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How I Got Here: Careers in Philanthropy LeadershipQ&A with Dr. Risa Lavizzo-Mourey, President and CEO, Robert Wood Johnson FoundationRisa Lavizzo-Mourey grew up with two parents who were also opinionated doctors that often brought work into their Seattle home. She followed their lead, and upon graduating from Harvard University, began teaching at the University of Pennsylvania. Her specialty: geriatrics. She later chaired several federal advisory committees including a White House task force on healthcare reform. Today she is the first African-American – and the first woman -- to head the Robert Wood Johnson Foundation, the largest philanthropy dedicated to health care in the U.S. Despite a full schedule, she also practices medicine at a community health clinic in New Jersey. Writer Dennis Nishi spoke with Dr. Lavizzo-Mourey about her career path. Edited excerpts follow.
Q: Your parents were doctors. What did they do and where did they practice? A: My mother was a pediatrician and my father was a surgeon and they practiced in Seattle in the 1950s and 1960s and into the early 1970s. Q: What was it like to grow up in that household? A: I grew up with a lot of dinner table conversations about health care and ways in which the system was inadequate for the needs of many of the patients they took care of. I also grew up with a real appreciation about just how wonderful and intimate the relationship is between a doctor and a patient was and the sense that this was a noble profession. Unlike many doctors today, they really liked their work. Q: Why did you choose to specialize in geriatrics? A: I had an interest in health policy and a realization that, as an academic physician, one of the things you're always looking to do is to have your clinical interests and your scholarly interests overlap and reinforce one another. So given an interest in health policy and the importance of Medicare in setting a national agenda for health policy, it made perfect sense to pursue geriatrics. And once I started working with older people, I realized how much I enjoyed the intellectual challenge of taking care of patients who have multiple, complex medical problems. Q: Then you went back for your M.B.A. Why did you see that as important? A: I decided to go back because I realized in order to be involved in health policy, you really had to understand more than the individual patient that we as physicians, are taught to think about. You really have to understand populations and how the environment influences the patients in front of you. And one way to do that is to pursue public health. And another way is to pursue economics and business and try to understand the statistical patient, the plural patient. So I chose to go to business school, and it's served me well because it has allowed me to see the ways in which business, clinical practice and health policy at the governmental level really do interact to influence how healthy people are and the kind of health care that they get. Q: You once had an incident with your daughter in an emergency room that has influenced you. What happened? A: I was much younger and had a two-year-old. I had just finished my residency and we had just moved to a new city. She developed a fever that went on for a few days and then got better. And then it returned again. After a sleepless night, I took her to the emergency room and was told, basically, that she was okay and that I shouldn't worry. I was persistent in demanding that someone else see her and that she get some additional tests. (Those tests) revealed that she had pneumonia. Q: Was it a turning point? A: That incident was certainly one where I came to appreciate how the interaction between a patient and family -- and the communication under times of stress -- were just not adequate and (I saw) the ways healthcare disparities can play out.
Q: Do you think the resident's dismissive behavior had anything to do with your race or the fact you're a woman? A: Well, if you look at the literature about how people tend to use shortcuts in their assessments of individuals, you can say (yes). But I think the issue here is more (about) what we need to do as a health care system to ensure everyone gets high quality care and that there's equality in the standards of care that people have access to. Q: I understand you want to bring back the house call. A: I think the house call is one of the ways I get an insight into the ways in which people live and the importance of environment in keeping people healthy. Q: You, yourself have made house calls. Do you still make them? A: I made house calls for ten years when I was at the University of Pennsylvania. In my current position, I don't really have that opportunity. I do a lot of traveling and it wouldn't be fair to patients. But I do continue to see patients at a clinic in New Jersey. Q: Did you gain any insight from home visits? A: One situation that gave me real insight into how the environment we live in affects our health in profound ways was a house call to an older patient. It was around holiday time and I was making frequent visits to make sure she was doing well. Older patients who live alone can become depressed. I noticed she was losing weight and there wasn't a good reason. She was getting Meals on Wheels but they only come once a day and don't provide any extras that you may need to keep your weight up. When I asked her about it, she didn't have a good reason why she was losing weight. So I asked to look in her refrigerator and saw it was empty. This woman had to rely on the system, she had no family to help her do things like go shopping. These are things we take for granted. Q: What successes have you had working at the foundation? A: I've been able to gain experience with government and clinical care and business. I realize there are few sectors that can do what philanthropy does, which is look at big problems, take a long term view, try to develop strategies for addressing the root causes and then go about solving them. And (it's also about) recruiting partners to solve those problems. So it is a proud moment when you can define a problem that way and make a commitment and begin to see a groundswell of activity towards addressing what has the potential to change the life trajectory of millions of kids. Q: You're one of the first African-Americans and first woman to head the foundation. How did you feel about breaking those barriers? A: I'm always proud and also really humble to be able to make those kinds of gains because I know that there were others in front of me who made it possible for me to do what I'm doing. And there's still work to be done. Q: Any advice for any minority women that would choose to follow your career path? A: Be persistent. Understand the ways in which your hard work is going to be necessary to achieve the goals that you want.
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Full name: Risa Lavizzo-Mourey 