SARAH: This is At the Core of Care. A podcast where people share their stories about nurses and their creative efforts to better meet the health and health-care needs of patients, families, and communities.
I’m Sarah Hexem Hubbard with the Pennsylvania Nursing Workforce Coalition and the Executive Director of the National Nurse-Led Care Consortium.
On this episode, we're going to explore the current landscape of community health centers with PHMC Health's new medical director, Dr. Pheobe Askie. Pheobe supports PHMC Health's clinical staff across five community health centers in Philadelphia. She received her undergraduate degree in nursing and is now a board certified physician in both lifestyle medicine and family medicine.
Prior to coming to PHMC Health, Pheobe practiced family medicine in Louisiana.
Pheobe, welcome to At the Core of Care.
PHEOBE: Thanks, Sarah. I'm happy to be here.
SARAH: So we love hearing about how our guests got into health care. Can you tell us your story?
PHEOBE: If you ask my mother, she'll tell you I've wanted to be a doctor since I was two years old. And so how I actually ended up in nursing is the interesting story. I actually went to Penn's undergraduate visiting days and, you know, there was nobody at the nursing table. I was like, Oh, okay, I don't want to wait in line for the other things. So I'll just go talk to them.
And they told me all the wonderful things that Penn Nursing did and how great their program was. And I was like, Oh, okay, but I'm going to be a pre-med. And then the girl goes, Oh, I'm pre-med and the girl next to her goes, I'm pre-law.
And so they proceeded to kind of tell me about what the benefits of a nursing education was and, you know, as a 17-year-old, it sounded pretty convincing. I was like, Oh yeah, that makes sense. It's like such a great education. Why wouldn't I do that? I said, Oh, if I get into Penn, I'll be a nursing major.
And, good thing I did get into Penn. It was one of the best decisions I made as a 17-year-old. It definitely provided me with my passion, I would say. Because I was able to be more hands-on as a nursing student, I got to be in the community for the first time and actually worked as a community health organizer during undergrad.
And that is my lifelong passion now. I want to be where people are… I feel like there should be like an Ariel song. Somewhere in there.
SARAH: We won't start singing in this episode.
PHEOBE: No, nope. Nope. I'm saving you from that. And then so, even though I did go into nursing school, I worked as a nurse for a year because I was tired after exhausting four years, but then ended up eventually going into medicine.
I went to med school at Robert Wood Johnson and came back and, again, family medicine all the way at Jefferson. Ended up in Louisiana and got even more entrenched in community medicine there. Louisiana is such an interesting place. Such lovely people, but also so many health system issues that need to be addressed. And so I was really excited to kind of get my feet wet in community medicine there. I learned so much about how our healthcare system is helpful and unhelpful at the same time for people.
And so as I continue on my community health journey, I am very grateful to have been in Louisiana to learn where some of our opportunities are and some of our challenges in community medicine.
SARAH: So prior to recording this conversation, of course, you know got very excited about Pheobe's undergrad in nursing. But you talked about the relationship focus of nursing and how that's really stayed with you. Can you tell us a little bit more about that?
PHEOBE: Yes. I think that, whenever I tell people that I was a nurse first, I like, Oh, that makes sense. It's just a different model. In terms of the medical model where it's more focused on disease and nursing tends to be more relational. And, I think that's also probably why I ended up in family medicine and lifestyle medicine, because I feel like to be able to, treat people, you have to know them.
Like, I can't prescribe anything for you if I don't know what's going to work best for your lifestyle. So I feel like nursing taught me that. Not to say that medicine doesn't teach that now. I just think they're just a little bit later in the game. Now, I feel like the kids are going to be okay, they're selecting for kids who want to like have that relationship.
I feel as if, having your relationship with your primary care, clinician is so important, because you may be completely young and healthy at some point, but at some point, you're not going to be and you're going to need them.
SARAH: And so moving into medical school with that background in nursing, how did you see medical training as a nurse?
PHEOBE: I felt like I was better prepared than probably my peers were. I had already learned to work in teams and I knew who did what in teams. And I think that that kind of helped me in medical school.
It definitely made me more of an asset to the team I was kind of working with because I was like, oh, I know how that works. Let me just go ahead and do that. I suppose that it is something you learn in medical school, but it just kind of made me a little bit ahead of the game.
SARAH: And as a clinician, you've mainly delivered primary care, largely in community health centers. So, looking at things now, 2025, how do you define primary care?
PHEOBE: Wow. That is a big question. Primary care is very all-encompassing and nobody knows what we do. Everyone has a little bit of a separate definition. How I define it really is care to maintain health at the everyday level. It definitely is something that can encompass many different specialties, depending on where you are, and the skill of the person who you're working with.
How I kind of practice primary care is kind of kind of a journeyman sort of mentality. I try my best to just kind of meet people where they are, especially at the community health center level, like where people are. We'll go together. We'll do this health journey together. You'll ask your questions. I'll ask my questions. We'll come up with a plan. So I think of it more of as like a partnership.
And I think that's why primary care is so important. There's so much information out there, so much. The Internet will tell you you were dying. Do not believe the Internet. You might be dying, but talk to somebody about it. So I think that's why primary care is so hard to define because it's a lot of different things. But it is something that I feel like you do together with whoever's providing you primary care
SARAH: And something that's so nice about the community health center setting, and for those who don't know, community health centers, we're really talking about federally qualified health centers. We’ve had a couple episodes in the past looking at the health center program.
So when you're describing primary care, is that a certain population? Like, is that pediatrics or the whole family? Who are you serving in a primary care setting?
PHEOBE: As a family doc I really enjoy getting to know the mother, as she journeys, and then when the baby comes out, you get two patients, which is such a lovely thing to happen. And kind of watching people grow is something that I feel like a lot of people who end up in primary care really like and then, at the other end of it, is kind of journeying as people kind of get probably a little bit sicker, a little bit, less able to take care of themselves and working with the family to kind of make sure that they do that in a way that's dignified and gives people a really good quality of life.
SARAH: When I hear you describe family medicine, I really hear the family in it. So I always appreciate that.
So, zooming out a little bit, you spoke about, the health systems and the ways in which that maybe advances health and maybe doesn't in some cases. So looking at our current health system structure, we had talked a little bit about how insurance plays out and what it means for the continuity of care when your insurance may be changing and all of that.
So, curious about, you know, your perspective on that. So we're recording this in March 2025. What does that look like right now? And then we can think about what things might look like going forward.
PHEOBE: I feel like our current insurance system makes it really hard to have those primary care relationships that I think are really beneficial for people's overall health. I think a lot of times people's insurance is related to their jobs. And then if their job decides that they want to get a different insurer, that may change who they get care from.
And people don't really have a lot of say in that. On the other end of like non-profitized, insurance, like Medicaid, definitely has its benefits, but also has its limitations. I love it that people who are coming to our health centers get access to us, get access to care. I am worried in this current environment that Medicaid will not cover as many people as it currently is.
I think that being in Louisiana, I definitely heard horror stories before they expanded, Medicaid, that you would get a patient and then they would come to the ER and then you couldn't do anything for them. They would just basically keep on coming to the ER until something really, really bad happened to them because Medicaid wasn't expanded.
As opposed to post, like you didn't have as many options as private insurance, but you still had something you could offer people. And I feel like that is something I am worried in this current environment that we may have to face again. We might have to start making choices.
Especially during the pandemic, a lot of people where I was got access finally to Medicaid and like had a list of things that they actually wanted us to kind of handle. And it was just amazing to see people who never had access before get access and actually make some of those changes that was so vital to them feeling like they could be well again, like actually take the time during the pandemic to get healthier.
Which you don't generally think about during a pandemic, but people actually took the time to come see their doctors. I feel as if community health centers are a great space for, I always tell people, like, no, no, no, I don't care if you have insurance because that's the point of the community health center. Come see me. Oftentimes people will be like, well, I lost my Medicaid because I fell off the rolls for whatever reason.
And I'd be like - you know that I can see you without health insurance, right? You know that we do a sliding scale fee. And they're like, oh, I didn't know that. Because that's how non-community health centers, a lot of them work, is that they don't necessarily operate with a sliding scale fee, so they can't see uninsured for various reasons, which are very complicated.
But we at community health centers can. So I love that ability to see people regardless of their ability to pay or, even their immigration status. It's just something that I think that community health centers does such a good job at, and especially addressing some of the particular concerns in those communities.
SARAH: So, at the time of this recording, the United States Congress is working through a continuing resolution that was actually just recently passed. For those listening in the future, you'll know how this all turns out. The bill does include significant domestic spending cuts and, very much on the table, is the conversation about Medicaid.
So, right now, Medicaid provides health coverage to more than 70 million Americans, and certainly, all across the lifespan, including children.
You just described some of the ways in which, you know, just sort of being on Medicaid and being tapped into the Community Health Center Movement, you know, that you can kind of have that continuity of care, really focus on building that primary care relationship.
What would it look like for Medicaid to go away or to be scaled back in any kind of regard?
PHEOBE: Let's, you know, hope that with future listening of this, that does not happen. But if it does happen, that does put the operations of our community health centers as well as our rural hospitals at risk of not being able to stay open. Medicaid definitely provides that little bit of buffer so that we can be sustainable at our community health centers.
On the patient side, I think that it will look very dire. I hate to kind of be doom and gloom, but I do think that people will have a really hard time accessing the care that they need. And kind of will do what they did before, they'll wait until it's really extreme, until they're at the point where they can't not seek care. Which we know that that leads to worse outcomes.
So I really hope that we're not in the future time talking about Medicaid cuts, but that is something that I fear. I hope that people do kind of get tapped into community health centers because we can, somewhat, provide some care. We won't be able to provide the full gamut if Medicaid was to go away, but it is another access point to at least get some medical advice.
SARAH: Yeah. And for those less familiar with the community health center. program. So health centers, federally qualified health centers, do receive base funding from the federal government. It's not sufficient to operate, but it's certainly very important in developing those access points. And then certainly Medicaid for health centers as well as for hospitals, large health systems, small health systems, really do depend on Medicaid and Medicare for their operations.
So, certainly a lot of uncertainty, certainly something that we'll all be paying attention to, but that has a very real impact on individual lives as well as the health system as a whole.
So let's, focus on something maybe less doom and gloom, of maybe a little bit more positive and also cost saving actually. So talking about costs on one side to the other. The trend toward preventative medicine, what has that looked like in your time? Obviously you became board-certified in lifestyle medicine. Can you tell us a little bit about what that is? How did you decide to pursue that as a field? What does it look like?
PHEOBE: So lifestyle medicine is the prevention, treatment, and cure of chronic disease, through lifestyle modifications, We target six areas. We target obviously nutrition and diet because those are really important things. We really try to promote plant-based diets. Sleep, because, you know, if you, don't sleep, we all know the effects of not sleeping.
And then also good social connection, avoidance of risky substances like alcohol and smoking, and then, of course, mental health, making sure that is taken care of as well.
I got into lifestyle medicine because I was like, well duh. This makes sense. And really a lot of my patients were asking me things that they could do.
I feel like at the center of lifestyle medicine is autonomy. Like I am choosing to do these things that are helpful, but then also in there is the social determinants of health that we know that what I do as a clinician is very minuscule in the terms of like someone's overall health. And so I wanted to figure out a way that I could help people to help themselves essentially.
And I think a lot of people who kind of journeyed with me into lifestyle medicine felt like they were more empowered. They would come back to me and be like, Dr. Askie, I did this, this, this, and this. And I'm like, yes, go ahead. You're going to do this. You got this. And my job really is just to provide that information so that they know what they should be doing or shouldn't be doing.
Change is not easy. So my support is like to kind of just help with people who struggled with that change. So I felt like lifestyle medicine was a great way to practice primary care. Cause I was already telling people how to do things, but, you know, your doctor tells you to go eat vegetables.
Great. Okay. What am I supposed to do with that information? Of course I know I'm supposed to be eating vegetables. Of course I know I'm supposed to not be smoking, but how to make that actionable is why I went and got that extra board certification in lifestyle medicine.
SARAH: And now you're back in Philadelphia overseeing five community health centers. And also for those not in the area, PHMC Health is responsible for the nursing services in the shelter system in Philadelphia and operates two medical respites. So it's a rather large portfolio, lots of different kinds of lifestyles, lots of kinds of healthcare being delivered.
What are you bringing to this new role from your work in lifestyle medicine, your time in Louisiana? What are your hopes and dreams?
PHEOBE: Oh, I have so many hopes and dreams. I really, really love the mission of PHMC. I was like, man, they provide a medical respite. How awesome is that? Like, it just makes sense. Somebody's sick. They should not be going back out into the street. They should be having a place where they can actually rest.
And then they're where people are in the shelters. Like, I really, really loved the mission of PHMC. What I hope to bring to PHMC is more of the lifestyle pieces of it. Trying to incorporate more community engagement so that our health centers function more as a medical home, a place where people really feel connected to their community and their health care team.
We are doing a lot of new things. We just recently added podiatry services, so that's super exciting. Then we're trying to expand our mental health program and including child psych. We're also trying to expand in general pediatric services.
So I am really hoping that we can become even more entrenched in the Philadelphia community, which we are. I really want that to grow. And I really want us to be a space where we are helping communities grow healthier every day.
SARAH: Well, and I know for us and for those who have been listening for a while, you know, that at NNCC, we do a lot of maternal child family health and really are excited that, that Dr. Askie will be able to bring some of that expertise to care for newborns, to care for mom, to care for family. So definitely excited about that.
PHEOBE: I'm also excited about that because we are also working to expand our reproductive health services as well. I was like, I say in my former life, but I was a reproductive health advocate, but you know, I'm still that and so I'm hoping that we can offer more family planning services as well as support anybody who wants to be pregnant, to maintain a healthy pregnancy, and then to also have a healthy childhood for those Children.
And we're going to work with NNCC and the Nurse-Family Partnership to continue connecting our patients to their community.
SARAH: And I know that for those who are very familiar with federally qualified health centers, you know that things like behavioral health, dental, podiatry, are really all seen as part of the standard of care. But for those who aren't, you might be surprised to hear about some of those services.
Can you just share a little bit about behavioral health consultants and what that kind of holistic model of care that we typically see in a community health center?
PHEOBE: Another reason why I fell in love with community health centers a long time ago is that they really do try to do one-stop shopping. So, you can come see your primary care clinician and then, on that same day, you're like, you know what, I really want to talk about something that's going on. Maybe it's surrounding your diabetes and you want someone to kind of work with you in terms of, like, the emotional side of diabetes, which there is. It's not just a physical problem.
We have our behavioral health consultants. They'll see you that same day and then, if you need to feel like there's more depression or anxiety kind of going on around that, we will do a nice little warm handoff and you can meet one of our psychiatric providers.
And, if you're at the right clinic on the right day, you might be able to even walk in for dental services. So that model of where we can have seen multiple different people in one day and one day off from work because I, you know, you are taking time off from work. So if you're going to take time off, might as well get it all done, is something that I really love about community health centers.
And we at PHMC definitely do that as well.
SARAH: I think that there's so much about lifestyle medicine, about meeting people where they are, that we do need to make it a little bit easier to maintain health as you had kind of set us up from the beginning.
So, coming full circle to nursing, to relationships, Why do relationships matter in health care?
PHEOBE: I think relationships matter in healthcare because we don't actually know when things are going to go awry, but they do. And having that relationship when you're well can really make it much easier to access care, and to have somebody actually know you and what your goals are and what you wish for, and that time of need. That just takes away so much stress when you're like, ahh I'm in the middle of these strangers and they don't know me. They don't know why I didn't come in for this until now. They don't know anything about what's important to me, what my goals are.
So really that relationship helps people care for you, and I know we all know that going into urgent care, they don't really know you, they're just trying to solve a problem and you kind of feel like I'm just a number. But when you get that personal relationship that you have with your clinician, who knows you and knows your wishes and desires, I feel like it creates a better outcome. And you're more able to kind of manage when you really, really need help and support.
SARAH: We're coming to a close in our conversation today. Do you have any final thoughts you want to share with our listeners?
PHEOBE: Call your Congress people and tell them to support funding for community health center. I really do think that community health centers serve a special place in communities across the country, not just here in Philadelphia. They provide care to people who wouldn't otherwise get care, but then are also a great access point for anybody who needs care.
SARAH: Well, you have your instructions. Pheobe, thank you so much for making time today. It's been a pleasure having you. We'd love to have you back sometime.
PHEOBE: Thank you. It was great talking to you today, Sarah.
SARAH: Special thanks to Dr. Pheobe Askie for joining us. You can find our most current and past episodes of At the Core of Care wherever you get your podcasts or at panursingworkforce. org. For more information on upcoming webinars and trainings for nurses to obtain continuing education credits, log on to panursingworkforce.org.
And on social media, you can stay up to date with us through our handles @nurseledcare and @panursingworkforce. At the Core of Care is produced by Stephanie Marudas of Kouvenda Media and mixed by Brad Linder. I'm Sarah Hexem Hubbard of the Pennsylvania Nursing Workforce Coalition and the National Nurse-Led Care Consortium.
Thanks for joining us.
