Q&A: ‘A Woman Has to Put in Twice as Much Effort as a Man’

By Rachel Z. Arndt for Modern Healthcare

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 practice administrators and executives. Fischer-Wright started her career as men still largely dominated clinical and leadership roles. Healthcare is doing better, she said, when it comes to closing the gender gap, but it’s not where it needs to be. She spoke with Modern Healthcare reporter Rachel Z. Arndt about the role of women in leadership and how medical practices can transform patient care. The following is an edited transcript.

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 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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