New HRSA Chief Brings Nurse's Perspective

Newly appointed Health Resources Services Administration Administrator Mary Wakefield says her background as a registered nurse will be as valuable to her new job as her years of experience and expertise in the healthcare policy arena.

"The frontline experience is as important as anything. Clinicians have had that up-close-and-personal experience with the problems that these vulnerable and underserved people face," Wakefield says in an interview with HealthLeaders Media. "When you bring in a healthcare provider into many of these administrative positions, you've got individuals who've got a sense of what it is like to operate inside the healthcare delivery system. Having clinicians in key positions gives them a finger on the pulse, brings them a little bit closer to the issues, and adds color and perspective to how programs can be deployed, how they can touch people's lives, and what differences they do or don't make."

Wakefield starts at HRSA on March 10. Since 2001, she has served as associate dean for rural health and director of the Center for Rural Health at the School of Medicine and Health Sciences, University of North Dakota, in Grand Forks. Before that, she was director of the Center for Health Policy, Research, and Ethics at George Mason University in Fairfax, VA. Before that, she worked in Congress in the 1980s and early 1990s as chief of staff for North Dakota Democratic Sens. Quentin Burdick and Kent Conrad. She is an expert on issues like patient safety, rural health, and Medicare payment policy, and has served on several federal health policy advisory commissions.

At HRSA, an agency under HHS, Wakefield will lead an organization with 1,400 employees in six bureaus and 13 offices, and an annual budget of about $6.85 billion—90% of which is doled out to provide grants that directly affect about 23 million people in urban and rural areas in every state and territory. HRSA grants are targeted to improve healthcare access, quality, and outcomes to vulnerable populations that include the poor, uninsured, people with HIV/AIDS, pregnant women, and mothers and children. The agency also oversees healthcare centers across the country.

Tim Size, executive director of the Rural Wisconsin Health Cooperative, says the Obama administration could not have picked a stronger advocate for rural health than Wakefield. Size says her selection has sent a clear signal to the public healthcare advocacy community that the new administration is serious about improving healthcare access and quality for poor and uninsured people. "If you named three people who are among the most respected in rural health in America, she'd be on that list," Size says. "She won't be there to represent a political ideology as much as to try to deal with the historic challenges that HRSA faces around disparities in rural and urban health."

Size says a nurse is exactly what HRSA needs. "Nurses, especially senior nurses, think very systemically. They are probably the one profession that is trained intuitively to break through silos," he says. "She will very much be working on how to help clinics continue to fulfill their mission, and also on how they relate to the rest of the system and how we maximize those relationships."

Wakefield made it clear that she does not regard herself as merely a functionary for the Obama administration. "Front and center I work for the president and I'll be taking my directions from his healthcare team. It's there that I'll be getting much direction," she says. "But in addition, I was brought to this by some of the expertise that I have. This is really about working for, on behalf of, and in sync with the vision that will be articulated by the administration. I have every intention of complementing that with the expertise that I will bring not just managing an agency but knowing something about many of the programs that are operationalized through that agency."

Wakefield says she expects her priorities at HRSA will include ensuring that the $2.5 billion in stimulus money that flows through HRSA goes toward its intended targets, which are improving the healthcare infrastructure and training healthcare professionals. She says she also expects to examine HRSA programs and their relationship with the health reform proposals that President Obama is bringing forward.

Wakefield says HRSA's role has become more critical with the collapse of the economy as more people lose their jobs and their health insurance. She says HRSA can greatly impact rural healthcare by promoting programs like the National Health Service Corps, which places physicians and other healthcare providers in underserved rural and urban areas.

She says she anticipates looking at the Office of Rural Health Policy, which is located in HRSA, to promote programs that encourage collaboration between rural and urban hospitals. "There are different program levers that can be pulled to try to meet the simple workforce needs and help support safety net infrastructure in urban and rural underserved areas," she says.

Wakefield was asked what message the Obama administration was sending to rural healthcare advocates and observers by picking her.

"What this communicates to me is that rural is not left behind. Rural is part and parcel of the focus of programs that are so important to individuals and programs that reach directly into the heart of communities," she says. "They are saying rural is part of that too."