When I was a resident, having graduated from medical school and entered pediatrics, I very quickly became demoralized. So much so, that I actually thought about quitting medicine. I was in Seattle as a resident, and I thought I could apply for a job at Microsoft, and that would be fine. My frustration was really rooted in finding that everything that I'd been taught about health care didn't really apply when I was actually taking care of patients. I could write a prescription, but maybe they couldn't afford it, or couldn't afford a copay, or maybe they didn't have a car to go pick it up, or maybe mom needed a job, and dad needed housing security. So many issues were at play, and the health care system was inadequate to take care of it, and I found the practice of medicine frustrating.
But I was lucky. I had some mentors who said, “you know, you can make a career out of trying to fix the health care system.” And I was like, “That's fantastic! Sign me up for that!”
And so, I stuck around for a couple extra years. I became a Robert Wood Johnson clinical scholar. I got a Master's in health services from University of Washington School of Public Health, and I became a health services researcher. I also joined AcademyHealth.
Throughout all of this, Lisa Simpson was a mentor. I've always been really passionate about the vision and mission of AcademyHealth - to work on the production and use of data and evidence to improve health and health care for all.
AcademyHealth is a Dream Job
When I think about my career before now, it comes in four phases. In the first, I was a pretty traditional independent investigator. I did a lot of work with clinical decision support. We looked at utility assessment, medical decision making, and cost effectiveness analysis, and I did some policy work as well.
In phase two, I got really into mentorship. I really wanted to build a cadre of pediatric health services researchers in my department, and I worked with my chair to start gathering pediatric sub-specialists and train them up. That later led to building programs in the school of medicine, and eventually an appointment as Associate Dean for Research Mentoring, where I helped create many of the major mentorship programs for researchers in the school of medicine.
In phase three, I really got into science communication. It was the late 2000s. It was the golden age of blogging; everyone had a blog. My partner Austin Frakt and I started The Incidental Economist, which focused on bringing data and research to the discussion of the Affordable Care Act.
That grew into writing for more major media outlets, as well as a YouTube show, but it was all about bringing data and evidence to the public, so that they could have better health and health care.
Finally, as Chief Health Officer at Indiana University, I helped with our pandemic response, before starting as CEO of AcademyHealth.
The thread that ties all that together is that each phase of my career has been about how we take data and evidence and bring it to where it needs to be to improve health and health care. I brought it to clinicians, through clinical decision support. I brought it to policymakers through medical decision making and cost-effectiveness analysis. I brought it to researchers so they can do a better job as I mentored them. I brought it to the public in columns, videos, and podcasts so that they can make better decisions about health and health care. And finally, I brought it to public health to try and manage the pandemic and other issues as best we could.
Which is why this really is a dream job. Because getting to work with AcademyHealth on the questions of how we produce and bring evidence – in all of its forms and all of its ways – to help us improve health and health care for all; there's nothing I would rather do.
Responding to Challenges
But things have changed quite a bit since I joined AcademyHealth, and the world has become a bit more challenging. There is a significant distrust in science, a lack of real confidence in what science is and how we should use it to make better decisions. There have been significant attacks on diversity, equity, inclusion, and the people that do that important work, making it much more difficult to do so.
There have been rollbacks of individual rights, most notably that of a woman's [or pregnant person’s] right to choose. But other rights are being rolled back as well, and it's of concern to everyone. And these challenges necessitate a strong, united response, which is why we need community and collaboration more than ever. We at AcademyHealth need to focus on our strengths – data and evidence and how they can be brought to bear. And we need to broaden our community and include patient advocates and other members outside academia.
We need to include those that work for government, for nonprofits, and even for-profit companies, that are engaging in data analysis and health services research, so that we can all bring that data and evidence to where it needs to be. We need to maintain a seat at the table of expertise to combat the misinformation that's being spread all the time. And we must engage with policymakers, decisionmakers, and communities at multiple levels to enact change. To do so, we need to make strategic use of AcademyHealth's and our members’ strengths, which include:
- Bringing experts together.
- Creating opportunities for engagement and innovation.
- Setting priorities and agendas.
- Acting as a trusted broker of information, and
- Advocating always for the production and use of evidence to improve health and health care.
The Future of AcademyHealth and the Field
I think that there are some things we could obviously focus on. We have to do a much better job at science communication. Too few people even know what health services research is, let alone why it's important or how we can use it to make better health policy and get better health and health care. We as a field need to focus more on solutions, and less on problems.
We are very, very good at doing analyses that tell us how bad the health care system is. We don't do as good a job at telling people what to do about it, or how they can make the world a better place. We need to continue our work on diversity, equity, inclusion, and accessibility, while still focusing on our core strengths: data and evidence. And then using that data and evidence to offer and study solutions for how we make all of those issues better in the future. We also need to bring in new voices, younger professionals, people early in their careers, and make them a part of AcademyHealth so that they stick around and feel more a part of what we do.
We focus a lot on the federal level, but we also do a lot of work that I don't think everyone knows about at the state and local level. We have some amazing programs that focus on Medicaid Medical Directors, on state universities, and on Medicaid programs working together for better outcomes. That's where a lot of the action happens. We need to continue to lean into that local level where policy still can be made, and we can make a real difference. And, of course, we'd be remiss if we didn't address the growing potential of artificial intelligence, data, and technology to improve health and health care.
We need not only to learn how to use these new tools to make our research better, but also to make sure that we study them as they're implemented, and really recognize that there can be harms as well as benefits, and make sure that we're doing as much for the latter and as little of the former as possible.
I know these times can feel hard, but I'm filled with optimism. Because I think there's an amazing amount of potential for all of us to work together to make a real difference. This is our time to be the voice of reason, evidence, and actionable insight. But to do that, we need your help.
Your active participation in AcademyHealth powers positive change. This meeting, the ARM, is the heart of AcademyHealth, and the foundation for future growth. I am excited and I hope you are too for all the potential learnings that are going to occur over the next few days. And, I really encourage you to listen for stories in the evidence, find new ways to connect and collaborate with new people in old, and focus together on a better future. We're so glad you're here.
These remarks have been edited for length and clarity.