Kate Goodrich, MD, MHS (Res'98) has taken a non-traditional career path as a physician and policy maker. Dr. Goodrich attended Rhodes College in Memphis, TN and Louisiana State University Medical Center in Shreveport, LA before coming to GW for her internal medicine residency training from 1995-1998. She completed a chief resident year from 1998-1999, and then stayed on as full-time faculty at GWU as a hospitalist physician, eventually rising to the level of Division Director of Hospital Medicine from 2005-2008. During her tenure as a full-time hospitalist, Dr. Goodrich received the residency program's Internal Medicine Faculty Member of the Year award three times. She founded the DC chapter of the Society of Hospital Medicine and served as its president for two years. Then, Dr. Goodrich's career took a new turn.
Dr. Goodrich left full-time clinical medicine to complete the Robert Wood Johnson Clinical Scholars Program at Yale University from 2008-2010. (Note: the RWJ program no longer exists and is now replaced by the National Clinician Scholars Program.) After this fellowship training, she launched a career in health policy at the federal level, which has included nearly a decade of public service and leadership. Dr. Goodrich's first foray into the Department of Health and Human Services was as a medical officer in the Office of the Assistant Secretary for Planning and Evaluation from 2010-2011. This was immediately followed by a one-year stint as senior adviser to the Center for Medicare and Medicaid Services (CMS) chief medical officer and the director of the Center for Clinical Standards and Quality (CCSQ). After three more years serving as the director of the Quality Measurement and Value-based Incentives Group within CCSQ, Dr. Goodrich took on the roles of those whom she previously advised, becoming director of the CCSQ and CMS Chief Medical Officer in 2015 – positions she holds to this day.
In her current roles, Dr. Goodrich and her team are responsible for over 20 quality measurement and value-based purchasing programs, including the Quality Payment Program establishing and enforcing the Federal health and safety standards for all healthcare facilities, and all coverage decisions for treatments and services for Medicare beneficiaries. Throughout her career, Dr. Goodrich has never stopped practicing clinical medicine. She continues to care for patients part-time as a hospitalist at GW.
We sat down for a phone interview with Dr. Goodrich.
JC: How did you choose GW for residency? Did any experiences at GW during residency or your chief year help you to plot your current career path?
KG: I came to GW because my fiancé at the time was in the Navy and was going at Bethesda Naval after medical school, so I looked at GW, Georgetown and University of Maryland for residency. It really came down to GW and Georgetown. Although Georgetown to me felt very academic, I wasn't 100% convinced I would have the patient care experiences that I wanted because I had come from LSU Shreveport, a place that was literally called a charity care hospital, and that's what I wanted in residency. So I chose GW, and I was glad to get the experiences there that I hoped for. I was at GW transitioning between my third year and chief year at the time they started the hospitalist program. It started off with three hospitalists who were only seeing GW Health Plan patients. It was really successful in bringing efficiency to patient care, so they expanded it to include seeing hospitalized patients of any GW PCPs. After my chief year, I was supposed to be one of Dr. Simon's ID fellows, but I pulled out of it to be a hospitalist, which he took very well and I was glad he didn't kill me! For several years it was me, Shirley Kalwaney and David Winn (who was my chief resident when I was an intern) for four years. There was a lot of support from leadership to make it work and that was exciting to me. Over time we expanded to nine hospitalists and started the PA Hospitalist program. I think our story is similar to other hospitalist programs in the country.
JC: Did you always know you wanted a career in health policy? What made you leave your full-time hospitalist position to get further training in the Robert Wood Johnson Clinical Scholars program?
KG: No, not in the least. I left my practice at GW in 2008 to try to become a rockstar researcher. That's why I did the RWJ Clinical Scholars Program - I wanted to be one of the few hospitalist health services researchers in the country. The RWJ program includes health services research training, which is what it is really focused on, but it has an equal emphasis on health policy and learning about health systems. Once I started there, I very quickly gravitated towards the health policy and health systems topics more than I did the research. While practicing as a hospitalist for 13 years, I had found myself overwhelmed with what we called “frequent flyers,” our patients' poor access to good healthcare, and the beginning of the opioid epidemic – which are the kinds of things you see so much as a hospitalist at GW. I realized I could have much more of an impact on these issues through a career in health policy and systems than as a researcher.
JC: You have a career not only in health policy and services but in leadership of large organizations. How did you prepare for a career in organizational leadership?
KG: I had a leadership role at GW as Division Director, but learning how to be a leader in that role was very much by the seat of my pants. I reached out to a handful of helpful mentors, like Dr. Richard Becker and Dr. Katalin Roth - and I made a lot of mistakes that I learned from. Part of the RWJ program involved leadership development. It was a course led by David Berg, who was an organizational psychologist. We learned about organizational psychology by talking through our own experiences as well as case studies on highly effective or ineffective organizations in different sectors, not just healthcare. I became very interested in organizational culture and leadership through that course.
I got to where I am now mostly because of mentorship and professional relationships I have had. I have had greater mentorship at CMS than I have ever had anywhere before. The main person who was my mentor is Dr. Patrick Conway. He is someone who is born to be a natural leader and a true change agent. I don't consider myself a natural. I learned so much from watching him, including watching him make mistakes and how he learned from that. I am still constantly learning how to lead well and actively seek out advice and input from people that I see across the agency who I think are outstanding leaders, including my current deputy. Even though she technically works for me, she is someone I go to in order to check myself, not just for policy for but for leadership and management advice all the time. The leadership here at CMS is unsurpassed in my view. In addition to being exceptional at running a complex regulatory agency, they really put a lot of time into developing themselves and developing others.
Many people at CMS also get an executive coach and the agency supports that. Everyone has said it's highly worthwhile and it's something I hope to do in the future. That's something you can do at any level, not just the executive level. I wish I had done it when I became Division Director- I think I would have been a better division director had I done that.
JC: You maintain clinical practice – how has this been a benefit and a barrier for your career?
KG: I see patients as a hospitalist at GWUH for two weeks per year and one weekend per month. I think it's been critical for me to continue seeing patients throughout the time I've been in government. First, I can literally walk into GW Hospital on the weekend and every time I get there, there is a new process I have to learn. Most are meant to be in service of patient experience and quality. One of the things under my purview is HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] and it has been fascinating to see the visible ways in which GW hospital is working to improve patient experience since part of their payment from CMS (and other payers) is tied to those scores. So I get to see up close the impact, both good and bad, of our policies.
One time, my former GW hospitalist colleague, Dr. Sian Spurney, told me there were three patients in the hospital who developed cellulitis after receiving the Pneumovax in-house. They discovered that it was due to a contaminated batch of the vaccine. When they reviewed the three cases, not a single one of those patients who got cellulitis, which prolonged their hospital stay, actually needed the vaccine. But they got it because the hospital had a policy that every person gets a flu shot and a Pneumovax to meet CMS measures. I brought that back to CMS because I don't think anyone here could have ever imagined how there could be a negative impact of that measure. But the measures change behavior not only on a personal level, but on a systems level. It struck me how important it was to keep practicing so I can understand the downstream impacts.
Second, I just need to feel like a doctor sometimes and that's important to me. Having said that, work-life balance is something I struggle with. Some of that is because I still work at GW, but some of it is that my CMS job is intense, it's 80 hours a week easily. I do just enough hospital work that although I may dread losing my free weekend beforehand, within 20 minutes of getting to the hospital, I'm totally energized and excited to start seeing patients.
Third, it gives me a lot of credibility here at CMS to be able to say that I'm a practicing hospitalist. CMS leadership strongly values the positions of physicians at CMS. They strongly believe that physicians here understand the policies and how they impact patients and providers much more than others in the organization. I do a lot of internal as well as external speaking and the fact that I still practice gives me a credibility that I wouldn't have otherwise across the board.
JC: Any words of advice for physicians who are interested in advocacy or health policy work?
KG: Networking is so important. The RWJ program has an unbelievable network. Taking advantage of the network around you is so critical, which I didn't understand until this all happened to me. One of the things I've learned is the importance of being a self-starter and just calling people. I think that was easier for me since I had been practicing for so long, so I was used to cold-calling people for consults. Calling consults and having difficult conversations with patients, families and colleagues taught me how to talk to people. My advice is to use the network you have at GW, including clinical faculty and the school of public health, to identify leaders and others in whatever field you are interested in and just call people and make an appointment to talk to them and hear from them. I cannot tell you how far that will get you! People like me who have alternative career paths are always very excited to talk to students and residents who are interested in that path. Most of us are here for a reason and are very excited we have the career that we do, so we are excited to smooth that path for others. So find out what your network is locally, but also do some research about who around the country is working in your area of interest. People are always happy to answer calls and you will rarely if ever be turned down.