Six Women Physicians Driving Change and Improving Population Health

By Vicki Ritterband, Interim Vital Signs Editor

Jessie Gaeta, MD, remembers the moment she realized that she wanted to use her skills and experiences on a broader stage — to help not just the patient in front of her, but the countless patients she and her colleagues cared for every day at Boston Health Care for the Homeless Program (BHCHP).

“I remember thinking that I could write a prescription for insulin, but half the time the patient couldn’t take it the way it was intended because they didn’t have a home and they had nowhere to store it,” says Dr. Gaeta, chief medical officer at BHCHP. “I thought that I could bring about more change for my patients on a broader scale and that there was a place for doctors doing that. I understood the health consequence of policies on people’s lives in a different way, and this seemed to be missing from a lot of conversations.”

In honor of Women in Medicine Month, Vital Signs spoke to six women physicians who have driven institutional and state policy changes that promote healthier outcomes among Massachusetts residents. The common threads in their stories include an understanding of the respect the initials MD garner, a passion for addressing complex social problems, and a unique perspective on those problems.

After Dr. Gaeta’s epiphany, she applied for and won a Columbia University fellowship that paid for her to continue her clinical practice while working part-time with the Massachusetts Housing and Shelter Alliance (MHSA), a nonprofit advocacy organization addressing homelessness. That experience was a crash course in deciphering the complicated formula for effecting change — or as she puts it, “how to pull the right levers with the right stakeholders and policy makers.” Dr. Gaeta recalls an exercise in which she mapped out 72 steps to generating change through legislation. “Some of the skills I was learning are role-modeled for us as physicians; they’re part of the doctor-patient relationship,” she says. “Every day we try to influence change in our patients to improve health.” While working with the MHSA, Dr. Gaeta helped secure housing for 200 formerly homeless individuals.

Like Dr. Gaeta, Ruth Potee, MD, identified a systemic problem in her daily clinical practice and decided to act. In 2014, she had begun working as the medical director of the Franklin County House of Corrections in Greenfield, where 90 percent of the inmates had a substance use disorder (SUD). To successfully care for those patients, Dr. Potee, a family practice physician and addiction specialist, had to bring on board the non-clinicians overseeing the facility, who emphasized security over treatment.

“I did some slow cajoling, some ‘shouty’ emailing to top leadership, and lots of education, including a talk on the physiology of addiction that I’ve now given dozens of times to correctional officers, probation officers, and judges,” says Dr. Potee. “We did a professional recording of it to be used in any jail in Massachusetts. It also helped that the sheriff is progressive and public-health minded.” Today, the jail is considered a paragon of SUD treatment and recently became the first house of corrections in New England to be federally certified as a methadone clinic.

Monica Bharel, MD, commissioner of the Massachusetts Department of Public Health, felt early on that she had an obligation to advocate for patients who couldn’t advocate for themselves. During her stint as chief medical officer at BHCHP, caring for people living in extremely challenging conditions, she began to see a role for herself outside the clinic walls. “I wanted to ensure that public policy doesn’t have unintended consequences and inadvertently widen gaps in patient care,” she says. She’s taken her core belief — that health care is a right for everyone, not a privilege for some — to a statewide stage. “Leadership is not about the title you hold. If you have a voice, you need to use it to advocate for others.”

Gender Bias in the Workplace

Gender bias has often been an issue for these physicians. “Who of us doesn’t have lots of examples of sexism in the workplace over the course of our careers?” asks Dr. Gaeta. “How many meetings have I been at where I’m the only woman and no one looks at me. The conversation and eye contact happen only among the men. I try to insert myself and I’m talked over. How many times am I at a meeting and the male doctors are referred to as Dr. So-and-So and I’m referred to by my first name?”

Physicians report that these experiences magnify when gender and racial or ethnic biases intersect. Matilde Castiel, MD, Worcester commissioner of Health and Human Services, immigrated to the US from Cuba as a young girl. She still bumps up against assumptions that are made about her as a woman and a Latina. “It’s always been tough, from medical school days all the way through. You’re a representative of your community and all eyes are on you. You’re expected to be ‘better,’ and that’s a weight you carry.”

Dr. Gaeta has had some success raising these issues with colleagues after they occur. “You have to do it in a way that won’t make the person defensive and stop listening,” she says. Several female mentors, who came of age professionally when gender biases were more deeply entrenched, have been invaluable sounding boards for her — but Dr. Gaeta acknowledges that professional power dynamics can be a barrier to consistently challenging discriminatory behaviors.

Occasionally, a gender stereotype may seem benign. Barbara Spivak, MD, president and chair of the board of the Mount Auburn Independent Practice Association since 1997, recalls early efforts to improve health care quality while containing costs. “Many physicians were angry at being told how to practice medicine. But when a youngish female doc goes in to talk with them and she’s calm and unflappable, it helps defuse the situation.” (Research suggests that positive stereotypes come at a cost and may amplify negative associations.)

Advice to Aspiring Women Leaders

Roseanna Means, MD, the chief medical officer of Health Care Without Walls, has spent her career caring for homeless women. While advocating for social change, she has always kept one foot planted firmly in traditional medical institutions, including the MMS. At Brigham and Women’s Hospital, she is a senior faculty member. At Harvard Medical School (HMS), she is an associate professor. “I have tried to leverage my positions at the Brigham and HMS to promote social justice and they’re catching on,” she says. “HMS now has a social justice community elective; students immerse themselves for a month in these issues.”

Credibility also comes through maintaining a clinical practice, even if it’s a limited one, says Dr. Spivak, an advocate for health care reform. “When I’m asking doctors to do something around the EHR or quality improvement, they all know that I’m living with those same guidelines. People know that I make decisions, particularly financial ones, based on what is good for the system and organization, not me personally.” Commissioner Castiel continues to treat patients one day a week at the Hector Reyes House, a residential substance use treatment program that she was instrumental in creating.

Commissioner Bharel recommends seeking out mentors and advisors, inside and outside medicine, throughout one’s career. Most importantly, she says, be guided by your values, not by prestige. “Know your own priorities and make sure that you take a position because it aligns with your vision and values. Use your voice to advocate for issues that you’re passionate about.”