Medical Schools Must Champion Health Equity - Dr. Valerie Weber, Dean of Wright State University Boonshoft School of Medicine

SHIV GAGLANI: Hi, I'm Shiv Gaglani and today on Raise the Line, I am really happy to be joined by Dr. Valerie Weber, who is the Dean of Wright State University's Boonshoft School of Medicine. Dr. Weber was previously a professor of medicine at Drexel University College of Medicine and Senior Vice Dean for Educational Affairs. Prior to Drexel University, she was chair of the Department of Clinical Sciences, Associate Dean for Clinical Affairs, and Professor of Medicine at the Geisinger Commonwealth School of Medicine and played a major role in the creation of the new medical school there.

Before we get started, I would like to thank a previous Raise the Line guest and one of our advisors, Dr. Lois Nora, who was the Dean at Geisinger Commonwealth School of Medicine, for making the introduction to Dr. Weber. Thanks so much for taking the time to be with us today.

DR. VALERIE WEBER: Thank you so much. I am so pleased to be here with you on today's show. 

SHIV GAGLANI: I know a lot about your background having done the research, but I'm curious if you could tell our audience, which is primarily current and future health care professionals, more about your background, and what led you to pursue a career, first in medicine, and then also in academic medicine. 

DR. VALERIE WEBER: Yes. Well, I grew up in a small town in Northwestern Pennsylvania. The name of the town is Harborcreek, right up on Lake Erie, and it really was a semi-rural area. It really did not have the greatest access to health care and I did not grow up in a family with any physician role models at all. In fact, as a young woman growing up, a young girl, I did not really have any career role models. I think my strongest role model that probably, when I think back on it, led me to a career in health care was my mom, who was a stay-at-home mother but who had a deep passion for caring for the elderly in our community.

Since I was the youngest of three, I was just kind of pressed into service as her sidekick, and she took it upon herself to make sure the elderly in our community had groceries and had their prescriptions. Honestly, I really grew this love and interest in older people. I thought they were fascinating.

Then as I got older, I identified with health care as a possible career, and I think one thing led to another. I, again, without a lot of female role models, I was not quite sure what you had to have in you to make it into medical school. But as I just kept setting higher bars for myself, and kept meeting them, I ended up into a path of medicine, and I really never deviated out of my interest in caring for older people as I trained in internal medicine after medical school. 

So it has really been part of my whole track of interest and then, yes, over time it really kind of led from patient care into leadership and education as I found ways to help people beyond one-on-one patient care, and I really became inspired by wanting to make the system better and make things better for people.

SHIV GAGLANI: That's wonderful. Actually, that is a theme that we have wound up covering quite a bit here on Raise the Line with folks like Alan Patricof and Abby Levy who started a firm called Primetime Partners, which is all about providing services to the ageless generation, the silver tsunami, that is happening, as well as several other people. We had Taylor Justice from Unite Us which is focused on social determinants of health. I am curious, actually, before we go into your work at WSU, is your mom still active in that community? I would love to hear more about your interest in geriatrics and how you see that shaping out over the coming years.

DR. VALERIE WEBER: My mom passed away some time ago, but during her life, that was her passion. She was very inspired to do good for people and to help people who maybe had no one else to help them. I think maybe it sounds a little corny but I think she had that passion for service that I think I just acquired at a young age. I think it's a key for people that are asking themselves as young people, "Should I go into medicine?" and making them realize it's not just about having a great career, or having an interesting thing to do every day. In the end, you really are serving people and you ought to have that service orientation if you are to be a good fit, I think. 

SHIV GAGLANI: Absolutely, that makes sense. This theme may come back later on in the podcast but going into how you’ve gone from internal medicine to then taking on leadership roles at several of these major schools. I mean, you have been involved in starting a new medical school at Geisinger. Can you talk about some of the seminal moments of your career in academic medicine? 

DR. VALERIE WEBER: I got involved in a leadership career quite early, and like many things in my career, they just sort of happened, or I stumbled into them, I guess. But somebody, after my 3rd year of internal medicine residency, identified me as a candidate to be chief resident, and I think it was that, seeing something in myself, that maybe it took somebody else seeing in me first to have the confidence to do it, and then one thing led to another.

My first job was a leadership job, right out of residency, being a medical director of a clinic in Philadelphia that was primarily serving economically disadvantaged and minorities, and we had a big population with HIV disease at that time. That was a very inspiring way to start my career. We started an early medical—we call it a medical home model—we didn't use that term then for patients with HIV, with wraparound services and did a lot of education. Then I went to Geisinger Health System for a decade where I was Division Chief of General Medicine, and did a lot with care for the elderly in the rural communities there. I started hospital programs and that was a transformative time in my career because that system was quite known, and continues to be known, for a lot of quality, and patient safety initiatives, and a lot of population health initiatives. So I kind of got that lens of making care better for people through population health, and through informatics, and through improving systems of care.

During that time, I did a Masters of Healthcare Administration at the Harvard School of Public Health, and I got very interested in workforce. I started reading about workforce and understanding how the dynamics of the aging of the population and the health care workforce were really coming together, in a way, in my home state in Pennsylvania that were going to be quite possibly cataclysmic. I heard about a new school starting in the northeastern corner of Pennsylvania, and the next thing I knew I was involved in starting a medical school, which is not at all for the faint of heart. It's quite a job, but it's a fun and rewarding one. 

SHIV GAGLANI: Yes, we are fortunate to work with a number of medical schools that are getting started, and the amount of paperwork that they have to do to get to that point is remarkable. We had Dr. Mark Schuster, who is at Kaiser Permanente, as their first dean—I'm sure you know him well—among others.

That actually transitions well into another question I had, which is, you've been in academic medicine long enough to know that the AAMC and other organizations have been talking about physician, nurse, and other shortages of health care workers long before any average American knew what a coronavirus was. Obviously, COVID has accelerated some of this demand and interest in health professional education and careers. What do you see? I mean, it just does not seem likely that starting new medical schools or even increasing enrollments will meet the demand that is coming our way. I would love to hear your thoughts on the ongoing shortage and how we as a society can address that.

DR. VALERIE WEBER: Yes, we have increased the numbers of medical school enrollment both in MD, Allopathic, and DO, and also mid-level providers. But whether it's enough to keep up…I think it is going to be very interesting to see what happens sort of post-pandemic when­—I'm quite sure like many would agree—that COVID is here; it's going to be as an endemic once we get it under control, and so it will be part of the landscape, much as influenza and things are. But I think we are going to have a big burden of PTSD. We had a crisis of wellness in the medical profession before this, and this has been quite a rough time for my colleagues on the front line, and I am quite worried about what this is going to do for the workforce—if people are going to just walk away, or if they are going to be doubly inspired to continue to serve, or to improve the system. 

Certainly, we have seen people applying to medical school in larger numbers. I think it was up about 19% this year, and it was at our own school as well. People continue to be inspired and want to serve humanity, and that is quite wonderful to see. At Boonshoft, at Wright State, we are going to be increasing our enrollment over the next few years. Whether it will be enough, whether burnout sort of quells these additional numbers that we have, remains to be seen. 

SHIV GAGLANI: Absolutely, it's kind of like a leaky funnel, and hopefully, there are systemic changes that can not only improve scope of work, and get more people into these careers, but also keep them in the careers even longer. You transitioned to Dean of Boonshoft last November. I am just curious, how has that experience been, especially in the middle of a pandemic where we are approaching the one-plus-year mark of the COVID pandemic in the US, at least?

DR. VALERIE WEBER: It was an interesting time to move and to change institutions. It's going very well. You just have to be very inventive with getting to know people outside of maybe normal channels. 

 

But this is a wonderful institution I have joined. I guess you could say I am an adventurous person. One of the things that was great is that the AAMC has a session for new deans that is usually done in person but this year was done remotely, and so I was able to network with about 18 or so new deans of other schools who also joined during the pandemic and so we were able to sort of compare notes.

As you know, any new job is about relationship building, and so doing that, trying to get visibility and communication channels while also managing an ongoing crisis. It has been a challenge, but a rewarding one.

SHIV GAGLANI: Yes. We had the dean of Wayne State join us a couple of months ago, too, and he was in a similar situation, having just moved his entire family from New York to Michigan for that opportunity. But obviously, being adaptable is key in the profession of medicine as a whole. 

DR. VALERIE WEBER: Yes.

SHIV GAGLANI: So speaking of adaptability, obviously, there are a lot of changes, I am sure, that Boonshoft and other medical schools have had to make as a result to COVID ranging from introducing telehealth curriculum to making sure the medical students and the others were getting vaccinated, or socially distanced. What are some of the lasting changes you think that will occur to medical education, and as a result of COVID, as well as health care as a whole?

DR. VALERIE WEBER: It's interesting because before I came to Boonshoft, I was Senior Vice Dean at Drexel, and some may be familiar with the fact that we had a very cataclysmic closure of one of our main teaching hospitals, Hahnemann University Hospital, which had served the community for hundreds of years—a hundred and fifty, I think. So we had this crisis that I had managed, which was the closing of a hospital, and it really brought into bold relief the idea of how are we best to clinically educate our physicians—our students, and our physicians.

This has been a crisis for a while. If you look at hospitals closing, and you look at the loss of clinical education venues, the competition from other schools, offshore schools, etc., managing through that crisis and then right on the heels of it, COVID. It just makes you realize that we have a lot of challenges on how we educate our physicians. 

Now, with COVID, we were able to turn on a dime, and one helpful thing was that as a country, all of us in Philadelphia who run medical schools all got together and made decisions in concert. This was something that we have never dealt with before. Pulling students out of clinical venues because of the shortage of PPE and just, "How bad was this? Who was going to get it? Were young people going to be affected?" So yes, we made a lot of changes. We turned on a dime with many things, and I think some of them will stay. Certainly, I think everybody knows telehealth is here to stay in some way, shape, or form. There still is no substitute for face-to-face, and the physical exam, and things that you need to lay on hands to do, but I think it can be a great supplement for people. 

I think there are certain educational models that we put in very quickly. For example, the use of standardized patients in health care teaching. We are able to convert that to zoom fairly smoothly. I think some of the changes that were made in the residency application process and the medical admissions process where students normally would travel all over the country for these interviews, and we found out they worked pretty well remotely. So it will be very interesting to see, this coming year, what goes back to happening in person with the application processes for both medical schools and for residencies, and what stays remote in the uncertainty of the upcoming year. So I think those kinds of changes, if we want to call them the “pandemic silver linings.”

Then I think obviously, the focus on public health, the renewed focus. We were quite mistaken to assume that we were not really going to have to deal with the pandemic. I think some in medicine thought, "No, that was something to worry about in 1918. That is not going to happen again. We are so much in better shape," and I think we have all learned that we are quite vulnerable and that we cannot let our public health infrastructure decline as we have had over the past several decades.

SHIV GAGLANI: Yes, certainly. We've all heard about the Fauci effect, which some people are attributing to the fact that there has been a 20% increase in applications to medical school this year. But also I imagine there will be a concomitant increase in Masters of Public Health and other of those kinds of careers. There is so much misinformation, clearly, about everything from what vaccine efficacy means— you probably saw recently the mayor of Detroit rejected the Johnson and Johnson vaccine because he misunderstood what that meant, but then kind of backtracked after Vox and others explain to him what it meant -- so I really think there is a role, not just for medical students, but as you are saying, public health infrastructure as a whole, to do a lot to combat not just the virus, but the virus of misinformation. 

DR. VALERIE WEBER: Oh my goodness, yes. We need to have a little bit of better understanding between our public policy and politicians, government officials, and science as a whole; certainly, vaccine science. I am here in Ohio and our governor has been fantastic with sticking to the science, believing the science. He is a Republican governor. He is quite, I think, artful at managing through this and so it can be done. It does not have to be politicized. There is science and there is fact and that is kind of the way we have to get through this. 

It is a miracle that we have so many vaccines. We were so fortunate to have so many effective vaccines and I think there is still a big gap in education about that. I mean, we had a problem with vaccines before this, and a distrust of science. So I think we have a lot of work to do there.

SHIV GAGLANI: Yes, absolutely. Not only health information, trust among the public, but also equity. I know that is something that you care about and all people in academic medicine and leadership should care about and do care about. Do you mind commenting a bit on that?  I know these are topics that you and your colleagues have been interested in, long before, not only COVID, but also all the things that have recently happened with regards to equity, ranging from George Floyd, to even last week's Atlanta shootings. I know this is something that the students are obviously extremely motivated by as well.

DR. VALERIE WEBER: Yes. So this May will be my 30th anniversary from my medical school graduation. Hard to believe.

SHIV GAGLANI: Congrats.

DR. VALERIE WEBER: I have been reflecting a lot on this because one of the first things I noticed as a medical student in Philadelphia is that we had a segregated health care system—and we still do to some degree—and we have known the science of health disparities has been quite clear over those three decades, and we have not nearly done enough. So one of the things that I think is just so important for medical schools and for academic medicine is to lead the way in being a champion for health equity.

Not only the science and the research can shine a light on it. But to really take our voice as an authority and our role. Many medical schools are located in big cities or other communities where there are health disparities. Here in Dayton, Ohio, we have some real health disparities as we have in many areas of the country. 

It's our job. It's not just our job to educate physicians. It's our job to be a community voice and to work with the community to improve our health care disparities. That is something that I am working very hard on as I get used to my new community and get to meet people. I think the COVID vaccine situation has shone a light on the disparities. If you set up a vaccine campaign that is based just on Internet access, that is going to be a problem not just for the elderly, but for people who do not have access. So this is an opportunity, with everything that has happened in the last year with the pandemic, George Floyd, the other things that have sort of come together, to make this a moment that we have to, we can not let pass by. I think we have to seize upon it.

So yes, I am very passionate about that and I do expect that my other partners and our medical schools around the country are going to be working as hard on this issue as we are here.

SHIV GAGLANI: Yes, absolutely. That has been one of the silver linings, I think, of all the stresses that have accumulated over the past year. It's what they say, a crisis is a terrible thing to waste, and I think there is a decade worth of change that is occurring within months—mostly in the positive direction, sometimes in the negative direction.

Obviously, we have all heard the studies about women in the workforce going back to take care of their family members at home. So it is kind of reversing some of the social change that we have seen very positively over the past few decades, but in other ways, it has accelerated that, so I think there are some silver linings. Are there other silver linings that you have identified either in your current role or just in general that you like to comment on?

DR. VALERIE WEBER: Well, certainly, I think it put a halt to so many things in our life and gave us the opportunity to re-examine these. We started off the podcast talking about identifying medicine and a life of service as something that was a good fit for me. Though I've found many roles within my career, it has always really been about making things better for people, and so I am incredibly fortunate, and I think the past year has just reminded me of how fortunate I am. As somebody who is as fortunate, you must use your role to help others and to make the system better. That's really what it's all about.

SHIV GAGLANI: That is a really good point and I am glad you even brought that up because that was actually what my next question is. What advice do you give to your students at Boonshoft? In general, what advice would you like to give to our audience of early-stage health care professionals, about meeting the challenges of COVID and beyond?

DR. VALERIE WEBER: Well, it has certainly been a hard year. But I mean, I am just struck by and honored by being part of a field in which—I actually think some of these new vaccines, particularly, the mRNA vaccines—are going to be the discovery of the century. I can be proven wrong but I strongly feel that they are going to become a platform for treating many different types of diseases and just how fortunate to be involved in a career in a field that has the ability to impact so many people positively.

I would say to students, and I do, this is the best career in the world. It is a hard one to go into. It is a calling. It is your life. It is not just a job that you clock in and out of, but it is primarily about service and it can be risky. We have seen health care providers lose their life over the past year, but certainly there is nothing more profoundly impactful and rewarding that one could do with one's life.

SHIV GAGLANI: Yes. That is absolutely a theme that has come up throughout the interviews we have done in the podcast. I know we are coming up on time, so is there anything else that we have not talked about that you would like to convey about yourself, about Boonshoft, or in general, that you think our audience would be interested in?

DR. VALERIE WEBER: Well, I think that one of the things that I have discovered through my career is the power of community-based medical schools and community-based medicine. Our medical school is one of the community-based schools, meaning, we are a little bit less of an ivory tower or highly research-driven institution. Certainly, those institutions are wonderful places to be, but I think the strength of community-based medical schools is that we are on the ground and have a lot more possibilities of impacting the local community in ways that are quite profound. 

I am just a big advocate. I started a community-based medical school in Pennsylvania as well. We have a pretty big tent in medicine, but I think I would like to share how special community-based medicine is.

SHIV GAGLANI: Yes, I wholeheartedly agree. Many of the programs we work with are very much focused, not only on topics like aging in place, but also, finding talent in those communities to teach. For example, we work with A.T. Still University, which is a DO program. They work with the National Association of Community Health Centers, and they are doing a huge DEI—Diversity, Equity, Inclusion—initiative to try getting people who come from rural areas to actually be empowered to become the nurses and doctors and PAs in those areas because they are more likely to not just graduate and leave the area, but have family roots and whatnot there. So I think that's a really powerful point you just made there too. 

DR. VALERIE WEBER: Yes. We do a really good job at retaining Ohioans, enrolling and retaining them into the community both for residency training and then thereafter. As a state-sponsored institution, that is what we are all about: serving the people of Ohio. We are quite dedicated to that.

SHIV GAGLANI: That's wonderful. I'm glad that that is a major key performance indicator of the school. With that, I'm grateful for your time, Dr. Weber, for taking the time to not only be on the podcast, but more importantly, for the work that you are doing to raise the line and improve access and healthcare education as a whole.

DR. VALERIE WEBER: Thank you so much for having me. It has been fun talking today.

SHIV GAGLANI: With that, I'm Shiv Gaglani. Thank you to our audience for check out today's show, and remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.