Transitioning Between Physician Roles

Modern Healthcare’s Next Up podcast for emerging healthcare leaders is hosted by Kadesha Smith, CEO of CareContent, a digital strategy agency for healthcare organizations.

This year, 2021, has been referred to as a “reset year” for many people. They’re reevaluating their priorities, how they spend their time, what their bandwidth is. They’re making adjustments, like spending more time getting rest or with family. As the world slowly moves back to normalcy, this “reset” year is also making people think about their next career move.

For seasoned physicians who are looking to make a transition — whether it’s moving to another hospital or specialty, becoming an administrator, or moving beyond the hospital setting — what do they need to do? What is actually involved in making a big transition? And what special challenges do women physicians face?

Today, we’re talking with Dr. Mandy Cohen. Since 2017, Dr. Cohen has held the position of Secretary of the North Carolina Department of Health and Human Services (DHHS). She is currently the face of the state’s response to the COVID-19 pandemic.

Dr. Cohen has also worn many hats, from treating patients as an internist, to being the Deputy Director of Comprehensive Women’s Health Services at the Department of Veteran Affairs. And Chief Operating Officer and Chief of Staff at the Centers for Medicare and Medicaid Services (CMS).

MODERN HEALTHCARE: Now let’s hear from Dr. Mandy Cohen on transitioning between roles, moving to — and beyond — the C-suite.

Listen to the podcast at https://www.modernhealthcare.com/physicians/next-up-podcast-transitioning-between-physician-roles

MODERN HEALTHCARE: Hello, Dr. Mandy Cohen. How are you doing?

MANDY COHEN: I am well. It's great to be with you. Thanks for inviting me.

MODERN HEALTHCARE: Thank you so much for making the time. We are here to discuss major career transitions — something that you know a lot about.

MANDY COHEN: I do.

MODERN HEALTHCARE: Before we get started with our questions, let me go ahead and just read a couple of data points that I think could help frame our discussion. We know that women in the healthcare field are 25% less likely than men to be promoted to director or senior manager. And this is despite the fact that they ask for promotions as often as men. We also know that women account for 66% of entry-level employees and 59% of manager positions in healthcare. But that drops to 34% when you’re talking about senior vice presidents, and then to 30% when you’re talking about C-suite executives.

And lastly, the number of physicians going into politics is increasing. Between 1960 and 2004, a total of 25 physicians were members of Congress. Since 2013, every Congress has had at least 14 physicians, as well as other types of providers like nurses and psychologists. In today’s Congress, there’s only one female physician.

So, this podcast is for women in healthcare who are looking to make upgrades career-wise. They’re looking to step into leadership positions and sometimes that includes a transition. Can you talk about what have been some of the major transitions you’ve made professionally?

MANDY COHEN: I have had a number of jobs, which is actually unusual for someone with a physician background. Because actually, physicians tend to sort of have a particular path that they go on, but I certainly broke from the mold. And I moved from being a practicing physician into policy and leadership roles pretty early on in my career. Really, right after I trained in residency, I took a job in Washington, DC, working for the Veterans’ Administration, doing a combination of policy work and clinical work. But within a couple of years from that, I moved almost exclusively to entire policy work at the Centers for Medicare and Medicaid Services. So, that was a big transition.

But Kadesha, I’ll be honest. The biggest transition for me professionally happened while I was at CMS. And it happened in the context of a crisis for the organization. And I would say that sometimes organizational crises present opportunities for folks to advance their career. And for me, folks may remember that back in 2013, healthcare.gov — which was the engine that, sort of, ran Obamacare — had a major failure. And it was a big deal for CMS. And at that time, you know, it was a big scramble for leaders and folks to do work. And I was asked to do something that I frankly didn’t really have the background to do, right? I’m a physician. I was working in some of the payment policy areas.

But folks asked me to go and work on healthcare.gov and run call center and navigator programs. You know, I jumped in to do that, even though it was a bit scary and it certainly wasn’t my background. But it gave me the biggest opportunity to lead in a crisis. And within six months of that first opportunity, I was asked to take over as the acting director of all of the health insurance exchanges for the country. And so, you never know when those moments are going to come and I’m sure we’ll get into this. It’s like, how do you take advantage of those opportunities and those moments that come for you in your career?

MODERN HEALTHCARE: Absolutely. And I think the pandemic has probably presented a lot of opportunities for people to step up and step in, and do things that they’ve never done before. And then be considered for some of the leadership positions that probably wouldn’t have happened without the pandemic.

MANDY COHEN: I think that’s right. It certainly was another moment for me as well. Here in North Carolina as Secretary of Health and Human Services (DHHS), I loved my job. But I will say, stepping into the role of also leading all of the COVID response work was sort of a next-level transition for me.

MODERN HEALTHCARE: Yeah. Tell me one milestone that made you realize, you wanted to make a big change and not solely focus on direct patient care.

MANDY COHEN: Well, this was always something that was of interest to me. I worked on Capitol Hill. During college, I did sort of an intern semester during college. So, I was always really interested in it. But as I was training as a resident, it really clicked for me. That I realized, both, where my skill sets and interests lie — but also that I wanted to make a change to the system itself. You know, I loved seeing patients one by one, but I recognized that I was caught — as well as my patients were caught — in a system that didn’t work as well as it needed to work.

I often tell a story about a patient who — I frankly did all the wrong things. I did a lot of medical workup for a patient when what they really needed was access to food. And for me, it really hit home — the need to think about the system that we all sit in and like those bigger changes at scale. And I really said, nope. You know what? I’ve got to put my energy towards that. It’s always what I’ve been interested in. But when I make this next career move, I want it to be into that systems thinking space. I didn’t know really what that meant at the time. And frankly, I’m still figuring out at different points how I want to contribute to that. But that is one of the moments where I said, I’ve got to think about more than just the clinical work, which I loved. But I really want to think about how to change and improve the system.

MODERN HEALTHCARE: And then you actually made the adjustments in career and in life to do that. Moving was part of this transition to your current position in North Carolina. What were some of your fears, just overall, about stepping into this new role? I mean, it’s almost like a new industry, going from the direct patient care to the policy side. How did you overcome any fears that you had about making this transition, and what did you do to, sort of, get a lay of the land?

MANDY COHEN: When making the transition to North Carolina, I’d already had almost eight or nine years of government experience and working in leadership roles. So, I left the Obama administration as Chief Operating Officer for CMS. So, I had operating roles before, but this would be the first time in North Carolina that I was taking on the Chief Executive role, right — the senior role in the organization. Going to a new state and I’ll be honest — I had never been to Raleigh, North Carolina until I interviewed with the governor for this role.

So, it was really brand new. But I saw that as an opportunity to say, look, I have experience at the federal level, but I’m going to be new at the state and it — I think it also allowed me to build new relationships from the beginning. Almost a clean slate, in ways that I think, if someone had been in North Carolina for 20 years and, sort of, had the baggage of what they had done in 20 years — you can’t kind of have that clean break. So, I tried to use it as an opportunity to introduce myself to folks in a different way. But look, North Carolina was a — not only a new place but with some really challenging politics here at the time I joined. The Cooper administration at the time when North Carolina was known as the bathroom state and there was all —

MODERN HEALTHCARE: Oh, wow.

MANDY COHEN: That stuff going on in the background. But I really learned lessons from my mentors about building relationships and communicating and being transparent. And so for me, it was about many, many one-on-one meetings to understand where other decision-makers in North Carolina cared about. What did they want to accomplish in terms of improving the healthcare system? Where are those places of alignment and consensus? I didn’t lead with partisan ideas. I tried to really find the place of consensus to start. I think that has put us on a really good path in North Carolina to really accomplish a lot of important things. And I think it set us up for even more success as we entered this pandemic because I did have good trusting relationships on both sides of the aisle, across many stakeholder groups. So, it allowed us to be on really solid footing as we went into a really hard time.

MODERN HEALTHCARE: I just want to underline something that you just said because I do believe it is the best first step when making a transition — talk to people. Sit down and have one on one conversations with people to understand their goals, their priorities.

Let’s talk about your experience as a physician. How has that helped you in leading North Carolina’s COVID-19 response?

MANDY COHEN: I think it has been invaluable because I can play a role for the governor, and frankly for the public here in North Carolina, to explain some really hard things about the science. I’m not only a doctor, but I have a public health background. I have a Master’s in public health. It was good that I could bring the doctor, the public health, and I’ve had experience in crisis management before. As I said, my biggest opportunity earlier in my career was stepping into a crisis. So, I was able to bring those things together.

And I think being a physician, one, obviously gives you credibility with the public. But I could more quickly absorb and dissect some of what we were seeing in the different studies, in the treatments. I could talk to my own colleagues in a way that was really important and critical. So, I think it was the credibility piece, which was important. It was important, so I could digest the information. But I think it also linked with the public health background, the crisis management, and I was also a healthcare insurance executive, really, at the core. I’ve been leading large insurance companies, but they’re in the government space. And this was all about, how do you use your resources to respond to this crisis? So, I felt lucky to be able to put all of that experience to work. I, sort of, felt like the universe put me in this place in North Carolina with the background that I’ve had. And it certainly, I think, led us to be in a very strong place to respond.

MODERN HEALTHCARE: It’s like you speak multiple languages, so you can talk to different groups of people.

MANDY COHEN: That’s right.

MODERN HEALTHCARE: So, like many women in healthcare, you are also a wife and a mother. Can I ask how old your children are?

MANDY COHEN: I have a 6-year-old and a 9-year-old, both daughters.

MODERN HEALTHCARE: So, what is your key to balancing work life and family life, especially during different parts of your career, like moving to another state or transitioning to another role? How does that, sort of, affect your work-life balance and how do you keep it all together?

MANDY COHEN: I will say this is where I have to thank my husband. And choosing the right life partner who can support you and your career aspirations is so, so critical. And at different moments, there are gives and takes in that relationship. And I will say particularly during COVID when I was working nonstop, 20 hours a day, every single day of the week for many, many, many months. He stepped up to just take over everything that was going on at home, from the kids’ school that was remote to like all the food shopping and the cooking and everything, really. And I’m so grateful that he was able to do it.

Now, I’m glad that things are more calm and we can bring more balance back to the sharing of our supports at home. But I was so grateful to have someone who was able to do that. And I will say at every turn when I said, “I don’t know if I can do this. This is scary, this is hard, I’m uncomfortable, I’m worried.” He’s like, “You’ve got this. You can do this.” And like, just even having someone in your corner that believes in you — maybe more than you believe in yourself — is really important. And my girls, like I said, are 6 and 9, and I really think it’s important that they see that their mom has a special job.

It does mean that sometimes I get really busy and I’m around less. But they recognize that I’m giving back to our state, to the communities, I want everyone to be healthy and well. And I think it will shape them and how they think about what they can do in their lifetimes and how they can hopefully positively impact the world. So, I will say, even with all that 20 hours a week of working, I found the time to come home, carve out one hour where we would have some dinner. I’d hang out with the girls for a bit and then I’d go back to work. So, try to find that balance, it’s never perfect. But like I said, the life partner choice is critical.

MODERN HEALTHCARE: Absolutely. You have an excellent partner. You know, your girls are seeing you be this rockstar. How do you take care of yourself? Are there any self-care tips that you follow to make sure you, by yourself, stay sane?

MANDY COHEN: Yeah. It’s a great question. And I’ll say, like, I’m not as good at this, right? Because if I’m gonna prioritize time, it’s gonna be with my girls. I’ll say work in progress. But one of the things that I have taken up in COVID is going for long walks outside by myself. So, even just that amount of time to just be alone, be outside, fresh air — just time to think and reflect — has been important for me. But it’s been a hard year to do that. And I am learning that, Kadesha, I wanna say that is one of things that I want to inject more into my life. There’s been times where I just said, I need to take this day off. I’m running on fumes. Lean on my team because they are fantastic. The work will continue, and you will come back refreshed.

MODERN HEALTHCARE: That’s right. Last question. So, for other women who have been in their careers for a while, they’re looking to become a senior leader at their organization or they want to transition into the health policy sphere — what would you have done differently, and what you advise them to do?

MANDY COHEN: What I would say first is, don’t be afraid. Be bold. And make sure to follow your gut. I’ve had a lot of great mentors and mentors are really important. But at the end of the day, listen to your intuition about where you want to go and what speaks to you. In terms of skill building, I really would advise everyone — no matter what role they want to take on in terms of leadership — communication skills are going to be incredibly, incredibly important. Written communication skills, verbal communication skills. Really finding opportunities to give speeches, to present at meetings — particularly executive-level meetings — in a concise, brief manner, so you can really get your point across. And tell folks what you need quickly.

And to find, again, those good mentors that can help you navigate space. And mentors are not always people decades ahead in your career. Sometimes, those mentors can be peers who are, sort of, going through things — maybe in slightly different industries or different spaces. I found a lot of really important girlfriends who don’t even work in healthcare, but we have similar types of experiences. And like, how do you build leadership skills? Because there’s so much that translates beyond the content area when you really get into leadership. It is about relationships and communication, transparency, focusing on values and vision and metrics and goals. So, I’ve learned a lot from fellow peers even in different industries.

MODERN HEALTHCARE: That’s excellent. Seeking out those opportunities to put yourself in that position to communicate to an audience. It’s practicing until you get comfortable with it because you’ll be doing it a lot if you step into a leadership position.

MANDY COHEN: That’s right.

MODERN HEALTHCARE: Thank you so much for your time. Thank you so much for your insight. We will be keeping an eye on you in North Carolina. And hoping that you get to take more long walks in the future.

MANDY COHEN: I hope for that, too. And I’ll listen to this podcast on one of those walks. So thanks, Kadesha, for having me.

OUTRO COMMENTS: Thank you, Dr. Mandy Cohen, for that amazing insight and very honest testimony.

As this “reset year” continues and people reevaluate their personal and professional priorities, we can expect to see people transitioning to new roles. For female physicians who are looking to take on administrative, C-suite, or political roles, the transition can be overwhelming. But it can be a little easier with the right strategy, outlook, and expectations.

I invite you to go to modernhealthcare.com and read Maria Castelucci’s May 25th report, outlining some of the measures that health systems have taken to help women — and all employees — deal with the personal and professional toll of COVID-19.

Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their growth goals through digital strategy and content.

And we’d also like to thank our sponsor, Ontrak. Ontrak is a behavioral healthcare company that identifies people who need more care and treats them for up to 52-weeks. With therapist-led care, members return to health. Payers get a return on investment.

Look for more episodes of Next Up at modernhealthcare.com/podcasts, or subscribe at Apple Podcasts, Google Podcasts, or your preferred podcatcher. Thank you so much for listening.