The United States healthcare system has long had a conundrum when it comes to representing women. At 76 percent, the number of women in entry-level healthcare positions is more than any other industry, but moving up the ladder, the number of women more than halves, with only 35 percent of women represented in the C-suite, as of 2024.1 The reason for that drop can be attributed to several factors, including lower promotion rates for women, the challenge for women to juggle the demands of healthcare positions and familial duties, and slowing external hiring.2
Elizabeth (Betsy) Nabel has held various leadership positions at esteemed organizations, such as the National Institutes of Health (NIH), Harvard Medical School, Brigham and Women’s Hospital, and the National Football League (NFL), for which she was the first scientific adviser. Nabel is currently the executive vice president of strategy at ModeX Therapeutics and OPKO Health, and she serves on several boards, including those of Medtronic and Moderna. Having come from a background in cardiology, Nabel brought the unique perspective of a physician to her leadership roles—a path that is increasingly more viable as hospital systems realize the value physicians’ distinct expertise can provide.3 This path has allowed Nabel to oversee health organizations with the same sense of empathy and adaptability that she had when caring for patients.
In this episode of the McKinsey on Healthcare podcast, Nabel spoke to McKinsey Senior Partner Pooja Kumar about her career path and the lessons she’s learned along the way. Throughout her career, she’s felt the pressure that many women in healthcare have felt and has overcome obstacles to seize opportunities and commit fully to every role she holds: as an executive, as a wife, and as a mother. She also discusses the structures she’s put in place to elevate the next generation of physician leaders and women leaders in healthcare.
The following transcript has been edited for length and clarity.
Great leaders stay true to themselves
Pooja Kumar: Can you share your journey to becoming a leader at both the NIH and Brigham and Women’s Hospital? What enabled your success?
Betsy Nabel: For individuals who are thinking about being leaders in healthcare and medical research, the journey starts quite early in one’s career. If you are interested in moving into leadership positions, think about the opportunities that you might have to do so.
For me, when I began as an assistant professor in cardiology at the University of Michigan, one of the first leadership roles I had was directing our cardiology fellowship program. Through that role, I gained experience leading our faculty and choosing our fellows. That was an important early leadership experience. I then went on to direct our Cardiovascular Research Institute when, importantly, I was asked to become the chief of cardiology.
There’s an interesting story behind that: I had just had my third child, and I was about six months postpartum. I wanted to take on the responsibility, but I had a six-year-old, a four-year-old, and a six-month-old who I was still breastfeeding. I thought about realistically what I could and could not do. One of the major lessons in leadership is don’t take on a position unless you think you have the resources, time, and support to be successful. If you take on a position without those things, it will backfire and end up reflecting negatively on your career and where you’re heading in the future.
So after thinking about it, I realized I didn’t have the time to do a good job. I knew that, as a mother, if I didn’t have the time to take care of my kids, I wouldn’t be happy, my husband wouldn’t be happy, and I wouldn’t do a good job at work.
Pooja Kumar: Was it hard to say no in the moment?
Betsy Nabel: Of course. You don’t want to disappoint your mentor or your boss. At that time, being a woman leader in academic medicine was extremely rare. I didn’t know if I would have another opportunity or if I would ding the opportunity for other women—there is a misconception that woman are just mothers and can’t take on leadership roles.
One of the lessons I’ve learned over time in my many leadership roles is that you have be true to yourself. You have to be honest with yourself. You have to be self-aware. You need to understand what you can do and what you can’t do. Because if you don’t, you’re never going to be successful. And others can see that you’re not genuine. Integrity and authenticity to me are two of the most important leadership attributes.
The mentors that champion for you
Pooja Kumar: I’d love to hear a bit more about your journey at the NIH and that eventual step to director.
Betsy Nabel: That’s another interesting story. We were living in Ann Arbor, Michigan, and were very happy there. One day in 1999, my husband Gary got a call from Tony Fauci at the NIH, who asked him if he would consider being the director of the new Vaccine Research Center at the NIH, which was an initiative under President Clinton that focused on HIV vaccines. For Gary, this was a once-in-a-lifetime opportunity, but I remember taking the flight home in tears knowing that I would need to give up our idyllic life in Ann Arbor. But I’ve always been a believer that if you’re given lemons, you make lemonade. And that’s what I tried to do.
I had been division chief of cardiology, so I had a very large budget and free rein to create programs. The late Dr. Claude Lenfant wanted me to come to the National Heart, Lung, and Blood Institute (NHLBI) and take on a role that had no budget and no responsibility. I declined because I didn’t want to accept a position where I was lowering my position, so Gary and I left the meeting. Later that day, I got an offer to be the scientific director of the intramural program. So I stood up for myself and got a lateral position. We moved on to the NIH, and it turned out to be a great experience. A few years after, Dr. Lenfant retired, and I became the director of the NHLBI.
Pooja Kumar: Are there other types of mindsets or behaviors that you point to now in retrospect that made you successful when you took these roles on?
Betsy Nabel: Having confidence in yourself and in your abilities and being resilient. Knowing that you’re going to get knocked down a few times, but you will pick yourself up, and you will just keep going. For example, I began my career as an interventional cardiologist. I encountered a lot of prejudice as a woman. I learned how to find my avenues of support. Fortunately, the director of the catheterization lab, my division chief, and the chair of the Department of Medicine supported me. Throughout one’s career, one constantly needs to be in conversation with mentors and advisers, people from whom you can get feedback and support.
Bringing perspective to leadership
Pooja Kumar: Tell me more about the jump you made from the NIH to the president role at Brigham and what the transition was like.
Betsy Nabel: We had just developed the Heart Truth campaign—the red dress campaign—to raise awareness for women with heart disease. Developing that cause was a real high from a professional standpoint because it had an impact on the health of many women in this country. So I wanted my next role to also make an impact. I decided I wanted to return to academic medicine in the next phase of my career.
I contacted several recruiters, and when I was asked to look at the job as the president of Brigham, it pulled on my heartstrings: I did my medicine and cardiology training there, it’s where Gary and I met, it’s where our son was born, and I still had mentors and friends there. Intellectually it would be challenging, but emotionally I knew it would be satisfying.
Pooja Kumar: As you started in that role at Brigham, what surprised you about that type of leadership role?
Betsy Nabel: I had been out of academic medicine for ten years, so I needed to catch up on the status of academic medicine and healthcare delivery systems. As you know, if you’ve seen one healthcare delivery system, you’ve seen one healthcare delivery system. I spent a lot of time meeting and greeting, listening and learning as much as I could. My whole first year was really all about listening and learning.
Pooja Kumar: Are there any pieces of advice you would give yourself now looking back at that transition?
Betsy Nabel: I probably could have done a better job of reaching out and forming liaisons and friendships more openly and eagerly. I shouldn’t have been as hesitant. But again, each healthcare ecosystem has its own culture and personality. If you’ve not been immersed in it, it takes a while—at least a good six months—to learn the landscape.
The move from physician to president
Pooja Kumar: Are there other parts of your clinical training and background that you think are relevant to your journey?
Betsy Nabel: I believe that physicians and physician scientists make great healthcare leaders. There’s an adage that if you’re a CEO in healthcare coming from a business background, it’s very hard to learn the medicine and science side. However, if you come from a medicine and science background, it’s much easier to learn the business side. And I think that’s true.
As physicians, we dedicate ourselves to the care of patients. During our internship and residency, we’re at the bedside day in and day out with very sick patients. With empathy, we know what that feels like, we see the effect on patients and their families, and we carry that wisdom and understanding with us throughout our entire career. I tried to bring that same sense of caring and empathy to every decision I made as a hospital president.
Pooja Kumar: In addition to all your leadership roles, you also serve on several boards. Given the breadth of your experiences now, what makes an organization successful? What advice or coaching do you offer to physicians who aspire to become presidents or CEOs?
Betsy Nabel: Many for-profit companies in the healthcare sector want a hospital CFO or CEO on their board. And they typically want a hospital CEO who is a physician because they need the healthcare delivery perspective, the patient care perspective, and the clinical perspective. If you’re a physician scientist and you want a leadership role, it’s important to get training in business subjects, such as the rudiments of finance and accounting. Business training also allows you to develop a network, take leadership roles, and develop leadership skills.
Physicians underestimate the difference between empathic roles toward one individual and empathic roles toward several thousand individuals. I like to think the role of the CEO is to set the strategy for the organization, so it’s important to anticipate the scale. You need to understand your vision and mission, then formulate that strategy collaboratively with your board. You need to understand what problems they are trying to solve. What’s most important to this board over the next three, five, and ten years? What is the impact that my leadership can have on a large number of individuals? Can I help develop new treatments for patients? Can I help families understand what their family member is going through? Can I help students enrich their education? Can I help grow our research activities?
You also need to develop that strategy with your executive team, then fully communicate that strategy throughout the organization. Equally important to strategy are the values and the culture that you embody. Unless you marry values and culture with strategy, you won’t be successful. Some physicians have difficulty developing their leadership skills, so I helped develop a leadership course for our department chairs, executive committee, and top-level managers. Every participant appreciated having the opportunity to engage in active learning with their colleagues. That would be another suggestion for physician leaders: Participate in or develop and sponsor a leadership course.
The opportunity for women in healthcare leadership teams
Pooja Kumar: Do you have any different or additional advice for women?
Betsy Nabel: I think it’s true of any professional woman: We work very hard throughout our careers. We want to be successful, and we want to give it our all. But at the same time, if we choose, we may have additional roles as a wife and as a mother, and we want to be successful in those roles as well.
It’s important for women to realize how important self-care is. Unless you take care of yourself, you can’t take care of your family or be an optimal person at work. So build elements of self-care into your daily routine. Looking back, I realized how hard I worked for so many hours of the day and how I often didn’t take the time to relax and enjoy and engage in that self-care.
Pooja Kumar: On a related note, in healthcare delivery, well over half of the entry-level workforce is women, yet we see a huge disparity in those numbers when we look at the C-suite or other top leadership roles. Why do you think that is?
Betsy Nabel: Academic medicine needs to rethink its organizational structure and the demands that it places on its leaders, clinicians, and its research scientists. Many women have trained in academic medicine, but they move to an opportunity in a practice, biotech, pharma, or public health because they see equally engaging intellectual challenges and opportunities as well as a healthier lifestyle. Women want to be equally engaged at work and at home, so they look for opportunities where they can be equally successful at work while being fulfilled in other parts of their lives.
Pooja Kumar: Over the next ten years, are there specific kinds of physician leaders you think healthcare is going to need the most?
Betsy Nabel: Healthcare is always going to need empathic, wise individuals who have emotional intelligence (EQ). Sometimes health systems and hospitals get caught up in hiring an individual who has a strong IQ, but lacks EQ. At a certain level, all physicians have high IQs because they’ve made it through medical school, training, and boards, but EQ is important to develop over the course of one’s career. My advice to hospitals and health systems is to support and develop individuals so they can have emotional intelligence, wisdom, and judgment to lead in a very complex environment.
Pooja Kumar: What are you most proud of in your leadership journey?
Betsy Nabel: I’m proud of the programs I helped develop that have had a real impact on patients’ lives, such as the Heart Truth red dress campaign at the NHLBI. Second, we didn’t talk about it, but I served as chief health and medical adviser for the NFL for three years. I’m proud of the rigorous academic infrastructure we put in place for the NFL to address player health and safety. Third, I’m proud of the numerous programs we put in place at Brigham to support the academic mission, clinical care, medical research, and training for the next generation. And last, but most important, I’m very proud of my three children. At the end of the day, it’s really about family.
