The Power Shift Podcast – The Power to Dismantle Hierarchies in Healthcare with Dr. Eva Balint

Sharon:

Dr. Eva Balint, welcome to the Power Shift Podcast. So, just to begin, help us understand. You’re a physician and you work in a large public health care system?

Eva Balint:

Yes.

Sharon:

So, just to set a foundation, what does power have to do with being a doctor in a health care system?

Eva Balint:

Thank you, Sharon. It is such a pleasure to be here. Physicians, we have a lot of power. The moment we finish medical school we are leading others. It just comes with the territory and we don’t always use it right. One of the issues is that we are here to serve the patients, and yet they’re at the bottom of the hierarchy. Even the name patient, if you think about it, it’s like you just sit in the corner and wait until you get something. I would love to change that name. I was thinking, client is not perfect, but if we put the patient first, if we really think about it why we are here, it would really change the health care system.

Eva Balint:

So, what is power? I feel that power is to use everything at our disposal to really advance the health of others and help with the patients that… If you look at health care systems, or if you look at just health care in general, there’s so much power out there that is focused on profits or jockeying for positions. I feel that this is one of the reasons why there is so much distrust in health care currently.

Sharon:

Oh, I am so excited because I can feel that I am in the presence of a change agent, and that’s very inspiring to me. So, maybe to start with, let’s hear a little bit more just about you and how you’ve come into your power. Then, we can be talking about some of the changes that you’d like to see in the system.

Eva Balint:

It was a process for me to learn how to use my power wisely. I was born in Hungary behind the Iron Curtain, and when I came to the US it was difficult to fit in because of the language barrier, because I have an accent, and it was challenging for me first. When I took my first Medical Director position, it was challenging to use my power wisely. I only had this very rigid top-down system. If you think about medical training, medical school or residency, the pimping, the rigid hierarchical system, it took me a while to learn to be including others, to have lateral leadership skills, to inspire instead of giving orders.

Eva Balint:

But I feel that this is, in terms of being powerful, I feel that when we can walk together, that’s the real power. There’s this African proverb that, if you want to go fast, go alone. If you want to go far, go together. So I learned to shift the traditional position of power into the power of inspiring others and going together.-

Sharon:

Beautiful. So, tell us a little bit about that journey of like, what was your experience then going through medical training? What did you internalize from that? What did you take on from that? Then, how did you come to be the kind of inspiring leader that you’re talking about?

Eva Balint:

It was an interesting transition. Before going to residency, I did a few years of research and I did basic science, and I worked with big and famous people, Nobel laureates, or to-be Nobel laureates, who would want to be called first name basis. Imagine, I’m a first-year intern and I called one of my attendings by his first name, and that didn’t go very well. It was very interesting to move from a very collaborative environment to a truly top-down environment. So that was a rude awakening. I didn’t want to insult the person, but I actually did. We were about the same age, and that made me really think about how we relate to each other and how can we really serve the purpose that we are here to serve the patients? That started me on my journey.

Sharon:

Beautiful. So, from those early experiences, tell us a little bit more about how you proceeded through the medical system, or in the health care system, having learned some of these lessons?

Eva Balint:

When I was in my first Medical Director position, I made all those mistakes and I was stumbling along. Then someone had the bright idea to send me for a leadership course, especially for physicians. It was the UCSF program at the time, and it really opened up my eyes in terms of how I come across and how I am perceived in a way that I really didn’t want to be perceived. So it opened up a long journey of personal work, and it helped me realize that what I truly care about is to be in community and to be in partnership. Slowly but surely, I changed my leadership style. It opened up avenues to much larger positions and to really help others and lead in a much larger scale. I had Chief Medical Officer positions and also VP level positions in health care systems where I was able to exert influence in a way that I never imagined was possible.

Sharon:

I want to hear about those. And I just want to give a shout out and score one for leadership development, training and coaching. Score one for self-awareness and personal development. I love the way that you said that, that it really opened up opportunities for you to have a much bigger impact. Tell us about that then. And then, how did you proceed? It sounds like you have observations about the health care system. I want to hear some more of those and then how you’ve taken on the system.

Eva Balint:

Yeah. I feel that this is about small victories and it is about maintaining the long view. There are certain things we are working towards changing, but we are not going to change tomorrow. So there is a lot of, as I mentioned, hierarchical thinking, top-down, and all the isms, the racism, sexism, ageism. I think health care systems and health care in general, unfortunately, carries a lot of that history that we need to dismantle and we need to move forward with. There are certain things. I’m thinking of sometimes the feedback women leaders get that you’re not assertive or you’re too assertive. Sometimes in the same session you get both feedbacks. It’s an interesting conundrum to sit with, that, “Okay, how am I going to do that? How am I going to walk in that very narrow tightrope?”

Eva Balint:

I got feedback at some point that I was very capable, but the organization wanted an older, white and bald and fat man in the top position. It’s something that I never… It’s not something to try for. I’m never going to be that person. So, part of it is, really pick the battles that I can, and what I feel is that, change what I can. I feel that I mentor like crazy, and one way to change the system is have other women in those positions. It’s a sad state when I’m the only woman in the room.

Sharon:

Right.

Eva Balint:

So, I feel that the way to change it is to mentor and mentor and help others and support each other. It is a change. It is really… I feel like it’s radical to women to support each other because it’s not how it’s been. And we can… Yeah. Go ahead.

Sharon:

So, your experience unfortunately is universal. It’s not uncommon, right? So, just to point out some of the things that you have been facing. So, the feedback that you got, just a few things here. So, one is that research shows that women tend to get feedback that is more about their communication, more about their personality and social style, and less constructive about outcomes or health outcomes or business outcomes. So it sounds like you faced that. Also, the scrutiny and what we call the double bind, right?

Eva Balint:

Yes.

Sharon:

That kind of tightrope that this is a very well-known gender and intersectional bias where women are told to act as leaders so that they could be leading people at a higher level. And then when they do act agentic, they’re given the feedback that they’re “too bossy, or, too arrogant, or too much,” or whatever the feedback is, and that they’re “not a good fit for our culture.” The implication of this is that women like yourself, whether physicians or leaders in any other sector are coming in every day, giving 150% of their effort to try to serve patients and clients and move the good work forward.

Sharon:

Then they have a whole extra layer of energy and drained focus, which is that scrutiny. Like, “Am I enough of this? Am I too much of that? How is this going to be perceived? Should I say it? Should I not? What’s really authentic to me? Can I really show up that way?” And I call this the swirl.

Eva Balint:

Yes.

Sharon:

… this is all that…

Eva Balint:

[crosstalk 00:19:09]

Sharon:

… in return, and I think… Actually, look, it’s universal these days that we all are kind of up to here. We all have too much to do. But I think it’s really the emotional exhaustion that leads to burnout. I think it really comes from this inner swirl that you were saying. Here we are, and we’re asking you to be making life and death decisions as women physicians to be treating us. The most important thing to us is on the line when we come to you and ask for your advisement, and you have to be thinking about these things in the background? Really?

Eva Balint:

Yes.

Sharon:

So, just to give some perspective and context to this. Also, I want to thank you, Dr. Balint, for being a woman who raises other women and sends down the ladder and brings up women. We had a chance to meet after I gave that talk at the World Business & Executive Coaching Summit. It was on this topic of working all-female. Loved that you reached out and we had a chance to connect. I could hear what an amazing change agent you are, and you shared some things with me about, it’s isolating, and that if there’s one woman at the top, just like you were saying, that she might be what we call the queen bee. So, let me hear from you about your observations, your experience, and I loved your antidote for it.

Eva Balint:

Thank you. I think it’s deeply rooted in patriarchy that women, we fight for the token position, and it has been like that for generations, I would say. I think this is the biggest shift that we can bring to start supporting each other. A very big change that happened to my life was a few months ago when I joined Chief. It was amazing to be in the company of other women, not all in health care, but other women who just support each other. They give advice, they are available for consult. It really made me think about a world where we could do this. Regardless of this role and regardless of the internalized expectations, if we would just support each other, I’m thinking that we… I often feel that we are the enforcers of patriarchy, women. Because-

Sharon:

Okay, slow this down, because this is going to be good, I think. People are going to be very interested in what you have to say here. Say more about this.

Eva Balint:

I feel that women have the power to raise children in any way they please, but the way children are raised, they are, with the best intention, they’re raised to fit in. I’m thinking of the next generation that they see, and I’m thinking of my nieces and nephews. I don’t have children on my own, which is also a huge other topic of having it all and the pressure to have children. But I don’t want to digress. I feel that some experiences, when women silence other women, like someone trolled me a few months ago, and it was shocking that it was another woman. Like, “Hey, we don’t need to fight here. There’s so much to fight. We don’t need to fight each other.”

Eva Balint:

And so many times I’m thinking of that double bind where we are not assertive, or too assertive. I got feedback from women that when I was too assertive, I made them feel uncomfortable. And, yes, we make each other feel uncomfortable because when we speak up, we challenge each other’s internalized assumptions of, we should stay quiet, we should be just in the corner, we should observe. When we see other women speak up, we either get drawn to and follow, or we just get very scared. I think this is the internal work that we all need to do in order to support each other. It’s really challenging all the assumptions. Some of these are unexamined truths that we take on as we internalize a lot of the expectations about gender roles. So I feel that this is the biggest revolution. If we women start to support each other, pull each other up, there is no patriarchy that can hold us back at that point.

Sharon:

Boom. That’s absolutely really inspiring. How have you done that? How have you examined your own assumptions? Even before you became a part of Chief, which I can hear has really expanded your sense of feeling supported, how did you make a policy before that? How did you examine some of these internalized expectations and negative messages?

Eva Balint:

I remember it was part of the personal work that I started several years ago. I participated in a workshop for women which was really gearing towards that. I remember sitting in a room with other women and first really nothing came, but then somebody started to share the expectations to be pretty, and what pretty means, like the only body type that is fashionable or that is expected. One after the other, things came up. Like in high school I heard this a lot, that you can be pretty but not smart, because…

Eva Balint:

And it was something that we sort of took in, but a lot of these type of things started to come up. And then I started to see it on billboards. I mean, recently I saw an advertisement, Louis Vuitton bags, and it’s a woman in the bed between sheets. Like, you really need to advertise bags that way? The everyday sexism that is always in our face. So it was a long and painful process, but once you start see it, you cannot ever unsee it. So it’s really everywhere.

Sharon:

That’s absolutely right, and I love that you’re fomenting revolution of the kind of women supporting one another to not believe these things about ourselves and to support one another. Sign me up for that, a sisterhood of revolution. Talk to me about health care systems and what is it like to be a doctor? A woman doctor? What’s it like to work in a health care system? You have an insider perspective, what do you observe?

Eva Balint:

In my current role, I am on the administration side, which is especially working for a health plan, even though it is a public health plan for Medi-Cal. For a lot of doctors to be on the health plan side is to be on the dark side. Health plans, I mean, they don’t always do the right thing, for sure, but I also feel that there’s a lot of good things that health plans can do. So when I talk about my role to doctors who practice, there’s always a power dynamic that, “Hmm, you don’t know what’s happening because you’re on the other side.” I feel that we are all in the same boat, and one of my dreams is to include how the health care system works in medical education, because that’s a conflict right away, and it doesn’t need to be.

Eva Balint:

If we all understand how the system works and what are the dysfunctions and how we can work together to dismantle it, it would really bring us… We could really walk hand-in-hand and make a change. But we currently waste time of pulling rank. Like, “You see patients and I don’t,” and, “You don’t know this.” I think it goes down, again, to culture change. The female part of it is, there is a hierarchy, and female doctors, we come after the male doctors. I was called a nurse more time than I care to count. The assumption is that the doctor is as a man and it’s slowly changing. Even in surgical specialties there are more and more women, but it’s going to take time. It’s going to take time before we get to a point that it’s not automatically assumed that the woman is the nurse.

Sharon:

Yeah. I’m sorry that you’ve faced that oversight of your true experience. Where do women physicians have power in a hospital, a health care system, a medical practice, a health plan? Where do women have power?

Eva Balint:

I think women, a physician, have more power than they realize.

Sharon:

I wholly agree with that. My next book is on that. Talk to me.

Eva Balint:

Oh, I can’t wait to read your next book. I have to share that in order to be successful in the current system, women absolutely must learn how to inspire and how to flex the leadership style, and not just lead from the position of power, but really bring in inspiration and not just to push, but a pull of others. I feel that in the current environment, a lot of men can just sit in and lead from their position of power and they don’t have to learn all these extra skills. So women… And then this whole other thing of raising the next generation, motherhood, which is the multitasking, the taking a lot on in the household.

Eva Balint:

Those are skills that are currently not recognized, but these are skills that really, I believe, they are superpowers, because women can… We are constantly working under pressure, even if we don’t realize. So to stay calm under pressure, to multitask, it is something that just comes with the territory. I feel that women have a lot of power in that. They don’t realize, and society tells us to be quiet and to make ourselves small, but it doesn’t have to be that way.

Sharon:

Absolutely right. Could you give us an example of how you’ve been a change agent? Maybe how you’ve been successful at making some kind of a change in the culture or the practice of any of the organizations that you’ve been in, because clearly you stand for this and have studied how to have influence.

Eva Balint:

I mean, I feel that I could talk about the times when we started a small… Not an experiment, but a pilot study that changed how patients received care. So what I’m talking about is in a previous position, we started a small pilot in acupuncture for pain management, and then for successful, it became a benefit for our health plan. Then, later it became a benefit for Medi-Cal in California. So it is something that we created this possibility for our patients. But I feel that the biggest wins are when I can support other women. I’m thinking of someone that I’ve been talking with the mentoring, a very challenging environment, and that just a few days ago she told me that she feels that she found her footing at the eye of the storm.

Eva Balint:

This took a few months, but this is a woman who found her way, who found her power. I feel that it’s little by little, one by one, but we can elevate each other, and I know that she is going to be one day a powerful leader. She already is, but she’s going to increase her sphere of influence because she was able to find her footing and she’s able to stand up. She was telling me that, “Dr. Balint, you’ve been telling me this all along, but now I know what you mean.” I feel those are the real victories, that elevating each other and helping each other really become our own and our own authentic selves. I feel that that’s the best. I was so excited when I heard that.

Sharon:

We can feel the joy and the delight and how reenergizing it is for you, right? And the renewable energy that you feel when you raise other women. That’s really a universal that I’ve experienced in coaching so many women leaders. This example of the woman that you mentored, it’s like every woman in her power is a change agent, right? Simply by being who she is, you know what I mean, and the way that she shows up or the things that she asks for, or what she advocates for and successfully influences, she creates that ripple. Every woman, no matter whether you’re the head of the health care system, you’re a doctor in it, you’re a nurse, you’re a patient, you’re an administrative person in the system, from right where you are now, that being in your power has a reverberative effect on the people around you.

Sharon:

When you do that, you get that glow and that being lit up in the way that you just did, and you impact the people around you. And just like you were saying, whether it’s a mother or someone who’s in a position to be mentoring or caregiving the next generation, that moral authority, that inspiration to help people see how it could be, what the culture could be like, all of these are just the beginning of a long list of a way that any woman, every woman, no matter where you are, right here, right now, in your life circumstances, to be in your power and to be that change agent.

Eva Balint:

Yes.

Sharon:

So, let me ask you then, just by way of closing, what is your vision of the health care system? Or this whole new idea about how health plans could be educating medical students and it all could be integrated, instead of at war with one another, which every person in their own health care journey experiences, like, “Dr. Balint, you have a solution. Please tell us what it is.”

Eva Balint:

I feel that the most fundamental shift that needs to happen is empowering patients. I talked about that very name of patient and how patients are at the very bottom of the hierarchy, that the current system is very doctor-centric. From the scheduling to everything is to improve the efficiency of doctors, and I think that’s important, but I think it’s overdone, and it’s overdone at the expense of patients. So I feel that the biggest shift that needs to happen is to level the playing field because we have this gigantic power differential. Informed consent, for example, when the doctors sit down with the patient and discusses the next step, it is very challenging to really do it in a truly co-creative way because of the immense power differential.

Eva Balint:

So, if we were to change that, I think we would improve health care outcomes and we would be able to truly be in partnership with the patients. I know it sounds Pollyannaish, but I feel that it needs to happen. Again, a Pollyannaish thought, but I’m standing for it, it is that if you think of health care, care is such a big part of it. If we care, we really care for each other. It brings in all the soft skills we talked about, the love, the caring, the nurturing. If you think about a very hierarchical top-down system that we currently operate, it just makes it very, very difficult or almost impossible to do.

Eva Balint:

So I feel that that that type of revolution is ripe. I don’t think that patients will march on the street and demand to be treated equally, but I think it needs to happen. And I think that doctors are in a very unique position to advocate for patients, and we need to examine our status and whether the current power that is given is really helping or hindering us. In some situations it’s important, but I feel that we need to come down from our pedestal and we need to walk together with the patients.

Sharon:

I am so excited to see that TED talk come to life. Will that come to life in a TED talk? Judging from just the one example that you gave from starting a pilot with acupuncture to getting that formalized into a policy and a benefit, I hope that that is only one of the very beginning ways that you are able to create change and make an impact on our systems. I look forward to seeing you testifying in Congress, being a change agent at your current and many future health care organizations, teaching in medical schools. You are thoughtful, you are wise, you are a visionary, and it’s been such a delight for you to share your contagion of joy and inspiration on the Power Shift podcast. Thank you, Dr. Eva Balint.

Eva Balint:

Thank you, Sharon. It was a pleasure to talk with you. Thank you.