Amanda: Hey guys. Welcome back to the podcast. I'm Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today we have a special guest star. Dr. Dara Kass is joining us today to talk about working in government. So many of us feel totally stuck. So we're starting to highlight just a few of the options that are available to doctors other than just working clinically. Dara Kass is an absolute dynamo that we heard speak in Washington DC in April at the AAWEP pre-conference for ACEP. She's currently serving as the regional director in the US Department of Health and Human Services, and our emergency medicine colleagues might know her from a group called FeminEM. Her energy and ability to get things done are infectious, so we knew we needed to have her on the show. Thank you so much for joining us, Dara.
Dr. Kass: Thank you so much for having me.
Laura: Okay. Dara, tell our audience a little bit about who you are, you know, your training, your family story, anything you wanna share with us about you.
Dr. Kass: Well, it all started when I was born in 1977 to an emergency medicine nurse in Brooklyn. It is actually kind of relevant, right? So my mom was an emergency medicine nurse at a hospital called Brookdale University Hospital. And the relevance there is that she was waddling around the ER when she was pregnant with me. And so, fast forward to, I decided I wanna be a doctor, which I kind of always do my whole life.
And I had heard about this practice of emergency medicine, which had just started really becoming a clinical specialty. And my mom had told me all these stories about how in the ER. Like, you know, July 4th, we couldn't have fireworks, right?
Because she would see people with their hands blown off and their noses off their face. And well, where do you go when you lose your hand or you lose your nose, you go to the ER. And so I kind of went into medicine knowing that I wanted to be an ER doctor because my mom made it sound amazing. You know?
Ironically when I trained at Kings County. So I went to medical school at Downstate in Brooklyn, and then I stayed there for residency at Kings County. I actually wound up rotating, as both a medical student and a resident, at Brookdale University Hospital. So I wound up walking in the halls and people who had been there long enough were like, "Hey, aren't you like Phyllis O'Koon?"
That's my mom's maiden name. " Aren't you her daughter?" Or "you look just like this nurse we used to know." And so there's thing very cool about that, right? As a legacy building experience. And then, the story I've told a lot, right, which is that I went through residency, and I loved my residency at Kings County. And then I got my first job as an attending at Staten Island University Hospital, which I also loved.
I really wanted to go to a different clinical environment than where I had trained, and I just loved the community aspect of Staten Island. And at that time I had just gotten married, and I decided to start having children. You know, which is kind of the arc that we go through. And I realized that a lot of the issues that I had not faced as my gender, you know, as a woman physician.
Because although a lot of the criticisms I had gotten around my personality and whether she's bossy or whether she's too comfortable or whatever it would be, were clearly gendered. The limitations to my career didn't really happen until I started having kids. And I also, and I say this pretty often, was married to my husband who didn't really take shit from anyone if, if I can curse on this podcast.
And was laughing and frustrated at what we absorbed as physicians, like the stuff that we took especially around things like change of life, like childbearing. Like how could we, as you know, physicians put women in harm's way as they're pregnant while we're taking care of other people who are pregnant. Like making us work early, you know, early, late, crazy schedules, not giving people time off to pump, not giving them appropriate maternity leave.
And so, I started looking at the practices around maternity leave, lactation, childbirth, stuff like that, and realized there was a better way. And as that fused with social media and community engagement and residency leadership and all the other changes in our lives, that kind of happened quickly as the interwebs exploded.
It kind of birthed, not just my three kids, but FeminEM, which was the idea of bringing together women in emergency medicine to have community and to also advocate for policies that were necessary to keep them in the workforce. Loved that. Changed jobs along the way a little bit just to kind of change my impact on the careers of women in medicine.
And actually, a couple years ago, I had become more active in kind of federal politics. I mean, my state and local politics are pretty tight, at least they had been for a while. But federally I felt like there was a lot more I could have impact in. And so I started getting involved at, specifically in a presidential race with a guy named Pete Buttigieg, who I became connected to and worked on his campaign. And did some health policy stuff and got really engaged in what was possible with the evolution of the healthcare workforce, healthcare policy, healthcare access. And when the, you know, eventual election ended up with a guy named Joe Biden becoming the president, I put my name in the ring for you know, any job in the federal government that suited my time and talents, if you will. And ultimately wound up with the job as the regional director in Region Two, which is New York, New Jersey, Puerto Rico, the US Virgin Islands, and eight Tribal Nations that are within the borders of New York State.
And I do a lot of work on intersecting stakeholders, state and local governments, federal policy, communicating what's going on with things like Medicare or Medicaid, or 988, which is a mental health resource. And we can talk about a lot of this, but it's kind of an amazing opportunity to truly understand the intersection of federal policy and opportunity, with the states and their laws and funding, and how we as physicians can really help change the healthcare landscape, but where that change needs to occur.
Laura: Okay, so what made you start considering government work?
Dr. Kass: So I didn't consider it until the election was over, and I started looking. A friend of mine said there's this book of all these jobs in the federal government, and I didn't know what exactly people like us were qualified for.
We don't have law degrees. We don't all have public policy degrees. I don't. And I just kind of said, if there's a job that suits me, I'm into it. And that's kind of what it was. So, you know, I realized in both the campaign, and actually as I had been paying attention now for almost, it's almost 10 years that I've been paying attention to federal and state politics. The most marginalized among us are- their healthcare access depends on the government. Whether that is your state government or your federal government or your local county government. And so if you are looking truly to affect healthcare access, that is one of the places you need to understand.
Amanda: I love it. Plus what you said- in person in Washington DC- like that you didn't want to complain about something that you weren't willing to do something about it.
Dr. Kass: Yeah. I mean, that's my MO always, right? Like, why did I start FeminEM? Because I was mad that women in our field were being put in positions I didn't think they should be.
And so rather than just complain about it, I created something that I thought could help change the conversation and create policy change. The same thing is true here. Like I certainly comment and complain a lot about what's happening in our federal politic and our state and local politic. But I also walk the walk, which is to say that I show up every single day, and I go into communities and talk about healthcare. And I really try to get people to understand. Like yesterday, you know, I spent my morning in a senior center in Westchester talking about the Inflation Reduction Act, which is a bill that was passed last year, that both affected climate and healthcare access for lots of people, specifically people that have Medicare. And teaching older Americans about their healthcare access in a way that means something to them is awesome. Right. It's just so much fun. And they have so many questions because they are high consumers of healthcare.
All of a sudden they have questions about their dental and hearing aid and prescriptions and access and nursing homes and so many things that I understand, but they need to understand.
Kendra: That's awesome Dara cuz one of the things that we see, and you can attest to this in EM docs is just meaning to our work. And so just hearing you speak, I mean, you are able to be in that position to educate those people. And that fulfillment and that meaning in your work.
Dr. Kass: And I go between, I mean I go to senior centers. I'll go to emergency medicine residencies. I mean I go to all these different places which are like kind of generational cross-section of the human experience. Right. And that's amazing. There's so many ways. I'm gonna start going to PTAs and, and schools talking about youth mental health. Right.
And like there's so many places we can affect the conversation and then inspire people to make a difference.
Kendra: Yeah. That's awesome. So tell us the difference between an appointed position and elected position.
Dr. Kass: Yeah, so this is actually super important. So most of the people that work in the federal government are career.
So there's appointed, elected, and career. There's three categories. So most people that work in the federal government are actually career, meaning that they have a regular job. There's a really well known emergency physician named Deb Houry, MD, works at the CDC. And she's a career. She's been there for a very long time. She's like, that's her job, right? Then you can be elected into your position, which means you run for office. So, for healthcare, we don't really have that many elected positions. You know, maybe a county health official may run for office or get elected.
And then there is appointed position. So in the federal government, there's something called the Plum Book, which is about 4,000 federal appointed jobs that happen at each administration. But even at the state level, right, you'll find that things like the commissioner of health or county health executives may be appointed by the governor or some other kind of appointing body.
So there's a lot of ways that you can get into federal service or even state or local service. I am a political appointee, which means that if the administration that hired me is no longer in control of who works there, I may or may not work.
You know, political appointees say through administrations if for some reason the, the next administration, even if it's not the same party wants them there. That it hasn't generally been the way we've done things in the past few years, but who knows.
Amanda: Well, and one of the things you had said was being an appointed position meant there was different ethics involved.
Dr. Kass: Yeah. I mean, this is a whole other thing. When I took this job, actually, it's part of the reason about FeminEM. So when I took this job ethically, I could not have any conflicts of interest for anything that the Department of Health or Human Services oversaw or interacted with or else I'd have to recuse myself. So, I can't work clinically except for a federal facility. So I volunteer at the VA as opposed to working at a healthcare facility closer to my house or, or one that I had worked on in the past. I can't own stock. I can't own companies. I could not own FeminEM. I had to give that away.
That is not true for people that are elected and I don't even think for career. So only if you're appointed into the position do you have a lot of opportunity to divest yourself from a lot of your ethics conflicts.
Kendra: That's really interesting. So what are some first steps for doctors wanting to get involved?
Dr. Kass: I think, first of all, pay attention to the
landscape, right? So what's going on in your state, local government? Many emergency physicians are state health officers or county health officers. Which is a really good idea. So, there's a couple here in New York. The state health officer for the state of Alaska is emergency physician. The state health officer for the state of Kentucky is an emergency physician.
We are really well suited for government service. Specifically for service that affects the public health and healthcare access for folks all over. So, if you wanna work on the federal government you can look at this Plum book, which I said. And then a lot of times it's reaching out to people that are either in the government or people that may know who to call.
Maybe it's your local congressperson or it's your maybe your state senator, state legislator. But really kind of connecting yourself with people that are in government and say, "I am interested in working in the healthcare sector in our government," or whatever it is. And just letting your interest be known.
And then oftentimes it's just that, that simple. USAjobs.gov has public posted jobs for, for the career jobs, if anybody's interested in that.
Amanda: I'm just imagining somebody who is ready to get rid of their clinical duties that's like, "appointed position is for me."
Dr. Kass: Yeah, I mean I think that that's like, there's a lot about being open to the new ways to get jobs. Right. Yeah. This is a whole new avenue, and like you could spend forever looking at usajobs.gov and look for jobs that you might be qualified for, you know?
Amanda: Yeah.
Dr. Kass: Who knows?
Amanda: It probably never occurred to many of us. This is something I wanna know. Given what you've learned working in government, is there anything, misconceptions, anything like that, that the average clinical doc should know?
Dr. Kass: So, we are problem solvers, and not every problem's gonna get solved right away. And especially when it comes to rapid shifts in healthcare access. Whether it has to do with new laws or losing protections, maybe in healthcare. And I think that the rea, the reason I say it like that is because the bureaucracy of the government has been both protective and frustrating. And knowing how to navigate that is really important.
Also knowing, and this part of the reason I love this job is, where the federal government should not solve the problem, right? There are a lot of people out there that believe in smaller government than I do. But I understand a belief that local governments and local leaders are really best suited to affect a lot of local problems.
And I think that really understanding when and how that can be great or when, and not that can be harmful. Especially around things like equity and access for people that are marginalized. But also realizing when you know, private companies or nonprofits are really best suited to solve problems.
Oftentimes, things that are, that may need to, to last longer than certain administrations. If you can't get something codified by legislation, it may be best suited that that comes from a nonprofit that has a much more even and consistent approach to the problem that needs to be solved.
Amanda: Great point. So are people able to contact you if they want to learn more or is it stuck deep within the government?
Dr. Kass: So I am an open book. I am way too accessible. Right. It used to be find me on Twitter, and now it's not. Like that's a whole thing. Yeah. I would say, you know, "DM me on Twitter," and I will tell you not to DM me on Twitter right now cuz I don't go there.
But my personal email, my work email are both available, but my work email is just [email protected]. And especially for anybody that wants to ask questions about working in the federal government or even state and local governments, wants to be connected to the regional director in their government.
So one of the things I didn't explain is that I'm one of 10 regional directors in the country. I'm the only physician right now. But I am, I represent the best region, I will say freely. Because I have a really easy job in lots of ways, right? Like I work for four. It's New York, New Jersey, Puerto Rico, the US Virgin Island. So they're two territories and two states. All with Democratic governors, all whom really prioritize healthcare access. And so that makes my job fun. Right. I get to go around and talk about the good stuff that our government's doing. I get to find out where we can solve problems. I get to write op-eds. I wrote an op-ed last week in The Hill about Narcan and how every family should have Narcan in their house. Because over the counter Narcan, especially for parents of high school students like I am, is really important. You know, to teach your kids and to de-stigmatize it.
But if anyone has any questions or lives in a state, especially a state that's going through some tough times for healthcare access, I'm happy to talk to you and happy to help you figure out how you can be engaged and make a difference.
Amanda: Thank you so much. This, this podcast actually came about because one of our clients was like, "well, I thought about what if I did something political, but I don't, I wouldn't know where to start."
I'm like, well, funny enough, let's have Dara on because she will educate all of us.
Dr. Kass: I just wanna say, what about the word political, right? So like I have no shame in saying that I'm a political person at this point, right? But healthcare access. Like it is often that healthcare access is politicized to marginalize.
And we need to, for us to keep centered on the access issue as being not political. Right? Healthcare coverage should not be political. Access to medications for medical conditions should not be political. Access to treatments, the best scientific and medical treatments we have for somebody's condition should not be political.
Right? And so, I, try to make sure that people that are in environments where the healthcare has been politicized, can still feel confident that their voice not just matters, but is even more critical right now. To remind everyone that you should not live or die based on the state that you live in and whether or not the leaders of your state believe in access to equitable and safe healthcare. That's one of those things that we are constantly, hopefully trying to fix. Not like continue and open the, difference between what is accessible in one state versus another.
Amanda: Well, that was pretty much a mic drop. I love that. Before we close out, any other tips or wisdom from you?
Dr. Kass: No, I think, look. We are in a crisis for the healthcare workforce. It is clear that what happened, not just through the pandemic, but what's happening before the pandemic. What's happening after the pandemic.
This is not just a covid pandemic related issue. It's a crisis of everything right? Economics, access, inspiration, survival. Like there's, I could go on and on about how hard it is to show up and work in an emergency department right now, every single day. I will also say that I now go to the ER because I want to, one day ever the week. Because I love being in an emergency department. And I love being in an emergency doctor.
Figuring out how to, how to get that back for everybody else, is one of the things that I'm really trying to do. Love what we do. That's why we went into emergency medicine. It is an honor to do what we do. It does not mean that we have to sacrifice and suffer for it. We need to figure out how to recenter the joy in it, and it needs to be a survivable and viable job.
It needs to be able to comport with our lives and our children and our families. And I think- if I go kind of off topic for one second- the next iteration of emergency medicine is gonna have to look critically at itself to say, you know, it's been almost 50 years since the, you know, beginning of our specialty. It's probably a good time to reckon with what does it look like to be a emergency physician over the course of a career. Which isn't just the first 10 or 20 years, but actually probably closer to 30 or 40. It may never have been created to be a sustainable job for 40 years. If it's not, it either needs to change or we're gonna have a massive exodus of everyone the day after they turn 45. And that's what we need to figure out.
Kendra: Thank you so much for being here, Dara. Thank you for sharing your wisdom. We appreciate what you're doing, not only as a woman in emergency medicine, but also just advocating for those that don't have a voice. So thank you, thank you very much.
So until next time, you are whole. You are a gift to medicine and the work you do matters.
