This post is the full-length version of an article featured in the October 2026 New Hampshire Medical Society Magazine.
It was not surprising that I was voted “least likely to speak” on the JV field hockey team at my small Upstate New York school. It is inherently who I am. I am a listener. I prefer to put the pieces together before jumping in with thoughts and ideas.
At the time, I thought this would position me well for my anticipated journey in medicine. I imagined listening deeply to my patients to understand their signs and symptoms, then using my knowledge and experience to diagnose disease, provide treatment, and offer comfort.
Fast forward almost 40 years, and that is not where I am today.
I am a health care administrator. I sit at tables and join meetings where I endeavor to advocate, navigate, and influence in support of patients and the people who care for them. I never would have guessed this is what I would do. Along the way, however, I realized I did not have the option to remain quiet. I had to find my voice.
When I practiced medicine in the Emergency Department, I experienced firsthand what was wrong within the system. It hurt.
To accommodate school events during the day with my children, I consistently worked night shifts for several years. During that time, we had an elderly patient who came to the ED two or three times a week. She had COPD, CHF, and anxiety and would experience shortness of breath at night. She and her husband felt they had no option but to call 911.
I watched the same people come to the ED repeatedly with unmet social needs, substance use disorders, and behavioral health needs. We performed blood work, gave banana bags, sometimes consulted social work or psychiatry, and provided a lot of turkey sandwiches. Then we sent people back into the same circumstances that had brought them to us.
The cycle continued.
I knew something was wrong, but I did not have the tools or resources to change it.
I also experienced how the system was not set up to support the people working within it. I watched medical errors and near misses occur when the “holes in the Swiss cheese” lined up. I sat for hours after shifts, double-checking and documenting, trying to make sure those holes did not affect the care I delivered. Despite all of that vigilance, I also felt the pain of what happens when things do go wrong.
I had leaders who tried their best but did not know how to effect change. I had others who walked through the ED, cup of coffee in hand, and simply smiled at us as we navigated the challenges. I worked shifts that were short-staffed. I even brought my kids to sleep in a patient room so I could work and help a colleague. (I do not recommend this.)
When the opportunity arose to lead quality in our Emergency Department, no one else wanted the job. Despite being the most junior physician, I wanted to understand how to keep myself and others from making mistakes, so I volunteered.
I am grateful that I did. That decision established the trajectory for much of my career because it gave me something I had been missing: the ability to improve the system itself.
At the time, I already possessed several of the individual factors associated with burnout when people work within systems that are not structured to support them. I was early in my career, a young mother of two children, and working full-time shift work.
I could and can always work on my own resilience. But resilience was not the fundamental problem.
In “Resilience and Burnout Among Physicians and the General US Working Population,” published in JAMA Network Open in 2020, West and colleagues found that physicians had significantly higher resilience scores than the general employed U.S. population. Yet physicians continued to experience high rates of burnout.
The people are not broken. The system is.
Working to improve that system helped me regain a sense of ownership and control that I had lost in medicine. It also left me with a question that has followed me throughout my career:
If not me, then who?
So, what have I learned along the way?
I have learned that building a better health care system needs to be intentional and evidence-based. Health care is a complex system, but we do not always manage it like one.
Patient factors, clinician factors, teams, tasks, technology and tools, the environment, policy, and organizational structures create a complex web of interdependencies. All of them influence the experiences and outcomes of patients, clinicians, and communities.
We cannot fix one piece in isolation and expect the entire system to improve.
To navigate this complexity, we need the right people, tools, and collaborative spaces. We need a human-centered approach that allows the people who experience these systems every day to help identify the problems, co-create solutions, test them, learn from them, and make them better.
There is evidence that this matters.
In “Cultural and Structural Features of Zero-Burnout Primary Care Practices,” published in Health Affairs in 2021, Edwards and colleagues compared practices with no reported burnout to practices with high levels of burnout. Among the characteristics they identified in zero-burnout practices were teamwork, communication, psychological safety, mindfulness of others, facilitative leadership, and an understanding that people make mistakes and can learn from them.
These practices were also more likely to use quality improvement strategies and to foster a sense of agency among the people doing the work. They discussed problems and opportunities, owned them, and developed solutions collaboratively.
That brings me to an important question:
What can we do about this, here and now, in New Hampshire?
The New Hampshire Medical Society provides us with an opportunity to come together to build and advocate for systems of care that better serve both clinicians and patients.
Within this space, we can create a community grounded in trust and psychological safety. We can bring together stakeholders who do not always have the opportunity to work alongside one another and create a place where we can move beyond talking about what is wrong to actually testing and implementing solutions.
As a member organization of the American Medical Association, NHMS also has access to innovative, physician-developed, evidence-based tools and resources through the AMA STEPS Forward program. These resources provide practical strategies to reduce administrative burden, optimize interdisciplinary care teams, improve schedules and workflows, and, ultimately, take better care of the people who take care of others.
But tools alone are not enough.
We also need infrastructure that supports sustainable change in complex systems. That means aligning with experts in performance improvement and sharing those methodologies and skills more broadly. It means developing growth-minded, facilitative leaders who know how to bring people together and navigate complexity.
It also means recognizing the different kinds of support people need. Coaches can help individuals and teams discover their own solutions to present and future challenges. Mentors can draw upon similar experiences, help problem-solve, and share what they have learned. Both have important roles in developing the people who will lead change.
Medical societies across the country have demonstrated what is possible when they create collaborative infrastructure.
The Monroe County Medical Society in the Rochester, New York area, for example, created a Community Health Consortium to provide a neutral platform where physicians, patients, health systems, insurance companies, and community-based organizations could work together on quality improvement initiatives. In Michigan, the Michigan Society of Thoracic and Cardiovascular Surgeons created a surgeon-led, multidisciplinary Quality Collaborative focused on improving care and outcomes.
New Hampshire has an opportunity to build on these types of models.
The Rural Health Transformation Program has provided New Hampshire with significant funding over five years for investment in key areas, including building and retaining a skilled rural health workforce. If we are serious about workforce retention, we need to acknowledge something those of us who have worked in these systems already know:
People are more likely to stay in systems where they can do meaningful work, feel supported, and have the ability to make things better.
Through the New Hampshire Medical Society, and in collaboration with other key stakeholders, we can build the collaborative spaces and infrastructure needed to make that possible. We can bring together clinicians, health systems, payers, policymakers, community organizations, and others to identify shared problems, apply evidence-based improvement methods, and implement solutions that work in the real world.
Almost 40 years ago, I was the quiet one on the field hockey team.
I am still a listener. I still prefer to understand the pieces before jumping in. In fact, I have come to believe those qualities make me a better leader.
But I also know that I cannot be silent now.
I owe it to our health care teams, our communities, and the physician I was in the ED years ago to use my voice to advocate for evidence-based models that can improve the systems in which we provide care.
I also know that I do not have all the answers. No one of us does.
That is exactly why we need each other.
By coming together in structured collaboration, improving processes, fostering teamwork, strengthening communication, and building trust across stakeholders, we can create a health care system that works better for the patients who depend on it and the people who dedicate their lives to caring for them.
If not us, then who?
