From academic practice to public health

Larry Fields, M.D., applies business skills to stabilize city's health care services

Larry E. Fields, M.D., presides over a meeting at the city health department discussing successes and failures in the prevention of communicable diseases.

Larry Eugene Fields, M.D., didn't come to St. Louis to run the city's health department and the region's health-care system for uninsured and underinsured patients. But it's somehow fitting that the assistant professor of medicine and of pathology ended up as the chief health officer for the City of St. Louis and as interim chief executive officer of ConnectCare.

As a child, Fields and his 11 brothers and sisters used the free clinics and public health facilities of Atlanta for their medical and dental care. Now, he's making sure those same kinds of services are available to St. Louis children who need them.

"Securing state funding for ConnectCare has been an enormous and complex challenge," said James P. Crane, M.D., associate vice chancellor for clinical affairs and the School of Medicine's representative on the ConnectCare board of directors. "Both in health department operations and at ConnectCare, Dr. Fields has provided key leadership and made significant progress toward ensuring the future of both organizations."

Although lobbying legislators and giving press conferences isn't what he had in mind when he decided on a career in medicine, Fields has become one of the most prominent people on the local health-care landscape since accepting an interim position at the health department in 1997.

Aspiring doctor

"He was extremely bright in school, and he worked very hard," said Anderson, now an assistant U.S. attorney in Atlanta. "He was always in such a hurry. He was always working so hard to accomplish things."

Fields knew his parents, with 12 children to support, didn't have enough money to send him to medical school, but he understood that financial help might be available if his grades were good enough. So he worked hard in elementary school and got that financial help long before he took his medical school entrance exam.

In the 1950s and 60s, the civil rights movement was opening the eyes of the world to institutional racism in the South, and some of the private schools in that region began to integrate their student bodies. With his good grades and help from the Stouffer Foundation of North Carolina, Fields earned the opportunity to attend St. Stephen's Episcopal School, a private high school in Texas.

"My life really began to change when I got word from a counselor in the eighth grade that some people were testing students to see if they could qualify for private secondary schools," Fields said. "The Stouffer Foundation committed to finding qualified students who could help integrate those schools, and after I passed the test, I selected St. Stephen's."

At the age of 14, Fields left his family in Atlanta and moved to Texas. Although his mother was wary of letting him live so far from home, she felt better after visiting St. Stephen's and meeting with an English teacher who offered to act as his mentor.

Fields went from being an oddity at the mostly white school to being class president his junior and senior years. He also earned the school's Brewster medal for overall excellence.

From St. Stephen's, Fields went on to Harvard. During his time in Cambridge, he took pre-med courses and toured New England with a student singing group. He learned science in the classroom, but he learned healing on summer vacation.

"During the summers, I would go back to Atlanta," Fields said. "I volunteered in the emergency room at Grady Hospital. I wanted to find out whether my desire to help people who were suffering actually translated into reality when I was face to face with that suffering. Those summers really convinced me that medicine not only was something I wanted to do, but it was actually something I could do."

He earned a degree in biochemistry and stayed to attend medical school at Harvard. Halfway through school, he got married. Over the next several years, he did an internship and residency in internal medicine, a fellowship in cardiovascular diseases and a fellowship in molecular biology at the School of Medicine here. Eventually, he had his own laboratory and academic practice -- teaching, doing research and helping run the stress-testing lab.

For many, that would be the end of the story, but Fields had other ideas.

"I distinctly recall meetings where consultants would say things that medical people didn't understand. And I thought that some of us should get to know the business terminology better," Fields explained. "The head of cardiology and the head of medicine provided a lot of support and acknowledged that there was a need for doctors who understood the management principles that were being introduced into health care."

So in the fall of 1995, Fields went back to school, this time for a master's degree in business administration at the John M. Olin School of Business. When he finished in May 1997, Fields was headed back to his lab, his teaching and his patients. He also was ready to help design clinical service lines, negotiate reimbursement rates and manage clinical revenue streams. But things don't always go according to plan.

Problems at the city's health department had rocked St. Louis government. Senior people had resigned, financial irregularities had surfaced, and the mayor needed someone to stabilize things. With his new business training, Fields got the call.

"Believe me, it was not on the radar screen when Dr. Peck called to ask me to consider moving to the health department," Fields said. "I had been going into community churches doing public health work in wellness 'ministries,' so I wasn't completely intimidated by the concept. But when it came to my knowledge of public health, I had a bit of catching up to do in those early days."

He had been a specialist, an academician who worked with heart patients. With his new MBA, he not only was an administrator, but he also suddenly found himself in the business of testing paint for lead, ensuring that schoolchildren got their required shots and telling restaurant workers to wash their hands to help prevent the spread of disease. Somehow, he made the transition.

Collegial style

In Fields' view, it's even simpler than that. Although he inherited some complex problems at both the health department and at ConnectCare, he knows that solutions have to be hammered out one step at a time. It's not that he doesn't have an eye on the big picture, but he's learned that little things often make the biggest difference.

"I'm incredibly humbled by the enormous importance of very simple things," he said. "Since 1900, we've gained about 30 years in life expectancy. About 25 of those years came from public health initiatives and not from the highly specialized medicine where I spent most of my career. I think both are important, but excellent specialized care services mean very little if you don't have a good public health system in place."