Some view the emergency room as one of the toughest places to work in a hospital. But Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2004-2006) and new White House Fellow Thomas Fisher, M.D., M.P.H., sees it as an opportunity to better understand the health and health care needs of a diverse range of patients. “I work in the emergency department because patients can be seen there no matter who they are—they receive care.” That important distinction is key to Fisher’s view of medicine. “I do not simply see health care as a business. There is a human rights component to it, from my perspective.” Fisher’s passionate commitment to creating a health care system that offers quality care to people from all walks of life will guide his work this year as he becomes the fourth RWJF Clinical Scholar to join the prestigious White House Fellowship program.
“I am interested in vulnerable populations,” Fisher explained. “In my work and as a White House Fellow, I intend to focus on a number of issues including questions such as, ‘how do systems of care produce disparities and how can those disparities be reduced?’ This year, I plan to add new tools to those I’ve gathered in my clinical and academic work and as a Clinical Scholar.”
During Fisher’s RWJF term, he taught high school students how to do research on disparities and analyzed discrimination in physician/patient relationships. “One of the members of the Clinical Scholar program’s National Advisory Committee planted the seed in 2006 that got me interested in the White House Fellowship program,” Fisher recalled. “That’s an example of the opportunities given to Clinical Scholars. Visionary guidance is one of the great assets of the program,” said Fisher, who was most recently an assistant professor in the Department of Medicine at the University of Chicago Medical Center.
An Inside Look at the White House Fellowship Program
As Fisher arrived at the White House in September to begin his term as a Fellow, Clinical Scholar (2006-2009) Anish Mahajan, M.D., M.P.H., completed his year as a Fellow and returned to the UCLA-David Geffen School of Medicine. Now free to discuss his experiences, he offers a view of an on-the-job training program unlike any in the world.
“In an effort to teach us how government functions in sectors that affect not only health, but all areas of public life, as Fellows, we were taken on policy study trips,” Mahajan explained. “My group went to El Paso and New Mexico to explore border control and immigration issues; New Orleans to understand how the city is recovering post-Katrina; and spent a night on an aircraft carrier in the Atlantic to understand the concerns of naval personnel who were about to be deployed to Iraq,” said Mahajan, adding, “I feel tremendously fortunate to have been given such an opportunity.”
Fellows learn about the inner workings of the large federal agencies, attend a series of seminars and work at federal agency assignments. Throughout their terms, they are given a rare view of how leadership works at the highest level of government. “We had off-the-record conversations with leaders such as President Obama, General Petraeus, Justice Sotomayor, among many others,” Mahajan said.
“It was also great to work directly for Zeke Emanuel, M.D., special advisor for health policy at the Office of Management and Budget (OMB), because he’s a physician from the world of academia like us, who is now making health policy at the highest level,” said Mahajan, who was assigned to then-OMB Director Peter Orszag’s team. “The experience at OMB taught me how policy is made and how scientific evidence is used,” continued Mahajan, an expert on HIV/AIDS testing and prevention, whose work included contributing to the rules for the meaningful use of information technology in physicians’ offices and shaping the National HIV/AIDS Strategy.
From Scholar to Fellow to Full-time Public Servant
While Mahajan and Fisher are unsure of the paths they will take after their Fellowship terms, Clinical Scholar (2005-2007) Patrick Conway, M.D., M.Sc., graduated from the program and immediately put his new skills to work as chief medical officer in the Secretary of Health and Human Services’ policy division. In his work, Conway helped allocate more than $1 billion for comparative effectiveness research on various aspects of the health care system.
Clinical Scholar (2003-2005) Laurie Zephyrin, M. D., a White House Fellow from 2005 to 2006, has also made a commitment to public service. This year Zephyrin, an obstetrician and gynecologist, became the first director of reproductive health for the Department of Veterans Affairs (VA).
“Being a Fellow completely changed my life,” said Conway, who suggests other RWJF scholars consider public service to learn more about public health policy. “It gives you a perspective far beyond clinical experience and aligns with the Clinical Scholar program goal to train leaders.”
“I had always been interested in health from a population perspective,” Zephyrin said. “During my RWJF term, I learned how to conduct health services research. As a Fellow, I was able to see how those research findings could be used to help real people from many viewpoints—and apply this to improving health systems.”
“Federal government employees are trying hard to serve the public,” Conway said. “But they need more people with clinical and research backgrounds to increase their effectiveness.”
Conway, a pediatrician, spent his Fellow term working for Carolyn Clancy, director of the Agency for Healthcare Research and Quality (AHRQ) and the Secretary. His projects included the first personal health record pilot program for Medicare and the National Quality Forum, where he worked on a strategy to reduce health-care acquired infections.
While Zephyrin’s work as an RWJF Clinical Scholar focused on cancer screenings for women with HIV/AIDS, as a Fellow she worked with a team to develop emergency preparedness training programs for various VA facilities. “That experience exposed me to issues related to providing quality health care to the increasing population of women veterans,” Zephyrin said, “and led to my interest in my current work, where I am lucky enough to be doing something I am passionate about.”
Becoming a Fellow
White House Fellows Fisher, Mahajan, Conway and Zephyrin join Health & Society Scholar (2007-2009) Mehret Mandefro, M.D., who was also a 2010 Fellow. Selection for the non-partisan, 46-year-old Fellowship program—created in 1965 by President Lyndon Johnson—follows, “a rigorous application process, but Fellows are ultimately chosen for their ability to be leaders in their field,” explains Cindy Moelis, director of the President’s Commission on White House Fellowship. “They may work in other disciplines, but they also learn about important public health issues.”
Now back at UCLA and preparing for a new career challenge, Mahajan says, “I now have a much greater sense of how to frame my research and determine what type of questions policy-makers need answered.” Conway has now returned to Cincinnati Children’s Hospital to take a new post as director of Hospital Medicine and Evidence-Based Decision Making. Zephyrin is building a groundbreaking department focused on women’s health at the VA. And Fisher says, “I hope to someday be influential in shaping the health care system and the incentives that will help physicians and organizations deliver better care to people without resources.”
The Robert Wood Johnson Foundation Clinical Scholars program advances the development of physicians who are leaders in transforming health care through positions in academic medicine, public health and other roles.