HMP Internship Reflection (Wicked Awesome Summa in Bawston)

andy-mychkovskyIn May, I arrived at Massachusetts General Hospital with mixed feelings:

  1. First and foremost, I was excited to get back to work. Graduate school is a fantastic place to learn a wide breadth of topics from professionals you may never otherwise come across. However, sometimes it feels like the Truman Show, with life revolving around the “ivory tower.” I find it essential to seek out real-world opportunities that foster applicability of learned skills. For example last year, I helped draft the UMHS Community Health Needs Assessment and found the experience to be unlike any offered in the classroom.  If it were up to me, practicums, research or internships would be ingrained into the student experience, but that is topic for another day.
  2. Second, having worked in healthcare consulting prior to graduate school, I was not sold on the hospital administration path. I love timely innovation, and developed a wariness for the bureaucracy of large academic medical centers and their fixed costs associated with facilities, research and teaching. Similar to Newton’s Third Law, for every new idea, there is an equal and opposite force acting against it (budgets, staffing, government regulation).
  3. Third, I was concerned that the institution may be overly braggadocios for my liking. Among my friends, it is no secret I hold great disdain for elitism, in the professional, academic or social setting. Having been declared America’s best hospital by U.S. News in 2012-2013, the third oldest hospital in the nation, and the original and largest teaching hospital of Harvard Medical School, I assumed this to be within the realm of possibility.

Despite these preconceived ideas, I did my absolute best to wipe the slate clean and begin my internship with an open-mind. My immediate preceptor is the Executive Director for the Department of Medicine, overseeing 11 of the hospital divisions. I also work with both the Hospitalists Medical Group and Clinician Educators (Practicing MDs with appointments at Harvard Medical School). Throughout the course of the summer, projects and conversations have challenged, enlightened and reaffirmed what I thought to be true. So how do I feel now after nine weeks?

  1. These three months may be the most formative of the two year program. This only reinforces my belief that practical experience is equal to if not more important than academic lecture. Hopefully another such opportunity may present itself for this upcoming school year.
  2. Do I desire to be an administrative director for a clinic in the hospital? Probably not. Would I work in hospital administration from a system-wide perspective? Possibly. Having spoken with several key leaders in population health management, I would definitely work for certain progressive hospitals, particularly those with Accountable Care Organizations or other demonstration projects. However, society has seen unparalleled opportunity for smaller organizations, such as Iora Health, Camden Coalition of Healthcare Providers, and Nuka Model to slash costs and improve quality. Although critics may question the scalability, I see great promise to get involved early in my career.
  3. My favorite realization this summer was that MGH is actually incredibly understated. Humility is pervasive throughout administration, support and clinical staff. I have never witnessed a hospital where the nurses seem so generally happy to work with the physicians. Physicians are salaried, with tight alignment between the Physicians Organization (MGPO) and the General Hospital (GH). I believe that everyone understands that despite the rankings, improvement is needed in almost everything it does. In my favorite story, President Peter L. Slavin, MD, was asked earlier in the year whether MGH was worried about John Hopkins gaining the #1 U.S. News ranking this upcoming year. In response, he told everyone that John Hopkins or Mayo Clinic is not our enemy, cancer and heart disease is. That is what we’re worried about.

Andy Mychkovsky is a second year HMP student at the School of Public Health.

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