Q&A with Physician Researcher of the Year: Dr. Michael Fassett

Michael J. Fassett, MD, came to work at Kaiser Permanente in 2000. Since then, his dedication to his patients through research has grown. He’s published more than 50 research papers in peer-reviewed journals. Now, as the regional physician-in-charge for Maternal-Fetal Medicine and the area research chair for the West Los Angeles and Kern County service areas, his research focuses on keeping moms and their babies healthy. He recently was named the 2023 SCPMG Physician Researcher of the Year.

Here is more about his journey …

Q: Dr. Fassett, where did your interest in becoming a doctor and researcher begin?

A: I grew up in Phoenix, actually wanting to be a wildlife biologist. I really liked being outdoors and was fascinated by the desert plants and animals. But my grandmother said “no.” She had more professional aspirations for me. My mom was a microbiologist, so I thought that might be a place to start and I got a bachelor’s in microbiology and French. Although my uncle is a nephrologist, a career in medicine wasn’t something I had thought of. Somewhere along the way my dad said, ”I think you would be a good doctor because you’re good with people.” And that’s what finally stuck.

Q: How did you come to Kaiser Permanente?

A: After graduating from medical school at the University of Arizona, I came to Southern California to do my residency and fellowship at Los Angeles County-USC Women’s Hospital. I had ranked other programs above USC, but I’m thankful I matched at USC. The training was so valuable because of the volume and diversity of the patients. I stayed on as faculty for 3 years and published my first paper there in 1999 about a rare kind of liver failure during pregnancy. Due to the ongoing changes in academic medicine and the faculty practice, I took a position at Kaiser Permanente.

Q: What was the change like for you?

A: As a new faculty member at USC, I had to generate revenue for my salary, and constantly seek out new practice opportunities to continue to generate revenue. At the same time, I also had been practicing as a contracted provider at Kaiser Permanente a few days a month in Bakersfield. At Kaiser Permanente, I appreciated the freedom to practice evidence-based medicine, without the insurance company authorizations I needed for my faculty practice. I could prescribe patients what they needed and practice the way we should practice without having the financial considerations. I didn’t know research would be part of what I would be doing, but I give credit to my department chiefs and medical directors who have allowed me the flexibility to make research a part of my practice.

Q: So, when did you become involved in research at Kaiser Permanente?

A: It started with doing a research paper I needed to complete to join the Pacific Coast Obstetrical and Gynecological Society. Having just come from academia where I had published a handful of papers, I was looking for a way to continue with research at Kaiser Permanente. That opportunity came during a quarterly regional perinatology meeting. Darios Getahun, MD, PhD, (a research scientist with the Department of Research & Evaluation) presented his perinatal research program and said he was looking for clinicians to partner with him in research. He asked, ‘Is there anyone interested’? No one raised their hand. Except me.

We published our first study together in 2009 about the racial and ethnic disparities in cesarean birth. Since then, we’ve published more than 40 papers in medical journals. All because I raised my hand that day.

Q: How has the collaboration with Dr. Getahun worked?

A: The collaboration with Darios has been one of the highlights of my career at Kaiser Permanente. Darios has strong research questions in areas where Kaiser Permanente can uniquely contribute to the literature. I’m able to provide the clinical perspective and know-how to help execute clinical studies, help programmers find data in Kaiser Permanente HealthConnect®, and be a clinical sounding board for ideas and papers.  We work together so that the research is strong and can have a real impact on clinical practice. For example, we did research on flame retardants in fabrics and their impact on preterm birth. He developed the research question, grant, and study design, but I was able to help organize the clinical work, such as recruiting the women to join the study when they initiated prenatal care, to get the data for the study.

In the resulting 2021 study of about 3,500 women, we showed that high concentrations of PBDE-47 — a chemical used in flame-retardant fabrics —  in a woman’s blood during the first trimester of pregnancy was associated with an increased risk of preterm birth.

We’ve also collaborated to look at hyperemesis, or morning sickness, which is one of those topics that isn’t flashy and often doesn’t get a lot of attention. But it’s a topic that Darios has a great interest in, and I am grateful to work with him on researching it. Hyperemesis often doesn’t get a lot of research attention because, for the most part, it is temporary and resolves by the end of the first trimester. I think that really discounts the often-severe difficulties patients with hyperemesis go through, as well as the impacts on their families and children.

One study we worked on showed that children who were exposed during pregnancy to hyperemesis gravidarum — a severe form of morning sickness — were 53% more likely to later be diagnosed with autism spectrum disorder.

Q: What research are you most proud of?

A: In 2020 during the first weeks of the COVID-19 pandemic, we were seeing what was happening in New York, where many women going into the hospital to deliver had COVID. Based on those early reports, everyone was operating on the assumption that the same thing was happening across the country and universal screening of laboring patients was recommended. We implemented universal screening and began to notice that our rate of infection among pregnant women was very low, and those that were positive weren’t passing the infection onto their babies. We were able to show that by performing universal SARS-CoV-2 screening on admission for delivery, knowing the patient’s COVID status allowed us to strategically direct our care and limited resources to where it was needed most. The study published in the American Journal of Perinatology and helped to inform how we and others cared for pregnant patients early in the pandemic.

Q: Where will your research interests take you next?

A: There are many directions I would like to go, but one focuses on making things better for our patients by supporting the kind of evidence-based practice that Kaiser Permanente is uniquely positioned to provide. As it is now, we often must follow national guidelines that often seem to be geared toward the fee-for-service model of care and generate utilization of resources and often anxiety for patients. For instance, one guideline calls for a very detailed fetal cardiac ultrasound if the mother went through IVF. But a moderately detailed screening evaluating the 8 most important structures would be adequate to detect most cardiac defects. There are other issues with required ultrasounds and growth curves that are outdated. So, going forward, I’d like to do the kinds of studies that promote or support the kind of practice we do here at Kaiser Permanente — the kind of practice that works well in an integrated system, the kind of practice where patients aren’t put through tests they really don’t need.

A bit of background:

The SCPMG Physician Researcher of the Year award has been given each year since 2007 to recognize a physician or surgeon for his or her outstanding contributions to the research community.

Dr. Fassett, the 2023 Physician Research of the Year,  has authored more than 50 journal articles and speaks both nationally and internationally about pregnancy and its complications. Between 2007 and 2014, he served on the California Maternal Quality Care Collaborative Pregnancy-Associated Mortality Review, which led to efforts that reduced maternal mortality in California. He is also a senior examiner for the American Board of Obstetrics and Gynecology’s national certifying exam.

Dr. Fassett is a graduate of the University of Arizona College of Medicine and is an associate professor in the Department of Clinical Sciences at the Kaiser Permanente Bernard J. Tyson School of Medicine. He is also a fellow of the American College of Obstetricians and Gynecologists.