Every physician I know constantly has great ideas about how to improve patient care. But owing to their busy lives and the friction inherent in healthcare, many of these great ideas idle as… great ideas. So I was curious…what does it take to be a changemaker as a practicing physician? How do you overcome institutional inertia? And what lessons can all of us take from these leaders?
Enter Dr. Laurie Green. As a clinician, she’s an OB-GYN who founded San Francisco’s second all-women OB-GYN group in the 1980s. As an innovator, she founded the MAVEN Project, which aims to provide subspecialty care to underserved communities. And as a public servant, she serves on the SF Health Commission as Commissioner Green with a book of business ranging from food insecurity to traffic deaths to communicable disease.
As I sat down with Dr. Green, I was struck by her thoughtfulness and the breadth of her experiences. It’s not every day that you encounter someone who seamlessly blends the roles of clinician, educator, mentor, and public health advocate. Her story is as much about the evolution of medicine over the last 40 years as it is a testament to the passion and grit required to make a difference at scale.
A passion for science
Dr. Green’s fascination with science and society began early. She had no immediate family members in medicine. Certainly, there were no women physicians she could remember. But she knew that she “wanted to take care of people….it was such an immature but nascent sense that I had.” She recounted her time as a fifth grader attending UCLA science classes - a program that had been designed to study whether children could learn advanced topics. She told me, “We performed as well as college students,” and with that confidence, she knew she was on a pathway to study medicine.
By the time she was at Harvard, her interests expanded to the history of medicine, culminating in a thesis on Walter B. Cannon, the physiologist who coined the term fight-or-flight response. She was particularly impressed by how Cannon married intuition with the scientific process. For example, in his book The Wisdom of the Body, he posited that the body operates as a finely tuned system designed to maintain equilibrium, or homeostasis, even under stress which at the time was provocative. This concept inspired Dr. Green to always consider the “why” behind the body’s physiological functions, particularly related to women’s health issues. For example, why does libido tend to decline after menopause? From an evolutionary perspective, it makes sense, she explained. “If the tribe’s survival depended on limited resources, you can’t waste energy on individuals that can’t reproduce.” Her research on Cannon inspired her to “question things that don’t pass the sniff test”—a mindset that has served her well in her career.
Breaking Barriers in Obstetric Health
Dr. Green’s professional journey has been defined by trailblazing moments. In the late 1980s, she co-founded Pacific Women’s Health Practice, the second all-women OB-GYN group in San Francisco. At a time when women were underrepresented in medicine, this was a bold move. “It was very scary,” she admitted, recounting how she launched the practice just weeks before giving birth. In fact, she returned to practice full-time 3 weeks after delivering her second baby!
Over the decades, her practice has grown into a beacon of personalized care. Unlike larger institutions, her private practice offers a level of agility and patient-centered decision-making that’s increasingly rare in modern healthcare. “We can be institutionally agnostic,” she explained. “I send my patients wherever they’ll get the best care, whether that’s UCSF, Stanford, or MD Anderson.” This freedom, coupled with her commitment to delivering most of her patients’ babies herself—rather than rotating among a group of physicians—has created a model of care deeply appreciated by her patients.
But make no mistake - running a private practice presents formidable challenges in today’s health care climate. In addition to the administrative burden of managing staff and negotiating with health plans, physicians in private practice assume a level of personal responsibility for patients that differs from hospital employees with institutional cover. As Dr. Green told me, “I have a full office today and I may have to run over and do an unplanned C-section on the 32-week pregnant patient…this would never happen in an employed model.”
To me, Dr. Green’s clinical career in California is remarkable when you consider the giant institutions in her midst, such as UCSF, Stanford and Kaiser. That practices like hers not just survive but flourish reflects the unique value that patients find in her approach. Her success, combined with spikes of physician dissatisfaction lead me to wonder whether private practice models will make a comeback in the coming years(in fact, the rise of digital health companies is a newfangled form of private practice). While the reasons for physician dissatisfaction are myriad and real, one part of the solution has to center around physician engagement, and Dr. Green has certainly hit the bullseye with the MAVEN project.
The MAVEN Project: Transforming Access to Specialty Care
Among Dr. Green’s most impactful initiatives is the MAVEN (Medical Alumni Volunteer Network) Project, a nonprofit she co-founded in 2014 to address one of the healthcare system’s most pressing challenges: access to specialty care. Across the United States, primary care providers in underserved communities often struggle to connect their patients with specialists. The barriers are numerous—from long wait times to geographic limitations to financial constraints—and the consequences are severe, particularly for those managing chronic or complex conditions.
The MAVEN Project bridges this gap by connecting seasoned specialists with frontline providers via telehealth. Volunteers, many of whom are retired physicians, offer expertise across over 60 specialties, from endocrinology to dermatology. “We’re stabilizing the workforce and enabling everyone to practice at the top of their license,” Dr. Green explained. They’ve also impressively scaled, now operating in 26 states and partnering with 400 clinics.
The frontline clinicians love the advice they’re getting from the MAVEN volunteer physicians. So many of their patients arrive at their clinics with advanced diseases like congestive heart failure or severe hypertension. For reasons described above, It’s often practically impossible to get these patients a subspecialist opinion owing to financial or logistical constraints. But with MAVEN, these clinicians can get great subspecialty counsel at the point of service. For the patients, this might be life changing. So many of them are uninsured or underinsured so getting the right answer to their problem when they can come to the doctor’s office is an incredible service. And for the physicians, you can imagine the pride they feel when they are able to help someone so efficiently. That’s the impact we as physicians always hope to have.
MAVEN is not only life-saving for patients but also empowering for frontline providers, as the program also addresses the epidemic of clinician burnout. Its mentoring program pairs less experienced clinicians with seasoned physician volunteers from MAVEN, creating a support network that fosters resilience and skill development. A mentee once described her MAVEN mentor as “the angel on my shoulder,” a testament to the program’s profound impact. The mentors also love it. Serving these patients and assisting their mentee clinicians “makes them feel motivated, and it allows them to continue to share their wisdom” for a population that desperately needs their services. Unfortunately, though, there are limits to what MAVEN can do. Dr. Green highlighted social determinants of health—factors like housing, education, food insecurity, and more—that frontline providers lack the resources to address. Sadly, this is not news as she and others have been warning us about these issues for many years. For the wealthiest nation on Earth, it seems like these are problems we are well-equipped to tackle, if we have the political will to do so.
Navigating the Crisis in Women’s Health
Speaking of the intersection of politics and health, Dr. Green’s work in women’s health has taken on new urgency in the wake of shifting reproductive laws. “Women’s health is in crisis,” she warned. “There isn’t a month that goes by where I don’t see a patient who would have faced a dire outcome in another state,” she shared, visibly moved. “It’s so heartbreaking to see what’s happening to women.” Her high-risk obstetrics practice frequently deals with complications that underscore the life-saving importance of access to comprehensive reproductive care.
Her concerns are echoed by alarming national statistics: nearly one in five women seeking abortions had to travel out of state in 2023, and an abortion ban in Texas was associated with an unexpected increase in infant mortality. Dr. Green fears these policies will not only endanger lives but also drive skilled physicians out of restrictive states; early evidence shows a decrease in OB/GYN residency applications to programs in states with abortion bans. Ultimately, this will result in less provider availability in these states, severely limiting access options for families in need.
“I think a lot of doctors are going to leave these states, whether they're pro-choice or pro-life themselves, because you just can't stand by and balance whether someone's going to become overwhelmingly septic, or whether you're going to end up in jail. And none of those things have been well clarified.”
Driving Change on the San Francisco Health Commission
Dr. Green’s commitment to public health extends beyond her clinical practice and nonprofit work. As a member of the San Francisco Health Commission, she plays a pivotal role in shaping the city’s healthcare landscape. “It’s an incredible privilege,” she said, describing her work overseeing initiatives ranging from substance use disorders to public hospital operations. One of the City’s proudest achievements was the recertification of Laguna Honda Hospital, one of the nation’s largest skilled nursing facilities. “It was a massive undertaking”, she explained, detailing the efforts to meet rigorous federal standards. The hospital’s successful recertification ensured continued care for some of San Francisco’s most vulnerable residents.
A focus of Dr. Green’s commission has been combating the city’s overdose crisis. This has been a vexing issue to solve, given the many complicated issues affecting those who are addicted. For example, 50% of those receiving addiction services are unhoused. Many have mental health disorders and cannot be forced into treatment by law. But by using multiple arms of government, there has been progress. They’ve significantly expanded access to Narcan and deployed street outreach teams to provide life saving care. These were hard-fought gains, made possible by collaboration between public health officials, policymakers, and community organizations. She readily acknowledges that there is much more work to be done but has been impressed with how much her colleagues in government care about solving this problem. For more reading on this, check out this recent SFgov report and SF chronicle article.
To Dr. Green, public service fulfills her goal of scaling her impact on healthcare beyond her clinic. I asked her if she recommended public service to her fellow physicians. ”The Department of Public Health is a wonderful community of people who are all marching in the same direction, very dedicated to the mission of really making San Francisco the healthiest place in the world…It's such a pleasure to deal with people at every level…it has been probably the most fulfilling experience in the last five or six years since I've been on the commission.” She also reflected on why she feels compelled to make an impact:
“Two interviewers at two different medical schools asked me why they should give a spot in medical school to me instead of a man,” she recalled. I mean…that was politically correct back then. But I think I've always felt I had a mandate since I took that spot to be able to have more global impact than just seeing so many people in my office every week.”
Addressing Mistrust and Misinformation
Dr. Green believes that the antidote to the trust deficit plaguing modern medicine is humility. She reminded me that the word “doctor” originates from the Latin word for “teach,” and so its our responsibility to not just diagnose and treat but to also educate. Sadly, we are not doing enough of the latter in medicine. In the social media era, unsubstantiated health claims from influencers are often more compelling than the attempts to explain evidence-based medicine underscoring a trust deficit in organized healthcare. In fact, a recent study revealed that only 34% of Americans have confidence in the medical system (source: Gallup, 2023). Dr. Green noted that this problem is particularly acute in women’s health due to some historical practices that prioritized invasive interventions over good science (the impact of the VBAC study is one such example). Social media influencers have tapped into this trust deficit, leaving patients caught between credible medical advice and persuasive yet misleading narratives (in previous posts, I went into this in some detail with Sanjay Gupta from CNN and Neel Shah from Maven Clinic.). Dr. Green recommended that clinicians demonstrate trustworthiness to patients by “approaching the situation with humility. You have to ask a lot of questions, and I think that’s one way to reestablish trust.”
As we wrapped up our conversation, I was struck by the importance of having a changemaker mindset in medicine. Dr. Green hadn’t conceived of MAVEN decades ago; only in the last decade had she identified the resource issues plaguing frontline health workers in underserved community clinics. But once she did, she acted with urgency and quickly developed an organizational plan to help these workers. Many might have been dissuaded by the financial, political, and structural barriers inherent in such an undertaking, but she embraced them as invitations to innovate. She was just simply obsessed with solving the problem - That’s inspiration for any clinician hoping to have impact at scale.
Thank you Dr. Green for all that you do,
Quick hits
Book recommendation
The Patient will see you now by Eric Topol
For Love of Writing
I found this sentence by Robin Givhan reflecting on Jimmy Carter’s transition to hospice deeply moving.
Unrelated to medicine, but a funny restaurant review - Jay Rayner incensed by the lack of lobster in a lobster dish
References
Gallup. (2023). "Confidence in the Medical System at Record Lows." Retrieved from: https://www.gallup.com/poll/1597/confidence-in-institutions.aspx
Guttmacher Institute. (2023). "Abortion Access Restrictions in 22 States." Retrieved from: https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans
Hammoud MM, Morgan HK, George K, Ollendorff AT, Dalrymple JL, Dunleavy D, Zhu M, Banks E, Akingbola BA, Connolly A. Trends in obstetrics and gynecology residency applications in the year after abortion access changes. JAMA Network Open. 2024 Feb 5;7(2):e2355017-.
Gemmill A, Margerison CE, Stuart EA, Bell SO. Infant deaths after Texas’ 2021 ban on abortion in early pregnancy. JAMA pediatrics. 2024 Aug 1;178(8):784-91.
Guttmacher Institute. (2023). “The High Toll of US Abortion Bans: Nearly One in Five Patients Now Traveling Out of State for Abortion Care.” Retrieved from: https://www.guttmacher.org/2023/12/high-toll-us-abortion-bans-nearly-one-five-patients-now-traveling-out-state-abortion-care
Dr. Rohan Ramakrishna is a Professor of Neurosurgery at Weill Cornell Medicine and one of the founders of Roon. He started Roon with Vikram Bhaskaran and Arun Ranganathan because they believe that patients need trusted answers to their healthcare questions, anytime and anyplace.
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The name Good Medicine reflects many things, but importantly, It also pays homage to Bon Jovi’s classic “Bad Medicine.” To our readers who are fans of 80s rock, this one’s for you.
Really great coversation - been enjoying your guest episodes!
MAVEN project. There is nuance to that acronym.