By Arjun Gupta, MD
I distinctly remember learning about a new position Costs of Care was launching- the Teaching Value in Healthcare Learning Network Fellow- last summer. I had just started Chief Residency and was getting my head around the job. I had always been interested in health care value, and this seemed like a perfect opportunity to learn from and work with some of the thought leaders in the field. I was also apprehensive about applying- in addition to regular academic duties, I was attending on wards for the first time, and had medicine boards and an entire season of Oncology Fellowship interviews in the next couple of months. I immediately went to our Department of Medicine Chair, an oncologist himself, to ask if he would be ok with me applying, and if selected, devoting some time to this endeavor. He told me I would be a fool not to take it on.
Things worked out and soon I was officially appointed as the Learning Network Fellow. As a trainee myself, I was most excited to spearhead efforts to ‘manage’ the Learning Network, a living breathing e-home of more than 500 trainees, educators, and administrators, with a common interest in health care value. Reshma and September- two of the Directors at Costs of Care- were my closest contacts, and were extremely approachable and patient. We held phone calls at a convenient time every couple of weeks for the first few months until I got my feet wet. They reminded me that this was for my learning and experience, and always made sure I had the bandwidth before we pursued any activity. Despite being in 3 different time zones, we always managed to find times to speak, united by a passion to advance the field.
One of the tasks was to better figure out what trainees wanted to learn about, so that we could cater our monthly webinars on the Learning Network accordingly. Also, we decided as a team to expand the scope of the Learning Network, focusing on including ancillary services. Both of these ideas were right up my alley.
I was trying to figure out the best way to teach residents at our program about high value care. Having been a resident just a few months previously, I understood things from a trainee perspective. It was great fun for me to brainstorm new ways to teach, and also figure out what content would be most engaging and useful for trainees. Additionally, the chief resident position gave me significant exposure to hospital leadership meetings. These multidisciplinary board meetings gave me perspective on how value based interventions could be applied across disciplines- what was working in the intensive care unit, and how we could apply this to the outpatient setting. I had enough freedom to tie these activities with my specific interests.
As an example, my interest in oncology led me to explore the role palliative care could play in enhancing value- more importantly by enhancing the patient and caregiver experience, and also by reducing unnecessary care. I researched the topic, networked with leaders in the field at conferences, and invited and conducted one of the monthly webinars with Arif Kamal, a thought leader of palliative care at Duke. Further correspondence and remote mentoring from him has helped me carve out a likely career path in oncology/ palliative care for myself.
There were monthly phone calls with all the members of the Costs of Care team, and the ABIM Foundation, and networking opportunities at multiple conferences. I met the entire team at the Costs Conversations meeting in Washington DC in October, 2017. There were further opportunities to attend the Institute for Healthcare Improvement meeting in Orlando, and the South by Southwest Conference in Austin. There were plenty of opportunities for scholarly work, and I could run projects and ideas- such as disinvesting labs or reducing low-value processes– by anyone on the team.
These opportunities also resulted in me being appointed the faculty mentor for two medical students at the UT Southwestern Medical School in Dallas as part of the STARS initiative. Connecting educational and curricular opportunities at different levels- medical school and graduate medical education- has been a very satisfying and wholesome experience.
In summary, I envision a very different career path for myself now, compared to when I started this academic year. From a past life of clinical trials and time in the lab, I have evolved and now hope to pursue a career in high value care oncology. The catalysts for this change were the people and opportunities at Costs of Care. I hope to be able to continue working with them throughout my career. As my Chair told me almost a year ago, ‘’you would be a fool not to apply for this position’’.
Arjun is the Chief Resident for Quality, Patient Safety, and High Value Care in the Department of Internal Medicine at UT Southwestern Medical Center, and the inaugural Learning Network Fellow for Costs of Care. He will be starting a Fellowship in Hematology Oncology at Johns Hopkins in July, 2018.