Leadership

Physicians-in-Training: An Untapped Resource for Health Care Innovation

Article · April 5, 2018

As the U.S. health care system seeks to improve the value and efficiency of its complex ecosystem, physicians-in-training offer a compelling opportunity to address these problems. Many members of the current generation of physicians-in-training are creative, tech savvy, entrepreneurial, willing to challenge the status quo, and increasingly are interested in cultivating expertise in innovation. These physicians have great potential to drive improvement in the health care system. However, established pathways for fostering the frameworks necessary to utilize these talents remain uncommon, and may be ill-defined or circuitous.

If leaders fail to engage these young physicians, they may choose to leave health systems to become external disruptors of health care or leave the practice of medicine altogether.  We offer a series of actionable strategies by which leaders can help unlock the potential of these aspiring physician innovators. We outline structural changes in training programs that can facilitate enacting the strategies. These five strategies consist of both formal and informal approaches, and can be pursued individually or in combination.

Develop Accessible Leadership Pathway Programs

No longer is the focus of physician training simply on clinical excellence; increasingly, residency and fellowship programs endeavor to create physicians who have specialized education beyond the bounds of core medicine training. The essence of innovation is improvement. Improvement requires change; effecting change requires leadership. As training programs increasingly recognize the importance of cultivating physician leaders, enrolling in a leadership pathway is a strategy that has become more accessible. Well-established pathways exist at Duke University; University of California, San Francisco; University of Pennsylvania; and Brigham and Women’s Hospital.

Still, this change is by no means universal and significant variation exists. Some of these programs are embedded in a specific residency program (e.g., internal medicine). Some are part of an institutional program offered to all residency programs. Some require an additional year of training; some are only available to residents, not fellows; some are available only to individuals with previous formal business training. Several of these programs pair trainees with a leader-mentor, who can help the trainee learn how best to present new ideas to health system leaders. Leaders can encourage participation in these tracks by portraying them as equally valuable as more traditional pathways (such as basic science or translational research), and by designing a clear pathway for advancement within the organization following completion of training.

Collaborate with a Health Care Start-Up

Physicians-in-training can learn much from collaboration with a start-up, and leaders need to facilitate such relationships. Start-ups offer agile and innovative approaches to issues of care delivery, cost reduction, and patient engagement. Start-ups rapidly and repeatedly modify products and methods in response to input from individuals in the target field with the goal of defining utility early. Start-ups can expose postgraduate trainees to principles of leadership that may be directly applicable to leading ward teams and teams of health care providers in organizations after training.

A key feature shared by great leaders is having a diverse personal and professional stakeholder network, as this enables leaders to engage people who think differently than their typical associates. In a complex world with increasing transparency, relying on traditional development practices will stunt a leader’s growth. Furthermore, changes in health care systems often impact stakeholders in the three major sectors of health care (private, public, and nonprofit) — an understanding of the private sector through collaboration with a start-up can foster an understanding of different frameworks for innovation and different stakeholder objectives. By collaborating with physicians-in-training, start-ups gain diversity of thought and insight into the workings of a field that they might otherwise lack. Compared to established faculty, trainees are still relative outsiders, and can offer fresh perspectives. Trainees may see start-up work as part of their future career, and thus may have more motivation to contribute.

Not only can health system leadership benefit by collaboration with start-ups, but those relationships also can offer valuable training for new leaders. Dreamit Health enables start-ups to have immersive experiences with a number of health systems across the country; the TMCx accelerator at the TMC Innovation Institute of Texas Medical Center formally pairs external entrepreneurs with internal thought leaders and advisors. The value in these collaborations cannot be seen only in terms of potential equity sharing or intellectual property ownership by the health system — indeed, such demands often turn away potential partners. Instead, the value lies in the ability to foster internal innovators by enabling the growth of their personal networks and providing exposure to individuals with different paradigms for innovation. The TMCx enables such partnerships without requiring membership fees or equity sharing on the part of the entrepreneurs. Health systems can support involvement by physicians-in-training by providing protected time (such as a dedicated rotation) to participate in these collaborations.

Create a Health SystemBased Accelerator Program

Health systems are increasingly creating methods by which innovation can be cultivated from within, a concept that has been dubbed insourcing innovation. Examples of such programs include the Innovation Accelerator Program at the Penn Medicine Center for Health Care Innovation, the Jefferson Accelerator Zone at Thomas Jefferson University, and the Innovation and Digital Health Accelerator at Boston Children’s Hospital. These programs provide many of the insights achievable from collaborating with start-ups without the potential conflicts of interest, and with an easier path to institutional support and acceptance. For example, the Penn Medicine Center for Health Care Innovation employs the strategy of experimenting and iterating quickly and at low cost, scaling only when a solution demonstrates value; this is a key principle of agile development practiced by many start-ups. The approach has allowed the Center to create value for the health system in a number of high-priority areas, including superutilization management, teledermatology, and new patient load balancing.

Physicians-in-training are well-positioned to participate in these programs and can often serve as project leaders. Training positions at such accelerators are often limited and competitive, but for the lucky few accepted, the opportunity offers valuable and personalized mentorship, funding, and institutional recognition. Leaders can support this strategy by introducing the accelerator to trainees early in their programs, and enabling protected time to work on such projects within the accelerator.

While such programs may not be practical for stand-alone hospitals, a system need not be formally integrated with a large academic medical center to create a successful accelerator. Mission Health, an innovative community hospital system in western North Carolina, operates the Mission Center for Innovation, which provides training and support for developing and deploying innovative ideas.

Support Health CareFocused MBA Programs for Physicians-in-Training

Physicians with business training have a unique ability to speak the language of both physicians and administrators. Acquiring an MBA during medical school is common (nearly half of U.S. allopathic medical schools offer combined MD/MBA programs, though room remains for improving business training in medical education). Similarly, acquiring an additional advanced degree or certification during residency or fellowship (such as an MPH, MPP, or formal training in epidemiology and biostatistics) is common. However, pursuing an MBA during postgraduate training remains an uncommon path for trainees whose interest in innovation is first piqued by experiencing the process of patient care after medical school.

Residency or fellowship may provide a superior growth medium to that of medical school — most MBA programs seek individuals who have real-world experience in their chosen fields, something medical students are just starting to build. Residents and fellows, however, are still active learners and bring significantly more experience and carry much more responsibility. A variety of MBA programs have dedicated health care tracks, including the Health Care Management Program at the Wharton School of the University of Pennsylvania, the health care concentration at the Owen Graduate School of Management at Vanderbilt University, and the Health Sector Management program at Duke University’s Fuqua School of Business. Such programs often incorporate field application projects, in which students immerse themselves in real-world consultative engagements (often outside of academic medicine) and gain exposure to different stakeholders and perspectives in the health care ecosystem.

The path of completing an MBA in training is not streamlined — programs that are willing to incorporate formal business education are rare, and the path to realize such training requires a trainee to be motivated and tenacious. Health care leaders should support more pathways to support participation by physicians-in-training in a full-time MBA program. Such pathways could be modeled on the structure of combined MD/MBA programs in which the MBA program is somewhat curtailed, could incorporate a full-time MBA program and require an additional year (or two) of training, could incorporate MBA training into research years, or could incorporate the training into a dedicated postgraduate management fellowship.

Given the investment required to complete an MBA, leaders can facilitate the process through financial incentives. Many employers (most notably, consulting firms such as McKinsey & Company, Bain & Company, and the Boston Consulting Group) seek to retain high-potential employees who choose to pursue an MBA by offering to fund the training if the employee returns to the employer (for a prespecified period of time — typically, 2 years) after completing the program. Alternatively, a leader might choose to provide loan forgiveness modeled after the NIH Loan Repayment Programs, a set of programs more familiar within health care. Incentives work, and may be particularly helpful for a trainee who has deferred earning potential for years while shouldering potentially immense educational debt. A trainee may receive such financial offers from consulting firms or other employers as he or she completes business training; similar offers from the health system can improve retention. Most important, such incentives can demonstrate to the trainee that the health system is truly invested in them as a future leader.

Embrace Continuous Self-Improvement

This strategy is the least concrete, but perhaps the most valuable. For long-term sustainability, today’s leaders need to support efforts to enhance innovation in tomorrow’s leaders. Becoming a leader of others, though, first involves mastery of the self, development of a growth mind-set, and learning how to turn failures (common in the world of innovation) into successes. Even though each of these strategies comes with obstacles (due, perhaps, to geographic or programmatic limitations), leaders must look for ways to support training in innovation, and motivated physician trainees can begin to independently develop an effective toolbox for leadership to serve as a foundation for future work in innovation. Such tools include reading books on leadership and innovation (or listening to them during the commute to the hospital), refining skills in time and energy management, creating a framework for effectively integrating work and life, and reflecting on goals and opportunities to improve productivity and focus.

Leaders can support this strategy by integrating the concepts into their teaching curriculum. A noon conference could feature a presentation on the principles of Stewart Friedman’s Total Leadership; a journal club could discuss Peter Drucker’s Managing Oneself. For example, at the Children’s Hospital of Philadelphia, John Flynn, MD, the Chief of the Division of Orthopedics, regularly gives a talk to residents and fellows that distills insights from thought leaders passionate about peak performance into actionable strategies. The messaging associated with a senior member of the faculty focusing on self-improvement for physicians-in-training is very powerful. Incorporating these concepts on a regular basis can make them part of an institution’s culture.

Pathways for fostering the development of physicians-in-training into physician innovators are becoming increasingly common, but often remain ill-defined. As we describe, physicians-in-training can leverage a variety of strategies, both formal and informal, to learn and practice the necessary skills to become physician innovators. Health systems that lack a defined strategy and infrastructure for promoting this growth will risk losing promising physicians to savvier institutions or industries.

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