Kate Goodrich, MD, MHS, was a medical resident at George Washington University (GW) Medical Center in Washington, D.C., in 1997 when a hospitalist service there was launched. A year later, as chief resident, she was able to work as a hospitalist. She enjoyed HM so much that she stayed on at GW in a faculty position and later directed its growing division of hospital medicine.
“I absolutely loved it,” she says.
But other career interests were calling her away from her patients and working the hospital floor. Eventually, she became a key player in the health reform debate and overhaul. “I became more aware of the issues that the country was grappling with because I was seeing them on the front lines—issues such as poor access to primary care,” she says. “I began to wonder: Why does a sector of my patient population keep getting readmitted to the hospital? Why is it so difficult for them to get medications, even when they have insurance? What happens to people who have poor family support or multiple comorbidities?”
Such questions eventually became more important to her than the clinical questions she encountered. And now she is in position to make even more of a difference to patients at GW and across the country. In March 2010, Dr. Goodrich became medical officer for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS). And more recently, she became senior technical advisor in the Office of Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), working closely with another hospitalist leader, Patrick Conway, MD, MSc, SFHM, who recently was appointed CMS’ chief medical officer (see “Hospitalist Takes Charge,” June 2011, p. 20).
“When I started this job, I was gratified to learn that my experience as a hospitalist had unbelievable relevance,” she says. “It surprised me how often I draw upon that experience. My clinical perspective on quality is really valued.”
She retains that connection by working as a hospitalist three or four weeks a year at GW. “I now view the hospitalist world from a different lens,” she says.
Winding Path to Washington
Dr. Goodrich’s path to a health policy career didn’t happen overnight. She originally enrolled in GW’s School of Public Health, taking classes at night, but soon realized that it would take too long to obtain a public health degree that way. In 2008, the Robert Wood Johnson Clinical Scholars Program, based at Yale University, offered her an opportunity to focus more intensively on research questions. “I discovered at Yale that what was more satisfying to me was application of research into action,” she says.
Sian Spurney, MD, director of GW’s hospital medicine division, once shared an office with Dr. Goodrich. She describes Dr. Goodrich as dedicated and committed. “Although I was admittedly very sad when she left GW to pursue her passion for health policy, I was hardly surprised to hear of her successes since completing the RWJ program,” Dr. Spurney says.
During a 2009 summer internship at HHS while she was doing her Yale coursework, Dr. Goodrich worked with Dr. Conway, who was working as the ASPE medical officer at HHS. Dr. Goodrich helped write a report to Congress on the Federal Coordinating Council for Cost-Effectiveness Research (CER), and became immersed in this area of research. She worked on an interagency work group to assemble a spending plan for $400 million in federal CER allocations.
“One of the premises of CER is that it will lead to improved quality of healthcare, which we all know isn’t where it should be—in part because of uncertainty regarding best care,” she says. “We think CER will help us define best treatment in the hospital, as well as outpatient settings.” Examples, she says, would be the treatment of delirium or care for patients with multiple comorbidities. “Hospitalists are well-positioned to disseminate CER within their hospitals and to train others, actively looking for the right evidence, and applying it in practice,” she adds.
Dr. Goodrich refers to Dr. Conway as a mentor and recalls days when they would “talk about the ways the issues we were working on affect hospitalists and how to make them aware of those issues,” she says. “I found myself drawn like a magnet to the policy stuff, especially during the 2008 election. It finally dawned on me that if I love this so much, why not see if I can make it a career?”
Exciting Times for Public Servants
Dr. Goodrich acknowledges the importance of care transitions and hospital readmissions for the national quality agenda. In fact, while at Yale, she researched care transitions for patients with low health literacy.
“I doubt that any hospitalist would disagree that readmissions are bad for patients, but sometimes they feel like everyone’s looking at them when readmissions happen. As a hospitalist, you know it’s a complex problem, by no means within the control of any single hospitalist,” she says. “But we also know that some hospitals have very low readmission rates. So it can be done, and we need to learn from the high performers.”
Given the current focus on healthcare reform, Dr. Goodrich believes now is an exciting time to be working for the government. She suggests ways that other hospitalists can learn about health policy and participate in its development:
- Get involved in local quality initiatives in the hospital and the community;
- Join SHM’s Public Policy Committee;
- Follow health policy blogs, websites, and other resources offered by HHS, SHM, and private groups such as the Commonwealth Fund; and
- Look into health policy fellowships or training opportunities.
Clinical experience is highly valued throughout CMS, Dr. Conway says, noting Dr. Goodrich’s background as a teaching hospitalist with more than a decade of patient care under her belt.
“In all of CMS, there are less than a hundred physicians in total, and not all of them are still in medical practice. So we have to leverage the clinical skills of that small group. As we develop health policies, that experience gives us a greater understanding of what the policies mean—their potential impact on patients,” he says.
Larry Beresford is a freelance writer based in Oakland, Calif.