When a child receives an autism diagnosis, the work has just begun. Parents are faced with a myriad of challenges, many of which may persist across the lifespan. Social skill deficits is one of the hallmark features of the disorder. This can impair a baby’s ability to give a social smile, or an adult’s ability to obtain and maintain meaningful employment.

Staffing crises have become endemic in healthcare. The costs go far beyond the financials, deeply affecting morale and patient care. Balancing patient needs, staff morale, equity, and future expectations is a challenging skill set. This project will describe a leadership journey through a staffing crisis, and highlight lessons learned.

am Director of Women’s Health for Eisner Health, an FQHC which provides physician and midwife care to 2000 birthing people annually at two safety net hospitals in Los Angeles. Local, statewide, and national data all show significant health disparities around maternal morbidity. The majority of maternal morbidity is secondary to the need for transfusion. Women who present to labor and delivery anemic are more likely to need transfusion.

Clinicians at Keck Medicine of USC are burned out due to the COVID 19 pandemic, competing demands on their time and insufficient support to achieve work life balance. This project was designed to establish a team-based care program at Keck Medicine of USC to reduce clinician and staff burnout in the Family Medicine Department. Burnout affects over 50% of physicians and nurses and leads to reduced access to care due to sick calls, reduced patient safety and lower quality of care.

In recent years, there has been increased focus on health equity, galvanized by events such as Black Lives Matter, and increased awareness of the porosity of borders during the COVID19 pandemic. In my role as faculty lead for DEI efforts within Stanford’s Division of Primary Care and Population Health (PCPH) as well as faculty lead for the division’s global health partnership in western Kenya, I realized that many of the challenges to health equity globally are at play domestically.

Problem: Currently, more than half of California kindergartners have experienced tooth decay, and by third grade, this number rises to over 70 percent. If left untreated, tooth decay effects children's overall health, social-emotional development, and academic performance.

Dental Decay is the most common chronic disease among school aged children. In fact, dental disease is more common than childhood asthma. By the time children go to school, 50% of them have already experienced tooth decay in California. As a result, children miss school, learn less, are in pain, or end up in the emergency room due to oral infections. Research, and reports support this position (California Children’s Report Card gave a C- for Oral Health Care in 2020). Treating decay in very young children is very challenging. The good news is that decay is a totally preventable disease.

Healthcare prices are hard to understand and navigate for patients and healthcare teams. Health care affordability (out-of-pocket patient costs) is a leading health care concern for Americans and a key voting issue. More than half of Americans worry about the availability and affordability of health care, and more than a quarter have delayed care because of high costs. I am passionate about this work after having a friend lose her life savings due to healthcare costs and my own family has faced large medical bills without guidance to navigate our healthcare system.

My project has been to create a physician leadership program called Site Medical Director University (SMD-U) at AltaMed Health Services, the largest Independent Federally Qualified Health Center in the nation. With clinics throughout Los Angeles and Orange counties, our current leadership structure consists of a Chief Medical Officer, 3 Regional Medical Directors, and 15 Site Medical Directors (SMDs) that oversee each clinic. Thus, the SMDs are the functional leaders supervising over 250 Providers.

Today, nearly 70% of healthcare providers are employed by large corporate entities. While there are benefits to large healthcare systems, providers in these organizations are feeling disengaged and disempowered due to the inability to effectively advocate for their patients or themselves. This lack of voice contributes to provider burnout, directly affecting the quality of care being delivered and physician attrition.