Foundation Focus

    • February 11, 2010

Linda Wright Moore, M.S., senior communications officer of the RWJF Building Human Capital Portfolio, recently sat down with David Krol, M.D., M.P.H., F.A.A.P., team director and senior program officer of the Human Capital Portfolio, to talk about his career and the challenges and opportunities ahead for scholars and fellows participating in Human Capital programs. Here are excerpts from their discussion:

Linda Wright Moore: What motivated you to enter the pediatric field?

David Krol: Before medical school, I played baseball for the Minnesota Twins. Jocks often go into orthopedic surgery, but I was very interested in health policy. In the summer of ’93, before I entered medical school, we were waiting for the Clinton [health reform] plan. Yale required a thesis for graduation, so I got an internship at the American Academy of Pediatrics. And I got bitten by the policy bug. I saw people who were passionate about something other than their own professional advancement.

So I went back to clinical rotations, and while I liked surgery a lot, I continued to be very interested in policy. And I found that when I worked in pediatrics, I went to work with a smile and came home with a smile. Plus, it provided an opportunity to do policy work. The joy and the opportunity to make a difference in kids’ lives meant a lot.

Linda Wright Moore: How did you come to focus on pediatric oral health?

David Krol: After medical school, I participated in the Clinical Scholars program—then I had to get a “real job.” But I wanted to do both policy and practice. I contacted Burt Edelstein, a pediatric dentist who had a policy center at Columbia University. He said that oral health had everything I wanted: policy problems, social determinants, health disparities. It was a microcosm of everything wrong with our health system. I fell into oral health because of that.

Deamonte Driver, the 12 year-old Maryland boy who died from a dental abscess in 2007, brought attention to oral health issues for children, and it resulted in some legislation being passed. But we still have a long way to go to improve both adult and child oral health.

Linda Wright Moore: What’s a step we could take to improve oral health?

David Krol: An important step is for everyone—physicians, patients, legislators—to recognize that oral health is a key part of overall health. If your mouth isn’t healthy, neither is the rest of your body. In fact, all the aspects of health above the neck are neglected—all the “entals”: dental, mental and developmental.

We need to get this knowledge into the medical school curriculum. It doesn’t make sense that a pediatrician, or any other primary care provider, should take care of every other part of the body except the teeth and mouth.

We need to build an alliance between physicians and dentists. We can make sure pediatricians and nurse practitioners know where the dentists are in their community, and we can make sure that they make referrals to them. There are always issues of turf and reimbursement, especially in work related to Medicaid, where there’s not much money. Some pediatricians are now putting fluoride on kids’ teeth, but that raises questions about what pot the money comes out of—dental or medical. Still, there are lots of reasons for hope. The American Dental Association Foundation has given a grant to the American Academy of Pediatrics (AAP) to train pediatricians in oral health.

Linda Wright Moore: What is your proudest moment so far?

David Krol: I’m proud of getting oral health into the AAP’s strategic plan. That has brought time and resources to focus on the issue. We’re in the process of figuring out how to make oral health resources more permanent and sustained. It’s a question of: Does it survive on grants or become something that the organization pays for out of its own pocket? We first got a HRSA grant, but living grant to grant makes it hard to plan, and you never know when the money will run out.

Linda Wright Moore: What excites you most about taking the helm of Human Capital?

David Krol: It’s a challenging time for Human Capital and the Foundation. I’ve spent a lot of time looking at what we’re going to do in the face of limited resources. We still give millions of dollars, but we’ve had to cut back and limit spending. There’s a real opportunity here to think about how we can be creative in addressing the challenges ahead.

Out of the $750 billion in the federal government’s stimulus plan, a considerable amount—$60 billion—has been put forward to support the health care workforce. Some of this funding is consistent with the work we are doing in Human Capital, including expanding the nursing workforce and providing for primary care. So there are opportunities for us to re-examine where we can best focus our resources.

There is also an opportunity to look at how the arena could change with health reform. We anticipate that much more emphasis will be placed on primary care, which also touches on much of the work we do. Seeing the government bring bigger dollars to what we’ve already been doing is a good thing. The Foundation has been ahead of the curve.

Of course, if Congress passes health reform, it won’t be “the end.” Human Capital programs do a tremendous job of preparing leaders, thinkers and researchers who will be needed if reform moves forward. And we still need to focus on the diversity of the health workforce.

Linda Wright Moore: Looking back on your time as a Human Capital scholar, was there a particular moment of your experience that stands out?

David Krol: The most important thing for me was developing critical thinking skills—the ability to be put into a situation and be prepared to think through what’s valuable and useful. For instance, which programs are good and how do you scale up a program as needed? I received those skills through the Clinical Scholars program. I see the same thing happening with other Human Capital alumni, such as David Blumenthal, a former Investigator Awards scholar whose work in Health IT entails giving grants at the community college level, among other things. Or David Michaels, a former Health Policy Fellow, who is serving as the Assistant Secretary of Labor for Occupational Safety and Health. These are just a couple of examples of people who took what they learned in the programs we offer and applied it to benefit others.

Linda Wright Moore: What do you see as the main benefits for RWJF scholar and fellow alumni in joining the Alumni Network?

David Krol: There is a large and growing group of Human Capital alumni. I hope they’ll take advantage of the Alumni Network to connect with people across disciplines and programs to address the issues we’re all facing. As much as we’d often like to do things on our own, the wonderful thing about being an RWJF scholar or fellow is that you become a member of this amazing community. You have a great opportunity to capitalize on the knowledge of this extended family—to advance your work and meet new challenges that affect us all.