Expanding Care for the Sickest: An Interview with Gary Gottlieb, MD

Clinical Innovators | Interview by Katlyn Nemani, MD

Gary L. Gottlieb, MD, MBA, served as president and CEO of Partners HealthCare, Massachusetts’ largest private employer and biggest health care provider, from January 2010, to March 2015. He recently became the CEO of Partners In Health, a Boston-based global health organization. After receiving his B.S. cum laude from the Rensselaer Polytechnic Institute, Dr. Gottlieb earned his MD from the Albany Medical College of Union University in a 6-year accelerated biomedical program. He completed his internship and residency, then served as Chief Resident at New York University/Bellevue Medical Center. Dr. Gottlieb also earned an MBA with distinction in health care administration from the University of Pennsylvania’s Wharton School of Business. In addition to his noteworthy academic, clinical, and management record, Dr. Gottlieb has published extensively in geriatric psychiatry and health care policy.

You have had a remarkably varied career—transitioning from a practicing psychiatrist to a national health care leader. Can you describe your journey?
I chose to train at Bellevue because I had an interest in caring for the patients with greatest need—patients with brain disease, with severe and persistent mental illness in the context of poverty, substance use, and medical risk. One of my mentors at Bellevue encouraged me to become a Robert Wood Johnson Foundation Clinical Scholar and I went to the University of Pennsylvania for the program. While I was a Clinical Scholar I earned an MBA in health care administration and was recruited to build Penn’s first program in Geriatric Psychiatry. I had the good fortune of being supported in learning how to manage and how to build programs from scratch in areas that I was passionate about, becoming Interim Chair of Psychiatry and Associate Dean for Managed Care of Penn’s Health System and then CEO of Friends Hospital.

In 1998, Partners HealthCare and its visionary CEO, Sam Thier, made a major commitment to invest in psychiatry and behavioral neuroscience when peer institutions were diminishing their investments in mental health. Sam recruited me to become chair of Partners Psychiatry, and gave me the opportunity to work with some of the greatest people in the field. From there I became President of North Shore Medical Center and, in 2002, President of Brigham and Women’s Hospital.

When I started at the Brigham, Victor Dzau, a brilliant cardiologist who was Chair of Medicine, was working with Paul Farmer to create a new division of global health equity in the Department of Medicine at the Brigham. Together with Howard Hiatt and Marshall Wolf, they developed a superb division and a global health residency program. I was swept away by their passion and vision and I had the privilege of supporting their work. We recruited Jim Kim back from the World Health Organization to become the chief of that division. Soon after, I joined the board of Partners In Health (PIH) and traveled to Rwanda and Haiti. Needless to say, I fell in love with Paul Farmer and Ophelia Dahl and the work that they were doing. I helped to continue supporting their work when I became the CEO of Partners HealthCare in 2010.

About 12 days after I started as the CEO of Partners HealthCare, one of the great tragedies of the western world occurred with the massive earthquake in Haiti. We already had people on the ground from PIH and the Brigham, and the Massachusetts General Hospital (MGH) immediately deployed its Disaster Management Assistance Team and assisted with the work of the USNS Comfort. My wife and I went down to Haiti in the weeks that followed. I saw first hand the kind of work that had inspired my career, trying to figure out how to bring the best and the brightest people to care for the sickest and the neediest populations.

At what point did you begin thinking about transitioning from CEO of Partners HealthCare to CEO of Partners In Health?
Well, last year as my 60th birthday approached, I was thinking about what opportunities might lay ahead and we heard that Ophelia Dahl was going to step down as Executive Director of PIH. A couple of fellow board members ultimately approached me to see if I might be interested in making this major shift in my life. I discussed it that night with my wife, who is my most powerful inspiration and is a much better person than I am (she has an endowed chair in public and community psychiatry at the MGH and is the director of the Kraft program for community health). She said, “You have to do this. This is why we became doctors.” So I made the decision to do it last fall.

And I believe you ended up transitioning earlier than expected?
Yes, for a couple of reasons. First, I was thrilled that Partners HealthCare found my successor, David Torchiana, a superb leader and, of course, a cardiac surgeon earlier than expected. Then, two of our PIH colleagues were infected with the Ebola virus—Sierra Leonean and American clinicians. There was a lot of work to be done with the CDC, the WHO, and ultimately the NIH to help our colleagues, so I started early to get involved with these efforts.

What was PIH’s response to the Ebola crisis?
PIH ran toward the fire. PIH stood up and said that this is a reflection of the lack of adequate health care systems in these countries. If adequate systems were functioning in Sierra Leone, Liberia and Guinea, this virus, which has been endemic in these areas for at least 30-40 years, would have been less likely to have created epidemic disease. While we do not ordinarily do emergency response, we were being asked by the governments of Sierra Leone and Liberia as well as the American government, the World Bank, and other funding agencies to get involved. We had our folks trained, created a supply chain, and our teams throughout the world ramped up a remarkable response. We’ve now made commitments to be in Sierra Leone and Liberia for at least the next decade, working in very poor, remote rural communities and supporting the Ministries of Health in rebuilding their health systems. And we’ve already started. I just got back from Sierra Leone and Liberia.

What are some of the current projects you are working on?
We’ve hired and trained a cadre of community health workers, which we believe is the most important technology in improving public health outcomes—these are people who live in communities, who are trained to do screening for critical diseases and to help with treatment of chronic illness. We have four basic strategic targets that are critical to us: ending maternal death, ending starvation for those under 5 years old, ending maternal-fetal transmission of HIV, and ending death from tuberculosis.

In Liberia, we just opened a renovated clinic in Maryland County, and we are working with the Ministry of Health to fortify the district hospital. We are deeply invested in work to enhance the full spectrum of human resources for health. There are challenges everywhere we work, but there are less than 50 practicing doctors in Liberia for four million people. That’s the equivalent of having eight doctors in Boston. We need doctors, nurses, pharmacists, administrators and others; it’s critical to the future of the wonderful people of that country.

In Sierra Leone, we are training hundreds of community health workers and rebuilding district hospitals while fortifying a wonderful health center established by a terrific partner organization. We are also deeply involved in supporting Ebola survivorship programs.

Partners In Health is a leader in sustainable development. What are the key components of your model?
First, we make a commitment to partnering with the Ministry of Health in each country where we work. This is challenging because each government is different and the stresses they face are unique. But we believe that the public sector is the best reflection of the communities we serve and the work we do is for the people. Every facility we build, every asset we create is for the government we are accompanying.
Our model is built on sustainability, on strengthening health systems in a way that will be perpetual. Community health workers, clinics, district hospitals, tertiary care centers, and human resources are all critical to this model. But we also must address the social determinants of health—we change roofs, rebuild homes, and address the food and water supply. We don’t have the resources to do all of those things as aggressively as we would like to, but they are part of the overall strategy and critical to the outcomes that we seek.

PIH has a number of priority programs in different areas of medicine. Do you have any that address cardiovascular health?
Like the rest of us, people in the poorest places are at risk for numerous noncommunicable diseases and they have become a critical focus of our work. Congestive heart failure, rheumatic heart disease, hypertension and diabetes are ubiquitous in many of these countries. These are deeply ignored areas in which resources have not been invested. One of our leaders in this area is Gene Bukhman, a cardiologist at the Brigham who just came back from living in Rwanda. Gene is a major thought leader and advocate and he is shaping our efforts globally.

People in these settings are also suffering with the psychiatric conditions associated with severe trauma and living in highly stressful environments. We cannot treat other disorders without offering psychiatric treatment as well, and I promise the cardiologists that this will improve their outcomes.

What are some of your goals with Partners In Health in the coming decade?
We need to achieve the four objectives I described [ending maternal death, ending starvation under 5, ending maternal-fetal transmission of HIV, and ending death from tuberculosis]. They are critical, and we are far from achieving these outcomes in all of the countries we serve, and they are the building blocks of a broader, high quality health care system. That requires a higher degree of programmatic strength and much more investment in our work from both the public and private sectors. We need to build human resources for health robustly. In this regard, we need to intensify our work with governments to create pipelines of superb people who will stay in country, with appropriate payment and retention. This is both a matter of social justice and will drive economic development. Additionally, we are about to embark on building a new medical school in rural Rwanda, starting with a master’s program beginning this fall. Hopefully, it will have its first class of medical students in 2018. We want to build on these dreams to ensure that the future of these places is stable and extraordinary. After all, PIH is truly an academic NGO, built through longstanding and terrific partnerships with the Brigham and Women’s Hospital and Harvard Medical School. That is an asset unequalled in this important work and it must be leveraged in everything that we do.

Learn more about Partners In Health at www.PIH.org.

Katlyn Nemani, MD, is a physician at New York University.

Keywords: CardioSource WorldNews, Brain Diseases, Geriatric Psychiatry, Mental Disorders, Mentors, Poverty, Psychiatry

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