Dr. Lisa Fleisher, PhD in Health Policy & Management | Senior Public Finance Advisor at USAID

In this episode, we discuss Lisa’s intentional and career-oriented approach to pursuing a PhD in Health Policy and Management, how she utilized trusted mentors and colleagues as a resource for making difficult career decisions, and her advice for being open to a variety of different career opportunities and making sure a company’s work culture aligns with your needs and values.

Hosted by Lois Dankwa

Transcript

Lois Dankwa

Hi I'm co-host Lois Dankwa and this is the 100 Alumni Voices Podcast, stories that inspire, where we explore the personal and professional journeys of a diverse group of 100 doctoral alumni from Johns Hopkins University. Today, we're joined by Lisa Fleisher, PhD in health policy and management and current Health Science specialist at USAID. Hi Lisa.

Lisa Fleisher

Hi Lois.

Lisa Fleisher

How are you today?

Lisa Fleisher

I'm doing great. Thank you. It's great to be here.

Lois Dankwa

Well, I'm excited that you're here, excited to dive in, and I want to first start by hearing about what made you want to pursue a PhD in health policy and management, and also just more about your graduate work at Hopkins in general.

Lisa Fleisher

Yeah. No, that's a that's a great starting question. Thank you. I can remember when I was finishing my MPH at Hopkins, I knew that I would eventually want to get a PhD, but I didn't want to go straight from the MPH into the PhD. I felt like I needed to go back into the working world for a while and kind of put my master’s degree to work and and explore more about what I was interested in before figuring out you know exactly what I would want to study for Doctoral Work. And so, I finished the Masters, worked for four more years, and realized kind of in the second job that I had after my masters that in order to really do the kind of work that I wanted to do, which really was for me, at that time kind of at the nexus of, like, the research to policy continuum or transition that I needed to have training in certain areas that I couldn't really get on the job, and specifically that was in Biostatistics and some econometrics to really feel like I was equipped with the tools to kind of understand a research study and be able to translate that in a way that would be meaningful for policymakers. And that so that was one piece of it. And then the other piece of it was that as I worked with people who kind of had just finished their PhD's, and I looked at jobs that I might eventually want, I realized that in order to get those jobs, I would need to have a PhD. A PhD was kind of a pre req, if you will. And one of the qualifications. And so, you know it took me a little while to kind of figure out what I would really want to focus on and to make sure that I really was willing to take the time and put the effort in to do the doctoral work, but that's kind of the the trajectory of what led me to come back for my PhD.

Lois Dankwa

It's exciting to hear kind of what influenced your initial rationale for pursuing a PhD. I'm sure it's something that a lot of people can identify with. And I'm curious how it seemed like you were really intentional. You mentioned that you wanted to understand kind of that pathway from research to policy. So how did that guide what things you wanted to make sure you learned in your program, but then also how you saw yourself using them afterwards?

Lisa Fleisher

Yeah, I I I feel like I was lucky in the sense that I worked for about 9 years before I started my PhD. And so, in DC, kind of in that policy arena. And then of course in the Health policy world. So, I think research drives so much of what policymakers talk about, and and my work is in international health. And so, research is just constantly kind of coming, you know, to the fore. And so, for me, I knew that I wanted more training and in methods like I said, quantitative. And then I also ended up exploring qualitative methods during my doctoral work as well, so it was kind of putting those building blocks of like the core skills and and methods together and and also, I think benefiting from having had great opportunities through my work, and especially honestly to work with people again who who already had that doctoral training and to to know the kinds of conversations they were able to have and the types of questions they were able to ask. And so, you know, I knew I wanted to take coursework that allowed me to kind of be able to contribute back in the same kind of way when I was finished. And so, I maybe over did it, like went overboard a little bit on planning out my coursework. I can remember like looking at the whole suite of courses across the whole university almost, you know, and like the poly sci apartment at Hopkins and at SAIS and at the School of Public Health and thinking about, you know, how I wanted to kind of construct this doctoral degree. I felt like if I was going to take so much time out of the workforce and spend so much of my time and energy and like blood, sweat, and tears and money, you know, doing this thing that I really needed to make sure that I was as, like, planful about it as I as I could be. I think my advisor was like you need to just relax a little bit. It's going to be OK. But that's how I went about it.

Lois Dankwa

As someone who had a boss who once told me to write everything down, I have a list for so many things, so I appreciate your approach.

Lisa Fleisher

Yes, lists are great. 

Lois Dankwa

So how did that approach then carry over to how you approached looking for your role after your PhD? Did you know you always wanted to work in a space like USAID?

Lisa Fleisher

I I kind of I kind of did in the sense that I I knew going into the PhD that I wouldn't go into academia in the sense that I was not going to be applying for a tenure track academic position. And that was something that I was really just very comfortable with knowing going in and interestingly enough, I finished the dissertation and ended up joining the University of Washington as as faculty not tenure track, but I surprised myself, and I think that that was just a wonderful lesson to like, just really never say never. So, you know, when I was going through the PhD, and especially when I was finishing, I I I knew that I would really ultimately, I, you know I well ideally at the time want to come back to work in DC. And at that time, so this would have been in like 20 late 2014, early 2015 cause I defended in March 2015, the one of the places where I really would have loved to go back to to work, the World Bank, was on a hiring freeze and so that just really wasn't an option. And I think in a lot of ways that was just a wonderful blessing in disguise in the sense that it allowed me to think much more broadly about geographies for where I could end up and the types of organizations that I might end up wanting to work for and so I had a great opportunity to go out to the University of Washington and work for the Institute for Health Metrics and Evaluation and do again kind of this like bridge between research and policy work there. And that was just a super exciting opportunity. And and and I jumped at it.

Lois Dankwa

I love that you mentioned that experience because so often, despite being aggressive planners or having all these lists, sometimes there's things you just can't control for, and those are sometimes the things that really work out in your favor. And I'm curious what things you learned in that experience that kind of has informed your approach to work now?

Lisa Fleisher

Yeah, that's a that's a really, that's a really thoughtful question. You know, I think the big one like I said was kind of you know just that never say never like you just you just don't know where life is going to take you, what might come your way both in terms of opportunities and challenges and and to sort of set yourself up I think on on such a like defined or or or tight boundary pathway, you just don't have control over so many of the things that ultimately may determine you know where you end up, whether that be changes in your life circumstance or relationships circumstance, or just kind of a serendipitous meeting of someone on a plane that offers you a job. You know, you just don't know, right. And so, I think maybe one of the big ones is just to really kind of try to keep an open mind and you know, allow yourself to be open to a variety of different opportunities. I think another one for me that I really learned through my Seattle experience was, you know, just that working with a whole bunch of different type of people can can really, truly be a blessing. And so, you know, I the the Institute for Health Metrics and Evaluation (IHME) is this is a world-renowned research institution that publishes incredibly robust data about the global burden of disease. And you know, there are people there who are doing super intense coding work and and I hadn't had the opportunity to work with folks who had that type of expertise very much before in my type of background and my professional work. And so being exposed to the types of presentations that they were giving at work and the types of work that they were doing was just was really interesting. And then I think the last one I would say is that, you know, the there's a lot of global health work in Seattle and being exposed to that type of work that's outside of the kind of core policy environment that's very prevalent, of course, in DC or in Geneva in terms of global health was also really exciting because again, you have a lot of, you know, kind of pure public health, global health research going on. And then, you know having the opportunity to kind of link that back to you know, well, what does this mean for the world? What does this mean for policymakers who need to make decisions about, you know, in my case, like how to allocate resources at the government level is is really interesting.

Lois Dankwa

That's so cool. And it's so cool to hear how rewarding that experience ended up being for you. I can imagine that the moment before ending up and picking that next opportunity for yourself was really scary. And I could see a lot of us being in a moment where it's scary figuring out what your next step would be after after your first step after graduation, the immediate next step, and I'm curious how you how you managed the kind of fear and anxiety that comes with picking a role for yourself?

Lisa Fleisher

Yeah, that's a really important question to ask because I think as you just as you said, I think a lot of us have that whether we like to admit it or not, you know the anxiety just in in general or specifically about making such a big decision after such a long journey of doing a PhD. I talked to a whole lot of people, you know that I trusted, you know, former bosses and mentors and you know folks who kind of again, were like at that stage of their careers just beyond mine, so PhD plus five years, let's say. And and I had a lot of anxiety about moving to Seattle. I felt like I was giving up opportunities that I didn't have in DC, right? So, it wasn't like I was moving away from something. I really felt like I was moving towards something, but I just felt like it was this huge risk because I had been in DC so long. And someone who I still really value as a mentor said to me, DC will always be here. If Seattle doesn't work out, you can always come back. And he was, you know, absolutely right. Institutions like excuse me like USAID or the World Bank, they're not going anywhere, for better or for worse. And you know, Seattle felt like much less of a risk when I kind of got that perspective. And then the other big thing was when I was interested in Seattle, the person who would be my boss, who was also a mentor and a and a former boss, brought me out on a recruiting trip. And he was very smart. He brought me out in June and it was this absolutely gorgeous weather and Seattle is one of the most beautiful cities in the world. I had been born and raised in California. And to be honest, I I landed on a Friday evening, I think. And you know the sun was still shining when I got to the hotel and I just really fell in love with the city. And so, it became, in many ways, a very easy decision after that. I met the team and they were wonderful. It was clear that this was going to be an exciting opportunity to join the team at IHME and to do work again, that like I wouldn't have had the opportunity to do in DC. And so, at that point, it became an an adventure in a very positive way. And so, I just felt like it was an opportunity that I just couldn't say no to and interestingly enough, I ended up getting laid off nine months after I started work, as did the rest of the team. So, you know, it had kind of this bittersweet component to it, but I have no regrets. I ended up staying in Seattle for another two years, and so even though there was this sort of unanticipated and kind of like, unfortunate way that that first position worked out it it was still an absolute it was absolutely the right decision and and and I'm just so glad that I kind of took the leap.

Lois Dankwa

I'm I continue to be so glad that you're sharing kind of this aspect of your experience, mainly because pursuing a doctorate or any type of terminal degree can feel so finite. Like, OK, I've done this. Now I'm the driver of everything for my professional life. But you're kind of reminding me and I'm hoping other people that it's so important to be open to the experiences you're not in control of because for you it sounds like it's been so rewarding.

Lisa Fleisher

It really has, yeah. I'm very fortunate. There's really not a day goes by that I don't feel gratitude for the people who have looked out for me along the way, but I also do, you know, I think more and more acknowledge that that I've also made good decisions along the way too. So, it's been it's been both parts of it, but I I do feel very lucky.

Lois Dankwa

So, I'm curious then kind of for what you do now, I'd love to hear more about what a Health Science specialist is, what it means you do, but then also, how are you seeing, if at all, parts of what you learned from your program apply and come into what you're doing now, if they still do?

Lisa Fleisher

So, you know, I was in Botswana last month to work with our office there and have Roni to help them think through how they can plan their some of their funding for health system strengthening and health financing in particular. And every time I go to a country to help our country offices to help our teams out there, I remember how important it is to listen to what they have to say and to listen to the government officials that we talk with about what their priorities are, and so a lot of my training in my PhD and I did a qualitative dissertation and, you know, did these in-depth interviews is is benefiting me still in the sense that I learned I was trained well to ask open-ended questions and to really pay attention right and to probe when you need more information or you think that someone’s raising something that they might need to express a little bit more, need a little bit of prompting to to really kind of, you know, be candid about, you know, to be mindful of the different levels of position that are in the room that people who maybe are more junior may not want to talk as much if their bosses are in the room, so you know to try to make sure that you can talk to a wide range of people, maybe even 1 to 1, even if it's just like at the coffee break in a in a conference or a meeting or something like that. So, I think my training in qualitative methods really has helped me be a better kind of policy advisor, if you will since I've joined USAID. And in terms of your first question, what a Health Science specialist does, so I work for the Bureau for Global Health within USAID, which is the largest Bureau, and we receive funding from Congress to implement and design the US government’s global health programming. And so that is in line with priorities for working on ending maternal and child deaths and preventing the transmission of HIV, AIDS and and other infectious diseases, and so right now my work specifically is focused on HIV in the office of HIV AIDS and I work for the health finance and economics branch within that office. It's a big office, about 300 people, and so my work focuses on how other country governments are financing their responses to HIV. And so right now, in a lot of countries, it's really about the sustainability of that HIV response because there's been such incredible gains made over the last 20 years, particularly under the President's emergency plan for AIDS relief for the PEPFAR program. And so, there's a really kind of exciting pivot moment, if you will, in the sense that so many countries are are close to reaching the control of their HIV epidemic. This isn't the case in every country, but you know, we think about, you know, how do we really try to assist country governments to sustain that response and to sustain the gains that they've made? And and it's particularly, I think salient now coming, you know, kind of through this COVID pandemic where a threat like an emerging infectious disease can really kind of threaten the gains that that have been made. So, the delivery of even essential health services, right kind of was stalled during the COVID pandemic. And so that means HIV services, too. And, you know, people who are on treatments need those medicines in in order to continue living a good quality of life and so, thinking through with country governments, you know how to finance that response out of their own domestic revenue, what that looks like? How to do that in a way that is equitable for their own country government responses? What does that mean for how incentives work in the system? So how do providers get paid? How do we ensure that households are protected from catastrophic illnesses so that they're not paying so much out of pocket at the point of service? All of these kinds of things are the types of issues that might come up in in any given country and and so I get to go out and and like I said, you know, listen to what government officials are having to say and help work with our our country offices to kind of align our our our kind of collective priorities.

Lois Dankwa

I am obsessed with everything you just said because it sounds very cool and very exciting. I also love that you started by putting out a plug for qualitative research because yeah, I obviously think interviews are really cool and interesting. But yeah, qualitative research is also cool, but I'm curious what is kind of challenging and exciting about the work that you do?

Lisa Fleisher

You know I think one of the challenges is that the problems are are they're big problems, you know, and and it can be sometimes on the days that aren't so good, really daunting to think about what how am I really making a difference, if at all, right? I'm I'm not in clinical medicine. I'm not a nurse or a physician or a first responder and so you know how is my work helping people in other countries and, you know, when are we going to see the end of this, in terms of HIV in particular? Those those are big things to think about and and again they they can be kind of, you know, daunting is one word. I think sometimes sad, you know, to think about just just again, like how long we've been working on these things. How much longer are we going to be working on these things given that I think all of us are in this business in some ways put ourselves out of a job, right. So that's a challenge. And I think, you know sometimes for those of us I think who have training and a background, in, in public health, we get into this work to do the work right. I mean we, we we want to, we want to make a difference. We want to help and we just kind of want to like roll up our sleeves and get in there and do the work. And you know, sometimes working for the government, you're reminded that there there's a lot of red tape and there's a lot of bureaucracy through which you have to work. Sometimes that's a really good thing in in the sense that there are processes in place that right govern how we use US taxpayer dollars. This is a really important thing to ensure that we're good stewards of that money and then sometimes when you kind of just want to get the work done and and you want to put, you know, two types of commodities on a truck and they need to just it'll be faster and more efficient for them to be on the same track. Like, let's just put them on the same truck, but sometimes there's rules that say no, actually, in order to make sure that we know exactly how all of these dollars were spent, we need to put them on two separate trucks. And so sometimes, you know, for the sake of efficiency, you sort of think, gosh, that's a little bit frustrating. Can't we just, you know, there's a more efficient way. Why can't we just do it a little bit differently? But anyway, those those are a couple of challenges that that sometimes we we face.

Lois Dankwa

Well, I so I I have two more questions for you and I'm curious what advice would you give to someone who is looking to have a career that looks like yours, whether it's about them being open to experiences in the beginning of graduation from their PhD or finishing a postdoc? Or just having a impact in the way that you're noticing that you are?

Lisa Fleisher

Yeah, I think you know something that I've kept in mind as I've gone through my career, having worked for really big organizations like the World Bank or USAID, and then really small organizations like nonprofits is you know what what type of place do you want to go to every day? And maybe it's that you're not actually leaving your house anymore because a lot of us are still working from home. But you know what kind of place do you want to be a part of, you know? And so, I think that that's something to really think about in terms of kind of the environment that's around you, the people that are around you and you know kind of the the mentality or the the the culture of the organization, right that that I think especially now as we are kind of coming through this COVID pandemic is is more important than ever. You know it's it's always been about your colleagues, but I think especially kind of you know what is the the kind of aura if you will of the of the organization. I think that's an important thing to think about for your for your for what it means for your own happiness and and sense of satisfaction with your job. Because it's certainly about the work, but it's also about, you know, your team, your boss, your managers, your colleagues, like all of that kind of stuff. So, I think that's one thing I would say and and maybe there's kind of like a a related point there, which is, you know, what do you want your quality of life to be like? And, you know, I think especially coming out of the PhD, my own experience was that I didn't really realize how burned out I was until I got to Seattle and I started my job I think about five months after I defended. And I didn't really realize until I was working full time again how burnt out I still was. And so, one piece of advice would be if you have the luxury of time after you defend, try to take some time off to just sort of like recuperate and recenter. But as you're going through that final phase of your of your dissertation, you know think about again, kind of what the quality of life might be like wherever you're you're heading next. And then maybe the last thing I would say is just that wherever you land after your PhD, it it's not necessarily going to be the place that's like the forever job. I mean, people talk about like forever homes. Like I don't know that we have forever jobs anymore. You know, and it and that's not to suggest that we should jump from job to job to job, but just that it's OK to go somewhere and to realize you know there might be something else that I really want to explore, whether it's the slightly different angle on research or the research question that you're interested in, or a slightly different type of organization or maybe it's a different field altogether. I don't know. Just allow yourself the space to kind of experience that and and to be OK with that because it's it is ok.

Lois Dankwa

That's such wonderful advice and such so many wonderful things to carry with us as we make choices for future us. So as my last question, I'm curious what inspires you right now?

Lisa Fleisher

You know it's it's amazing to me, having worked for USAID for the past four years, the institutional knowledge and memory that the staff at USAID offices and countries have the staff who are the the local nationals, the the like the Kenyan nationals or the Botswana nationals. They have worked for USAID in many countries for decades, and they have seen governments come and go. They have seen priority shift. They have seen USAID leadership come and go, staff come and go, cause in our offices and country, you know, the American staff will rotate through because they're part of a foreign service, but these are staff who who just have so much brilliance and and really, in in many ways keep the programs going and so I don't I didn't have a good understanding when I joined USAID that that workforce was really like the the foundation of the work that USAID does. And I'm still learning from all of them, the, the, the teams that I get to work with just really how important their work is, but every time I go to country every time I'm I have the opportunity even just to be in a meeting because now we do so much more virtually, to hear their thoughts and their opinions about what the work could be or should be that's honestly, that's what inspires me.

Lois Dankwa

I love that. Being able to kind of work and learn with people that inspire you is a great way to be inspired.

Lisa Fleisher

It really is. Yeah, it really, really is.

Lois Dankwa

Lisa, it's been such a pleasure to chat with you. Just hear a little bit about your experiences and the things that have got you to this moment today. So, thank you so much for taking the time.

Lisa Fleisher

Oh, it's been a pleasure. Thanks so much, Lois.