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Face of Defense: Health Affairs Leader Reflects on Career

By Lisa Daniel
Military Health System

WASHINGTON, March 29, 2013 – As the Defense Department observes Women’s History Month, its second-in-command for Health Affairs, Dr. Karen S. Guice, is a testament to how far women -- and men, too -- can climb when they reach out for new opportunities and have a strong support network.

Click photo for screen-resolution image
Dr. Karen S. Guice, the principal deputy assistant secretary of defense for health affairs, right, discusses work with Navy Cmdr. Karen Leahy at the Pentagon, March 28, 2013. DOD photo by Lisa Daniel

(Click photo for screen-resolution image);high-resolution image available.

When Guice was in medical residency at the University of Washington to become a surgeon in the late 1970s, there were no female faculty members. In 1991, she became the first female faculty member in Duke University’s surgery department. Today, she noted, half of all medical students are women.

Guice attributes improved diversity at medical colleges to leadership growth and says the change is good for everyone.

“Your health care providers should reflect society,” she said in a recent interview with

Guice has served as the principal deputy assistant secretary of defense for health affairs for two years, as part of an appointment that combined her years as a practicing surgeon and clinical researcher with a mid-career move into the policy arena. Her ambition and quest for knowledge carried her through multiple higher degrees, prestigious fellowships, positions at various major medical centers, a health care advisor to a U.S. Senate committee, then senior appointments at the Veterans Affairs Department, and now, the Defense Department.

Ask her about her greatest achievement and Guice doesn’t hesitate: her marriage of 32 years to Keith Oldham, chief of surgery at Children’s Hospital of Wisconsin, and their two sons, Christian and Brian, who are college students also pursuing science careers.

Now that her children are grown, Guice said she takes much satisfaction in knowing that the couple raised “two great kids” while pursuing demanding careers that often had them working in different cities.

“It has been interesting deciding whose career takes precedence over the other’s,” she said.

The couple met during their medical residency and married during Guice’s last year at the University of Washington just before Oldham left without her for a year in Cincinnati for a pediatric surgery fellowship. She later joined him there as a research fellow in pediatric surgery.

Over the next decade, the couple would manage to both get faculty positions in surgical departments at the University of Texas, the University of Michigan, then Duke University. It was at Duke where Guice decided to go into public policy.

“It was the start of the Clinton health care reform, and I just got tired of everybody whining about stuff,” she said of her fellow doctors’ frustration with the health care system. “I decided if you want to be part of that solution, you’ve got to learn to play in that arena.”

Guice took a year of absence from her faculty position in surgery to obtain a master’s degree in public policy. She didn’t perceive a career in government at the time, she said.

“I just felt I needed to speak the language and have the tools,” she said. “The coursework at Duke was very challenging and really fun. I learned the politics and the economics of public policy, and really enjoyed putting all the pieces together and coming up with the strategy.”

Guice soon applied for a Robert Wood Johnson fellowship and was accepted for the year-long program in 1996 to serve as a health policy advisor to the Senate Labor Committee, now called the Senate Committee on Health, Education and Labor. Her husband and two young boys stayed behind at Duke and she flew home on weekends.

Guice credits her family’s support -- and that of a good, full-time nanny -- with allowing her to take opportunities like the one in Washington. When the fellowship ended and the committee’s chairman, Sen. James M. Jeffords, asked her to stay on for another year, her answer was “yes.”

“Spending that first year of marriage apart is how we learned to accommodate each other’s needs,” she said of her marriage. “We talk about career choices all the time. When I came back to D.C., [Oldham] was very supportive. He said having a happy wife who comes home weekends is better than having a grumpy wife who lives with me.”

In 1999, the family relocated to Milwaukee so Oldham could take a faculty position at the Medical College of Wisconsin. Unable to find a good job fit in Milwaukee, Guice went to work at the American College of Surgeons in Chicago, making a 90-minute commute by train each way every day. Not minding the commute and arriving home by 7 p.m., Guice said they were balancing as they always had, but with one difference: their nanny had not wanted to move north and they had been through a series of child care providers.

One night at dinner, they announced to their children that they had to let their latest nanny go, Guice said. Their older son, who was not yet in middle school, replied, “There goes No. 9.” The couple was incredulous, she said, until their son named all the nannies they had employed in just two years.

“There are times when you have to make choices,” Guice said. The couple agreed that she would give up her position as director of fellowships at the association to become an independent health services researcher, working from home. That change worked out well, she said, allowing her more time with her sons while they were at an impressionable age.

Asked about tips for success, Guice said it’s important to be self-aware and reflective, take risks, and pursue opportunities. Also, she said, mentoring is important -- not only to those being mentored, but also for mentors themselves.

Guice recalled her first interview with the chairman of the University of Michigan’s surgery department, who became her mentor.

“He said, ‘What can I do to help you? Because if you look good, I look better,’” Guice recalled.

“I always remembered that because if your people excel, it makes you look like the smartest kid on the block,” she said. “If your people perform extraordinarily well, the leader of whatever group it is, wins -- big-time.”

People should seek out mentors -- even where there aren’t formal programs, Guice said, adding that younger professionals ask if they can talk to her about careers, and she’s happy to help.

“You need different mentors for different things,” she said. “All you have to do is ask somebody. The worst thing they can say is, ‘No, I don’t have time talk to you.’ Most people, if you ask them, they will say, ‘Sure.’ I’ve never had anybody say, ‘No.’”


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