LINDA HARDER | PHOTOGRAPHY TRACEY BROWN
Four amazing women. Four different career paths. Their stories underscore the fact that the state has more than its share of outstanding leaders who just happen to be women.
At age 74, Catherine DeAngelis, M.D., MPH, University Distinguished Service Professor, Emerita, professor of Pediatrics, Emerita at Johns Hopkins University School of Medicine and professor of Health Policy and Management at Johns Hopkins University School of Public Health, has hardly slowed down. This year, in addition to teaching nationally and internationally, she is writing her memoir, which she jokingly calls “JAMA Mama” in a reference to her tenure as the first female editor of the Journal of the American Medical Association (JAMA).
The daughter of two Italian Americans who didn’t get past the eighth grade, Dr. DeAngelis knew she wanted to be a doctor since she was four years old. “By the time I was nine, I thought I was going to be a medical missionary. But at age 20, my father said he’d never sign for me to become a nun, and my high school advisors told me I had to be a nurse before I could be a doctor, so I pursued nursing.”
Thanks to a series of scholarships and a chemistry teacher who helped her get accepted to Wilkes College, Dr. DeAngelis was able to go to medical school. Ironically, Hopkins initially rejected her for medical school. “When I was a child, I thought I couldn’t be a doctor anywhere except Hopkins. Later, I knew I would not be accepted there, but I applied anyway. They sent me a ‘sorry, hon’ letter that I wish I had kept!”
As one of only seven women in a medical school class of 112 at the University of Pittsburgh, Dr. DeAngelis later was accepted at Hopkins for her residency – where she was the sole female.
From Transplants to Pediatrics
Dr. DeAngelis initially planned to pursue a transplant surgery residency at Pittsburgh. “But an incident in my second year, while working at a free clinic on Greenmount Avenue a few days a week, convinced me that, for every surgical procedure, there were thousands of patients who could benefit from primary care. A sick child was brought to the clinic burning with fever from pneumonia. I took him to Hopkins’ ER, where he received a shot of penicillin, and by the next morning, he was tearing up the place. They came to the clinic because an ER sign required a dollar to sign in, and they didn’t have it. I took that sign down.”
Ever a trailblazer, Dr. DeAngelis became a Hopkins professor in 1985 – only the 12th female professor in nearly 100 years, and one of even fewer women who weren’t basic scientists. “I worked to get women promoted and to improve their salaries,” she recollects. “During my tenure as vice dean from 1990 to 2000, 67% of all Hopkins women professors were promoted to be a professor, and today, more than 160 of us are full professors.”
She reflects, “I’ve never chosen a profession based on what it would pay. People told me I was throwing my career away to turn to general pediatrics. But my advice for everyone is to follow your heart. If you choose a specialty based on how much the salary is, you probably won’t be happy.”
Early on, Dr. DeAngelis was an advocate for nurses and nurse practitioners. She states, “Lots of medical care can be handled by a nurse practitioner. It takes a team to care for a patient. The right nurse practitioner can augment a physician’s practice hugely. Only about one-quarter of patients who come for health maintenance need a physician’s input, so they can augment care.
The Four T’s of Leadership
To be a leader, Dr. DeAngelis advises people that they need the “Four T’s” – being tough-minded (but not tough), tenacious, tenderhearted and thick-skinned.” In more than a decade as the editor-in-chief of JAMA, she certainly needed those characteristics to fight pharmaceutical companies and to ensure JAMA’s scientific integrity. She was the first to require that an independent academic statistician review industry-sponsored clinical trials before the article could be accepted, and she more than doubled the journal’s impact factor.
Claiming that she’s dyslexic and is therefore really only 47, “Dr. De” has a lot of life left to live, and many more people to help through medicine.
Overhauling the Medicare Waiver
Minnesota is a long way from Maryland, but after Carmela Coyle, now president and CEO of the Maryland Hospital Association (MHA), finished her undergraduate degree at Carleton College, she was determine to move east. It took persistent pestering to get an internship with the Congressional Budget Office, but once she did, her long career as a policymaker was launched. “I fell in love with healthcare issues,” she says, “and the American Hospital Association (AHA) had the best reputation on Capitol Hill.”
After spending 20 years in increasingly responsible positions with the AHA, including working under CEO Dick Davidson, who had been MHA’s first president, Coyle decided to throw her hat into the ring when Cal Pierson announced his retirement as MHA’s second CEO. “I knew that the MHA position would allow me to stretch myself, especially since it was clear the Medicare waiver would have to be revised,” she recalls.
MHA: Tackling Multiple Challenges
Shortly after Coyle took the helm at MHA in 2008, the stock market collapsed. “We needed to focus on our core mission of policy development and advocacy, so we downsized and sold two for-profit companies,” she comments.
She also tackled the long-simmering debate over the False Claims Act. Working with Lt. Governor Anthony Brown, Health Services Cost Review Commission Director John Colmers (see Maryland Physician March/April 2014) and others, she helped craft a compromise that lessened the financial risk for hospitals and physicians when they made an honest mistake in filing claims.
Another challenge Coyle faced was the nursing shortage. “We learned that one of the major issues was student retention. In 2009, we raised $17 million to support training programs for nurses, much of which was focused on addressing retention issues – many nursing students dropped out before completing their training. Even when the recession made it look like we had fixed the nursing shortage, we realized there was still a structural deficit we had to tackle as baby boomers neared retirement.”
When Coyle was appointed CEO, only one woman sat on MHA’s board of trustees, and men dominated the leadership team. Today, seven of the 24 board members are women, and the leadership team consists of more women than men. “It’s important to have a balance, because women think and work differently than men,” she says. “The waiver required open mindedness and good listening skills, at which women typically excel.” Coyle also purposely increased minority representation in the MHA board.
At the Top of the Roller Coaster
Clearly, Coyle’s greatest challenge was in helping to structure and implement the new Medicare waiver. “We enjoyed 40 years under the old waiver, but as we moved more patients to outpatient observation, the old rules made it look like we were failing,” she says.
“In the future, we won’t be as focused on the four walls of the acute care hospital,” Coyle continues. “I’m pleased we could come to an agreement about the new waiver, but the first step was really just to put a policy framework in place. Now, we have to work on how we get there. Hospitals have to rethink how they serve the community, and we have to help them build new skill sets to manage care and pull out unnecessary services. We have to focus on prevention in more than a token way, and we can no longer wave goodbye at the door. And after discharge, we have to create clear pathways that require nurses and care managers to practice at the top of their license.”
Coyle likens the journey ahead to being at the top of a roller coaster – with excitement that is combined with a fear of the unknown.
A personal challenge that Coyle faced in 2011 has contributed to her compassion for patients today. “Both my husband and I were diagnosed with cancer 10 days apart. We underwent surgery, chemotherapy and radiation at the same time. Stories of others who came through to the other side were very helpful to us. It was a transformative experience that reminded me why we healthcare providers are here.”
A Progressive Solo Practitioner
No one can accuse Holly Dahlman, M.D., founder of Green Spring Internal Medicine, of not persevering through hardship. Born with a number of congenital birth anomalies, Dr. Dahlman underwent more than 30 reconstructive surgeries in her youth. She recalls an early experience with her Chicago pediatrician, “When he asked me what I wanted to be when I grew up, I told him, ‘A doctor!’ Soon, I knew that was the right answer. This was one of my earliest memories. Medicine has been a lot of sacrifice, but I believe it is worth it for those who are called to it.”
Making up a large percentage of the primary care field, women doctors are underpaid relative to their male counterparts, even up to the level of department chairperson, research shows. “Women physicians should have ‘equal pay for equal work,’ but payment inequities are still a major problem,” notes Dr. Dahlman.
She believes that medical schools’ historic Socratic method of teaching, where questions are fired at students, favored male students. Today, that is changing. “I was at the top of my class at Mt. Holyoke, but at Johns Hopkins I was happy to graduate in the middle of my class. Most of my colleagues were heavy on the scientific end of the temperament scale, whereas I was more on the creative/intuitive end, but when I found primary care, I knew it was a good fit for me.”
Her first job was with a group practice of seven primary care physicians. “I was young and inexperienced,” Dr. Dahlman recalls. “When you start out in medical school, you don’t know what you’re getting into as far as the business of medicine. I struggled in the early years at the practice. When half of the practice converted to concierge medicine, I had a huge ethical conflict. Fortunately, I was able to depart without controversy since the concierge doctors had downsized their panels and were not upset that I was leaving with my own patients. I decided that starting my own practice would be the best way for me to implement electronic medical records and practice according to my values.”
Dr. Dahlman notes, “While it’s a huge amount of work, today I am able to set my own schedule. In a group, the office manager called many of the shots – here I call all of them. I don’t always love supervising people, but if I hire the right staff, then it works out.”
As if her early experience with repeated surgeries wasn’t enough for one person to bear, in 2009 Dr. Dahlman underwent chemo, radiation and surgery for breast cancer, and then tore her ACL at the end of the year. Because of the electronic medical record, she was able to get through these hardships as a solo practitioner.
Dr. Dahlman is one of the pioneers of electronic medical record implementation in our area and one of the first to adopt the Patient Centered Medical Home (PCMH) model. She opened her practice in 2006 with an EMR, and was invited to participate in the state pilot PCMH program despite being a solo practitioner. Perhaps even more impressive is that her practice achieved Level III NCQA certification in the first year. “In 2011, we pushed ourselves to achieve Level III and also to attest to Meaningful Use,” she proudly states.
“PCMH is a model in progress,” Dr. Dahlman continues. “It’s a lot of work, but it changes the nature of work for the entire practice. Everyone is working at the top of his or her license. Today, the care manager gets the hospital on the phone, which used to be on my shoulders. I’ve become the leader of the team, which is very satisfying for me as a physician. I’m doing more creative work, focusing more on sick patients and spending more time with them.”
She adds, “Primary care physicians are on the front lines. We’re the monitors for the healthcare system. We can provide key pieces of information that affect patient care when they are admitted.”
Dr. Dahlman advises other female physicians to have a business mentor and consult an attorney when negotiating contracts with a group or hospital. “Join a practice whose vision and values you share. Interview your employer at the same time that they interview you. Ask how you’ll be compensated and what standards will be used to evaluate your performance. Take care of your own health by following the advice you would give to your patients.”
Sheri Rowen, M.D., director of the Eye and Cosmetic Surgery Center at Mercy Medical Center and owner, Baltimore LASIK, Cataract and Cosmetic Center, didn’t take a direct path to becoming a physician. She originally hated science and wanted to be a psychologist, but then fell in love with zoology and science in her first year at the University of Maryland College Park. “At first, I thought of becoming a nurse, because I never thought I could be a physician – my brother was slated to be the brilliant doctor in the family,” she recalls.
At College Park, though, “A male friend told me that I had the capability to become a doctor. I still wasn’t convinced, but a week before I had planned to start a PhD program in psychology, I realized I wanted to achieve my own dream, and went for it.”
Dr. Rowen worked for four years at the pediatric oncology department at National Institutes of Health (NIH). “It was so meaningful to take care of people, and I knew I wanted to be of service. I originally thought I would be a pediatrician, as many women did, but later found the challenges of correcting vision and restoring eyesight to be amazingly interesting and rewarding.”
Few Women on the Lecture Circuit
Like Dr. DeAngelis, Dr. Rowen had a limited number of female colleagues in her medical school class and at first, as a young female ophthalmologist on the national lecture circuit, she was one of only two women in the country on the podium. Today, she remains nationally renowned as an educator of her peers.
“We’re looking to create programs for mentoring women. We want to help take the next generation of women ophthalmologists and pave the way for them through meetings and mentoring relationships. Ophthalmology has been a man’s world, and now that the percent of women in the field is increasing, it’s time for more women to come to the forefront.”
Dr. Rowen also is the rare woman ophthalmologist to set up a laser vision correction and aesthetic business, which she opened in a mall store in 2000. “LASIK has been a tough road,” she acknowledges. “Even before 2008, the market started to change. People became fearful after 9/11, and to this day, many are fearful that LASIK might negatively affect their vision, even though the equipment and techniques continue to significantly improve. I inform them that all-laser LASIK is really safe.”
In 2000, she incorporated skin care and aesthetics into her practice, giving her additional experience with the self-pay side of medicine. That entrepreneurial spirit is less typical of today’s medical residents. “Most primary care doctors coming out of training today want to be employed,” she exclaims. They want a work/life balance, which I understand, but the entrepreneurial spirit is being lost. The hospital can’t make the practice for you – you still have to go out and build it.”
Dr. Rowen is also known for introducing innovative cataract procedures, and in early 2014, she became one of only a few ophthalmologists to perform laser cataract surgery, which uses a 3-D imaging system to map the cornea and customize treatment. The device allows the surgeon to create precise cuts in the cornea, to enter the eye and also to correct astigmatism. “It’s the biggest technology breakthrough in cataract surgery in years. The laser softens the lens, so you use less energy and it’s safer for the cornea.”
Dr. Rowen had family support to help her care for their two now-grown children. She says, “You can’t raise a family and be a physician without support. Women have a lot of other responsibilities, and you need help. Those of us who went through what we did became stronger. Female ophthalmologists today are grateful that we paved the way.”
What does Dr. Rowen advise for becoming an entrepreneur and bucking the employment trend? “Determine what would make you happy. If you really want to make your own rules, go for it. Perhaps first work with a small practice, then work to become a partner or owner. Don’t be afraid of hard work – it will be a very rewarding career in the end.”
Catherine DeAngelis, M.D., MPH, University Distinguished Service Professor, Emerita, professor of Pediatrics, Emerita at Johns Hopkins University School of Medicine and professor of Health Policy and Management at Johns Hopkins University School of Public Health
Carmela Coyle, president and CEO, Maryland Hospital Association
Holly Dahlman, M.D., internist and founder, Green Spring Internal Medicine
Sheri Rowen, M.D., director of the Eye and Cosmetic Surgery Center at Mercy Medical Center, owner, Baltimore LASIK, Cataract and Cosmetic Center, and clinical assistant professor, University of Maryland