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Home Again in California, Physician Focuses on Care of the Caretakers

Avram Goldstein, Senior Engagement Officer
Avram Goldstein
Avram Goldstein

Last spring, obstetrician Carolina Reyes joined the California Health Care Foundation board of directors. Reyes is recognized nationwide for her career-long efforts to improve the care of women with high-risk pregnancies — especially those in medically underserved communities. The goal, she says, is to use available knowledge to ease persistent racial and ethnic health care disparities and to recognize that unequal treatment resulting in increased morbidity and mortality is unjust. Reyes has advocated for increasing the proportion of minorities in the health professions, adopting evidence-based team care models, and measuring racial and ethnic disparities as part of overall performance. She emphasizes the powerful influence that physician communication with patients has on health outcomes.

Carolina Reyes, MD

Reyes served on the Institute of Medicine's Committee (now the National Academy of Medicine) on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, which published a groundbreaking report on the subject in 2002. She is a former vice president for evaluation and planning at The California Endowment. She was executive director of the Healthy Births Initiative and coordinated the LA Best Babies Network for high-risk patients in Los Angeles County. Reyes serves on the boards of the Catholic Health Association of the United States and Providence St. Joseph Health. After graduating from Stanford and Harvard Medical School, she completed her ob/gyn residency and maternal-fetal medicine fellowship at the University of Southern California Keck School of Medicine.

Seven years ago, Reyes moved to the nation's capital so her family would spend less time apart from her husband, Xavier Becerra, a top Democrat in the US House who represented Downtown Los Angeles for 24 years. The couple returned to California in 2017 when Governor Jerry Brown named Becerra to succeed Attorney General Kamala Harris following her election to the US Senate. Reyes and Becerra live in the Sacramento area, where Becerra was raised. The transcript of this interview has been condensed and lightly edited for clarity.

Q: Why did you choose to specialize in maternal-fetal medicine?

A: I wanted to contribute to improvements in health and in society. My parents were migrant farmworkers, and I was the sixth of their eight children. I come from the San Joaquin Valley, an area that was and is quite underserved. When I was born, we were living in Fresno. As a child, the effects of inadequate access to health care were painfully obvious to me. I remember that I didn't see physicians who looked like me. It made me want to work with people who were disenfranchised.

Patients can be very intimidated when discussing things with physicians and may not understand all the implications of major, life-altering decisions. Maternal-fetal medicine appealed to me because women tend to be the central caretakers in their families, and I realized I could help them understand ways to improve the lives and health behaviors of their whole family.

I was also profoundly influenced by the struggle within my own family when my mother was confronted with some challenging health care decisionmaking. My mom raised eight children, and she felt that her role in life was to help God raise children and to have as many children as God allowed her to. She had many pregnancy losses, including a newborn loss. Contraception violated her deeply held religious beliefs as a Catholic. Her doctor was counseling her about whether she should take on the added health risks of having more than eight children. He recommended that she consider a tubal ligation to prevent pregnancy. She agonized over what to do. Ultimately, she chose to have the tubal ligation because she wanted to be there for her children, but her struggle over that decision has stayed with her ever since — and now she is 94 years old.

My mother's struggle with her conscience over this decision was a formative experience for me as a physician, and I wanted to help women deal with those kinds of conflicts and choose the health care they wanted. It is critically important to me to be accessible and available to listen to their experiences and to provide valuable medical information. My hope was to be a physician who wouldn't say, "You need to do this," and instead be a physician who would listen to them, respect their beliefs, and help them make their own decisions.

My mother has always been proud that I went into obstetrics and that I care for women at momentous times like pregnancy and childbirth. I don't think she and I ever spoke much about the challenges she had over contraception or related that experience to my choice of specialty, but over the years I realized just how much that episode really stuck with me as an important experience.

Q: Are you practicing medicine in California?

A: I recently became regional medical director for maternal-fetal medicine for the Dignity Health hospitals in greater Sacramento. I am based at Mercy San Juan Medical Center in Carmichael, and I focus on high-risk obstetrics. Our practice cares for high-risk labor and delivery patients referred from seven area Dignity hospitals that deliver 6,000 babies a year in all. I oversee maternal health policies, protocols, and quality improvement efforts in care provided by both physicians and midwives. We look at outcomes and try to identify possible improvements in obstetrical care.

Q: How is your transition to California going?

A: This was the easiest move I ever made. I am elated to be back in California — not only because family lives here, but because California has always been a leader of collaborative efforts to improve health care. I missed those partnerships, such as the collaborative that brought together the California Department of Public Health and the California Maternal Quality Care Collaborative (CMQCC). I'm very excited to be back in a place with that collective leadership. I lived in Sacramento once before during a short internship with the Office of Statewide Health Planning and Development (OSHPD). Sacramento feels like home. To me, it's not very far flung from Fresno, and I visit my family there quite a bit. Now my husband travels throughout the state instead of back and forth across the country. It's wonderful for us both to be in one time zone.

Q: How do Washingtonians perceive California?

A: California is definitely different. Some of that is because of the sheer scale of this state. One in eight US births are in California, and that drives some of our public health as well as medical initiatives. But while it's one thing to have scale, it's quite another to have leadership that brings people together, and California has that. In many fields, California is known as a dynamic leader. Constant change is the norm in the California culture — a culture that isn't mired in tradition. The western culture accepts change. People who were drawn to the Wild West were willing to take risks because of the prospect of a greater good. And because it has the world's sixth largest economy, California speaks with a stronger voice in our national politics.

California is unique as we look at federal issues like immigration. We have one-quarter of the nation's Dreamers [undocumented young adults who were brought to the US as children], and that drives California policies regarding immigration. Many look to California for leadership. By necessity, California embraces change and its multicultural communities, which is important because the state is a strong indicator of what's to come in other states. Whether rural or urban, we have all the issues of other states — just on a different scale.

Q: Why did you decide to join CHCF's board?

A: I've watched CHCF evolve over my professional career and have always been impressed by its commitment to improving access to care, especially for the underserved. I love that the foundation has invested in development of physician leaders through the Clinical Leaders Training Program. Health care has an impact on the lives of all Californians. As our state moves to expand access to health care, it's important for providers to be a voice for improving the system. As a clinician, I see that CHCF plays an important role in laying that foundation for change.

A beautiful example is the investment in maternal health with the collection of important data through the CMQCC network. It's great to see CHCF help develop a maternal database and maternal quality improvement infrastructure. Now that I'm back in California, I see that there has been tremendous growth, with over 200 hospitals involved in CMQCC's efforts to improve quality and reduce maternal mortality on a large scale.

Q: The delivery of health care is changing at a dizzying pace. How should we change the way we train doctors for the challenges this creates?

A: The newest generation of docs was raised in an environment where change is the norm. Unfortunately, we haven't introduced that comfort with change within our medical education system. We need to improve doctors' training so they become better listeners with their patients. In terms of the curriculum, doctors lack experience in the business of medicine. We train excellent clinicians, but that happens in a silo. Physicians need to learn about the challenges of a business practice — whether they practice in an academic setting or in the community. Doctors also need to understand more about the health care delivery team and how physicians fit into it. We need to give our young physicians that perspective instead of forcing them to learn about it on the job or by default.

About Avram

Avram Goldstein is a senior engagement officer at CHCF, where he is the editor of the CHCF blog and supports the work of CHCF's State Health Policy Office.

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