By Christopher Guadagnino, Ph.D.

Published February 1997

• React to this article in the Discussion Forum.

Wanda D. Filer, M.D., is the newly appointed state Physician General. She has a family practice in York and teaches in the Thomas Hart Residency Program at York Hospital.

PND: Is PA Physician General a full-time position, or are you concurrently practicing?

WF: This is a full-time job. I am continuing to teach family practice residents and medical students at the York Hospital. I see it as a hiatus; I turned my patients over to my partners at this point. That was one of the most difficult things to me about agreeing to take this job, because I really enjoy clinical medicine and relationships with patients. But I kind of figured that I’ll be back there in a few years.

PND: What about your background do you feel prepares you for this new position?

WF: In addition to having served as a teacher of health care, I spent the last six years working on our NBC affiliate in Lancaster doing health care reporting. In addition to that, I’ve traveled all over Pennsylvania and some other parts of the country talking about issues of domestic violence. Part of that has gotten me very involved in the Healthy York County program to reduce health risks. We were able to develop partnerships between business and education, health care, the judiciary, youth and lots of different people and develop action teams. I chaired a medical advisory task force called the Pennsylvania Coalition Against Domestic Violence, who I’ve done work with for several years. I did some lecturing on a consultant basis for a couple of groups, one through the Pennsylvania Medical Society and another one through Physicians For Social Responsibility, the Philadelphia Chapter.

PND: Why have you chosen three areas of social policy priority, i.e., family violence, tobacco and the elderly?

WF: The governor asked me if I could pick three areas that I believed could help the public and, frankly, these are three areas that I have in my heart and soul, I guess you would say. Tobacco is very clearly an addiction, is a leading preventable public health risk, the leading cause of premature death. I think we need to continue to reduce usage and addiction. It is clear to me that we need to redouble our efforts to see how we can work with these kids to make some healthier choices, especially if you consider that tobacco may also be an entry level into other high risk health behaviors. I also happen to have two very young children, and I do believe that you can send very powerful health messages to children. About senior populations, I think a lot of it is based on the fact that I am a family physician. Many of my colleagues have sensed in their patients a very strong fear, almost a disenfranchisement with the health care system over the last several years. The elderly in particular seem to be very vulnerable, and at a time when they may be experiencing more health care needs. That’s worrisome to me. We can empower senior populations to make some healthy choices, to know that they are in control and provide them with tools to make informed decisions and let them know of programs that are out there.

PND: What specific initiatives do you have planned for each of these areas?

WF: I have been on the job about five weeks, and I am learning what programs the state has to offer. I have the opportunity in this job to move between different departments to link people to resources. I would like to see different organizations reach initiatives that the state is trying to launch: to increase children’s immunization rates, decrease youth access to tobacco, and that sort of thing. As far as youth access to tobacco, the Health Department has recently launched their Stop The Sale, Prevent the Addiction Program. The plan is to try to partner effectively with retailers to provide better tools so that they can help their clerks out of actually selling tobacco products to kids. In terms of violence issues, what we have planned is to sit down with Mrs. Ridge and the Children’s Partnership to see what initiatives they’ve taken and assist them as they link to organizations that I already know. There is going to be a major media component in this position, because we are launching a public health education campaign on a vast array of issues. I can assist in reminding people on a repetitive basis about prevention and other issues of health care.

PND: The state’s tobacco control efforts have been viewed by some critics as ineffective. What can you do to improve the efforts?

WF: When I listed as a priority reducing youth access to tobacco, I was very curious what the Governor’s response would be, particularly because of his political affiliations. He was very supportive. What can we do from a purely public health perspective without being partisan? This was a major area of questioning on the part of the senators on the Public Health and Welfare Committee during my confirmation hearing. They asked me questions such as, what’s your position on pre-emption [of local ordinances by state laws]? And basically what I said to them is that it’s really a political issue in some respects. I don’t really care, from a purely health perspective, how they work out that issue. If local municipalities have strong legislation in place and they have been able to reduce youth access, that’s a tremendous goal. If the state can craft similarly stringent or more stringent legislation, I would support that. I don’t know that I want to get into the political "one side versus the other side" because frankly, that part doesn’t interest me. The part that interests me is reducing access.

PND: But wouldn’t some legislation make it more difficult to reduce access to tobacco, such as raising the legal age from 18 to 21?

WF: From the Department of Health’s perspective, there are advantages to the law at 21 and at 18. The federal law is 18, and that basically put them in compliance so that they could get the CDC Program. That does not negate the existence of the 21 law, nor should it. The last thing we need right now is a divisive issue in a war on tobacco. I do think there is legitimacy to both positions. The Department of Health does not have enforcement capabilities. We’ve done anticipatory guidance with these kids for years. Parents are role models for kids. How do we bring parents into the organization? How do we bring kids into the equation and say, you tell us what would work? How can we give you the tools to help your peers avoid or quit? For instance, when we did our Stop The Sale, Prevent the Addiction Campaign, we had a student who had written his own rap around his concern for his 12-year-old brother who just started to smoke. The guy stole the show. So how could you potentially make a better impact with kids than using one of their own who speaks their language, I don’t know. There are other kinds of strategies that we need. Obviously, what we’re doing now has not been successful.

PND: On the minds of many physicians is probably the question of your authority and power. What real power do you have as PA Physician General to effectuate change?

WF: My position is considered, as the Governor referred to it, as a cabinet-like position. That frees me from doing a lot of the administrative sort of things, which frankly as a clinician, I don’t have a lot of interest in doing. I get to work inter-departmentally with people and pull people together. There has been, over years, a culture where someone with a piece of information that may be of benefit to this person over here could not speak to that person directly, and they needed to go up the ladder and then back down the ladder, and anywhere along the line it could be cut off at the knees. My role, as I see it, is to identify those issues, make those connections. As an example, I went into one of the state prisons last week. I met with the medical director and learned that he has needs which I think many people in the public health community assumed were already being met, but had not been accomplished by previous people in his job. The Department of Health had some resources that he could use to improve the long-term public health implications for inmate care, but didn’t know it. They weren’t aware of his existence or his needs, since he’s new to the job. So it’s pulling those people together: in a way, that’s not authority, but it’s clear to me that they’ve given me the ability to work for some systems to come into play that haven’t been there before.

PND: Have you been given any guarantees by the Governor or by the Secretary regarding any formalized authority?

WF: This is considered an advisory capacity. The Governor said for me to work closely with Acting Secretary of Health Daniel Hoffman, "but I want you to know, at any time that you need it, you have a direct line of communication to me." And he is very aware—the Governor is not shy—that if he has a question or a need, then he’s going to direct it to me. I have no intention of usurping other people in their roles, but if the issue is critical enough from my interpretation in the public health arena to say this is one that I need to go the Governor on, then I know now that I can do that. And that to me is very reassuring. Frankly, if I didn’t feel that I could do that, I’d leave, and I wouldn’t have taken the job in the first place. Frankly, I was very happy with my other life. If I really had thought that this position was not going to be able to make a difference for people, I wouldn’t do it, nor would I stay.

PND: The position of Physician General is seen by some as a bargaining chip for dropping the requirement that the Health Secretary be a physician. In that light, how do you see your role as a physician representative?

WF: I view myself as being partially a physician representative. Mostly, I see myself as being a facilitator for all sorts of public health issues. I don’t see myself as representing physicians from a political perspective. I don’t believe it’s my job to necessarily get in there and lobby for this change or that change. Physicians have very differing views on issues. There’s a lot of turf battles between different disciplines. For example, the expanding role of allied health professionals: some physicians see that as very negative, others see it as a positive. I believe that my number one responsibility is to the citizens of the Commonwealth, and not to any particular interest groups. There will probably be positions that I will take that some physicians will be in favor of and others will not, but that’s my job. There are huge numbers of issues that are put on my plate at this point, and I need to decide how to prioritize those. Ultimately, my goal is to look at quality and access, and how do we best get patients served. So, one of the things I’m trying to do in representing physicians is saying that we want to provide good quality care and we’re not out here just to protect our turf.

PND: What challenge does being the state’s first Physician General present?

WF: I am very cognizant that I am the first person to do this job. It’s very clear to me that there are issues that I may need to go to the wall on that are going to be difficult, not only for myself, but for those people who are going to come behind me in this job. It is not my intention to sell my soul. I said to one of the Senators that frankly, I’m going to be in this job for 2 to 6 years, and after that I need to step back into a medical community. I need to feel that they believe I represented them well. I’m only 37. That’s where the rest of my life is going to be. I really need to do the very best I can in a very short time so that the people behind me can hold to that level and not feel that we’ve sold them out.