vis­its. I don’t think that’s what pa­tients want. If you ask five pa­tients what’s the most im­por­tant part of health­care, 4 out of 5 will say it’s their ac­tual re­la­tion­ship with their physi­cians; 1 out of 5 will say it’s the knowl­edge. Peo­ple re­ally need that con­nec­tion to a hu­man be­ing. The role of tech­nol­ogy is not to erad­i­cate the hu­man con­nec­tion but to find ways to make that hu­man con­nec­tion stronger, bet­ter, and to fo­cus on well­ness as op­posed to sick care. We’ve not used tech­nol­ogy in that way. By and large, we’ve used tech­nol­ogy for billing pur­poses, for data col­lec­tion. We’ve never re­ally looked crit­i­cally at tech­nol­ogy as a method­ol­ogy to make what we do more ef­fec­tive.

MH: Within physi­cian prac­tices, what mod­els of care do you find par­tic­u­larly promis­ing?

Fis­cher-Wright: I’m writ­ing a book called Back to Bal­ance right now—it will be out on Sept. 12—and we found lots of ex­am­ples of prac­tices get­ting it right, dif­fer­ent sizes, dif­fer­ent places across the coun­try.

Iora Health is a very atyp­i­cal model. It’s backed by ven­ture cap­i­tal, and they do not ac­cept tra­di­tional pay­ment. They ba­si­cally work with in­sur­ers or with Medi­care to do per-mem­ber-per-month fees, and they de­liver com­pre­hen­sive care around that. They’re us­ing in­ter­nal clin­i­cal met­rics like high blood pres­sure, hy­per­ten­sion, hos­pi­tal ad­mis­sions, di­a­betes care and look­ing at a long-term per­spec­tive of, if we keep this pa­tient en­gaged for many years, how do we see those health pa­ram­e­ters change? And they are also re­ally tack­ling the so­cial de­ter­mi­nants of health.

There’s a model around women’s health that we saw in Port­land, Ore., where they did some­thing amaz­ingly rev­o­lu­tion­ary: They asked their pa­tients what they wanted, and they built a prac­tice around that. And they have ac­tu­ally—it’s kind of funny—been around for 20 years. What’s re­ally rev­o­lu­tion­ary about it is ev­ery time they hit a ma­jor stum­bling block or had a ques­tion, they’d dis­cuss it, and it is a big prac­tice—100, maybe 200 doc­tors. Then some­one would say, “Wait, maybe we should go back to the pa­tients.”

MH: You men­tioned so­cial de­ter­mi­nants of health. How do you think the in­dus­try needs to adapt to al­low for ac­tu­ally tend­ing to those things?

Fis­cher-Wright: The shift from fee-for-ser­vice to value-based care will make that ba­si­cally manda­tory, be­cause as the health in­dus­try gets held re­spon­si­ble for out­comes, we know how pro­foundly those so­cial de­ter­mi­nants of health re­ally af­fect our out­comes. And so we’ll have to mean­ing­fully en­gage in those so­cial de­ter­mi­nants be­cause there are not sus­tain­able mod­els with­out ad­dress­ing those is­sues.

MH: Draw­ing on both your clin­i­cal ex­pe­ri­ence and your ad­min­is­tra­tive or­ga­ni­za­tional ex­pe­ri­ence, what do you think those two sides can learn from each other?

Fis­cher-Wright: I’m so glad you asked. One of the things I al­ways talk about is that we speak dif­fer­ent lan­guages, and so I al­ways ask the ques­tion, “Do you speak art or do you speak busi­ness?”

Health­care has to be in bal­ance. The art, sci­ence and busi­ness need to work to­gether. You can­not have one out­side of the other. We have seen in the past 10 years where the art of medicine is kind of start­ing to phase out to ev­ery­one’s dis­sat­is­fac­tion. Ev­ery­body is dis­sat­is­fied. The in­sur­ers are dis­sat­is­fied with the re­sults they’re see­ing. The pa­tients are dis­sat­is­fied. The providers are dis­sat­is­fied. But you can’t just get rid of busi­ness ei­ther be­cause it’s a $3.4 tril­lion econ­omy. If you take out health­care, the U.S. is the fifth-largest econ­omy in the world; it’s a chunk of change.

The ques­tion be­comes: How can we com­mu­ni­cate be­tween those two pa­ram­e­ters to re­ally drive the kinds of out­comes that we are look­ing for? Health­care ex­ec­u­tives can serve as trans­la­tors. I think providers, if they re­ally un­der­stand that things have to be in bal­ance, can also learn how to trans­late that, and then it be­comes col­lab­o­ra­tive as op­posed to ad­ver­sar­ial. I do think right now health­care is set up, al­most un­in­ten­tion­ally, to be ad­ver­sar­ial.

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