A 6-Month Wait For A Specialist Is The New Normal": The CEO Fixing The Physician Shortage | Michellene Davis

[00:00:00] We've made certain that we are one of the aspects in this country that is addressing the physician shortage. Lots of folks say that they don't think about the physician shortage, and I promise you, you do. When you call to make that appointment with that specialist and you get an appointment, that's like six months out.

[00:00:18] Laurie McGraw This is Inspiring Women. I'm Laurie McGraw, and today I'm speaking with Michellene Davis, and she is the President and Chief Executive Officer of National Medical Fellowships. She is a social impact advocate.

[00:00:32] She is a health equity evangelist. And every day she is looking to be an equity innovation strategist by creating impact with her work at NMF. She is a litigator. She is an executive. She is an author. Michellene, thank you for being on Inspiring Women. Michellene Davis Thank you so much for having me, Laurie. Laurie McGraw Well, let's dive in. I want to start our conversation with a little bit of the career.

[00:01:02] Michellene Davis Thank you so much for that question. Boy, I feel like my whole life is a career arc and what you are doing today. Michellene Davis When you started off as the state treasurer of New Jersey working government, when you started off as the youngest ever CEO of the New Jersey State Lottery, what led you to health care? What led you to the impact and the health equity work that you are doing today at NMF?

[00:01:28] Michellene Davis Thank you so much for that question. Boy, I feel like my whole life just flashed before my eyes. You've definitely done your research. Michellene Davis I will tell you, you know, so much of being in health care has directly to do with my time as a litigator. Michellene Davis Laurie, I began my legal career as a public defender, right? So actually doing adult trials and what we used to call the belly of the beast, which was in the largest city in the state of New Jersey, which is Newark, New Jersey.

[00:01:57] Michellene Davis And what I will tell you is that so many of the clients that I encountered were actually in the criminal justice system merely because the health care system had not served them well. Michellene Davis And as a result of that, I distinctly recall trying cases and literally arguing really public policy before a jury where I was saying, if my client had universal health care, none of us would be here today.

[00:02:27] Michellene Davis But because of the fact that my client, who had a history of mental health challenges, had lost their insurance coverage, but still had a need to quiet the voices in their mind that was telling them to harm themselves or their child, right?

[00:02:48] Michellene Davis That they unfortunately had been arrested because they were in a particular part of a town doing something that they would really rather not do because they no longer could afford the prescription medication. Michellene Davis That's an incredible, that is an incredible leap, you know, that I, I mean, that's a surprising thing for me to hear that that's sort of like what you saw as a common thread.

[00:03:15] Michellene Davis I mean, that's incredible. Usually it's income, income inequality and those types of issues. And you really like recognized early that it was the health care system letting people down and bringing them to, you know, very, very challenged and difficult circumstances. Michellene Davis So how did that then lead you to, because you went to government next, I mean, as one of the places to spend your time, and you immediately moved into leadership.

[00:03:44] Michellene Davis I mean, you didn't just, you know, just some government job. I mean, these were like, you know, I mean, the state treasurer. I mean, these are, it's the CEO of the lottery. These are big government jobs in the state of New Jersey.

[00:03:57] Michellene Davis I will tell you, right, my career has been shoots and ladders, but so much of it actually began in that courtroom. And I'll say this to you. When I say that the system, you know, failed them, I want you to understand that it is because exactly what you just described, income inequality, right? Education inequality, all of those things all operate in systems, right? They exist in systems. And so it's a confluence of them all, not any one of them on their own.

[00:04:24] Michellene Davis And so for the client that I would have, who literally had aged out of say foster care and was now no longer attached to any particular subsidy, no one had stopped to think about the fact that this person needed a continuum of care, right? Michellene Davis No one in the school system, no one in the healthcare system, no one in the, so you get that, in the foster system. And so that's literally what I'm regarding. But because they all really intersect, right, that is why we have to figure it out.

[00:04:54] Michellene Davis I will tell you this. I actually, it sounds so much like a CBS after school special. I was literally trying cases in a courtroom and the judge that I was before had invited the senator who had nominated him to court to watch me try a case.

[00:05:10] Michellene Davis I did not know who he was. I did not know who he was. I didn't know anything about it. And I shortly thereafter got a phone call. And it was to come and serve as the policy advisor to that particular, he was a senator, he very quickly became acting governor. Michellene Davis And as a result of that, I wound up in the Department of Health and Senior Services being a policy advisor to the Commissioner of Health.

[00:05:36] Michellene Davis Shortly thereafter, however, that same governor called me in and said, listen, this is going to sound really odd, but we have this position at the lottery. It's a $2.4 billion entity. It's the fourth largest revenue producer for the state of New Jersey.

[00:05:53] Michellene Davis And I would like to ask you to go lead it. And I distinctly recall saying, I'm a lawyer. Like, what in the world? But do you know what really touched me very deeply? He literally said, and I didn't know this, he said, it's your reputation for integrity. Michellene Davis And the fact that the lottery had the fourth largest contract in the state of New Jersey, and so they needed someone who would, right? So having that criminal defense background, right, actually proved pretty well.

[00:06:20] Michellene Davis And then I will tell you that so many of the skills, talents and abilities that you both learn and then, right, you acquire them, but you hone them through litigation, easily adaptable to business, easily adaptable to government, right?

[00:06:36] Michellene Davis So what am I talking about, Lori? I'm talking about your critical analytical skills, right? I'm known today as a chief strategist. And I know that so much of that really came through that entire practice and the opportunities that I had. You are correct. Michellene Davis And then while I was serving as the CEO of the lottery, I got asked to serve as the chief of staff of treasury and then the deputy state treasurer and then the treasurer.

[00:07:04] Michellene Davis So these are all, I mean, first of all, like the through line here is leadership. You have a brand of being known as high integrity, and that is extremely important. Michellene Davis I think there was a lot of great work, but I'm not aware that you are here and those things are earned and they show up just again and again, sort of doing the work. Michellene Davis But was there ever an intentional? I want to get to a next place?

[00:07:26] Michellene Davis I don't, I've never heard anyone say, I want to go run the lottery, but I've heard many people say, I want to go run this, that or the other thing. Was there, I mean, you were pulled into these things is what it sounds like from being recognized as being excellent at what you were doing, having the skills and the brand that's going to be important for positions like the head of the lottery. What was the intentional move?

[00:07:54] I want to do this next to have this impact. So I will tell you this. I really wish that I could tell you that you're right, that I woke up and I was just like, oh, I want to go get that job. That is not what happened, at least not at the lottery level. It also was not what happened at the treasury level. And so this is a really key component of this. At the time when I was the state treasurer, there were very few women treasurers in the country. And truth be told, there were only two of us who were of color.

[00:08:23] Still today. Very few still today. Yeah, myself. And I was only the second woman treasurer that the state has ever had, right? We've since had another. So, you know, that's positive. But what I will tell you is that when I was treasurer, however, I knew that the position that I really wanted was to be chief policy counsel.

[00:08:43] And I literally had women's groups from across the country contact me because the governor at the time was asked by the New York Times whether or not he how he was doing on his search for a treasurer. And he said, I have who I want. I'm not searching for a treasurer. But I already indicated that I didn't want to hold on to the job. And so I had a lot of folks say, you know, this is a really important thing for women. We really need for you to keep this job. Like, we don't know what's going on with you. But what I will tell you is this.

[00:09:12] The treasurer role is very important. You know that, right? With $75 billion investment portfolio, right? $35 billion state budget. Very important job. But the way that I was best able to explain it was that the treasurer holds the purse, but the chief policy counsel tells the governor where best to situate the coins. And for me, that was the most important thing.

[00:09:42] And so that was the job that I wanted to get. And it wasn't vacant at the time, full disclosure. And so I had to, you know, spend some time as a senior special counsel and then eventually became the chief policy counsel for the state, which is something that I felt like was giving. It gave me the opportunity to give a gift back to communities that I care deeply about. Well, also, in terms of your systems understanding of what serves or does not serve people and then how to change that. But we also know that systems are hard to change.

[00:10:10] Maybe let's sort of like move forward to your current work at NMF. Maybe talk about what the national medical, what NMF does, the impact that it has. Because you are very clear and intentional. As president and CEO, your job is to not just run this organization.

[00:10:33] Your job is to have impact on a large system of physicians who take care of people and are a direct line to whether they are going to be healthy or have bad outcomes. So let's just talk about your work and what you do at NMF and what the impact is that you're trying to have. Thank you so much. I describe myself as the chief servant there, actually more than just the president and CEO.

[00:10:58] And what National Medical Fellowships has done over the last eight decades is we have literally lifted from every community the talent and the brilliance that has been found there, that has had a desire to go into the clinical space and to make the health care outcomes better for everybody involved. Why do I say that?

[00:11:21] I say that because National Medical Fellowships helps to address structural barriers by making certain that no matter what your income is, there's an opportunity for you to achieve the very expensive journey of becoming a physician. It also provides you with professional development skills and opportunities. And so once you are a medical student, NMF makes certain that you are given a chance to serve in communities during the summer sessions

[00:11:49] and places students at FQHCs and hospital clinics around the country for our primary care leadership program. We have a health care excellence leaders program. I really came to NMF from large-scale academic medicine, healthcare delivery, not to just create more physicians, but really to create more physician leaders.

[00:12:11] And, Laurie, that's because oftentimes what we notice is that institutional policy and other policy get set through a privileged lens, meaning those who do not have the direct experience of either being the end user recipient or the direct deliverer of the benefit, have been involved in crafting the policy. And so what I know is that when that rubber meets the road, right, there's a disconnect.

[00:12:37] So how can I make certain that there was more opportunity for those who either had been end users at one time, who have now had the wonderful opportunity to become physicians applying their rich-lived experience to, right, clinical practice, which helps you to see your client in their wholeness, right, your patient as a whole person. So go back to that public defender rule, right?

[00:13:06] And how do we make certain that we are treating the whole person in that situation is to make certain that we are recognizing the importance of your clinical education along with your lived experience. And so that is what NMF has been able to do. How has it benefited others, like our general impact? Well, over the course of that time, we have given out some $50 million to over, right, 35,000 alumni.

[00:13:32] We've made certain that we are one of the aspects in this country that is addressing the physician shortage. Lots of folks say that they don't think about the physician shortage, and I promise you, you do. When you call to make that appointment with that specialist and you get an appointment, that's like six months out. Yeah. And it's getting worse. Maybe let's talk about just the physician workforce in general.

[00:13:55] And specifically how you are impacting that because it's materially important which physician you see, where you see them. If they look like you, speak the language that you do, whether you as a person who needs clinical help are going to take that advice, trust that system and act on that very good information coming from a physician.

[00:14:24] So the physicians that you serve and that you provide scholarships for and that you train and turn into physician leaders, who are they? Why are they specifically important? We know there's a physician shortage, and we are seeing it show up in places you would be surprised that now in places like San Francisco, six months for a primary care physician appointment is the new norm.

[00:14:53] And that is incredible for something that simple. Now try going to a rural community. Now try going to, you know, finding someone. There's only two specialists of any, you know, particular kind in many, many states. We're hearing these stories again and again. So talk about, Micheline, the physicians that you are training and why they are so specifically important to better health outcomes for people.

[00:15:22] Thank you for that. So I think two things. One, if we apply Angela Glover Blackwell's curb cut effect, right, what do we acknowledge? We acknowledge the fact that when we take care of the most vulnerable, everyone else is, right, benefited. When we take care of only the elite, right, only the elite are benefited. So what do we do? We make certain that our curriculums or our programs, et cetera, really acknowledges what does the most vulnerable population or community or individual need.

[00:15:52] Our services are available for anyone based on income eligibility. And so if you have, if you meet the income eligibility threshold and you also meet the proven track record of a dedication towards community health, we welcome you in. I don't care where you come from. I don't care what your background is. We welcome you in. Why is that important?

[00:16:11] And it's important so that everyone has the opportunity to learn what it is in order to ensure that we are never setting policy through a privileged lens, that we are making certain that everyone has a level of, right, cultural awareness and competence and dealing with everyone. And everyone has that capability. They have that ability so long as they are exposed, right, educated and supported through that process. So that is who we are here for. But how does that impact the community?

[00:16:40] It impacts the community because of exactly what you just described, right? So you're talking about something in San Francisco. Listen, in L.A. County, there is one physician to every 1,000 individuals, right? But think about what it is in Mississippi. In Atlanta, in Georgia, it is one to every 3,000 residents, right? So think about what that is. And you're absolutely right about rural areas. But it's really affecting everyone everywhere. And that's the important segment.

[00:17:09] It's really important that we are making certain that folks understand that this affects you whether or not you are on 5th Ave, right, or whether or not you are on the south side of Chicago. Everyone is affected about it across the board. Now, you mentioned something really important. And that is why is it important to make certain that there are individuals who are representative, right, of every community who are actually on your clinical teams? Well, that is because, and I often say this, Lori, do not be mad at me for saying this.

[00:17:35] It is because of the fact that I quote the studies, the studies evidence, that when you have a clinical team that is made up of different individuals who are representing different specialties, who are representing different communities, who are representative of different groups, that clinical outcomes are better. The scrutiny that gets applied through that, which is not a mono lens, is only better for whoever the patient is who was on the table, right? And so that is what we are putting more of into the world.

[00:18:04] And if you go back and tie that back to your early, you know, start as a litigator, recognizing some of the people who were not served in a way that, you know, allowed them to thrive. I'll just, you know, state it like that. You know, the work that NMF is doing, can you see the impact that it's making? Can you bring it back to the systems that you early on sort of like, you know, energized you to try and solve some of these problems? Absolutely.

[00:18:34] You know, so much about systems change is both individual as well as the system, right? I always say there are three tiers, individual, community, and the system itself. But what the individual opportunity does is that it provides you a chance to create proof of concept, right? It's just like policymaking. It really is. And that's whether or not you're talking about upstream or downstream. It really gives you that opportunity. Because once you have proof of concept, then you can literally say, because of the impact that we have made in the life of this student,

[00:19:01] and I know that with greater investment, we have the ability to scale that impact and to make it even greater for all of these students. And that is exactly what NMF has done historically. It is what we are doing today. And it is what we will continue to do into the future. Well, Michellene, one of the things I wanted to maybe like a little bit of a pivot in this conversation, when I speak with leaders like you who have, you know, an entire career, decades sort of, you know,

[00:19:28] with very high-powered positions, a lot of stress, a lot of opportunity for impact, a lot of impact. You are well-recognized, decorated, awarded as a leader. You are sought after as a speaker. You're busy. You also carry with that a level of responsibility. You talked about, you know, being known as somebody with integrity, and that was important to others. And that's why you were chosen for certain leadership positions.

[00:19:58] And life is big and complicated. When you bear those kind of mantles and responsibilities, the not having time for other things sometimes gets in the way. So the pivot of the conversation I want to make is, we were talking before we started this conversation about you as a caregiver. And you are in a period of your life where that's a big part of your life. But could you just, and would you mind sharing what that is and how that is impacting your ability

[00:20:26] or how you approach leadership with caregiving as something that you're spending a lot of time on? Yeah. Thank you for that. It gives me a chance to honor my mother. The fact that I have been her caregiver for the last 13 years. The fact that she has very advanced Alzheimer's. I have cared for her at home all of this time.

[00:20:53] And as a result of some recent illness for the first time, I cannot do so at home. And that has torn me apart. The way in which that affects and impacts my leadership's style is that two things. One, and I've said this to everyone who works at NMF. I don't want your family, right? I don't want their families to hate where they work.

[00:21:22] So I am adamant about, have you taken your time off? I want to encourage them to do so, right? I want to ensure that, you know, during the summer months, like everyone Friday at 12, we are shut down. Because there are lots of folks with small children and there are those of us, right? With parents. Go sit by their bedside. There is nothing that we do. And our students are incredibly, incredibly talented.

[00:21:51] They are incredibly bright. And they need us. But if we do our work right, right? We can avoid the emergencies. I don't, I don't transplant hearts at NMF. But I sure enough encourage them. But there, I am better at so doing after I've spent time in her presence, making certain that everything is right. And so for me, that's really important. I will be in the middle of meetings and tell people, all right, get off of this. Go, go take your, you know, kids and eat ice cream, right? Folks need, need other things.

[00:22:21] So for me, it has really helped me to identify and ensure that we are recognizing the human being who is in the role that is doing the work, not just the, not just the role, right? And not just the work. It is all important, but nothing is more important than this moment in your child's life or this moment in my mother's life. I can tell by the trajectory that she's on right now. My days are numbered with her. I can tell that.

[00:22:51] I can tell that. So I cherish them, right? I have told them before, listen, I'm going to need some flexibility this following week because I've got, you know, a variety of things going on. That is why I have good C-suite leadership, right? And I need to be able to pivot and they need to be able to pivot back. And that is what we do one for another. I think it's really keenly important. Well, Michelle, I'm going to talk about it first in a systems way.

[00:23:18] So in the United States today, caregiving is on the rise in terms of the number of adults at all stages of their career, not just young children anymore, but the situation of caring for parents or other family members who are well, not well aging and needing additional support.

[00:23:44] And the burden of that caregiving is very much falls to women leaders. It's one more additional pressure that they're having. And it takes something extra for someone in the position that you are in to be very open and clear that this is important to you.

[00:24:09] It is difficult to go through and to show up in, you know, your words, authentic ways that it's okay to make space for that. So I just want to acknowledge that there's a very large issue here. And that's just what, you know, just thank you for sharing that. And I am sorry that this is the stage that it is because I know there's, that's very important,

[00:24:34] but also that you're taking the time to spend every moment that you can with what matters the most and still be focused on the impact that you are having. It's just incredible. So I just really appreciate, like, I feel this from you and I just really appreciate you sharing that in this conversation. Thank you for that. I do appreciate it more than you can possibly imagine.

[00:25:03] I think that it also shows us a lot of, you're absolutely right, it is deeply weathered by women. You know, she's been in the hospital a lot. We had four stays in the hospital recently. And every so often someone would look at me and say, you're an only child. And I was like, no, but he's a boy. So I understand exactly what you are referring to. That's one. Two, I also think that that's why we're seeing the shifts in careers. There was a recent statement about physicians leaving the profession early.

[00:25:33] Well, that is because women physicians, quite frankly, do leave much earlier, but it is because of the fact that they weather the full burden of caregiving. And so as a result of that, something's got to give. And usually, unfortunately, it tends to be their career because, right, how do you say, well, I'm not going to raise my children or I'm going to disown my parent. I'm not going to be that one. Right. And a lot of us are not either. But it does also get to something about the impact and the weathering on our mental health and well-being.

[00:26:04] And one of the things about caregiving is the fact that there's right now discussion about the fact that it should be literally listed as an aspect of a person's well-being. Right. That literally they were like, it's an aspect of a diagnosis. Like it should be listed. And, you know, as we are experiencing interactions with physicians as a result of the fact that we know what happens to the caregiver. Lori, I'll be completely candid with you. I had a very dear friend.

[00:26:34] Her name was Iris Perkins. Iris cared for her father. He passed away and she passed away four months later. Oh, my. Yeah. Right. I have another best friend. She was a judge. She took care of both of her parents on the anniversary of her parents of her mother's passing. She collapsed in an airport and passed away. She was my best friend. It happened three years ago. And so what I will tell you is I really try to be hypervigilant. I fail. I fail often. Right.

[00:27:03] About my own care and well-being. I know I'm delinquent right now, but at least I know it. And I am reminded of that every time. Well, Michelle Lina, as we close out this Inspiring Women conversation, you're making a big statement about a different part of leadership, which is recognizing when you need to focus on different things. So as we close out the conversation, I would just love there are many women leaders who are

[00:27:33] trying to make decisions about what they focus on right now. They've had success. They're thinking about the next thing. They're trying to deal with things like you are talking about, whether it's caregiving or other things. What's your advice for women, not like the earlier stage in their career, but at maybe the middle stage of their career in terms of like how to focus, how to go for or pull back.

[00:28:02] What do you tell others? I know that you are often sought after for advice from so many. What do you tell people? So two things. One, to take a deep breath. Right. We tend to be, especially those of us who are high achieving. We are very hard on ourselves. And so sometimes, often, most times, we get on ourselves for not already having figured this out.

[00:28:28] And so I really need for us to take a deep breath and to be gentle to apply grace. The second thing is to really make certain that we are listening to our own heart, that we are sitting quietly and asking her with our hand on our heart. When I am lowered into the ground, what do I want to have truly done?

[00:28:53] And the reason why I say that is because oftentimes we think that it's about the bio. It is not. Most of your bio doesn't make it to your obit. What is the legacy? What do you want your children or your children's children to have known about you? What is the experience of love and laughter that you want to leave behind? I really want them to be true to themselves, not to what you think other people are going to interpret, because I'm going to tell you something.

[00:29:23] They're not even going to come to your ceremony. What do you want to be able to lie back into the earth with a smile on about? Do that thing. That is amazing. And that is incredible advice. And this has been an amazing, inspiring women conversation. Micheline Davis, thank you. Thank you so much. Thank you, Laurie.