Over its 23 year history, the Commonwealth Fund Fellowship, along with California Endowment Scholars program and Joseph Henry Oral Health Fellowship, has a proven track record of creating physician/other health professional leaders; the Alumni Spotlight interviews showcase the expertise and dedication to care for vulnerable populations as a testament of that success. Interviews have been edited for length and clarity.
Anne Newland, MD, MPH (CFF '13)
Chief Executive Officer, North Country HealthCare, Flagstaff, AZ
Q. Could you please describe your current role in your organization and your journey to that role?
A. I’m the Chief Executive Officer for North Country HealthCare. North Country is a multi-site, federally qualified health center. Our main offices are here in Flagstaff, but we’ve got clinics all across northern Arizona—from Mojave County, which is on the California-Nevada border, all the way over to the New Mexico border.
Before the fellowship, I’d already been in clinical practice for a number of years. I’d worked for eight years with the Indian Health Service (IHS) in Kayenta, Arizona, and was in progressive leadership roles when I was in IHS. I was just a general medical officer, and then I was their chief-of-staff, and after that was named the Acting Clinical Director. That meant that I was over pharmacy and radiology, the lab, medical staff, etc. I got exposure to handling lots of different types of problems—everything from hiring people, firing people, dealing with a CMS complaint about a potential Emergency Medical Treatment & Labor Act violation—just lots of the nuts and bolts of the administrative part of medicine in a high-need community.
After the fellowship, I took a position with North Country and started as their Deputy Chief Medical Officer. When I thought I was going in for my 90-day evaluation with my boss, he told me that he had taken a job in San Francisco. So, within six months of starting at North Country, I became their Chief Medical Officer. But shortly after I became CMO, my CEO at the time announced she was planning to retire; she planned to retire within about two years of me taking the CMO position. They didn’t start the search until about a year out. I thought, do I really want to have another boss? Or should I put my hat in the ring for that? It was really contingent on me being able to bring on a couple other clinician leaders. That’s a hard background to find in medicine, somebody who is a competent physician/executive—when you’re not in a hospital system, oftentimes, we have to grow our own.
Q. How did your training prepare you for the job that you have? What areas have you identified for continued leadership and additional training in order to move forward to a leadership position at senior levels?
A. In all my roles, there was a lot of learning along the way. The Commonwealth Fund Fellowship was instrumental in my feeling that I could take on this role. It gave me a different grounding and perspective on working with community and leveraging partnerships.
One of the areas that I’ve been continuing to educate myself on is negotiation, just reading different books. And even this morning, I had a call with somebody that I knew was going to be contentious. But I find that if I prepare for those calls, they go much better. I have a rubric for how I prepare for certain calls. One of the books I read was Never Split the Difference. It’s by Chris Voss, who was an FBI hostage negotiator. It’s a good read, because he intersperses advice with some hostage situations. He gets you to think about: what questions can I ask that help open up the conversation, that help me get more information? And that really echoes what I learned from Dr. Joan Reede about asking questions. So many times, you go to a lecture, and people have the opportunity to ask questions, but they don’t actually ask questions; they usually present a position. But in asking questions, it’s very helpful to think very clearly about how you can get the information you need, or use those questions to confirm your understanding of the dynamic.
In terms of development, to go on to the next level—for me, the next level would probably be leaving North Country, and I’m not contemplating that at this time. I have wondered: do I want to do something different? Because, after I’ve been in something for seven years, I start getting that itch. But the role I’m in right now continues to be very challenging. There’s always something new, always something different to learn. So, right now, I think I’m where I need to be.
Q. What’s the best piece of leadership advice you’ve ever received?
A. That was from a woman I worked for when I was in college; she ran her own literary agency. Her name was Marlene Connor—the Connor Literary Agency. Her advice was, “Put down the blue pencil.” Because, back in the day, to edit a document you would mark it up with a blue pencil. She said that it’s really important for an editor to preserve the voice of the author. You’re not there to phrase things the way you would phrase them; it’s to help somebody else make their point more clearly. As a manager, my job is not to make a bunch of people into mini-Anne Newlands; it’s to help them be better versions or more articulate versions of the people they already are. How do I help them express what they want to express more effectively, or be more effective in getting work done?
Q. Could you tell us about a difficult decision you had to make as a leader?
A. One difficult decision was when I realized we didn’t have funding lined up for the family medicine residency program. There were some problems with the way the accreditation had been set up. This was before we launched the program. I had to make some staff changes, and then make a decision: Are we going to keep working on this project, or are we going to put it on the shelf? There’d been a lot of time and energy put into it, and there were a couple of consultants who actually recommended, “Oh, just withdraw your institutional accreditation, just withdraw the accreditation for the residency as well, and then go back at it.”
And I thought, I don’t have to withdraw the accreditation yet. I knew that the date was out there in the future, probably about nine or ten months. I thought, I’m just going to pour on the gas and really, really work on it: we’ve got this timeframe; let’s see what we can accomplish if we really put our shoulders to it—and we were able to get it done. Whereas, if I’d withdrawn the accreditation, I don’t think we would have launched the community-based family medicine residency program a couple of years ago with Teaching Health Center-Graduate Medical Education (THC-GME) funding. That’s going to be a game changer for northern Arizona.
It’s not something that’s got an impact just in my lifetime; that’s going to be generations of impact. We did a feasibility study to start a community-based psychiatry residency program. Our consultant who worked with us said, “Oh, there’s a long timeline on this. It might be seven years.” I’m not interested in the seven-year timeline. I’m interested in the twenty-year timeline, the forty-year timeline, the sixty-year timeline, to the point where I’m not even a memory.
Q. Can you describe your career goals?
A. My career goal is very simple. I want to change the world. Right? And the question is—how do you do that? Where’s the environment where you can do that effectively? I’m reminded regularly how deep and nuanced my network is here in northern Arizona. I’ve been here since approximately 2004, aside from the year I did the fellowship. I just know lots of people; I know lots of communities here. I have a lot more ability to affect change. Some of that’s directly related to my company; some of it’s more indirect, where I help and support other leaders—sometimes giving them a little advice, sometimes making an introduction, sometimes helping to bring people together to influence an issue.
I want there to be greater access to health care, particularly in this little corner of the world. I want to make sure that we’ve got high-quality docs serving high-need communities, particularly on the Navajo and Hopi reservation, because my deeper connections are Navajo and Hopi. And I know how hard it is to recruit the right clinicians for those environments.
Q. When you’re in a situation where stakeholders don’t share your values regarding health equity or social justice, how have you been able to move the needle to seek the outcomes that you’re after?
A. I’m thinking of a couple of situations where I had the opportunity to nominate some other people for leadership positions on a board. There was a board member with a more traditional medical background, who questioned the value of some of the folks that I recommended because they were community members, and not necessarily business owners or working in finance, and they certainly didn’t have a lot of healthcare depth. But I felt they offered a really important perspective. So, sometimes, what I can do most to help broaden the conversation is help make sure that people of diverse backgrounds are invited to the table.
A good example is working for, or volunteering for, the Flagstaff Shelter Services. I’ve served on their board for a number of years. I was president for a while, and now I’m trying to dial some of that back, partly to create space for other people to take those roles. But 60% of their clientele are Navajo or Hopi. There hasn’t been traditionally a lot of Native representation on the board. Now there are more members of the governing board who are Navajo or Hopi and who are connected to other service entities within the city of Flagstaff. That has led to more nuanced conversations about how services are delivered, and how to make sure that there’s greater equity in delivering those services. And it leverages the expertise of those individuals. One of the folks that was brought onto the board actually had worked for the shelter for a number of years. She has a lot of hands-on, firsthand experience working with people experiencing homelessness; and that’s beside all her other relevant experience.
Q. How does your personal narrative and your past experience influence your career progression?
A. I would say my personal experience is that in just about every environment I’ve been in—and this is since I was a young person—I’ve fallen into some leadership role. Not necessarily seeking out a ladder, but: what’s the next logical step from where I’ve been?
I also think my career choices have been affected by the fact that I’m gay. When I interviewed for residencies, for example, I made a decision that I wasn’t going to be out during those interviews. Because as a resident, you have a whole lot less power. There was one institution where I was asked a number of illegal questions about who I was with, who I was dating. But I’ve made decisions about where I want to work, where I feel like I can be authentically who I am, and be that way in a quiet, matter-of-fact, Midwestern way. So, I’ll be in the White Mountains in a really conservative environment —in, say, a heavily LDS community, for example—and somebody asks me, “Oh, what does your husband do?” I’ll say, “I don’t have a husband.” I’d be matter-of-fact, before we separated, about having a partner, and I’ll talk about my daughter. I’m able to be direct and matter-of-fact about who I am and who my family is.
Q. How do mentors play a role in your present life, and how have your mentorship relationships developed over time?
A. The mentors I’ve had just happened organically; it’s not like I sought certain folks out. Even now, when I’m puzzling through something challenging, there are people I’ll call and maybe we’ll have a cup of tea and talk things through. As you think through complex choices, it’s immensely helpful to be able to talk to people with different professional experiences, different life experiences.
Not every mentor is with you for all your life. Sometimes they’re there for a period of time where their expertise is relevant and then you move on; you learn something new and different, and then maybe you rely on somebody else for information. I’m thinking of somebody that I had a very close collaborative relationship with for a number of years, and then I outgrew that person.
Q. How do you balance policy work with professional responsibilities? Do you have any advice for others on keeping that balance?
A. I would say for me, the policy work that I’ve been involved with has all been directly related to my professional responsibilities. Here in Arizona, we assisted passing legislation to allow community health centers to receive Medicaid GME funding. Through the state of Arizona, and this most recent legislative session, we helped pass legislation around the 340B program, and to prevent clawbacks from pharmacy benefit managers. For me, I don’t have to make a choice about my other professional responsibilities and policy things, because a lot of the work I do, the policy issues can flow in naturally.
I think you’ll find, talking to other fellows, that many of them are still clinically active, and they’re pulled into those worlds. When I retired from clinical medicine in November of 2019, it was a hard decision to make, but one of the things Dr. Reede said to my cohort of fellows was, “You guys realize you’re going to have to give up clinical medicine sometime, right?” I know we all looked at each other, like, “No! How could we do that?”
But there also reaches a point where it’s really hard to do both. And even toward the end, when I’d really dialed back my clinical presence, I was still logging into the electronic health record—at least three times a week, every other day—to make sure phone notes were taken care of, and different requests. There was always this pull, and it was a relief when I finally let that go. Of course, then the pandemic happened. I was extra relieved that I hadn’t tried to maintain both during the pandemic, because I think it would have been much harder to give it up when our staffing was so, so thin.
Interview date: July 2022