In this episode, Raj and Max talk with Dr. Denise Jamieson, the vice president for medical affairs and dean of the Carver College of Medicine at the University of Iowa. They discuss health care leadership, collaboration, and the intersection of clinical medicine and public health.

The views and opinions expressed in this podcast are solely those of the students, hosts, guests, and contributors. They do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health.

Lauren Lavin:

Hey, everyone. Welcome back to Plugged in to Public Health. Today we have the privilege of speaking with Dr. Denise Jamieson, a distinguished figure in medicine and public health. Dr. Jamieson serves as the Vice President for Medical Affairs and the Tyrone D. Arts, Dean of the Carver College of Medicine at the University of Iowa. This position she has held since August 1st, 2023. Prior to joining the University of Iowa, she chaired the Department of Gynecology and Obstetrics at Emory University School of Medicine, and was the chief of Gynecology and obstetrics for Emory Healthcare. Her extensive career includes two decades at the Centers for Disease Control and Prevention where she led critical responses to public health emergencies such as the Zika virus outbreak.

Dr. Jamieson’s research focuses on emerging infectious diseases in pregnancy, including influenza, Ebola, Zika, and COVID-19, as well as maternal immunization. She is also dedicated to addressing health disparities in social determinants of health affecting maternal morbidity and adverse pregnancy outcomes. Join us as we explore her journey, leadership experiences, and the vision for the future of healthcare at the University of Iowa. Plugged in to Public Health is produced and edited by students of the University of Iowa College of Public Health. And the views and opinions expressed in this podcast are solely those of the students, hosts, guests, and contributors. They do not necessarily reflect the views or opinions of the University of Iowa or the College of Public Health. Now let’s get Plugged in to Public Health with Max, Raj, and Dr. Denise Jamieson.

Max Hansen:

Thank you very much, Dr. Jamieson, for taking the time to talk with us today. We’re super excited to have a nice discussion about the work that you’ve been doing over the past couple of years with the College of Medicine. We have a couple questions to start off just about your career and the leadership positions that you’ve been in, as well as the current one that you are in right now. When you took on the role of vice president for medical affairs and Dean of the Carver College of Medicine in August 2023, what has been your vision for UI Health Care in your first few years?

Denise Jamieson:

So we are really grounded on our mission, which is to serve 3.2 million Iowans. It was one of the things that really attracted me to coming to the University of Iowa and one of the things that I really think grounds our work. And by serving I don’t mean that we provide clinical care for everyone in the state, but we partner with other health systems and other hospitals and other clinics to help support clinical care in the state. And then in addition to clinical care, we also help serve Iowans in two other missions. One is education. We have the opportunity to really train and educate the next generation of health professionals. And we do that in a variety of ways, medical students, PA students, physicians, physical therapists, radiation technologists, perfusionists, nurses. And so we take that responsibility very seriously. And then the third area, after clinical care and education training, is research. We really have the opportunity to conduct cutting edge research that benefits Iowans and benefits larger communities.

Max Hansen:

Thank you very much. That’s a very comprehensive answer. I really appreciate it. Moving forwards, I guess your career throughout your life, it’s spanned across multiple industries including clinical medicine, public health, academic leadership even, and government service. How would you say that these experiences have shaped your approach to leading UI health care? Particularly, how does it set you apart from those others?

Denise Jamieson:

Well, I think I’ve not had a linear typical career path. I think I’ve had a large variety of opportunities to serve in diverse settings, and I’ve learned something at each one of those institutions that I’ve worked with. So for example, when I was at the Centers for Disease Control and Prevention, or CDC, I learned a tremendous amount about leadership and I was involved in a lot of large, complex emergency responses. And what I learned from those is how to build teams quickly and really how to create a vision and a mission quickly for the work that needed to be done and then try to inspire people to get on board and join the response. And I like to often say that it was really fun leading emergency responses like Zika because at times people would rise to the occasion under very stressful circumstances and really do the best work of their career. And I enjoyed leading in that environment.

Max Hansen:

I often hear public health professionals always have not a very linear story to their final destination. So I guess it’s, once again, very consoling to hear that testament once again. I also love to hear the stories about workers rising up and taking action in moments that they were needed most. I feel like that’s almost a cornerstone to the work that public health professionals do. Moving on, you mentioned your work with the CDC. What lessons from your time at the CDC and Emory have been most valuable to you in your current leadership role, would you say?

Denise Jamieson:

Wow, that’s a hard question to distill that, I feel like I learned so much at CDC and at Emory. I think one of the things that I learned at the CDC was the importance of really clear communications as a leader. You almost can’t over communicate. You need to say it multiple times in multiple ways to multiple different audiences to ensure that everyone is aligned. And one of the things that happens during a complex emergency response like Zika is we started out the outbreak and Zika was a mild disease. It’s been around for a long time. We had surveillance systems set up to track it. And had no idea that there was a link between infection with Zika in pregnancy and devastating birth defects. And so first we had to figure out the science and confirm that actually Zika infection in pregnancy could lead to this very specific pattern of devastating birth defects. And then we had to figure out guidance for what to tell people about it.

If you’re pregnant and living in Maryland, is it safe to take a cruise to an area that has Zika? If you’re pregnant or you want to get pregnant and you’re living in Puerto Rico, what should we be saying in terms of guidance? And then the science keeps changing rapidly as we learn more and more. At the beginning of the outbreak of Zika that swept through large regions of the US territories in particular, we didn’t know how to test for Zika. We didn’t know what the testing meant. And so the science is developing at the same time you’re trying to give people good guidance. And one of the really important things that I learned is to be very clear, this is what we know today. Based on what we know today, this is what we’re recommending. We anticipate that things will change and we will let you know. We will get back in touch with you and let you know when the science changes.

And then the next time you speak to the American public, you say, this is what we’ve learned in the interim. This is how it changes our guidance. This is the best that we know today, but things are changing. And then the other thing that was key was we kept a published record. So we didn’t just update websites that disappear. We kept a written published record through the MMWR, which is the weekly publication from the CDC. And we had a box at the very top of every guidance document that said what had changed and why, so that people could understand why these changes were occurring. And I think what happened during COVID was changes would occur, one day you don’t need to wear a mask, one day you should consider wearing a mask. And no one understood how the science and the guidance was aligning. And people got very confused and people started distrusting the science. And so that to me is a perfect example of regardless of what organization you’re trying to lead, you have to communicate really clearly.

Raj Daliboyina:

That is quite fascinating to say. Because especially your work with both public health and clinical investigation, my background as a physician in India and my work through COVID, and now I’ve taken MPH. So I am quite fascinated by the fact that you’re focused mostly on emerging infectious diseases in pregnancies, which including Zika, Ebola, and COVID. So I would like to know how has that shaped your perspective on the intersection of public health and clinical medicine?

Denise Jamieson:

I had the great opportunity, while I spent 20 years in the US Public Health Service working primarily at the CDC on, as you said, emerging infectious diseases, at the same time I was also practicing clinical medicine. So I’m an obstetrician gynecologist by training. So I was working in a large busy public hospital delivering babies. And so for me, that intersection was really productive because I would help write and formulate guidance on, for example, during the 2009 H1N1 influenza pandemic. I was helping to look at the surveillance data and help write the federal guidance, at the same time I was taking care of infected pregnant women at the hospital. And so it was this back and forth between looking at the data to formulate the guidance and then seeing how the guidance was implemented in a real world clinical setting and getting feedback.

There was one time when I was in a cesarean delivery and we were working on the guidance for treatment of influenza in pregnant women. I was had a mask on and nobody knew who I was, and then the pediatric team was around the baby bed waiting for the baby to be born. And I overheard a conversation amongst the neonatology team talking about how ridiculous the CDC guidance was, about how the people who wrote that guidance probably know nothing about clinical medicine. And it was really good, humbling insight into what sometimes is a disconnect between public health and the practice of clinical medicine. And I really loved being at that intersection of clinical medicine and public health for most of my career.

Raj Daliboyina:

That’s fascinating because that’s how I felt when I was doing COVID and I decided to take MPH too. Especially in a nation like India with its population, we have a lot of things to do in public health too. And following up with that, as you mentioned in your service as physician, you must have seen a lot of health disparities and social determinants of health, and I also believe that they were central to your research. So what steps is UI Health Care taking to address those challenges in Iowa?

Denise Jamieson:

Yeah, I’ll use one example. So my work when I was in Atlanta really focused on maternal mortality and trying to get at disparities in maternal health in Georgia. And I see some of the same issues here in Iowa. So we do have a maternal health crisis here in Iowa. We do not have enough obstetric providers. We have rural hospitals that are closing. Hospitals that are closing their labor and delivery units. And our maternal mortality rate is unacceptably high. And so at UI Health Care, we’re really trying to think broadly, not just about the care that we deliver at UI Health Care but broadly across the state, how to better support maternal health. And we do that in a variety of ways.

We do that by supporting other rural hospitals. So we have a program called Community Connect whereby we provide electronic medical record support, epic support, to community hospitals. We also have a program whereby those hospital CEOs meet regularly with us to talk about ways to partner and better support each other on a variety of issues including but not limited to maternal health. And then we have specific maternal health programs that are trying to support the efforts of rural hospitals. For example, we have a simulation program whereby OBS and anesthesiologists go out to rural hospitals with mannequins and do training on obstetric emergencies in rural settings. And all of that is a way to try and reduce the disparities of pregnant women who don’t have access to local obstetric care, or limited opportunities for care in rural settings, and the opportunities for women in the Iowa City area who can deliver at the downtown campus or deliver at our university campus. And so trying to address those rural disparities in health has really become a focus of what we’re trying to do at UI Health Care here.

Max Hansen:

It sounds like there’s a lot of moving parts going on with this system. I’m sure that it’s-

Raj Daliboyina:

Especially these days.

Max Hansen:

… safe to assume that, I’m sure. But I mean, it’s clear that you oversee an integrated health system that includes hospitals, a medical school, and a physician practice group. What are your key priorities in leading such a complex organization?

Denise Jamieson:

So we are really focused on efficient system of care. So we’ve gone from being a one hospital system, this main campus university campus hospital. Then a year ago we acquired the former Mercy, now our downtown campus. And in April we’re going to open North Liberty. And so one of the things that’s really important is that we have an integrated system of care so that patients are getting the right care at the right place. So for example, when North Liberty opens, we’ll have three emergency departments in our system in the Iowa City area. So it’s really important to coordinate care so that if you have a broken leg, you get to the North Liberty campus. If you have the flu and you need IV fluids and antivirals, you get to the downtown campus. And if you’re in a catastrophic car accident, you get to the university campus which has the highest level of trauma care.

So trying to ensure that patients get to the right place for the right care is a very high priority. Another high priority is addressing our access issues. If you’ve tried to make an appointment at UI Health Care, you probably know that there can be very long waiting times. Those are unacceptable. In addition, every year between 3,000 and 6,000 patients are referred to us for inpatient care and we can’t accept them. That’s unacceptable. We really need to figure out how to increase access. That means hiring more physicians. That means hiring more health professionals, more nurses, more perfusionists, more physical therapists, more physician assistants. I mean, we are short in almost every area and we need to fix that and focus on workforce issues, both recruiting new people and retaining those who we have, so that we can improve access in the state.

Max Hansen:

I think to kind of switch gears a little bit, I just want to ask how do you see Iowa’s only allopathic medical school evolving to prepare future healthcare providers for the challenges ahead?

Denise Jamieson:

So medical school education is certainly evolving since I was in medical school. It’s much more hands-on, it’s much more integrated. Our medical students get exposed to patients and clinical care much earlier in the process than I did. There’s much more focus on simulation. And in fact, we have a great simulated patient program where our patient volunteers come and really help teach the medical students and give them feedback so that the first time they help take care of a patient they’ve had experience getting a history, doing a physical exam, and they are much better prepared for their role in the clinical setting. So I think the other thing that we’re doing is students have much more exposure to more topics than they did, things like artificial intelligence and really robust ethics. There are a lot more elements to medical student education than when I was in school.

Raj Daliboyina:

And do you think that’s for the better?

Denise Jamieson:

Oh, absolutely, yes. Yes. I would say the other piece you didn’t ask about, but the other piece is training. After you graduate from medical school, you generally enter the residency match, which is a nationwide program that matches graduating medical students with residency programs. And the process of residency training has really evolved. When I was training, we had very, very long grueling work weeks. We were working over 100 hours a week, every third night we were on call and did a 36-hour shift. And that was not good for physician wellness. And I think our focus on well-being and resilience has drastically improved our training and educational experiences. And it’s much less punitive too. I think there’s much more support for trainees and it’s a more supportive environment than when I trained. And so I think many of the changes in medical education have been really, really strong. I think the other thing about medical school education is there’s much more structured, helpful, in the moment feedback than there was previously. We have apps and other things that we use to give students real-time feedback on how they’re doing so that they can improve.

Raj Daliboyina:

And do you think that the new focus of research being integrated into med schools is also a good thing?

Denise Jamieson:

I think it’s really important to integrate research into medical student education because so much of what I learned in medical school is now completely outdated. So when I think about the field, for example, of immunology, almost everything I learned is now known not to be true. Science evolves. And I think in order to be a physician now, you really have to know how to read and critically evaluate the scientific literature. And the best way to do that is to have some involvement in research, that you understand the process and understand how it works and understand how to critically evaluate it for when you’re in practice.

Max Hansen:

Yeah. I really think that’s a very great point to bring up because I often hear of general practitioners who spend their entire lifetime in practice and then once they are out of their education, they stop learning. And I can’t really imagine any professor or any mentor in their life that has made that seem like a good perspective to take on their practice. But regardless… Moving forwards, we’d like to ask a quick question about the COVID-19 pandemic. The COVID-19 pandemic accelerated changes in healthcare delivery. And we were just wondering what lessons from the pandemic should health systems like UI Health Care carry forwards into the future?

Denise Jamieson:

Wow, that’s a hard question. There was so much that happened so fast during COVID. So at the time I was the chair of Obstetrics and Gynecology at Emory. I was responsible for staffing nine different hospitals in four health systems. And so we had to move really quickly. And as you can imagine, there isn’t as much elective stuff that you can cancel because women get pregnant and the babies have to be delivered. They don’t wait until the pandemic’s over. We could not scale back clinical care. We had to keep going. And there was a lot of fear early on. People were really, really, I was afraid. We didn’t know much about the virus. We didn’t know the effects it would have. We were seeing a lot of sick and dying people in the Atlanta Metro area. People were concerned about their families and bringing COVID home. It was before the vaccine. It was before we understood much about the virus.

And so one thing that I learned is it reinforced my belief that communication is really important. And so I spent a lot of time, every week I would have a one-half hour discussion with the department about, by Zoom, what was going on, what we knew, what we didn’t know, and what the plans were for the coming week. Another thing that I learned is it was really important to communicate calm and to reemphasize every opportunity I got that I know you’re scared, I know these are really hard times. The work that you’re doing is important and the work that you’re doing has to continue. We’re all in this together. I think the other thing that I learned during COVID was how fragile public health and the role of public health is.

I never thought in my lifetime that there would be increased skepticism about vaccines. We always said vaccines are one of the greatest ever public health accomplishments. Vaccine preventable illnesses have decreased over time due to vaccines. And the fact that there’s increasing distrust of the science behind vaccines and decreasing vaccination rates was really a surprise. And so I think it just reinforces, as public health professionals, that we really need to focus on communicating the science clearly and addressing public concerns.

Max Hansen:

I often feel like that happens as a result of us being siloed into our interests very quickly, especially at the foundation of our careers in school. So I’m curious if you believe that your background in clinical medicine was actually a piece of your background that’s made you a better communicator?

Denise Jamieson:

I think so. I think we all could be better communicators. But I do think that intersection between clinical medicine and public health is a helpful place to live because you need to address physician concerns, you need to address patient concerns, but you need the public health science to be able to say this is the science behind vaccines, for example.

Raj Daliboyina:

Picking up from all the troubled times we are in, doing a 180. I would like to ask what excites you about the future of UI Health Care and academic medicine in particular?

Denise Jamieson:

Oh, I’m really excited about academic medicine and public health. I think there are a lot of bright opportunities for you and the next generation to have a huge impact in terms of both public health and clinical medicine in Iowa and beyond. I’ve had a great career so far. I’ve gotten to do a lot of really interesting work in a lot of different places in the world. And public health and clinical medicine are both such great places to have impact and to feel like the work that you’re doing means something. And so I’m excited about UI Health Care expanding our reach and expanding our ability to care for the patients who want to come to us as patients and helping to support care and health across the state.

Raj Daliboyina:

That’s really nice to hear that from you because the more I interact with med students at this point of time, I sense a lot of apprehension in them and a lot of fear as such about the field they’re getting into and how things are going to be, the serious skepticism the whole scientific community faces in today’s time. And in light of that, I would like to know what advice would you give to the students and young professionals who aspire to leadership roles in healthcare?

Denise Jamieson:

So I would say follow your heart. Do what you love and the rest will fall into place. I know that people are feeling discouraged in healthcare and in public health for a variety of reasons, but don’t let this crisis define you. In my role I’m committed to not letting the crisis define who we are at UI Health Care. And we need to continue our mission. And there’s so much important work to do here in Iowa. And find what excites you, find what your passion is, and then find a way to contribute. But there’s lots of good stuff ahead.

Max Hansen:

Thank you. Thank you very much, Dr. Jamieson, for the time today. We really appreciate it.

Raj Daliboyina:

It was a great talk.

Denise Jamieson:

Great, thanks. Thanks for having me.

Lauren Lavin:

What an interesting conversation with Dr. Denise Jamieson. From her experiences leading during public health crises to her commitment to advancing maternal health and addressing health disparities, this discussion highlighted so many key takeaways. One of the biggest lessons I learned, effective health care leadership requires both clinical expertise and a deep understanding of public health. Dr. Jamieson’s work reminds us that tackling emerging infectious diseases isn’t just about treatment, it’s also about preparedness, research, and policy. I also really liked hearing about her dedication to improving medical education and supporting the next generation of healthcare professionals.

Her career is a testament to how leadership in medicine isn’t just about decision making, but it’s about collaboration and commitment to patient-centered care. I hope you found this conversation as inspiring as I did. So that’s it for our episode this week. Again, thank you to Dr. Jamieson for joining us today. This episode was hosted and written by Raj and Max, and edited and produced by Lauren Lavin. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at cph-gradambassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.