There is little argument that the level of specialized medicine has a profound impact on the care of Americans for both good and bad. The Family Practitioner is a generalist and aware of a patient’s overall health and habits as well as medical history.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Dorothy Gibbons.
Dorothy’s leadership has led to many firsts — she employed patient navigators when no one had heard of that terminology, established a 500+ member strong Physicians Network that provides pro-bono care for the uninsured; brought in the first truly portable and business adaptable Mobile Mammography units which now serves a 35 county area in Southeast Texas, created the Breast Health Collaborative of Texas, was the first female selected for the Community Health Leadership Award in 2008 by the Episcopal Health Charities, named Houston’s first “Fearless Woman” Awardee in 2011, was the first recipient of the Trekker Award, and her first national award was as Yoplait’s Breast Cancer Champion in 2012.
Her nonprofit experience involves healthcare, education and women’s issues. As a CEO, community leader, published author, wife, mother, yoga instructor, lecturer at the Jung Center, rancher, and advocate for women, her labels are many.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?
Poverty, family sickness, and the lack of healthcare were constant companions throughout my childhood. I have often wondered if that history prepared me for the work I do today.
At age 55, my father’s third heart attack left him jobless with no hope for future work. His solution was to abandon my uneducated mother to care for four children, the oldest, me, at ten years old and the youngest was nine months old. Mother’s family took us in, and we spent years moving from place to place. I watched my Mother slip deeper into mental illness and depression. She died of metastatic cancer in a charity hospital when I was 20 years old. Even though she knew something was wrong, working part-time meant no health coverage.
I remember holding her hand as she took her last breath and wondering what would have been different for her if she had had insurance.
At The Rose, my mother’s story is replayed daily. We care for women who have no money, no insurance, and they didn’t know what to do about the lump in their breast until somehow, they found The Rose.
While I am proud to be a Texan, we have nothing to brag about when it comes to the State’s healthcare for its poor citizens nor its attitude towards women’s health. Every day, I deal with the State’s health programs and the narrow-mindedness that perpetuates its limitations and failure. I’ve seen too many women die because access to health care for the uninsured does not exist. As a women’s advocate, I vow to continue to challenge this system and am committed to finding a better way.
Can you share the most interesting story that happened to you since you began your career?
There are so many stories but this one happened most recently. I needed to hire a new executive assistant and dreaded the whole idea of recruiting and training someone. On the first day the job was posted, I received a call from the very first assistant I ever had when I was a director at Bayshore Medical Center. That was Debra’s first job out of high school, and she was with me until I left the Medical Center to start The Rose. Over the years, we had lost touch, but I learned that she had been laid off from a job in Victoria due to COVID and had returned to Houston to be near her daughters. Imagine someone walking back into your life after 37 years. Someone who knew a younger, more adventurous person than the one you had become. It has been a delight having her back in my life and as before, she is the competent, efficient assistant any CEO would be pleased to have.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
We started The Rose by holding a Bachelors Auction. It was our first fundraiser and we sold every man we could convince or cajole to be a part of it. Its proceeds, a whopping 7,000 dollars, created the seed money to rent an office space that housed the donated 160,000 dollars mammography machine and opened our doors.
Today, when I tell people that we sold men to raise money to start The Rose, they look at me aghast. I remind them it was the 80’s and things like that happened. Whether or not this was a mistake, looking back, it was funny — ironic may be a better description, and taught me so much.
We didn’t have a clue what we were doing. Dixie was a physician with no business sense, I was a marketing director who knew nothing about healthcare delivery, and neither of us knew anything about nonprofits. Yet we forged ahead mainly because so many people helped and believed in what we were doing. It was years later before I realized what a miracle it is that The Rose survived. Not many nonprofits from that decade did.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
One of my favorites lately is this one: “I hope that all mankind will at length have reason and sense enough to settle their differences without cutting throats.” Benjamin Franklin.
Life is too short and our world too small these days; we must learn to live, work, and grow healthy together.
How would you define an “excellent healthcare provider”?
Such a being is undefinable and not limited to any one person’s description. As a physician once explained to his students, the difference between minor and major surgery is: “Minor is being done on someone else; major is the surgery being done on you.”
For a person suffering from painful kidney stones or a life-threatening heart attack, the excellent healthcare provider would be someone who has relived the suffering and put them back onto the road to health.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Too many to list but lately, Thomas Cahill’s series has been inspiring — knowing history only makes us better equipped to fashion the future.
Are you working on any exciting new projects now? How do you think that will help people?
We are currently launching a Mammogram to Medical Home program, led by a Nurse Practitioner who will serve as the referring physician for our uninsured patients. Next to financial costs, lack of insurance and transportation, another major barrier is that the woman who needs a mammogram must have a physician’s referral. For The Rose, this accounts for 1,500 women annually who call and want an appointment but do not have a physician. Some women have not seen a doctor in ten years or since their children were born. In the past, obtaining that referral meant the woman had to go to a community clinic or Federally Qualified Health Center, which for her meant another cost and additional time away from work. Many times, they simply gave up, deciding to wait until a later date. That decision often came too late, after their cancer had metastasized. The ultimate goal of this program is for our navigators to secure a medical home for all the uninsured women, providing them more than a mammogram and allowing them to have all the other services that are available to them within the community. Our new program will once again eliminate another barrier for uninsured women and mean access to care to life-saving services.
Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
This type of study has been conducted for almost a decade, and all continue to show that U.S. healthcare ranks at the bottom. In almost all measures, including access to care, administrative efficiency, equity, and health outcomes, the U.S. compares poorly relative to other industrialized wealthy countries. In fact, the only areas that the U.S. outperforms its peers is in preventive measures — it has one of the highest rates of breast cancer screening among women ages 50 to 69 and the second-highest rate (after the U.K.) of flu vaccinations among people age 65 and older.
The U.S. is the only nation among those high-income industrialized nations which does not provide national healthcare insurance. That probably says it all. As a “healthcare insider”, If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
A look at the top causes for the U.S. poor rankings also provides the possible solutions:
- Access to healthcare. At the top of the list is making healthcare services available to everyone. Until universal health coverage and access to care are resolved, all the health ‘education’ in the world won’t matter. When a person is sick, they shouldn’t have to decide between spending money on food or a doctor’s visit. Health is more than health insurance; it involves our nation utilizing and applying preventive measures, insisting on less stressful lifestyles, and embracing the basics: good nutrition, adequate exercise, and maintaining practices that promote overall well-being and good mental health. It’s difficult to stay healthy when one has to postpone treatment because they are worried about ending up in bankruptcy. Insurance coverage and a myriad of other situations, such as education, availability of medical services and engagement must come together to provide each patient a full spectrum of care. The only options for the uninsured are urgent care centers or public hospitals. Both are avenues that contribute to healthcare’s overall cost and ensure the patient receives limited or one-time, disease-specific care with little to no follow-up, all deteriorating the chances for building a healthy lifestyle. As a very famous Canadian physician once told me: in Canada, there are two healthcare plans-private and national health coverage; in the U.S., there are three: Private, public health, and none.
- Obesity. The U.S. has an obesity rate that is two times higher than the average of the other industrialized and wealthy countries. Two times!! Obesity creates the basis for poor health. The answer to decreasing the obesity rate does not lie in simply telling people ‘not’ to eat. Until we can also determine what is ‘wrong’ with the foods we do eat, what preservatives are causing the craving syndrome, why good nutrition and ample food are not synonymous and understanding that what we’ve been told was ‘good for us’ by authorities in the past has contributed to the obesity problem. This issue is not simply a matter of personal choice, but a result of everything ranging from how foods are grown to how they are marketed and what they cost. Quality food isn’t cheap, neither do most folks have the time to prepare food properly. The demands of life and working hours combine to eliminate sit-down, well-planned dinners. When twenty bucks can feed a family of four at the local fast-food place, the arguments for eating higher quality, more costly foods fall on deaf ears.
- Fewer physicians, especially family practitioners. There is little argument that the level of specialized medicine has a profound impact on the care of Americans for both good and bad. The Family Practitioner is a generalist and aware of a patient’s overall health and habits as well as medical history. If provided enough time to be with their patients, family practitioners could better guide health practices and be a positive impact on health outcomes. Americans visit a physician less often than people in other countries, partly because of the lack of general practitioners, partly because insurance plans control which physicians are ‘in network’ limiting the patient’s choice and mainly because way too many people lack insurance coverage and access to care.
- Overuse of technology for the wrong reasons. Americans are the highest users of expensive technologies. Studies conducted over the past decade continue to point to overuse of MRIs and specialized procedures, and still, our healthcare outcomes rank dead last. Hospitals and physicians are often torn between ordering all that is diagnostically available against the possibility of a costly medical liability claim due to a misdiagnosis. It’s difficult not to wonder how higher reimbursement for one service over another plays into these decisions.
- The current system and built-in fragmentation. Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths. Some of this resulted from the inefficiencies built into the system and the continuous tug of war antics between insurances and physicians/hospitals. How many people are discharged way too early due to the dictates of a medical insurance plan? They leave the hospital with less than adequate instruction about their follow-up care or more importantly, leave knowing they will have to make a choice on which of the three prescriptions they can afford. Invariably, without follow-up or the right medications, they end up being readmitted, usually too often and sometimes too late. The fragmentation of the overall healthcare system is another factor in its inefficiencies, from lack of coordination between scheduling and billing to the impossible burden placed on the patient to ‘carry’ their medical records from appointment to appointment. Without a correct medical and health history, few physicians are able to diagnose and provide treatment efficiently.
What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
At the end of the day, too many of these problems stem from poor policymaking. Like it or not, healthcare is one place that government involvement could benefit the largest number of people and make the most impact. We, Americans, pride ourselves on the free-market system determining the success of any company, but it has not worked in healthcare. Next to salaries, providing competitive benefits, such as health insurance, is the highest cost to any business.
Until physicians and hospitals are not reimbursed for the number and types of performed procedures but instead paid for keeping people healthy, costs will continue to spiral out of control, and we will be no healthier than we are today.
A goodly percentage of U.S. healthcare costs arises from horrific malpractice insurance rates and pharmaceutical costs that include expenses to cover the catastrophic failure of medication. It is so easy to yell SUE for the slightest missed diagnosis by a doctor or a totally unforeseen reaction to a drug.
Tort reform concerning physicians is now standard in 33 states. While some might argue it isn’t totally fair, it has done much to change the way malpractice claims are managed, and, to some degree, lessen the degree that lawsuits impact the system and drive up insurance costs.
That aside, I truly believe the interference and influence of insurance and drug companies are more of the issue. Insurance companies dictate care and try to take on the role of the doctor by approving or disallowing certain tests. Drug companies are now directly marketing to the public under the ruse of spreading awareness. Both unhinge the role of the physician, usurping their authority, and threaten the foundation of best practices in medical care.
Finally, we cannot ignore the importance of personal responsibility and people advocating for their own good health first by doing whatever is possible to stay healthy. But until access to quality healthcare is available to all and is equitable, I’ll save that thought for another article.
The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle?
The practice of having supplies and equipment arrive ‘just in time’ resulted in hospitals being poorly prepared to meet those initial needs of the pandemic. A failure of national leadership during a time it was most needed was the ultimate contributor to the mayhem that we lived through during those first months. Allowing public opinion to outweigh scientific facts was criminal. Decades of underfunding of our public health entities meant the infrastructure was totally inefficient and ill-prepared for a true health crisis. Take your pick: the lack of foresight despite repeated global concerns predicting the ‘next’ virus, the lack of true vision for the overall safety of the country, and miserable funding compacted by continual cuts in budget, on top of the blatant refusal to consider and value scientific findings — all added up. We are fortunate that there weren’t more deaths. One in three Americans lost a loved one from COVID; that is a statistic none of us should ever forget.
How do you think we can correct these issues moving forward?
The one thing COVID taught us is that we can make changes that directly impact health. A vaccine for one of the most contagious and deadliest of viruses was created in record time, and that it was quickly approved for use and made available to the public at large — all feats that in the past required years to complete!
Of lesser note, for the first time in decades, we did not experience a ‘Flu Season.’ Adopting a habit of washing hands and limiting physical contact have proven of value.
How do you think we can address the problem of physician shortages?
Why would anyone want to enter a profession that requires decades of education that costs a tremendous amount of money to end up with a median annual income of 206,500 dollars? Sure, some specialties earn more, a lot more, but nonetheless, family physicians don’t even make it to the top ten best-paid specialties. Add medical liability insurance and overhead costs, and it is little wonder that more and more physicians in private practice are becoming ‘employees’ of hospital systems. Some physicians would rather retire than have their decisions undermined by the bureaucracy of hospital administration. Others concede but struggle against feeling their authority is being systematically diminished.
Top that off with the fact that those willing to work as locum tenens can expect to earn30–50% more than a permanent position. Physicians may still be among the most respected professionals in the U.S., but that respect comes with a cost, especially when a physician’s compensation falls short of many other professions, including software programmer. Granted, the choice to become a physician isn’t about compensation alone, but life-work balance also ranks poorly. This profession is fraught with medical-legal challenges and boasts one of the highest suicide rates of all professions.
These and so many other factors contribute to the lack of interest in a medical career and the declining enrollment in medical training and have extinguished the dream of becoming a doctor.
How do you think we can address the issue of physician diversity?
The lack of physician diversity results from years of systemic racism, gender bias and the covert cultural mistrust of other nationalities, which if resolved would open the door to huge supplies of trained and experienced physicians. We must find real solutions to these longstanding issues, which continue to impact every area of our lives and threaten our ability to ever reach optimal health. That change could start within the medical community, and leadership for change must emerge for it to begin and be successful.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
We’ve lived for too long under the impression that general physical and mental/behavioral are different types of ‘health.’ Nothing could be farther from the truth. I remember a time when even those within the medical community scoffed at the term of integrated medicine. Concepts such as mindfulness and the whole person were viewed skeptically and often belittled. If we want to reach a state of true well-being, we must value general and mental health, ensure appropriate funding for both, and find ways to end the separation.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Obviously, my ‘movement’ would be in the U.S. healthcare arena. If anything, I think it would be breaking the paradigms that currently exist in the concept of we must “pay to be cured.” Health can’t be compared to any commodity, just as a dollar sign can’t determine the value of a human life. We, as human beings, could create care that comes from our village. And that village is not just our neighborhood, nor our town, our county or state, but as far as nations and planets can extend. Until the inhabitants of this world realize that there is no “them” and “us” and that we are but a single organism, currently all bleeding red when cut, and understand that as one element fails, we all fail, we will never rise above the intolerable situations we find ourselves in today. It mars every interaction between neighbors, countries, and continents, and I fear if left unattended, this attitude and fear will eventually reduce us to less than any animal that roams the countryside.
When asked about the first sign of civilization, anthropologist Margaret Mead said, “the first sign of civilization in an ancient culture was a femur (thighbone) that had been broken and then healed. Mead explained that in the animal kingdom if you break your leg, you die. You cannot run from danger, get to the river for a drink or hunt for food. You are meat for prowling beasts. No animal survives a broken leg long enough for the bone to heal. A broken femur that has healed is evidence that someone has taken time to stay with the one who fell, has bound up the wound, has carried the person to safety and has tended the person through recovery. Helping someone else through difficulty is where civilization starts. We are at our best when we serve others. Be civilized.”
How can our readers further follow your work online?
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.