We need all of your “too much” here.
Earlier this month, on International Women’s Day, the #BalanceForBetter campaign was launched, calling for collective action to drive gender balance across social, economic, cultural, and political realms worldwide. Here in the U.S., one of the most glaring examples of gender imbalance in a business setting is in healthcare, where only about 30% of senior leaders are women — despite making up 80% of the total industry workforce.
Things look a little different over here. The majority of our clinical leaders are women, driven by a shared determination to radically change how we deliver care to where it’s needed most.
Welcome to Cityblock.
“I’m allowed to be myself here. And being genuine is better for our members.”
Christina Gerdes, MD, is a first-generation American, her father’s family having emigrated from the Dominican Republic. Today, she is one of Cityblock’s Medical Directors, focused on behavioral health. She grew up in a big family, and as a teenager, she noticed that one of her cousins exhibited symptoms of being on the autism spectrum. “He couldn’t talk, he had minimal words,” Christina says. “I remember thinking in high school, why wouldn’t you just bring him to the doctor? Why would that be an issue?”
Throughout her education and early career, Christina put those early observations and interests into action, volunteering with an organization that served children with autism and a women’s shelter in college and working at a student-run free clinic during medical school. She later chose Columbia University’s residency program in part to train in its state-run facility that offers free inpatient and outpatient behavioral health care for the local community.
It’s at Columbia that she first met Juliana Ekong, one of Cityblock’s Associate Chief Health Officers and a fellow psychiatrist. “I loved Cityblock’s mission of providing really great care to underserved communities who wouldn’t get the same kind of care elsewhere,” Christina says about her path to Cityblock. “And I wanted to work with people like Juliana who cared about that, too.”
For Christina, Cityblock was a place she could be totally herself. “In other places that I worked, I was often the only woman in the room, certainly the only black woman in the room, and the youngest. I remember someone making a comment about my hair, and thinking, why are we talking about this?” Christina pauses, shaking her head in disbelief. “When I came to Cityblock, it was nice that I didn’t have to think about not fitting in. It hasn’t crossed my mind since starting here that I’m young, or African-American, or a mom.”
Her interactions with members look different at Cityblock, too. “I’m more comfortable, I can bring my whole self to the interactions with members. Because my personality comes through, they feel like they’re working with a person, not a doctor who they feel won’t listen to them.”
“One thing that’s different here is an intense focus on maintaining our cultural philosophy, this clear sense of how we want to be driving better outcomes.”
When Juliana Ekong, MD first looked at the Cityblock playbook for how the founding team aimed to deliver care, she noticed right away an important difference in their approach. “Often it’s business decisions first, and how the organization wants to define culture comes from or alongside those decisions,” she says over breakfast at the long communal tables in our Brooklyn office.
“As opposed to here, where treating people with respect, autonomy, and compassion, is in itself the business decision. It is the outcome — it is what we agree that drives results. Our ‘Ways of Being’ are intentional and core to our care model.”
She goes on to explain how these “Ways of Being” extend to seemingly simple decisions about using respectful, inclusive language in Cityblock’s care delivery platform, Commons — because how care recommendations are presented in Commons directly translates to how Community Health Partners view their roles and how, in turn, they work alongside members to achieve outcomes.
For Juliana, these “Ways of Being” were a crucial factor in choosing to work at Cityblock. The focus on social determinants of health and the fact that Cityblock prioritizes working with people living in economically disadvantaged communities were some others.
“As a younger psychiatrist working with a mostly immigrant population in Washington Heights, I quickly realized that my tools for helping were woefully inadequate. Therapy and psychopharmacology were not what many of my patients needed to get healthy — food, work, a safe home, literacy, and social support were much, much more important,” Juliana explains. “The issue of how to treat those illnesses within a holistic care setting, valuing them as illnesses that are in some situations even more important became a focus.”
She goes on to say, “Delivering holistic care is very intentional and core to Cityblock. And I was beyond thrilled to discover that. I am grateful and lucky to be working alongside a team with a similar perspective and an inspiring drive to succeed. It is a fantastic feeling to do good work, in a good way, with good people.”
“It’s all about empathy and how you treat people at a basic level. It’s that humanism, that we’re all aligned on how we treat people first — that’s beyond amazing to me.”
Josefina Aquino, LMSW, ACC, a social worker by training and Director of Care Team Development at Cityblock, is exactly the kind of person you hope to meet on your first day at a new job. She exudes optimism and has a knack for supporting others in working toward their own career goals. It’s no coincidence that new care team members spend more time with Josie than anyone else in their first weeks at Cityblock.
“When new team members come in, I think it’s helpful that they know I’ve done this work before, I’ve been in the field doing what they do,” Josie says between training sessions for new Community Health Partners. “It helps them to really take in strategies I’ve learned, such as motivational interviewing, that they can then take to how they care for our members, try it, adjust to make it work for them.”
Josie joined Cityblock after having her own successful healthcare consulting and coaching business, where she helped leaders across the healthcare industry develop and execute care management programs and build integrated care teams. Before that, she worked at a large managed care organization, where she met Juliana. Together, they built and lead integrated teams of medical and behavioral health care providers, collaboratively caring for patients in a previously siloed organization.
It makes sense, then, that Josie shares Juliana’s value of Cityblock’s “Ways of Being,” and works that into how she trains new care team members. “People here are aligned on those core values of how to treat people, how to focus on trauma-informed care, how to build trusting connections with members. It’s an amazing thing that we started with this baseline,” Josie says. “And to maintain this amazing culture, it’s now on team members who are here over time to embrace it and keep it alive as the team grows.”
“I have loved the fact that we have had really strong clinical, operations, and product/engineering voices on equal level carrying out our mission.”
Ari Rosner, LCSW, Head of Social Care, had never met a software engineer or product manager before joining the founding team of Cityblock — but she saw the opportunity here to build exactly what the communities she cared about needed most.
Before Cityblock, Ari worked at a large health system, where she was a part of team-based care for patients with conditions that have a significant mental health component — including patients with kidney disease and HIV-positive pregnant mothers to ensure their babies were born without the virus. Later, she built and ran a Health Home as part of New York state’s inaugural program, caring for individuals on Medicaid facing chronic health conditions and social challenges.
“These programs were successful in many ways, but they were hard to scale,” she says. “Cityblock gave me the chance to build something with a team from scratch, to design and promote how interdisciplinary care teams can drive behavior change and help people to achieve their health goals.”
When she joined, Cityblock was early in its conception, still at Sidewalk Labs — and the team consisted entirely of men. But with Ari and Toyin joining the founding team, Ari says things changed quickly. “I felt welcomed and heard from the start,” she says, “And as we’ve grown, I feel so fortunate that I have so many examples here of women who are strong executives but also extremely warm, compassionate, and humble people. I learn from them every day and can only hope that I’m also able to provide that kind of modeling and guidance as other women join.”
As Head of Social Care, Ari is tasked with leading Cityblock’s understanding of the challenges members face in their daily lives and addressing those needs as part of their overall care plan. She emphasizes that it’s critical for care teams to work closely together and ensure members are part of making decisions about their own care.
“I got a call from a member last week who didn’t buy it, he didn’t believe that we had all of the services we were saying could support him,” she recalls, smiling. “His Community Health Partner called me to legitimize it, and he was able to come to the Hub, to meet with a doctor and a psychiatrist at the same time, and then we connected him with the right program in the community. That just doesn’t exist elsewhere.”
“Trust is so important in how we deliver care. The values of the people that we hire are where that comes from. It sets the norm for how we reach out and take care of people.”
Marcy Carty, MD, MPH, one of Cityblock’s Associate Chief Health Officers, says that her career started on one great love: “fixing hospitals.” A bit tongue-in-cheek, but it’s clear that Marcy’s entire career has indeed been dedicated to improving care delivery in large, complex healthcare organizations. After working in hospital leadership, she moved on to population health (“how do we keep people out of the place I love?”), eventually becoming a hospice medical director — and throughout, she was always focused on enhancing people’s quality of life.
“The [traditional healthcare] system doesn’t focus on the lives our patients lead,” Marcy explains. “There’s so much waste, so many people who don’t have a voice, who don’t understand what good or great looks like in terms of their own care. I was always asking, how do we decrease waste? How do we empower and connect people to a good system that takes care of them?”
Cityblock, Marcy says, offered her the chance to work with a team on tackling these big questions and building better solutions. “I was intrigued by the ability to build for purpose, to use technology, to build quickly so we could have an impact in a year, not in ten years like in traditional healthcare.”
She stresses that for a company like Cityblock to have that impact, and to be sustainable, it has to invest in supporting and nurturing its teams — having transparency about why decisions are made, ensuring everyone’s ideas and opinions are considered and valued, and empowering people through autonomy in their role while also knowing that their team has their back. She also says it’s important that leadership respect people’s own time and priorities in their lives beyond the office, even when there is a lot of work to do.
“I want people to make sure they’re growing towards whatever goals they have in life and career,” she says, “And part of that is for me as a leader to be available to them and to make sure they are able to voice their opinions and ideas. If anyone needs anything, I make it happen. It might be 8:00 at night after a crazy day of meetings, but I will make it happen.”
“I’m sitting on a giant beanbag with my laptop, wearing jeans, my boss has her shoes off…and 10 of the 11 leaders in this room are women. This is a totally different world.”
That’s the awesome text message that Theresa Soriano, MD, MPH sent to her friends on her first day at Cityblock. Theresa, an internist and palliative medicine physician, is the latest addition to our clinical leadership team, joining us as Regional Chief Health Officer in New York and Connecticut after developing and leading programs in hospital and home-based settings for people with complex health and social needs. She says that she joined Cityblock for exactly the reason she went into healthcare — to impact communities that fell through the cracks and were too often ignored.
“I believe the way Cityblock approaches care — integrated, rooted in the community, not a one-size-fits-all clinic — that’s how you change healthcare in under-resourced communities,” Theresa says. “Because the members we’re engaging may not trust the healthcare system, a system that’s failed them, it’s especially important that Community Health Partners are from the community or understand the circumstances there — and that we put them at the forefront of care, building trusting relationships with members first.”
And she realizes that it’s up to leaders like her to continue to build and embrace that culture, Theresa says. “Being a woman leader and not always having women mentors — the majority of mine are still men, that says a lot about the last 15–20 years in healthcare — it’s a responsibility I want to take with people, championing women leaders internally and externally.”
Another important point she makes: it’s okay to not be all about work, all the time. “As a mom and a wife, I want women to know it’s okay to prioritize all of those parts of your life and take them as seriously. It doesn’t diminish your work quality or priority. Your life outside of work is so important for fostering your strengths and contributions.” Theresa says.
“And you know what else? It’s okay to have help to do all of this. Even as mentors, if we can help in our own way to get people to advance to a greater potential, then we’re helping to make the world a better place.”
“When I started at Cityblock, I thought, ‘I could pick any one of these women to be a mentor.’”
If you’re sensing a trend here, you’re onto something: Cityblock’s clinical leaders envision a better way of caring for people — and Associate Medical Director Emily Hurwitz, DO, is no exception. “I became a DO, a family doctor, because I was always looking for different ways to improve health and well-being, instead of reactionary medicine or pill-giving as a way to appease patients,” Emily says. “I wanted to get to the bottom line of what’s bothering them and causing their illness.”
After residency, Emily spent time at a practice in North Philadelphia, serving communities that faced significant social challenges in addition to high rates of chronic conditions. There, she saw the value of team-based care but wanted to take it a step further than caring for members at the physical doctor’s office. But she wanted to be out in the community more, meeting members where they are literally and figuratively — and Cityblock was the place she wanted to make that happen.
“At first I didn’t notice it, it felt so natural to be in a room of powerful women making important decisions,” Emily says on joining a team of women leaders as a young physician. “But then I stepped back and realized how lucky I am to be a part of this group. Everyone is different, with their own niche, but we all have the same mission, passion, and goals. We all have different paths, but we all ended up here for a reason.”
She says that Cityblock cultivated collaboration and learning through mentorship. This culture is something she had been looking for in the first years of her career. “I realized that the guidance was missing, I had just started my career and knew that I could go a lot of different ways. But, the mentorship and focus on example-driven ways to find solutions was missing, “ Emily says. “That pulled me towards Cityblock. When I started here, I thought, ‘I have so many accomplished and trusted women to choose from and any one of them will play a key role in supporting and teaching me.”
That mentorship has already been valuable, Emily says. “I have incredible, positive support here. I have colleagues in my corner, who understand me and will go above and beyond to support me both personally and professionally.”
“We need all of your ‘too much.’ All of the things that in the past made you less endearing to people who are not used to women leading, those are exactly the things we need from you.”
The first question I ask Toyin Ajayi, MD, MPhil, Cityblock’s Chief Health Officer and Co-Founder, is how in the world she managed to convene this team around an incredibly difficult problem.
“Predominantly hiring women wasn’t intentional!” she laughs, sitting at a table where she had moments before been chatting with a member who stopped by at the first Cityblock Neighborhood Hub in Brooklyn. “We wanted people who were at the top of their game, who had built teams, who understood that health is about what goes on every day in people’s lives, who could convey warmth and tie that into concrete, operational workflows.”
“In the past, I’ve felt a ton of pressure in previous roles to suppress the feminine aspects of my leadership style, that they’re too emotional, soft, not operational,” she says. “But here, we want all different styles. There’s room here for doctors who love spreadsheets and data, for technologists who feel deeply about how we deliver better care to people, there’s room for men, women, for all gender backgrounds to behave in ways that are not normative in most workplaces.”
It was important to her that she convene a diverse team like this, united around a commitment to improving community health in neighborhoods where people had been burdened with the consequences of long-standing social inequity. She says that was as much about people bringing different experiences and perspectives to the Cityblock team as it was gender, race, and ethnicity.
“It’s so important that people can be themselves, that they bring their whole self to work. In the male-dominated spaces where I’ve previously worked, I found myself being as unobtrusive and non-threatening as possible, concealing some of my skills, playing down strong opinions, being less strident.” she says. “We’re told that we’re too aggressive, too much.”
She pauses, then in true Toyin style, says, “We need all of your ‘too much.’ All of the things that in the past made you less endearing to people who are not used to women leading, those are exactly the things we need from you.”