Steve & Vicky

“We talk about it all the time,” Steve says. “We don’t believe we could have done this anywhere else.”

Steve & Vicky

Steve Miller and Vicky Fraser came to St. Louis with the intention of staying just three years. Newly married, recently minted physicians, they intended to hone their training here at Barnes-Jewish Hospital and get to know each other’s families – although both grew up in St. Louis, they didn’t meet until later. Then they would leave, they told themselves, perhaps for Denver, where they had done their residencies, where the mountains loomed.

That was more than 25 years ago. 

Today Steve is chief medical officer of Express Scripts, the largest pharmacy benefit manager in the country and one of the most spectacular success stories in St. Louis business history.  Founded in 1986, Express Scripts now has revenues in the vicinity of $100 billion, making it the biggest company in the region by that standard and, in fact, one of the 25 largest public companies in the United States.

In 2012, meanwhile, Vicky was appointed chair of the Department of Medicine at Washington University.  The job puts her atop the largest department at the medical school, a department with 19 divisions, from allergy to rheumatology, and nearly 2,000 employees.  Because the more than 400 faculty members are also the medical staff of Barnes-Jewish and St. Louis Children’s Hospitals, the department also has clinical revenues.  These approach $250 million, while grant awards total more than $100 million.  Vicky is the first woman ever to hold the position.

Steve and Vicky, in short, are the consummate uber power couple in the area’s largest industry by employment, healthcare.  About 190,000 people here work in healthcare and social assistance, the U.S. Bureau of Labor Statistics reports, representing nearly 15 percent of the area work force.  The category, which is dominated by its healthcare portion, has been the fastest-growing industry here for many years.  More important, the quality of healthcare here is on a par with the care in nation’s leading healthcare centers – Boston, Baltimore, San Francisco – all much more expensive places to live.  St. Louis offers an outstanding delivery system, with at least two hospitals ranked among the nation’s top 10  (Barnes-Jewish and St. Louis Children’s); an outstanding educational system, including medical schools at both St. Louis University and Washington University, the latter often ranked in the top 10; and nationally prominent corporations, like Centene Corp. and Express Scripts

So, one might wonder, why? Why have such organizations thrived here so? 

Of course, no one couple, even one as strategically situated as Steve and Vicky, can speak for the entire medical community.  But in a conversation at a sidewalk café in Clayton, Steve and Vicky do offer some thoughts about why their own organizations have prospered here, and why they personally have been able to pull off their connubial high wire act. 

The answer, they say, can be boiled down to one word: support.

A key reason why the Washington University School of Medicine has been so successful, Vicky says, is its tradition of career development and mentoring.  Junior faculty are nurtured by more senior colleagues, and also receive generous support with grants from local foundations.

The atmosphere in general, she says, is conducive to “team science.  Our people are willing to work together, as opposed to a cutthroat environment where people are competing against one another.”

The same is true at Express Scripts, Steve says.  The company has developed many of its key executives from within, and has fostered a culture of collaboration internally and externally, developing relationships with Washington U., St. Louis University, the University of Missouri St. Louis (on whose campus the company has its headquarters) and other local institutions.

Support also characterizes the community in general, Steve and Vicky say, and has made the kind of life they’ve led here possible. 

“We talk it about it all the time,” Steve says. “We don’t believe we could have done this anywhere else.”

The community has nurtured them and eased their path in countless ways large and small, they say.  Vicky points to the support they enjoyed from their neighbors as they raised their three children, the youngest now in college.  When she had to bail on a car pool plan, there was always a neighbor to call on to help her out.  “All the other working parents helped each other,” she says.  “There’s a real village component to having a family here.”

When they needed to find a new house to accommodate their growing family, Steve notes, they were able to find one in a beautiful, safe neighborhood with good schools only 10 minutes away from both of their work places, which lie in different parts of the community.  While friends in other cities commute an hour or two a day, he commutes 20 minutes round trip.

“You increase your day by at least 15 percent!” he exclaims.  “And you get to spend the time with your family.”

Now that their children are out of the house, Steve and Vicky are spending what leisure time they have exploring the area’s restaurants and theater scene.  They’re impressed not only by the quality but the easy access.

Recruiting people from the coasts to Washington U. or Express Scripts can be difficult, Steve and Vicky say, because St. Louis is an unknown quantity to many of them.  

The trick is to get them to stay a few months, Vicky says.

“You expose them to some of the opportunities in culture and recreation, the greenery of the landscape, and the warmth of the community,” she says.  “And a lot of them are just taken aback.”

Just like Steve and Vicky were all those years ago.