Tennessee Department of Health Commissioner Dr. John Dreyzehner (L) welcomes Dr. David Reagan aboard as the state’s chief medical officer.
East Tennessee Physician Named to Health Department Post
On Jan. 3, David R. Reagan, MD, PhD, a board-certified internal medicine physician, stepped into the role of chief medical officer for the Tennessee Department of Health. It was a return trip to the state capital for the native East Tennessean who spent a decade in Nashville while completing his education and training at Vanderbilt.
“One of the pluses about this position is Nashville is such a great city,” Reagan said of moving to Music City, where the family previously lived from 1978-1988.
While there are many familiar landmarks, Reagan also said the change over the last two decades has been tremendous. “There are whole areas that are totally different and unrecognizable,” he said with a laugh. “The biggest example is Cool Springs. It didn’t exist when we were here before.”
He and Claire, who enjoy hiking, bicycling and photography, have begun to reacquaint themselves with the city’s network of parks and trails. The couple also enjoys spending time with their adult children — Emily, Whitney and Joel — and their 16-month-old grandson.
Born and raised in Johnson City, Reagan said that although he was always attracted to science, medicine wasn’t really on his radar in the beginning. In fact, while pursuing his undergraduate degree in chemistry and physics at East Tennessee State University, he used to shake his head over the hours, workload and years of training his best friend, a pre-med student, had opted to undertake.
Upon graduation, Reagan married his college sweetheart, Claire, a nursing student two years his junior. When the young couple moved to Nashville for Reagan to begin his graduate work and Claire to finish her nursing degree, he said he found himself picking up her textbooks. Not only did he find them interesting, Reagan said he soon began to enjoy them more than his own studies.
“I was a slow convert to medicine. It took me awhile to see that it was incredibly interesting and enjoyable,” he recalled.
Karma is a funny thing. For the student who once questioned his friend’s sanity, Reagan actually began med school while still completing his doctorate in organic chemistry.
Once he took the plunge into medicine, however, it didn’t take long for him to find his passion. “There were some wonderful mentors in med school who were in infectious disease,” he said. Reagan was also drawn to clinical epidemiology and liked the puzzle that both areas presented. “If you could figure out what was causing the illness, many times you could prevent it.” Similarly, he said he was interested in discovering how diseases were spread within the healthcare environment to find solutions to prevent that transmission.
After residency, the family relocated to Iowa City as Reagan completed a fellowship in clinical epidemiology and infectious diseases at the University of Iowa Hospitals and Clinics. From there, it was a return home to East Tennessee where Reagan quickly put his training to good use as chief of Infectious Disease and hospital epidemiologist at the Veterans Affairs Medical Center in Mountain Home, Tenn. He also held a dual role at the James H. Quillen College of Medicine at ETSU, serving as dean for veterans affairs and a clinical professor of medicine.
“About five years into that, I began to feel that physicians need to be involved in how healthcare is run,” he said. Although he relished his primary role as a physician, Reagan also believed that insight into care delivery could be put to use in looking at how processes and systems functioned. Ultimately, he was named chief of staff for the VA system, which cares for approximately 54,000 veterans in a four-state area covering the eastern portion of Tennessee, southwest Virginia, part of western North Carolina and eastern Kentucky.
“The VA has undergone a remarkable transformation over the last 10-15 years,” Reagan noted. “It’s been shown to be a very efficient healthcare system in terms of cost effective care, and many people have said it is an example of large scale change in healthcare.”
After nearly seven years as chief of staff, Reagan was excited to realize that many of the system’s goals were becoming reality. “I had a lot of investment in the VA, and things were going well. It was difficult to think about leaving that environment,” he said.
Still, it’s hard to say ‘no’ when approached by Tennessee Department of Health Commissioner John Dreyzehner, MD. The two had worked on initiatives together in East Tennessee and shared a mutual respect.
Before taking on the daunting task of the CMO role, though, Reagan said, “I had to talk to a lot of people to see if the experiences I had been fortunate enough to have would be relevant to the job.”
Happily, it became apparent that his work with the VA would translate well as all of healthcare looks at reform measures and the need to reinvent delivery systems with a strict eye toward balancing cost, efficiency and quality.
With a federally-legislated budget, central office instituting systemwide initiatives, political sensitivities on a national, state and local level and challenges unique to his specific network of VA facilities, Reagan said, “I did have experience working in a hierarchical but distributive environment.” He also knew something about crossing silos and had seen first-hand the success the VA enjoyed once they reigned in the hierarchy to allow frontline workers to be empowered to successfully deliver healthcare.
“In large organizations, it’s a challenge to optimize the environment to support those efforts. That really requires a tremendous amount of coordination and collaboration and alignment across departments.”
Excited about the state’s progress in improving health status, Reagan said he believes the lessons learned at the VA will bring added value. However, he was also quick to say that there is much he is learning from the “remarkable people doing remarkable work” that he has met so far in the Department of Health. “I’ve tried to do a lot of listening to start with.”
He noted, “In 2005, Tennessee was 48th in the nation in overall health rankings. In 2011, we had risen to 39th. That’s very significant. That doesn’t happen randomly; it represents a lot of hard work. My goal is to see how do we build on that success.”
When he spoke with Medical News 11 days into the job, Reagan had already been in the field visiting a number of county health departments to get a better understanding of the work environment. He also was meeting with representatives from the state’s academic medical centers and said Tennessee is blessed to have strong academic institutions statewide with which to partner on innovative initiatives.
Among the many needs, Reagan said there are three key issues that must continue to take priority. The first is addressing the obesity epidemic, particularly childhood obesity. “Another area that is clearly important is dealing with infant mortality in Tennessee,” he said, noting the state currently ranks 45th, putting us in the bottom 10 percent of the nation. “We can do better than that,” he asserted.
A third area of emphasis is on the appropriate use of controlled substances. “More Tennesseans died of drug overdoses in 2009 than died in motor vehicle accidents … so we’re really talking about an epidemic here.”
Already, the Department of Health’s leadership is working to update the ‘top-to-bottom’ review as requested by Gov. Haslam, crafting an updated strategic plan and looking at staff development to continue to move Tennessee forward to meet its health goals. Reagan said these three tools would play an important role in long-term planning for a healthier future.
“The public servant heart of the people at the Department of Health … it gives me energy … it gives me passion. I’m really looking forward to how we can work together across the state to continue the recent remarkable improvements in health status,” Reagan concluded.