Pathologist Finds a Natural Niche in Population Health

Stephanie Mayfield Gibson, MD, FCAP, has training and experience in anatomic pathology/clinical pathology, an affinity for technology, an inclination to collaborate, and a patient-centric worldview. It's not surprising, then, that a satisfying medical career begun in the laboratory would come to embrace leadership in population health.

Dr. Mayfield Gibson launched her practice in 1995 as a staff pathologist for the Veterans Administration Medical Center in Louisville, Kentucky, and an assistant professor of pathology at the University of Louisville School of Medicine. Soon, she was managing Joint Commission interface at the hospital while taking part in continuing groundbreaking research at the medical center on the troponin marker for heart disease.

In the years that followed, Dr. Mayfield Gibson became associate chief of staff, associate professor, and director of the blood bank; she also helped to implement electronic medical records and managed employee health. In those roles, she learned a lot about outpatient services and the business side of hospital management. As associate chief for education, Dr. Mayfield Gibson learned the Accreditation Council for Graduate Medical Education program requirements inside and out. Much of her learning in those years was a spontaneous outgrowth of relationships with other providers in medicine, nursing, and hospital administration. Multidisciplinary relationships prompt professional development, she adds. They can make unexpected career opportunities sound more reasonable and look more appealing.

The key to a well-rounded career in pathology is to be a well-rounded physician, Dr. Mayfield Gibson says. Volunteer for what falls within your scope of responsibility and also for what does not. Make the most of your analytical, organizational, and intuitive firepower. Use the powerful tools already at hand (particularly the CAP accreditation checklists) to ensure that the quality of your work exceeds expectations.

"Pathology helps prepare you for a broad, interdisciplinary role," Dr. Mayfield Gibson says, in part because standards and practices that are second nature to pathologists are so readily scaled up and transferred to other domains. "Whether I'm talking to providers or policymakers, vendors or administrators, I'm looking to see a buy-in for quality," she adds. The rest is details.

In retrospect, Dr. Mayfield Gibson's decision to accept a position in the Kentucky Department for Public Health as director of the Division of Laboratory Services is not surprising. Nor is her success with projects to improve population health, such as an expanded newborn screening menu that garnered international recognition. As part of state government, she would learn a lot about how hospital regulation and health policy takes shape, and the art of tracking multiple moving parts while negotiating measures that support a broader vision.

In 2012, Dr. Mayfield Gibson accepted a gubernatorial appointment to become state health commissioner for Kentucky. In this cabinet-level position, she coordinated the seven public health divisions and became the primary bridge between state and federal health entities, both public and private.

The overall health status of Kentucky residents had been near the bottom nationally when adoption of the Affordable Care Act (ACA) expanded access to care and preventive services, Dr. Mayfield Gibson says. The ACA enabled a comprehensive approach to health planning—an accountable health system as opposed to an accountable health care system. (In January 2016, the Centers for Medicare & Medicaid Services [CMS] launched a project to test the concept via grants to establish accountable health communities nationwide.)

The ACA rollout gave more patients access to caregivers and medication. It boosted the role of community health workers, whose greater involvement in post-discharge follow-up reduced readmissions. Regular access to care disrupted the emergency department-to-inpatient cycle and promoted integrated whole-person care.

"An accountable health system embodies the belief that if you want to achieve comprehensive health, you have to address basic human needs, often referred to as social determinants of health," Dr. Mayfield Gibson says. Those include support for those who need housing, employment, economic well being, food security, education, and freedom from violence. Successful leadership in population health, she says, will call for dynamic public/private partnerships, enabling integrated approaches to health care delivery and basic human needs assessments with referrals across multiple jurisdictions.

At the end of 2015, Dr. Mayfield Gibson left state government to become senior vice president of population health for KentuckyOne Health and chief medical officer for KentuckyOne Health Partners, where she could focus on enhancing health care delivery across the total continuum of health. A novel way of thinking about population health was finding its moment, and she wanted to be part of it.

"As anchor institutions, hospitals and university health systems are rooted in local communities by networks of social and financial investment," Dr. Mayfield Gibson says, which means that they understand the needs of the community "and can respond to them through a robust multisector approach that has been shown to decrease chronic disease mortality."

Dr. Mayfield Gibson recently left KentuckyOne Health and is now a population health consultant to health systems and a global pharmaceutical corporation. She also serves on two national boards: ChangeLab Solutions and Trust for America's Health. Her story shows how the roles of pathologists have evolved, a trend that is poised to accelerate. And as it does, one intuitive, fearless, and nimble pathologist will continue to embrace what may come and nudge her teams to anticipate what might come to be.