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Women in Healthcare: An Interview with Dr. Elizabeth Cherot, Axia Women's Health

Waller's Denise Burke talks with Dr. Elizabeth Cherot, Chief Medical Officer with Axia Women's Health, a fast-growing healthcare company operating more than 150 women’s healthcare centers and 400 women’s health providers.

Dr. Cherot is an established and highly skilled physician with more than 20 years of experience in obstetrics and gynecology. 

In addition, she also completed the Executive MBA at Johns Hopkins University Carey School of Business in 2016. She has spearheaded several projects, resulting in promoting best practices and implementing progressive change in an OB/GYN practice.

Dr. Cherot completed undergraduate studies at Johns Hopkins University. She received her medical degree from the University of Rochester School of Medicine and Dentistry and completed her residency training in OB/GYN at the University of Rochester School of Medicine and Dentistry in New York.

The following is a transcript of the conversation:

Morgan Ribiero: Welcome to PointByPoint. This is Waller's Chief Business Development Officer and the host of the podcast, Morgan Ribiero. Along with Waller's Women's Leadership Council, we have launched a new series on the podcast focused on women leaders in the healthcare industry. On this episode, I am joined by Denise Burke, a partner in Waller's healthcare operations group, and Dr. Liz Cherot, the chief medical officer of Axia Women's Health, a unique organization of specialized providers offering personalized health services to women through in-person and online care. Denise and Dr. Cherot, welcome to the show.

Dr. Cherot, we've asked you to join us today as we are profiling women who are leading the way in healthcare, and what better way to kick off these conversations than talking with a female CMO who is improving health outcomes for mothers and children on a daily basis.

In addition to being an OB/GYN, you have trained future physicians, and now you are leading a unique and efficient delivery care model. Would you share a little bit about yourself, particularly how you transitioned in your career as an OB/GYN to the business side of the industry and why you're passionate about what Axia is doing?

Dr. Elizabeth Cherot: Happy to Morgan. Thanks again for having me. So I'm an OB/GYN. I have been practicing for about 20 years in central New Jersey. I started practicing in academic medicine but quickly shifted to private practice, and I eventually ran a really large practice. Sometimes I joke that my senior physician stepped back rather than me stepping forward. But, eventually, I ended up running a very large practice of about 17 providers, which in New Jersey ended up merging into a larger practice, from north to south in New Jersey and then Pennsylvania. We formed Axia in 2017. When I began my career, I was thinking all the decisions that I would make would be of consequence to my patients, they'd be made at the bedside. But I quickly realized that such decisions are just as often made in other settings and often by individuals who have not graduated from medical school. So my goal has always been to become a truly effective physician leader, and my experience thus far has shown me that this must be based on an equal level of comfort in both patient care and business.

In order to be a more complete physician - sounds crazy - but I decided to pursue a graduate degree in business, and in 2016, while having two kids, practicing full-time, taking no vacation for two years, taking calls in the hospital, etc., I graduated with my MBA from the Johns Hopkins Carey Business School.

I will tell you that the practice of medicine in recent times has become increasingly subject to the axiom that size matters, and the outlook for smaller practices that can't increase efficiency and achieve economies of scale was even more unfavorable.

Conversely larger institutions can leverage their size to streamline both clinical and business processes in order to better serve the patient and the bottom line. So, for me, the process was: 1) private practice, 2) growing and getting into the right kind of frame of mind and 3) conversations and realizing I needed to pursue not only personally, but also just for my business and bottom line. But at Axia, the whole point is to put the patient first, and have a progressive community of providers that provide innovative healthcare, and that's our goals and our mission, and I think we've done it really well.

I personally have been taking care of patients, and then the transition was slow, but then rapid in the last year. I started doing more of the business side of things. And in January of 2020, right before COVID, I took over as chief medical officer, and so that's my story and a little bit about Axia and our industry.

Morgan: I think there's a way to impact patient lives either at the bedside or even being a business leader, there's just a different angle in each of those.

Denise, your career path has also been pretty interesting. You started out working in-house at a healthcare system and made the transition into the legal field. Maybe you can talk about your career path.

Denise Burke: That's certainly true, Morgan. I never planned on being a lawyer. Somedays I'm not quite sure how that happened. I had an undergraduate degree in health information management and was happily working in quality and utilization review at a large not-for-profit hospital when my boss literally just walked in one day and said, if you want to go to law school, we'll pay for it. I had never thought of going to law school.

I went home that night and thought about it and came back and told them, yeah, I was interested in that offer, took the LSAT the next weekend. So it's funny how people can intervene in your life and make good changes in your life that you never would have dreamed of.

And that certainly was the case with that person. I swore I was never going to work for a big law firm. I was always going to be on the provider side, and I did that for a while. I worked in-house with companies that did physician office practice management, durable medical equipment and home health.

After an OIG investigation that was successfully handled, I started getting calls from law firms and, since President Clinton had just signed the Balanced Budget Act, that was going to significantly cut our funding. And I wasn't sure that I would still have a job on the provider side. I took that leap over to the law firm side and have been doing law firm-side advice and compliance and regulatory and diligence of transactions ever since.

So it was not a planned path, but it's certainly been one I've enjoyed.

Morgan: Never say never. You never know where you'll end up, and you both achieved so much. And it seems that your careers have taken paths, that again, you might never have dreamed of. What was the inspiration behind your achievement as female leaders? Did you have a mentor along the way? Denise, you mentioned your boss coming in and making an offer that you really couldn't refuse, or was there a particular event that inspired you to go down this path? Dr. Cherot, I'll start with you.

Dr. Cherot: I've really been lucky to be around a lot of supportive women in my life. My husband was certainly super supportive, and when I wanted to switch gears. I would say to you, when I look back over all of my career, there's always someone, whether it's a math teacher, a chemistry teacher, who pushed me. I ended up at a summer program in science; I probably would never have gone into sciences. Over the years, you look back, and I think there are different people that influence you along the way. When I look back at every stage, there's always somebody there. I think for women, especially, you need a supportive network. I was on a discussion panel the other day and talking about that it's a lattice of support, rather than a ladder. And I love that idea. I love that - and when I think back - that's exactly how I like to develop my teams, but also how I think I've developed over time and, actually considered Denise in that lattice today. As that develops, each part of that lattice, there's something else that someone adds to it. I like to think of my career going in that direction because of the support of the other women that I've worked with.

Denise: Yeah, Morgan. I sort of had the same experience.

It's not like there was not one person that took me under their wing at my first job and said, here, I'm going to lead you all the way through this. But at the same time, there have been just so many people all the way along the path. That has been helpful and supportive and helped in so many ways. And it's interesting because now you hear so much about what having women sponsors and women mentors does to try to help change some of the disproportionate opportunities for women, and I think I was always just fortunate that I just had people, that those were built in. I received those benefits without my organizations having to tell people that they needed to do that. I think it's great that organizations are focusing on that now because many times it does not happen naturally. I was just very blessed. I think that I came in contact with people that did it naturally. And, I do think it is important for all of us to try to help the younger people coming along, because I don't think it happens as frequently as maybe it should for women.

But I was very fortunate to feel like I have had support all of my career in every organization I've ever worked.

Dr. Cherot: I feel fortunate. My medical school was 50% women and 50% men. My undergraduate was not, but as I've moved on in the career, OB/GYN, obviously much more women today than there ever was. I was trained by some women, not just older men. I feel lucky. And to Denise's point, some people paved the way ahead of me.

Denise: I think there are similarities in law and medicine in that regard. In law now as well, there are as many women going into law school classes as men.

It's just later in the career, you don't see women that are at the level as the men are. And there are so many potential reasons for that. Some people just choose not to want that lifestyle because they're raising families or doing other things or just want lifestyle differences, but there are some women that want to achieve at those same levels as the men that have difficulty in doing so, just because they don't have the access to the opportunities. They feel if they could get the opportunities, they could be wildly successful, and they have difficulty getting those and, still in today's world, men just hold a lot more of the access to opportunities.

So if we can get support for younger women in those areas, I think it goes a long way, and that it's great to have champions like Dr. Cherot and so many other women we know that show people what people can do when they get these opportunities.

Dr. Cherot: To your point, I do think the pipeline narrows. So as you go up further and further, there are fewer women, but also, when I look behind me, there's less and that is very concerning, and I think COVID has proven that people are going to make some big decisions for their careers. I think we have to be super supportive and mentor others and continue to build that lattice that I was mentioning because I think it's really important. But I'm a little disheartened about how that pipeline has really narrowed.

Denise: I think you're right. I'm very concerned that COVID may impact this pipeline and undo some of the work that's been done over the past few years. I saw a graphic recently that I thought was just hilarious and also so poignant. It was a race, and it was like a race of executives trying to get up in their career. But in the lane in front of the women, there were children and nurseries and school closings and all of these things that they were trying to tackle along with the work-related problems. And that's not really a fair comparison either because my husband has been incredibly supportive my entire career and probably has done as many doctor's appointments and dentist appointments as I have.

So it's certainly not universal that women take on more of the childcare duties. But I do think it is still common. And I think that's what I'm seeing, even in our practice, that more of those extra responsibilities that no one was anticipating because of COVID are falling on the women. And the truth of the matter is there's only so many hours of the day and hours translate into success in many professions. So it is something that we're going to have to be really careful about and just have some grace for this COVID period on how people get through it and realize that's not a reflection of what the rest of their career will look like.

Morgan: Yeah, Denise, I agree. During this time with COVID and a pandemic and lockdowns, remote working, remote learning, women have had to sacrifice a lot. And not to say that men have not. But in all of this, there's a lot of commentaries, a lot of articles, a lot of data out there that women have had to leave the workforce in higher numbers. And they've had to sacrifice given the things that are going on in their personal lives. And I'm hopeful that this won't interrupt a lot of the progress that has been made over the last decade or so, and that we can continue that progress. I think this is an interesting segue into my next question, which is, of course, this has also been a really challenging time for the healthcare industry as a whole, regardless of the segment. And whether or not you're a hospital system or a dental care provider or in your case, Dr. Cherot, women's health, you've seen your own set of challenges. You've been a doctor for many years, you've seen an organization with 400 physicians who are on the front line of this crisis, and your company is continuing to deliver babies safely, including in states like New Jersey that were really hard hit and one of the first hotspots for the pandemic in the US. Tell us more about that time and what was happening in particular and what you prioritized as a leader.

Dr. Cherot: What a huge question to start with. In the first week of March, we were planning our annual event, bringing in all of our providers to have a national meeting, and I'll tell you, my CEO loves this meeting. He looks forward to it every year, plans and obsesses about it. And there I was, three days beforehand, saying we can't have this meeting. We didn't have a lot of science. And, at the time, I think some big academic centers in New York City were closing, but others weren't, and telling their providers they couldn't travel, but others were continuing to have meetings.

And these were super-spreader meetings when you look back at it now, but at the time it was a huge decision. Even talking to infectious disease specialists who said, "I don't know what to tell you." And that, I think Denise was even on a phone call where I was just venting saying, "Would somebody please just give me an answer?" So I had to go directly to my CEO and say, "We have to cancel." And put a stake in the ground, and luckily he listened, but it was not a five-minute conversation. It was over a day-and-a-half, getting a lot of providers together to cancel. So we did, and then it was getting PPE and getting N95s and getting, "You don't need to wear a mask" to "you need to wear a mask." And then all of a sudden it was big announcements of closing down offices, which we did, and explaining to providers, please don't travel. Please take care of your providers and yourselves. And, one of our core values is valuing our community.

And, I think it's one that it was really easy for me to put a stake in the ground in as well to say, you need to take off if you're sick, and do the right thing for each other and their offices. We needed to not go to the operating room and not open our offices and do all that.

New Jersey got hit hard. We've had a lot of pre-term labor. We had some really scary cases. We started tracking all of our employees, with their exposures and their risks. And, yeah, I think like the rest of the nation, we were hit very hard. And then it turned to reopening and what that looked like. And even retraining everybody and doing spot checks in all the offices. So it's taken on a life of its own. I feel like we're doing what everybody else is hopefully doing and trying to be compliant, and also very supportive because it's not going away. I think we all hoped that it would by now, but it looks like it's going to be going on for a lot longer. So we've had to be pretty agile. We've had to be a united team. I've had to really educate some people who aren't in medicine, which is my business side, but that's what I put myself in this role for. It's been challenging but I think on the other end, we're better for it.

As I said with COVID in general, there's been a lot of challenges and ups-and-downs, but I think we're slowly moving it forward and feeling we as a community have kept ourselves safe. We have large practices outside of Cincinnati and they're looking at the COVID numbers there and just getting ready for this next wave, to be honest.

Morgan: Denise, I want to hear from your perspective, piggybacking on what Dr. Cherot was covering in terms of all that went on at Axia in the midst of the height of the pandemic and your role as a legal advisor and some of the issues you were tackling.

Denise: It was so interesting being involved with Dr. Cherot being in a New Jersey hotspot at the beginning of the pandemic. Doctors always say you don't want to be an interesting case when you're the patient. I think she probably felt that she didn't want to be the interesting client as well because she was the first person that called that said we've had an employee test positive.  She's the first person that called, that said we have employees that don't want to come to work because they're afraid that they will get the disease and take it home to their families. She was the first person that called that was canceling major events. In fact, on that one, she was canceling events several days to weeks before the government started telling people to cancel events.

You can only imagine some of the names that she was called, for some of these decisions. She was certainly considered to be a hysterical alarmist, at times, and so it was very gratifying within a week of her decisions, the government came out and was making exactly the same suggestion.

So that was a little fun moment that we had of, "See, when you follow the science, sometimes it does make sense." And then, of course, when we all heard about that biomed super-spreader event where so many people were infected and that event was just about the same time as the event that Dr. Cherot was canceling.

You just realized how her biggest fears could have come forth because in that case, even if a large number of her providers were not infected, if someone at the event had tested positive, she would have theoretically at least needed to quarantine a large number of providers. And then who's going to deliver babies? And then just the interesting things that you get into with hospitals trying to control the number of people in their hospitals. But, of course, you've got fathers that want to be there when their child is born. You would think that all those fathers would be willing to take a COVID test. People being people, they can have some really strange ideas on what they should have to do to participate in the birth of their child.

And then just trying to figure out the exposures that might have to the staff and the newborns and the other newborns in the nursery. It was truly a fascinating experience to get to hear and hopefully try to help navigate through some of these issues. But I think I was having a little more fun with just the "Gee, this is fun to learn" than Dr. Cherot was. She was actually having to deal with the people that were literally distressed to a high level out of real concern for themselves and others.

Dr. Cherot: You make it sound so - maybe I blacked out some of it - because I do remember being stressed out about telling people please don't travel. I was even called draconian at one point. But it was about doing the right thing for each other and for our patients.

So I feel we made the best decisions we could at the time. And it was great to have the sounding board I see other healthcare communities and hospitals who don't do what we do. We make sure we do a lot of contact tracing. We notify all of our patients if they've been exposed. We've closed down practices because we felt like there might be a spreader event and want to be really cautious.

We are mandating that all our providers are wearing masks, so I'm trying to find and follow these CDC guidelines whenever there's something new. It was up and down. I felt like it was a moving train that was just going super fast.

Denise: Additionally, then you implemented telemedicine at warp speed, trying to get all of the infrastructure and all of the forms and all of the consents and all of the training that you needed to implement telemedicine, literally, almost overnight. It was fascinating to see what can be accomplished in a short period of time when it absolutely has to be.

And, hopefully, patients and providers will benefit from some of that in the future because clearly, I think CMS and the insurers have seen the benefit of telehealth. Dr. Cherot was a big proponent of if we can do visits from home and not make these pregnant patients have to come into our office where they might be exposed, we need to do that, and that it will make the office safer for those patients that actually do need to come into the office, but it was a whirlwind to implement.

Dr. Cherot: Seven days. So we had it on our strategic plan for 2020 - thinking you'd pick a couple of vendors and work our way through over nine months, 10 months. And it would be the big launch for 2021. And who thought in seven days that we had 400 providers trained - we had a platform, we had guidelines and guiderails, videos, training webinars - just trying to get everybody up and running.

Providers really wanted to do it pretty quickly for their patients. We use it as triage: do you need to come in, do you not need to come in, and use it that way, but also being able to take care of patients throughout the beginning of the pandemic, and we continue to do it now. It's been amazing to watch, and I think it's here to stay. I don't think it's going to change. I don't think we'll go back. I think the biggest issue will be for payers to make sure they keep reimbursing us. It's also making sure that all of our providers are trained appropriately on how to use it. Which you would think, we all know how to Zoom now or FaceTime.

We actually don't know how to do that in the healthcare setting appropriately, and we've all seen the videos of people getting undressed or changing while they're on a Zoom meeting. So explaining to patients, you can't expose yourself on a Zoom meeting. And so all of those things, we had to stand up pretty quickly.

It's been exciting to launch and to see how that's moved the needle. For us, not only on a business side, but clinically and, for the future, we're partnering actually with a new company that has a fetal monitor that's remote. We'll have a fetal monitor that picks up an incredible amount of data that we can do completely from anywhere. We're really excited to launch a business that could be really novel and new and that will hopefully keep patients safe for the future because we're still recommending that pregnant patients avoid as much COVID as possible.

Morgan: Do you have a group of peers from other healthcare organizations that you can reach out to and say, "Hey, here's what we're dealing with? How have you dealt with this?" And I know even in my role, I have other folks at other law firms that I reach out to to ask questions.

Dr. Cherot: I love that you asked this because about a month or two ago, I said - besides my own clinical team, and I have vice presidents of medical affairs in each of the states that we're in and some really strong, leader physicians in each seat -  I reached out to Audax and asked the private equity firm that brought us together within women's health.

So I asked if I could meet with the chief medical officers or clinical leaders and if we could get a bunch of these people together. A couple of emails later, there was a Zoom meeting scheduled. I got on the Zoom call, and I was the only female. That was number one - first thing. I'm not the youngest by any means, but I certainly was shocked to find that some of them aren't really chief medical officers or their titles are a little different roles. Boy, did we have the most fascinating hour-and-a-half conversation of: "Are you COVID testing? Are you wearing? What are you doing here? What are you doing there?" And, I really just wanted a sounding board. I wanted a comfortable place to ask questions that I wish I had back in March that maybe I would have had a lot more confidence with making some of the decisions we made. It's been really helpful.

We've met only a couple of times. I actually started it late August. And, it's been really eye-opening, just what the different rules are, regulations in different states, what people are doing in different specialties. and we're talking from dentistry to gastroenterology to ENT. We're in most of the states across the country.

So it's been really helpful. I wish I had done it sooner. I think just with the pace and speed of COVID, I was really using the people within Axia. But I'm so glad I reached out because we've had some fascinating conversations. But I will tell you just to watch all the tiles come up across the Zoom and be like, "Where's the other women? There's has got to be one other woman." There wasn't one. So it was really fascinating.

Denise: I'm curious from a medical perspective. I know my husband had a minor outpatient procedure recently. In the past, when you would have those, they would not start the procedure until your responsible person was sitting in the waiting room and agreed not to leave.

On this occasion, I never entered the building. I stayed in my car with my cell phone. In the past, you would have been invited back to recovery after the procedure while they're waking up. And now, you just get a phone call from the doctor telling you how it went. I picked him up at the door. I literally never went in. I know in labor and delivery, many more people used to get back into the delivery suites at times than just the husband. Do you think that the rules will relax again after COVID is over? Or do you think we're going into a time where just for general infection control, fewer people are going to be allowed back into those patient care and post-operative or post-procedure areas?

Dr. Cherot: Obviously with everything that happened in New York, everybody was saying that when they wanted nobody in labor and delivery, all the labor and deliveries that we work with have at least one support person with them.

They are getting COVID-tested. They have to stay within that room. Obviously, if there are any symptoms they're not allowed in. I think for the future, I think you can have one support person. Interestingly, my particular hospital here in central New Jersey was talking about for some of those scheduled procedures like a C-section - this is pre-COVID - were thinking that more than one support person would be allowed. Logistically that is a lot to handle. I've certainly had people pass out that are watching procedures and that kind of stuff that always makes me nervous for it. But I think for infectious purposes, right now, I think for a long time to come, we're going to be really minimalistic.

We've been doing that in our offices. We don't allow people to come in, even for their ultrasound that becomes a big moment in a lot of women's lives. We've really restricted and we've asked patients to be as compliant as they can. I think in this time period in the middle of this pandemic, I think it's going to continue.

Morgan: Dr. Cherot, you and your work are an inspiration, and you have an awesome responsibility of bringing life into the world. And it sounds like that may be looking different for the near-term future, at least, and how that care is provided.

As a female leader, during these uncertain and very unusual times, I'd like to ask if you could tell us something in the industry's future that you're excited about. I know you mentioned, telemedicine and telehealth, that may be one, or there may be others that you're most excited about.

Dr. Cherot: I think fetal monitoring is actually one of the most exciting. If you think about how much we've changed the banking industry -  you can bank from your phone. I can deposit a check now. I can pay my bills. I can do all of this. We're moving healthcare to that. For good or for bad, I don't know, but I do know that with wearables, with technology, with what we've even done within Axia with different touchpoints for patients, using apps and doing a newer way of healthcare. I think it's going to be transformative. I'm looking forward to that. I think that's what I look at as the future of what we will be able to do. Some of that is getting better data, but it's also going to be different. I love sitting in a room and talking to patients. I miss that terribly. I would chit-chat a lot, whether it was about my kids or their kids, or what had happened over the year. Or even, I love talking about the kids that I've delivered that are now about to go off to college.

It makes me feel like I've earned all my gray hair, but I enjoy that part of what I do. I like the relationships, and I think that will be a little different, but I think we also can advance in a different way. And so being able to have access to healthcare in different places - imagine being at your work and being able to do your prenatal care visit between the Zoom call and then go back to work. Of course Denise will have to write all the regulations for it, but I just can't wait to see what that looks like for women in the future, and knowing that women are really going to have to change their life and their lifestyles, maybe because of COVID. Then maybe that's what we have to do. We have to be adaptable. 

Morgan: To your point, we've talked about that healthcare is behind other industries and when it comes to innovation and we've been slow to adapt, and you take telemedicine, for example, we've been talking about this for years and there have been certain areas of healthcare that have started to introduce it.

But now it just seems like within a matter of weeks it was widespread and we were able to make more advances in a matter of two weeks than we were in the last five or so years. It's going to be different, but there's definitely some positives that can come out of it.

Denise: I completely agree. I'm so excited about the remote monitoring piece of the technology, because for my entire career when a patient leaves an office, you're rescheduling your next appointment at 30 days, 60 days, three months after surgery, whatever it is, which probably had very little relation to what that particular individual patient needed. They were just random periods of time. And now, if those patients can be remotely monitored, we will actually for the first time know which patient actually needs to see a physician in that timeframe.

And, you may have just left the office with an appointment to return in 30 days. And there may have been something drastic that's changed four days later, so that patient may need to be back immediately. And of course, the converse is true. A patient may be absolutely stable and not need to see a physician for a while.

So it's really going to be the first time we have the ability to actually match the patients that need to see a doctor with the right time of getting in to see them, and that really should be a gamechanger. And part of the hesitancy of all of this has been the technology and the internet broadband capabilities in a lot of these rural areas.

As a silver lining, COVID is making us address that because to have kids doing remote learning right now, many places are having to update the cable, the internet capability in the area, and hopefully we can piggyback off that for healthcare monitoring.

Morgan: Great. I have enjoyed the conversation. Appreciate you both making time to chat with me today, and I look forward to future conversations.

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