Leaders in Medical Education

Michael W. Painter, Robert Wood Johnson Foundation

Osmosis Team
Published on Jul 21, 2014. Updated on Invalid date.

Dr. Michael W. Painter serves as a senior program officer and a senior member of the Robert Wood Johnson Foundation Quality/Equality Team. He holds both medical and law degrees and uses his expertise to advocate for health care policy at the national level. His work aims to improve the quality of community health, specifically for patients with chronic conditions. Dr. Painter served as a 2003-2004 Robert Wood Johnson Health Policy Fellow and, prior to that, he was the chief of medical staff at the Seattle Indian Health Board, where he worked closely with the urban American Indian and Alaska Native populations. We were very excited to speak with Dr. Painter about his remarkable impact on health care policy in the US.

How did you decide on a career in medicine and, specifically, health care policy?

I’m a JD/MD, and I went into law school in a bit of a quandary about whether I should go to law school or med school. I decided on law school because I love policy and constructing arguments, but I was left with the sense that I was missing out on something I should be doing with my life. I ended up practicing law for a while, but that question about med school kept nagging me and I decided to answer it. Part of my argument for going to med school via that route was an interest in health care but also an interest in the major problems that we were seeing in health care. When I entered med school in 1991, we were thinking about health care access, quality issues, and disparities. I was really interested in primary care, which made Washington the perfect place for me. I was focused on a patient population of American Indians and Alaska Natives, and there is a health clinic in Seattle that focused on that population. As soon as I got there, I started doing some volunteer work at their clinic. I applied for a Board of Directors position and got it. It was terrific and it solidified my interest in health care policy. I was able to work with the Board and leadership, and we did a number of trips back to DC to help our Congressional delegation understand the needs of the population, which only furthered my interest in health policy.

It seems that more medical students are pursuing interdisciplinary careers and degrees (MD/MPH, MD/MBA, etc). Can you describe how you managed to combine your career in medicine with your interest in leadership?

In some ways, my law practice was really distinct from my subsequent career in medicine, as the settings were very different. I felt that my law degree was very helpful in trying to articulate what the needs were to health policy makers. Every year at the clinic, we received a brochure about the RWJF Health Policy Fellowship. People told me I would be terrific, but it was a residential opportunity, and so I would have to move my family DC. One year though I applied, got it, and my wife and son and I moved to DC. It was a wonderful opportunity to realize what I wanted to do, which was somehow knit together my med training and law training into health policy. The fellowship introduced me to all the major federal health policy players, and after about six months, we all interviewed for staff positions on the Hill. I was given unbelievable and rewarding experiences on the Hill. I think that one of the reasons I was desirable was because I had two degrees and at the time, the senator I worked for, Senator Bill Frist, was interested in health disparities. I became his lead staff person in his Closing the Health Care Gap Act. After my fellowship the Foundation recruited me to come here and I’ve been here ever since.

What changes would you make to improve the quality of the health care system today?

Interestingly, that is essentially what I’ve been working on all these years. The Foundation has been a leader in the field in helping everyone understand the health care quality, cost, and value problems. You can’t look at those issues in isolation, and so we started to get leaders in different communities to address these problems: increasing information transparency, changing payment systems to reward improvement rather than penalizing systems for doing the right thing, making sure health professionals have the resources to improve the system. We were really setting the stage and making the case for payment reform and accountability. We were trying to start the discussion about all that, and we are really pleased with the direction that it is now going. But, it isn’t enough because health care in isolation only gets us so far. The real goal, of course, is how and whether people are able to achieve health and wellness in their lives. That is the real next challenge.

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In your bio, I see that you are particularly interested in improving the quality of health care for patients with chronic illnesses. What do you believe is the biggest obstacle in treating these patients?

We talk a lot about chronic illness because it is an example of people who are not served well by the status quo in health care. It is not something that the health care status quo does well. Even more important, though, we need to understand how an entire community can support people as they make enormous life decisions about their health and wellness. How did we get to the point where we have all this chronic illness? The health care system wasn’t and isn’t set up to help people manage something like that for a long period of time. How do we engage the patient and the family? What do we expect if after a brief visit to health care, patients go back into the reality of their lives with, say, poor access to healthy food or no ready way to exercise? Or what if the education system isn’t preparing them to learn about health opportunities? All of these things optimize health. Ideally health care would get better at treating people with chronic illnesses, but we also would prefer to avoid getting chronic illnesses in the first place. That’s how we are thinking about it these days.

As a health policy advocate for urban American Indians and Alaska Natives, how do you think the health care system could more effectively treat minority populations?

Historically in an American Indian or Alaska Native community, there are strong traditions and cultures helping those people be resilient to threats and injuries and illness. But over time, in our country there has been so much violence, dislocation, repeated trauma, and disintegration of traditions and sense of community. All that damage has reduced the ability for these people to bounce back. It puts these people in a really vulnerable position and makes it difficult for them to navigate towards health. We have to be aware of that. It is important to build evidence about how cultures and traditions play a role in health and how we, as health care providers and other leaders, can help communities become more resilient. I think that is a really critical part of how to helpAmerican Indians and Alaska Natives generate better health.