A New Point of View:
The Health Policy Elective
IQ Solutions, Inc.
You are in a meeting listening to acronyms that are faintly familiar, trying to wrap your head around the problem that needs to be solved, and you are amazed at the brainpower at the table. Clinical Scholars who choose the policy elective find themselves in such situations, and they speak about the experience in glowing terms. The policy elective was a natural outgrowth of the program’s commitment to marry medicine, health services research, and community-based participatory research. Scholars can spend one to three months with fellow physicians and policy-makers intent on improving health policy—in an office in the U.S. Department of Health and Human Services, in a local or state public health department, or at another organization with a health policy focus.
This elective is enabled and enhanced by the large number of program alumni who work in policy positions and are enthusiastic about mentoring current Clinical Scholars. The policy elective was piloted at the UCLA site and has been adopted at all four program sites.
Ken Wells, MD (UCLA CSP 77–80) Clinical Scholars program co-director at UCLA, says, “To me, the community work and the policy work were always very connected. To get impact at the community level, policy has to be aligned with the needs and resources available in the community.”
From the beginning, Clinical Scholars have gravitated toward policy positions. A few examples: David Satcher, MD, PhD (UCLA CSP 75–76) became U.S. Surgeon General; David Carlisle, MD, PhD (UCLA CSP 88–90) became director of health planning for the state of California; and Kavita Patel, MD (UCLA CSP 03–05) became senior health deputy for Ted Kennedy, and then policy director for the White House Office of Intergovernmental Affairs and Public Engagement. As more Clinical Scholars have chosen the policy path, the mentoring options have grown.
Pediatrician Ashaunta Tumblin, MD (UCLA CSP 11–13) recently finished a policy elective in the state of Vermont. She traces her interest in health policy to one pivotal moment. “When I learned that medical care services make up only 10 to 15 percent of what determines health, and behavioral patterns and social circumstances make up 50 percent, it seemed clear that policy could be a major lever for change.” One of Tumblin’s mentors in Vermont was a Clinical Scholars national advisory council (NAC) member, Karen Hein, a fellow pediatrician who serves on a board focused on reforming the state’s public health system.
Arjun Venkatesh, MD (Yale CSP 12–14) is currently in a policy elective at the Center for Clinical Standards and Quality within the Centers for Medicare & Medicaid Services (CMS). He talks about being influenced by the stories he heard from individual patients. “In emergency medicine, we see everyone from richest to poorest, and we also get to see the whole spectrum of clinical disease. So you start hearing why it’s often not what medicine you prescribe, but the other challenges—being able to fill the prescription, being able to afford the prescription, being able to follow up with somebody in two or three days to see if the medicine is working—that separates patients with good outcomes from those with bad outcomes.” Venkatesh focused his research on performance measurement, and his policy elective has given him a different angle on the subject. “I’ve had the opportunity to go from doing research around quality measurement to actually seeing it implemented in policy, which means that when I go back to Yale and finish my fellowship, I’ll have a million new research ideas just by seeing this side of it.”
A Place at the Policy Table
Ashok Reddy, MD (Penn CSP 12–14, VA Scholar) is currently at CMS as well, serving in the Center for Medicare and Medicaid Innovation. “While it’s often said that the plural of an anecdote is policy,” he says, “it’s been great to see what type of research and data can shape that policy. I think my background as a physician has allowed me to bring my perspective on how a given policy or program can affect clinicians and patients.”
Nicole Lurie, MD, MSPH (UCLA CSP 82–84) is one of those Clinical Scholars who took the path toward policy-making early on, and she has been a key player in developing and promoting the policy elective. As the current Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services, she has mentored many Clinical Scholars who have come to her office for the policy elective. “For me,” she says, “each Clinical Scholar comes with a different background and experience, and each one is expected to contribute to the problem solving. They keep our thinking fresh and cutting-edge. There’s a very intelligent give and take, like in the Clinical Scholars program itself. It enriches not only them, but also the experience of this organization. They are people with vision.”
Absorbing New Lessons
Lindsay Jubelt, MD (Penn CSP 11–13, VA Scholar) was mentored by Lurie. She says, “Nicki’s schedule is very busy, and her office covers an incredible amount of different areas. So trying to wrap my head around what was going on in each of the meetings and creating a conceptual map for myself took some time. But there are good things about just being thrown in. I think it’s the quickest way to learn.” Jubelt says the policy elective gave her skills she might not otherwise have gained. “Seeing Nicki manage large groups of people, and seeing how she approached, structured, and solved a problem was amazing. I got to sit next to her and ask her questions and be on the inside of her thinking process. Also, she’s a wonderful storyteller, and that is an incredibly effective way for getting attention for a problem, and getting people on board to want to solve it.”
Leadership and the Larger Community
Nishant Sekaran, MD (Michigan CSP 10–12) also admired the leadership qualities of his mentor, former Clinical Scholars NAC member and RWJF Harold Amos Medical Faculty Development Program fellow, Hermina Palacio, MD, MPH, at the Harris County, Texas, Department of Public Health. Sekaran says, “You can analyze leadership upside down and sideways, but at the end of the day it’s like analyzing a musical performance. You absorb it on many different levels, you’re processing that information, and you hope you can take all the good from that and make it characteristic of your own style.”
Good communication was also an important element of Sekaran’s experience.
“It’s a lot about framing the issues and making information accessible to people in a very personal way so they care, and at the same time translating the complex scientific findings so they’re accessible to the public. The way information was communicated in Harris County was inspiring, and when I came back to Michigan, I sought out an opportunity to work with our local NPR affiliate to report health news for our community.”
Health communication is front and center for Lisa Rosenbaum, MD (Penn CSP 12–14, VA Scholar) in her policy elective at the New Yorker magazine’s online edition. “I’m not making health policy,” she says, “but I hope I’m informing the conversation.” In addition to writing articles on health and health policy, Rosenbaum helps decide which aspects of health policy to cover and which writers should be assigned to health topics. She also advises the editors when health-related content edges into hyperbole. “I believe the cultural conversation that often drives the legislation can be shaped by certain pieces that appear in the press. It’s hard to draw a straight line from an essay to a policy, but I feel—and often worry—that those types of work can inform policy even more than research does.” Even as she moves into her field of cardiology, she feels that writing about health and health care will feature prominently in her career. “A lot of this is about, ‘Who am I, and what do I love?’ I love taking care of patients, and I love writing. The Clinical Scholars program is very good about letting us find our niche.”
Personalizing the Policy Elective
Ken Wells described the way Desmond Runyan, MD, DrPH, the Clinical Scholars national program director, and others have tried to help identify policy opportunities that closely fit each scholar’s interest. Wells says, “We think the scholars will have more impact, and it will be more sustainable for them, if the policy work is closely aligned with their passions.”
Ben Springgate, MD (UCLA CSP 05–08) a New Orleans native, tailored his policy elective in a way he could not have predicted. Springgate came into the program the year Hurricane Katrina hit his home town, and he spent much of his time in relief efforts, then strategizing with Louisiana public health officials. “After the immediate shock and rescue mode,” he said, “there were a number of individuals and institutions that came together to begin to create a new vision: what health care services delivery could look like in the reconstituted greater New Orleans area.”
Nicole Lurie has seen a steady stream of Clinical Scholars with a range of interests, and she attests not only to the gains they’ve made, but also to the new ways their passions have aligned with their health policy options. “Often they’ve defined an area that’s fairly specialized. They’re interested in making change, but they don’t yet have the experience of how you frame that, what might influence policy. Many discover there are more choices than they thought.” Lurie recognizes this wider view as something that was given to her, and that she’s interested in passing on. “Since the time I was a Clinical Scholar, I have relied on the network. My old colleague and mentor John Eisenberg said, ‘If you see a turtle on a fencepost, you know it didn’t get there by itself.’ It’s our responsibility to help train the next generation for lasting and enduring change.”
The Clinical Scholars network provides not only direct mentoring, but also a series of open doors to other alumni who work in policy. Ben Springgate calls it “a unique time, and a tremendous opportunity to learn.” Arjun Venkatesh says, “Throw yourself in the pool. Be there in person and spend time developing the relationships you need on your career path.” According to Lisa Rosenbaum, “You get to see how other people think. You can’t ever lose with that.” And Nicole Lurie sums it up this way: “There’s a different kind of confidence you gain in the policy elective, a different toolkit. It’s scary to get out of your comfort zone, but it’s one of the most important things you can do, if you want to be a change agent.”