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The Lessons and The Legacy of the Pew Health Policy Program APPENDIX A. Telephone Interviews Table of Contents Telephone Interviews 1. Bill Weissert 138 2. Carroll Estes 144 3. Dennis Beatrice 151 4. Hal Luft 153 5. John McDonough 162 6. Lisa Bero 164 7. Leon Wyszewianski 168 8. Mark Legnini 175 9. Patricia Butler 177 10. Pamela Paul-Shaheen 183 11. Stuart Altman 187 12. Sarita Bhalotra 190 13. Stan Wallack 193 14. Marion Ein Lewin 203 15. John Griffith 215 16. Dan Rubin 216 17. Joan DaVanzo 226 18. Terry Hammons 232 19. Jonathan Howland 237 20. Kate Korman 245 21. Steve Crane 255 22. Al Williams 275 23. Kathleen Eyre 282 24. Leighton Ku 288 25. Linda Simoni-Wastila 294
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The Lessons and The Legacy of the Pew Health Policy Program Telephone Interview with Bill Weissert Thursday, August 17, 1995, 10 a.m. 1a. Based on your experience and familiarity with the fellows and the programs, what did we really accomplish? What were the most important contributions? We trained a lot of people in research findings from health services research, and we trained the last three or four cohorts pretty well in methods. We helped quite a few careers, and as with any program, we gave some degrees to people who probably should not have them. A program like this is particularly vulnerable because you hope that people will either stay or go into the health policy field instead of becoming academics. This is a real risk when you give a doctoral degree without requiring residence. You wind up giving a degree to people who are not really academics, but who are now qualified to teach. That is a downside of our program and something about which we are constantly vigilant. The most obvious [contribution] is career development. You can clearly see that and more or less count it. Many alumni were promoted or got better jobs in the policy field as a result. There is much about the policy process that is still happenstance and convenience—who is around. You can only improve the chances that rationality will play a part in policy by having around a lot of people who are trained rationally. So, the more people you put out there, the better chance you have to formally or informally influence the policy process. We train a lot of people who are interlopers or daily workers in the policy process. Therefore, we increase the chances that what comes out the other end will be better informed than it would have been if people had been shooting from the hip. Yet, it is hard to quantify that. 1b. What is the Pew ''legacy'' in terms of: health policy? We made a lot more people aware of the power of the literature to answer a lot of the questions in a systematic way rather than guessing, as they were doing before. We helped with the diffusion of the health services research findings. I am always struck when I go to meetings and talk to folks who are making major policy decisions or influencing policy decisions without reading the literature. These foundation types and policy types have almost never read the literature. It's shocking. They are trying to move forward the state of
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The Lessons and The Legacy of the Pew Health Policy Program the art without having found out what the state of the art is. They are verbal people, and they learn by hearing; they don't read. So, the bottom line: the more people who know about the literature and what it says and can relate to it, the more likely you are to influence the policy process. It may be an inefficient way, but I have not found anything that works better. Certainly, sending policymakers the articles does not work. education (doctoral, postdoctoral, or midcareer programs)? your institution? For our institution it has led to a new degree program which we will keep. It broadened our presence in training health services researchers at the doctoral level. We had been primarily a master's program with a very small doctoral program; this gave us a whole new program, more bodies, and a slightly different cut of people. People came who were more in the policy process. Pew definitely had an influence on this institution's functioning and its contribution to health services research and health policy. It also made both the program and me more flexible in terms of how policy is defined. Policy is being made even within institutions. For example, I initially opposed a dissertation topic by somebody who was interested in how hospitals allocated the funds they were getting that go to education, how the medical school and hospital fight that out. I had said that wasn't really policy. Well, it is a policy question and now it's the leading policy question. It has made us more flexible as a program in what we do to support women. When you take women who are in the midcareer process and they come into a long-term program like this, they are going to have babies. You have to be able to cope with that. You have to be prepared occasionally for a baby in the classroom. These are all good things. They make us a better university. I am pleased with that aspect of our program. 2. How and why did your specific program develop? To what extent will your program continue now that Pew funding has ceased? We had an innovation here that dates back 25 years, which is this midcareer weekend program where people come in and take 2 years of the same courses. That was a proven idea that worked and cranked a huge number of people out into the health management community. So, with this program we extended that to the health policy commu-
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The Lessons and The Legacy of the Pew Health Policy Program nity, and I think it's a good idea. And, it gets better every year. That's how it developed. It was basically an incremental change over a proven program that was and is unique in the country. It was innovative at the time and continues to be innovative. There is no question that this program will continue. We have expanded it and bought off on it and found that we can sustain it. The big problem is that we will not have funding, and therefore, we will have a limited ability to reach people who need to be here with fellowships. We just don't have the money. To the extent that you're trying to reach people in the policy process, funding is pretty important because it's a field where people are not particularly well paid. Thus, without the proper funding we reduce our likelihood of influencing the policy process. But we will continue to get people who are either able to afford the program because they are MDs or because they are supported by their organization or interest group. 3. What was the need in the health policy community when your program started, and how have those needs changed today? Is the job done? The need is the same. You have to train a lot of people because the path to influencing policy is very murky and difficult to predict so its better to have a lot of trained people around. Certainly, the job is not done. I continue to be shocked at the poor quality of policy in some areas, although I think it has gotten a lot better in the 20 years since I've been doing this. 4. What was it about your curriculum that contributed or did not contribute to your program's success? The cohort effect—locking people into being part of a group for 2 years of intensive course work. I think that has a terrifically positive effect, is very successful, and socializes a lot of people. They learn from each other like crazy. The faculty learns as well. Those things that do not contribute: It's difficult to take people who are midcareer and send them off after 2 years and have them finish their dissertation, although we have worked on that and we are about where we want to be on that. That's been a difficult problem to overcome. Getting back into the work site and not being forced to show up with papers every month. It's difficult not to let job demands take precedence. There is no solution to this dilemma, however the
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The Lessons and The Legacy of the Pew Health Policy Program degree requirements that are imposed upon us by the accrediting organization of the schools of public health do not contribute to the success of the program. To satisfy the public health requirements, we had to find people to teach from other departments. That can lead to courses of variable quality. We amend this by flying people in from Boston and other universities. Every year it's a struggle. 5a. What was the most innovative or unique aspect of: your program design? Lockstep. Everybody has to take the same courses; they come in on weekends, they're midcareer, but the demands on them are no less than those on students in on-campus (OC) programs and may be even greater. methods of implementation One method that works (Leon Wyszewianski's idea, but I implement it) is to give the students the usual statistics courses but have the methods course taught by a practitioner rather than a methodologist. That seems to be one of the most important courses we offer. The idea is that they will know what to do with the knowledge they learn. It's the best idea we have in the program. It takes these people from being theory-trained to appliers. educational process? Answered previously. 6. Based on your experience, what lessons were learned about the educational process in terms of: recruitment? We tested the likelihood that we were producing a lot of false negatives. In the past we had been turning down people who might have been able to make it, and this year we let them in. What we found was that with a 10 percent drop in Graduate Record Examinations (GRE) scores we could increase our cohort size by 100 percent. I do not see a substantial difference in performance. We have proportionately more people who shouldn't have been in, but not an increase in the percentage. So, we have the same number of people we wish we had not admitted, but we always have some we wish we had not admitted. Some of those drop out and some don't. It confirms my long-held hypothesis that
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The Lessons and The Legacy of the Pew Health Policy Program we only worry about false positives and in the process throw out two or three who could have made it, and this year we included those people and most of them were pretty good choices. degree requirements? We dropped a bunch of prerequisites this year that we thought were pseudo prereqs. We required people to worry and study to pass an exam that everybody passed or everybody flunked. I just threw out everything that wasn't either statistics or economics prerequisites, and it worked. We got rid of some people who just couldn't cut it in terms of the quantitative stuff. And as for the others, we didn't put them through a lot of Mickey Mouse stuff. curriculum and content? integration of fellows with other students, the rest of the university, and the program in general? It's approaching zero. We have them here all day in class, and they work and party as a cohort. There is almost no interaction with other university students. I have tried to integrate the OC and off-campus programs, but the OC programs are threatened. Someday we'll get more integrated. The greatest positive of integration would be to give a dose of reality to the OC people and perhaps a little more of the role of cognates in research to the off-campus people. relationship between faculty and students? I don't think there are programs in which the relationship is better than in this program. The faculty and students are collegial. The students are experienced and not shy. There is a very good relationship. completion rates (where applicable)? This is something we have worked on constantly. Our penultimate cohort is up to 66 percent with a couple more likely to come through. I don't think doctoral programs ever want to be 100 percent. So I think that's just terrific. 7a. To what extent do you think there were "programmatic" barriers to student completion? We didn't really have anybody whose job it was to make sure the students were equipped to do a dissertation. They
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The Lessons and The Legacy of the Pew Health Policy Program had advisers, but they weren't even seeing their advisers once a month. So, we made an institutional change and added a course where someone actually taught the students how to write, one step at a time. 7b. To what extent do you think the program was beneficial for those who did not finish the program? Everyone who drops out basically praises what they've learned so far and report that they are immediately applying the stuff. We know from classroom assignments that it is very typical for the students to use what we assign that month or the next in their job. An example would be where we sent them off to do a policy analysis and provide policy options for the Secretary, and the Secretary actually chose one of their policy options. That is not untypical. 7c. How can we measure success for those programs where completion rates do not apply (i.e., postdoctoral programs)? Look closely at the people who applied and were turned down. Compare their outcomes and influences with those who got in. Where are they with their careers and what kind of impact have they had on the policy process? Do a comparison group study. 8. How does the Pew fellowship approach differ from a traditional fellowship approach? How have the major outcomes differed? The major differences are within the cohort. We examine the product that these people are getting and make changes in faculty and courses in order to change their total product. So, it is not a course-by-course assessment, which is true for traditional OC programs. We look at the product and say, "Are these people getting enough of this particular thing? If not, where in all of their courses can we add it?" Since there is no discretion, we can focus on things they really need. Major outcomes do not differ very much. Pew people tend to be somewhat more policy focused and more involved. 9. If you were asked to give advice to another university attempting to initiate a similar program, what would you say? You need to make sure that the best faculty are willing to teach Saturdays and Sundays. Faculty do not realize that they will be teaching at least 5 of the 7 or 7 of the 9 months on weekends, both Saturday and Sunday. This is a big commitment that needs to be established up front.
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The Lessons and The Legacy of the Pew Health Policy Program Telephone Interview with Carroll Estes Wednesday, August 23, 1995, 4 p.m. 1a. Based on your experience and familiarity with the fellows and the programs, what did we really accomplish? What were the most important contributions? I think the Pew program has very successfully seeded the field with competent, well-trained scholars at government levels, nonprofit and foundation levels, and university levels. The flowering and capability of those fellows and their contributions are beginning to be recognized at fairly significant levels. For example, one of our fellows was chair of one of the White House task forces on benefits in the health reform area (Linda Bergthold). The most important contribution of the fellows is a passionate commitment to health policy and health services research that is objective and has an impact and the ability to carry out that work either directly themselves or to stimulate organizations and institutions to do it where they are. 1b. What is the Pew "legacy" in terms of: health policy? There is very specific expertise that is available in the field as a result of the Pew program. I don't think it's enough. I think the program falls short by cutting itself to an end prematurely. I think the Pew Health Policy Fellowship Program needed to be extended a minimum of another 10 years. I look more toward the Robert Wood Johnson Clinical Scholars model. The magnitude of the work and the magnitude of change in the field is such that health policy contributions have just begun to be made, and these scholars will be around as they are becoming policy makers. Nevertheless, there is very important substantive work that still has to be done in health policy, and the training of more leaders continues to be needed. education (doctoral, postdoctoral, or midcareer programs)? There certainly are seminars and courses that exist on our campus that would not have existed on this campus without support from Pew. There are other postdoctoral programs that are multiplier effects from the Agency for Health Care Policy and Research (AHCPR), but now we don't know the extent to which AHCPR is going to be a viable institution to continue what would be complementary
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The Lessons and The Legacy of the Pew Health Policy Program programs of training. There is no question that interdisciplinary, scholarly work in health policy has been forwarded as a result of the Pew commitment and faculty commitment to education on a multidisciplinary level has probably grown. In terms of UCSF (University of California, San Francisco) there is no question that the Institute for Health and Aging, which is a major research institute that did not exist prior to the Pew program, probably exists in large part because of the support from Pew for both research and the training program. It does research in education and is a multimillion-dollar-a-year institute that is contributing quite a bit in terms of disability statistics and health and long-term care policy. your institution? Answered above. 2. How and why did your specific program develop? To what extent will your program continue now that Pew funding has ceased? It developed because we had two people who had significant research backgrounds and experience on which a successful training program could be built. Furthermore we had faculty who had many specific methodological substantive skills to offer. Our particular program began with pre-doctoral, management, postdoctoral, and midcareer components. I think we found that the midcareer program was a very good route for certain people who were quite accomplished and had a lot to bring to the classroom, but who needed to acquire the health policy and interdisciplinary skills. These people already had positions of influence into which they could carry this. We obviously had a charismatic leader in Phil Lee. He had great vision of where health policy needed to go, and he served as a catalyst to bring together existing resources and capabilities and make this happen. To what extent will the program continue now that funding has ceased? I think that there are serious institutional problems at the University of California which have to do with funding problems. There has been a 25 percent cut in educational resources in the last 4 years alone, with no appreciable resource increase. The academic health centers questions with regard to health care restructuring and their competitiveness in the new managed care world have further raised resources questions for major medical centers and health science centers. This just means that the resource base from general-source supports that one had hoped to institutionalize are more difficult than ever to access due to factors
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The Lessons and The Legacy of the Pew Health Policy Program that have nothing to do with the success of the program and that are totally exogenous. There are and will continue to be research seminars. There will continue to be the search for postdoctoral training programs—individual and institutional—to keep the concept alive. However, the lack of institutional support or the lack of faculty support and uncertain or declining federal training grant support will impede the magnitude or the size of such programs. It's not news. It has been said at every meeting we've had that Pew should not be cutting off at this point. 3. What was the need in the health policy community when your program started, and how have those needs changed today? Is the job done? We were very concerned about access, cost, and quality when we started, and we are still concerned with access, cost, and quality. No, the job isn't done. Access is worse than ever. Quality questions are bigger than ever. There are programs that attempt to cap cost but really don't do cost containment on the system level. The work that needs to be done is bigger and more important than ever. 4. What was it about your curriculum that contributed or did not contribute to your program's success? UCSF has a health policy specialty that it did not have prior to the Pew doctoral program in the Department of Social and Behavioral Sciences. A major success of our program has been the curriculum of the writing seminar and every week a seminar on health policy issues with faculty and fellows presenting on a convening ground. The writing seminar is stunning, and our fellows probably have a much stronger publishing record than they would have had without it. We have been very fortunate to have on our faculty the West Coast Editor of JAMA, Dr. Drummond Rennie, who has really done an incredible job with stimulating and encouraging publications. 5a. What was the most innovative or unique aspect of: your program design? One innovative aspect is the hands-on research with ongoing faculty investigators who have major programs of research and the competency to direct fellows in wide areas of interest, which allowed for special approaches that fellows might have. I think the writing seminar was very crucial and very exciting in teaching how to critique and to take critique.
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The Lessons and The Legacy of the Pew Health Policy Program methods of implementation? Implementation was through the colleagueship and mentoring and the coauthorships and separate authorships through these large-scale research projects. The fact the two institutes at UCSF together have about $20 million in funded research every year and probably 40 faculty investigators who are well known in their area has really contributed to implementing very significant training opportunities. educational process? The Pew conferences every year have been important. Networking and socialization to the field, the norms of work, and networking of colleagues have been important parts of the educational process. I have already mentioned the unique element of the writing seminar, which was very challenging or is very challenging to fellows, while also being very productive. Our weekly seminars are valued and the rooms are packed with a lot of other people wanting to join these seminars. 5b. What were the biggest challenges or barriers to overcome of: your program design? Getting doctors to mix with social scientists, to be open to learning, to be able to do what is basically social science-type research. For the social scientists it's similarly the obverse of learning more about how health care institutions actually work from a health professional perspective. methods of implementation? educational process? The integration of the disciplines really has worked, the method of implementation was constant, and there are continuing opportunities for interchange and various projects and seminars. 6. Based on your experience, what lessons were learned about the educational process in terms of: recruitment We probably send out 200 institutional letters a year. As everything, the word of mouth in the field and the referral from other fellows is a very important source of recruitment. Obviously, the excellence of our faculty and their reputations
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The Lessons and The Legacy of the Pew Health Policy Program 3. What was it about the curriculum that contributed or did not contribute to the program's success? I have mixed feelings about the curriculum. On one hand the freedom of the curriculum was one of the things that the students liked a lot; on the other hand I think that the BU/Brandeis program didn't give people a good enough methodological training. It was not rigorous enough in methods. What can you say about the dissertation process? The process for me was relatively painless. I had a topic that worked fairly well and a dissertation committee that was nice, compliant, and responsive. They would read my things and generally not take me to task too badly. It went well for me. Were there structures built into the curriculum that kept the process going or at least helped to keep it at that fast pace? There were definitely efforts to try to start it up. The major problem was that the hardest thing is to find the topic, find the niche, and find some way to deal with that, and then different students have different strategies on how they build their committees. I prefer to find my own project and then pick a committee that will give me support in the areas that I need and not give me a lot of hassles. Other students think they have to pick out the most prestigious names and the biggest experts in a given area to help guide them. That had its virtues too. 4. How, if at all, was the Pew approach different from the traditional teaching approach? The Pew approach was somewhat different because there was a given set of classes and a slightly different program philosophy. I'm not sure when all was said and done that there was a massive approach difference, but maybe there was something that was a little different: My impression was that at Brandeis, perhaps there was somewhat more of an emphasis to think that either I'm a political scientist, an economist, or a sociologist, whereas at BU there was not an emphasis to identify with one or another social science discipline. 5a. How has your professional life changed as a result of the Pew program? What value has Pew training added to your life? 5b. Has your career trajectory changed as a result of your time spent in the Pew program? If yes, how?
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The Lessons and The Legacy of the Pew Health Policy Program It certainly changed my professional life somewhat. I was doing policy work and policy research in the federal government beforehand. On the other hand, the area that I was working in, food and nutrition and welfare policy, was fairly different from what I do now, so it permitted me to shift areas into a somewhat broader area and get some extra training. That was very useful and very helpful to me. 6. If you did not complete the program do you plan to? If yes, why? If no, why? Obviously you completed the program. Do you have any ideas how valuable the program was for those who did not complete? There are two things. The first is that they all got some additional training, regardless of whether or not they finished. I think the other thing is that a fairly high proportion of those who did not complete the program (meaning that they did not get their PhD) still harbor a hope that at some point they will complete it. I know this because when I periodically talk to some of the people who didn't complete the program in the first 2 years, they say that they still plan on getting around to the dissertation any day now. At the least they harbor some hope of completing it. I think that in any PhD program there are those who after the first few years don't complete the program, and then there is a small percentage of the noncompleters who then do finally complete it. Would you guess that an accelerated program produced more or fewer completers? I think that it produced a fair number of completers in the time frame. It may well be that one of the things that happened, because of the emphasis on a quick time frame, is that if you didn't complete the program within the first few years, then you sort of had to go out and find a real job and perhaps move away from the Boston area, and then there was a greater likelihood that you wouldn't complete it. There is a different philosophy than that perhaps at Michigan, where you knew you were in it for the long haul and you didn't feel the same pressure to complete the program quickly. I will say that my recollection from the statistics that you showed in Washington was that I think fellows at BU/Brandeis had among the lowest completion rates. However, by the time I completed the program, BU/Brandeis had lots of completers and Michigan had maybe two. It was an issue of different timing.
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The Lessons and The Legacy of the Pew Health Policy Program 7. What is the Pew ''legacy'' in terms of: health policy? It would be difficult to say that there is a clear and unique Pew legacy in terms of health policy. Actually, just recently I saw the video of Mr. Holland's Opus. Remember at the end when the people say, "Gee, Mr. Holland, you didn't do your opus, but we are your opus." That's sort of what the Pew legacy is. Is there a grand work or something that Pew can say is their legacy? I'm not sure that there is something sitting out there brassy and shiny, but there are lots of people that it affected both from the students' perspective and I think also from the program directors' and faculty's perspective. It encouraged faculty to do teaching and furthered them as well. education? One of the things that Pew did was that it helped make more formal the idea that health policy was an area of interest, and it is slowly gaining in acceptance. I do a lot of work for the Association of Health Policy and Management, and the health policy group there seems to keep getting a bit stronger and bigger. Still, that was well reflected in the journal, but partly they are correct because there are lots of health journals but there are not that many management and welfare policy journals so they want to emphasize that. I still wish I'd see a few more health articles in the journal though. your future? I'm still doing the sorts of things that I studied. It had a long-term effect on my past and I assume it will affect my future in the same way. At the November meeting you made reference to the fact that you are no longer in government and yet you have more influence on policy in your current position than before. The context of this statement was that we were talking about what Pew wanted to produce. Can you speak a bit to that? Partly it is because when you're in government, at least when I was in government, and for what I did dealing with the program, I was sort of the major policy and budget analyst for a long time, but you are always sort of fitting in and just trying to keep up with a broader administrative agenda for the Administration and/or for Congress. You can shape things, but you're shaping things within that context. If
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The Lessons and The Legacy of the Pew Health Policy Program you're on the outside doing policy research, then you can try to shape the agenda somewhat. Whereas when you're working in the government, the way the government is set up it's very hierarchical. Basically speaking, most government people work in relative anonymity, and information goes up the administrative hierarchy and then occasionally goes across into other policy circles, whereas if you're on the outside at a place like the Urban Institute, you can deal on lots of levels with policy makers in government, in the executive branch, in Congress, at state levels, and with some of the other associations. In the past few months I've given talks to the national council and state legislators, and the American Medical Association, and it is the sort of thing that would be unusual to do if I were still in the government. 8. Are there any important issues that this interview does not address? If so, please feel free to add comments and/or concerns. Not that I can think of at the moment. Is Pew at this point having any clear thoughts about what it wants to do in the future in this area? As far as I know they are not thinking about health policy. They did start up another program that is more clinically based.
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The Lessons and The Legacy of the Pew Health Policy Program Face-to-Face Interview with Doctoral Alumna Linda Simoni-Wastila Wednesday July 3, 1996, 10 a.m. 1. Based on your experience and familiarity with the Pew program, what did the program really accomplish? What are the most important contributions? I think the best thing that the Pew program did was that it took people, mostly from different disciplines, and gave them very similar training. There were four programs and each one had different goals but essentially it developed this cohort of people who could do health services research, who could do health policy, and who could talk the language and walk the walk and put them out there all over the place. Pew developed this huge network. Not only did it help those who went through the program but it also helped shape health care and health policy. I think that's one of the most important contributions. I can go anywhere, to any meeting, and start talking, and someone will say, "What's your background?" I'll happen to mention that I'm a Pew health policy fellow and they'll say, "Oh yeah? I was a health policy fellow too!" I think the other thing for me, on a personal level, is that I really felt nurtured through the program by the staff and faculty, particularly Steve Crane (even though he was at BU; we had the joint program then). He was a real mentor. I also got some good mentoring here, and we nurtured each other. My class was particularly tight. We nurtured each other and sort of developed a need to mentor other people. That was nice; I enjoyed that. Now I find myself in a mentoring position for students and even for some colleagues, and I am prepared. The Pew program sort of facilitated that. Network building began in the first year. In the first year, all the first-year fellows go to Washington, D.C. You were introduced right away to the Washington scene and the hot issues of the moment, the real cutting-edge issues. If you wanted to know about health care reform you got the latest and the greatest right there. It got students really excited. And, it helped to bridge the programs, to develop that commonality and similar approach to health and health policy. The same thing was true of the annual meetings. The great thing about the Pew program is that it got people excited about the issues and exposed them to the experts, and I'm sad to see that ending. It was almost as if you too became a cutting-edge person. The conversations are incredibly intellectual yet practical at the same time. You felt like, "Wow, we can change the
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The Lessons and The Legacy of the Pew Health Policy Program world!" You just don't get that a lot in typical academic programs. You know, even for me, I'm very specialized, I'm not out there doing health care reform, but I was able to apply my interests and expertise. I would love to have a weekend retreat like that every year. I know the AHCPR (Agency for Health Care Policy and Research) fellowships are happening, but I don't think they have the same sort of bringing together of people from across the country and exposing them to some of the leading minds and practitioners. That was one of the biggest benefits of the Pew program. 2. What was the most innovative or unique aspect of your particular program design and implementation? The most useful and very unique aspect when I was here (the program was a joint BU/Brandeis program) was the dissertation seminar where we were exposed to the second-and third-year students. It really was a dissertation seminar. Every other week there would be a presentation of different research methods and designs. We would spend a whole 2 to 3 hours discussing internal and external validity. The issues discussed were very relevant for the dissertation proposal work. One could take the issues beyond the dissertation process per se; however, they were specific enough to apply to whatever you were working on. It was very useful. It was basic yet thorough: Epidemiology, research methods, and some biostatistics thrown in. The discussions were very cogent. What was even more useful was that we were all, the first-and second-year students, told that we had to be present. This was not something that was taken lightly. Our sessions were 2 to 3 hours; they were long and everyone participated. You didn't get credit, but everyone came. The second-year students and even some of the third-year students came and were helpful in getting us younger folks to start formalizing our ideas. At the same time we were exposed to different processes and different levels of the process. For example, we might have someone come in and say that they were defending their proposal next week and would like to have a dry run, so we'd see what a formal dissertation proposal would look like, and we were then able to provide feedback and hear feedback that was given by other students and/or professors. We had a very good idea what to expect before we actually went through the process ourselves. We even had dry runs for people who were defending their entire dissertations, so by the end of my first year, I was no longer afraid of the dissertation. It was no longer that big huge "D." It was no longer the big black hole that so many
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The Lessons and The Legacy of the Pew Health Policy Program students talk about. They don't see that there are steps to it and that there is a sequential process and that it happens over time. I was able to see very clearly after 1 year what the process was, what the steps were, and what sort of things I should consider. And these principles are not just useful for the dissertation process; they are principles that any researcher or user of research will apply throughout his or her career. Another thing that I liked about the program at Brandeis was that every year we had a seminar series that focused on an area. Some of them were very good, and some weren't so good. We had one that Stan Wallack did on health care financing that was extremely tedious, I guess, but we were exposed to the latest economics in health care in terms of financing and reimbursement and it was excellent, very in-depth. It provided us with an evaluation of the literature. There was another seminar on people's dissertations that were made into books. They were all related to health care. We were thus able to discuss these issues and at the same time examine other people's research. Our focus was mostly qualitative, which is important because I think most research programs don't have enough qualitative courses. One year we had one just on AIDS, which was fantastic. Jonathan Mann came and spoke to us. Overall, the dissertation seminars were the best. We really learned from each other and developed connections that still exist today. I still call on people, and vice versa. Going through the process together bonded us personally and professionally. 3. What was it about the curriculum that contributed or did not contribute to the program's success? From the Brandeis side—and it's not a fault of the Pew program, rather, it is a fault of the Heller School—most of the curriculum offered at the Heller School is just not rigorous enough. We had to go off campus to get more economics, econometrics, or statistics. Bill Crown was great. When you get into the Pew program you've already come from a background that's pretty rigorous, like the Agency for Health Care Policy and Research (AHCPR), and so for the most part we really didn't need all this introductory stuff that you get here. That's my one complaint. Part of it may have been that I was younger than most people, and the program was really geared toward people who had been out of school for awhile. I came out of a fantastic master's program and was very well prepared. So indirectly, the Heller School curriculum did not
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The Lessons and The Legacy of the Pew Health Policy Program do much to increase the Pew program's success. (I should note that The Heller School has since addressed this concern by overhauling its PhD program curriculum.) 4. How, if at all, was the Pew approach different from the traditional teaching approach? It was different by the fact that there were smaller seminars, more one on one. There was a lot more mentoring. There was a lot of collegiality between faculty and students in my master's program, which is really unusual for a master's program. So, I thought that would continue in my PhD program. I dreamed of working alongside some great experts and solving the problems of the world. Yet, when I came here I thought this was the most closed-door place I had ever been. At first I thought it was just this place, but then I talked with my friends at Harvard and Johns Hopkins and they said it was the same everywhere. But, the Pew program helped immensely in that area. Some key faculty were available and eager to mentor the Pew fellows. We had ready access. It was built in. We had Stan Wallack, Steve Crane, Jon Chilingerian later, and many others, mostly BU people, which is interesting. Having that available, as well as a really good group of folks, made it different. But it is interesting: a lot of other students resented that; they hated the Pew fellows. Part of it may have been that the seminars were closed off to non-Pew fellows. And so during my last semester we opened it up but only one other person came. But one of the best things about the seminars was that they were so small. There was a real sense of camaraderie. We didn't really want it to be opened up. On the other hand, it was a great opportunity, and all doctoral students should have the same opportunity. So there was a real conflict in my mind about how I felt about the setup. There was also a lot of fuss made about the Pew fellows which I didn't think was appropriate. 5a. How has your professional life changed as a result of the Pew program? What value has Pew training added to your life? I don't think I would be where I am now if I had just gone through the Heller School PhD program and not specifically the Pew program. I think the Pew program just gave it that extra boost. I don't even know if I would have finished my PhD otherwise. Yes, the funding facilitated it, but the pressure and support to get done also facilitated it. I almost quit the program after 1 year. I thought I might follow another interest of mine, art, but the reason I didn't was
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The Lessons and The Legacy of the Pew Health Policy Program because I kept on thinking about what Marion Ein Lewin said at the meetings, "OK, you guys, you can all get done, you can all do it." She would always talk about how important is was to finish. And, then I said to myself that I've got to get done, I've got to do this, I'm not a quitter. I'm really glad I did it. That kind of support motivated me to want to contribute. And, I'm very pleased with my position. My experience with Pew continues to motivate me. When I get the Pew newsletter and I see where everyone is and what they are doing I think, wow, that's great. It makes me want to go out there and publish more, contribute more, and do more. In that way Pew has touched me professionally. It has made me more enthusiastic about what I do, not that I wasn't before, but it has given me that extra boost. It made the Heller program, which was pretty good, excellent. 5b. Has your career trajectory changed as a result of your time spent in the Pew program? If yes, how? When I finished my master's program I had applied for the Presidential Management Internship but didn't get it. I thought I had wanted to work in Washington. I have many friends who did that and are now "Beltway Bandits." I thought I wanted to be down there doing policy. I thought I wanted to be a policy wonk. But, the Pew program made me realize (even though it is a policy program) that I was not a policy wonk. It didn't make me dislike policy. I actually believe that my research is policy relevant. But, it made me realize that I have a personality that doesn't fit that role. And that's just fine. Yet, it reiterated to me the importance of policy and to study things that have some sort of relevance to a policy, political, or social issue, to strive to deliver as much truth as possible to that particular policy area. In that regard, yes, Pew changed my career trajectory: I realized I was a research nerd. But I do research with practical applications. 6. If you did not complete the program do you plan to? If yes, why? If no, why? I did complete the program. Just going through the course work is the easy part. All it is is foundation. The hardest part is doing the dissertation. The comprehensive exams don't pull all our knowledge together. Nothing but the dissertation can do that. That is the big challenge. People who don't finish haven't met that challenge. I feel sorry for them. I really think they've missed out on the best part of the whole program. I don't know why they haven't finished.
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The Lessons and The Legacy of the Pew Health Policy Program Maybe people think they can come in here and pull it off while keeping their full-time jobs, running a family with two kids, and all that going on. Some people can actually do all that. But, you have to really make a commitment to completing the program, and the dissertation needs to be a real priority. I teach a dissertation seminar, and I tell people this: "Don't plan on remodeling your house in the next 2 years. Try to limit everything else. Focus on your dissertation. It's only 1, 2, maybe 3 years of your life." And people get tied up with thinking they need to have blocks of time. You don't need that. You just need a few hours a day or even an hour a day. People just don't see that. I think one of the reasons the Pew program wasn't refunded was because there was a low completion rate. I get a little angry about that. I think it's been denied to other people, this great opportunity to get exposed and get the funding, etc. Of course they still made great contacts. Unfortunately, I think some people come into this just to make the contacts and they sort of leapfrog over people. 7. What is the Pew "legacy" in terms of: health policy? What it has really done is to put people out there who have superb training and an interesting way of attacking problems. These people are now in high-profile positions. They are able to make a real contribution to the field. I think that's real important. I also think that below that there is a level of people, like myself, who are more background people, who do the research. And I think we are real important too, because what we are doing is building a foundation of knowledge that has practical applications, and I hope is done as objectively as possible and as rigorously as possible. But, there are definitely two layers. Policy isn't just those people working for Rockefeller or Kennedy or the bureaucrats in the U.S. Department of Health and Human Services. It's also about the people who do the background work. Pew has done an excellent job of supplying these kinds of people. education? There are two levels here as well. I do some education too. I think it's real important that I return the mentoring that I received, and I think a lot of people came out with that attitude. There are now incredible role models out there for people who are starting out. There is a high profile of Pew
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The Lessons and The Legacy of the Pew Health Policy Program people, and that is a real legacy. To have those type of role models out there and for them to be visible. It seems to me that the Pew programs provided some consistency to the whole arena of health policy in terms of the quality and expertise of people that may not have been there before. That was achieved through the educational mission and policy focus. What Pew had also done was to make sure that programs like those at Brandeis, UCLA, and UCSF have the programs even without funding. They all have a real strong interest in continuing programs like this through other funding sources, like AHCPR. They all continue to build this health policy area, broadly speaking. Pew really enabled a few programs to develop educational programs in health policy and gave people fantastic skills. And they are now ongoing. It was like seed money. It's really important. Everyone else can't find jobs, but this is one area where there will always be jobs. Health policy keeps on growing. Pew fostered that, and that's the legacy. your future? Pew gave me a head start. It allowed me to evolve my ideas in a less pressured environment. I didn't have to worry about where my next paycheck was coming from. I didn't have to worry about not having colleagues and peers to support me and mentor me. It gave me a real boost. I'm really happy for that. I'm grateful for that. I know a lot of graduate students who feel like they are in perpetual alienation. Pew prevented that from happening to me. 8. Are there any important issues that this interview does not address? If so, please feel free to add comments and/or concerns. We have to address the gaps that will now exist without Pew funding. For instance, if AHCPR does go under or if other foundations fail to kick in, hopefully, Pew will reconsider this sort of program, again, but maybe in a different way or with different institutions. We need to always be thinking about training health policy professionals at the pre-and postdoctoral levels. We need to keep an eye on the field and seeing where and what the gaps are in health and medical training.
Representative terms from entire chapter: