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  • Leadership Lessons from the  White House Fellows Program

    Author: Jeremy Hosein, MD

    The Roosevelt Room is a stately suite just across from the Oval Office. On a day in January, I sat near the President listening to patients recount how illness encumbered their health and how surprise medical bills hobbled them financially. A Colorado man shared how his wife had spine surgery and signed a consent for neuromonitoring, not realizing that the price tag was nearly $100,000 and was not included in her insurer’s network. The President would shortly thereafter wade into a fight among well-fortified executives from insurance companies, hospital systems, and provider groups who, all too often, were not clinicians.

    Last year, I served as a White House Fellow. President Lyndon B. Johnson established the White House Fellows Program so that “...future leaders in all walks of life have opportunities to observe at firsthand the important and challenging tasks of American Government.” His goal was to expose young professionals to leadership and policymaking with the hope that they would return home as seasoned leaders ready to participate in civic affairs. After a rigorous application and interview process, a little more than a dozen Fellows are selected to serve alongside senior White House staff and cabinet secretaries.

    Once chosen, Fellows undergo extensive leadership training. From professional communications training to direct mentorship, we learned about crisis leadership, failing forward, leading upwards, and balancing priorities. We had intimate conversations with Chief Justice John Roberts, businessman Peter Thiel, Senate Majority Leader Mitch McConnell, General Colin Powell and David Petraus, Secretary Mike Pompeo, and many more. These history makers in politics and business shared their thoughts on surviving in Washington, leadership of large teams with complex missions, and staying focused on the big picture. These lessons often occurred in real time.

    My days varied from advising the Secretary of Health and Human Services (HHS) on the immigrant crisis at our border, legislative strategy for value-based healthcare, working on Senate confirmation of nominees, and drafting portions of the President’s healthcare agenda. My experience in neurosurgery proved valuable in delivering complex messages concisely, performing under pressure, and using creative thinking to problem solve. I also witnessed the impact of failed leadership when traveling to South America. Venezuela’s economy was in ruins. Once a beacon for its excellent medical training programs, its hospitals had shuttered and Venezuelans flurried across the border into Colombia where hospitals were overrun with patients who no longer had access to necessary medications, prenatal care, or vaccinations. One pediatric surgeon said he was seeing parasitic illnesses that he had not witnessed since training due to lack of access to clean water and electricity.

    I was privileged to serve and learn alongside my classmates who were largely military servicemen and women. They were Navy Seals, ship commanders, and infantry leaders who had been shaped in the crucible of war for their entire military careers. 

    They were challenged with maintaining readiness, preparing for intensive missions, and dealing with the repercussions of constant threat and trauma that have parallels with our craft. Leading dozens to hundreds of soldiers, these Fellows had practiced command, execution, accountability and mentorship with responsibility over human lives. In the year we spent together, I devoted time to understanding the precepts of servant leadership: building trust, being deliberate and thoughtful about individuals and the team, and cultivating future leaders. I took these lessons back with me to residency in preparing for my chief year with an understanding that my professional growth may be able to help the team, the organization and ultimately patients’ lives.

    Declaring that “a genuinely free society cannot be a spectator society,” President Lyndon B. Johnson announced the establishment of the White House Fellows Program in the East Room of the White House in October 1964. Prompted by the suggestion of John W. Gardner, then President of the Carnegie Corporation, President Johnson’s intent was to draw individuals of exceptionally high promise to Washington for one year of personal involvement in the process of government.
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    I underestimated the importance of leadership before serving as a White House Fellow.  In my year working in health policy, I encountered government, hospital, pharmaceutical and insurance executives where the decision-maker was most likely not a clinician. From the vantage point I had in the West Wing and HHS, developing more leaders in medicine is a worthwhile endeavor. Changing the regulatory arc of our profession requires more than a strong advocacy arm but elected and appointed leaders who can slowly tip the balance of competing forces to drive endpoints toward optimal patient care. 

    Theodore Roosevelt, whose presidential portrait hangs over the fireplace in the conference room that bears his namesake, connected leadership with the responsibilities of a citizen in his “Man in the Arena” speech. Today, that arena may be working with bundled payments in value-based care, knocking down the barriers of pre-authorization that delay needed surgery, or reforming a medical liability system that creates unnecessary friction in doing the hard and necessary procedures for our patients.  Preparing clinician leaders for the arena now will pay dividends for a generation of rising neurosurgeons.

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