Stepping Up to the Big Leagues

    • June 9, 2014

Context. Working on local health issues is one thing; moving up to the national policy level is something else. The question then becomes whether you’ll want to go home again.

Born and raised in New York City, Richard Krugman, MD, followed in his father’s footsteps to specialize in pediatrics. After graduating from New York University’s School of Medicine in 1968, he completed his internship and residency at the University of Colorado School of Medicine in Denver, and became chief resident in the department of pediatrics in 1970.

By 1977 Krugman had risen to become director of the general pediatrics program at the University of Colorado School of Medicine. Meanwhile he had become steadily more involved in state and local politics, working to help establish two innovative projects: the Colorado Area Health Centers Program, which seeks to make sure all the state’s residents have access to adequate health care, and the Child Health Associate and Physician Assistant program, which trains physician assistants to work with pediatricians.

The latter program received some of its initial funding from the Robert Wood Johnson Foundation (RWJF), as did two other projects with which Krugman became involved: the Colorado site in RWJF’s Rural Infant Care Program and the Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect. C. Henry Kempe, the founder of the Kempe Center, had previously been chair of pediatrics at the University of Colorado School of Medicine, and in that capacity served as Richard Krugman’s mentor.

Going national. Krugman says that he never planned anything in his career. “I had no long-range vision,” he says. “I’ve just done whatever job seemed interesting to me and when that was done, or three quarters done, if someone came along and said, ‘Here’s something else we need you to do,’ I’ve generally said ‘yes’ and it’s turned out to be interesting.”

Spending a year in Washington as a Robert Wood Johnson Foundation Health Policy Fellow was a case in point. Krugman didn’t seek out the fellowship and didn’t think of it as something he desperately needed in order to move forward—since he had not mapped out a career path. But his superiors at the University of Colorado Medical School nominated him for it, he went to the interview, and was accepted.

Since 1973, the Robert Wood Johnson Foundation Health Policy Fellows program has given exceptional mid-career health and behavior science professionals an opportunity to better understand health policy at the federal level. After an extensive orientation, fellows seek work placements in government—most choosing a congressional office—where they contribute to research, drafting legislation, briefings, and other vital policy-related activities. Read the Program Results Report for more information on the program

Before Krugman left Denver for Washington in 1980, his mentor, Henry Kempe, extracted a commitment from him not to stay there. “Henry said to me, ‘I know you. If you don’t have something to do you’re going to become infected with Potomac Fever Virus and not come back to Colorado. I need you to direct my center.’”

After a short time in Washington, Krugman began to appreciate Kempe’s concern. “It turned out to be an absolutely extraordinary year,” he says. “It also turned out that Henry was correct. If I had not made the commitment to come back, I’d probably still be there. It wasn’t just intoxicating, it was addicting.”

In the trenches. Krugman spent his fellowship year working for Sen. Dave Durenberger (R-Minn.), who was then chair of the Health Subcommittee of the Senate Finance Committee. Krugman chose Durenberger because he wanted to learn something about finance, which was something he hadn’t worked on directly in Colorado. He also knew that Durenberger had not only welcomed previous Health Policy Fellows into his office, but had let them work directly with him, rather than under an aide. “In Durenberger’s office you were the legislative assistant for health,” Krugman says.

Krugman embarked on his apprenticeship with Durenberger at an historic moment. Ronald Reagan had been elected to his first term as President and the balance of power in the Senate had shifted toward the Republicans. Robert Dole (R-Kan.) replaced Russell Long (D-La.) as chair of the Senate Finance Committee. Krugman began working with Dole’s chief of staff, Sheila Burke, on health issues.

One of the achievements he is proudest of is their campaign to secure funding for the Maternal and Child Health Services Block Grant. The grant supported a variety of health programs for pregnant mothers that had been put at risk in the federal budget proposed by Reagan’s director of the Office of Management and Budget, David Stockman. The turning point in the campaign came when Krugman and Burke organized a Senate hearing in which a pediatrician from the Centers for Disease Control and Prevention showed how neo-natal and maternal mortality rates had increased in the state of Alabama when budget cuts there had reduced the ability of poor mothers to receive pre-natal care.

“After that data was presented,” Krugman recalls, “Dole and Durenberger turned to Sheila and me and said, ‘Write a Maternal Child Health Services block grant. We need to preserve these programs.’”

Learning to respect the process. The cliché is that you never want to look too closely at how either laws or sausages are made, but Krugman found the opposite to be true.

“I came away from this with an enormously positive appreciation for how Congress works,” he says.

“From my perspective it is an accurate reflection of our society, because what you learn is that there is nothing you can do that’s good for somebody that doesn’t have either intended or often unintended consequences that screw things up for somebody else. And it is through the process of legislative hearings that you actually find that out. The other thing that impressed me was the collegiality of the senators, Democrats and Republicans, and how well they worked with each other.”

Krugman adds, ruefully, “That has completely eroded over the last decade or so.”

Back to Colorado. His fellowship complete, Krugman kept his word and returned to Denver, where he spent the next decade as director of the Kempe Center. During that period the political expertise he had developed during his fellowship helped him to become a national leader on child abuse issues. He helped establish the National Child Abuse Coalition and served on the United States Advisory Board on Child Abuse and Neglect, meanwhile doing government relations work on behalf of the Academy of Pediatrics and the American Pediatrics Society.

In 1990 Krugman was about to leave on a sabbatical when he received a call from the chancellor of the University of Colorado Health Sciences Center, asking him to step in as acting dean of the School of Medicine. He did, and two years later he was named dean, a position that (as of April 2014) he has filled for 22 years. During his tenure as dean he stayed involved with RWJF as a board member of RWJF Health Policy Fellows program until 2009 and as chair of the national advisory committee of the RWJF Clinical Scholars program starting in February 2009 (the program is scheduled to end in 2017).

Back to the Kempe Center. In January of 2014, Krugman announced that he would be stepping down as dean of the School of Medicine when a replacement was found. He planned to return to the Kempe Center, not as its director but as a professor, a demotion he clearly relished. “I’ve heard that being just a tenured professor is a fabulous job,” he says.

Looking back, Krugman says he considers his RWJF Health Policy fellowship excellent preparation for some of the challenges he faced during his years as dean.

“It helped me understand and guide the political process,” he says, “because academic institutions are pretty political as well. The old phrase is that the reason academic politics are so brutal is because the stakes are so low. Having had experience with the real thing in Washington was good training. You learn how to listen to people.”

RWJF perspective. “The RWJF Health Policy Fellows program is a flagship program for the Foundation and one important way we seek to improve the health and health care of all Americans,” says Michael Painter, JD, MD, senior program officer and himself a 2003 RWJF Health Policy Fellow.

“It is critically important that health care professionals—physicians, nurses, behavioral scientists and others—realize that they can and must play important roles in promoting impactful, positive, informed change. The program provides a great way to help them learn how to do that and to learn firsthand the important relationship between politics and policy.”

“I absolutely could not do what I’m doing today without that experience,” Painter adds.

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RWJF Health Policy Fellow Richard Krugman took his natl policy experience back to U Colo med school as dean