"So much of who we are comes from where we have been. Our experiences mold us into the people we are today. I would not be the person I am today and may not have chosen the paths I’ve taken without the people and places I have been blessed to encounter. Many of the people here in this room tonight have played a role in my standing before you now as the 174th President of Iowa Medical Society. This is an honor and privilege I do not take lightly.
Much of who I am was shaped by two people who are not here with us tonight. I am a third generation osteopathic physician. My grandfather was the son of Polish immigrants born in New York. He graduated medical school in Chicago during World War II, finished training and started his practice in rural Michigan recruited by a local factory. He had completed a surgical residency but had limitations in his scope of practice as a DO for a number of years. So much was diﬀerent about the practice of medicine during those times beyond the diﬀerence in understanding of disease and treatment options. The cost of medical school tuition was a mere $500 per year. Less than 10% of Americans had private health insurance as we know it in the early 1940s. Many of my grandfather’s patients paid for their care by bartering.
His practice encompassed what we now think of as full scope family medicine with surgical privileges. His profession defined him. Everyone called him “Doc,” including my grandmother. To me, he was Grandpa Doc. His Normal Rockwell existence was most vividly portrayed at his retirement party. After nearly 50 years in practice, people travelled over a 100 miles to visit him, thank him and share stories of the generations of their family touched by him. I was in middle school at the time deep in the self-centered throws of adolescence. And even I was awestruck by the impact of my grandfather’s life of service— his calling.
My father’s education journey brought him to my grandfather’s alma mater for medical school in the late 1960s. He was drawn to rheumatology inspired by a dear cousin who had suﬀered from rheumatic disease during an era where most diseases were yet to be fully delineated let alone successfully treated. He was an academic rheumatologist whose clinical practice spanned from urban and suburban Chicago area to rural outreach clinics. His passion was clinical and pharmaceutical research, and teaching in all capacities. I have many vivid memories from my childhood that revolve around his career— rounding with him at hospitals on the weekends, the doctors lounges where I could always find the best treats, sometimes being pulled into the patient room with him to meet someone who has been hearing all about me and my brother for years, and many vacations centered around conferences where he was an invited speaker. As a child, I was given a glimpse of the sacrifices that a career in medicine meant. But I was also aware of the gratitude his patients, nurses, and trainees had for his compassion, time and enthusiasm for learning and teaching.
It is unclear to me exactly when I decided I wanted to follow in these giant footsteps. I suppose like many who enter “the generational family business” there was a part of me that didn’t really ever think twice. There were moments of guidance from both men on things to consider. There was not once ounce of pressure. If anything there were conversations about medicine changing. During the course of their careers, the science of medicine advanced immensely and the practice of medicine changed significantly. I didn’t fully understand their warnings at the time.
Once I had become steadfast in my desire to be a physician, it was clear to me that my motivation was to help others. How I would accomplish this was much less clear. I too followed my family footsteps to the same medical school in the late 1990s where I quickly became involved with student government as class president. This opened doors to a path toward organized medicine through the American Osteopathic Association - the AOA. I attended annual student lobby days in DC each year. Increasing roles in student leadership ultimately lead to being a voting student member of the AOA House of Delegates. Exposure to organized medicine and healthcare policy so early in my career was an absolute blessing; one I had not intentionally sought out but more or less stumbled upon. Having a voice on the floor during policy deliberation, and involvement on committees was truly eye opening. I learned that our oath to protect our patients did not start and stop at the bedside. This was not a lesson taught to my classmates. It was not in our curriculum. My classmates and I did not have the widespread use of the internet to gain information let alone algorithm-based social media to bring social & economic policies and constructs to our attention with little eﬀort. Organized medicine introduced me to other student and physician leaders whose professional successes and challenges helped shape my views on changes needed in healthcare.
In hindsight, my love of pediatrics and critical care medicine seems like it was predetermined, but Pediatrics was not even on my radar entering clinical rotations. It was, however, my FIRST rotation. And it quickly became the standard to which I subconsciously compared every other field. Having had the fortune of my first impression of pediatrics being at a high-acuity community children’s hospital opened my eyes to the complexities of care for our most vulnerable population. I later returned there for residency. The place where I fell in love with the care of children and found my calling was only two miles from my high school. There were stretches of my training where I lived at home with my parents. The dinnertime discussions with Dad during those years were on a new level. I had rotated in his hospital throughout medical school — the same hospital where I rounded with him many years before. The wards, the clinics, even the doctor’s lounge, had new meaning but still felt like home. One of my favorite experiences was a two-week elective on his service. Like many young adults, I took for granted that unique opportunity to fully witness my father in his element. These are now some of my most cherished professional and personal memories. Here’s why:
Around the time I decided to apply for pediatric critical care fellowship, my dad was diagnosed with pancreatic cancer. The 14-month long battle taught me countless lessons personally and professionally. I was blessed to be training so close to home allowing me the opportunity of time with him. His sense of responsibility for his patients and trainees were unwavering during that time. That same hospital where he dedicated his career and where I grew up is where his battle with cancer ended.
His death at the beginning of my fellowship along with the birth of both of my children during fellowship solidified the coming years’ focus on family and career. My graduation occurred during a down-turned economy causing the majority of the hospitals to which I had initially applied to pause hiring. Pediatric Critical Care had been a field of significant growth throughout the country during my training as more hospitals were opening PICUs placing supply and demand in my favor. But this promise was not my experience. I had received my bachelors from University of Iowa and gladly considered the opportunity to return to Iowa. Our family of four moved to Des Moines to join what is now known as MercyOne Children’s Hospital Pediatric Intensive Care Unit staﬀ. Coming from two large, extended families, moving hundreds of miles away from all things familiar with very young children was no small feat. We quickly fell in love with all the charms of life in Iowa. Almost 14 years later, we are immensely grateful for the happenstances that lead us here to a community that has helped us raise two truly awesome teenagers.
As the strain of the early years of parenthood and my career subsided, opportunities to become more engaged within my hospital and IMS surfaced. It has been my experience that saying yes to opportunities that were not necessarily on my radar have been some of the most fulfilling. My subspecialty historically, and unsurprisingly, has one of the highest burnout rates. To borrow from Sheryl Sandberg, leaning in and broadening my horizons past the number of patients on my census has paid oﬀ many times over for me. The timing of IMS leadership in my life was nothing short of amazing— reigniting my interest in advocacy and organized medicine.
The fellowship and knowledge I have gained from my fellow board members, I cannot possibly find enough adjectives to describe. I want to thank each of those with whom I’ve served. Your perspectives and impact will forever remain.
I joined the board roughly a year before the pandemic was declared. The impacts of the pandemic on healthcare are ones that we will be feeling for a long time. Iowa has been no stranger to the discussion of workforce issues and access to care long before COVID-19 became a household word. However, the pandemic has taken our workforce issues to a new level. The economic impacts we are facing are unprecedented. Although, the pandemic was oﬃcially declared over recently, those of us in healthcare will be tending to our wounds for years to come. And I believe the wounds in Iowa to be deeper still as one of the lowest- reimbursed states in the country. With reimbursement rates essentially unchanged over the last decade in stark contrast to inflation in supply chain mixed with cost of contract labor to staﬀ our practices, the number of problems to be solved are piling up. Meanwhile, we are still desperately trying to provide the best care for our patients and communities. Do more with less. We have seen closures of hospitals and birthing centers in rural areas that arguably need MORE, not less, help. In fact, there are few hospitals in our state that are not financially struggling to make ends meet. This is not sustainable.
The closures of hospital-based services for children over the last 2 years impacted families around the country. Many of my eﬀorts during the pandemic were focused on pediatric access to care in our state. Surge planning changed over time from our perspective. Thankfully, children were not the primary burden on our healthcare systems. Pediatric wards and ICUs were frequently utilized for adult care due to overwhelming need. As the economic weight became heavier, many places around the US chose to permanently convert pediatric wards and ICUs to adult services due to low patient volumes and significant disparity in reimbursement. Over 25% of the PICUs in the country closed months before the respiratory illness surge hit last fall. I am incredibly proud to have worked alongside my fellow Iowa children’s hospital leaders on a daily basis over the last two plus years in an attempt to improve access for Iowa’s sickest children. All three of our hospitals received children from our surrounding states where they had run out of PICU beds due to closures. Our collaboration was grassroots and unprecedented but born out of necessity. Although there is still much work to be done for our state to improve ease of access to higher level of care centers for patients of all ages, the groundwork has been laid. That alone is progress.
It is only human during times of stress to become focused on self-preservation, and those who were in the midst of their training years during the pandemic were forced to do just that. If you don’t have the pleasure to work with the phenomenal medical students, residents and fellows who are training in Iowa, or have had a new grad join your practice in the last few years, you may likely not have reflected on how this has impacted them. Practicing physicians… I challenge each of you to consider how diﬀerent your knowledge and experiences would have been in your given fields if your clinical training was limited in the ways our current trainees experienced. At minimum, the learning curve would be steeper and perhaps your choice of field would have been completely diﬀerent. Please remember this as these fine trainees recover from these extreme challenges. Their experiences are like none before. To our next generation of physicians, I want to commend each of you for taking on medicine as a career as I know how diﬃcult the journey was for me. Mentorship is the hallmark of our profession and I hope we, as already-practicing physicians, rise to the unique challenges to meet your needs.
The challenges faced over the last three years and over the coming years, in many ways, have amplified the problems that already existed in our healthcare systems. We must not overlook or forget some of the extreme things we encountered. Perhaps, you closed your practice and paid employees to remain at home all while trying to figure out how to pay the rent for your space. Perhaps you were the critical access physician who held up the morale of your emergency room while attempting to care for patients much higher in acuity than what you are designed to handle. Or you were the hospitalist, Intensivist or infectious disease specialist at a tertiary/ quaternary center who is trained to always take the patient and be of help but cannot as you drown in the weight of dying patients at a volume you’ve never imagined. The moral injuries we have sustained cannot be ignored. And yet, we are here persevering for our patients when our own reserves are low.
For me, self-preservation during this time caused me to question my purpose. What on Earth was I thinking going into medicine?!? I was at a personal low point when I was invited to Carver College of Medicine’s convocation ceremony last year on behalf of IMS to be one of a few physicians on stage. Almost exactly 25 years prior, I had been performing on the stage at the old Hancher Auditorium as a dance major. Sitting on the stage of the reborn Hancher, I found myself reflecting back on that young lady and her journey. Would she make diﬀerent choices if she knew what I know now? That all changed the moment they began calling individual students’ names to be hooded. I was one of the first people to see the glimmer in the eyes and the overwhelming sense of accomplishment and hope on the faces of each student as they heard their names preceded by the word “doctor” for the first time. The ‘why’ for which I did this, the ‘why’ I’m STILL doing this became much more clear. The words of the oath taken had renewed meaning on a day that was almost exactly 20 years from the date I took it.
There is hope that the trials and tribulations we are facing will be behind us one day. Medicine and healthcare changed a lot over the last few years. As a Greek philosopher once said, “change is the only constant.” Over the lifespan of the three generations of doctors in my family, the science and art of medicine, delivery of medicine, oversight of medicine, and cost of care has changed immensely. Changes in workforce and demands of the evolving populations are not a new problem. The scope of practice changes for DO’s was born out of necessity during wartime when MD’s were sent overseas. As I stand here now, I feel it’s especially important to remember that it took physician advocacy to achieve that.
Our discussions of workforce shortages and potential solutions including scope of practice today are diﬀerent, but these discussions need our voices to assure that any changes made are executed well and with a focus on patient care at the center. “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” Charles Darwin said that and I believe it to be true.
As I move into this new role, I want to assure you that IMS has, and will, continue to respond to changes needed to improve patient care, your practice of medicine, and uphold the sanctity of the patient-physician relationship. We are an ever-evolving profession and it is imperative for us each to lean in and speak up when possible for the sake of our patients. Medicine is deeply personal to each of us. I hope that you find reflecting on & sharing your personal stories with colleagues, legislators, and others will help renew for you WHY you took the leap and put in all the grueling years of work to do what we do.
I thank you all for your time and willingness to listen and I look forward to meeting as many of you as I possibly can through the coming year as we try our best learn how IMS can help you achieve what you need to serve your patients and communities.
IMS would not be the organization it is today without our staﬀ. Steve, Phil, Kady, Sara, Heather, Mary, Lori, Sydney, Petra— thank you for all that you do to support the physicians of Iowa.
Lastly, I want to thank my dear friends and family who joined me here tonight. Your love, support and understanding over the years has carried me through some of the darkest days. To my phenomenal husband, Joe, and amazing children Jillian and Ian I cannot begin to thank you for being my rock and my home. Your sacrifices have been many. I am forever grateful. I love you to the moon and back."
Jessica Zuzga-Reed, DO, 174th President of the Iowa Medical Society keynote address - April 21, 2023 President's Inaugural Reception and Awards Ceremony