Karen Guice, MD ’77, only has a few minutes to talk. She has to leave her office in the Pentagon precisely at 1:30 p.m. to head across the Potomac to the White House to give a briefing on opioid abuse.
“The President has said we need to do more to figure out the opioid issues within the country,” Guice explains, “so I go as the Department of Defense representative for what we’re doing for managing pain and the approaches we’re taking.”
It’s a typical day for Guice, 64, who is quick to point out that there really is no such thing because her schedule usually changes three or four times throughout the day. “I have a lot of meetings,” she says.
Guice works in a building where most people are in full military uniform, but she isn’t in the military. She serves as the principal deputy assistant secretary of defense for health affairs, second in the leadership chain of the Military Health System.
“This is kind of like being the COO of the Military Health System,” Guice says.
She helps oversee a $50 billion budget and manages 59 military hospitals, including the Walter Reed National Military Medical Center in Bethesda, Md., and the Dwight D. Eisenhower Army Medical Center near Augusta, Ga. There are also 360 health clinics, the Uniformed Services University and assorted private-sector health business partners. It’s Guice’s job to ensure that cost-effective, quality health care is available for 9.6 million active-duty military, as well as for retirees, survivors and their families.
She also develops military health policy and figures out how to respond to health crises, including the Ebola epidemic and the emerging threat from Zika virus.
Guice picks up one of the thick white binders stacked on her desk. “This is all the things Congress asked us to do this year,” she says as she flips through it to make sure the Defense Department is on track. Her desk is 1,884 miles from UNM, where she returned earlier this year to speak at the MetaECHO Conference about the military’s partnership with Project ECHO, the telemedicine program that enables medical specialists to help physicians in remote locations care for their patients.
Guice was raised in New Mexico. Her mother’s family has lived in Las Cruces since the 1920s. Her father, a World War II veteran and Louisiana native, worked at New Mexico State University while her mother was a teacher.
Guice discovered a passion for chemistry in high school and majored in it at New Mexico State University, which turned out to be a good preparation for medical school. She doesn’t have a real answer as to why she decided to pursue a medical career, though. “I’m not sure,” she says. “It’s one of those things that sort of just came to me. “
UNM was four hours from home, and the School of Medicine was still fairly new when she enrolled. “It was exciting to be there,” she says. After graduation, she did a surgical residency at the University of Washington in Seattle.
“I liked surgery,” she says. “It’s challenging. It’s fun to be able to figure out the surgical problems and find solutions.”
It was there that she met her husband Keith Oldham, now chief of surgery at Children’s Hospital of Wisconsin. “He was a year ahead of me,” she recalls. “We were on the same rotation. We were doing a case together – I think it was a pancreatectomy – and I said, ‘Have you done one of these?’ And he said, ‘No.’ And I said, ‘Well, I have. Let me show you how to do it.’”
A few years later, they started playing racquetball together. “One thing led to another and we married,” she says.
They spent the first year of their marriage apart when he took a job in Cincinnati. She joined him there and then they moved together first to the University of Texas Medical Branch at Galveston, and then to the University of Michigan at Ann Arbor. Later, they both worked at Duke University, where she became the first female professor of surgery.
Guice set aside her surgical career 20 years ago to devote herself full-time to health policy.
“It was Hillary Clinton and health care reform,” Guice says, explaining why she decided to get a graduate degree in public policy. “My fellow surgeons would talk about health care reform and say, ‘Oh, this is awful,’ and, ‘They don’t understand.’ To me, it seemed like you can be part of the solution or part of the problem. And I like to be part of the solution.”
The Sanford School of Public Policy is a 15-minute walk from the Duke University Hospital. Guice enrolled there in 1995, earning her master’s degree in public policy. “I loved learning the language of public policy and learning the levers public policy offers and learning how to navigate in that role,” she says.
Later, she moved to Washington for a year to serve as a Robert Wood Johnson Foundation Health Policy Fellow on Capitol Hill.
“She is very impressive,” says Nancy Ridenour, PhD, RN, dean of the UNM College of Nursing, who was also a Robert Wood Johnson Fellow. “In addition to being a surgeon, policy wonk and public health expert, she is very personable and interested in helping others.”
Guice went on to serve as a staff member of the Senate Committee on Labor from 1998 to 1999. She returned to North Carolina on the weekends to visit her husband and young sons – or they came to visit her.
“The kids loved coming to D.C.,” she says. “When I was leaving, they said, ‘Mom, it’s really great you’re coming home. But can we keep the apartment in D.C.?’ Because they loved coming and going to the Air & Space Museum and they went to the Clinton inauguration. They just loved it.”
The family instead moved to Milwaukee, where Oldham had been recruited to be head of surgery at the children’s hospital. Rather than return to her surgical practice, Guice conducted health services research. Then she was asked to be deputy director of the President’s Commission on Care for America’s Returning Wounded Warriors.
Soon, the Veterans Affairs secretary asked her to work for him. She liked helping veterans “navigate very complicated health care systems and get the benefits of services lined up for them,” she says.
Guice has a seemingly endless capacity for work. She sets her alarm for 5 a.m. and gets to the office as soon as she can. She stays past 6 p.m. most days, and often works much later. She lives in an apartment in Arlington, Va., just a few minutes from her office. Most weekends, she flies to Wisconsin to be with her husband.
Guice still has the love of problem-solving that she discovered during her surgical residency. Just this morning a soldier had emailed her because he wasn’t getting needed diabetes medicine. She solved his problem with one phone call.
She also manages much bigger crises that potentially affect thousands – or millions – of people. For example, during the 2014-2015 Ebola outbreak, she helped develop a strategy for how the military could work to try to get the virus under control.
Now she is developing guidance for military and civilians in the DoD for dealing with Zika. “We have deployed DoD servicemen, but we also have civilians everywhere,” she points out. “What is going to be our advice to them? Particularly if they’re pregnant or thinking about getting pregnant? How do we manage our people?”
Guice loved surgery, but says she doesn’t miss her practice.
“As a surgeon, you help one patient at a time,” she says. “If I’m working on a piece of policy – or with the Labor Committee on legislation – the words that go into a statute or the words that go into a policy affect many more people. The fact that I can actually do something that has a bigger influence was really appealing – and remains really appealing today. While I stopped practicing surgery, I was still able to influence the practice of medicine in a bigger way.”
With the current administration in its final year, Guice is winding down her Pentagon career. All her free time is devoted to building a retirement home on Orcas Island in Washington State. At the moment she’s reviewing landscaping plans, plotting where walkways will go and what she’ll plant in the garden.
“As for the house, I think we’re down to the last decision, which is what cabinet knobs I’m going use,” she says. “Do you know how many cabinet knobs there are? Oh my God! It’s daunting! And you can pay a lot of money for cabinet knobs.”
She and her husband are also downsizing their home in Wisconsin – deciding what furniture will go to the house on Orcas Island and what will go to the smaller place.
Her sons are grown now. The oldest is finishing a master’s degree in herpetology at the University of Kentucky, while the younger earned an MBA and works for Ernst & Young in Charlotte, N.C.
So, what’s next?
“Good question,” Guice says. “And I don’t know.” She does know she won’t go back to practicing medicine.
“I’ll do something in a medically related field,” she says. “I just don’t know what yet. It’s probably time that I start figuring that out. But I don’t have a plan yet.”
First, though, she has to go to the White House – and then pick out those cabinet knobs.