Steering the Wheels of Change

reprinted from Issue 12, Spring 2011 of Frontiers of Medicine (PDF)

“I want to use the skills that I’ve garnered here in San Francisco to see whether I can make positive change on a broader level," said Mitch Katz, MD.
photo by Noah Berger

I live to make health systems better, especially for vulnerable populations,” says Mitchell Katz, MD. After 13 years as the director of health for the San Francisco Department of Public Health (SFDPH), Katz became Los Angeles County’s health director in January.

After graduating from Harvard Medical School in 1986, Katz came to UCSF for his residency because of its outstanding primary care programs. He interviewed with Steven Schroeder, MD, founding chief of the Division of General Internal Medicine who is now the Distinguished Professor of Health and Health Care. “As soon as I met Steve, I thought, I’d like to work for him,” says Katz. “He is a mentor of mine to this day.”

Schroeder encouraged Katz’s interest in improving health care systems. For example, much of what physicians know about heart disease comes from the Framingham Heart Study, which has followed thousands of participants over three generations to learn about cardiovascular disease. “Steve looked at me and said, ‘Go do a Framingham study,’” said Katz. “Obviously, he knew it wasn’t cardiac disease that was my interest. What he meant was, figure out the best way to do something, and do it that way. That’s certainly had a very strong impact on me.”

“Mitch Katz was an outstanding resident: smart, intellectually curious, and with a great nose for what was relevant and could make a difference,” says Schroeder. “San Francisco has been blessed to have his leadership in the Department of Public Health, as he skillfully navigated treacherous political waters, dealt with never-ending budget crises, and implemented national model programs.”

Putting Knowledge into Practice

After his residency, Katz remained at UCSF as a Robert Wood Johnson Foundation Clinical Scholar, working with Bernard Lo, MD, Thomas Newman, MD and Margaret Chesney, PhD. “I got my first introduction into broader policy issues and health economics, and learned how you influence the political process,” says Katz. “A lot of what I’ve tried to do since then is bridge the gap between academic research and translating those findings into practice.”

As a clinical scholar, Katz studied evidence demonstrating the effectiveness of needle exchange programs in lowering HIV transmission rates. When he became director of the SFDPH AIDS Office, he developed the nation’s first publicly funded needle exchange program. As director of health, Katz is proudest of designing and implementing Healthy San Francisco, a comprehensive health care coverage program serving more than 53,000 uninsured people. “Even state programs like Massachusetts have excluded certain groups, and we have not,” he says. “To me, that’s a tremendous accomplishment.”

Another highlight is providing housing with onsite medical and social services to more than 1,000 formerly homeless people. “Our program takes people directly from the streets or the hospital, without requiring that they go through a cumbersome program,” he says. Katz also developed legislation making San Francisco the first U.S. locality to ban the sale of tobacco at pharmacies.

Listen and Build Consensus

“Even though San Francisco is a very politically contentious place, it’s also filled with people who want to do the right thing,” says Katz. “I’m a big believer in bringing everybody in, showing them the best quality data, getting people focused on the outcome, and having them write pluses and minuses about different options. If you do that with an open heart, usually the choice becomes fairly clear.”

While working at SFDPH, Katz also served on the UCSF faculty and treated patients at San Francisco General Hospital and other sites; he hopes to care for patients in Los Angeles as well. Being a primary care doctor taught him how to listen closely, both to patients and constituents. “I believe in emotional intelligence,” he says. “Often, getting to the right decision depends on understanding how people feel about things.”

His residency experience also provides him with a sense of perspective. “I trained during the years when the death toll was heaviest from AIDS,” he says. “One of the things it taught me was, if the issue you are confronting isn’t death, then maybe it isn’t so bad.”

In Los Angeles, Katz hopes to strengthen the county’s health department and build a vigorous ambulatory care system. “I want to use the skills that I’ve garnered here in San Francisco to see whether I can make positive change on a broader level,” he says, noting that while San Francisco has about 80,000 uninsured people, Los Angeles County has between 1 and 2 million.

A devoted bicycle commuter who was sometimes mistaken for a bicycle messenger in San Francisco, Katz now gets around on four wheels as well as two. He and his partner, Igael Gurin-Malous, have two children, Maxwell and Roxie.

Frontiers of Medicine Main Page