Understand the Financials: Physician Leader’s Advice to Women Physicians

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Today’s interview is with Dr. Mary Dale Peterson who has been an inspiration to me ever since I heard her speak at the American Society of Anesthesiologists Annual Meeting a few years ago. She is one of those leaders who I saw who made me think: how did she get to where she is today? What has her leadership journey been like? I was lucky enough to have a chance to ask her about her journey recently.

 

Dr. Mary Dale Peterson, MD, MSHCA, is Emeritus Staff at Driscoll Children’s Hospital and Vice President of the Driscoll Children’s Health System and President and CEO of the Driscoll Health Plan.

She is the also the Treasurer for the ASA (American Society of Anesthesiologists)  and has held multiple leadership positions at the Texas Society of Anesthesiologists and at the Texas Medical Association.

 

Dr. Peterson, you have a very impressive resume with a long list of leadership positions you have held over the years. How did you start? Did you have a focused plan for leadership at the beginning of your medical career?

Not really.

When I joined Driscoll Children’s Hospital, I was the second pediatric anesthesiologist hired. We were actually faculty at UTMB Galveston but working at the Children’s Hospital 200 miles away. The pediatric anesthesia program was in its infancy at the time. For the first five years I took every other night call. After that, I knew I couldn’t sustain it and so I approached my Chairman to hire another physician. I was told that we were not generating enough income, although we had high case loads and we were working long hours, to hire another physician. So at that time, I offered to take over the billing and collections as well as negotiating the contracts. Income improved and we were able to hire a third partner. That was my start in understanding the financial aspects of running a medical practice.

Around 1992, the RBRVS system for reimbursement was being introduced. As a Children’s Hospital we had a lot of Medicaid patients – about 72%. Texas Medicaid was going to cut our rates by 25% in accordance with implementation of RBRVS payment methodology.. We were not going to be able to sustain ourselves with these cuts, so I approached the CEO of Driscoll Children’s Hospital and explained the need for subsidies if we were going to maintain pediatric anesthesia services. Of course, he wasn’t happy about it, but he understood and couldn’t afford to lose our services.

The next step was a few years down the line when the hospital CEO approached me to take charge of the Pediatric ICU because it was very dysfunctional. At that point I took the opportunity to take my Critical Care Medicine Boards and our group took over the ICU. That program is now flourishing and a recent offshoot has been a hospitalist program.

 

What other leadership positions have you held?

I have held a number of positions in a variety of areas.

At the institutional level, I have been involved in various leadership positions including Chief of Staff as well as serving on countless committees.  I am now a Vice President in our health care system and the CEO of the Driscoll Children’s Health Plan. I started as the Medical Director and eventually became the CEO.

At the organizational level, I got involved with the local medical societies. At the State level, I have served in various committees and I have chaired committees from the County Medical Society, to the Texas Medical Association and the Texas Society of Anesthesiologists.

I initially started attending the meetings of the TSA (Texas Society of Anesthesiologists). At one of the meetings I was offered the position of Delegate to the ASA. Then when the District Director retired, he recommended me for that position. From there I became the President of the TSA.

I also ran for Alternate Delegate to the AMA (American Medical Association) and won that contested race in the Texas Medical Association.

I have served on various committees at the ASA. I ran for the office of the ASA Board of Directors. When I was elected, I was the only woman on a Board of 50 people. Eventually when we got a couple more women on the Board, I took everybody out to dinner to celebrate!!

Now I am running for the office of the ASA Treasurer. If I win, I would be the second woman in that post. The first one was a long time ago! (Dr. Peterson did win that election in October 2015)

 

Going back to something you said earlier about taking over the billing for your company. Did you already have a financial background or was that something you learnt as you went along?

I mostly figured it out. I hired a new office manager. I learned from him. I went to meetings and asked a lot of questions. Then in 1997, I went back to school and got my degree in Masters in Health Care Administration from Trinity University. That was when I was pregnant with my third child and working long hours. That was a challenge!

 

 How did you balance your personal life with all these responsibilities in your professional life?

It wasn’t easy! There were times that I was pretty burned out. One such point was after I had been working for about 18 years. I had three kids and a husband who is a busy cardiologist. And I was still logging about 80 hours a week in the OR and ICU. We were very short staffed. At that point I seriously considered leaving the practice because I could not negotiate a reasonable work schedule. At around that time our hospital CEO was setting up a health plan and when he heard I was considering leaving, he offered me the job of the Medical Director of the health plan and to work the hours I wanted in the OR and ICU. That position eventually morphed into my becoming the CEO of the plan that has now grown into a $350 million business from about $10 million when I started..

We now have more revenue coming into the plan than the hospital. We have created an integrated delivery system looking at population health for all of South Texas, concentrating on pregnant women and children.

 

So obviously all these skills are not taught in a traditional residency program.  Did your two additional degrees help you with learning the business of medicine?

Yes, the degree in healthcare administration obviously helps. It gives you the credentials. You learn how to deal with massive hospital financial spreadsheets. I had to teach myself Excel but I figured it out. Like anything you learn it when you need it.

 

It does seem as if you kept reinventing yourself.

Yes, I’ve had three careers. First as a pediatric anesthesiologist, then as a pediatric intensivist, and now I am involved in healthcare administration.

 

What are the biggest challenges that you have faced in your career?

The biggest challenge initially was to achieve a good balance between work and family. My husband and I always tried to make sure one of was there for all the special events with our kids- sports, plays, etc. So it was always a juggling act.

Then, going to medical school itself was a challenge.

When I went to medical school, it wasn’t traditional for a woman to be a doctor. A lot of people, including my premed advisor asked me whether I was sure I didn’t want to be a nurse. But I am a fairly stubborn person and I have a family that never put any limits on me. I put myself through college. I was a cook at the athletic dorm and when I told one of the coaches I was going to medical school, he thought I was insane. He said “you are a cook in the jock dorm and you’re going to go to medical school?”

I never let somebody else’s perception stop me from doing what I wanted to do. You have to be willing to work harder sometimes, even more than your male colleagues. Someone advised me once to show up and do your homework. That’s half the battle.

 

Why do you think fewer women are choosing anesthesiology as a career and even fewer are choosing to aim for leadership positions?

Yes, I do worry about that. I think it’s multifactorial.

I think one of the reasons is that it is hard to juggle a career and a family. My husband came from a traditional Cuban family, so it was a challenge for both of us to juggle our roles and responsibilities that were different from his upbringing. He is finally at the stage in his life that he is able to be more supportive. So then it’s a slower process to move up the ladder. I wanted to make sure I was available for my children so I made sure I took the slow journey. I’m going to run for First Vice President of the ASA in two years. It may have been easier and faster from a political perspective to run for office earlier but from the family perspective I wasn’t willing to do that. Timing is a challenge for women even in academics when you’re trying to publish or going up in leadership so we tend to spread things out a little bit more to be able to meet our family’s needs.

 

 I believe one of the biggest barriers for women going into leadership roles is to juggle their priorities of family and career.

Right. For me, my husband and my children are important and so are my patients and my clinical responsibilities. Both my husband and I are first children, so we have also had the added responsibility of taking care of our parents. His father suffered from Alzheimer’s for about 15 years. We took care of him at home, which wasn’t easy with young children and our busy professions. It’s not easy to juggle all those roles.

 

What advice would you give young women physicians just starting out in practice who want to get into leadership roles?

  • Be willing to volunteer to do things that may not always be glamorous.
  • Be willing to work up in an organization whether in your hospital or in your community.
  • Make sure you have good help at home. I do have a woman who I built a garage apartment for. She’s been with me for 30 years. It is difficult to do everything without adequate help. The first year my husband and I started working was pretty rough. Both of us were on every other night call and we had a newborn baby. At the time, I did not have live-in help. There were times when I would be on call and in the OR at two in the morning and Rafael would get called to another hospital. So he would bring Christopher to the Children’s Hospital where we had a crib set up in the nurses’ lounge. Whoever finished first would bring the baby home. That was our version of childcare back then. Many of the nurses were in the same position and we all looked after each other’s children.
  • Ask advice of other people. I’ve got a young colleague who is interested in leadership opportunities and I’m trying to make sure she gets appointed to committees. When I make a legislative visit I try to bring her along so she get’s the exposure.

 

So you are mentoring other physicians. Did you have a mentor too?

I would say I had “encouragers” along the way. There were people who saw that I had the potential in one area or the other and encouraged me. And with the exception of Betty Stephenson, they were all men..

 

Are there any leadership courses or activities that you would encourage women physicians to take?

The ASA is working with the Kellogg School of Management on leadership courses. Another good one would be the ASA Practice Management course held in January. Then there is the ASA’s Certificate in Business Administration. All of those are good.

And I really do encourage women to not shy away from the numbers. When you understand the finances you really understand the organization. I would encourage folks to really understand the finances in their group to make sure your compensation is fair and your billing is being done correctly.

 

Who are some of the women leaders in medicine you admire and why?

Madame Curie ( I read her biography when I was a child- she was truly amazing)

Dr. Lois Collins (she was a family friend, a radiologist who was married to a radiation oncologist, she had 3 boys, was a lovely person, who made everything look easy, even though I know it was very hard. When she graduated from medical school she couldn’t get an internship position because no-one had call quarters for women (back then, you lived in the hospital the first year) Her father, who was an obstetrician, finally stepped in and pointed out there was a vacant closet that his daughter could use!

Betty Stephenson- the first female ASA president who was a force to be reckoned with. She had 4 children, was married to an orthopedic surgeon, was also from Texas, and was very supportive of women getting involved. She didn’t put up with much nonsense.

 

 

 

Question of the day:

Which female leader in medicine do you find the most inspiring and why?

Please answer in the comments, or on Facebook, Twitter or Linkedin

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