A Neurosurgery Resident in the White House

Guest post written by Jeremy Hosein, MD, PGY 6, from the Department of Neurological Surgery at University of Colorado

On a hot and humid day in August, I stood at the Simon Bolivar International Bridge and observed the refugee crisis at the Venezuelan border. Thousands of Venezuelans sought meals, supplies, education and health care as they walked across the border into Colombia. Traveling with U.S. Health and Human Services (HHS) Secretary Alex Azar, this experience was part of an unforgettable year in which I advised the Secretary on congressional outreach for value-based health care, worked on presidential priorities, including drug pricing and kidney care, and developed as a leader and professional. As a neurosurgery resident at the University of Colorado, I was selected as a White House Fellow and spent a year working in the White House and HHS. In these roles, I saw positive leadership in action and obtained first-hand experience in the policymaking process.

In 1964, President Lyndon B. Johnson established the White House Fellows Program by Executive Order that stated in part, “It is in the national interest that our 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 select young professionals, place them into the highest levels of government, and expose them 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.

Inside the White House and the HHS, I was the legislative lead on
moving from volume to value in health care. Working closely with the Director
of the CMS Innovation Center, I briefed Congress as the Administration rolled
out payment models that radically change how the U.S. pays for health care. For
example, I was responsible for working with the House and Senate to sponsor
bills to support the Advancing American Kidney Health initiative.  For kidney disease patients, policy changes
will promote earlier and more transplants, provide support to living kidney
donors, move from facility-based to home-based dialysis, and extend
immunosuppressant medication for the life of the transplant patient.  I participated in discussion panels related
to spine surgery reimbursement and met with the AANS/CNS Washington Committee
on their legislative priorities. In these efforts, I found that physicians and
other constituencies have a strong voice in policymaking, and those who have
published research on topics related to policymaker concerns have significant
influence in shaping that policy.

The White House Fellowship includes a formal education program, which in addition to speech and media training, organizes remarkable off-the-record conversations with leaders from government, business, and the military. This year, I spoke with Chief Justice John Roberts; Housing and Urban Development (HUD) Secretary Ben Carson, MD; former National Security Advisor Henry Kissinger; businessman David Rubenstein; House Majority Whip Jim Clyburn (D-S.C.); General Colin Powell; and more. Themes from these conversations ranged from leading large teams with complex missions, developing a strategic framework toward delivering outcomes, exploring failure and resiliency, and achieving success in a political environment. Fellows also have the opportunity to travel on domestic and international policy trips. I traveled to Japan and South Korea and sat with the U.S. Ambassadors, C-suite executives from mega-corporations and startups, and military leaders where I learned about the opportunities and threats in the Indo-Pacific region — particularly from North Korea and China.

The White House Fellows program is unique in that it places
individuals into top leadership positions with responsibility over national
priorities. At the same time, it makes a significant investment in their professional
development that has paid dividends to the country, as former fellows include
elected officials, business leaders, university presidents, cabinet
secretaries, and other neurosurgeons. The opportunity to work closely with
talented and driven staff in the federal government has changed how I think
about leadership, government and health care. Previously maintaining a narrow
focus of health care delivery, this experience has widened the aperture on
issues that also touch health care such as national security and resiliency of
our infrastructure, disaster response, labor, economic development and global
health. This year has given me insight into federal policy development and
implementation and the privilege of learning leadership from accomplished
Americans. I plan to repay the privilege by staying civically minded and
engaged in organized neurosurgery and health policy.