Northwell Health President and CEO Michael Dowling likes to ‘be 1st in everything’

When the first shipments of Pfizer-BioNTech’s Covid-19 shots were ready in December 2020, so was Michael Dowling.

US healthcare leaders scrambled to be the first to inoculate frontline staff against the virus that had laid siege to hospitals, nursing homes, and other facilities for months. But it was the Northwell Health president and CEO who ultimately secured that bragging right—and thrust New York’s largest healthcare system into the national spotlight.

“I just wanted to do it quickly because it’d give confidence to the staff and everybody else,” Dowling told Healthcare Brew.

But the Irish immigrant, known to be as competitive on the hurling pitch as he is in the boardroom, conceded that he had another motivation: “I like to be first in everything.”

Chasing perfection

That drive to be No. 1 has fueled Dowling’s journey from humble beginnings in Knockaderry, Ireland—a village roughly 25 miles southwest of Limerick and where he grew up poor and working on farms—to the corner office at Northwell’s headquarters in Long Island’s New Hyde Park.

His energy permeates the culture at the health system, which he helped build up into a $16.5 billion enterprise that employs more than 83,000 workers across 21 hospitals and almost 900 outpatient facilities—and he has plans to grow it another 50% in the coming years.

“You’re always chasing perfection, all the time,” the 73-year-old Northwell leader told more than 200 new employees when asked about the organization’s “unwritten rules” at an early March orientation. Dowling stressed later that he’s more concerned about his employees seeking that quality rather than actually achieving it—a leniency he doesn’t often seem to extend to himself.

For about 20 years, the Northwell leader has attended the weekly Monday morning sessions to meet new hires and answer their questions—which can range from inquiries about his brief tenure as an Empire BlueCross BlueShield SVP (a job he found “boring”) to which woman he’d want to be for a day (Jennifer Lopez).

To Dowling, these candid interactions are key to his “in the trenches” leadership style, which eschews titles and isolation in the proverbial ivory tower.

He routinely walks the floors at Northwell’s hospitals (during a pandemic or not) to check in with staff, at times posing for 50+ selfies along the way. That engagement has inspired the #IMetMichael hashtag on Instagram and foiled any hopes of Dowling appearing on Undercover Boss.

“He has an intensity that even among executives is rare,” Don Berwick, president emeritus and senior fellow at the Boston-based Institute for Healthcare Improvement—a nonprofit for which Dowling serves as a board member—told Healthcare Brew. “I don’t know how he gets everything done. I’ve never seen anyone work harder.”

Under Dowling’s leadership, Northwell has transformed from a regional operation to a nationally recognized system that treats more than 2 million patients each year and tallies over 5.5 million patient encounters.

The health system includes five major hospitals—Lenox Hill Hospital, Long Island Jewish Medical Center, North Shore University Hospital, South Shore University Hospital, and Staten Island University Hospital-North—16 other hospitals, multiple academic institutions and partnerships, and a research institute, as well as urgent care centers, pharmacies, and ambulatory specialty centers across the Greater New York area.

The health system has more than doubled its operating budget in the last decade, and Dowling expects to grow that to $18 billion by 2024. (He’s also been rewarded for his efforts: Dowling earns $7.6 million in annual compensation, according to Northwell spokesperson Barbara Osborn.)

To do that, Dowling and other Northwell leaders have focused their efforts on internal innovation, data strategy and partnerships, venture investment, and joint ventures and partnerships—notably  partnerships with Aegis Ventures like women’s health company Caire and AI-focused healthtech company creator Ascertain. The leaders also hope to partner with “like-minded and equally motivated health systems” across the US.

Ken Raske, president of Greater New York Hospital Association (GNYHA)—an influential trade group for which Dowling serves on the board of directors—said the Northwell leader “may have demonstrated the most impressive growth in the country in developing a [health] system.”

Berwick, who briefly served as Centers for Medicare and Medicaid Services administrator under former President Barack Obama, offered that the Northwell leader’s “courage” to break the mold, innovation, and “real sense of the workforce” not only distinguishes him from other healthcare executives but also makes him “a case in point for effective leadership.”

From the public to the private sector

A dock worker turned Fordham professor and eventual power broker, Dowling first gained attention for his role in shaping healthcare in the ’80s and ’90s as a member of former New York Gov. Mario Cuomo’s administration. He served as state health, education, and human services director; deputy secretary to the governor; and commissioner of the New York State Department of Social Services.

During his 12 years in state government, Dowling helped craft policies that, among other things, set new work requirements for public assistance and ensured children who were born with AIDS and in the foster care system received care.

Following a brief stint at BlueCross in 1995, Dowling joined the then-North Shore Health System later that year as EVP and chief operating officer. He oversaw its 1997 merger with Long Island Jewish Medical Center (which became North Shore-LIJ Health System) before being named president and CEO five years later in 2002.

Despite never officially returning to the political world—even though he said he’s received offers to do so from leaders in the US and abroad—Dowling has continued to help craft key healthcare policies in New York while leading Northwell Health, as it was christened in 2015.

Under Mario Cuomo’s son, then-Gov. Andrew Cuomo, he cochaired both of New York’s Medicaid redesign efforts—initiatives that had major implications for New York hospitals that often rely on public funding to offset low Medicaid reimbursement rates.

Andrew Cuomo again turned to Dowling as New York became the global epicenter for the coronavirus outbreak, meeting with his father’s former commissioner in addition to his own administration officials.

Dowling, who used his vast hospital network to balance patient loads—which hit 800 Covid patients in some of its tertiary facilities at the height of the pandemic—also inspired the Cuomo administration’s decision to adopt a similar strategy statewide.

Northwell teams assisted in New Rochelle, the state’s first Covid hot spot, and the system’s laboratories were among the first in the nation approved to process Covid tests.

The New York governor was not the only one who sought out Dowling’s help to fight Covid. The Northwell leader said he fielded calls from healthcare officials and leaders in Ireland, and he also coordinated with other hospital executives across the US on staffing.

“Everybody in the country who runs a healthcare system knows about Mike Dowling and Northwell Health, and has a great deal of admiration for him,” Raske said, adding that CEOs checked in with him about the Northwell leader during the pandemic.

Loretta Glucksman, who chairs the American Ireland Fund and the Glucksman Ireland House at New York University, told Healthcare Brew that Dowling also invited an Irish family who had been struggling to access care into his home during the pandemic—just one example of the many people the Northwell leader confirmed he’s brought to the US for healthcare services. That “deep respect for individuals as human beings,” she argued, is key to his success.

But while Andrew Cuomo’s hospital-centric pandemic response contributed to his public fall from grace (and eventual resignation following several sexual misconduct allegations), Dowling has largely not come under fire for the state’s Covid-era policies.

Northwell, however, drew scrutiny after the New York Times reported that the system continued suing patients over medical debt during the pandemic, at a time when others had suspended the practice.

And Dowling did not escape the pandemic entirely unscathed.

Hammond and others criticized Dowling for endorsing a controversial Cuomo administration report that undercounted Covid deaths in nursing homes. Dowling also faced backlash—including demonstrations outside his home—for requiring Northwell employees to get vaccinated against Covid.

Raske argued that Dowling’s ability to make tough decisions, like the vaccine mandate, highlight his leadership abilities.

“You could teach everything else about being a CEO: listening well, communicating well, and obviously evaluating, analytically, situations. But the one thing you can’t teach […] is courage,” he said. “Mike has that very distinctive characteristic of a man of courage.”

What’s next

Now in his 21st year at the helm of Northwell, Dowling has no plans of slowing down—even as he prepares to hand the reins over to someone else “in the next couple of years.” Still, he “can’t ever contemplate” actual retirement, calling it “God’s waiting room.”

Dowling is eyeing major expansion opportunities for the health system in Connecticut and other states as he looks to grow Northwell’s already large footprint outside of New York. He’s also looking at ways Northwell can reenter the insurance space (getting out of it was the “biggest disappointment” of his tenure, he said), and he’s leading a national coalition of hospital CEOs in a campaign to combat gun violence.

That Ahab-esque ambition and his inability to be “completely satisfied” shone on a trip to Huntington Hospital, as Dowling paused mid-interview with Healthcare Brew to take stock of a new for-profit medical practice Summit Health location.

The Northwell CEO later told Huntington Hospital employees that he’s not too fazed by the competitor: “We know the people who run it. He lives in Florida; he’s on the beach right now.”

Competitors like Summit underscore the need for Northwell to continue to innovate and run its facilities better than emerging companies in the healthcare space, Dowling said. Those changes will dictate the future of the health system, which Dowling said he hopes to steer with a hand-picked team of executives and his eventual successor—who has not yet been named publicly.

“The key role for someone like me is to make sure that the next leadership can build upon what you’ve developed,” he said. “It’s a balance between staying around long enough to build, but not staying too long that you diminish the creativity of the organization.”

But the transition away from Northwell—of which Dowling knows every “nook and cranny”—will not be easy.