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.
Associate Professor, Pediatrics-Cardiology, Baylor College of Medicine; Pediatric Cardiologist, Texas Children's Hospital, Houston, TX
Q: Can you describe your current role in your organization?
A: I am an Associate Professor in the department of Pediatric Cardiology. I'm the Director of Cardiology Transition Medicine Program and the chair of the Scholarship Oversight Committee, which oversees all fellow research in pediatric cardiology. Outside of my own department, I’m part of several diversity and inclusion groups: I’m a Diversity and Inclusion Ambassador to Baylor College of Medicine, which is our partner hospital on the adult medicine side, I am on the Diversity and Inclusion Executive Steering Committee at Texas Children's Hospital (TCH), and I am on the DEI committee as well as a faculty-at-large member of the TCH Medical Executive Committee. Currently, the largest percentage of my time is spent doing research. I am NIH-funded with a K23 early-career grant to improve transitions of care from pediatric to adult care by using mobile app technology. So, a lot of my time is spent in research on health disparities and health equity efforts. I also have clinical time and do teaching for the cardiology fellows when I’m on clinical cardiology service in the ICU. The last part is I'm an advanced imager in pediatric cardiology. I perform and teach fetal echocardiogram and transesophageal echocardiograms in the operating room.
Q: That’s a lot of hats you wear! Can you tell us about your journey to these roles? How did your training prepare you for the job you have? What training, if any, was missing?
A: When I applied to the Commonwealth Fund Fellowship, I didn't know how much the program would apply to my future career. I wasn't a cardiologist then, and I didn't know how I would apply training from the fellowship to my subspecialty where I worked with patients born with heart problems (congenital heart disease). I learned that there were a lot more applications of public health in my subspecialty than I realized when I was training back in 2007. And that has really increased a lot over time. I had no idea that my public health training would be so well suited for subspecialty care. Most people think about public health in terms of prevention—obesity, hypertension, diabetes. So, I was told, “Well, you can't go into pediatric cardiology. If you want to do public health, you can't do that unless you want to work on obesity.” At the time, I didn't know any better. However, it turns out that my training prepared me to do a lot more than I thought possible. I now take the public health and epidemiological principles I learned, and I apply them to congenital heart disease, which, as far as we know, is largely not preventable.
If there was anything that I'd say that was missing, it would probably be that I wish I’d had more training in biostatistics. People would say, “Oh, you have a public health degree, so you must know a lot about stats.” And I was like, whoa, whoa, I was largely trained in health policy! I had a four-week biostatistics course during my Commonwealth Fund Fellowship, and I was kind of annoyed that I had to take it, not realizing the importance of it at the time. Resultantly, I had to get more formal training in biostatistics. Compared to other people who, you know, have an MPH in biostatistics, I was just embarrassed at my knowledge level, and at some point, I was like, “I gotta get it together!” The other thing, in terms of training I wish I’d had, would be how to use the software for mining large databases. I think that would have been helpful—SAS training, SPSS training, anything that we use to run all these big data sets.
Q: Can you tell us a little bit about your leadership style, or about any leadership advice you’ve received that has really stuck with you over the years?
A: That last part I can answer straight away because it came from Dr. Joan Reede. It's amazing how I have heard her over the years, like a little person sitting on my shoulder. There have been so many times where I hear her words and felt like I must to rise to the occasion. When I have to “represent” because I'm the only one in the room who is an underrepresented minority, or I'm the only person who is going to advocate for minority populations in the room. It doesn't help to have a seat at the table if all you're gonna do is fill the seat. And so the best advice she ever gave me was, “You need to get a seat at the table, and once you do, don’t just sit there.” I remember this—it plays like a broken record in my brain because I hear it all the time.
The second piece of advice that I learned from her was: never come without data to a meeting or to large gathering where you’re going to have to make decisions. Ever. As a woman, if you don’t have data, then all you are perceived as is “an emotional female.” Of course, she said that not only because I'm a woman, but also because I am an underrepresented minority. And I remember that vividly because I have used it in many academic contexts. This has directly influenced my leadership style. I'm a pretty straight shooter—I tend to be very matter of fact and open about what I think, but I never come without data. I remember Dr. Reede’s words and it has proven to be one of the best pieces of advice I've ever received. Statements like, “Well, it's just not fair!” may be true, but they come off sounding hyper-emotional. This stereotype and perception of women as “overly emotional” may be further propagated and enhanced if they don't come to the table with data. And so those two pieces of advice, I think, are the ones that I have honestly lived by and that have really helped me grow in leadership.
The other piece of my leadership style is that I tend to infuse humor. I tend to use humor in a lot of ways—as appropriate, of course. But humor is a part of how I break up tension. It is something that I'm relatively good at, and I can use it because people know that that's my personality. I tend to be able to get my point across, without making an awkward situation worse, and am usually able to diffuse it, if you will, with humor. Half of the message you deliver—and I teach my fellows this all the time—is how you deliver it. So, I use humor, but I use it selectively.
Q: When you’re in a situation where stakeholders do not share the same values regarding health equity or social justice, how have you been able to move the needle to seek the outcomes you wish?
A: To date in academic medicine, most diversity and inclusion efforts are voluntary. All of them essentially are voluntary at our institution, which is fine because there are a lot of us who volunteer, but none of that actually counts towards promotion or payment. And when things are all voluntary, it's a part of the minority tax that that comes along with being an underrepresented minority in academic medicine. And I find that to be frustrating, when other areas are counted, like Quality Improvement. Clearly QI is important, but DEI efforts are as well, and if the administration or leadership really want to value this area, then they need to show that by actually counting it towards academic promotion or FTE (work time that you're paid for). And so, in my work performance review, where they asked, “What can we do better as a department?”—I wrote what they could do better if leadership and administration took DEI efforts seriously, by paying people for their time or having efforts count towards promotion. Because otherwise, it’s a nice idea, but it works against minority faculty retention, which doesn’t actually get at the values you claim to have. My review was not very well received by my boss, because he felt that my critique was unfair, and he said, “I'm always supporting you. I'm always promoting you.” I said, “yes, you are—but with no protected time to do the work and with no activities that formally count towards promotion. I want this to count towards something because if you really want to move the needle on equity, you have to give people the tools and the time.” Now, at our institution, a few of us are given a small percentage of FTE for DEI efforts. I want to move the needle on getting protected time to do work in DEI that helps patients, helps recruit underrepresented minorities to residency and fellowship programs, and helps minority faculty retention as well.
Q: How have your personal narrative and your past experiences influenced the progression of your career?
A: I always knew that I needed to do more than see patients daily in a clinic. I couldn't articulate why that was, but I just knew it was true for me, and I felt like there are so few Latinos that make it this far, I had to do more. Only 6% of doctors in the US are Latinos, and only 40% of those are women. Those numbers are even fewer in academic medicine, and even fewer in subspecialty fields. So, I knew that based on my level of training, I was this unicorn, and I thought, “I have to do something more.” It’s not even a “want to,” it’s “have to.” I have to take broader steps to affect the lives of more numbers of people, and that helps reduce the inequities that affected my own family. My parents are immigrants. My dad's English is limited, and I've seen some of the results of how it plays out in his medical care. So, I knew that to be an advocate for Latino populations in particular, I would need to effect change on a broader platform.
And so, that was already the seed that was planted in my head. And then, of course, when I saw the opportunity to pursue a public health degree at Harvard, I felt, “Well, this sounds interesting.” And I hadn’t really heard of public health or even epidemiology prior to that moment. No one in my family here in the US is a doctor or in healthcare. I just wasn’t exposed to public health in med school. And then, of course, when I started public health school, every day was mind blowing. “Why didn’t anyone teach us this in med school?” I would often wonder. Thankfully, nowadays there is much more training in terms of public health principles in medical education. To date, the Commonwealth Fund Fellows program at the Harvard T.H. Chan School of Public Health was the single most influential training I’ve ever had. It was a life changer and game changer—what I learned changed everything for me. So much so that while I was in the program, I thought, “you know what, I don’t think I’m going to do cardiology anymore. I want to do public health!” and called the cardiology program to tell them. Thankfully, the program director, Steve Neish, said, “You know, you can apply the public health principles you’ve learned to impact pediatric cardiology.” And at this time, we were just beginning to do that in pediatric cardiology.
As public health in pediatric cardiology progressed over time, I decided that I needed to focus on health disparities within pediatric cardiology. Whatever applied to pediatric cardiology in terms of health equity and health disparities, I said, “I’m interested.” So now, I am generally known in pediatric cardiology as the health disparities person in my field, ranging from prenatal care to transitioning from pediatric to adult care. Many areas where there are poorer outcomes tend to disproportionately affect minority populations.
All of this has melded together starting from the desire to affect the care of a larger swath of the population, to my medical training to my public health degree, which has influenced how I’ve moved forward, how I’ve created my narrative, and what I’ve decided to focus on. The work I am currently doing is the most rewarding thing ever, because my research can impact health policies that have the potential to impact so many more people. And now I’ve been able to influence fellows and trainees to do health disparities research, which is also very rewarding. So really, without that training in the fellowship program, none of this would have happened. I feel indebted and forever grateful for it for changing the trajectory of my career.
Q: How do you balance policy work and professional responsibilities? Do you have any advice for others on keeping the balance?
A: I initially struggled with that. But I do have a few pieces of advice.
First, seek out mentors who have demonstrated similar visions/aspirations. The beauty of our network of alumni from the fellowship is that there was one physician, Dr. Jean Raphael, who was an alumnus before me—probably about three years ahead of me. He was already at Texas Children’s when I arrived, and he’s an academic pediatrician. So, I reached out to him, and since then, he’s been one of the biggest mentors and sponsors in my experience at Texas Children’s. He started the Child Health Policy Center here and I’ve been a part of that from the very beginning. I have a grant in food insecurity—he’s on it. He’s working on diversity and inclusion efforts for US News and World Report—I’m on those efforts. The two of us are synergistically working toward the same goal. So, I rode on his coattails and he helped reengage me in policy efforts.
Second, look for opportunities in health policy in and out of your field. When I finished the fellowship program in minority health policy, I started a cardiology fellowship, and was soon drowning in clinical work. I had no time for policy or advocacy because I was just learning to be a cardiologist. I was very scared that the window to do policy work was going to close, and that I would not have the opportunity to do policy in general. I was especially concerned about working on health policy while being a subspecialist—could I still influence policy? You hear about the pediatrician or the internal medicine doctor or the ER doctor who is a policy expert, but my impression was that it seemed to be rarer for subspecialists. But if you believe in something, you have to pursue it, even if you’re really busy. You have to say, “this is important enough, I’ve just got to fit it in and work it out.” So, because of the work I had done at the Health Policy Center and in health disparities research with Latinos, and sponsorship from a Latina (Rosie Valadez-Mcstay) at Texas Children’s, I received an invitation from the Mayor of Houston to be on his Covid Health Equity Response Task Force. I was the only Latina physician and Spanish speaker on the task force and was able to use some of my policy background to influence messaging for Latino populations in Houston. So, the balancing act here ended up being seeing an opportunity and saying, “Boy, I do not have time for this. But also—this is so important. I can’t say no. I’m the only one.”
Third, remember that part of keeping the balance involves merging interests, which may lead to bigger opportunities. A recent example reminded me that you can say “no” to some things, but don’t say “no” to everything, even if you’re busy. Choose wisely, because some potential “no’s” open other doors for other opportunities which you didn't even know existed. My example is speaking at the NPC-QIC, which is a Quality Initiative for patients who have half of a heart (hypoplastic left heart syndrome), at one of their conferences on health equity. I didn’t have a ton of extra time to give talks at that time, but decided I had to do it because it had to do with health equity in CHD. The person who opened up the session was the president of the American Board of Pediatrics. He gave a talk about the landmark work that's been done in disparities in congenital heart disease, and one of the papers cited was one of mine. There was a woman on this call who heard the entire exchange and subsequently heard my talk, and then reached out to me and said, “I heard your talk and I thought you had really, really important things to say. There's this fellowship award in QI through the American Board of Pediatrics—their focus this year is health equity, and I think you should apply for it.” And when I said, “but I’m not formally trained as a Quality Improvement person,” she said, “A lot of the disparities work that you do is QI, you just don’t call it that.” So, I looked at the opportunity and saw that recipients of the Paul V. Miles fellowship go to the American Board of Pediatrics (the entity that board-certifies pediatricians and updates and maintains their certifications) and provide expertise to help them decide how they’re going to train future pediatricians in various aspects of improving quality of care. I didn’t think I had a shot, especially as a subspecialist—as a pediatric cardiologist. A few months after I applied, I found out I was their selected fellow, because of the work that I’ve done in health equity and health disparities, and projects I’m undertaking in transitions of care, educating non-English speaking populations, etc. They said, “We would like you to come to the American Board of Pediatrics and teach us what you know about health equity so that we can infuse this into the training for current and future pediatricians.” As a pediatrician, I have to tell you, there may not be any other more gratifying award that I have ever received than that one, because the policy implications of that award are so profound. I just can't believe I have this opportunity. I'm so humbled and excited about it.
Q: Is there anything you want to add?
A: You can't underestimate the importance of sponsorship. Mentorship is important. Sponsorship is almost as—if not more—important, and I didn't understand that nuance in the beginning of my career, because I didn't understand what sponsorship was. If someone sponsors you, they are promoting you and bringing you up and helping you move into more leadership positions. You then you owe it to others to be their sponsor as well. If you're given the opportunity to be in a leadership position, then sponsoring others—not just mentoring but sponsoring—is critically important.
The one other thing I'll add is the fact that this network of Commonwealth Fund Fellowship alumni is the best thing since sliced bread! I learn so much from this group and feel that the collective impact is immeasurable!