PERSPECTIVE

Administrative Fellowship Prepares the Next Generation of Physician Leaders

Allen Bookatz , MD

Medical Director, St. Francis Medical Center

Vanessa Calderón , MD, MPP

Emergency Physician

Published April 22, 2019

Graphic depiction of physician leaders after fellowship

Vituity’s one-year administrative fellowship helps physicians develop the skills they need to lead in challenging times and transform the delivery of healthcare. Fellows are mentored by the group's leadership and have the opportunity to work on projects related to quality, risk, advocacy and continuing education.

Perspectives recently sat down with two of our current fellows to talk about their experiences and how they plan to use their learning in their future careers.

Perspectives: Welcome Dr. Calderón, Dr. Bookatz. To start with, can you tell us why you applied to the administrative fellowship program?

Dr. Calderón: My core mission is to provide high-quality healthcare to all, especially underserved communities. In medical school, I rotated through both affluent hospitals in Beverly Hills and county hospitals. There were stark differences in the way the two delivered care, with apparent inefficiencies and disparities in the county hospitals. Being motivated to provide the best care to county patients sparked my interest in administration. So I took a year off from medical school to get a master’s degree in public policy with a focus in public administration.

All through residency, I worked on projects to improve healthcare delivery. As I thought about my next steps after residency, I knew I was interested in affecting change on a larger scale, and I wanted more training and experience. I looked for administrative fellowships that would offer this type of training but also strong mentorship. This fellowship provided exactly what I was looking for: tangible leadership skills and mentorship from successful physician leaders.

Dr. Bookatz: For me, there were two reasons to pursue a administrative fellowship. One, I realized during my training that moving patients through the system was sometimes more challenging than providing the actual clinical care itself. As a resident, I became quite involved with process improvement and throughput. I really wanted to be involved in the key decisions that improved care delivery.

Second, I've realized that the disposition decisions we make as physicians have a big impact on the financial health of our hospitals. For example, admitting a patient from the ED is becoming more and more of a luxury as our industry shifts toward value-based reimbursement. We need to be good stewards of healthcare resources, and then we can demonstrate our value in the complex world of healthcare.

Perspectives: How has this fellowship helped you develop as a leader?

Dr. Calderón: The fellowship has given us both direct leadership training and improved our professional development.

We attend all of the Partnership's leadership programs, including the Medical Director Academy and the Leadership Development Series. We’re also invited to all the professional development courses like the Risk Management Course. Those are fantastic opportunities, because admission to some of these programs is competitive, and without the fellowship, we might have to wait a few years to get in.

Also, as fellows, we’re present at the high-level meetings happening at Vituity. Sitting at the table with the C-suite and board members has been a fantastic experience. Observing the thought process of brilliant and experienced physician leaders has been an incredible learning opportunity.

Dr. Bookatz: I agree that one of the most exciting parts of this fellowship is having a seat at the table and seeing firsthand how decisions are made for our group. I think what's been most impressive to me is how thoughtful our leaders are. Before they act, they always consider the impact on providers and especially on patients. I feel they really are servant leaders in the truest sense. We’ve never had a meeting where the "culture of caring" hasn’t come up. It really is the central theme around which the organization operates.

Dr. Calderón: That’s something that struck me as well. Our leaders make it clear that the reason we're here, the reason our Partnership matters, is because of the patients. It’s definitely something that’s been reinforced in me. I think about it on every shift.

Dr. Bookatz: Another thing the fellowship taught me is how invaluable it is to have our practice management arm at the table. I never realized how much talent and effort goes on behind the scenes to handle marketing, billing, recruiting and everything else that goes into making our practice successful.

Perspectives: Tell me about your fellowship projects. What are you working on?

Dr. Calderón: Well, first I want to say that the project is a highlight of the fellowship. You design your own, and it's supposed to be large enough in scope that you have to navigate your way through the Partnership and have contact with many parts of the organization, which has been a great learning experience. A lot of Vituity programs started out as fellowship projects, including our Advanced Airway and Risk Management courses.

My project is part of the Vituity joint knowledge management initiative. I'm working on building the Quality Improvement Community of Practice, which will bring together all of our quality directors from across the country and give them a place to access resources and share best practices.

Dr. Bookatz: For my project, I’m working with several of our medical directors and quality directors to implement Choosing Wisely, which is an initiative aimed at reducing unnecessary care. As physicians, I think we realize when we're ordering a test or procedure that isn't likely to benefit the patient. But at the same time, we're pressured by patients, some of whom have been referred to the hospital by their primary care physicians. We're also concerned about risk. So often it's just easier to order an unnecessary test than argue about it.

I work with our ED site leaders to help them educate providers about Choosing Wisely's recommendations and encourage courageous conversations with patients. For each site, we assess needs, set goals and implement a stepwise process to guide provider's clinical behavior. This kind of change takes time, because there’s a big cultural shift that needs to happen. The key, we're learning, is to make the change relevant to the front-line providers.

Perspectives: Well, it sounds like we're lucky to have both of you as our fellows this year. After fellowship, how do you plan to use what you've learned?

Dr. Calderón: I love the practice of emergency medicine. Every interaction I have with a patient reinforces my decision of becoming an EM doctor. However, I also enjoy affecting change on a larger scale. I’ve gained a wealth of knowledge this year, and I hope to take what I’ve learned to become a steward of the Partnership. I’d like to take on a medical directorship soon after my fellowship and put into practice some of the fantastic tools I’ve learned as a fellow.

Dr. Bookatz: I would love to hold a leadership position down the road. But for now, I’m focused on becoming the best Partner I can be. Medicine is going through unprecedented changes, and as a fellow, it's exciting to have a thousand-foot view of the forest. Seeing our leaders in action has given me the perspective I need to be an informed participant in decisions affecting our patients, practice and profession.

2019 update: Since this interview was originally published, both Dr. Calderón and Dr. Bookatz have successfully completed their administrative fellowships. Both now serve as emergency department medical directors with Vituity.

Learn more about Vituity's administrative fellowships, and apply online.

Originally published April 8, 2015. Last updated April 23, 2019.

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