Dr. Ada Steward is an inspiration to us all. As the first African American female president of the AAFP, she was born into the Cleveland housing projects and rose to success against all odds. Her story is one of determination, hard work, and perseverance through adversity. Listen to her inspiring journey from humble beginnings to a place of power and leadership in this uplifting podcast. Be inspired by Dr. Ada Steward’s remarkable story – Listen Now!
[00:00:05.130] – Dr. JB
Hi everybody. Welcome to the Hope4Med podcast. I am your host Dr. JB, and today our guest is Dr. Ada Stewart. She is a family physician with Cooperative Health in Columbia, South Carolina and is board chair of the American Academy of Family Physicians and recent past President. The AAFP represents 127,600 physicians and medical students nationwide. As AAFP Board Chair, Dr. Stewart advocates on behalf of family physicians and patients to inspire positive change in the US. Healthcare system. Welcome to the show.
[00:00:47.150] – Dr. Stewart
Thank you. Thank you so much for having me.
[00:00:51.010] – Dr. JB
So Dr. Stewart, you have an amazing background and an amazing story and I am so excited to share it with my listeners. So could we please start from the beginning? Could you share with my listener your origin story?
[00:01:10.310] – Dr. Stewart
Oh my goodness. So I’ve gone down some different paths, but I was born and reared in Cleveland, Ohio, in an urban area, in the housing projects there in Cleveland, attended high school there. And during that time where it was time to really choose that career path, I chose a career in pharmacy. And that was based on a lot of things that was going on. Number one is I did not have exposure to a physician. My family, we didn’t have that primary care doctor. If you got ill, you went to the emergency room. And I love science and math and caring for individuals. And so my chemistry teacher in high school during career day brought in a pharmacist and a pharmacist that looked like me. And I found that that is what I really wanted to do. I wanted to go into pharmacy. And so from there I ended up going to undergrad at Ohio Northern University in Ada, like my name Ohio, and completed my degree in pharmacy. And I’m going to tell you, it was not like a smooth transition. I end up leaving after a year and a half and going home and working and then going back.
[00:02:39.220] – Dr. Stewart
But here’s to say that I was able to later on complete that while working as a pharmacist there in Cleveland and seeing how important prevention was and also seeing that within my family, I lost my mom to breast cancer during that time and my dad to heart disease. And all of these things are preventable. And I watched other family members and other members of the community lose their lives or suffer from chronic illnesses. One day I was reading the Cleveland Plain Dealer, which is a paper that we have there in the city, and they talked about the Sunday paper. They have these huge articles and they talked about a family physician and she actually talked about what she did and the importance of prevention, importance of looking at the spiritual, mental and physical well being and the impact that she has had on the community there in Cleveland. And I said, after I read that article, I said, this is my calling. And so I think this is where I really need to be. And then thinking back, had I probably had been exposed to a physician early on, I probably would have gone down that path initially, but it didn’t happen.
[00:04:13.890] – Dr. Stewart
Dr. Jocelyn Elders once said, you can be what you don’t see. And so when I thought back, I said, that is so true. I did not see someone who looked like me or someone even who was a physician. And so that set me on that journey to be a family physician, and she was a family physician. And with that, I ended up going back to school. I had been out for a long time, over ten years, and so I had to take courses over again, chemistry, to get ready for the MCAT. But I set my journey at that time and felt that this is something I really wanted to do. And so hence, I took some courses and was able to take the MCAT and did okay, wasn’t that stellar performance that we all strive for, but it was enough to be able to get into medical school. And so with that, I was accepted into Medical College of Ohio. I was actually in a non traditional program. They had a way where nontraditional students were able to set their goals to be a physician through this particular program, where they split that first year into two.
[00:05:37.640] – Dr. Stewart
It worked out well for me because I was able to work as a pharmacist there in Toledo, along with going to medical school. And then at that time, as I was setting on that path to become a physician, I realized how important it was to be that voice, to be that voice of change, to advocate on behalf of many others who cannot advocate for themselves. And so that set me on the journey to be that what I call that servant leader, to realize how important it is to serve others. And so, as a medical student, I was part of Organized Medicine, part of the American Medical Association, their student section, and a leader there in their Minority Issues Forum committee that was back in that day, and then doing things in family medicine. I was a student member of our American Academy of Family Physicians and continued to just go and try to lead at every level through medical school and then through residency, and then as an active practicing physician. And so I continue to do all of that. Meanwhile, just making sure that I was an advocate for all my patients. And as I worked as a National Health Service Corps scholarship, because that helped me to be able to decrease my indebtedness, I set on working at a community health center, and that’s where I am today, and that’s where I began after residency.
[00:07:23.370] – Dr. Stewart
And I continue to serve in every way possible. After 911, and we all saw what happened September 11, 2001, and many of us felt what could we do? What could we really do to help and to be able to have our mark and help others as we suffered during that time? And so then I joined the military. I joined the reserve. And right now, I am colonel. I’m still in, still active within the military, just completed my annual training and continue to do what I felt was just service, service not only to my community and my profession, my specialty, but also my country. And so it’s been an honor, just as you mentioned, served as the president of the American Academy of Family Physician, the fourth woman and the first African American female. And what an honor it has been to be able to serve and to be able to be one where others and I can lift up others on my shoulders so that they can see what they can achieve. In this coming year, we will install the second African American female president to our academy. And it warms the heart, the soul, and realize again what we can accomplish.
[00:09:01.550] – Dr. Stewart
But it’s through courage, it’s through dedication, it’s through others that have been there before me that helped me to achieve all the things that I’m able to achieve, because we don’t do this alone. Everything that I have accomplished has been through work of others, through being lifted on the shoulders of others. And I am just honored to have been able to accomplish the things that I’ve been able to accomplish and again, hopefully have others do the same.
[00:09:39.130] – Dr. JB
Wow. Can we just start there? Very impressive. Yes, indeed. So one of the things I heard over and over and over, as you shared with us, your origin story was the first. So can we go back and say and explore, when did this the first begin for you in your life? Right. So if we go back to your childhood, middle school and high school.
[00:10:15.430] – Dr. Stewart
[00:10:15.830] – Dr. JB
There other people in your immediate family who had gone to college, or can you walk us through that?
[00:10:22.420] – Dr. Stewart
Yes. Thank you. When you said that, I’m thinking, yes, I was the first in my family to go to college, the first in my family to achieve a medical degree. And I have a nephew who is starting classes as we speak, and he’s my great nephew, and I’m hoping that I can nudge him into medicine. And so, yes, again, the first there and even within my community, from my community. And many of my friends back in those days, they looked at me and they were like, wow, I can’t believe that you have achieved so much. And I tell them, this is something that has not been without a lot of struggle, has not been without a lot of help from others. And I tell you everything that I have done. I can say that I’ve had others to really encourage me and to help guide me through all of this. Many of my friends and colleagues, when they meet me and they hear some of the stories, they say, well, how did you do this in your family? You didn’t have that success. The mom and dad and sisters and brothers and others within your family.
[00:11:52.880] – Dr. Stewart
And when I think about it and I look at it in a spiritual way, I feel that God really had a plan for me and that with the will and all those things that were given to me, I was able to accomplish this. And being the first, that means that there will be a second and a third and a fourth and a fifth. I’m looking forward to what the things that I have accomplished can help others to be able to accomplish.
[00:12:28.910] – Dr. JB
But how did you get the willpower to be the first? How did you get the willpower to say, I am going to create a path for me where no path has existed before?
[00:12:44.690] – Dr. Stewart
And I hate that we try not to bring in spiritual things, but it was all I felt. It was just God given. Because again, to be able to succeed, you have to try something. There’s a saying, and I can’t remember exactly, but to fail, you have to try. And so having that courage and I think about that oftentimes when someone says about what are your guiding principles? And I say number one is that desire to serve and then also having courage. And that takes a lot because there are so many barriers that are placed before many of us. And it takes a lot to have that courage, that will power to continue to try to get over those barriers and boundaries when they do arise. And for me, that’s been a blessing. And I’m thankful that I have that. And it’s something that you can’t really quantify. But when I look at it, I say, I just have so much that was given to me and I have to ensure that I give some back. And hopefully I can mentor others and inspire others to be able to achieve things that 1 may not think that one can achieve, but it takes a lot of courage and encouragement from others.
[00:14:30.980] – Dr. Stewart
I had teachers and many of I feel bad for many students now. They don’t have that connection and part of it within the school systems that they’re suffering through. But I had some teachers that really took out the time because I didn’t have it at home. I really did not, but took out the time to encourage me and to help me to aspire and be inspired by others and to look at areas that I may not have looked at previously. Neighborhoods like, you can live in this neighborhood, but you have to finish school, you have to do well, you have to get a decent job. You don’t have to always live within these boundaries. And so those are things that I am thankful for and so very grateful. And I feel that that is something that I can hopefully help to inspire others to realize realize their greatness.
[00:15:40.350] – Dr. JB
I think one of the key things that you brought up was this is not something that you did all by yourself.
[00:15:49.100] – Dr. Stewart
[00:15:52.210] – Dr. JB
That great American saying, pull myself up by my bootstraps. That’s what pretty impossible. But it’s embracing the idea that it actually does take a village.
[00:16:08.630] – Dr. Stewart
Yes, it does.
[00:16:11.510] – Dr. JB
And where do you find your village? Sometimes part of your village may come from your immediate family and household, but sometimes you have to look elsewhere for it. But it’s out there. But you just have to identify where is your village. You have to have that seeking spirit and be open to receiving support from others.
[00:16:39.950] – Dr. Stewart
And the other thing is to have that courage to really go out and talk to others and ask someone, how did you do this? Or how can? So many times we feel that doctors and others are not approachable or they are up here and I’m down here and I may not be able to talk to them, but hopefully one will realize how important it is to open up and be open to ideas and be open to talking to others. And I tell everyone one of the stories from my background as I talked about when I was in pharmacy school and I was sent home for grades in the middle and had to get back home, and I was like, oh my goodness, this is not part of it is. I was not as ready as I thought I was, even though I was getting great grades. And then I went to a private university. There were so many things. And then not having that family support when I called home trying to talk to someone about trying to get some help, like, oh my God, I cannot accept this collect call. Do you know how much this is going to cost?
[00:17:52.940] – Dr. Stewart
Blah, blah, blah. It was tough. And when I think back, I say, I think I had a little depression or something back in those days and that impacted me. But then when I was out working, after I had been sent home and realized that this is not where I wanted to go, I want to finish a pharmacy school, I talked to every person who would listen, and I ended up meeting the vice president of Then Retro Drug, which is now CVS. While I worked at Cleveland Clinic as a unit secretary, in between time, and so the only reason why I was able to meet him is because everyone knew that I wanted to go back to pharmacy school. And so when one of his family members was there at the hospital, they said, hey, do you need to go and talk to blah, blah, blah in that room? And I was like, oh, okay. And so I went and I talked to him and I told him my story and told him how you know, I know this is not where I want to be. I want a complete pharmacy school and what do you think I need to do to be able to do that?
[00:19:04.350] – Dr. Stewart
And so he said, meet me at the office, the main office there in a couple of days. I did so, and the rest is history. I was able to get a scholarship back to the university and I end up doing well. And at the end of the day, he said that he was so proud of me and even the dean, they were good friends and that connection, he said that he knew that I could do it. He knew that I can do it. And again, having that openness and realizing that just because you fail once, that does not mean that you can’t succeed. And you have to have that encouragement and that will power and that support and help to continue to push on and try to get over those barriers. When I think back, and I tell you, right before I ended up graduating from pharmacy school, I ran out of money and the dean of the university cosign so that I can complete my training. And just those, again, people in my life that really helped me to achieve the things that I was able to achieve. And again, as you said, it takes the village and it really does.
[00:20:33.770] – Dr. JB
[00:20:35.220] – Dr. Stewart
[00:20:37.470] – Dr. JB
I can only imagine how much courage it took you to introduce yourself. He didn’t know you.
[00:20:43.230] – Dr. Stewart
But move on. Again, have I not? Who knows? But you know, it was just and that’s what I tell students when they come to me and they ask questions or even now letters of recommendation after they do their rotations with me. And they’re like, I was almost afraid to ask. I was like, Please, I am so honored to be able to write you to a letter, a recommendation. Again, it takes a lot of courage and just realizing that you have to ask. If someone says no, then at least you ask.
[00:21:22.120] – Dr. JB
Exactly. Because literally, what is the worst that could happen?
[00:21:25.690] – Dr. Stewart
[00:21:29.690] – Dr. JB
They say no, then you move on.
[00:21:30.920] – Dr. Stewart
To the next one. Just move on to the next one.
[00:21:34.830] – Dr. JB
And actually, I think the worst that can happen is that they don’t say no, but they have.
[00:21:42.430] – Dr. Stewart
Like limbo, period.
[00:21:44.590] – Dr. JB
I just want my no so I can move on to the next person. In addition to the courage and being the first, the other thing I heard you say a lot was about advocacy.
[00:21:58.960] – Dr. Stewart
[00:21:59.720] – Dr. JB
And so was there something that happened that made you realize the importance of advocacy during your journey?
[00:22:08.910] – Dr. Stewart
Oh, yes. And I could say pretty much every step of my way in my life, being born and raised in Cleveland and the inner city and the housing projects, and just seeing so much that individuals felt that they had no voice in. We talk now about social justices and things like that. And you have to have someone to really beat your voice if you don’t feel that you can be that voice and to speak up. Throughout my years in medical school, just realizing how important it was to address what we now call health disparities, social determinants of health, those were terms that now we use regularly, but those were real where I grew up and realizing how important it is to address those issues, seeing what my family went through. My mom was diagnosed with breast cancer late and she did not have anyone to speak up for her to really talk about how important it was to get those mammograms done. And she was one that had diabetes and hypertension and would go to the doctor regularly, but not to the doctor like to the Er and to this and that, and never really had that personal relationship with a physician.
[00:23:47.890] – Dr. Stewart
And so again, those are things that I felt that were really important and how important it was for me to be that advocate on behalf of people who looked like me, people who suffered many of the things that I suffered through. And then now I am HIV specialist in realizing how important it is for people of color who are disproportionately diagnosed with HIV and living with HIV. And being that advocate on behalf of those individuals has been something that I am so honored to be able to do right now. We talk about a lot of things that and covert really unveiled so many things that we are now bringing to the forefront. And those are things that have been issues that I felt that were really important early on and ensuring that I would be able to speak up. And I said you have to be the voice of change if we’re going to change the way our health care is functions. You have to be that voice and you have to be there. Right now it’s really important for us to be in places where policies are made and just being honored to have that opportunity is something that I have strived for and will helpfully continue and will continue to do so and encourage others to do so.
[00:25:28.330] – Dr. Stewart
We need more people in the C suites right now, especially individuals who look like me, who realize that some things have to change and you have to be there at the table to be able to impart that change. And if you’re not, then things can happen to you.
[00:25:52.610] – Dr. JB
Well, along those lines, we talk about change and things happening to you. Could we talk a little bit about what you either have experienced or seen in health care professionals in relation to burnout and career longevity?
[00:26:09.430] – Dr. Stewart
Yeah, this has been a tough time. I want to say that even though I’ve been serving as one of the officers, a past president, and even as Board chair, and even as my time as President elect, I’m still practicing I’m still working every day. And a couple, I would say about five or six months ago, I realized that I was actually feeling some burnout, you know, the the impact of, you know, electronic medical records, prior authorizations, and just, you know, the things that we had to deal with with encouraging our patients to be vaccinated for COVID in addition to other vaccinations. And there’s so much being placed upon physicians and realizing that, especially in primary care, and not discounting any other specialty. But primary care has been undervalued for so long, and we continue to bear the burden of prevention, of caring for chronic diseases, acute diseases. And as we dealt with the pandemic, we were on the front lines. We were able to transition from the Er to the Ambulatory to the ICU, wherever we needed to be. Family physicians were there, along with not being valued. As far as number one is salaries, reimbursement, those things, in addition to so much of this typing and clerical work, that we really have to change the way we do medicine.
[00:27:57.580] – Dr. Stewart
And I see more of my colleagues who are deciding that they no longer want to practice, they want to do something else. They want to get out of patient care. And this is the wrong time for this. We really need to increase our workforce. And number one is we have to change the reimbursement, especially in regards to primary care. You know, there was a study that was done in 2001 that looked at the impact of primary care and found that, you know, that’s the one specialty where an increase in investment in primary care really shows better outcomes. And our country, we spend less on primary care, and we have the worse outcomes than any other developed country. And so all those things really kind of shows us what we’re doing wrong. And how do we write that wrong? Number one is we really need to increase investment and take care of payment and reimbursement for primary care and also other specialties who are suffering through all of this and then do something. As far as the administrative burden, we look at these EMRs, and I spend every day, even when I’m not in the office, at least five or 6 hours, clicking on charts and doing all these things.
[00:29:40.300] – Dr. Stewart
That really doesn’t add to what I’m trying to do for the patient within that office. And it wears on you, and you get tired. And then when you have someone say your quality measurements aren’t quite where they need to be and blah, blah, blah, blah, you’re like, what the heck? It does. We really have to change the way we’re doing business. And now it’s a time because we see our population getting older and more mature, and many have chronic diseases, at least two or three chronic diseases. And so how best are we going to care for those individuals? Other than ensuring that you have the workforce to be able to do that. And then as we try to encourage students, what do they have to look forward to? Sitting there on the computer typing all day and not really having that interaction with patients is not really something that we want to really advance. We want to ensure that they see the value and see how important it is to serve patients and to care for them and to have those interactions within that room and be part of the community. When you have them so burdened and so wore down with working within the office, how are they going to have that energy to go out to the communities and be part of the community and even encourage them to advocate or to do more?
[00:31:21.930] – Dr. Stewart
We really have to make it where we have physicians who bring back that joy that we used to have all the time. And one way is to ensure that we decrease administrative burden and then increase that investment in primary care.
[00:31:44.210] – Dr. JB
So can we go back a little bit in time and see what exactly has changed in terms of the administrative burden and things like that, that sound like they’re contributing to? They’re part of the driving forces that are causing healthcare professionals to leave the system. What changed? Was it just the advent of the electronic medical record or were there other things that changed?
[00:32:12.590] – Dr. Stewart
That was one, the electronic medical record. And you think about the biggest thing was about safety. You remember it was about having the opportunity to not have to read an order from a physician. Yeah, exactly. And then also having the opportunity to be interoperable. Has that happened? No. And then the insurers now have all these prior authorizations and so things constantly change. Most of it is about profit. And we are going to only have these drugs as part of our formulary and we’re not going to have these. But who knows? And each insurer has their own little formulary, which makes it even more complicated. It makes it more complicated for the patients. In addition to us, we have no idea because remember, one thing could be covered today and then tomorrow it can no longer be covered under that insurance company. And so there are so many things that has changed that make life worse. And so again, continuing to advocate because many, such as CMS and all these individuals don’t know what we’re actually doing within the exam room. And they have their agenda. And our agenda is all about the patient. Yes, they say that it’s about the patient, but it’s through the burden that they’re placing on many physicians that we are suffering.
[00:33:57.620] – Dr. Stewart
And so we need to continue to still get those things that are so important, making sure things are affordable, making sure that we address costs, but in a way that, again, does not place the burden on physicians. That does not delay care to our patients by trying to get something authorized. That ridiculously. We know that it may be very inexpensive, but why is this no longer on the formulary? And then removing some of the barriers that have come with electronic medical records in addition to ensuring that we do have true interoperability, which right now we don’t.
[00:34:48.750] – Dr. JB
The part of it that’s just so concerning is we were already projected to have a shortage just based off of how many healthcare professionals were able to create from the schooling and things like that. Right, so we’re ready at the shortage, but now we have these healthcare professionals that have gone through all these hoops and hurdles and things like that and we’re losing them.
[00:35:16.650] – Dr. Stewart
[00:35:17.670] – Dr. JB
Which is just worsening the situation for the patients. Yes, there’s a huge hole in our cup.
[00:35:29.850] – Dr. Stewart
And then we still have issues with we talk about the pipeline and the pathway to medicine. And even when we get students who decide to choose to have careers in medicine, we still don’t have the number of sites that we need to even train them. We continue to fight for increase in residency positions. We’re still at the 1990s number of residency. We did have a slight increase, but that’s all of a thousand and that’s all across the board. That’s not just primary care. So we really need to do something. And a lot of this is through legislation. Again, it goes back to advocating and making sure that you’re in places where decisions and policies are made so that we are able to show the true need and true value in ensuring that we have the workforce to be able to care for our community moving forward. The path we’re going right now, like you said, it’s not going to happen.
[00:36:44.130] – Dr. JB
So when you said having feelings of burnout, what did you do?
[00:36:51.650] – Dr. Stewart
I reached out to my friends and my colleagues and that really helped because many of us were going through the same things and it really helped to be able to talk to others. Some individuals who had talked to me about their burnout, I encourage them to talk to professionals. Again, as physicians, we have this feeling that we are resilient and I hate that word, but we have that strength and that ability to overcome a lot. But we’re still human beings and we still have families, we still have situations in our personal lives that impact what we do every day. And that’s something that, again, really helps to. And it’s not about I hate years ago when they were talking about do yoga and all that, that doesn’t work. Okay, I work out every day, but I was still burnt out. But it’s all about being able to express what’s going on with you and feel comfortable doing that. And it really helps to have individuals in your life that you can talk to. And it’s not just having another doctor, but it helps sometimes because they’re able to relate to the things that you’re. Going to through, but having those friends and those colleagues, because so many times they’re going through similar situations.
[00:38:35.010] – Dr. Stewart
And right now with the pandemic and now with another potential pandemic with monkeypox. And I see that within my practice because I care for many individuals who are more vulnerable to monkey pox. I’m like, oh, my goodness, here we go again through another crises. But I have the same with crises comes opportunity. So again, it’s an opportunity to really be able to talk to others, to express those things that are going on with you and to try to ensure that things we improve the life and the processes as we move forward because we cannot continue to do things. It’s not business as usual moving forward and we have to make a lot of changes as we get through this. But it’s really important to talk to others and just let loose. Our academy, we had a town hall one day that really focused on burnout and it had individuals who talked about their experiences with burnout. It really helped a lot of individuals because they saw that it wasn’t just me. And how do I see I did an article too within our academy, a little blog and says getting through these unbelievable times and how do we do that?
[00:40:14.550] – Dr. Stewart
Seeking out resources. Many specialties have different resources that you can seek to also help you get through things. Our academy has a wellness conference. They really just brings everybody together and they talk about how they continue to look at physician well being and wellness. So looking at resources and then talking to others and just having that time to relate and talk about your story and to give your story.
[00:40:49.950] – Dr. JB
And all of those things that you mentioned are things that we do here at Hope for Men in our community. Beyond the podcast with the Hope for Med membership site where you get to get together with your peers and just release and talk and share and connect and realize that indeed you are not the only person and together collectively we can get through this and grow and continue doing what we love.
[00:41:20.460] – Dr. Stewart
Amen. So true.
[00:41:23.290] – Dr. JB
So with that being said, if my listener wanted to get in touch with you, how can they do so?
[00:41:30.990] – Dr. Stewart
I am on Twitter and also Facebook and please forgive me, I don’t have my handles available but I’m sure that you can provide the listeners with that information. If you google me, you can find how to reach me. I’m here in Columbia, South Carolina. My cell phone is always available. Just reach out by me and reach out and talk to me. And I’m always open to hear individuals and to try to help others because again, I could not be where I am today without the help of others. And so I want to make sure that I can help others achieve and be inspired and aspired to do all the things that they can do.
[00:42:21.730] – Dr. JB
Okay, thank you so much for that. And we will include your handles in our show notes.
[00:42:27.950] – Dr. Stewart
I usually have them written somewhere, but don’t I have them today, so please provide that information.
[00:42:35.250] – Dr. JB
No problem. And in closing, do you have any pearls of wisdom? I know you’ve given us a ton already, but closing words, pearls of wisdom you’d like to share?
[00:42:46.150] – Dr. Stewart
I would say, in closing, you can achieve anything. Just be inspired, have courage. I like what John Lewis once said. Representative Lewis. And he says, be bold, be brave, be courageous and find a way to get in the way. And with that, I will close and just inspire everyone to try to achieve and to reach for the stars. Because even if you fall, you got to fall on those clouds that are soft. But we can all achieve what we think is the unachievable with the work, with hard work and with others and the support and with guidance and just with courage and love.