Q&A with Bridgette Wiefling

As a CEO, an alumna helps turn around a health care center and continues the rewarding work that she sought as a physician.

Though she planned to become a physician since she was a child, Bridgette Wiefling, M.D. (R ’05), took an atypical path to medicine. After graduation from college, Wiefling worked as a researcher at the University of Wisconsin at Madison, helped launch and run a technology transfer company, and studied German in Austria and soil chemistry in Russia. She joined the staff of the Anthony Jordan Health Center, an important community health organization in Rochester, N.Y., right out of her medicine/pediatrics residency and at a time when many people thought financial problems could force the center to close. Within a year, Wiefling, who is now 40, was the center’s medical director and, in 2007, she was named Jordan’s president and chief executive officer. The center had a deficit of $1.2 million and an annual operating loss of $600,000. Since Wiefling’s appointment, Jordan has erased its deficit and become financially stable. The number of patients has increased from 9,000 in 2004 to 16,000 and the number of patient visits annually has grown from 35,000 to 51,000.

RM: How did you get interested in community medicine?

When I was in medical school at the University of Wisconsin in Madison, I worked at a free clinic in Milwaukee. It was similar to Jordan, and there was a large refugee population. At that time, I really started to see the differences between suburban health issues in Madison and disease burdens in the inner city of Milwaukee. There were disparities in health care and in outcomes. I wanted to understand why. This question drove my desire to work in urban medicine and I wanted to make a difference. I came to Rochester for my residency because of the opportunities to work in community medicine.

As a resident, I did an international rotation in Honduras, which was a powerful experience. This experience led me, early in my career, to work with the University to put together an international medical track in Honduras. The needs there were very similar to what I had seen in urban communities. The gaps between needs and service availability were exaggerated, but similar gaps nonetheless. What I saw in Honduras was so dramatic, it was like getting hit with a sledgehammer. When you see such dramatic gaps, it becomes easier to see the same patterns in your home community. When you are able to see patterns, you can start solving problems. This is something I believe strongly we need to foster in the next generation of physicians to encourage physician leadership at the policy level.  This can be accomplished through well-planned experiences locally and abroad.

 I also had exposure as a resident to many non-governmental organizations in Rochester through a program at the Medical Center, Pediatric Links with the Community. Throughout my work within the community, I would hear about this place called Jordan and what a great place it could be and what a shame it was not. I recognized the role of Jordan and how it was needed to address health care disparities in the city.

RM: What had to be done to fix Jordan?

Jordan had strayed from its mission. It also had been ravaged by the health care system and changes in that system the late 1990s. There was a lack of responsiveness to changes in the health care environment and in the community. Jordan had become disconnected from the community. We had to work hard to reconnect to the community and put patients first. I had a lot of help from the great people on our staff. We had to go out to the community organizations, many of which I had learned about through Pediatric Links with Community, and build relationships. We had to create a true network in the city, not just to address health care, but also some of the social issues that affected the health of the people in the community.

We conducted focus groups and held meetings with organizations and groups throughout the community. We asked people what they thought we needed to be doing. There were problems with the way we did scheduling, the phone systems and the hours. We recognized we had great providers, but many of services that once were offered had been cut off. For example, we worked hard to put a mental health program back in place and started a hepatitis-B clinic because people were having trouble getting to the Medical Center to maintain treatments.

You can see patients as a physician and give them a prescription for blood pressure medicine, but if they don’t have transportation or the money to get the medicine, it won’t do them any good. You can try to treat a child with asthma, but if the home has a roach infestation, your treatment won’t go very far. We had to link with other organizations to solve transportation problems or deal with landlords. We worked to better connect people with groups or programs that could help them with food, clothes and housing. We learned to leverage the skills of our partners better. We used to have an oral surgeon, for example, but now we send our patients to Eastman Institute at the Medical Center. We had to figure out what needed to be done and what we could do with our resources, then articulate what we could deliver and how.

RM: How did you deal with the deficit?

We found ways to get grants and made sure we were billing everything we possibly could. Every dollar matters. We figured out how the health system worked in Rochester and specifically how the Federal Qualified Health system worked nationally and then maximized our opportunities.

Combining my business experience before I went to medical school with my community experience after, I had a sense of what it would take to run a health center. The patients are our customers, the community is our customer, and we have to be cost-efficient with our services.

We are large enough now that we have the ability to flex with budgets, but unfortunately we will always be close to the edge. We are paid very little to care for so many patients who are uninsured or underinsured for the level of care they require. This is the nature of caring for patients from resource-poor environments.

RM: Even though you are Jordan’s CEO, you continue to practice. Why?

I love this kind of medicine. You have to be a resourceful and tenacious patient advocate. You get to practice incredible medicine. I have seen and treated more varied medical problems than I ever could have in private practice. You practice medicine in full force. It is never routine and it is not boring. It allows clinicians to practice at the top of their game. At the end of the day, I feel like I made a difference.

Also, it is incredibly important for an administrator to practice medicine in a system they are governing. It is very challenging to stay connected to what’s happening if you don’t. Also, in an organization like this, you need everyone to be working and pulling their salary weight. The board initially was concerned about my being CEO and continuing to practice. I helped them understand that by continuing to practice at the health center I would actually be able to do more for patients and staff. When the CEO makes a decision, it has effects throughout the entire organization. By continuing to practice, I am able to experience the effects and understand the consequences of decision-making much better.

I am so grateful for our entire staff. They’re not here for money or prestige. They are here for a mission that makes all the difference in the world to so many people in our community. We need more physicians who want to do this kind of work. Emergency medicine and procedure-intense specialties are not the only things that are interesting and sexy. Community health, once thought of as boring, not challenging or even unimportant, has made great status gains with technology and the realization that great medicine starts with great primary care. It is nuanced work, academically challenging and exciting. I don’t think I have ever cried so hard or laughed so much as I have with some of our patients. You can really feel it when you make a difference with a patient and that is what I was looking for when I set out to be a physician.