Today I had the pleasure of speaking with Fatema Zanzi, an Associate in Healthcare Law at Drinker Biddle. I bet a lot of you are in the same situation: a lot of friends are lawyers, but like me, you don't really know exactly what they do and what a lot of the terms mean.
I found out from Fatema that healthcare law is an area that allows for a wide-ranging practice that may not get as repetitive as some other areas of law, which is good to know if you're considering how to specialize within the legal profession. Because you may have an organization like a hospital as a long-term client, you could end up helping the organization with all kinds of situations as a healthcare law expert, as opposed to taking on many clients with the same type of case again and again. It allows you to develop a strong area of expertise while still keeping things interesting over the long term.
I also got to hear from Fatema about some general terms I've never totally understood such as clerkships as well as her perspective on family and women's issues that come up at large firms like hers.
[I called Fatema around 8:30pm...]
FZ: I’m still at work…
ES: Is that a common
occurrence?
FZ: It depends. Some weeks are busier than others and this
week was actually okay until today. I
typically take Fridays at home because I work 80% of full-time, but as of
January 1, I’m going to become full time.
ES: Is that something you
had planned for a while or is it just that things are getting busy?
FZ: I think things are
getting busy. Plus, I am at the stage where it’s time to prove myself in order
to become a partner. So in order to
achieve that goal, I kind of have to put things into high gear.
ES: It’s something you think
about when you’re younger, becoming a partner, and suddenly now it’s actually
almost here. Is your husband a partner
at his firm?
FZ: No, but he’s close to
that stage too. He’s a year ahead of me out of law school, and he did an 18
month clerkship for a federal judge, so that changed things up for his
timeline.
ES: I’ve never understood
clerkships. How do they work? Why did he decide to do one?
FZ: It
depends on the firm. Some firms will
tell you that they’ll give you credit for your clerkship year and you’ll remain
on the same kind of lockstep year as every other person you started with who
graduated the same year as you from law school, while other firms will say they’ll
dock you a year.
Sometimes it’s kind of loose, because they want to
see whether you’ve gained the experience that you needed at the clerkship to
benefit your particular practice.
My husband worked at one firm for three years, then
did a clerkship, and then moved to a different firm, which is not typical. Most people graduate from law school, then do
a clerkship, then go to their law firm.
ES: Was he really burned out after the first three
years or something? Did he just need a
change?
FZ: Yeah,
he was at one of the mega-firms with 1,000+ attorneys across the world, and he
just got burned out and needed a new direction, and this opportunity popped up
that was just what he needed.
ES: Well
it’s good that he was able to do that and that it worked out for him then.
FZ: Yeah.
I don’t know if he ever told you the story, but the guy that we bought
our condo from – he was actually the clerk for that same judge. When we went in for our inspection, he was
there, and we were chatting and he mentioned that his judge was looking for a
clerk for the following year. So it’s
funny how that worked out.
And then even funnier, our neighbor below us was
looking for a clerkship and asked my husband if his former judge was looking
for somebody, so now that particular condo has bred three clerkships.
ES: But doing a clerkship isn’t something you were
interested in doing?
FZ: No,
clerkships are actually something more useful if you’re going to be a
litigator. I’m a healthcare attorney, basically
a corporate and regulatory attorney who works in the healthcare industry
only. So because I’m an industry
practice lawyer instead of a subject matter practice lawyer, I don’t practice
real estate or patent law. I practice in
an industry, and being an industry practitioner, you really do everything for
your clients.
I do employment agreements and I deal with
litigation as well, but I usually work with a litigator. The litigator will be
the expert on the procedures of the court and I’ll be the one who knows the
subject matter and the client.
It’s interesting because you really do get a
broad-based experience because your clients in the healthcare industry really
need you for everything under the sun that they need to run a hospital or
whatever, and then you find the subject matter experts to assist you as needed,
but you yourself are kind of the healthcare expert.
So you know the regulatory scheme that these
particular clients deal with. And it’s
one of the most highly regulated industries, so you kind of need to know all
the various regulations that interplay, and a regular real estate lawyer won’t
know the healthcare aspects of a real estate deal in healthcare.
ES: What
would be the healthcare aspects of a real estate deal?
FZ:
Here’s an example. Two really
significant laws in healthcare are part of the regulations around curtailing
fraud and abuse in the Medicare and Medicaid programs. One is the Anti-Kickback Statute, which
basically prevents any person from offering or receiving a kickback, or some
type of remuneration, for referring someone for any services or items that are
covered by a federal healthcare program.
Let’s say in the real estate context, I’m a
physician and I want to lease some space owned by a hospital, and I’m also on
the staff of that hospital, and I refer patients to the hospital
regularly. Because of that referral
relationship where I refer patients regularly, those services like lab services
or whatever services I refer the patient for, they may be covered by Medicare,
Medicaid, Tri-care, etc.
There’s a financial relationship that’s being
created because I’m also paying a lease payment to that hospital, so they want
to make sure that you’re not receiving any kind of benefit for referring
patients. A bad scenario would be where
a hospital who had a suite they were going to rent out to a physician might
give it to the physician for an under-market rent because they knew that the
physician was going to refer a lot of patients to them.
The Stark law is very similar, only it’s more
limited to referrals for certain services and it’s only limited to Medicare and
Medicaid patients, not just anything in the federal healthcare program, and
it’s limited to physician referrals, not referrals by anybody or anything.
So in my real estate example above, the lease could
be with a pharmaceutical company or with a medical device company, or a vendor
of healthcare supplies whose supplies are covered by the federal healthcare
program. But Stark is more limited.
But to know those laws is so essential, and just a
general real estate lawyer won’t necessarily know that it applies in a
hospital/physician lease. And so you typically
need to have a healthcare lawyer who knows the nuances of what can and cannot
be in that lease working with a real estate lawyer who knows the basics of real
estate.
ES: So
is that common, for somebody leasing space in a hospital, to even know that
they need a healthcare lawyer to help guide them through that process? Or is it the real estate lawyer who says to
the client, “Look, I really need to bring in a healthcare law specialist
because this is beyond what I know how to do?”
FZ: Yeah,
that’s typically the case, or they don’t really service clients like that. If they’ve done physician or hospital leases,
they should know of the healthcare laws, and if they don’t, they typically
bring in a healthcare lawyer. I
typically represent only hospitals, and they will typically only use lawyers
who are healthcare attorneys.
ES: I had no idea how many hospitals were in the
Chicagoland area, like thousands, and I have only really heard of the main ones
and never really paid that much attention to the others but apparently there
are so many. So I guess that’s good for
you because you always have a lot of business.
FZ: Right
– and especially in this climate of health reform, with the Affordable Care Act
and everything else that was passed in 2010 and is now being implemented, with
a million regulations being drafted day in and day out, I feel like I’ll never
be unemployed in this economy – unless I royally screw up I guess.
ES: How
do you stay on top of it all with everything changing so quickly?
FZ:
Right –I was recently speaking with an attorney who just joined our group,
fresh out of law school. She went to
Michigan and took one Intro to Healthcare Law class but doesn’t have a ton of
experience. She was just asking me about
what she has to know and how she can get to know about the industry and keep up
with everything.
Literally I’m on like five or six different
listserves. I receive email alerts from
various associations – I get emails daily from the American Healthcare Lawyers’
Association. I get alerts from the BNA
Health Law magazines daily. So I
subscribe to various listserves that keep me abreast of the main developments
in Health Law on a daily basis.
In the four or five different emails that I get,
that pretty much covers the latest and greatest. I also get probably four or five periodicals
too.
It’s hard to keep up – sometimes you have to take a
half a day and just catch up – it’s constant and you just have to keep on top
of it or your clients will ask you a question and you’ll sound really dumb if
you don’t know about it.
It’s hard, but for me, the reason I went into it is
because it’s so interesting and in particular, it has so many effects on the
healthcare of people that interests me.
Every one of these regulations is going to affect the way we get health
care indirectly or directly in this country.
So, it makes me want to keep up with it because I want to know what’s
happening.
ES: What
do you think about Obamacare? How do you
feel and how have your clients been reacting?
FZ: It’s
kind of a mixed bag. I think in general,
they’re happy that something is happening with respect to health care reform
because costs are spiraling out of control and hospitals’ profits, if they have
any, are miniscule. It’s like 2-5% -
it’s so small. Hospitals desperately
need help.
For most hospitals, their most regular and/or
largest payers are the government – Medicare and Medicaid. And Medicaid has not been paying as regularly
because most state budgets are totally cut and it’s really hard to get Medicaid
payments on a timely basis, and a lot of services that used to be covered are
not covered by Medicaid.
And with Medicare, there are just so many changes
in terms of what services are covered as well.
Obamacare is changing what is covered as well.
The whole healthcare industry is being redesigned right
now, which I think is a good thing. In
the past, the way the industry was being paid, or providers were being paid,
was based on the amount and/or frequency of services provided. The shift now is
going to be reimbursement based upon the quality of your service, which is a
huge paradigm shift in the healthcare industry.
It requires more coordination of care amongst
providers – from the physician, to the hospital, to the home health agency, to
the nursing home – all of these various providers on the continuum need to
coordinate care better because, guess what?
They may start getting a single payment based on that episode of care
vs. various specific payments to each one of those providers that they used to
get.
They’re going to get one payment, and what they’re
going to have to do is manage their costs so that payment is actually worth
something to them, and I think there’s going to be more efficient and
coordinated care being provided, and people are going to get dinged if they
can’t provide the care with the quality outcomes that are standard in the
industry.
For example, there are penalties against hospitals
if you get a post-surgical infection and you’re readmitted within 30 days. With things like that, payers are getting
pretty savvy and saying, “We’re not going to pay you for that second admission
because you didn’t do something right in the first admission.”
ES: Is
there some workaround for that that hospitals are going to start doing to avoid
that kind of penalty? Like keep patients
longer, or say the readmission is due to something unassociated with the
initial admission, or something to keep them out of trouble?
FZ: What
they’re actually doing is coming up with more standardized protocols based on
evidence. It’s kind of looking at
medical evidence and looking at what are the best pathways and protocols and
implementing those clinical protocols at your hospital, and then measuring how
often you implement those protocols.
For example, taking a group of physicians and
saying, “we’re going to measure how often you prescribe an antibiotic after
surgery to prevent infection, and if it’s 100% of the time, you will
automatically realize a reduction in your infection rate post-surgery.”
It’s kind of surprising that this doesn’t happen in
the healthcare industry already, but for a long time, physicians just kind of
did what they wanted to do. They’re
professionals; they’re able to determine what they want and what they don’t want
for their patients. And now, what they’re
saying is “well, in order to get the best outcomes, you have to follow this
protocol because it’s based on evidence and this entire hospital’s going to
adopt this protocol for this type of care, and we’re all going to be measured
against this protocol.”
ES: I
read an article (in the New Yorker, I think) that mentioned an example of a
hospital that did research and figured out they would only cover a certain
brand of knee implant. The surgeons
could substitute something else if they wanted and the cost was equal to or
below this certain one, but they determined that the quality of this particular
implant was completely adequate and there was no reason a surgeon should
increase the cost to the hospital or patient just on their own preference. So, I feel for the physicians who are so used
to doing things a certain way, but I see the need for this change.
FZ: I
think the whole key when implementing these types of protocols is to get
physician buy-in. And really, it’s
exciting to look at the evidence and figure out what really makes sense. I’m sure when that hospital came up with that
protocol for the knee replacement device, they tapped a whole bunch of
physicians; they asked them what they liked to use for their patients and what
had the best outcomes; and decided, “Okay, let’s use this.”
That way, they’re able to determine exactly what
their cost is every time they do a knee replacement, or at least their spectrum
of costs, and if they know that every knee replacement is between $5-6,000 for
each patient, then they’re actually able to make profits off of that cost
because they’re able to keep that cost at that level.
ES: It’s
amazing how inefficient of an industry it is.
Maybe it’s due to the pharmaceutical manufacturers and the insurers
reimbursing at nonsensical rates?
FZ: Yeah, I think all of that’s part of it. One of the things with Obamacare is the whole
concept of an accountable care organization where physicians and hospitals
basically team up and enroll these Medicare beneficiaries into this accountable
care organization and they pretty much budget a fixed cost per beneficiary, and
they need to manage that person’s care for that fixed cost. It’s kind of back to the days of the HMO
where you got a case rate for every patient who was part of your HMO.
It’s basically managing care within a certain cost
amount with good outcomes, and not compromising care to that patient. Which, at the end of the day, I think is what
patients want. I don’t think they’re all
looking for the Cadillac service.
They’re looking for good outcomes at a low cost so they don’t have to
pay a ton of money out of pocket.
ES: It’s
crazy to think of how much money is spent in the last year of life in this
country. We spend so much money keeping
people alive for such a short amount of time.
FZ: Lots
of times, families don’t think about these things and are suddenly put in
situations like, “should we pull the plug” type of situations. Or, should we not provide this really
expensive surgery when it’s not going to have a good outcome for the 90 year
old mother.
ES: What
about physician-assisted suicide? Does
your practice deal with that at all?
FZ: I
actually haven’t dealt with that. We’ve
definitely dealt with the persistent vegetative state issues like the Schiavo case. I don’t really do as much in my practice with
that though.
ES: It’s
great that you’re in such a rich area of law where you deal with so many
different types of cases and you don’t get as bored. You mentioned the real estate example as
something you deal with a lot – are there others that are somewhat routine for
your or that you’ve handled several times that are interesting?
FZ: Yeah
– there are a couple areas I really enjoy working in. One is with hospital governance. Most of my clients are hospitals. Most people don’t know this, but most
hospitals are not for profit, tax-exempt organizations that are, under state
law, charitable institutions and, under federal law, exempt from tax. So they don’t have that any
shareholders.
The hospital is a community asset. The board of the hospital, their fiduciary
duty is to the community, not to any one person to make a profit.
So you know, you kind of deal with a lot of governance
issues with respect to how hospital boards should act and how they make certain
decisions. One of the areas that I’ve
worked a lot in is that hospital boards are required to grant privileges to
physicians to allow them to practice at a hospital.
Being on staff at a hospital means that you have
medical staff privileges at a hospital – you have clinical privileges to
perform certain services. So I’ve done a
lot of work with hospital boards and their executives as well as medical
staff. Medical staffs are kind of an
interesting mix – the hospitals under hospital licensing acts as well as
federal laws are required to delegate the task of credentialing a physician to
become part of their medical staff. They
need to delegate that activity since most hospital boards are made up of
non-physicians.
They need to delegate that task to physicians, and
so they delegate it to this body that is the medical staff. And it’s basically all of the physicians that
are appointed and have those privileges at your hospital, and they can have
different categories of privileges – some physicians are very active at the
hospital; other physicians are consulting physicians who come once in a
while. Some physicians are employed by
the hospital; some physicians are independent have their own practice; but they
are all part of the medical staff of the hospital.
So this body has a very interesting relationship
with the hospital board as well as the administration of the hospital and that
can cause all sorts of strife, especially when it comes to appointing someone
to the medical staff and giving them clinical privileges or suspending
someone’s clinical privileges and basically telling them to leave. It can be a big issue because if you suspend
someone’s clinical privileges, that person can no longer admit or provide
services to patients at that particular hospital.
I’ve worked with hospitals and their physicians to
create certain documents that govern the medical staff. Usually there’s a set of bylaws that govern
the medical staff and all sorts of policies and procedures that the medical
staff has to follow.
And then I’ve also worked with them on how to deal
if there’s a physician who’s performing below the standards of care or who’s a
disturbance to the other physicians at the hospital, who’s harmful to the
patients or shows up drunk to the E.R., who never answers his or her pages and
doesn’t show up if he/she’s on call.
There’re all sorts of issues and you end up
suspending them or doing some type of corrective action with them and I work
with hospitals in dealing with those types of scenarios when they have to take
some type of corrective action against a physician. So that’s definitely an area that I enjoy –
that whole body of law that deals with medical staff issues.
Then in other things that I do right now, I think
mergers and acquisitions are happening at a very frenetic pace because
everybody’s trying align themselves with other people. They realize that they need to cut costs
because they’re not going to get paid as much, as providers. So everyone’s just trying to affiliate with
somebody else, whether it be via merger or some type of acquisition or some
other type of affiliation between organizations.
Those deals are interesting because I’m mostly dealing
with nonprofit boards of hospitals and how they navigate this whole system of
affiliating with another not-for-profit hospital or health system, and all the
things that go along with that. It
becomes interesting because oftentimes there’s a ton regulations they need to
overcome.
In Illinois for example, there’s a board you need
to get approval from in order to change the ownership of a hospital. So if you’re going to sell your hospital to
another entity, you’re going to have to go through that board.
The state attorney general has rights to review
your deal because it’s community charitable assets that are being transferred,
so the state attorney general has the right, under their Charitable Bureau, to
oversee that.
And then there are things associated with Medicare,
and being a Medicare provider, that you need to change if you’re going to
change the details of yourself as a provider.
Then there’s a ton of antitrust stuff that goes
along with all of that too.
ES: So
there’s a lot of consolidation in the industry because they all feel they can
cut costs if they join forces?
FZ: Yep,
that’s what’s happening. And not only
with hospitals buying hospitals, but hospitals are also buying up physician
practices left and right because many physicians don’t want to be independent
anymore. They want to be employed. Many physicians don’t have the margins that
they used to and they can’t keep up with the overhead because they’re not
getting reimbursed at the rates that they used to from various payers including
government payers. So they realize that
it’s probably just more efficient for them to become employed.
And there’s interesting ways you can become
employed – you can become employed directly by a hospital, or you could be
employed by a hospital’s controlled subsidiary that is a medical group. So you have a bunch of physicians that are
part of this medical group that is technically controlled by the hospital, but
they have some say in the governance of that medical group still, so they don’t
feel like they’re completely employed quote-unquote by the hospital.
ES: I’m
always a little fuzzy on those physician groups. I always wonder if Northwestern Memorial
Physician’s Group is part of the hospital…
It’s like they purposely try to make this all confusing and you get
bills from like five different entities.
FZ: Yeah,
they’re affiliated.
ES: I
feel like just that medical campus could keep you employed for a long
time. I don’t know – it’s confusing and
all I know is that I’ve paid a lot of bills to a lot of different people. Hopefully that’s something that Obamacare
will address and make it a little clearer to the patient!
FZ: Those
academic medical centers have their own nuances too, because you’re dealing
with medical schools as well as the hospital, and sometimes even the university
which the medical school is part of, so you have a ton of charitable/nonprofit
institutions that you’re working with.
It becomes complicated.
ES: Is
this area of law something you intentionally chose and thought would be
interesting, or is it something you kind of fell into like the other recent
grad you said just started in your group?
FZ: It’s
interesting because several healthcare lawyers that I’ve spoken with thought
about going into a healthcare career, whether it be a physician or other type
of healthcare career. I actually was
pre-med in undergrad but was a history major and kind of kept my options open,
and when I graduated, I kind of thought I had to take a couple years off and
think about whether I really wanted to do medical school, because I know it’s a
long haul.
I decided to work for a consulting firm and it was
in the heyday – it was in 2000, and everybody was getting these great
consulting gigs. I ended up at a firm
that focused on healthcare consulting. I
worked at hospitals all around the country and we would have projects where we
went into hospitals and we’d do all sorts of things to help them cut costs and
manage their revenue better.
We’d look at their entire revenue cycle and see
areas where there were hiccups, where they were not efficiently collecting on
their revenue, whether it be back office stuff where they were getting denials
from payers because they weren’t processing their claims right, to front end
stuff like when you get a patient in the door, are you registering them
appropriately and getting their basic payer information.
We would help hospitals cut costs based on the way
a patient was progressed through a hospital.
For example, does it take a long time, once a patient was discharged, to
turn over that room to another patient?
Because every time that room sits empty, that costs the hospital
money. Does it take them four hours or
one hour to get it ready for the next patient to come in?
And not just rooms, but are they doing lab services
in a timely manner? So we would do lots
of studies like that, and once we had done our assessment of the situation, we
would come up with a whole bunch of recommendations and we would then sit and
help them implement them. We would
basically be a counterpart to one of their managers and we would be on site to
help them implement all the recommendations.
And some of these projects lasted six, seven months. And when I was consulting, I would basically
live in that city for that time.
ES: It’s
interesting to hear these details because I was a consultant straight out of
college, but we didn’t get staffed on site like that. But I had friends who did, and I always
wondered about more of the specifics of the projects. And also, I remember that jobs like that
would position it as offering “great travel opportunities” to undergrads who
were applying to them, but the truth was that you’d be living out of a hotel in
Tampa or wherever four nights a week and have no life.
FZ: Yep,
pretty much. So back to your question,
the whole healthcare law thing started to seem interesting because I was
dealing with a ton of regulatory issues while I was consulting, having to deal
with government payers and rules and all sorts of issues that are very
consulting-oriented that also had a legal overlap, so I figured I’d apply to
law schools that had healthcare certificates and focused on healthcare.
Loyola has a certificate through their Institutefor Health Law – it’s actually a pretty rigorous program in order to become a
healthcare lawyer when you graduate. You
actually have taken a substantive amount of classes that can help you in your
career. The last two years, the majority
of my classes were healthcare focused.
ES: Did
you find that they were practical? A lot
of people I know complained that law school was too theoretical and not
practical enough when it came to working at a law firm.
FZ: Yeah,
a lot of them really were because they were taught by adjunct faculty who were
practitioners, or faculty that were former practitioners. So it was very practical.
One of the classes was like, here’s a fact scenario
that you might get presented in real life if you were an associate at a law
firm, and you had to review laws, draft a memo, and present the solutions or
options to the client hospital or executive.
So we’d have to do that as a project.
I think it definitely teaches you the underlying
laws that are healthcare-specific and also in healthcare, there are a ton of
acronyms, so you just need to know the industry really well.
ES: That
must have been really empowering coming out of school and feeling so directed
as opposed to being in that kind of generalist zone. It sounds like you had a really good
experience in law school. It seems like
the more focused you get in one direction, the easier it is to get a job when
you come out and the more you get out of it.
FZ:
Yeah, for sure, and actually the people that were part of that Institute for
Health Law, I’m still close to to this day.
They come to all the Health Law Bar events and I go to a lot of the
Loyola Institute for Health Law events, and we’ve kept a close alumni
connection afterwards.
And every time they have a person who’s going to
graduate form that program, we get an email from the program director with two
or three resumes of people we should consider hiring for our group. So in the past couple years, we’ve taken a
couple people from that program. In a
lot of ways, it really does help. And I
kind of know what we’re getting when we get someone from that program.
ES: So
it’s a really nice pipeline for your firm and for the graduates as well. It’s so unique for people coming out of
school to have that kind of strong connection already, to feel like you
actually have a really good chance of getting a job in the field you want.
When we last spoke, we talked a little about being
a woman in your field. Is there anything
you want to share about that?
FZ: Yeah,
sure. I think it’s definitely still a
very male-dominated industry. I don’t
know for sure, but I bet it’s around 10-20% of law firm partners that are
female. It’s so interesting because if
you look at statistics of graduates from law school, you’ll see it’s pretty
much 50/50 male/female, or even more females than males graduating.
But it’s such a triangle because if they join a law
firm and once they progress in their careers, most of those females leave law
firm practice and go into other areas and you have a very small percentage of
females getting to the partnership ranks of a law firm. It’s definitely an issue that we deal with on
a daily basis.
In fact, it’s kind of interesting that we’re
talking this week because just this week, our firm’s women’s committee – the
committee that is supposed to bring women’s issues to the firm’s management –
had a meeting within our subgroup to talk about our maternity leave, or parental
leave, policies, and our alternative work schedule policies.
We wanted to come up with something that was
inviting and fair to both men and women when it comes to parental leave, when
they have children, and how to celebrate that process and also when they come
back how to help them transition back into the practice.
Hopefully there’s going to be a shift as more
females join the ranks of management at law firms, which is still very hard to
do because it’s just a numbers game – there just aren’t as many females to join
the ranks because not as many females last to that level.
ES: Is
it just that women don’t like the grind and the hours, especially after they’ve
had kids, or what is it that causes the drop in numbers?
FZ: I
think it’s a number of factors – one is that the lifestyle is demanding and you
have to be available to your clients in this world 24/7, and you have to
produce at a law firm in order to profit the law firm, so you have to be able
to go out and get clients and you have to do projects and keep yourself
relevant, and that’s a lot to balance when you have children. It’s very hard for you as a part-time lawyer
in a law firm to move up the ranks quickly.
As with any other profession, in order to become
better at this profession, you need to get a lot of experience and do a lot of
different projects, and have that visibility amongst clients to be someone that
they want to hire to do their legal work.
So, in order to have that visibility, to learn and get all those
experiences, you just have to be available and being a part-time lawyer doesn’t
really work in this type of service industry when your clients really need you
full-time.
So, I don’t do shift work. I’m on the clock all the time, and for the
most part my firm is reasonable so I’m not working late nights all the time and
I’m not working weekends all the time.
There are some exceptions to that rule.
That’s my firm. There are other
large firms out there, especially the New York law firms, where you work
weekends and nights and that’s typical.
So, that’s not the case thankfully in my particular practice in my law
firm but in many large law firms where partners are making a million plus a
year, that is definitely required that you work that many hours and that you
work all the time.
So that’s just the nature of the beast in a way and
women I think naturally just feel like they don’t want to put themselves or
their families through that, so they decide to opt into other legal professions
like in-house or other types of legal consulting work, or joining a smaller law
firm that is more flexible with their time, or putting up their own shingle and
becoming independent lawyers. Or get out
of the practice of law generally.
I think there is a high burn-out rate in the
profession overall because it is so demanding, especially in the big law firm
world, but for women it becomes a matter of, “do I want to go home and spend
time with my family this weekend or do I want to write this brief or memo for a
client, or be available to travel to a client site on a dime?” For many women, it’s just not worth it.
I’ve been able to make it work because thankfully
in the healthcare industry, you’re dealing with a different breed of
professionals. You’re dealing with charitable organizations
and I think they handle things differently.
You’re not asked to stay up through the night or work on a weekend for
my clients. Of course there are
emergencies once in a while, but it’s not all the time.
And also, it’s an issue of role models. If you don’t see role models ahead of you on
the path, it’s hard to get to that point.
ES: I
totally feel you on that issue, because that’s how I felt at the consulting
firm I worked at right after college.
All the partners were men, and truthfully I wasn’t incredibly passionate
about what I was doing, but that combined with not seeing an easy path to
advancement made it impossible for me to keep going. If you don’t have a tremendous amount of
talent and passion for what you’re doing, I think it’s virtually impossible to
make your way up the ladder without role models to light the path and mentor
you.
FZ: I
agree, and that’s exactly the case here.
I think there are a lot of women lawyers of my age who are trying to
change that, because we feel it but we also hear from our clients that they
want a diverse team and are demanding that – not only female vs. male, but also
diversity in ethnicity and color etc.
And so one of the things that a lot of law firms
are struggling with and trying to become better at is promoting and retaining
that talent and figuring out the cause of them leaving. It’s a minority issue too. There just aren’t as many minorities in the
upper ranks either. It’s a huge issue –
I don’t see a woman there, so what’s my role here?
Given the service industry that we have, what can
we do to retain talent and make work life more reasonable and balanced for
everybody? Because our generation’s
males are much more family-oriented and want that work-life balance more than
our fathers did. I don’t think it’s
necessarily a female issue, but just a work/life issue for everybody.
ES: Yeah,
and not just when it comes to paternity leave.
You’re right, men are becoming more family-oriented, and also are being
looked to for more of the childcare and household needs too. Women of our generation expect their husbands
and partners to take on more work at home and with the family, so they also
need more flexibility from the office to do that. Women do still do more than men in that area,
but compared to our parents’ generation, it’s way more balanced.
For my husband, and for me too, it was unthinkable
that he wouldn’t take at least a week off when our son was born. I really needed him there, and he wanted to
be there. And fortunately his firm has a
flexible policy and he was home for close to two weeks (while still doing work
remotely.) But I know he felt a little
uncomfortable with it even though technically it was allowed, and also he’s
told me about other guys he works with who were back right away after their
kids were born.
FZ: In
our firm, men are entitled to twelve weeks just like females are for parental
leave. And the male never takes the full
twelve weeks, and just the fact that that happens is wrong. Our view of that concept needs to
change. We’re starting with the females.
Interestingly, maybe the reason males in management
are pushing this agenda with the parental leave or family leave, and more
flexible work arrangements, is because their own daughters are facing these
issues, some of them lawyers at big law firms.
So they’re seeing, “wow, my daughters are dealing with this at their
firms, so maybe we have these issues at our firm.”
...Maybe the reason males in management are pushing this agenda with the parental leave or family leave is because their own daughters are facing these issues, some of them lawyers at big law firms.
ES: Right,
or maybe their daughters are giving them a hard time about it and pushing them
to treat their coworkers fairly on this issue.
Daughters can exert really strong pressure on their fathers.
FZ: Maybe
in ten years, after some of these things do change, there will be more females
who decide to stay at their firms and become partners.
ES: Even
if men don’t take the full amount, just making the symbolic statement of
offering them the full twelve weeks of leave is a strong thing.
FZ: And
the other policy statement we’re pushing for is that taking those twelve weeks,
essentially a quarter of a year, for parental leave won’t affect your movement
through the ranks. For a female who goes
on leave and is only there for 75% of a year, that won’t impact her career
progression. The training in the
management ranks to let management know that that’s how we’re now looking at
things is important.
And the same goes for alternative work
schedules. At first when my son was
born, I was only in the office three days a week and worked from home a half
day, so I worked 3 ½ days. Then I
increased to 80% and now I’m increasing to 100%, but I’m going to try to still
work from home one day (with nanny coverage that day.) I want to be at home as much as possible..
ES: Well,
it can take a while to change cultural norms but it sounds like you’re headed
in the right direction. Before we wrap
up, I had one more question: what do you think the most important qualities are
to excel in your job?
FZ: Hmm. That’s interesting. I mean, I think the typical “lawyer”
qualities of being diligent, meticulous, attention to detail type of person is
important in any law career in general because that’s what you pay your lawyer
to do – to look at the details! So I
think that’s kind of a given.
In this particular healthcare practice, you really
need to have somebody who is compassionate, because you’re working with a
different type of industry. You’re
dealing with people for the most part that take care of people. I feel very
personally invested in all of my clients because I know that I’m helping them
achieve their goals, which are very noble.
And those goals are being able to care for people and make sure that
they’re giving a high quality of service.
They pride themselves on that, and I want to enable them to pride
themselves on that. So, I feel like you
need to be compassionate enough to work with these mostly charitable organizations.
I think service is a really important thing – this
is a service industry after all. Being
able to provide timely, efficient, and responsive client service is vital. That’s becoming more and more important in
the legal industry because there are a ton of lawyers and everybody pretty much
knows the law.
What differentiates one lawyer from another is the
level of service you provide, and if you feel like you can trust them and get
ahold of them and get their service in a timely and efficient manner.
ES: Well
Fatema, you’ve provided so much thorough information about working in
healthcare law as a woman. Thanks so
much for speaking with us today!
