Changing your lens on healthcare and community health, with Dr. Sarah Hoehnen, DO

hosted by:

In this episode, Sujani sits down with Dr. Sarah Hoehnen, an infectious disease physician who is passionate about improving health systems. They discuss what drew Sarah to community health, her experience with leadership and expanding her work to include medical administration, and what Sarah has learned about marrying healthcare with other public health services.

What You’ll Learn from this Episode:

  • How a medical school rotation drew Sarah into public health
    • What made Sarah interested in social systems and the way they impact health
  • How western healthcare systems differ from others around the world and what we could learn from them
  • How we can start changing systems to better connect individual clinical care to the health of the community
  • The value of playing to your own strengths and perspectives in healthcare
  • Sarah’s experience transitioning from a clinical role to a directorial/management role
    • Why it’s important for Sarah to continue her clinical work along with her administrative work
    • The biggest challenges Sarah has come across in her experience working on both sides
    • What additional training Sarah has gone through or considered to succeed in her administrative role
  • Ways to successfully lead a team and have everyone work in their own zones of genius

Today’s Guest:

Dr. Sarah Hoehnen is a practicing infectious disease physician who is passionate about improving access to infectious disease screening, treatment, and prevention through integrated care and harm reduction models. Dr. Hoehnen partners with behavioral health and primary care providers to implement innovative systems of care that improve patient outcomes.

Featured on the Show:

Episode Transcript

Sarah 0:00
There’s something about this poll towards systems based thinking and thinking about how we structure healthcare to better serve that just continuously kind of pulls me forward in that direction. So I, I’m trying to listen to that. And when I do have opportunities to have more system influence, or to kind of work in a way that allows us to change or improve or be innovative or creative about how we’re delivering health care, that’s a space I want to move towards.

Sujani 0:34
Welcome to PH SPOTlight, a community for you to build your public health career with. Join Us Weekly right here. And I’ll be here too, your host Sujani Siva, from PH SPOT.

Hi, Sarah, and welcome to the PH SPOT podcast. So wonderful to be able to chat with you about your career journey in public health.

Sarah 0:58
Thank you so much for having me.

Sujani 1:00
Awesome. So one of the best questions, you know, I have for my guests, and my one of my favorite ones is kind of their discovery of the field of public health. Because at least when I went to school, it wasn’t a super popular one. I know a lot of my family members and friends were like, Oh, what is that that you’re doing? And even for myself, I think I had intentionally kind of gone down that road of researching into epidemiology because a friend of mine had mentioned it. And I had taken an elective course. So my discovery has been super accidental. And so I’m curious to hear how you discovered the field of public health. And at what point you ended up thinking, you know, maybe I could build a career in this field?

Sarah 1:45
Sure, yeah, I had a pretty circuitous route to public health. So I’m a physician. And I wanted to be a physician for a long time, as many of us did, even as a child, that was a pursuit that I was interested in. And I thought that I wanted to go into the field of developmental pediatrics working with kids with special needs and developmental needs. That was an area that I really loved and enjoyed. And that was the education that I pursued when I was an undergraduate. And it was also the focus of my research at that time. And I went to medical school, and I had never really traveled or seen the world or experienced other cultures. And I wanted that opportunity. And it was something that was afforded to me to do it like an international clinical rotation. And I thought, what a great opportunity for me to just to learn more, and it kind of opened my- my mind, which I felt like was very important, as a person who was going to be providing health care. So I went on an international rotation to South Africa, this was in the early 2000s. And the HIV epidemic in South Africa was at a critical point, there was not a lot of access to medication. And people were suffering greatly. And I witnessed just a part of life and a part of our reality that I hadn’t known before. And it just immediately drew me in as a place that I could fit. And I ended up going back for a year, I ended up doing a fellowship through the Fogarty International Center, and I worked with mothers and children with HIV in South Africa. And this was again like mid 2000s. And at that point, that’s what I knew I was going to do, I was just very intrigued by the relationship of social and political dynamics and how that interacted with disease. That’s been something that’s continued to fascinate me and drive me throughout my career.

Sujani 3:57
So when you’re heading off to South Africa, that first I suppose rotation, were you still kind of interested in developmental pediatrics? And is that what you were hoping you might get more experience in? Or were you open to just exploring other areas of medicine, I suppose?

Sarah 4:16
I think I just wanted to explore I mean, it was really an opportunity for me just to learn and I think I understood even at that young age, that there was so much that I still needed to learn not not only about medicine, but just about the world and about people medicine is such a people driven pursuit, and I knew that there were so many gaps in my knowledge, and I wanted to just take in as much as I could. So you know, that was kind of the motivator. And actually, the neurodevelopmental interest remained. And when I was in South Africa for the year, my research project was actually looking at neurodevelopment in children who were impacted by HIV. So that kind of thread remained, but it just it transitioned and it turned into something a little bit different than what I could have imagined before. And I think that was just because my perspective was so limited.

Sujani 5:06
And I suppose, you know, during medical school, you’re exposed to, you know, public health as a concept. Is that something that you were intrigued by before going on the rotation to South Africa? And had you even considered perhaps, you know, I might be a physician who’s focused more on public health, rather than maybe like bedside treatment? Or is that you know, something that you were still not sure about, even as you were leaving for the rotation.

Sarah 5:36
I think it was something I was starting to consider it. You know, as I learned, I started to recognize how connected medicine is with other things and it wasn’t so narrow, as one might hope, you know, that you could just go in and treat an individual and, you know, somehow impact things in a greater way, I feel that in order to have impact, you really have to look at things on both a small scale and large scale. And I think that that’s something that right now, in many ways we lack as a healthcare society, we have people who take kind of the broad view, and we have people who take the narrow view. But there are a few people who are really able to kind of look at things in both ways. And I think that that ability to change your lens is actually essential for us to move forward and do things in a big way.

Sujani 6:28
I’m not sure you know, how your training was at the University that you kind of did medical school, but it based on some of the limited conversations I’ve had with peers who did pursue medical school, it sounds like public health is kind of just this one off course, during their training. And it’s really on the individual to dig into it a bit more and perhaps even find rotations like you did. So curious to hear for, you know, any of our listeners who may be training to be a clinician, whether that’s in medicine, or nursing, or dentistry, what’s some advice that you’d have for them, just so that they think about that bigger picture and kind of see how their work, whether they do choose to be kind of on the clinical side. Yeah, they’re more aware of how their day to day kind of work with their patients does translate into impact into into that bigger picture?

Sarah 7:24
I think that’s a great question. And my advice would actually be to listen more than you speak. And just to keep an open mind, I think that’s so important, especially for clinicians who are trained in a different way, clinical medicine, whether it’s, it’s nursing, or physicians or other providers is very hierarchical, and you kind of learn things in a very black and white way. And then when you- you get out there, you realize that everything’s gray. So this ability to really learn, you know, I think a lot of folks, when they hear about you going and doing international work, people think, Oh, you’re helping folks who really need help, I learned phenomenally more from the people that I was working with internationally than than I could have ever brought. A lot of the concepts that I carry with me now, because I’m kind of half in clinical world and half in more of an administrative space, or a healthcare leadership space. A lot of what I’ve learned, and a lot of concepts I bring to that work are from what I learned internationally. And it’s actually that we can do things in a different way than what’s described currently in kind of modern medicine in the US or in the Western world. And that those ways can be effective, and that those ways can be really more effective for taking care of communities and for approaching big problems, like pandemics and big public health emergencies. That perspective is has been invaluable to me. So it’s really having an open mind and appreciating what you can learn as well as what you can bring to the table.

Sujani 8:56
Absolutely. I think yeah, just kind of stepping away from thinking I’m treating this individual who’s my patient and changing that perspective to say like, what can I learn from them? And I think, yeah, just always trying to connect that individual back to the larger picture. And we’re all part of this huge system.

Sarah 9:14
Yeah, and I think system based thinking is something that’s really important. Now, as we’re seeing a lot of the disparities in care, in medicine and just in the world, we’re seeing that there are a lot of disparities in the way that our systems serve people and the healthcare system is included in that. So how do we do better at kind of approaching our systems, and a lot of that then drills down to well, how do we do better as approaching the individual? And how do we change our mindset? And I think that those things are so interconnected. I always say like, the the little things are the big things. And a lot of the stuff I say now like I’ve learned from making my own mistakes or from wishing I would have done things differently, you know, years ago, but when that person that’s taking care of somebody at the bedside, you know, the way that they deliver that care and the perspective that they have in that care delivery, if that’s how everyone around you is operating, that creates a system. So the small stuff, the individual care, that individual bedside care, and the big stuff, it all goes together. So it’s just kind of like thinking about, about that that’s really been a big interest of mine in public health.

Sujani 10:25
Love that. So you said you went back for a year for a fellowship, kind of in the mid 2000s. And I’m assuming you kind of wrapped up your studies at that point as well in medicine. What happened after that for you, after that year back in South Africa?

Sarah 10:41
So that was right as I was at the end of my medical school. So I came back finished up my medical training, and then I did a residency, I did internal medicine and pediatrics. And I went to the University of Minnesota, which you wouldn’t might think that this would be such an opportunity to experience diversity, but it was a beautiful program. And they had an international health track. And there’s a very big refugee population in Minnesota, and I had the opportunity to work with a lot of refugees and learn from that population and experience many cultures while I was living there, which was amazing, and really brought me a lot of joy. And it kind of helped me translate my experience that I had living abroad to being back in the United States. And then when I did my fellowship and infectious disease, I went to Chicago and I worked at Cook County Hospital. This is a major county hospital system in a major urban area in the US and I, I think one of my main take homes from that experience was that a lot of what we see abroad is very similar to what we have here. I think that’s also a perspective that people don’t necessarily have, if they haven’t had the opportunity to live abroad. You know, there’s a lot of, well, we have it this way, and they have it this way. And I think what I actually recognized was, our problems aren’t that different?

Sujani 12:01

Sarah 12:01
And it allowed me to understand that I could still do that kind of important work of thinking about social structures, and what I’m doing on a day to day basis, and how those two things aligned.

Sujani 12:14
Yeah, it sounded like, you know, even when you were taking on that first rotation in South Africa, your intention was always to take those learnings from living abroad and come back and work in the US. And yeah, I’m gathering that, you know, when you went back for a year, there wasn’t an intention to always stay kind of international, you always wanted to kind of come back home to the US to work. Am I getting that, right?

Sarah 12:36
Well, I would say I really enjoyed living abroad, I think I would have, I think I would have stayed forever if I had the opportunity. Practical, but it wasn’t practical. And I think the love I had for the work was really in kind of the communities and in the way in which folks abroad deliver care. You know, there’s a very community based approach, there’s a team based approach, it’s just a little bit different. And some of the ways that we do things here. And that felt good to me. So when I came back, my family’s here, I’m married, and I have kids. So for me from my personal life living abroad was was just no longer feasible or practical. But I recognize that a lot of those concepts of marrying social dynamics and care and having more of a team based approach, and taking care of communities and kind of leaving that as the backdrop of the work could still be done here, and could still be fulfill here.

Sujani 13:38
So after Chicago, did you end up staying there as a clinician?

Sarah 13:44
So no, I ended up moving back to Cleveland, which is where I grew up, again, that that goal of family, I did a few things after I came back first, I just kind of worked in the local area, in hospitals, just doing kind of general infectious disease work, I really kind of needed to get my feet wet, get to know the area, get to know the providers kind of get to know the community. And that was a wonderful experience for me. But I really my heart is in community based medicine and taking care of people with HIV and other infectious diseases. So I started working in a clinic that primarily cared for people with HIV. And then I kind of recognized an opportunity to broaden that work in community infectious disease everywhere, but but in the US in particular, there’s a lot of overlap between populations that are at higher risk for infections and you know, social dynamics, poverty, substance use disorder, marginalized groups that experience higher risk because of these kind of what we call, you know, social determinants of health, but that those two things are intricately linked and can’t be pulled apart. So I kind of soon recognized that I could do this work, I could do this work of HIV care, kind of in a silo you know, don’t just provide that medical care but wasn’t really serving the community impact. And the reason the underlying drivers that we see these infections, and that’s kind of what I saw in in South Africa as well. So, you know, I thought like, How can I brought in this ended up working in an FQHC, setting a federally qualified health center, where there was a really large focus on taking care of some of those other social determinants of health, housing, health insurance, food insecurity, mental health, taking care of people with substance use disorder, kind of those drivers of what we’re seeing, in terms of rates of infectious diseases that have been exploding like hepatitis C, HIV has been relatively stable, but we haven’t made the moves on that in terms of elimination that we could, and that we should if we were reaching the right populations, and if we were kind of getting the work where it needed to be. So when I kind of entered that space, that kind of felt like home, being in a space that we can really do both things, at the same time really focus on those social determinants of health and those basic needs that people need to have taken care of, in order to even get to the point where they can focus on health. So that’s, that’s where I’ve been ever since. And that’s that space has really felt right. But it can be challenging, it can be challenging to be in that space, because then clinicians and medical people have to work hand in hand with non clinicians and non medical people. And that’s a challenging space. And I think that’s the biggest take home I’ve had and kind of my public health work to date is that it is really challenging to marry healthcare with kind of the other essential public health services. But that’s what we need to do in order to be effective.

Sujani 16:45
Yeah, I’m just kind of reflecting on what you’re talking about. And all of the- all of the pieces that you were able to kind of put together starting from your, I guess, even you know, as early as your rotation, and I think it’s very easy, as you’re being trained in medical school to kind of, you know, just think about the patient, the treatment, you have to provide them and kind of be done with that individual and move on to the next, you know, trying to understand how you were able to think about the social determinants of health to think about the social and political dynamics, what do you think it was kind of in your life and the experiences that you had that kept kind of pushing you to want to think about this bigger picture?

Sarah 17:31
Well, it’s an interesting question. And actually, I think a lot of it is my family of origin. I was fortunate to have a family, a wonderful family around me, but- but our family, we had our own struggles, and especially the women in my family really had to work against a lot of difficult social dynamics, and had to push hard to achieve things that, you know, we now take for granted. And, you know, I think, you know, as a young person, I kind of witnessed this, this kind of struggle that felt like it was very ingrained and kind of a social dynamic, and was always encouraged to do something different with my life, and to take more power, you know, into my own life, and to achieve the things that I wanted to achieve. I was lucky that the people who raised me were able to take their experiences all be it be them negative at times, and translate into telling me that I can experience something different and better. It helped me see from an early age that it’s not all tie up your bootstraps yourself, their social systems, that leaves some people able to achieve more, and that there’s something wrong with that. And I think that’s something that a lot of people maybe see. But it’s hard to do something tangible. It’s like, What can do I do about this? You know, is this is just kind of the way it is. And that was just something I was never willing to accept. And I think that’s because I had a lot of strong women who raised me.

Sujani 19:14
I love that. Yeah, I think it’s one of the frustrations of working in public health. I think there are no shortage of problems, the problems are massive. But sometimes, you know, after decades of working in the field, it might feel like you haven’t seen the impact of your work. And I think, to your point, when you said you, you won’t kind of give up and you’re gonna keep pushing. I think that sort of motivation has to come from something more powerful. And for you, it seems like it’s your family and the powerful women that you’ve been surrounded by.

Sarah 19:50
Absolutely. And I still have a picture of my grandma that sits right on my across my desk. Whenever I need a little motivation. Sometimes I just look up at her, but you know that that motivates me. And sometimes I think, you know, what could she have done? If she had the opportunities that I have today? You know, I think about her grit, and it does get hard.

Sujani 20:16

Sarah 20:16
It does get hard. Sometimes you need something like that to say, Okay, I’m going to do this. I’m going to keep- keep doing this for one more day.

Sujani 20:25
Yeah, yeah, absolutely. Kind of the saying, Be Yourself comes to mind. And I think the other way of looking at it is looking inwards at all of your life experiences and going on your, on your career path, especially in public health, based on those life experiences and, and trying not to be someone else, or trying to be this stereotypical picture of you know, someone who’s successful in their career, I don’t know if I’m wearing that, right. But all this to say, tap into yourself, tap into your experiences, and really make all of that shine and and use that as your your inspiration and motivation.

Sarah 21:05
I think you’re absolutely right. And authenticity is something that’s been important to me, it’s actually been really challenging for me as a physician, because you do feel that pressure to conform, and to have no imperfections and to know everything, and to be very professional and well spoken and to be a certain kind of person. And that’s frankly, just not, that’s just not who I am, I’m just, you know, I think if I was going to describe myself, but you know, it would be a little more like words like tenacious, that that might come other than polished. And it’s not necessarily always a bad thing, you know, some of the ideas that I present in medical leadership, they’re a little different than you know, it’s not typical, it’s not maybe the typical way we would view things or do things. But I am persistent, in you know, that this is the way that we should really be approaching this or that we at least need to consider some of these other things. And sometimes you feel in the moment, like I’m pushing a boulder up a hill, but then you look back on a few years of work, and you think, wow, wow, we really went far. So you know, sometimes those kind of things that might not fit into your perfect role, or you might think that aren’t quite right. And that you’re not sure if you’re representing the profession the right way. Sometimes those are your, your, your biggest gifts, I try to remind myself of that. And oftentimes the people that I work with, you know, I think there are a lot of folks who get into medicine, and they’ve had experiences or experiences in their family, that motivate them to do something else. And it can also lead to a lot of imposter syndrome. So just reminding people that you bring value in that your experiences are valuable. And that sharing experiences or having lived experiences that look like the lived experiences of our patients or populations, actually something that’s really important to bring to the table. And I would really like to uplift the voices of more of those people who have some shared experiences, and who are able to better bring to the table the voices of the people that- that we want to serve.

Sujani 23:22
I love that. Thanks for sharing that. So you know, I think you kind of alluded to this, that you’re in more of a leadership role in kind of a health care center. And it sounds like maybe as early as 2018, you kind of transitioned into more of that role and doing less clinical work kind of on a day to day basis. How did that transition happen for you?

Sarah 23:47
It was interesting, when I left the clinic that I was working with when it was primarily taking care of folks living with HIV, I was essentially recruited, which I wasn’t expecting, I was pretty, I was still pretty young in my career that I had gotten to know people through doing this work when people had started referring patients, and this local FQHC that did a lot of behavioral health care and was doing a lot of care for people with substance use disorder, was noticing this huge incidence of hepatitis C. And of course, that was related to the opiate epidemic that we have here in Ohio and over all over the US and reaches broader than that. So they had talked to me and said, Hey, would you be interested in starting an infectious disease program here? And I thought, okay, it was actually pregnant with my second child at the time. And I thought, Gosh, I don’t know like I you know, I’m doing this job. I love it. I love my patients and I have a family and I’m very green and I don’t know anything about starting a program and Okay, so, I reached out to some of my mentors in in Chicago and from my past. I- I had a mentor in particular who I really respected a strong woman, she ran the HIV and hepatitis C program at Cook County Hospital when I was in training, and I just, I thought a lot of her I thought the world of her and I reached out to her just randomly after not talking to her for a couple of years on. I said, you know, what do you think, what should I do this? And she was like, yes, who’s going to just bring this to you? You know, you know, there’s never a good time, just Yes, of course, you should do it. Then all those things flared up, I’m not good enough to do this. I’m too young. I’m too inexperienced.

Sujani 25:34

Sarah 25:35
I’m glad I didn’t listen to any of that. And I and I went ahead and did it, it was an amazing experience. And I learned a lot. And I made a lot of mistakes, just like anybody does when they’re starting something new. But I learned from those and we ended up developing a beautiful program that I’m proud of, and that I was able to build up to the point where there were people that were there that could do it without me. And that’s the best success of my mind, if you can build something that then you can leave behind and kind of leave a legacy and then you can go do that work somewhere else that needs it. So I just kind of went through that journey, I just actually left that organization and came to New Line, which is actually where I’m sitting today, I’m hoping to replicate some of that work of marrying infectious disease care, substance use disorder treatment, and treating that kind of syndromic that we see that overlap, really treating that in a very integrated and patient centered way. And that’s kind of a model that I’ve really enjoyed and that I hope we can build more of in the community because it seems to be a little bit more effective. So that’s, and that’s where I am today.

Sujani 26:42
And so kind of that role for any anyone listening who might be thinking, Okay, I could see myself working kind of as a clinician for a few years and then want to transfer into a role like the one that you’re describing, do you mind kind of sharing what a day in the life of perhaps you know, that the title is probably going to differ from organization to organization, but it sounds like, you know, one of the titles could be a medical director, another one could be, you know, Director of, and then it would be the area that you’re going to specialize in and acknowledging that, you know, each organization is going to do it differently, maybe just give a sense of what a role like this could look like.

Sarah 27:21
Absolutely. So I still do a fair amount of clinical care actually spent about 60% of my time in clinical care. Clinical Care is where I renew myself. So when I feel like I’m going to hit my head on my desk. Go and see a patient and then somehow it renews me just that that relationship, that recognition of a yeah, this is why I’m here. So I feel like it’s actually important for clinicians who care about those relationships, to stay in that in that clinical care and not to remove yourself too much from it. Because not only does it kind of bring you back to the work that you want to do, but it also helps you really understand where my providers coming from, and where are my patients coming from so that when you’re making decisions, you’re making the best decisions for both of those groups. So as people move on to administration, medical administration, switch, many clinicians do, you know, I feel like that’s the one thing that gets lost is people lose their connection to the clinical work. That’s a very fragile place. Because in order to move healthcare in the right direction, we have to have people who are intimately involved in the clinical work and who know it extremely well. And not only from a perspective of just knowing how it works, but from also from the perspective of knowing how it feels. And sometimes we lose that perspective before we move away from it for too long or far away from it from a period. So it’s that like that connection between the little things and the big things that as people kind of grow into administrative roles, they have that big picture, but they lose a little picture. And the little picture is, you know, essential. So I do administrative work a couple of days a week. And a lot of that is advising the direction of where we’re going to go as an organization and an advising our leadership team and how we should move the needle on some of our health care programs to better serve our communities. Being in that space, I think to do a good job, you have to be in the nitty gritty a little bit. So probably as my career moves on, and as my interest in systems based improvements increases, because that’s kind of where I think we need to go in healthcare right now is actually improving the system so that they work better for providers and they work better for patients. Naturally, my time for clinical care will become less as clinical care. You have to devote yourself to it, you know, fully and really, really be engaged in it to do it well. It’ll never completely go away. Like I can never see myself doing less than like, say one day a week.

Sujani 29:54

Sarah 29:55
Because I feel like I need that connection to work and to people to, one, keep myself going into to really be a good voice for staff and for- for patients. So my day to day is kind of like a mix. And that can be really challenging because clinical care always needs to take precedence. You know, your first priority always needs to be that patient care. But sometimes the other stuff can feel really big too. And it can be challenging to not be in crisis management mode and trying to check off all the things on your task list and really focus on what are the important things, checking off that task list can be very gratifying. But when you’re doing that, oftentimes, you’re just kind of getting little things taken care of, and you’re not focusing enough energy on the big stuff that requires you to sit down for two hours and put some real mind work behind it. So I think that, you know, for anyone who wants to kind of do a clinical administrative hybrid, my advice would really be to find the ways to do the big things with the never enough time that you have, instead of checking off a million little boxes, which is gratifying, but doesn’t move the needle.

Sujani 31:03
And it sounds like if someone’s in this type of a role, they could probably, you know, negotiate and figure things out and see, you know, how much time they want to see patients versus doing administrative work?

Sarah 31:15
Absolutely. And it is a challenge, because clinical work is what drives revenue and, and healthcare organizations. So when you’re a clinician administrators want you to see patients revenue. It’s important when you’re talking to administrators and folks who don’t have the clinical experience or don’t have that day to day bedside experience to help people understand, you know, what is it that you bring to the table? And why is it that it’s important to have you at the decision making table? What is that perspective? What exactly is it that you’re doing? What’s the business case? How does your involvement in this helped move the organization forward, not only from the perspective of taking good care of people, but from the perspective of sustainability for the organization, financial sustainability of the organization, because that’s how you get your message across to folks who don’t have your perspective. And I think that is challenging for clinicians. It’s not something we learn about in school, but it is- it’s an absolutely necessary component to having conversations with folks who are making big financial decisions.

Sujani 32:20
Absolutely. I kind of want to go back to something you said, when you were first offered this role as you transitioned into the administrative side of things. And you said, I don’t know anything about this. But then you still said yes. And I’m wondering, did any part of you during this period, you know, since 2018, to now think, maybe I should go back to school, maybe I should get more training to do this administrative side of my work better? Or maybe I need to learn other things. And just wondering, because then, you know, I would have probably convinced myself to go back to, quote, unquote, learn in a more structured setting how to do like medical administration. And and I’m wondering if any part of you wanted to do that. And it seems like you didn’t and so why that decision?

Sarah 33:10
That’s such a great question. It’s something I thought about a million times. So when I first started this role, I had the opportunity to do a fellowship, it was called a primary care champions fellowship, where they provide it was HERSA. So the Health Resources Services Administration, I’m sure I’m missing that. But the big government health care provided this actually excellent program to help support providers who are in these spaces, federally qualified health centers and community health centers in integrating kind of quality improvement and leadership and management. And I took that opportunity. So it was a two year program. I did like a mentored quality improvement project. And I learned best by doing I love book learning, I loved school, but it wasn’t the most effective way for me to get things done or to learn. I love to learn by doing processes and by actually doing the work. So this allowed me to kind of hone my skills as I was actually doing the work I wanted to do. For me, as a clinician, I finally got to the point where I said I’m educated enough. To undergrad, I went to medical school, I did a four year residency and a two year fellowship. So at some point, even though I’m somewhere inside of me, I will never feel like I have enough information or know enough. At some point, I decided that I am qualified to do this and there are things that I need to learn, but I can learn them while I’m going I can find ways to incorporate educating myself into my life. That doesn’t necessarily look like going back to a formal school for two years.

Sujani 34:55

Sarah 34:55
Or you know, getting an MBA or even getting an MPH which actually is something I would love to pursue because I would really love to learn more about statistics. That’s an area where I feel like I’m a little bit not as great in and I would love to know more. But I will say there are things I bring to the table that amazing epidemiologists and statisticians don’t, you know, it’s in, that’s my clinical knowledge. So what I have preferred to do, as I’ve kind of grown in this is actually partner with people who already have the skills and expertise that I’m lacking and form a team with them. And everyone worked to the top of their level, I kind of recognized I can never be the best at everything. But I find people who have those skills that I lack, and I can work closely with them, and I can work in my zone of genius. What is it that I’m really good at? And do I need to be an expert at everything else? Or can I really work hard on developing partnerships and great relationships and great teams, so that, you know, together, we can do the best work. And for me, that’s kind of where my sweet spot spent, I think it’s been in seeing the potential and the skills that other people have and being like, wow, let’s use those skills. Rather than me, kind of being the holder of all knowledge, which I recognize out, I never will be.

Sujani 36:14
I think that realisation comes with, you know, a bit of maturity, and also feeling really comfortable with yourself. Just knowing that, you know, this is my zone of genius, I don’t need to be great at everything I can bring in people that are great in these different areas to work together on this problem. And then kind of you know, to your story, it’s like this organization saw that you are capable of this and reached out to you. So they believed in you. And you know, the easiest part is for you to believe in yourself, which sometimes ends up being the hardest part.

Sarah 36:49
It is the hardest. You know, there’s still those moments of questioning, even in my mind, like that, you know, do I belong here? Should I be doing this? But with time, those voices are getting quieter for me.

Sujani 37:03

Sarah 37:04
Really a big part of my journey, too, has been learning boundaries. And what I’m willing to accept and not accept, I think that’s not been a part of a medical conversation in a long time. Maybe ever, for medical providers were expected just to kind of never ever to consider our own needs. But again, that’s a really short sighted view. So developing those boundaries around what I bring to the table, what I’m able to offer, and being real honest and upfront with people about, you know, this is my skill set. And, you know, in order to do this, well, I need to have this in this expertise. And I want to utilize that in this organization to kind of move this forward, not pretending that somehow I have all the answers.

Sujani 37:46
Yeah, yeah, absolutely. Not to go back to something else. You also mentioned, I think, a bit earlier on in our conversation, and I think you’re alluding to the fact that you may have done certain things differently. And I’m curious, you know, when you reflect back at your career journey to date, what are some of those things that you think, you know, maybe I could have done that a little bit differently to change, either you know, the path or maybe the speed at which you got to where you are now? Or maybe it’s for a different reason?

Sarah 38:18
It’s an interesting question. So when I think back on those early couple of years, when I started that first role, that was kind of a bigger role for me, I don’t know if I could wish I would have done it differently, because I learned so much from making the mistakes. But I still have that very clinical mindset of you know, I was very decisive, very, like, do this now, you know, I was used to being in the hospitals stakes are high, you, you’re not thinking about things, you’re making decisions, and you’re moving it along, then I’m kind of getting into this pace where I need to be more thoughtful, I need to listen, I need to consider other people’s perspectives, I need to wait and then make a decision. I can’t just shoot off an email reply. I need to slow down. And I had people telling me to slow down, but I didn’t understand what they meant. I thought they just meant just stop doing all this stuff. You’re doing too much. You’re moving too fast for the organization. And and I think what they really meant was, think more about the bigger picture, think more about the bigger implications and how it impacts things that you might not be considering or directly involved in. And I did learn to have more of that approach. But it took time and it took getting my wrist slapped a few times. And it took actually delaying some of the projects that I would have liked to get off the ground because I had to do some relationship repairing because I was in this space that we’re just going to move things so fast and everyone’s just going to accept what I say should be done and do it rather than in a space of, I need to get buy in, I need to move a little bit slowly, I need to make sure I have everyone’s input on this before I move it. So I think that that was important. I did a 360 review, I don’t know what- what you call it, but where you anonymously asked people to work with to provide feedback on your- your leadership style. I did that as part of a leadership course, that was the other thing that I do, you know, when you asked about kind of getting education, I really look for opportunities for my own professional development, I do a lot of reading, I listen to a lot of books, while I’m driving back and forth to work and, you know, opportunities to learn leadership skills, I really try to take those because I understand that that’s my responsibility to learn how to be a better leader. And sometimes you have to really pursue those opportunities, it’s not like people are just going to hand on to you. So you know, you do have to kind of take responsibility for your own professional development in some ways. But I do try to do that and kind of keep a growth mindset. So with that 360 review, as part of this leadership course, that I took part in, a lot of the feedback I got was actually very positive. But the negative feedback, of course, it’s what you remember the most was, you don’t always have to fill in the gaps if there’s silence, you can just notice the silence, you can just notice that that’s there, and maybe be curious about it.

Sujani 41:22

Sarah 41:22
And, you know, people might not do things, the way that you do them, they might not move at the pace that you move it. But you have to trust them enough to give them something and then let them do it, and even let them fail. And that was enlightening for me, because I needed that, I needed somebody to let me make my own mistakes in order for me to grow. So why would I expect that from people that are working for me or with me that they they need the same thing. You know, they need to be supported, they need to be given direction, they need accountability, they need follow through, but they don’t need me to be, you know, checking in constantly, hey, where are we at with this? Where are we at with this, I do trust them and let them kind of flounder a little bit so that they can learn get better, and do more in the long term. So I think if I could go back and do anything differently, I might have applied some of those principles earlier, being a better listener, and thinking more about the long term benefits, thinking more about the long term outcome, rather than we just need to get this done now.

Sujani 42:30
Yeah, what are some of the positive reviews you got?

Sarah 42:35
I think people appreciate the fact that I have a team based approach to care and that my approach is fairly non hierarchical, meaning that I want everybody’s input in it doesn’t necessarily matter if you’re a doctor or a patient, or what role you have, it’s all important and equally important to have those perspectives. So you know, I think people did appreciate being heard and valued.

Sujani 42:58
Yeah, I kind of gather that just based on our conversation here that you’re you’re very good at that.

Sarah 43:03
I try to be. Too many people are unvalued, in our society and in healthcare, and we’re missing out on so much good information by not bringing those voices to the table.

Sujani 43:14
Yeah, yeah. Agreed. I think just the exercise of the going back to that 360 degree feedback or review, I think, you know, even if there isn’t something formal at the organization, it’s a great exercise. And I think there’s tons of templates and questionnaires that you can grab online and just kind of circulated within your team just to get that feedback, because I think both the positive and the negatives, or the constructive criticism is, is very helpful to just, you know, improve yourself and to do better in your work.

Sarah 43:48
Yeah, absolutely. I would tell people, it’s a gift, but it might take I feel like, but it is actually helped me a lot. And I hope to do it again. Now, you know, once I have a couple of years and see like, Have I been able to implement any of the things that I learned from this? And am I doing better now.

Sujani 44:08
To your point earlier, where you said, you’re working your zone of genius and some of those you know, strengths that you have, other people may be able to identify it sometimes a bit better than you are, especially early on in your career, right? When you’re feeling like you don’t know what your strengths are, what you’re great at. People give you hints and like one exercise I like to encourage people to do is just message a bunch of people in your network and ask them what you think about me. What’s one thing that you think I’m great at and then see if there are themes that come up.

Sarah 44:39
I love it. It’s such a hard question to ask people because you don’t want to feel you know, you want to feel humble or you don’t want to ask those questions, but it’s a great way to identify some of your own strengths. And certainly I try to point out people’s strengths to them when I’m working with them because people- people don’t see them. It’s so much easier to see the bad but we- We kind of bring out what people are good at, and kind of let them work with that. It’s just amazing what you can produce. And I’ve enjoyed that. That’s been one of the things I’ve enjoyed the most in leadership.

Sujani 45:11
Yeah, I love that. So we kind of talked about, you know, your journey so far. And now switching gears a bit. And as you look forward at all the things that you’re excited about, what’s the most exciting thing in your life right now, when it comes to your your public health career, or you know, some goals that you’re setting for yourself?

Sarah 45:31
So I’m in a new place, it’s really interesting to be in this space of observation and learning, again, and just trying to see, you know, how do I fit here? And how do I take what I’ve learned and apply it here, but also not apply it so blindly as to say that, you know, what worked there is going to work here, you know, take kind of that knowledge that I’ve gained, and really be intentional about applying it in a way that makes sense in this environment, which was going to be different than what it’s looked like, in the past, trying not to have too much tunnel vision. And then just also thinking about where do I want to go in terms of more of a systems based approach to care, you know, it’s not something I ever thought I would want to do. It’s not the direction that I thought I was going to go into when I was young and kind of thinking about this career field. But there’s something about this poll towards systems based thinking and thinking about how we structure healthcare to better serve, that just continuously kind of pulls me forward in that direction. So I’m trying to listen to that. And when I do have opportunities to have more system influence, or to kind of work in a way that allows us to change or improve or be innovative or creative about how we’re delivering healthcare, that’s a space I want to move towards. So I think one thing I learned in the course of like trying to learn this leadership development was really to create a personal mission. And that kind of helps you decide what you’re going to say yes, and what you’re going to say no to and I’m trying to flex that muscle a little bit, like really, what is it that I want to do with my career? And where do I think that my skill set fits the best? And if saying yes to something moves me in that direction, then that’s what I want to do. And if it doesn’t, then I don’t. Right. It’s about kind of prioritizing your time and making sure you’re getting to those important things, and not necessarily checking all the little things, that kind of concept again, which is kind of a personal journey for me as a kind of recovering perfectionist, you know, always wanting to get every little thing done, you know, just trying to move towards what is the mission, what is- What is really important and is what I’m doing right now helping me achieve that are not?

Sujani 47:46
I love when my guests kind of leave off on a cliffhanger this, this whole concept of a personal mission is something I’d love to talk to you about more maybe on a future episode. But with that Sarah, I just wanted to say thank you so much for joining us today on the episode and for sharing your absolutely wonderful journey with us and, and all the great advice that you had to share along the way.

Sarah 48:11
Thank you so much. I’m still learning and looking forward to what the future holds. And I’m so glad I had an opportunity to talk to you.

Sujani 48:22
Hey, I hope you enjoyed that episode. And if you want to get the links or information mentioned in today’s episode, you can head over to And we’ll have everything there for you. And before you go, I want to tell you about the public health career club. So if you’ve been looking for a place to connect and build meaningful relationships with other public health professionals, from all around the world, you should join us in the public health career club. We launched the club with the vision of becoming the number one hangout spot dedicated to building and growing your dream public health career. And in addition to being able to connect and build those meaningful relationships with other public health professionals, the club also offers other great resources for your career growth and success, like mindset coaching, job preparation, clinics, and career growth strategy sessions in the form of trainings and talks, all delivered by experts and inspiring individuals in these areas. So if you want to learn more, or want to join the club, you can visit our page at And we’ll have all the information there. And you know, as a space that’s being intentionally curated to bring together like minded public health professionals who are not only there to push themselves to become the best versions of themselves, but also each other. And with that, I can’t wait to see how this is going to have a ripple effect in the world as we all work together to better the health of our populations and just have immense impact in the world. And I hope you’ll be joining us in the public health career club.


About the Show

PH SPOTlight: Public health career stories, inspiration, and guidance from current-day public health heroes

On the show, Sujani sits down with public health heroes of our time to share career stories, inspiration, and guidance for building public health careers. From time to time, she also has conversations with friends of public health – individuals who are not public health professionals, but their advice and guidance are equally important.

Join the PH SPOT public health community

A place where passionate public health professionals commit to take their career to the next level – there is no other place like it online!


A simple template to get you started.

We will also add you to our Public Health community so that you can receive more awesome stuff from us. If you’re not enjoying them, you can unsubscribe instantly.