Dare to follow your vision
National leader appointed new chair of anesthesiology
Alice A. Coombs, M.D.
This story was published in the spring 2022 issue of 12th & Marshall. You can find the current and past issues online.
From the time she was a young child, Alice A. Coombs, M.D., already had a model for the kind of physician she would become. Growing up in the Los Angeles neighborhood of Compton in the 1960s and '70s, she would join her mother on visits to bring food, prayer and comfort to people on their church’s “sick and shut-in” list. “She taught me what giving really is,” Coombs says.
On those visits, Coombs also became curious about questions of health and wellness – about why so many in her mostly Black community seemed to suffer from chronic illnesses, and why those problems couldn’t be prevented. “That sparked my interest in health care and health disparities,” she says.
Today, as chair of the VCU School of Medicine’s Department of Anesthesiology, Coombs keeps central to her work those lessons in caring she learned early.
Clinician, educator, advocate
Coombs arrived on the MCV Campus in 2017 after practicing for more than 30 years in Massachusetts. She brought a patient-centered commitment along with an extraordinary depth of knowledge and clinical experience. She’d completed residencies in both internal medicine and anesthesiology, as well as fellowships in critical care medicine and cardiothoracic anesthesia, along with a master’s in public administration. And she has broad expertise across a range of services, including critical care, surgery and obstetrics.
“Her wealth of knowledge is endless,” says Christin Kim, M.D., associate professor in the Department of Anesthesiology’s division of Critical Care Medicine and medical director of the Cardiac Surgery Intensive Care unit. “She has seen it all, and there is really no patient that she is challenged by.”
Coombs’ appointment as chair in 2021 brought additional administrative responsibilities, but she remains very active as a clinician, notes professor emeritus and past department chair John F. Butterworth IV, M’79. “She has a lot of experience and a lot of training, but she is also a good generalist,” he says. “She is a good role model for the residents.”
“She leads by example,” Kim agrees. “She would never task someone with something she wouldn’t do herself.”
Coombs also brought to VCU an extensive record of advocacy, professional leadership and educational outreach. During her years in Boston, she became active in the Massachusetts Medical Society (the oldest continually operating medical society in the country and publisher of the venerable New England Journal of Medicine), eventually becoming the first Black woman to serve as president of the organization. Her involvement began when she instituted an anti-smoking program, still going strong after 28 years, in which physicians volunteer to go into schools on National Anti-Smoking Day in November and discuss the hazards of smoking in relation to their areas of specialty.
During her time as president, Coombs was instrumental in helping bring about the passage of a “disclosure, apology & offer” law in Massachusetts, which offers a less adversarial pathway to resolution when patient care results in adverse events or outcomes. She also was appointed by the Government Accountability Office during the administration of former President Barack Obama to serve on the Medicare Payment Advisory Commission.
“If I am in the room where decisions are happening, I see myself as bringing the patient into the room," Coombs says. “I had a role to play because I actually took care of patients, whereas many of the commissioners around that table didn’t.”
Groundbreaker
A case in point
Department of Anesthesiology’s perioperative center has opportunity not only to improve surgical outcomes but also to reduce disparities in health and health care
VCU Health has participated for more than five years in an initiative to improve surgical outcomes, known as Enhanced Recovery After Surgery. The initiative involves measures taken before, during and after surgery to optimize outcomes by enhancing patient recovery, reducing pain, minimalizing opioid use and reducing complications.
Importantly, an essential element of ERAS is optimizing patient health prior to surgery by addressing pre-existing medical conditions and other risk factors that can affect outcomes. Patients are evaluated and their health conditions targeted through the Department of Anesthesiology’s Preoperative Assessment, Communication and Education Center.
Department Chair Alice A. Coombs, M.D., sees a broader opportunity for the PACE Center to have an impact. “One of the things we have to talk about is what do we do to decrease health care disparities when patients come under the auspices of a health system,” she says. She imagines the scope of ERAS expanding to address a broad spectrum of challenges – what are known as social determinants of health – that drive disparities, from cultural and language barriers and health literacy to the ability to navigate through the many stages of care for a medical or surgical condition.
“It’s important that we consider all these things in ERAS,” says Coombs, noting that patients with a high a burden of adverse social determinants often present in poorer health, with more advanced disease. “We would like for people to have their social determinants of health addressed early enough so that it improves their recovery after surgery.”
Her perspectives are shaped by the professional success she’s achieved as well as by the biases she has faced and obstacles she’s had to overcome.
In the neighborhood where she and her five siblings grew up, crime and danger were ever-present, and “safety became a preeminent concern” for her parents. “I went to school, ran track, and went to church, and those were my three activities,” says Coombs, recalling rising at 4 a.m. to study with her sister at the kitchen table. She was a dedicated student who loved learning, and in high school she added evening and summer classes at a local junior college, accumulating enough credits that she completed her undergraduate degree in only three years at the University of Southern California. While there, she also found time to compete with the track team in the quarter mile and long jump.
In medical school at UCLA, Coombs was deeply interested in anesthesiology, but her adviser pressured her into choosing internal medicine instead, insisting “that anesthesia was a low-esteem profession and the only people who went into it were people who couldn’t get a residency in another specialty,” Coombs says. (His persuasion ultimately didn’t deter her: she would go on to discard his advice and complete a second residency in anesthesiology.)
She credits another UCLA professor and mentor, Wilbert Jordan, M.D., however, for encouraging her to pursue a life-changing choice: trading sunny southern California for a residency at Massachusetts General Hospital (“I’m going to need a hat,” she realized). Coombs thrived under the exhausting, sleep-deprived hours and grueling pace of her old-school-style residency. “My internship year I was like a sponge,” she says. “I had some of the best professors I ever had in my life, and the experience of learning from patient care was phenomenal.”
Entering a profession long dominated by white men, she was one of only two Black women in her internal medicine residency class (the two became lifelong friends), and she found a mentor in anesthesiologist Marlene Meyer, M.D., who called herself Coombs’ “East Coast mom.” Having herself “learned the hard way to endure the prejudices women faced” in medicine, Meyer says that, “the prevailing attitude among the powerbrokers was, irrespective of their achievements, women and anyone of color accepted into residency was ‘less qualified’ than their white male classmates. Coombs was one who dared to follow her vision to become a physician at a time when hostility to women and people of color was openly expressed in so many ways.”
Nor would Coombs’ residency be the last time she faced such attitudes. When she was ascending through various leadership roles at the Massachusetts Medical Society before her election as president, another member asked her to step aside and allow him to take a position instead. “He said, ‘I don’t think you are qualified to be here, and I’d like you to withdraw your name,’” Coombs recalls. “When he finished, I said ‘Thank you. I needed to know what opposition looked like in a place I didn’t expect it.’”
Coombs acknowledges she is not one to back down from a challenge. “The resolve I have is the result of my ancestors who worked so hard to free me,” she says. “When you think you would like to marginalize me, it actually motivates me to work harder.”
How often has she been the only person of color – not to mention the only woman – at the table? “So. Many. Times,” she says, emphasizing each word.
A voice for equity
“But times are changing,” she adds, pointing out that on the board of directors of the VCU Health System where she now serves, “it is so encouraging to look around the table and see the diversity of women and people of color.”
She credits here the leadership of VCU President Michael Rao, Ph.D., but throughout her career Coombs herself has demonstrated a deep commitment to equity, whether in patient care, in the workforce, or in who gets to be at that table – all of which, she points out, are interrelated. To fight health disparities, you need a more diverse workforce, “people who understand the communities and the nuances of the cultural gaps,” Coombs says. To address complex problems that affect all of us as a society, you need multiple perspectives.
“We benefit from learning from others,” she says. “Having that diverse input takes us away from single-channel group-think.”
On workforce diversity, while practicing in Massachusetts, Coombs became involved in the American Medical Association’s “Doctors Back to School” program, which “aims to inspire children, especially underrepresented minority children, to consider medicine as a profession,” according to the AMA. The program typically sends physicians into low-resource elementary to high schools and helps students understand what it takes to become a health care worker while also seeking to inspire them with the confidence that being a health care professional is possible. “We want the doctor to get up in the classroom and say, ‘I didn’t think I could do it, and I did, so you can, too,’” Coombs says. Her goal as chair of the workforce diversity committee for the AMA commission was to reach 100,000 students; they succeeded in only two years.
In her work with the AMA Commission to Eliminate Health Care Disparities, she also was involved in promoting increased workforce diversity through developing educational “tool kits” for legislators, for medical staff and for hospital governance. At each of these levels, the tool kits focused both on increasing understanding of the value of workforce diversity and developing better pipelines.
Former Anesthesiology Chair Butterworth says that this work is essential because, as he points out, “Diversity in a residency program, section, department or school can’t be passive. If you don’t think about eliminating unnecessary preferences that are unrelated to job requirements or performance, you greatly reduce the pool of ‘acceptable’ candidates and will end up selecting only those people who most resemble those who are already here. If you don't think about who you want to hire, and how you want your department to look, you will never get there.”
At an individual level, Coombs emphasizes the importance of mentorship. Quick to credit her own, from that long-ago professor at UCLA who steered her to Massachusetts General to Butterworth at VCU (“I would not be where I am at VCU had it not been for him,” she says), she has paid it forward in her support for younger physicians. “She has particular interest in guiding minority female physicians in this field,” Kim says. “She has empowered us and trained us to be good role models and good leaders — and she has supported us endlessly.”
For those who don’t have a voice
For all her strengths as a physician and an advocate, however, it is her warmth, her generosity and her positive energy that seem to truly set her apart as a leader.
“I have never met someone so humble and so approachable in a leadership role,” Kim says. “If you walk down the hall with her, she knows everyone. From the greeters at the door to environmental services to the nurses and care partners and residents, there is not a person she doesn’t say hello to.”
“It is hard to overstate the fact that Alice brings enthusiasm,” Butterworth adds. “It is hard to be a good leader if you are not outgoing and an optimist. Alice brings that in great quantities.”
That optimism is evident in Coombs’ vision for her department. She came to VCU in part, she says, because of the high-need communities the health system serves and the opportunity to make a difference in the lives of the most vulnerable, underserved patients. Her ambition is to be instrumental, she says, in helping build a workforce focused on education, innovation and research, and “incredibly tenacious about the mission of caring for patients.”
“There is so much that we can do in terms of improving access and quality and outcomes for the patients we are serving,” Coombs says. “I want to be making a difference for patients who may not have a voice.”