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First Fellow


 

Pediatric hospitalist Patrick Conway, MD, MSc, has become the first hospitalist accepted into The White House Fellows Program, a spokeswoman for the program says.

Dr. Conway had just reported to a new job at Cincinnati Children’s Hospital Medical Center when he found out he’d been accepted into the White House program. He’s serving with 14 other fellows, including one other medical professional, until August. He’ll return to Cincinnati with a deeper understanding of how physicians can affect federal health policy.

“It’s a once-in-a-lifetime learning experience, to see policy setting at the highest level of government,” Dr. Conway says.

Throughout the year, Dr. Conway, 33, will work in the office of Michael Leavitt, secretary of Health and Human Services (HHS), and with Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ).

“He’s an amazingly sharp physician who brings a great wealth of expertise, both because of the research he’s done but also in a clinical sense,” says Dr. Clancy, one of Dr. Conway’s mentors in the program. “He has a great grasp of policy.”

Dr. Conway

Dr. Conway

Dr. Conway has had to hit the ground running in his new role.

“We’re involving him directly in a number of very high-priority areas” including the improvement of healthcare quality and value, Dr. Clancy says. “He’ll be doing some research and a lot of trying to distill what we know from research to try and influence policy.”

The year will also bring another achievement: Dr. Conway will become a dad for the first time; his wife, Heather, is due March 30.

“I’m sort of peripherally involved,” he says ruefully. “I haven’t made it to any OB appointments.”

Dr. Conway, originally from College Station, Texas, received a master’s in health services research from the University of Pennsylvania. He earned his MD from Baylor College of Medicine and did his pediatrics residency at Children’s Hospital Boston, the primary pediatric teaching hospital for Harvard Medical School. He worked with healthcare clients as a management consultant at McKinsey & Company in Chicago, and he was a Robert Wood Johnson Clinical Scholar from 2005 to 2007. He’s done volunteer work in Nicaragua, the Dominican Republic, Bolivia, and Ghana. When he returns to Cincinnati Children’s, he’ll resume work as assistant professor in the Center for Health Care Quality and the Division of General Pediatrics.

The White House Fellows Program

The program was established in 1964 by President Johnson at the urging of John Gardner, president of the Carnegie Corporation in New York City. Fellows work for one year in paid positions at high levels of government. The object is to get talented and motivated young professionals involved in public policy, give them the experience of a leadership role in government, and inspire them to become “ambassadors” in their fields when they return to the private sector. For more information or to apply, go to www.white­house.gov/fellows—LT

On the Radar

While a Robert Wood Johnson scholar, Dr. Conway’s primary mentor was Ron Keren, MD, MPH, attending physician and director of the General Pediatrics Fellowship Program at the Children’s Hospital of Philadelphia. They worked together on a study of the use of prophylactic antibiotics in recurrent urinary tract infections in children, published last summer in the Journal of the American Medical Association (JAMA). The study found that, contrary to expectations, prophylactic antibiotics are not associated with a lower risk of recurrent infections and are associated with a higher risk of resistant infections.1

Dr. Keren was one of the people who recommended Dr. Conway on his application for the White House fellowship.

“Patrick … is intense,” says Dr. Keren, laughing. “But not in an obvious way. He’s very mild-mannered and polite and easy going on the outside. But when he starts a project, he is pretty aggressive as far as setting a very ambitious timeline, pushing things forward, and working as hard as possible. I just had to point him in the right direction every now and then, and he got the job done.”

Dr. Conway, lead author of the JAMA study, also contributed to a video news release and podcasts about its results. He impressed some of Dr. Clancy’s colleagues at the AHRQ with his ability to make the information easy to understand for people without a clinical medical background, Dr. Clancy says. That skill made him a good candidate for the fellowship.

“My goal is that he would get a lot of exposure to how healthcare policy is made, and that he would go back to Cincinnati Children’s understanding how physicians can play a more vital role in making sure that we get health policy right,” Dr. Clancy says. “To do that, you’ve got to be bilingual both in policy and in medicine—and there aren’t enough people who have that skill.”

And there’s something else to look forward to. “Supposedly we get the opportunity to ride mountain bikes with the president if we’re good enough,” Dr. Conway says. “I bike, but not extensively, so I’m working up to that. I need to make sure I don’t embarrass myself.”

Dr. Conway and his wife, Heather, at the White House.

Dr. Conway and his wife, Heather, at the White House.

Hospitalist Goals

Dr. Conway says one of his focuses is on the implementation of health information technology that better serves physicians and patients.

“We are interested in the alignment of incentive payments to physicians who use information technology to improve the care delivered to patients,” including electronic medical records and interoperability of data, he says. “In the last five years or so, there’s been increased interest in pay for performance, and now we’re moving toward thinking about how to structure these programs to pay for and enable quality improvement and the effective utilization of information technology.

“From a hospitalist perspective, I think one of the important issues is that many of these quality measures are directly related to the care delivered in hospitals by, primarily, hospitalists, so therefore it’s important for hospitalists to be involved in these processes.”

He’s also working with HHS on a value-driven healthcare initiative, intended “to bring transparency around quality and cost in healthcare and to enable quality improvement,” Dr. Conway says. “In this case, transparency for all stakeholders, so for consumers, for providers, for payers. We can criticize the process from the outside or we can get involved. We need to get involved.”

He has had a clearer idea than most about his career plan from the start, said Chris Landrigan, MD, MPH, research and fellowship director, inpatient pediatrics service, and assistant professor of pediatrics at Children’s Hospital Boston, where Dr. Conway interned. The two found they had a lot in common: Both were interested in the operations of the health system and in finding ways to improve it through clinical work, research, and policy, Dr. Landrigan says.

“Most of our work together has revolved around looking at the variations in care in hospital systems,” Dr. Landrigan says. “Some of my work has been in trying to set up a research network for pediatric hospitalists, and to try and improve the care of hospitalized children.”

Dr. Landrigan was surveying pediatric hospitalists about how they treat several common conditions, looking for variations, when Dr. Conway arrived at Children’s.

“He immediately said, ‘How do we know how this compares to what pediatricians do?’ ” Dr. Landrigan says. “I said, ‘Well, we don’t,’ So he set out on a project and asked a random sample of pediatricians around the country.”

Dr. Conway’s work revealed greater variations of care among pediatricians than among pediatric hospitalists—a finding Dr. Conway brought all the way to publication.2

HHS and AHRQ “have been very focused on issues that are near and dear to Patrick’s heart,” Dr. Landrigan says. “I think he’s got the experience and the intelligence to really make substantial contributions there. There’s no question in my mind that he’ll end up a leader in healthcare.”

One of those contributions has been to educate high-level decision-makers on a vital question.

“I have to explain every time I meet somebody what a hospitalist is,” Dr. Conway says. “We meet with everybody, from President Bush to Cabinet secretaries, and at all those meetings I say, ‘I practice generally as a pediatric hospitalist,’ at which point they say, ‘What’s a hospitalist?’ ”

That’s not likely to remain a problem as more hospitalists get involved at high levels.

“I would fully expect that we’re going to see hospitalists play a major role in assessing patient care and quality, and I hope that Patrick’s being named a White House fellow is a harbinger of that,” Dr. Clancy says. “We’re thrilled to have him here, and I hope to see more physicians taking a very serious interest in healthcare policy.” TH

Liz Tascio is a journalist based in New York.

References

  1. Conway PH, Cnann A, Zaoutis T, et al. Recurrent Urinary Tract Infections in Children: Risk Factors and Association With Prophylactic Antimicrobials. JAMA. 2007 July 11;298(2):179-186.
  2. Conway PH, Edwards S, Stucky ER, et al. Variations in management of common inpatient pediatric illnesses: hospitalists and community pediatricians. Pediatrics. 2006 Aug;118(2):441-447.

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