Young Change Makers: Why and How Dr. Madeline Sterling of Weill Cornell Medicine Is Helping To Change Our World
Focus, focus, focus! Early on, I was very tempted to try to tackle every problem that my patients encountered in the healthcare system. That is just not possible. A better approach is to focus on one or two specific areas of research and set small goals. Once the early work gets off the ground, you can then expand your portfolio to related areas.
As part of my series about young people who are making an important social impact”, I had the pleasure of interviewing Madeline Sterling, MD, MPH, MS.
Dr. Madeline Sterling is a board-certified general internist and health services researcher. She is an Assistant Professor of Medicine at Weill Cornell Medicine. Her research aims to improve healthcare delivery for adults with chronic conditions, with a specific focus on home health care and empowering the home health aide workforce to improve patient care.
Thank you so much for joining us in this interview series! Before we dig in, our readers would like to get to know you a bit. Can you tell us a bit about how you grew up?
Of course! I grew up in Oradell, New Jersey. I loved school and learning new things. I also loved sports and learning how to work as a team on the field or on the court to achieve a goal. I’m very close to my parents and although neither are in medicine or research, they instilled several important values in me early on: get a good education, work hard, help others, and give back to the community.
Is there a particular book or organization that made a significant impact on you growing up? Can you share a story or explain why it resonated with you so much?
I remember reading “To Kill a Mockingbird,” by Harper Lee in middle school. The book inspired me to see how a girl (Scout) defied social norms and expectations to do what she thought was right. I also admired her father (Atticus Finch) who constantly sought justice, and even if he did not succeed, he fought the good fight and laid the groundwork for future change and advocacy.
How do you define “Making A Difference”? Can you explain what you mean or give an example?
To me, “Making a Difference” can occur at two levels. I can care for an individual patient as a doctor and help them feel better. As a researcher, I can advance science to improve healthcare and healthcare delivery for a large number of people, or a population.
Ok super. Let’s now jump to the main part of our interview. You are currently leading a research lab that aims to make a social impact. Can you tell us a bit about what you and your research are trying to change in our world today?
75% of adults wants to age in place; they want to avoid nursing homes and stay home for as long as possible and remain independent. Doing so requires that they rely on their loved ones for help. It can also mean that they get home health care services to support them. My research aims to optimize how home health care services are provided and delivered, including leveraging and empowering the home care workforce (home health aides and attendants) to provide high quality care in the home.
Can you tell us the backstory about what inspired you to originally feel passionate about this cause?
Simply put, my patients inspire my passion. During medical appointments, many have told me over the years that they rely on home health aides to help them manage their health at home. This really made me stop and think because in all of my medical training, no one ever mentioned home health care or home health aides. I began to ask myself, what health care services do patients receive at home? Who are home health aides? What do they do? How does the care they provide influence my patients’ health? and In what ways could this workforce be better supported to provide high quality care?
Many of us have ideas, dreams, and passions, but never manifest them. We don’t always get up and just do it. But you did. Was there an “Aha Moment” that made you decide that you were actually going to step up and do it? What was that final trigger?
The home care workforce is comprised mostly of middle-aged women of color, who work long hours and earn dismally low wages. Despite this, they are dedicated to their patients and care deeply about providing good care. And yet they remain largely invisible in the healthcare system. Our research has also shown that home health aides crave more training. They want to become a part of the patients’ health care team. All of this together made me realize, wow, we really need to dive in and tackle these issues. I had a hunch that doing so would not only help to elevate and empower workers, but also improve the health of their patients.
Many young people don’t know the steps to take to start a research program. But you did. What are some of the things or steps you took to get your project started?
Partnership is key. To understand the issues at hand, I realized early on that I needed to partner with organizations that had first-hand experience with the home care industry. In fact. I recall setting up a lot of meetings where I mostly just listened. What were the challenges? Where were the pain points? How could a researcher like me advance the field and produce evidence that could lead to change? Later on, I formed an Advisory Board that included experts in the field and home health aides themselves. We meet regularly and this group often helps our team shape research questions, interpret findings, and prioritize which studies should be done first.
Can you share the most interesting story that happened to you since you began conducting research in this area?
Like many of us in healthcare, COVID-19 came and we rolled up our sleeves to care for patients. I did not expect to do research on COVID-19. But, the pandemic, especially here in NYC, had a profound impact on the home care industry and on home health care workers. Home care agencies were struggling to source and provide personal protective equipment to their worker and home health aides were going into homes, day after day, to help their patients, but often without recognition or the resources they needed to do this safely. And yet, none of this was mentioned on the news or in the press. A few weeks into the pandemic, a leader of one of our community partners called me up and said, “Dr. Sterling, someone needs to tell the story of what is happening in home care and what aides are going through. This is not a job where you can “socially distance.” They are providing essential care, but no one sees it that way. They need help and support.” It was from this call that I knew we had to act. We conducted the first study in the United States of home health aides’ experiences providing care during COVID-19. This study was the first of many to shed light on just how tough things were. I’m so glad we did this — the findings led to tangible results — more awareness of the workers’ contributions and policy changes to improve working conditions, including hazard pay and supplies.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson or take away you learned from that?
In the beginning, we used to schedule focus groups with home health aides from 5–7pm at night so that they could participate in our studies after work. We assumed 2 hours would be enough time to hear what they had to say. Boy, were we wrong! Once aides got to talking about their experiences, they wanted to keep talking with us and with each other! I vividly remember needing to tell them and my staff to wrap it up at 10pm, “we all need to go home!” I think this demonstrates just how important it is to ensure that frontline workers have a voice in healthcare — historically they have not and this needs to change.
None of us can be successful without some help along the way. Did you have mentors or cheerleaders who helped you to succeed? Can you tell us a story about their influence?
Absolutely! I’ve been incredibly fortunate in that respect. Frances Sadler, the Assistant Director of the 1199SEIU Training and Employment Fund, and Faith Wiggins, the Director, took an early interest in my research and my career. I remember having several conversations where we really got to know each other, including the mission of their organization. We also brainstormed ways in which research (and my studies) could be impactful. Penny Feldman, PhD, Senior Scientist and Director Emerita of the Center for Home Care Policy & Research at VNS Health, also met with me a lot in the beginning. I remember her taking me under her wing and literally drawing out diagrams of how home health care works (it’s a complicated topic, so this helped me get a lay of the land). Finally, I’m incredibly grateful to my research mentors at Weill Cornell Medicine, Monika Safford, MD, Lisa Kern, MD, MPH, and Mary Charlson, MD, who have supported my scientific lines of inquiry and provided critical guidance and feedback along the way. Some of my collaborators at Cornell University and Cornell Tech — Nicola Dell, PhD, Ariel Avgar, PhD, and Deborah Estrin, PhD — are also tremendously creative and real joy to work with.
Without saying specific names, can you tell us a story about a particular individual who was impacted or helped by your cause?
Our team developed and piloted the first heart failure training course for home health aides here in NYC. An aide who took the course called us a few months later to tell us how she applied what she learned in real-life and helped her patient feel better. This really meant a lot to us.
Are there three things the community/society/politicians can do to help you address the root of the problem you are trying to solve?
- Pay workers a living wage.
- Provide benefits, including health insurance and sick pay
- Create paths for career advancement.
Fantastic. Here is the main question of the interview. What are your “5 things I wish someone told me when I first started” and why? (Please share a story or example for each).
- Focus, focus, focus! Early on, I was very tempted to try to tackle every problem that my patients encountered in the healthcare system. That is just not possible. A better approach is to focus on one or two specific areas of research and set small goals. Once the early work gets off the ground, you can then expand your portfolio to related areas.
- Expect rejection. I remember one early study I wrote got rejected from 8 different journals before it found a home and was published. Over time, I’ve learned that rejection is common and part of being a successful researcher requires growing a thick skin.
- Work with people that complement your skillset, but also lift you up. Conducting research can be hard and a slog, at times. It is critical to assemble a team of collaborators that bring diverse experiences and different areas of expertise to the table. Also, work with people who you enjoy spending time with. This sounds simple but it can make all the difference.
- Celebrate the wins. It’s important to take time to celebrate achievements, big or small. I’ll never forget when one of the first big grants I wrote got funded, a few of my colleagues took me out to celebrate and it was great to share that happy moment with them. I try to do this now with my team.
- Be patient. I’m not a patient person by nature. I expect to work hard and see immediate results. Unfortunately, that is not how clinical medicine or research typically work, in fact, the reality is often the opposite. I’ve had to learn over time to reset my expectations. I’m still working on this!
If you could tell other young people one thing about why they should consider making a positive impact on our environment or society, like you, what would you tell them?
We each have the power to make a positive impact on society. Although that may seem overwhelming, it doesn’t have to be. It could be as simple as listening deeply to someone facing a challenging situation, or getting involved in your community or with a cause that matters to you. Whatever it is, identifying a compelling problem and approaching it with an open mind, a collaborative spirit, and (some) energy, are key.
Is there a person in the world, or in the US with whom you would like to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. :-)
Michelle Obama. She has been a tireless advocate on behalf of women and for improving healthcare and economic opportunities of all Americans, particularly those living in underserved communities.
How can our readers follow you online?
You can follow me on Twitter @mad_sters
You can also learn more about the research at madelinesterling.com
This was very meaningful, thank you so much. We wish you only continued success on your great work!