The Beyond the Practice Interview Series has been created to give you an insight and advantage into the profesional side of anesthesia through interviews conducted with leaders in the industry. Dr Peterson has been the Chief of Staff of the ICU, the Medical Director and then CEO of a health care plan and is now the COO of a Health System. Her story of leadership spans decades and exemplifies the potential we as anesthesia providers have to offer in healthcare.
BagMask: What were the series of events that took you from a staff anesthesiologist to different leadership roles and eventually to the position you hold now as Executive Vice President and COO of Driscoll Health System?
Dr. Peterson: My career started as one of two pediatric anesthesiologists at Driscoll Children’s back in 1984. It was a great opportunity to build a program and in my naiveté I didn’t realize the time commitments. My husband, who is an interventional cardiologist, and I had just moved here with a newborn baby. Between the two of us we were on every other night call the first five years. So it was definitely a challenge but eventually we started to build up that anesthesia program as the hospital grew.
At one point, I became very involved in a congenital heart disease program and, working with surgeons, we had a lot of breakthroughs as far as providing better operative procedures for children born with the disease. In addition, because I am boarded in critical care and anesthesia I was also working in the ICU. Then one day the CEO asked me to manage the ICU as well because, at this point, it was a pretty dysfunctional unit. So I said “Ok” and would end up doing that for 12 years.
Eventually during that time period another CEO came in and I was going through a burnout period. We had three kids by then and I was still logging about 80 hours a week and couldn’t find a compromise with my group to work less hours because of a staffing shortage. So I went to the CEO and said that I’d found a job down the street where I could do day surgery.
He replied “I can’t lose you. You’ve been Chief of Staff, you established the program, you’ve done XYZ, it would be very bad if you were to leave.” And he basically asked, “What do you want?” We ended up negotiating a better schedule and in the process asked me to be the Medical Director for a new health plan program. So I took on the “full-time medical director job” and did the other 20 or 30 hours a week practicing as a physician. When I started in the health plan, I think we had a staff of 10 and about 10,000 CHIP (Children’s Health Insurance Program) lives. And now we have 177,000 CHIP lives, almost 500 employees, and increased revenues from about $10 million to roughly $670 million now.
About two years or three years ago I was still practicing part-time and the CEO said, “You’re much more valuable to me over here and there are plenty of people you can rely on to cover the clinical work.” I had reached that point in my career that I said, “Okay”. Just recently, the CEO left and there was a job search. I actually applied for the CEO position, but it ended up being a shared model and I am now the System Chief Operating Officer. Now I am in charge of the health plan, the clinics, and the hospital on the system side. On top of all that, I’m honored to be the president-elect for ASA.
Oh, one other thing. I did get my Masters in Healthcare Administration in, I think, 1997. I was pregnant with my third, Chief of Staff and working full-time so that was kind of an in-between step there too that helped me on my journey.
BagMask: My goodness, they should have cloned you at some point in time, that’s very busy. So, out of curiosity, when you accepted that first medical director role, was it an open job search you applied for or did they come to you?
Dr. Peterson: Well, this is in the ‘90s during the age of Hillary care where there was all this consolidation and people looking at different models of care. And that was when the CHIP enabling legislation came out. They decided to start the health plan but there was some tension between the PCP and the pediatric specialists. Everybody was supportive of a health plan, and to make it work, we compromised by having the pediatricians choose a representative and the medical staff did the same to represent all of the specialty and hospital care.
The medical staff chose me as the representative because they said, we trust her to do this work in utilization management and working in this health plan. And actually, a good friend of mine Dr. Buck, was chosen on the pediatrician side. He started as the Medical Director and I was the Associate Medical Director and then we switched off. And then I eventually became the CEO of the health plan.
When the CEO first asked me to do this, I said, I’ve got so many things on my plate. I’m already doing two full-time jobs, you can’t ask me to do one more thing. Of course, he cajoled me into doing it and by saying yes to that, it then opened a position later on. And that was when they decided to hire a CEO for the health plan.
I was a part of the interview process for the health plan CEO. I finally got sort of frustrated with the process because I was afraid that the people we were interviewing were going to ruin all the great things we had accomplished. THey didn’t really have a good understanding of how an integrated delivery system should work.
I went back to the CEO of the health system and said, “I know you had me involved in the search process, but I’m actually going to put my name in the hat for this because I’m more qualified than any of the people that I’m interviewing.” And he said, “Oh, good idea. You will have to go through the whole process.” I said, “Of course.”
Well, then I didn’t get a phone call for a couple of months and I told my cohort, Dr. Pack, “Well, maybe they considered somebody else.” He said, “I don’t think so.”
And so I showed up in the parking lot one day at the hospital and saw the CEO and he said, “Oh, by the way, we’ve made this decision that you’re going to be the CEO of the health plan,. When can you start?”
BagMask: Wow, that’s amazing. So you said something earlier on that really stuck out in my head. You said that the medical staff trusted you to do that job. How did you build that trust?
Dr. Peterson: Well, I think it is what I tell my son, who is a resident in anesthesia, and I tell all those residents that come and ask for advice on careers. I think, number one, you have to be the best you are at your job and to really be respected as an anesthesiologist.
I worked really hard at my job. I was always available. I really made an effort to be an example of excellence in care and service. I think also, I tried to get along with everyone, but I think everybody knew I had a line in the sand. I would do anything to accommodate you, as long as it didn’t jeopardize patient care or safety. I’ll be here all night with you and we will keep figuring out what’s wrong with this patient in the ICU. And I think one should always try to stand up for good patient care, even if it’s not politically expedient for administrators or anybody else. I think the medical staff saw me as somebody that would always stands up for what was right and knew I would go to bat for them.
BagMask: And it’s tough to stand up sometimes. Especially, when you have somebody on the opposite side of the line that might hold a position of authority above you or sometimes they are just physically intimidating or emotionally more aggressive. How did you overcome some of those hard conversations you had to have with people?
Dr. Peterson: Well, I think I grew up in an era where basically, you’re going into a man’s world, it was different. When I first went to apply to medical school, they were just beginning to let women in. So you’re always a minority and it was that way with college, medical school and residency. I went to a school that had been pretty much all male before, Texas A&M. I was one of two women in a class of 100 in engineering, calculus, science, or whatever. And you just, I don’t know, you just work harder than anybody else. And I think it was hard at first, especially with some of the older surgeons. I would put up with some of their stuff because I thought they were actually good surgeons and eventually they saw that I was providing good care and we built a level of mutual respect.
Now, occasionally, you get into these toxic areas, you’ve probably been there. You’re in a difficult heart situation, the cardiac surgeon starts to lose it with the staff and I was always kind of trying to be the peacemaker. Basically, I just tell them they needed to settle down because screaming and yelling doesn’t help anybody work better or faster.
I had one situation where we had a new interventional cardiologist and baby in a cath lab. I saw the vital signs deteriorating, recognized the pattern and told him that we were dealing with a cardiac tamponade, but he didn’t listen to me. He wasn’t paying attention to my clinical assessment and, whether it was that he was new or I was a woman, for whatever reason he wasn’t listening. And I’m starting to resuscitate the baby and said, you need to put a pigtail catheter in and he still didn’t listen to me. And so I finally just turned to the cardiac cath lab staff and ordered them to get the cardiac surgeon and the whole OR team stat into the cath lab. I basically overruled him, we got the surgeon and he put the catheter in and they released the tamponade. By that point, we were already doing CPR.
I was pretty angry about the whole situation and talked to the Chief of Cardiology. So we held a meeting and I basically said, “I don’t know what your preconceived notions are, but I’ve done this for over 20 years. I’ve been in the trenches, headed up the congenital heart program, and I’m on your side and I’m here to help you and help our patients and you need to listen to me, if I tell you, there’s a problem.” And to his credit, he was very apologetic and contrite, and we had a very good relationship after that. So I think you have to confront it when you deal with biases or prejudices or people not working as a team, and try to bring them to a different place.
BagMask: So from some of those hard situations, you learned from those experiences and continued to advance professionally. What has been some of the unexpected benefits of leadership that just puts a smile on your face?
Dr. Peterson: My goal is to continue to improve patient care and health. And a lot of people ask, how could you go from being in the OR to being an administrator of a health plan? Well, I tell them that working in a children’s hospital for so many years, you see a lot of very sad things. You see children with cancer that die, you see children with congenital heart disease that die, you see a lot of really sad things. But the saddest thing to me of all are these children in the hospital with preventable diseases and illnesses. That to me is sad.
Why aren’t we doing a better job treating simple things like Caries? Why do we have thousands of children having to go to the OR and have general anesthesia for severe early childhood Caries when they’re two or three years old? So I took those experiences in the Children’s Hospital and in the OR and said, okay, these things are preventable. We’re going to figure out programs, policies, and incentives and work with our community and we’re going to fix it. We got the early childhood Caries operative intervention rate down. We also lowered the preterm birth rate from 15% to under 9%.
There’s still a lot more work to do. But to me, what makes me happy is knowing that you’re creating a healthier community. And my focus has always been on children because I think you get a lot more return on your investment so to speak. You get that whole life long potential in a child.
BagMask: It’s sound like something I have heard before. I can be an anesthesia provider in a room taking care of one or two, maybe three patients a day, but if I move up to a leadership role, I can take care of thousands every day.
Dr. Peterson: Yes, exactly. I have a job at the state level. I’m Chair of the Quality and Payment Advisory Committee for Health and Human Services and we just signed off on a report to the state legislature where our committee thinks we will need to go for Texas Medicaid. So just being involved in an advocacy role at a higher level, you can extend that even further than just your local community.
BagMask: That’s great. So I don’t want to hold you up too much longer. But I do have one question I love to ask at the end of all my interviews. What is your hope for all the job seekers out there right now?
Dr. Peterson: I hope you find a job that fulfills your dream of being an anesthesia provider and that you continue to follow your passions. I once gave a talk to the medical students at UTMB Galveston that had received scholarships. I said, “Please don’t pick a job or a part of medicine that’s just about the money. Try to pick something that fulfills your passion because it’s going to be hard work no matter where you go or what you do. But the work never seems as hard if it’s something you like doing. And always find the joy in your practice.”