My experience in two large public health systems that deliver charity care to underserved populations helped form my interest in the disparities of care.— Katherine E. Reeder-Hayes, MD, MBA
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Breast cancer specialist Katherine E. Reeder-Hayes, MD, MBA, was born on a farm in Morgan County, Alabama. “My family grew soybeans and cotton and raised cattle. None of my family members were in the medical field, but I always felt comfortable around people who were sick or had emergencies and needed help in some physical way. I was also sort of a geek, if you will. I loved school and learning, which is perhaps one reason I went into medicine,” said Dr. Reeder-Hayes.
Deciding on College
Dr. Reeder-Hayes began nurturing the idea of becoming a doctor while in high school. “Medicine is one of the careers that kids who do well in school think about. I didn’t come from a family where a lot of people went to college. So it was a new experience for me. I chose to go to Vanderbilt University in 1998 because it had a strong science and premedical program. I also had a strong interest in literature, so I did a double major in biology and English literature,” said Dr. Reeder-Hayes, adding, “I also chose Vanderbilt because they offered me a scholarship, and for me to access college, that kind of financial help was an absolute requirement.”
She continued: “However, after graduating from Vanderbilt, I wasn’t accepted the first time I applied to medical school, and it seemed like such a long road ahead that I actually questioned my decision to become a doctor. I knew I wanted to be in health care, so I went to business school and got an MBA with a concentration on health care. But during that process, I decided I wanted to stay on the people side of medicine, so in 2004 I entered the University of Alabama Medical School. At the time, I certainly wasn’t aware how much my interests in the health-care system from the business side and in patient care would come back together to create a research career.”
The Big Decision: Oncology
Asked about her decision to pursue a career in oncology, Dr. Reeder-Hayes replied, “I think a lot of people make the decision to become an oncologist more with their gut than their head. It was certainly true for me. As a third-year medical student, I did a surgical oncology rotation and loved it. I knew I didn’t want to become a surgeon but loved working with oncology patients and decided that this was the place for me within the medical field. And as a senior medical student, I spent a large part of my time on the oncology wards.”
In 2004, Dr. Reeder-Hayes began her internal medicine residency at the University of North Carolina (UNC) at Chapel Hill. “UNC had a very strong hematology/oncology program, so I actually stayed there through my residency and fellowship years. In addition, it was fortuitous I landed in a university with a strong tradition in public health research, which was an important interest of mine,” shared Dr. Reeder-Hayes.
Breast Cancer Mentor
“I was mentored beginning in medical residency by Dr. Lisa Carey, whom I found incredibly intimidating as a first-year resident but who has turned out to be a wonderful mentor! Even though our research interests are quite different—she is a translational researcher and clinical trialist, and my interests are in cancer health services and disparities—she really listened to my interests and ideas, and threw her weight behind the direction I wanted to go, while also challenging me to make my ideas clearer and better. Through her and later by other great senior folks in my division like Dr. Ethan Basch, I was introduced to great collaborators in the School of Public Health and in the population sciences group at the Lineberger Comprehensive Cancer Center, who have really been key to moving my career development forward. I think it’s a great gift as a mentor to be able to produce junior people who don’t just look like carbon copies of you, but who are flourishing in their own areas and taking ownership of their own research program, and then to challenge them to make their ideas interesting to people outside their own silo. Dr. Carey and Dr. Basch both have that gift as mentors. ”
Dr. Reeder-Hayes explained that breast cancer also fulfilled her interest in evidence-based medicine, noting the way breast cancer is diagnosed and treated was appealing. “I like practicing medicine where I have a firm base of guidelines and high-quality information from which I can assist patients in their shared–decision-making process. I also liked the spectrum of breast cancer in that every patient can have a very different presentation: from those who have a very good prognosis and only need minimally invasive treatment to those whose life is in imminent danger.”
Dr. Reeder-Hayes’ interest in health-care issues such as comparative effectiveness and health-care disparities blossomed while she nurtured her career in the clinic. “As a resident, I wasn’t aware that people pursued real academic research careers examining statistics and health systems in the context of how care is delivered. I had what I think is a pretty common misconception among students, that research always involves a lab with pipettes or mice. But during my fellowship, I had the good fortune to work with some very smart and well-trained researchers in the population sciences, which piqued my interest in that area, so I extended my fellowship for 2 years to do research at the Cecil G. Sheps Center for Health Services Research at UNC.”
“My experience in two large public health systems that deliver charity care to underserved populations helped form my interest in the disparities of care. Both the University of Alabama at Birmingham and UNC have patient populations that include advantaged patients similar to other tertiary care centers, as well as deliver a significant amount of charity care. I really got to see huge gaps in the delivery of care between patients who were financially well off and the poor. As a physician, you appreciate there are appropriate differences in how we treat people based on age and comorbidities, but you also appreciate the differences in care that are issues of income and access.”
Dr. Reeder-Hayes noted that cancer care outcomes have continued to improve, and the growing attention to personalized medicine and targeted therapies will accelerate that positive trend. “We know from our history that whenever we see marked advances from the lab to the clinic, the potential for disparities in care actually becomes larger. I think of disparities as a health-system problem that requires system-based solutions. It also needs a hard look for us to realize that disparities of care are not a phenomenon that happens in some distant developing nation; it happens right here as a result of how a particular health-care delivery system is built. Although in breast cancer we’ve made significant progress in screening and early detection, over the next 20 to 30 years, we need to improve disparities, what I call hard treatments, costly treatments that need adherence on the part of patients in the face of financial burdens. In a word, our next big challenge moving forward is equity.”
DISCLOSURE: Dr. Reeder-Hayes reported no conflicts of interest.