Hanna Renaldi's Blog: Pediatrician and Social Entrepreneur: Meet Dr. Anne Steptoe [Episode 246]

Our guest today, Dr. Anne Steptoe, earned her BA in Classics and English at Harvard in 2009. She then worked for two years as a Health Policy Senior Analyst at Mass General Hospital and attended medical school at Brown. Along the way to her current position as a pediatrics resident at UNC Chapel Hill, she earned an MBA at Duke Fuqua and started her own social enterprise with a partner.

Can you tell us about your background? Where did you grow up? What do you like to do for fun? [1:29]

I grew up in a small town in West Virginia. There were about 2,000 families in the town and relationships really formed the fabric of the town. A sense of community has always driven me, which I attribute to my time there. In terms of my free time, I am now a North Carolinian – and there is amazing food here and some of the best craft brewing in the country. And of course basketball enthusiasm is in the water here.

How did you go from an undergrad degree in Classics and English in 2009 to starting med school in 2011? [2:47]

I knew a couple of things at the start of college. I loved Latin, one of my singular passions in high school, and I was not done studying that. I also loved to read and wanted to spend my college years doing more of that. I didn’t see myself as a professor, which would have been a typical pathway for someone with my majors, so I wanted to be a student for a bit longer but needed professional experiences to answer the question of what I wanted to do for the rest of my life.

I got interested in public policy, an obvious extension of the community idea, and had some internships on Capitol Hill. I sought out the most interesting people in our office, and as it turns out I was most drawn to the health policy legislative aide. I loved that she would be on the phone with a single mom walking her through how to sign her child up for CHIP in the morning, and then in the afternoon be in these huge plenary sessions about what the future of the entire healthcare system looks like. The micro and macro look at change was really fascinating to me.

This still didn’t get me to med school, though. I actually thought med school was the last path I would follow, since I had to be hospitalized as a 7-8 year old and thought doctors were the worst. But another summer I had been given a small grant to go to West Virginia to ask, what in retrospect seems like an arrogant question, about the disconnect between health policy on obesity vs what was happening on the ground. West Virginia has one of the worst obesity rates in the country. The reason I say the question was arrogant was because it was almost as if, “What are those pesky doctors doing messing up the beautiful portrait we have of how an ideal healthcare system should work?”

I did some qualitative research in a healthcare center in West Virginia, and after 1.5 days there realized we weren’t asking the right questions. There is a huge disconnect with people enthused about national level policies, but who don’t have the experience of healthcare on the ground. I was struck by how little I knew about how healthcare functioned, which was the turning point to med school for me. I was introduced to the concept of a doctor as a change agent in the community. Providers were stepping in as entrepreneurs in their communities in the absence of policy. From there I was hooked.

I was lucky enough to have figured this out at the end of my sophomore year so I had enough intro science classes that I was able to stack a few extra classes on to get the core med requirements before graduating. I took two gap years since I wanted to confirm this path, since it wasn’t a natural fit necessarily. I took a job at Mass Gen to test out my interest in the field, and to get other pre-reqs done, especially the MCAT.

You did your medical school studies at Brown Alpert Medical School. What did you like best about your med school experience? [9:56]

It was important for me to still be myself in the med school process, and that challenged me in ways I didn’t fully realize. One of the biggest issues is that most people have so little choice in their medical education process. All of us had a non-tailored curriculum which I knew was going to be tough. One of the reasons I chose Brown was its scholarly concentration program, which provides the space to go after other fields of interest as well – health policy was my choice. I found that to be a little oasis to remind myself to continue to learn ways of thinking that may not have made it into the med school curriculum.

What could be improved? [11:44]

The life of a med student can be very boring nuts and bolts sometimes. I realized after I was in, that I didn’t ask hard questions as an applicant to med school, or detailed questions about what it means for my life. A particularly hilarious example of this was that one of the reasons I chose Brown was the emphasis on humanities as a potential part of the curriculum. For me as a classics major I saw this as a way to not let my love of classics atrophy, and had this lofty vision that I would be taking a Latin class every other semester. I am sure there were smarter and more pragmatic applicants than me, but I was thrilled there was a policy that I could have gotten credit for any number of courses as long as I could justify they were med related.

However, after I started I couldn’t find anyone who had taken any humanities courses, and when I looked to older students, they said, “Maybe you could do it a little bit in your fourth year but it might be hard.” The curriculum really is all-enveloping, and for an interdisciplinary person it can be hard. Ultimately I learned that I needed to be honest with myself about what I needed in my educational experience for my career, and maybe I couldn’t get all of that through my medical training.

Today you are a resident in pediatrics at UNC. Did you ever have a rotation or period in your path to date when you thought of giving up on medicine? [16:58]

I don’t think I had a pivotal moment, but any thoughtful person can infer that at the end of a 24-hour shift you would have to be superhuman to not wonder if there are alternate ways to make an impact. For me it was more an accumulation of small moments when I felt like I was getting put on a conveyor belt and had lost a bit of control or felt separated from my vision of what I wanted in this career path. The absence of engaging certain parts of my brain was rough since a lot of medicine is memorization and typical clinical skill building but without emphasis on change that I engaged in and thrived on. There were moments I saw gaps in the system that I had no power to address. I had a little slip of paper in my white coat to write stuff down since that was all I was empowered to do at the time, with the hope that someday I could address them.

There were insights in the healthcare system where I wanted to make an impact that made me realize I’d like an MBA, so I could effect change now as opposed to in 7-10 years. I proposed MedServe as my scholarly concentration in health policy during my first year. Others were excited about the idea but told me it was too ambitious of a project for the med school framework, that I should do a small research study instead since that would be better for my residency application. Seeing potential for impact, but being told that now wasn’t the right time and med school wasn’t the right place led me to getting an MBA.

Did you find that Duke Fuqua’s MBA program provided the breadth that you didn’t get in medical school? [21:00]

Absolutely. The breadth and freedom was great. Other than college I think the MBA is the only professional degree that’s essentially a blank slate degree that you are responsible for crafting. For me, Fuqua was a canvas for me to try and accumulate a unique skill set to be a person that provides impact in healthcare through projects and programs.

What did you like best about Duke Fuqua’s MBA program? [22:04]

It’s hard to choose one thing! One is I loved the accessibility of it. I had no business experience coming into business school and just two years of work experience, with a very foreign skill set compared to most of my peers. I was very nervous about the process walking in but gave everyone on my team disclaimers early on about my background, almost apologizing for it. It took me two weeks at Duke Fuqua to realize the emphasis is on critical thinking over anything else. I built a threshold of knowledge with an emphasis on healthcare. I would have felt some isolation about my passions in reverse had there not been a strong focus on healthcare in the program. More practically I wouldn’t have found co-founders and volunteers for my business since I was a non-traditional student with non-traditional goals. There were many people excited about my field which was fantastic.

Can you tell us about your social enterprise, MedServe? First, what is it? [25:24]

MedServe is a two-year, service-learning program that works with students between college and med school to connect them with a full-time service engagement in primary care in underserved communities around the state of North Carolina. We recruit from 60 universities across the country and have candidates who matriculate from as far as the West Coast. We like to see some tie to North Carolina or with the types of communities we serve, but we have heard from those who come in that it is hard to find clinical engagements that connect community service with clinical medicine, so they are willing to move.

Did Duke play a role in getting MedServe going, and if so, what was that role? [27:08]

Yes, it played a huge role in a number of dimensions. I did not go the traditional route with an internship between my first and second year, but did market research and developed a business model instead, and received a sizable grant from the Center for the Advancement of Social Entrepreneurship to do so. I didn’t realize it, but I had been doing research for MedServe for a long time, seeing the disconnect between being a doctor and the impact I wanted to make. I understood my colleagues and their similar experience, so I had more pieces to start the company than I realized. I felt like an outsider coming into Fuqua, but very quickly I gained the confidence and structure to start MedServe. I had the pieces of information to start, and then Fuqua offers a curriculum that allows students to get course credit for working on their own entities. I was hoping it would be a step-by-step guidebook on how to run your business, which it wasn’t, but it gave me the tools to build my confidence.

If I’m a listener and a senior in college and am interested in applying, can you walk me through the process and what would happen if I’m accepted? [30:01]

Our main application deadline is February 15th. We get feedback that our application process is long and a little bit intensive compared to other job opportunities, but there is method behind our madness for a couple of reasons. It is so important to get real clinical experience. I hated shadowing – it was a terrible feeling to hover over someone’s shoulder and feel like an onlooker. It is important to us that if you are going to go out and get clinical experience it is to figure out the broader impact you want to make in medicine.

We are not comparing people against each other in terms of who is minutely better or more qualified than another applicant, but instead, we want to have “spark matching.” For example, we offer a fellowship at a clinic in eastern North Carolina that in addition to the resident populations serves migrant farm workers. I would trust any of my fellows to be confident and caring, but in this case, fellows who have thrived had spent a year in rural Alaska on public health issues and had also spent time in South America in cultural immersion. Another had done community outreach with the Hispanic population in North Carolina.

I hope the MedServe experience is a time to deepen passions about things participants already care about. That to me is the broader point, which is how we select applicants. We conduct interviews geared toward confirming who the person is in comparison to the paper application. Applicants do a final interview with clinics themselves to confirm that what I think is a great spark match is with the clinic also.

NOTE: After the interview, Anne clarified that if you listen to this podcast after the February 15 application deadline, you should still contact them and apply.

I’ve applied, been accepted, and placed in the clinic you think is the best fit for me. Do you provide any training? [34:01]

We do. Some of our candidates come in with clinical experience, maybe having been an EMT, for example, but others have no clinical experience at all. There is a skillset that is very tangibly new and fellows are doing it in new communities maybe hundreds of miles from where they went to college or grew up. We have a two-week training boot camp which provides background knowledge in the public health landscape, the business of healthcare, and concrete things like taking vital signs, and we talk about the mindset for service that is productive to prepare for from a personal and emotional standpoint. It can be tough to be the only fellow in a tiny town in western North Carolina.

Fellows are paid a $20K annual stipend, and while I wouldn’t say I am proud of the salary, I tried to find a salary that is a living wage in the communities we work in. We know it’s not a glamorous salary, so we try to provide support around financial planning, help with housing, and just overall be as supportive as we can.

A lot of our role after they are in the field is in continuing education. We have quarterly skill summits that happen throughout the two-year experience, to continue gaining knowledge so fellows can talk through and troubleshoot difficult situations. We also talk about the med school application process, the MCAT, etc. We especially gear this content towards students who have an interest and passion for service, and whose goals are a bit different than traditional applicants. This is the program I would have joined after college if it existed!

If a pre-med wants to become a scribe, what is the advantage to him or her of participating in MedServe over just becoming a scribe or working in a primary care doctor’s office? [39:43]

The experiences that will impact you will happen in both roles, but the things I hear from fellows that drive them to our program is the desire to be exposed to making an impact through a clinical career in medicine. They spend half of the two years in a clinical role, and the other half is spent in a community role, as part of a community health team or health coach, for example, with dedicated time and exposure to healthcare system issues that are very specific to this population of people. I hope it is an exciting and engaging experience for two years. We make this position not just a job but a program. I am very proud of the cohort nature of the program, where fellows network with each other – I don’t think students have access to this as a position in an individual practice. I think the cohort will ultimately be one of the biggest benefits to them in the future, and also fosters the sense of community.

Do you plan to expand MedServe beyond North Carolina? What are your plans for the future? [42:41]

With MedServe we continue to operate at a scale where we have more qualified applicants than we can take and more requests from clinics than we can accommodate. Our fellow acceptance rate last year was about 10%, so I see a lot of potential for growth. I would love to take this program back home to West Virginia at some point. For now, we have been working to scale the program in North Carolina, and we will have a much larger footprint this year. There are similar dynamics in other states, but I am mindful of not wanting to scale the program at such a rate that the things that make the program really special get lost in the process, so we are taking it one level at a time. As I mentioned, the next step is to expand in the state, and we will about triple the size of the next cohort. We are getting such a high quality of applicant that we can start meeting some of the demand out there.

For me personally, my path is a little bit set for the moment, as I am in my internship year of residency, so I actually have four more years as a pediatric resident. What’s great is that UNC has allowed me to do 2.5 months clinically, then have 2.5 months to work on MedServe. This is the first time I’ve been in the position to be able to tailor the academic process with my passions. To the credit of UNC they were receptive of the idea, and I am midstream right now. After that, I really see a much broader set of options than before. What I do know is that I will be working in the healthcare system on new and innovative ideas in communities that help drive that change – through MedServe, or through innovative health systems with new models of delivering care.

What would you have liked me to ask you? [51:24]

I think we talked about the process of me being an applicant and all the things I wish I had known, but I would say the lesson I really learned is to not lose yourself in the process of getting a professional education. There are lots of expectations in professional fields, and students often focus on just meeting the demands, and are surprised there is a job and career path at the other end. It’s a true job-seeking process and it requires some thought on what you really want to do while you’re in the middle of it. If you have truly been on a conveyor belt driving to do well in what the profession asks of you and then figure out what you want – it can be a real problem. For me I couldn’t spend 10 years not engaging a part of my brain, so that is what has guided me, not just doing what is demanded of me.