Retired Denver Health CEO Gives Barrier-Breaking Leadership Advice

Patricia Gabow, MD, MACP, maps her career journey while offering insights into healthcare leadership as a woman.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below.

Patricia Gabow, MD, MACP, has had a medical career spanning over 50 years, and she's still working to improve healthcare during her retirement.

Gabow was an academic nephrologist, a physician leader and clinician, worked as a contributor to national healthcare policy, and served as health system CEO of Denver Health and Hospital Authority for 20 years. She's also professor emerita for the University of Colorado School of Medicine.

Currently she is working on her third book around the topic of healthcare and continuing to champion for women leaders.

During the latest HealthLeaders podcast episode, Gabow talks about her amazing career journey and her book Time's Now For Women Healthcare Leaders: A Guide for the Journey, and she shares advice for women who want to break through barriers and become leaders in healthcare.

This transcript has been edited for clarity and brevity.

HealthLeaders: Can you walk me through your career journey?

Patricia Gabow: While you probably would expect that I would start this answer by talking about my first real job, I want to start with my family, because that underscores that the path to leadership starts very early in a girl's life. The messages and support that we give our young girls from the very beginning is important.

I was lucky to grow up in an extended Italian immigrant family that valued education for women and men. When I was about 10 years old I started talking about wanting to go into medicine, and my mother encouraged me to be a doctor, certainly not the norm for a second-generation immigrant growing up in rural America. I attended a rural high school and my father was my teacher for all my history classes. He had three rules for me: Do your homework, sit in the front row, and raise your hand. I followed those rules my whole life.

I attended medical school at the University of Pennsylvania, where I was one of six women in a class of 125. There was a woman faculty, I think the only woman faculty, in nephrology, and she was a great doctor and a gifted teacher. She was one of the reasons why I went into nephrology, and it shows the importance of having women faculty at our medical schools to be role models and mentors for us.

The other reason I went into nephrology is I loved the specialty, and we should do what we love.

By the time I finished my training, I was married. Fortunately for my husband, who was an academic computer scientist, and for me, the Denver/Boulder area fit our bill.

I wanted to be at a safety net institution, and I wanted to be in academic medicine, and Denver Health was perfect. But there were two problems: Denver Health had no nephrology division, and there was no open position; an interesting challenge. I was right out of my training, but I accepted the challenge to start the division of nephrology. That underscores that women who want to move into leadership positions have to be willing to take risks. If you always want to be safe, you're not going to enter the executive suite.

I then became chief of medicine, then chief medical officer, and then for the last 20 years that I was at Denver Health I was the CEO. Each step of promotion that occurred was because my mentors and my sponsors pushed me forward. My mentors and sponsors said, 'You can do this, you should do it.' And so I did.

HL: What has been your overall experience learning and working in healthcare as a woman?

Gabow: I know this isn't a universal experience for women, but my overall experiences in becoming a physician, an academician, and a leader were all positive and rewarding. In some ways, it was an advantage being the only woman in many groups. I was always noticed; I also found I could say things to men in power that another man could not say. That gave me a lot of influence with people in leadership, whether they were division chiefs, department chiefs, or even mayors.

A large part of my positive experience came from where I worked. I tell my mentees that you need to work at an institution that aligns with your values. Denver Health, as a major academic safety net, was a perfect fit for me. And in some ways, a safety net institution is a really good environment for women who aspire to leadership, because these institutions are committed to equity in a very broad sense, so they're open to women in leadership. And in turn, I've had many men tell me that women leaders perpetuate that commitment to equity, creating a virtuous cycle.

Another reason why it's so positive an experience was I was blessed to work with a great team of men and women, not just doctors and nurses, but housekeepers and gardeners, who all were exceedingly mission-driven, and it created a wonderful environment.

The other reason why I think my experience was so positive was I was able to give opportunity to other talented women. Throughout my 20-year tenure as CEO, COO, CFO, CNO, chief government officer, chief communication officer, general counsel, and head of the health plan who were all women. Women often say they feel isolated in leadership, but I spent a lot of time with my leadership team, both men and women.

HL: In addition to your career, you also published a book in 2020, titled Time's Now for Women Healthcare Leaders: A Guide for the Journey. Can you go into a little bit of detail on why you wrote this book, and why women leaders are needed in healthcare?

Gabow: I wrote the book for four main reasons.

1. American healthcare has many problems. I don't blame men for all these problems, but the fact is, if you look at all the tables of leadership, whether it's government or healthcare institutions, they're predominantly white men. If we want different answers, we need different leaders at the table. I really believe that if we want to solve the problems that exist in American healthcare we are going to have to have different people at the table.

2. Fairness. 83% of the frontline workers in healthcare are women, but they make up only 30% of the C-suite and only 16% of the CEOs. That's just not right.

3. Women have a great deal to bring to the table. There's a lot of robust data that when women lead an organization, the profitability of that organization increases. But women's skills go way beyond profitability. One of the studies that I love was by Zenger Folkman, a consulting company. They looked at 7,000 managers and executives in high-performing companies using their Leader 360 evaluation. and women scored higher than men on many variables, including integrity, driving for results, championing change, and inspiring and motivating others.

I saw this firsthand with my team at Denver Health. I mean, we were a safety net with 40% of our patients not being able to pay us and 70% of our patients were vulnerable individuals. Yet we were in the black every year for 20 years, and we had outcomes that were equal to the very best academic health centers.

4. The journey to leadership has a lot of barriers. It's helpful for women to have those who have walked the path create a guide for them about the things you have to look for and how you can get around these barriers.

HealthLeaders: How can healthcare leaders continue to diversify their healthcare C-suites and even leadership below them?

Gabow: The first part of solving a problem is to identify it and to be aware of it. One of our governors in the past said there are four stages to solving problems:

• No talk, no do. When you don't even know the problem exists.
• Talk, no do. When people start to think this is a problem.
• No talk, do. When you start to problem-solve.
• The final phase is you've solved it, and now you're back to no talk, no do.

We recognize the problem to some degree, but for a long time we thought the problem was one of the pipeline. But it's very clear that it's a barrier problem. One of the greatest barriers to equality and leadership is lack of equity. We often use these terms equity and equality interchangeably, but they are different, and that difference matters to women.

Equity is about leveling the playing field, and if we're going to level the playing field for women, there are four areas we have to address:

1. Maternity leave
2. Childcare
3. Family leave
4. Pay equity

The health profession is the profession with the greatest gender inequality. A recent study from Doximity showed that there's more than a $100,000-a-year difference in pay between a woman physician and a man physician. That hasn't changed over the years. Our institutions, if they're going to have women in the C-suite, need to level the playing field.

As women physicians, we have to be aware of this for all women in healthcare. We need to think about these things for our clerks, our housekeepers, our nurses, our medical students, our nursing students. This is about creating more equality for women across the board in healthcare and we shouldn't forget that.

HL: What advice do you have for women working in healthcare who want to break through those barriers into healthcare leadership?

Gabow: The best way to be successful is to be authentically you.

Another important piece of advice is you have to lead from where you stand. Start where you are right now; show up not just physically, but emotionally. Identify your passion and become an expert in that area, then go where the action is around that, and raise your hand and contribute. When you do that, you'll become a thought leader. When you become a thought leader, that can lead to positional leadership. But even if it doesn't, it will lead to having influence in the domains that you care about.

HL: Are there any passion projects that you're currently working on during your retirement?

Gabow: Throughout my entire career, my passion has been to try to help create a fairer and more just healthcare system, and that really didn't change when I retired. I hope to continue to contribute to that effort until the day I die. There have been two activities that enabled me to continue to exercise that passion. One is serving on boards whose missions were meaningful to me and the other was to share my experience through writing and lecturing.

Since my retirement, I've written two books, The Lead Prescription: Powerful Medicine for Our Ailing Healthcare System, about Denver Health's Lean System. We talked about Time's Now. Now I'm working on my third book on Catholic healthcare in America.

I love opportunities to talk to other women about the rewards of healthcare, and the opportunities that healthcare creates for us to help American healthcare be what it can be.