Every doctor, nurse, pharmacist, dentist and social worker learns during their training to care for patients one at a time.

That’s true whether they’re diagnosing health problems, spotting health risks, offering preventive care or treatment, or following up after major health events.

But some of these clinicians also see the entire American health care system – or big slices of it – as their patient.

They’re driven to diagnose and treat problems in how care is delivered, paid for or regulated. They want to test and share solutions for system-wide ills, such as safety problems and inequity.

And they want to see if changes in laws, treatment options or technology have actually achieved what they were supposed to do – or had unintended consequences. 

For this kind of clinician, the University of Michigan has become a key destination for the training they need to achieve their goals.

The effort started in the mid-1990s. And over the past decade, the U-M Institute for Healthcare Policy and Innovation (IHPI) has become the nexus of that training.

Right now, 19 such clinicians from a broad range of specialties are honing their skills in health services research and health policy at IHPI.

More than 110 others have graduated in just the past six years from IHPI’s Clinician Scholars Program.

“People come here from across the country solely for this training – because there’s no other place like it,” said Rodney Hayward, M.D., a professor of internal medicine who just stepped down as director of the program after more than 15 years. Six of those years were with IHPI’s program, and the rest with a predecessor program for physicians that was funded by the Robert Wood Johnson Foundation and began in the mid-1990s.

A path to impact

All scholars in the program learn from the dozen core faculty – but they also connect with and learn from many others in IHPI’s 670-person faculty membership and 35-person staff.

Recently, Hayward handed the reins over to Tammy Chang, M.D., M.P.H., M.S., associate professor of family medicine, who herself graduated from U-M’s program during the RWJF-funded era.

“We take people who already have talents and strengths, and equip them with the tools, experiences and networks to do what society needs today,” said Chang. “We’re going beyond a traditional research training fellowship to a program that helps people down a path to impact.”

Hayward notes that dozens of the U-M faculty members who make up IHPI’s membership are alumni of these programs, or of similar programs at a handful of other academic medical centers nationwide.

That includes the five other National Clinician Scholars Programs, based at Duke University, Yale University, the University of Pennsylvania, and the University of California’s San Francisco and Los Angeles campuses.

Beyond their IHPI network, IHPI scholars also have a built-in national network of the program alumni who went on to careers in academia, government health agencies,  nonprofits and industry after completing their U-M training.

A key part of the U-M programs is the master’s degree in Health and Healthcare Research that nearly all scholars earn, through classes that focus on everything from methods for analyzing health care data to how to connect with policymakers and how to conduct community-based participatory research.

The scholars even have their own designated suite in IHPI’s headquarters at the North Campus Research Complex, giving them a place to connect, share ideas and provide feedback on one another’s projects.

Diversity of disciplines

That cross-pollination is especially powerful given the diversity of scholar backgrounds and disciplines.

Hayward notes that the IHPI leadership team made a deliberate choice to expand the professions eligible for the scholars programs starting in 2017. 

Surgeons, doctorate-level nurses, primary care and emergency medicine physicians, pharmacists and others bring their unique experiences and perspectives to each cohort – including those who work mainly with a veteran patient population at the VA Ann Arbor Healthcare System.

Last year, for the first time, another type of professional became eligible to join the program: architects and designers interested in transforming the physical environments in which health care is provided. These scholars can now apply for the Health & Design fellowship based in the Department of Surgery.

The faculty who lead the training and serve as mentors now also come from many more fields than had previously been involved with the program – including non-clinicians such as operations engineers and public health researchers.

“The result is, we produce people who, even when they’re a clinical subspecialist, they understand the system and the role of teamwork in a much broader way, which brings incredible value to their future work,” said Hayward.

Alumni reflect

Such is the case for neonatologist Stephen Patrick, M.D., M.P.H., M.S., who completed U-M’s Clinical Scholars Program in 2012. He’s now the William R. Long Director of Child Health Policy at the Vanderbilt Center for Child Health Policy and an Associate Professor of Pediatrics and Health Policy at Vanderbilt University.

“The analytic foundation of the program allowed me to think more broadly about what I saw playing out in the clinical environment,” he said.

“The team building, leadership, policy analysis, all those things were really formative for me, and gave me the skills to be able to do the work I do today.”

Sonia Angell, M.D., M.P.H., went straight into the policy world after finishing the program in the early 2000s, starting with a role in New York City’s public health department and continuing in leadership roles at the CDC and in California’s statewide health department.

“Sound scientific evidence is the most important component in any policy recommendation,” she said.

“Again and again in my work, I have seen that the best way to counteract partisan politics is to bring forward policies built on a firm foundation of evidence.”

The training program not only acts as a magnet for those seeking to make a difference in health care and health policy, but also as a way to attract new emerging faculty to U-M and grow IHPI’s community of researchers. 

One of those who stayed at U-M after his training ended is Kevin Chung, M.D., M.S., a hand surgeon and health services researcher in the Department of Surgery, where he is now a U-M Distinguished University Professor and national leader in his field.

“The program has been fundamental to my academic development and success,” he said.

“I was one of the first surgeons to be selected into the program. I am grateful that the NCSP and U-M faculty took a chance to train me. Without their mentorship, I would not have been able to gain the skills to mentor countless trainees, including a number who are now program alumni.”

Future directions

Looking forward, new NCSP director Chang said the IHPI training programs will continue to adapt as they prepare scholars to study and drive change in health care and health policy, locally and nationally. 

The programs are looking to grow their financial base through philanthropy – such as a gift from Gary Kaplan, M.D., and Wendy Kaplan that funded travel to Washington, D.C. to give scholars in-depth insights into federal healthcare policy.

Academic departments and their training grants also help fund the programs by paying the tuition of master’s degree students who are their senior residents, research fellows, or newly recruited faculty, and the VA supports one NCSP position every year.

“The needs of society have changed and continue to change – we cannot continue to do the same things as we have in the past,” Chang said.

“But we can create clinician leaders who are able to adapt and evolve to find the solutions that will help people live healthier and better lives now and into the future.”

In honor of Rod Hayward, M.D., gifts can be given to the IHPI training programs.