Speaker 1: 00:01 You're listening to Intermountain Healthcare's Podcast Channel.
Dr. Anne Pendo: 00:07 Welcome to Intermountain Podcasts. I am Dr. Anne Pendo, the senior medical director for experience of caring, and that is responsibility for our patient experience and physician in APP experience. I am excited to share with you a conversation that we'll be having with my friend and colleague and partner, Dr. Donna Barhorst. Donna's a pediatrician and a leader in the Intermountain Medical Group and the Intermountain Healthcare as a system.
We wanted to really spend some time today in honor of women in medicine month, to get to know Donna better and understand how she moved from a pediatrician into leadership roles. Welcome, Donna.
Donna Barhorst: 00:59 Hi, how are you?
Dr. Anne Pendo: 01:00 I'm good, I'm good. We are doing this podcast late on a Friday night, so hopefully we will not decompensate during our time together. Anyway, I thought it would be really useful to have you share what prompted you to consider medicine, to consider pediatrics, and then Salt Lake city.
Donna Barhorst: 01:27 Okay, great. Well, I'm the first position in my family. I don't really have other family members who have been in medicine, other than an aunt who was a nurse. But I always enjoyed science and being active on those things, doing sort of first day, lifeguarding, those kinds of things all through like junior high, high school. When I first went to Baylor University, I thought it was going to do medical technology, and so I started in that to that path and was doing that. I was also volunteering as a CNA, not a CNA, sort of a nurse's help back then. It wasn't all the certification and stuff that's now. I realized that I was in all the premed classes with everyone else and I really, when I started learning and sort of the laboratory side of things, I thought, this isn't really what I want to do, because I really enjoy people, and being with people, and just interactions.
And so, I started thinking about medicine as a career. I think part of it is I never really thought that that was a possibility, but I had two really supportive parents and wonderful brothers and sisters that said go for it. I'm pretty much like a bulldog. If I start down into something, I pretty much finish it. So I started doing that. I also worked in nurse's aid for a couple of summers, and realized that that was really what I wanted to do. I was fortunate enough to get accepted to medical school the first
time around, and so I attended Texas Tech Health Science Center in Lubbock, Texas. It is geared towards primary care. That was why he was founded. Texas has, at that time, eight medical schools, and the whole purpose of Texas Tech was produce primary care physicians.
At that time, they split that first and second year everybody did in Lubbock, and then we went to a regional site for our clinical work, and I happened to go to El Paso. Which was a blessing, because it was a great clinical experience. I was able to really do a lot of things because there were residents but no fellows and a very big population of patients. As a student, I delivered 35 babies by myself with the resident in the other room kind of yelling into the room. That would never happen today, but it was a great experience. I really loved the hands on medicine. I've never looked back. It was definitely what I wanted to do, and I just enjoy taking care of people and kids.
When I was trying to decide what I wanted to do, I was kind of torn between the OBGYN, because I'd had such a great experience as a student, and pediatrics. Really everything I had ever done in terms of jobs or that kind of work was always with children or women, and so I knew I was in one of those fields, so I actually did electives in both things for my fourth year and kind of had to come to the conclusion. I happened to do a rotation in upstate New York at university of Rochester at Strong Memorial. Talk about happen chance, but I doubled my clinical rotation in Houston for outpatient pediatrics I met a nurse there.
We started talking and she had grown up in Rochester. I said, "Oh, I'm going to go do a rotation there for infectious disease," because it was at that time it was one of the strongest pediatric programs in the country. She goes, "Oh really? My mom is a works there. She's in the pediatric department." I'm like, "Oh great, that's great." She said, "I bet she'd let you stayed with her for that month." I'm like, "No, no, that's okay. I'm going to get housing and all that." She goes, "No, no, let me ask her." And so sure enough, she asked and she set this whole thing up that I would be able to stay with her mom and dad while I was there.
Well, two days before I am going to that rotation, I happened to open all the materials and I'm looking at it and I'm looking at the back. Her mother was the program director for the pediatric residency there. So I went to stay in their home for a month.
Dr. Anne Pendo: 05:58 You developed a tight relationship and she wrote you a lovely letter of recommend.
Donna Barhorst: 06:02 Oh, very tight. Yes, and I just fell in love with the area and that's where I ended up doing my residency. We had a very close relationship. She actually, she and her husband, they're quite characters. They've passed away now, but she was definitely one of my mentors, one of my role models for a physician, a woman physician with a family. Her husband was anesthesiologist. They had been very successful, had a successful marriage. She was like, "You can do all of this," kind of thing. But she was also a very strong leader. I ended up being a chief resident there and just really enjoyed it.
I also met my husband there and I always thought I'd go back to Texas after I finished my residency, but I met someone from New York who was never going to live in Texas, and loved the outdoors and the West, and so we moved West when we finished.
Dr. Anne Pendo: 07:03 I'm thinking about you in that doing that sub internship with someone who is really able to really kind of model for you what your life could be. Had you had opportunities to see your potential future in that way before?
Donna Barhorst: 07:26 Not really. I think my head was down and just trying to get through medical school. I didn't really love the first two years. I have dyslexia, so the amount of information to try to process in medical school was really challenging, those first two years. But as soon as I got to the clinicals, it was like this it, because my hands on I could really process it and remember, and it made sense to me. Just looking at pharmacology tables and trying to memorize stuff was just not. I almost quit, actually, in my second year because I was just like, "I can't do this." But my dad, who's my hero just said, "Yeah, you can do it. You just go take a shower, go take a walk, come back and try again." That's what he always, that's what he always did.
But yes, she was probably the first person I could see that did it. At the time, it was very unusual for her to be in the role she was in as a woman. Actually shortly after that, because I'm talking 30 years ago guys. I'm that generation. She, after that, I think it was probably within six years, we had our first women, a female department head there at Rochester, which was a big deal.
Dr. Anne Pendo: 08:44 Well, I know that when ... So yes, you are someone who when you put your mind to something you do it. Also I know from
working with you, your commitment to your patients and those you serve, whether it's in a leadership role or a patient care role. Your path to leadership was through your clinic and leading there. As I think about us in conversation and the audience listening, as you started in your practice, did leadership, was it something you sought out or did it come to you?
Donna Barhorst: 09:39 It came to me and I think part of it is at that time, the medical group was two years old when my husband and I joined Intermountain we. Were the first to employed pediatricians in the north part of the state. We started that practice, so it was just the two of us. We were on call every other night. It was just the two of us. There was other pediatricians in the community, but they did not have the greatest relationship with Intermountain and we were trying to kind of build some bridges and really build a a community and collaboration up there.
There was a third person who joined within a year, I think. At that time we had had Ask a Nurse, and we did have that service to help a little bit with the triage calls and stuff, which didn't make it unbearable. But literally when it came down to they needed a chief of the department of peds and we needed a clinic lead and we flipped a coin.
My husband said, "Okay, I'll be the chief and you do the clinic," because that was where we were in the path. I was actually the clinical aid for 13 years for a very long time, which I really enjoyed. But what that opened for me was the ability to go to the regional leadership council where I got to know people and understand how the organization worked, and also really got to meet senior leaders. Then I was on the board, medical group board, as an elected representative for three years, so I got to see that next level. I think that's probably why I decided to apply for the geographic medical director position when Dr. Muse decided to transition to st George.
Dr. Anne Pendo: 11:26 Yeah, I remember that really well. I was so happy that you were stepping into that role, not just because I thought you were going to be an excellent leader, but also because I felt that you were stepping into a role that a woman physician leader had not been in before. I was hoping that this was the beginning of something new. I don't know if you felt that?
Donna Barhorst: 12:01 I didn't as much, I guess. I don't know. I've always just thought about when the opportunity comes up. I've never stopped to
think, "Oh gosh, I'm a woman or not a woman." You know what I mean? I just go for it.
I think part of it is I didn't have a design on like a major plan that said, "Oh, someday I want to be the interim senior medical director." You know? It just wasn't the way my life unfolded. Most things for me have been great opportunities that present themselves, and if the timing is right, which is always part of that for my family and for myself or my husband, then I take that opportunity. Because I actually had the opportunity a little bit earlier to consider that role, but the timing wasn't right. My kids were young and I had a conversation with Dr. Leckman, and I said, "You know, I can't do it right now." But then sometime later the opportunity arose again in the timing was right.
My kids were kind of through high school, they're going to to college, and I felt like I had the bandwidth to be able to do that and still do some of my clinical work, which I wasn't at that time ready to do a lot less off, you know?
Dr. Anne Pendo: 12:01 Yeah.
Donna Barhorst: 13:17 Because I still really enjoy taking care of patients. I have one day of clinic now and sometimes it just doesn't feel like enough. But it's all good and it's a different kind of influence things and a different way of making an impact, which is really what my whole career has been about, just do some good in the world and let it spread out from there, and good stuff happens.
Dr. Anne Pendo: 13:46 I think about, so your commitment to when you make a decision, you jump in with both feet and don't give up. I think that that's been well-demonstrated in all of your different roles. I think about when you started in your pediatric leadership role. How did you figure out what to do first in that role and talk a little bit about, I know it's relatively new, but it for the service line, how did you figure out what the things you were going to work on first and maybe share an example of where that sits?
Donna Barhorst: 14:29 Sure. sure. The first thing I did was try to develop a really great team around me to help support the work. I was lucky to have a wonderful operations partner in Justin Oram, who was creative and energetic, and his brain does everything my brain doesn't do, and so together we made up a really good brain. We really had a great team. Then we selected some outstanding associate medical directors. I kind of first looked for who would be my operations partner that I knew would have sort of the skillset different than than mine, but also lots of energy, commitment,
and enthusiasm. It just has to be fun. You know? We spend so much time doing this, we need to enjoy it. I'd worked with Justin as in my role at the medical directors of the geography on my team up there as an ARU and we just always did great work. I had the experience having a wonderful team there, and I had seen how that synergy really makes a difference.
Then I thought about the structure and really trying to think about what do we really need to help organize these 104 pediatricians who are very geographically dispersed, who haven't always had the best voice or advocacy for general pediatrics. The clinical programs historically had really been specially based for peds, and we really needed a way to organize ourselves for the general pediatric world. The FTE for leadership was like a 0.1 to 10 physicians, so basically I tried to look at the whole area and divide it up equally so we'd have an equal cohort. I was lucky to really interview and find some outstanding associate medical directors who just are very committed people. That's Alexandra Barrera and Laura Steinberg, and just fabulous, hardworking, energetic, just really, really good to work with.
Then we had the medical sub specialties in the pediatric hospitalists that are smaller cohort, but have never really had a voice, so I sort of lobbied for an AMD creatively taking a position from the north and the south and mixing it up into a brew, and somehow got enough FTE to have a hospitalists AMD in Matt Steinfeld, who's wonderful. He helps in Utah Valley but also coordinates with the hospital step at McKay, and we're traveling next week down to Dixie to try to help start a pediatric hospitals program down there.
Then our medical subspecialists, we have five of them in Utah Valley, and we are having a lead role in that cohort now, which we've never had either. That's Dr. James Hoffman. I just was down orienting him. That's where I was down in Utah Valley. I felt like we needed the right people in the org structure to be able to raise the voice of the people doing the work, so that was the first thing.
So build a great team, look at your population, your cohort of folks, and decide what's the best way to build a structure to represent them. Then we got out and met everybody. We did an annual meeting in all the geographies, and we just talked to people. We did an annual professional conversation with all the pediatricians. I mean, we didn't get stood up until November, and we did it all between November and the end of the year.
Laura, myself, and Alexandra. But we met with all of the general pediatricians, and some of the hospitals, not all hospitalists, because we didn't have Matt in that role yet.
We got out and talk to people and really found out what issues were really causing them the barriers, the stones in your shoe, whatever they're called, the boulders in the pathway and the burrs under your saddle. I mean, all of those things. What are the things that make it hard to do their work every day?
I think one of the big things was that the after hours call burden for pediatricians can be really excessive, and in some practices in the winter, the phones turn at five, and then 30 plus calls in the evening. They felt like there was no balance. That discussion was going on the same time as we were talking about the full time FTE of 32 hours. Face to face hours. But the call didn't play into that, and so they felt like they had no balance and it was really burning folks out. We've been working really hard to get an RN triage process set worked out.
Fortuitously, we also realized that the NCQ a recognition requirement for 2020 needs us to do a different type of work for after hours calls, and so the stars kind of all aligned and we're going to be able to get that in place before the end of the year. We've just had one site up in Budge who had piloted it, and then one now at Altaview that's doing it. I think it's a real win for the service line, because it is something that is hard for the folks providing the care. We want to give that great care to our patients, but people need a balance in their life. I think that's one of the things I feel really good about that in our structure.
Then kind of the last thing I've been working on for really all of primary care is to try to get a clinic lead in each of the primary care settings. We've been working on this since about November. But we've gotten approval now, we're starting the interview process in all of our primary care sites. I mean, we're cohorting some of them because they're just not big enough, but to have a boots on the ground physician leader who knows the work, who can partner with the practice manager and the nurse coordinator, and really be the triad leadership on the ground in the clinics I think is going to do great things for our engagement and for our just efficiency. Then we can learn from each other.
Dr. Anne Pendo: 21:11 It sounds like you're creating the position that you had at your clinic kind of across the system to, you said, raise the voice of
the people who are doing the work every day. It sounds like that will-
Donna Barhorst: 21:28 Happen.
Dr. Anne Pendo: 21:29 Happen, yeah.
Donna Barhorst: 21:31 We're piloting that in primary care, and that's really a legacy of Dr. Jerry Gardener. He was the first medical director of the Weeber geography or region at that time and one of the first medical directors in the medical group. He set his region up that way from the beginning. He had a clinic lead in each of the sites, and we were the only region that was paying for some protected time. I had to go to bat and kind of argue it when I first became a geographic medical director, but we were the only ones doing that. But I had seen how it worked and it worked pretty well.
It's kind of, I don't know. My philosophy is you learn what's going on when you're heating your tomato soup up in the microwave. That's when you know those colleagues, you know what's happening in their lives. You can really have those conversations with them and you understand that work, then you can advocate for it and really help support the care that's being delivered.
Dr. Anne Pendo: 22:32 Yeah. One final comment is in medical school and residency, we are expected as physicians to have all the answers, to know everything. I was struck by your comment that when you stepped into the service line leader role, your very first thought was to gather a team around you. And so from that, I conclude that you are not a leader who feels like they need their success is linked with their subject matter expertise. Is that something that came from being a pediatrician, or from your family, or from an experience that shaped you? Because I think that as we step into these leadership roles, we have to shift from subject matter expert to team leader. That's a significant shift and it sounds like you've done that really well.
Donna Barhorst: 23:38 I think part of it is probably I was one of six kids, and I was the third, and so I was always the sort of collaborator. I think I'm a connector on the tilt, and so it's all about the people. I don't know where I learned that, but I guess I learned that multiple brains work better than one and we can come up with better solutions if we work together.
I really do believe that that's how we're going to be successful moving forward, because things are too fast and too quick, and you just don't know all the answers. Maybe I learned a long time ago. Actually from a family medicine doc, we worked on the reservation for four years, King and I did after residency in Chinley. There was a family physician there, is probably one of the best family docs that I've ever worked with.
I said something to him once. I said, "Isn't it hard to know everything about all of these things at the same time?" He said, "You know what? The biggest lesson I learned long time ago is to know what you know, and know what you don't know, and know when to ask for help." That is always stuck with me because that's really what it's about as a team, right? So Justin, and my new Justin Vorhees, who's taking the ops role now, is the same thing. He has that strength of the analytic brain and that operations brain that I don't have. I have a different skillset and together I think we can make it work. And so that's the exciting part about it.
Dr. Anne Pendo: 25:17 Yeah. I agree. That's exciting. Well, I think I want to end with summarizing your comments of know what you know, know what you don't know, know when to ask for help, and it's all about the people. Because I can, just from our working relationship and knowing how you care for your team and your patients, that that's the piece that really matters the most.
Donna Barhorst: 25:50 It does. Yeah.
Dr. Anne Pendo: 25:51 Thank you. Thank you for your leadership. Thank you for joining me on a Friday night late, and thank you and the audience for joining us. We appreciate you listening to our conversation.