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Women in Healthcare: Haley Schools, Axia Women's Health

In this episode, we are continuing our Women in Healthcare series with a conversation with Haley Schools, Vice President of Corporate Development for Axia Women's Health, which is a private equity-backed network of women's health providers with locations across the Northeast and Midwest.

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Morgan Ribeiro
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  • Transcript

    Morgan: For those who are new to this series, these interviews are with women who are leading the way in the healthcare industry. We've interviewed chief medical officers, COO's, development officers and investors, and in these conversations, we are talking about the various roles that female leaders play in the healthcare industry and the pressures they face, mentorship, the change they are driving forward within each of their organizations and much more.

    I've really enjoyed these conversations. There's no shortage of topics for us to discuss today given the focus on diversity, equity and inclusion that in recent times has begun to receive much deserved and overdue attention. So with that introduction:  Haley, welcome to the show.

    Haley: Thanks for having me.

    Morgan: So Axia Women's Health was formed in 2017 with an investment by Audax Private Equity and the company has quickly grown to 150-plus locations. Prior to Axia, you were in the investment banking space. Can you tell us more about your background and your current role? How did you make that transition from investment banking to working at a rapidly growing healthcare company?

    Haley: Absolutely.

    I started my career in investment banking to refine my analytical skillset and getting exposure to different industries. After a demanding start at a boutique investment bank, I joined PwC's investment banking division. And even though I think most folks know about PwC, it was actually their very first investment banking venture in the United States.

    So I joined as their first analyst in the New York office. In that well-positioned role besides the everyday of doing deals, I took initiative and was able to pursue opportunities that not many IB analysts get to do. That eventually prepared me for my transition to Axia. For example, I was one of the main liaisons for international PwC counterparts working on deals, which exposed me to reaching out to company executives and pitching deals to them.

    And that's really similar to how my team pitches partnership opportunities to physicians today. I was also responsible for building some of the templates and vendor relationships that laid the foundation for the group's later junior bankers. And as I look back, it was these experiences - rather than the technical ones - that prepared me best for my current role at Axia.

    Said another way - what I gained the most from investment banking was learning how to build processes from scratch and quite frankly, how to hustle doing it. By this time, I knew I wanted to be a builder. I didn't like doing a deal and then just moving on to an unrelated deal like I was doing in banking. After investing six months with a client and building relationships, not hearing how they were doing and using that feedback to adjust their acquisition strategy, it seemed like a missed opportunity.

    I also wanted to really focus my efforts on a single company and dig deep into their strategy rather than dip my toes in a few different companies. From here, a natural adjustment to corporate development. I joined Axia in May of 2017 after a little over three years in investment banking.

    My main mandate was to lead M&A, but when I started, I was doing FP&A, physician compensation, analytics, ancillary development because we didn't have any people focused on those roles. Flash forward to today - May 2021 - and we have over 15 people doing what I was doing as one person four years ago.

    Now my focus really is mostly M&A - all the way from initial strategy on what regions do we focus on, how do we prioritize targets, to evaluation, legal document negotiation and diligence. I also provide some support on payer contracting and our other corporate development initiatives, including hospital partnerships.

    Most importantly, my colleagues across Axia trust me as a thought partner when difficult scenarios arise.

    Morgan: And I think it's interesting like you said earlier, PWC is known as this big accounting firm, but you were really working at a startup within the firm and Axia was much the same way when you first joined- wearing all those different hats and being exposed to different areas of the business.

    So in a relatively short amount of time, over the last six to seven years, you've really been able to position yourself and to be able to learn so many facets of the business and I think Axia is growing rapidly and will continue to expose you to different things.

    So how has the company, and your role in particular, been impacted by COVID and the lockdowns over the last year? And are you still seeing challenges as a result of the pandemic, or are things primarily back to normal?

    Haley: So it's a good question. And, I figure as you look across healthcare services, Axia is in a special place.

    I almost think of Axia as two separate businesses sometimes. We have the GYN part of the business and the OB part of the business. So during the height of COVID-19, our offices had to mostly shut down. Our GYN business was maybe 1% of what it was a year earlier, but the obstetrics part of our business continued almost with no changes. Babies don't take a pandemic into account when being born.

    And for me, even pre-COVID-19, I was about 60% remote. And when you think back to my role, most of the people that I'm working with - they're not in the office. I'm working with potential physician partners. I'm working with third-party advisors. So I was working about 60% remotely. I did shift to a hundred percent remote like most other office folks in March of 2020.

    And what was interesting to me was seeing my colleagues transition from a hundred percent in the office to a hundred percent remote. Touchpoints that used to be phone calls where I'd be working from home and my colleagues would be in the office, those became video calls. So I joke with some of my colleagues now that for me personally, I see them more often post-COVID than I did pre- COVID.

    So I think we have settled into a new normal. But some challenges remain. We've had a lot of new folks join Axia as we continue to grow. I think of a director that joined my team in October. We still haven't met in person, which is crazy to think about. And while I believe almost all the work my team does in M&A can be done virtually, there is value in making that face-to-face connection at least one time to build the relationship. I don't think we're quite yet at the point where everyone feels comfortable meeting in person, but given how quickly folks have been getting vaccinated, hopefully, that day is not too far away.

    Morgan: Yeah. We're having a similar debate across the legal industry. What is that balance? People are used to working remotely and like that flexibility, but at the same time, there's a lot of benefit to getting to know your colleagues and the training and development piece of the job as well. I would be interested to know what are the next 18 to 24 months look like for you all.

    Haley: So at Axia we say, we go deep, not broad. When we enter a market, we want to provide a woman the full continuum of care - all the way from seeking fertility services to try to get pregnant, going to the OB, getting their blood drawn, getting their pap smear, having that read by the pathologist in our lab. And then later in life getting a mammogram to proactively detect breast cancer. And we've had a lot of success with this strategy in Pennsylvania and New Jersey.

    And we've made a lot of big efforts to do that in the Midwest, including opening our second lab out there. So as I look ahead to the next 18 to 24 months, I think our growth is going to be focused in two areas. Firstly, new geographies, and then secondly, newly expanded care specialties.

    So starting with the new geographies, we haven't yet gone in as deep in the Midwest as we want to. So we're going to continue building that region, but we also want to expand into one to two more regions. We want to be a national player that women anywhere in the U.S. can trust for quality healthcare and expansion comes with challenges though- given our strategy is deep, not broad. We don't want to expand just for expansion's sake and have a single office in one state.

    We want to partner with physicians to share a mission and who want to provide a full continuum of care to women. And we also want to prioritize the market where value-based care has the highest potential. And we also have to prioritize our expanded care specialties.

    Women's health is a really broad space. It covers OB-GYN, fertility, urogynecology, breast surgery - and you can even put primary care and behavioral health in there.  Many people underestimate the complexity of women's health, but there's a lot of subspecialties to manage across our portfolio. And that's going to be a big focus for us over the next 18 to 24 months.

    Morgan: So we talked about this a little bit earlier on, but I'm curious how your role in corporate development has changed as a result of COVID over the last year and how deals get done.

    Haley: So I think there are really two big changes. Firstly, before COVID-19 and you think about our particular target, our most common target would be a five-physician practice and we would sometimes struggle with what I call gatekeepers - folks like the office manager - who might vet a physician's phone calls.

    And with physicians too,  they weren't often checking their email, which is how we would reach out to them. Fast- forward to now, physicians have actually been a lot more responsive to outreach. A lot of what I've heard physicians say is that the struggle during the height of COVID-19 made them realize not only how important it is to have a partner but to really have the right partner.

    Just to give you an example, in April of 2020, when physicians were struggling for PPE, especially in the women's health space, we had enough scale at Axia to collect PPE centrally, and then distribute it to our smaller care centers who on their own might not have had the scale to get the supplies they needed.

    And more importantly, we provide a community to physicians. Our physicians are entrepreneurial. And when COVID-19 started, they all collaborated with our clinical leadership. They stood up telemedicine, they developed safety protocols and for these five- physician practices who are independent, that's a daunting project. They have limited staff and limited capabilities. So now they're more open to hearing Axia's message. And then secondly, some folks have said limited travel might be hindering M&A, but I think it's the exact opposite.  Since we don't have to physically meet partners, we're now able to meet more of them.

    Pre-COVID-19, physicians generally wanted to meet in person and that meant we had to coordinate travel times and coordinate dates. We had to make sure all the physicians in the same place had to make sure patients wouldn't be in the office. Now we can conduct a Zoom intro meeting during the lunch hour.

    And to my point earlier, I would still love to meet our potential physician partners in person, but I've realized that for the first in-person meeting, it might be better-placed in the process after we've already had the introduction and they formulated some questions. This virtual first meeting - it's effectively lowered the time investment that our physicians need to accept the meeting.

    And it's that first meeting that's the hardest for us to get.

    Morgan: That makes a lot of sense. That's really interesting again, on your first point, just in terms of being a good partner. I remember I was interviewing Dr. Liz Cherot, the chief medical officer of Axia, a couple of months ago and we were also talking about the benefit of you all being part of a private equity firm that has access to all of these other healthcare companies. So she's able to lean on other CMOs as a sounding board. So it's learning lessons from others so that then you can relay that on to all of your physician practices. So I think that's a huge benefit there.

    Healthcare is rapidly evolving, particularly in a time of a pandemic. I'm curious. How did you decide to get into healthcare? And did you always think you pursue a career in this industry or was it somewhat happenstance?

    Haley: I did not think I would end up in healthcare.

    My dream job in high school was actually a marine biologist. I became interested in healthcare after working on several deals at PwC. And that was one of the great aspects of PwC, I was able to work in packaging, chemical, insurance but the only deals that really excited me were in healthcare.

    And what I really loved about these deals was the focus on innovation, not just scale. So to give you an example, I was working with a medical device client and their growth opportunities were focused on investing in the business so that they can expand their devices to new clinical indications so that they can help more patients whereas, for my packaging and chemical clients, their growth opportunities were, if we invest, we can double the size of the factory and increase sales and get more blue-chip clients. One of the reasons why I went into healthcare and joined Axia was because I wanted to be part of a mission-based organization that was focused on helping people.

    And I wanted to be in an ethos of innovation. And maybe going a little bit forward now that I've been in healthcare for almost five years, one of the reasons why I continue to love it is I love the physicians that we work with. I think of them as everyday heroes, especially given the risk they put themselves through with COVID-19.

    Morgan: I want to switch gears here just a little bit and really dive in deeper on the focus for this podcast series, which is women in healthcare. Over the last decade or so, there's really been increasing attention about women being better represented in leadership roles within healthcare organizations.

    And there's a lot of studies out there, a lot of articles and conversations on this topic. I was recently reading a McKinsey study that said that the proportion of women in the healthcare industry decreases as the responsibility level of the job rises. And the share of white women, in particular, in entry-level positions is 41% compared to 26% at the C-suite level.

    So it is pretty staggering and I think we can all assume various reasons for why this is happening, but do you have any reaction to these statistics?

    Haley: Sadly these statistics do resonate with most of my experiences, especially when I was an investment banker. At the first firm I worked at, I was the only female banker.

    It also reminds me of an article I read that there are more CEOs in the S&P 500 named Michael or James than there are women.  That being said, I'm hopeful and I think of Axia's leadership when I first joined in May of 2017 to now four years later, and I'm proud of our leadership team.

    We have strong female leaders -- our chief financial officer, our chief operating officer and our general counsel -- and that's only a few of them. I think this progress shows an organization can have diverse leadership, especially diverse female leadership, if they make it a priority like Axia has.

    Morgan: What can we be doing more or less of in healthcare to create more advancement opportunities for women? It seems at Axia, you all have really made this a priority.  So what can we be doing as a collective to continue this progress?

    Haley: I think the "we" in your question is the critical word.

    Creating more advancement opportunities for women - It's something that companies and leadership have to focus on like Axia has, but women also need to step up. Some of the best advice I've gotten as a woman in healthcare is to self-advocate and be confident. You might have heard this statistic that men typically apply for a job when they've met 60% of the qualifications and women will only apply if they meet 100%.

    I understand why many women feel that way. And I think it's important to encourage women to reach higher. I think a significant amount of advancement opportunities are already out there, but women have to be willing to step outside of their comfort zone and apply for that next position. Ask for that promotion as men are currently doing today, and companies can help women do that.

    They can rewrite job positions and the criteria they actually need versus criteria that's preferred. So women are more likely to apply and company recruiters can also proactively look for women on LinkedIn, for example, and meet the profile that they think that the company is looking for.

     Morgan: That's a really interesting observation and something I hadn't thought of before, just even how we write the job description in the first place.  And how a woman might interpret that. That's a theme that I've heard in these conversations is that women do feel like they've got to meet a hundred percent of the criteria in order to ask for that promotion or apply for that job.

    More specifically, in your particular field, I have read some statistics, I think a few years ago, there was an Advisory Board article about the changing demographics in the OB-GYN field. And the article states that the share of male OB-GYNs has dropped significantly over the past five decades. And women are increasingly dominating the field, although they represent less than one-third of doctors overall. So I think that's a positive thing.  Currently, women account for almost 60% of OB-GYNs, and that was up from 7% in 1970.  And overall by 2025, women are expected to make up two-thirds of OB-GYNs. So any reaction to that and what you're seeing in your work at Axia?

    Haley: Yeah. So your statistics, again, they resonate with my experience.  Oftentimes, when I'm meeting potential partners, the owners of the practice are typically older given they've been building the equity, et cetera, and they're predominantly male.

    Whereas the associate physicians that they've hired over the last five years who are not yet owners are predominantly female. And I expect that in the next 10 years, as we see those associate physicians gain experience, they'll become promoted to partners and the owners of the practice are soon going to be predominantly female.

    And maybe going back to what you were saying, what's really interesting to me is the pace if you look at the pace of change in OB-GYN versus the pace of change in the corporate development space. Completely different. Seeing how quickly women are making up and, even reversing the gender gap in OB-GYN gives me hope and inspiration that we can do that in other fields too.

    Morgan: So I mentioned earlier back in November of 2020, we actually launched this “Women in Healthcare” series with an interview with the chief medical officer at Axia. And we discussed a variety of topics in that conversation, but one point in particular we discussed, I wanted to get your input on, as so many industries and companies have made a lot of progress over the last couple of decades in hiring and retaining and advancing women through the ranks.

    And in 2020 with the COVID-19 pandemic and the resulting lockdowns, obviously, everyone's shifted gears to remote work and remote learning and more women had to make sacrifices. They're either taking on the childcare or they've got an elderly parent that needs help.  And not to say that men have not also had to step up, but there's a lot of commentary and a lot of articles and data out there that women have had to leave the workforce in higher numbers over the last, 12 to 14 months. 

    And I'm hopeful that this won't interrupt the progress that has been made over the last decade or so with women in the legal field, in particular, being promoted to the partner ranks and, staying in the legal field. Do you think that the pandemic will set us back and, in particular, how do you think it impacts women and the healthcare workers?

    Haley: I'm not actually sure how the pandemic will affect women in the healthcare workforce. On one hand, I've seen the articles that you're referencing, but on the other hand, I think the pandemic has shown the world what powerful woman leaders are in times of crisis. I think of Jacinda Ardern, who led New Zealand through the pandemic losing only 26 people and locally I think of our chief medical officer, Dr. Cherot. People are noticing now in ways that they didn't pre-COVID-19, that the perspective women bring to the table is unique and it drives results. So I think companies are going to be much more focused now than they were previously on retaining women.

    The ultimate effect that the pandemic will have on the workforce depends on how well companies execute their strategies to retain women. If companies shift back to normal as the economy reopens and require everyone to work from the office without considering flexibility that might be needed for childcare, I think that would be tougher to retain progress than if companies are more flexible and embrace different models of working as they're doing now.

    Morgan: That's a really interesting observation.  And I agree, right now is the time for companies and firms to really step up and put their strategy to work.

    If you were speaking to a young woman looking to pursue a career in corporate development we've talked about obviously the representation of women in corporate development roles. What advice would you have for her and what can we do to improve some of the statistics that we've discussed?

    Haley: My main advice is the same advice folks gave me. Self-advocate and self-advocate in multiple ways. Not just raising your hand and volunteering for that new project, but advocating for yourself to yourself. I think a lot of women, including myself, sometimes suffer from imposter syndrome where you believe your success is a fluke and not the result of the hard work and capability.

    So you have this type of mindset that can subconsciously hold you back. What I do to overcome these feelings is I keep a value tracker. Whenever I have a big one, such as closing an acquisition, spearheading an initiative, I save specific details on how I led to that success. And I put it in my tracker. Then whenever I feel struck by self-doubt, I have the instant file of proof supporting that my success is of my own merit.

    And my other advice is to embrace balance.  I think we've all heard about the empty cup metaphor in high-paced roles, like corporate development. I'm not sure it's possible to completely disconnect. So what I do for example, during my time off is I schedule a specified amount of time to check email each day.

    That way, I knew if there's any emergencies, but then the rest of the time I stayed disconnected. And I also recognized during the workday, when, let's say I'm working on a term sheet or I'm working on a presentation and it's something that should take me 30 minutes is taking an hour, I take that as a cue to pause,  do some mindfulness exercises, maybe do a chore around the house and then return to the tasks with more presence and focus.

    Morgan: Okay, I'm going to steal some of those tips. I love the value tracker and I've not heard of that before. But I love that for your own purpose. It's not to put on my resume or to prove my value to someone else. For your own self-doubt and overcoming that impostor syndrome.

    I am going to definitely steal that one from you.

    What does diversity, equity and inclusion mean to you and what types of DE&I programs do you all have at Axia?

    Haley: So I think of DE&I in terms of a table metaphor, like a board table. So in terms of equity, that's making proactive efforts to have people of different perspectives at the table. The diversity is the fact that the folks actually do make it to that table. And then, importantly, inclusion is that the folks at the table feel comfortable speaking.

    And I think you need all three to be successful. So at Axia, we have DE&I programs that are both internally for our employees and also externally for patients. So internally, we're focused on hiring a variety of candidates, including underrepresented individuals. It might take us a longer time to hire a position because we want to make sure we have a diverse candidate pool to pick from.

    Secondly, Axia has also sponsored several listening sessions where underrepresented individuals in our community share their stories in a safe place. So the rest of the community can better understand these colleagues and the concerns they have. And then in terms of patient-facing,  within the healthcare services space, one of the items that we're trying to do with our physicians is increase our acceptance of Medicaid so that we can reach more patients that need quality healthcare.

    Morgan: I love that. I think regardless of male or female, we all can have stories of how we've advanced in our careers by having others lift us up or provide that guidance that we need. Either informal or formal, have you had mentors that have helped you along the way?

    Haley: Absolutely. I would not be where I am today without the mentors I had starting my career. And I'm thankful at several of those early mentors are still my mentors today. I'm also lucky to have several mentors at Axia. Almost all of my mentor relationships have been informal and really crafted through the everyday working together.

    Just to give you an example - one moment that stands out to me was when I was first starting my career in investment banking, the senior associate I was working with, he pointed to these two managing directors and said, that will be us one day if we want it. And one day you'll be like me helping folks like you. And it starts by just doing this extra step now.

    And that moment, just the visualization, hearing someone telling me a senior leadership position was possible, and then the actionability sharing that one small, but doable step toward getting there that really helped spark the rest of my career.

    Morgan: It's funny how those little conversations can stick with us for a long time.

    Anything else that you would like to add for our listeners?

    Haley: Believe that you can. Even if you have to pave the road as you're driving it. Drive your career and be on the road to success.

    Morgan: I've  learned a lot in this conversation. I've got some tips to take back to my own personal career and appreciate your time so much.

    Haley: Thank you. Thanks again for having me.

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