A few weeks ago Michael Dowling returned to west Limerick where he grew up in the late 1950s. He was astonished at how dramatically the area had changed but not altogether surprised to see his childhood home in Knockaderry had fallen down.
“Part of it fell down on us when we in it when I was young,” says Dowling, who is chief executive of New York state’s biggest private employer, the North Shore-Long Island Jewish Health System. The cottage had a thatched roof and mud walls – “the kind of thing they build for tourists now” – and no electricity or indoor plumbing.
Dowling’s father was a labourer with the county council but suffered from such severe arthritis it rendered him unemployable. His mother had lost her hearing as a child. Materially things were not easy. When Dowling was 15 he stepped up to the plate as the eldest of five children and went to England to work in a steel mill for a summer.
His family’s economic situation was driven home to him during an encounter with a local farmer whose son was getting ready to go off to college. The farmer said offhandedly: “Isn’t it a pity someone like you can never go to college?”
Dowling determined then and there never to let his circumstances limit his potential, and decided he would become the first in his family to go to third-level. He was subsequently accepted into UCC.
In order to pay his way and help his family financially he went to New York for several months each year and worked seven days a week on the docks in west Manhattan. The gruelling hours meant he had no social life but he remembers being “totally energised”.
After graduating from UCC he returned to New York, where he earned a master's degree in social policy from Fordham University.
He was then asked to teach at Fordham, one thing led to another and he became a faculty member and heading the university’s Westchester campus.
Through his role at the university he became involved in public policy in New York, and when Mario Cuomo was elected as the city's governor in 1982 his staff got in touch and asked if Dowling would be willing to join his administration. Despite initial reluctance Dowling accepted, and worked his way up to become deputy secretary to Cuomo.
What was supposed to be a year-long sabbatical from Fordham turned into a 12-year stint serving in government during which he held a number of positions including New York State director of health, education and human services. “I never intended to stay 12 years but it was a fabulous education.”
He was then recruited into the private sector, initially joining insurance company Empire BlueCross/Blue Shield before moving to North Shore in 1995 – “a very big, very reputable hospital here in New York”.
He joined as chief operating officer at a time when the company was beginning the process of creating a large, integrated health system: since then it has expanded “like crazy”. In 2002 he took over the reins as chief executive.
North Shore now has 50,000 employees, 17 hospitals, its own insurance company and $7.1 billion (€5.5bn) in annual operating revenue. Under Dowling’s watch the organisation has earned a myriad of awards for the quality of care it provides to patients, and the Limerick man is ranked among the 25 most influential healthcare leaders in the US.
Despite the demands of his position he has always maintained links with Ireland, bringing students from Cork and Limerick over to North Shore for work experience every summer. More recently he has become involved with Irish affairs, sitting on the Taoiseach’s healthcare committee.
When it comes to the travails of the HSE, Dowling believes the Government has to leave behind the “micro-management” mentality and allow innovation to blossom.
Of course, unlike the HSE, North Short is a private operation, allowing Dowling great freedom. “In my organisation I can do the hiring and firing. If people are not producing here you can change them. I notice that’s very, very hard to do in Ireland.”
Despite the cultural differences he believes that if the Government does not get too rule-bound and allows “smart people to figure things out”, the foundation will be laid for “better outcomes” in the Irish health system.
And what of today’s generation of Irish emigrants – can they still expect a welcome in the land of opportunity?
The visa situation is far more restrictive now but Dowling says that if you can get past that hurdle there are still amazing opportunities for people who are “hard-working and passionate”.
He says emigrants in general tend to succeed because by definition they are not afraid of risk. After all, they left their home country to try and improve their situation. “They’re willing to do anything to be successful.” And Dowling himself is testament to that.
Michael Dowling was speaking yesterday at the West/North West Hospitals Group healthcare conference in Westport, Co Mayo.