Ep 72: Relentless Optimism

[00:00:18] Ceci Connolly: Hello, Her Story friends. I am so excited to be back with you all today guest hosting with a terrific friend and person that I just admire and am so excited to maybe introduce to a few of you, although she’s awfully well known these days. It is, of course, Dr. Megan Ranney. She is, among many things, an emergency physician, practicing, an academic Dean of the School of Public Health at Brown University in Rhode Island. Megan, it is great to have you.

[00:00:54] Megan Ranney, M.D.: Thank you. It’s a joy to be here with you, Ceci.

[00:00:56] Ceci Connolly: And thank you for fitting us into your schedule, which I know just keeps getting bigger and busier these days. But Megan, on Her Story, we are particularly interested in understanding how women leaders in healthcare have gotten where they are and some wisdom to impart on the group. So maybe we just start a little bit with medicine and emergency medicine. What pointed you in that direction?

[00:01:25] Megan Ranney, M.D.: So emergency medicine was never in my career plan. And in fact, when I finished college, I didn’t think I was going to go into medicine at all. I thought I would be a journalist or a foreign aid worker. I actually spent two and a half years in West Africa in Cote d’Ivoire as a Peace Corps volunteer. And I was in Cote d’Ivoire in the late 90s at the height of the HIV Aids epidemic, at a point when antiretrovirals were utterly unavailable to folks on the African continent and watched a number of villagers and friends die of aids. And although I was deeply involved in trying to prevent the disease, it also became very apparent that it’s difficult to prevent things if there’s mystery and stigma and lack of treatment around them. And I wanted to be able to treat, as well as to describe and develop programs to prevent. So that’s what brought me back to the United States to go to med school. I thought I was going to go into infectious disease so that I could go back and go back to the towns that I’d worked in in Peace Corps. But I happened to be matched with an emergency physician my first year of medical school for our doctoring course where you get exposed to clinical medicine and I absolutely fell in love with it. Ceci, emergency medicine is everything that I wanted out of the practice of medicine. It is challenging. It requires the instant ability to create trust with patients, families, and your team. You have diagnostic mysteries. And it’s the safety net of the healthcare system. I frequently say, especially now during COVID times, but before as well, that we’ve served as the canary in the coal mine for so many of the dysfunctions with the healthcare system, as well as with, honestly, society. Gun violence, opioid epidemic, domestic violence. They all come through our doors and we see rising numbers before anyone else in the system. That’s what drew me to it. And here I am almost 20 years later still practicing and still loving this specialty.

[00:03:22] Ceci Connolly: Well, and I want to get to a couple of thoseyou rattled off there: opioids, gun violence, obviously coronavirus as well, because they have factored into, I think, your career paths and they’re so interesting. But before we do, I have to ask, because you mentioned interest in being a journalist and we see and love seeing you on TV and that’s my former life. So I am curious if you’re a little bit of an adrenaline junkie, because I think of journalism and emergency medicine as kind of having that buzzy feel.

[00:03:57] Megan Ranney, M.D.: Yeah. I often say about myself that one thing that I never am is bored. I’m always finding ways to grow or stretch, always looking for kind of the next space to step into, not in a way that abandons the things that I’ve done, but there’s so much in the world to both understand and to help move forward. And yeah, the whole rolling stone doesn’t gather moss definitely applies to me.

[00:04:24] Ceci Connolly: And so, let’s start, med school, early days of being a physician. Particular challenges as a woman in emergency medicine, or was that pretty accepted and smooth sailing?

[00:04:39] Megan Ranney, M.D.: It’s a great question. So I’ve been very involved in, I was involved with women’s studies. As an undergraduate, I was the president of our women’s undergraduate council, the Radcliffe Union of Students, so had a long history of kind of advocating for women and talking about intersectionality and got into emergency medicine, thinking like I knew this, right? I understood and knew how to hold my own. I didn’t necessarily feel gender discrimination during my training. I will say that the thing that took me aback was being a mom. So I had my first kid at the end of residency and I think that balancing act, that was really the first time that I realized that my male colleagues were getting to move ahead quickly. Well, my female colleagues, we were all of that kind of that early to mid thirties child-bearing age were facing barriers that hadn’t existed that our guy friends didn’t have to deal with. It wasn’t macroaggressions, it wasn’t like people were telling me, oh, as a woman, you can’t do this. But rather, you would find yourself not being able to make meetings or kind of subtly cut out of things. Then, as my career progressed, as you start to move up kind of the leadership hierarchy, you do start to feel more of that gender. When you’re an intern and second year, everyone treats you a little bit like a baby regardless. So I also started to notice the gender dynamics more as I moved further in my career, when I was an attending and expected to be the ones calling the shots and still got patted on the head by the consultants, right, metaphorically, while my male colleagues, didn’t, started to notice some of the gender disparities there as well. I think it’s everywhere in our society and I’ll be honest, I still feel it today, where there are things I’m ready to do and I’m told, well, politically, it’s better for you to take a little bit because people will come and criticize and say you’re too young. No one would say that about me at this age as a man. So I don’t think it ever goes away. It just manifests itself in different ways at different points of time.

[00:06:48] Ceci Connolly: And so along the way, as you’ve encountered those things, how have you managed them, navigated?

[00:06:56] Megan Ranney, M.D.: A few different things. I think the first is having an incredible network of peers, particularly peer women, one of whom in invited me into a network that you and I are both in. I think that’s my biggest support and it’s actually something that I frequently say to my mentees, is that you can have great mentors, but you need to have that peer network to bounce ideas off of, to serve as a sounding board and to help. We kind of leapfrog together. So that’s the first part. The second part is having a tremendous partner. My husband is, I feel, very, we’ve certainly worked through those early child rearing years together. It’s not always smooth sailing, but he’s been great. And then the third thing is having those mentors and sponsors who’ve helped to lift me up and to create opportunities. And they’ll say to me, I’ll never forget, a colleague of mine, a guy named Judd Hollander, nominated me to be an editor for Annals of Emergency Medicine. At that point, I was already grant funded. I’d been on the board of one of our major emergency medicine societies. He said, I’ve nominated you. Folks have said that they think you’re too young, but I’ve told them that you’ll do a great job. And again, like that’s ridiculous that people said that. But I came in and I did a great job. So he very intentionally put my name forward and helped me progress. I think it’s something that people do for each other all the time, but there’s an intentionality to it sometimes with sponsoring women and also people of color. We have to have folks that are willing to go to the mat who are a stage ahead of us in their careers to advocate for our getting a seat at the table.

[00:08:37] Ceci Connolly: Well, and I couldn’t agree on all of those and the networking you were mentioning, that’s Women of Impact. I think some of the Her Story listeners, audience, have heard from another co-host of ours, Joanne Conroy, who was really the key founder of that organization. And we’ve had a few other Women of Impact members come in and join us and I agree with you. It sort of nourishes the soul, but it can also be an incredibly practical group.

[00:09:11] Megan Ranney, M.D.: And both matter. You need your soul nourished as well as the practical advice. You can get all the practical advice in the world, but if you’re not feeling self confident or happy, or socially connected, you’re not going to succeed. And so I think there’s a reason that guys go and golf and go to cigar bars. I mean, it’s fun. You should have fun together. That’s part of a career, right? Life is too short to just work. It’s, all work and no fun does not create for success.

[00:09:40] Ceci Connolly: I wanted to pick up on the fact of having a family and that balance that you mentioned. So that was early, you mentioned your husband as an incredible partner. Sort of pull that line forward and how, over the years and phases of your career and ages of your children, how did that play out?

[00:10:04] Megan Ranney, M.D.: So I definitely stepped back in the early years of my kids, really up until my younger one, who’s now 10, until he was probably three or four. I took not necessarily an intentional step back from my career, but there just wasn’t time or emotional energy in the world for me to be out there the way that I would, the way that I am now. I developed a lot of supports along the way, not just my husband, who, again, I don’t want to portray that it’s smooth sailing and somehow I have this magical unicorn of a partner who just took everything 50%. There was a lot of negotiation back and forth and there’ve been periods, the little years, I did a ton more. These days he’s actually really doing, he just took my little guy to school while we’re on this podcast. I feel very lucky. So there was that negotiation. There was my stepping back a little because I couldn’t travel as much. Nursing was tough. The kids needed me. I wanted to be present for them in the little years. And then there was also setting up the support structure, childcare, a network in our neighborhood of other families. That was really critical to my being able to move back out into kind of feeling like I was my full self in the workplace and in the world. There was definitely a few cocoon years there, which is fine. But it was challenging for me because I wasn’t used to that. It’s not my normal self to spend more time at home.

[00:11:30] Ceci Connolly: And then, as you sort of emerged from those cocoon years, I like that description, and were then maybe shifting a bit more of the time and focus to some of the career moves, talk to us a little bit about what I might describe as the Megan portfolio, if you will, because it’s not as if you just have a single job and you get up in the morning and you go to work and that’s that. Let’s talk a little bit about all of the incredible balls that you’re juggling these days and how you put together that portfolio. Is it intentional? Is it happenstance? Is it opportunistic?

[00:12:12] Megan Ranney, M.D.: I frequently tell folks that, when you look backwards at your career, you can draw a very clear straight line and trajectory. But in the moment it doesn’t feel that way, right? Every day you face branch points and decisions, and there’s not necessarily a right or a wrong, but each decision takes you down a certain path. And again, at the end, you can draw the line. On the way, it’s not always so obvious. There was some intentionality. I’ve known since I was a kid that what I wanted to do in the world was to make it more equitable and healthier and to share people’s stories along the way, right? And so that was that kind of potential journalism road. Medicine works wonderfully for it as well. I think what motivates me to get up in the morning is understanding the human experience and then working to create opportunities for people to kind of live to their full potential. And from the space where I sit, that full potential is about creating that possibility for them to have health, both physical and emotional. And so every choice that I’ve made along the way has been with that goal in mind of, does this create a healthier world and does this help share stories of folks whose stories are not being shared? My decisions were not necessarily made with an eye to, does this get me kind of the next leadership opportunity? Does this get me…, right? I have friends who have been very strategic around kind of climbing the ladder so that they can have impact in their way. Mine has been more about that end goal of the impact on the world rather than my own title. But when I look back, there has been intentionality there. So phase one, that cocoon phase, was about getting my first NIH grants, which both helped me to be a great scientist, to be able to do that work to make the world better, to understand the methods, to be able to evaluate interventions and changes rigorously and were about starting to build my career skill set. And then I’ve branched out from there. So when you ask me about what my day is like, there’s a few different things. So I still have my NIH research, NIH and CDC research portfolio. I practice clinically. It keeps me honest. It keeps me grounded and I love it. And I run our center for digital health, which I created. It’s a series of growth steps, but it’s origin was about a decade ago. I was working with text messaging to help deliver behavioral interventions to folks that didn’t have access to other preventive healthcare, particularly around violence prevention and mental health, and realized that at that point in the early 2010s, there was very little work being done around digital health for the populations that I take care of in the emergency department, right? There’s lots of quantified self, stuff for the upper middle class, not so much for the people that generally walk through my doors. So I created what is now the Center for Digital Health based on this idea that we should be developing equitable and usable digital interventions that make a difference for real people’s problems, not just for kind of wellness and weight loss. So created that with that kind of, again, intention and impact in mind. And then I’ve taken various other leadership roles in societies along the way. And then had a couple of really big shifts. So one is the violence work. I’ve been working, again, in violence prevention since before I was even a physician. But again, in that same time period in the early 2010s, had a number of clinical experiences that made me really start to question why we weren’t talking about firearm injury as a public health problem. And so very intentionally stepped into that space of saying, we need to change the public conversation about firearm injury and frame it within the health space, rather than within purely the criminal justice or policy space. So did a lot of work on that, created a nonprofit, have a whole line of research and a whole network of folks from that work and we’ve largely kind of made a lot of progress. We have federal funding for the issue for the first time in 23 years. Just yesterday, i n President Biden’s new budget, he has a lot of money in there for community violence prevention. There’s a lot of really exciting things happening and it wasn’t only me. It was a large network of us. So that’s part of my day to day and part of my trajectory. And then COVID of course happened. And I stepped into that in the same way, where there were PPE shortages, we tried to call attention, and then there was a space where no one was doing anything. So I and a group of colleagues from across the country created an organization, Get Us PPE, to get donated PPE to those who needed it most, not just physicians, but nurses, folks that work at nursing homes, home healthcare workers. I think it’s important to call out that most home healthcare workers and aids are women, often women of color, often working at minimum wage. And they were the folks that had the toughest time accessing PPE who are also at some of the highest exposure risks to COVID. So created that organization with that goal in mind. And then moved into my new job over here at the School of Public Health, where I still held on to all the other things and have incredible teams that I work with, right? So it’s never me, it’s like being part of a bigger group who are just so inspiring and incredible. And now, took on this job at the School of Public Health as academic Dean, where my goal is really to help us. We have a great school of public health already to help us kind of think about where public health needs to be in the next 25 years. How do we educate? What type of scholarship needs to be done? How do we create community impact? So taking all those lessons that I’ve learned along the way in my other work and applying it now on a larger scale to public health, writ large. The job I’m in today wouldn’t be possible if I hadn’t done my NIH grants, done the work on firearm injury, done the work on COVID, done the work on digital health and opioids. It all informs it. Would I have said two years ago that this was where I was going? No. So that’s a little bit of an accident, but there’s also intention.

[00:18:13] Ceci Connolly: What’s so obvious is that you are a person with big ideas. And as I’m listening to you tick through the different organizations that you have created and the way that you’ve activated and mobilized groups on some very big, challenging, and, in some instances, certainly controversial topics, I’m imagining, has there been that moment when you’ve had one of these big ideas and you’ve gone to whomever you are asking for money or proposing a new center that the bosses or the funders, whoever it is, and, have you hit a brick wall or how is it that you sell these big ambitious ideas that I’m sure people along the way have found arguments against them?

[00:19:10] Megan Ranney, M.D.: So I think that hitting brick walls is part of innovation and change. And I think that one of the things that differentiates those that go on to make a difference from those that don’t is the ability to evaluate why there is the brick wall and then find a way around it. When my son was little, one of his favorite books was Going on a Bear Hunt. I’m going on a bear hunt. I’m going to catch a big one. Oh, there’s mud. I can’t go around it. I can’t go over it. I’ve got to go through it. And I feel like life is kind of like going on that bear hunt, where you hit these obstacles and you’ve got to find ways through them. Sometimes the obstacle is a very, very real one that makes you kind of retreat and reevaluate your path. But often it’s that you haven’t used the right strategy or created the right alliances. I rarely take a no as a final no, but rather, why are they seeing no? What are the other opportunities? How do I make my way through this mud in a way that preserves my integrity and my end goal, and doesn’t bog me down to the point that I can’t do anything anymore. But I see it as a, it’s a challenge rather than a wall. So there’ve been lots, I mean, we could spend an hour talking through all the no’s I’ve gotten in my life and then the ways that I’ve worked around them. And so I’ll just say, so firearms. When I started working on it, when I said, this is horrible, right, not just my victims of community violence, but my victims of domestic violence. You’ll hear me kind of say in public, I tell a story about a young man who killed himself with his father’s gun, who I took care of in my emergency department. And when I started trying to have that conversation, I was told in no uncertain terms by mentors within my specialty, mentors outside of my specialty, people at my hospital, Megan, you can’t talk about this. And I said, who says and why? And let me figure out a way that I can talk about it, that you’ll let me do, but let’s figure out ways where I don’t have to get your permission. If I’d listened, if any of us had listened, we’d still not have funding for firearm injury prevention. So it’s just about figuring out coalitions and ways around it.

[00:21:23] Ceci Connolly: So I’m always curious, when I talk to women about how they find their ways around or over or through or whatever it is, must it always be done with a smile on your face. Or how do you kind of strike that balance of, you don’t want to anger and frustrate these individuals who may not have the same vision as you. How and when do you decide that this is a charm offensive or, no, I’m going to put my stake in the ground here?

[00:21:58] Megan Ranney, M.D.: I wish I had a perfect answer for that. I don’t. Come back to me in another 10 years. I’ll say that one of my most dominant characteristics besides caring about people’s stories, besides constantly kind of wanting to see improvement in the world, is a relentless optimism. I think folks that know me, it’s not that I’m like rainbows and unicorns, but I believe the change is possible. And so do I do this with a smile on my face? Probably, because I’m optimistic about it. I do think that, as you move up in the kind of hierarchy or in age, that charm offensive becomes inappropriate, right. But at the same time, friendships and relationships are never inappropriate. So I would never use charm as a way to manipulate or wheedle, and I certainly moved on from that ingenue kind of naive brand new resident or brand new professor world. But at the same time, I push back against the idea that, just because the guys that existed in these roles 15 years ago slammed their fists on the desk in order to make a point, that doesn’t mean that’s the way that I’m going to lead. So I would say that it’s a, I don’t know exactly the right answer, but I would argue very strongly that having an optimistic bent and a relationship based bent is part of the trick to long-term success. And it results in more sustainable change if you have trust among team members.

[00:23:34] Ceci Connolly: I think you’ve hit on one of sort of our central Her Story questions, which is around this notion of, is there a characteristic that you feel has given you an edge? And I hear you saying optimism, which is interesting because I think, particularly throughout this pandemic, as I’ve been talking with a lot of our CEOs around the country, the number of them that have said to me, well, I’m an optimist and I think that’s really helped me these east past few years. Is there any other characteristic that you would say has kind of helped give you the edge in certain situations?

[00:24:11] Megan Ranney, M.D.: I think another thing that gives me an edge is the willingness to step into a blank space. So it’s not just optimism, but it’s also the ability to see possibility and to take that risk. I was just on a call before this podcast with my team and we’re doing something that I’m actually not sure is going to succeed and they’re feeling pretty down. And my answer is, we’ve done something that hasn’t been done and it’s okay that we may not reach the goal that we set. If we hadn’t tried, there’s no way we would have reached that goal and we’re going to learn from it. And so I think that ability to tolerate a little bit of risk and to see where there is possibility over the hill to not be incremental, but rather to be bold, is another skill that I have. The willingness to say yes and to step into things.

[00:25:06] Ceci Connolly: You When I listen to you talk about any number of your focus, areas gun violence, opioids, domestic violence, and more recently coronavirus, and wearing my Washington DC kind of political hat here, I would say, well, gosh, you really seem to be drawn to controversial subjects. Maybe they shouldn’t all be controversial, especially for a physician and someone in public health. And that may factor into your answer here, but never the less, I’m sure a lot of people would sort of describe these things as controversial, even look at everything that we’ve been through in this pandemic around vaccination and masking. And you recently wrote in the Washington Post about how it’s probably not over yet, friends. And even though this is not going to be popular, we need to kind of still stay focused on it. What’s your strategy for being in high profile, highly visible, often controversial issues, and probably taking some arrows, I’m thinking now about Twitter, for instance, and like still have that smile on your face?

[00:26:26] Megan Ranney, M.D.: So I think of it, a little bit, it’s a challenge, right? So to me, the way that I approach any of these issues is that they’re all things that affect all of us across the United States. When I talk to any human being in this country or outside of it, but I’ll focus on the US. When I talk to any human, kid or adult, in the US, no one wants to get sick. No one wants to be depressed. No one wants to lose a loved one to a preventable disease or injury. Where we debate is, what are the strategies so that we’re not sick, so that we don’t lose loved ones, so that we’re not sad, right? So my goal is, how do we create a conversation where we can see that the way to get there, we may come from one side of the political divide or the other, but given that we have the same goals, we can create paths to get there that converge. I’m not going to agree a hundred percent of the time. And there’s going to be a percentage of folks, the 10% on either side of the bell curve who are never going to come along. But gosh, talk about opioids, I mean, or firearms, or COVID. There’s not a person in the United States that hasn’t been touched by those in some way. And so recognizing that, instead of fighting, let’s talk about what those pre-existing risk factors are and how we can mitigate them in ways that are respectful of communities and community values and community mores, kind of that idea of trusted messengers or cultural competence. I think a big part of it, Ceci, is taking out the judgment about how people have responded and I’ll take the COVID vaccine debate as one example. So there’s a lot of papers being published right now about the red blue divide in vaccination rates. It is true that you can look and find a correlation between counties that were red and counties that were blue and vaccination status. But I would argue very strongly that labeling it as a red or blue issue, first of all, further divides us. But second of all, ignores the underlying drivers that have caused those disparities. So let’s talk about education being equally correlated with willingness to get vaccinated, governmental policies being equally correlated. Did you have access to it? Was it emphasized? Let’s talk about social media and misinformation and disinformation and who’s exposed to what? So that red blue divide to me is far too facile and gets us all off the hook of doing the work. It allows us to other half of our country. And I just don’t accept that. So to me, these are not controversial issues per se. They don’t need to be controversial, but rather they have been labeled that way because it’s useful. It’s a tool that politicians use, that sometimes the media uses, sometimes that scientists use to allow us to kind of feel better about the fact that we have these huge disparities. And I refuse to accept that.

[00:29:23] Ceci Connolly: So brilliant. Brilliant strategy. And I do think that, sometimes, looking at things through a little bit of a different prism is so smart and can change the nature of some of these very contentious debates. On a personal level, how do you recharge? How do you cope with being in the spotlight at the center of controversy a fair amount of the time? What are your little tips for this audience, especially as many of the women listening and watching to this podcast are aspiring to move up in their careers and become more prominent themselves?

[00:30:12] Megan Ranney, M.D.: I think it’s a few things. So first is maintaining integrity and a sense of really kind of what your north star is. I have watched friends and colleagues go a little off the rails in that search for prominence or for power and it makes me really sad because they’re brilliant people and I think you’re going to have seasons where you’re rising up the ladder and you’re going to have seasons where you’re not, and it’s all okay as long as kind of what your end goal is. And so I think that’s the first thing. The second thing is, relatedly, recognizing that there are going to be periods where you’re really busy with one thing or another, whether it’s you’ve got little kids or you’ve got a sick parent, or you’ve got a health issue yourself, or work is all consuming. And Ceci, you and I started off this podcast by me saying right now is a moment where I’m having to, I’m thrilled to step up on behalf of my school, but I’m also having to step up because my Dean, Ashish Jha, is, I’m so excited, temporarily transitioning to the White House to run the COVID response. So there’s a bunch of stuff that I’m taking on that was previously on his plate. And I am so thrilled to do that for the school, for the work that we’re doing within the School of Public Health. And my family knows that for the next month or so my life’s going to be a little off-kilter. So that’s part of it is accepting that there are moments where you’re in, but then also having moments to breathe. And so that last part for me, of how I keep going, it is my friendships. It is reading. It is travel. It is exercise, which is really one of my big ways to stay sane and maintain my energy and protecting my sleep as much as I can outside of these temporary periods. One of my mentors said to me, there’s these maxims out there about academic medicine. And he said to me, Megan, the institution will never love you back. I think that’s a little bleak. The people within an institution certainly learn to love you and you learn to love them. But at the end of the day, we have one life, right? And so, I am not willing to spend my entire life working because I want to make sure that I’m upright, I’m healthy, my kids are great, my husband is great, my friendships are maintained. And there are periods where one or the other takes more priority for various reasons. And that’s okay. But making sure that, over a period of time, you’re not completely out of kilter.

[00:32:33] Ceci Connolly: I love it, Megan. We want to be mindful of your very busy schedule, but maybe we could close this Her Story conversation today with, is there a closing piece of advice that you would offer in particular to women in healthcare that are emerging leaders or they’re partially along their leadership journey and any tip or advice from you?

[00:33:01] Megan Ranney, M.D.: I think that my biggest tip is to, when you identify a problem, be willing to step up and be the person to do something about it, but do something with a coalition. So don’t ever feel, not that you shouldn’t lead, but having a team around you, a coalition, even co-leaders, is, to me, one of the biggest facilitators of success. Being willing to step up and do those things is also one of the biggest facilitators of success. And I will say, in the position that I am in now, when folks come to me with a complaint, with a concern, with an idea, my encouragement is always, I will mentor you in creating a solution. My plate is full. I cannot take on creating all the solutions for everyone in the world. I am going to ask you to step up. And that’s actually one of my tests about who comes onto my team at this point, is, are you someone who’s going to step up and do it and create that team? And again, you may not have time either, but that’s where the team comes in. That to me would be my biggest tip.

[00:34:09] Ceci Connolly: I love it. And on that note, please follow Megan on Twitter. Keep an eye on CNN for her and publishing. And we’re just gonna, on behalf of all of Her Story, wish you great success in your important work. And thank you, Megan.

[00:34:26] Megan Ranney, M.D.: Thank you. It’s a joy to be with you, Ceci.