Andrew Leubitz, DO, MBA
Clinical Innovations Fellow
US Acute Care Solutions
Nishad Rahman, MD
St. John’s Riverside Hospital
Jonathan Oskvarek, MD, MBA
Clinical Instructor in Emergency Medicine
Summa Health/US Acute Care Solutions
Description of the specialty
The need for innovation in emergency medicine has never been greater. Stressors to the U.S. health-care system in the form of pandemics, downward pressure on reimbursement from private and public payers, ED crowding, and patient demands for faster, more convenient care are necessitating innovations in acute unscheduled care. If the answers to these challenges were easy, solutions would already exist. Most hospitals and health systems are surviving on tight budgets and have a low tolerance for failed initiatives, but constant innovation remains imperative to create any fundamental improvements to the system. Although some large companies have separate departments focused on innovation, future leaders in EDs, hospitals, health systems, consultancies, start-ups, and other organizations can be tasked with developing, implementing, and evaluating new projects and would benefit from an Innovation Fellowship. These innovative leaders specialize in taking ideas from conception to implementation with the goal of improving the quality and value of care. This might be as locally minded as developing protocols for a fast track at single ED or as intricate as conceptualizing and implementing a new reimbursement structure for an entire state or even nation.
History of the specialty/pathway
Innovation as a subspecialty of EM encapsulates many different possible activities that many physicians have been doing in conjunction with clinical duties. Innovation refers to various parts of clinical and non-clinical work including quality improvement (QI), mobile integrated care (i.e., telehealth), venture capital, health-care startups, and much more, all in an effort to find and solve pain points to better help patients.
Innovation as a distinct fellowship is new, with a handful of programs across the country specifically devoting the time and energy to engage with emergency physicians who have an interest in working on specific aspects of innovation.
Why residents choose this career path
Residents who choose to pursue innovation feel called to treat not only the patient directly in front of them, but the system as a whole. Interested individuals love working on and building upon the cutting edge that will shape health care for decades to come, from telemedicine to alternative payment models to groundbreaking research. Clinical work is always foundational, but this group tends to want more than clinical work alone, finding fulfillment and purpose in creating an overarching impact beyond what any single clinician can possibly accomplish. Ultimately, a career in innovation is defined by increased scope, and physicians pursuing this path are obsessed with creating a brighter future.
How do I know if this path is right for me?
If you find yourself constantly pondering the many inadequacies of our current health-care system and pontificating to friends, family, and unsuspecting strangers about better ways to run things, an innovation fellowship may just be for you. This path is for those who possess internal drive and passion for constant improvement, even if incremental, and who find true fulfillment from seeing the fruits of their labor affect patients and colleagues in a positive way. If maximizing revenue is the only priority, clinical innovation may not be a great fit, as clinical work is often the most lucrative option.
If you always enjoy being on the cutting edge and figuring out solutions to difficult problems, then an Innovation Fellowship might be right for you. The Innovation Fellowship will be particularly helpful if you want to build upon or if you have not had much applied experience in quality improvement, research, project planning and implementation, design thinking, or your particular area of interest. Many fellows have already obtained a Master’s in Business Administration (MBA), Master’s in Health Administration (MHA), or similar, but still others have not. What is more important is a keen desire for hands-on involvement in developing and implementing problem-solving ideas.
Career options after residency
Some options to consider when designing a career with a focus on innovation include:
- Administration (quality, assistant medical director, medical director)
- Entrepreneurship (founding a startup, serving on a startup board, working for a startup)
- Research (core faculty at academic ED)
- Venture capital
- Change Management
- Leadership positions at EDs or hospitals/health-care system
- Medical education/teaching and mentorship
Splitting time between departments
Many emergency physicians, especially when starting earlier on in their careers, enjoy the reduction in shifts especially, during a fellowship. Most fellowships in this space have structured their fellows to work 0.5 FTE (Full-time Equivalent) clinically with the opportunity for moonlighting and the other 50% of their time on the administrative and fellowship projects. Those additional projects can vary from working on infrastructure support, teaching and academics, administration projects, working with outside partners (e.g., design and venture firms), and much more.
Academic vs. community positions
There is a wide array of pathways towards innovation. Some academic programs tend to be focused on a more particular topic in innovation. Community programs may have a more general focus. The best fellowship fit for a given applicant is entirely dependent on what skillset is desired. Examples include those who are aiming for entrepreneurship, pursuing a MBA while at an academic fellowship (sometimes paid for by the fellowship program), or hands-on innovation for a particular hospital, health system, or group available at community positions. Successful applicants will avidly pursue the best match towards their own interests.
IN-DEPTH SPECIALTY INFORMATION
Number of programs: 10
Duke Innovation in Education and Training: Education focused
Emory Fellowship in Innovation and Discovery: Innovation and Discovery in Emergent and Acute Sciences (IDEAS) is a research fellowship for physicians interested in neurological emergencies or injury prevention.
Gold Innovation Fellows: Partnership between the Gold Foundation with hospitals designed to facilitate skills in health-care quality improvement
Massachusetts General Hospital Global Health Innovation and Fellowship: Field work, clinical work at MGH, and advanced degrees in fields such as public health, public policy, tropical medicine, or research as well as degree or certificate programs in global health
Massachusetts General Hospital Innovation Fellows Program: Team-based experiential projects with industry players in categories such as drug or device development, care redesign, clinical trial strategy, regulatory affairs, company financing and launch, or reimbursement and portfolio management (“Outbound Fellows”) or, at Mass General, working of cutting-edge research, asset identification and commercialization, and education (“Inbound Fellows”)
National Clinician Scholars Program: Focused on research, policy, and leadership training. Partnership between several large academic systems and the VA.
Stanford Innovation Fellowship: Three pillars of biodesign, design thinking, and digital health
University of California San Francisco: Acute Care Innovation Center: Merges institutional and domain expertise with a “human-centered design approach.” Focuses on high-yield innovations in EM. Focusing on rapid-cycle research and testing.
University of Nebraska Medical Education, Technology, and Innovation Fellowship: Education technology competency, foundational education theory and curricular design, clinical service and bedside teaching, educational leadership and administration, innovation support infrastructure, scholarship, teaching and mentorship opportunities, and interprofessional collaboration
US Acute Care Solutions Clinical Innovation Fellowship: Fellows to work at any USACS-staffed clinical site throughout the country, while working with the leadership team and Innovation Fellowship Director Dr. Jesse Pines on fellowship-specific projects both locally and at a national level
Preparing for a Career in Innovation
Typically, there is no firm research requirement for innovation fellowships; however, you’ll want to show your interest and involvement by participating in research projects, quality improvement projects, entrepreneurship, or other innovative activities.
Suggested rotations to take during residency
The ideal rotations to take during residency are ones that will build out your portfolio in hands-on, active innovation. This can take multiple forms, from administration and research rotations to specific quality improvement projects and process optimization. This can be a fantastic opportunity to refine your interests and discover where your passions are, and all residents interested in pursuing innovation should take full advantage!
Suggestions on how to excel during these elective rotations
They say that medicine is a small world. Emergency medicine is even smaller, as is the group pursuing innovation within this space. It is virtually guaranteed that every person you meet in this career will have a degree of separation not of Kevin Bacon’s six, but only two to three. It is therefore critically important to embrace building networks and personal connections. The good news is that emergency medicine is overwhelmingly occupied by passionate individuals who want to do good in the world. Showing genuine interest and chasing projects with enthusiasm is a fast track to meeting potential life-long mentors!
Should I complete an away rotation?
No particular away rotations exist for innovation fellowships. Starting and completing an innovative project usually is not feasible in the short timeframe of an away rotation. Completing an away might help in other ways. It can be a great way to experience the variety of practice patterns in different EDs while also networking and building your skills as an emergency physician.
How can I make my CV stand out from the crowd?
Most residents interested in this type of fellowship (whether administration, innovation, or other) have already proven themselves capable and have a desire to work on improving emergency medicine. When applying for this type of fellowship, it is important for your CV and cover letter to tell the story of why you have an interest in innovation and include an example of a project you worked on (e.g., a QI project during residency).
Should I join a hospital committee?
Hospital committee participation, especially early on in your career and in residency, is always helpful. It is important to get a pulse on how a hospital operates and to explore opportunities those committees have. As the saying goes, you “want to be in the room where it happens.” It is one thing to complain about lack of certain medications or communication between departments, and it is another to work with the pharmacy committee or with nursing, pharmacy, and other departments on finding solutions. Those opportunities help show how leaders think and how to communicate problems and solutions effectively. If you are ever frustrated on why something is done or have an idea on how to improve it, these committees are where you build those day-to-day working relationships to both understand and influence those changes.
Publications other than research
Any sort of publication will be a helpful experience and look good on your CV. Having publications shows that you are interested/engaged with projects.
Textbooks to consider reading
- Emergency Department Management (Straus, Mayer)
- The Definitive Guide to Emergency Department Operational Improvement-Employing Lean Principles with Current ED Best Practices to Create the "No Wait" Department (Crane, Noon)
Important skills to practice during residency to prepare for a career in innovation
In general, residents interested in an innovation fellowship should engage in activities that build leadership skills and knowledge of operations. This could include — but is certainly not limited to — working as a chief resident or administrative chief in residency, implementing projects in an ED, forming a startup, or working with entrepreneurs. Residents can get ahead by paying close attention to ED operational issues, gaining familiarity with basic finance terms and concepts, and gaining experience with statistical analysis. However, most importantly, becoming an excellent emergency physician with great clinical skills and knowledge is paramount to success as an innovator.
Creating a Career in Innovation: Convincing Your Employer
How do I stand out from the crowd in the interview/hiring process?
Your goal during the interview is to be engaging, confident, and personable. Be courteous to everyone you meet, and treat every event/interaction as part of the interview. Make sure your application is complete and you fulfill all requirements in a timely manner. Communicate a clear vision about how your future career will include innovation. Also, interviewers often ask applicants about their 1-, 5-, and 10-year career plans.
What types of questions are typically asked?
- Why are you interested in an innovation fellowship?
- What are your 5- and 10-year career plans?
- What specifically was your innovation training during residency?
- How do you plan to expand our department’s involvement and education in innovation?
- What are your strengths and weaknesses?
- Tell me more about the [fill-in-the-blank] leadership positions that you list here on your resume.
- Why do you seek employment at our institution?
- What are your areas of interest when it comes to innovation?
- What do you see as the key problems in emergency medicine and how might you solve them?
How many recommendations should I get? Who should write these recommendations?
Innovation fellowships and potential future employers will have their own policies regarding the number of recommendations required. Seek letters from physicians who know you well and will advocate strongly for you. Letters from program directors and/or department chairs would be favorable and are likely required by some fellowship. If you have a mentor within the niche of innovation, a letter from him or her would be ideal. Letters that display your knowledge of and competence in innovation will help support your cause for a career that allows you to continue to build and expand upon your innovation training.
- The Innovator’s Dilemma: When New Technologies Cause Great Firms to Fail (Christensen)
The Innovator's Solution: Creating and Sustaining Successful Growth (Christensen, Raynor)
- The Innovator’s Prescription: A Disruptive Solution for Health Care (Christensen)
- Design Thinking: Understanding How Designers Think and Work (Cross)
- Reverse Innovation in Health Care: How to Make Value-Based Delivery Work (Govindarajan, Ramamurti)
- The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (Reid)
- Start with Why: How Great Leaders Inspire Everyone to Take Action (Sinek)
- Deep Medicine (Topol)
- The Dip (Godin)
- The Art of Healthcare Innovation: Interviews and Industry Insights from 35 Game-Changing Pioneers (Warner, Southorn)
- The Lean Startup (Reis)
- Blue Ocean Strategy (Mauborne, Kim)
- The Presentation Secrets of Steve Jobs (Gallo)
- Getting Past No (Ury)
- Nudge (Thaler)