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Establishing a Legacy

On a cool spring evening, friends, family and colleagues gathered at a winery in Maryland to honor Fitzhugh Mullan, MD, a professor of health policy and manage- ment at Milken Institute School of Public Health (Milken Institute SPH). W ith wine glasses raised high, attendees toasted to Mullan’s long and distinguished career spent fighting to make health equity a focus of all health professions.

At the celebratory dinner, Thomas J. LeBlanc, president of the George Washington University (GW), announced the Fitzhugh Mullan Institute for Health Workforce Equity (Mullan Institute). The Mullan Institute, originally named the GW Health Workforce Institute, was established in 2015 by Mullan and Patricia “Polly” Pittman, a professor of health policy and management, to research and address issues facing health professionals. The institute was renamed to honor Mullan’s lifetime commitment to public health, policy and medicine.

Lynn Goldman, the Michael and Lori Milken Dean of Milken Institute SPH, has worked with Mullan for nearly a decade and attended the dinner. She
gave an emotional toast to highlight Mullan’s influence on the Milken Institute SPH community.

“Fitzhugh has been a great mentor and teacher to many at our university, and I am honored to call him a colleague and a friend,” Goldman says. “In naming the Fitzhugh Mullan Institute for Health Workforce Equity, we commit to continuing his work toward creating an equitable health work- force for decades to come.”

A trained pediatrician, Mullan’s distin- guished 50-year career includes time as a civil rights worker, National Health Service Corps physician, federal admin- istrator, state health secretary, assistant Surgeon General, researcher and teacher. At age 32, in the midst of his public service career, Mullan was diagnosed with cancer and underwent surgery, chemotherapy and radiation. He founded the National Coalition for Cancer Survivorship, which continues to serve as the leading voice for addressing the needs of cancer survivors nationwide. Mullan, who is also a professor of pediatrics at GW’s School of Medicine and Health Sciences (SMHS), first joined the university in 1998.

“It’s an enormous honor that GW would be generous enough to name the institute after me and allow us to slightly redirect its purpose to focus on equity,” Mullan says. In order to create an equitable health workforce, professionals, educators and policymakers must address the various elements that contribute to inequity in the health professions, Mullan says. The Mullan Institute works to further research and education in health workforce equity through three areas: data and research, convening and education.

The first area, data and research, focuses on the improvements that can be made in efficiency, graduate medical education, workforce migration and policies, and other topic areas. The second area, convening, is explored through leadership summits and an annual conference that brings together health professionals from across the nation. The third area, education, is highlighted through two fellowship programs targeted at professionals and medical residents.

The three focus areas of the Mullan Institute will be led into the future by three accomplished women: Pittman, who now serves as director of the Mullan Institute; Candice Chen, MD, MPH, an associate professor of health policy and management at Milken Institute SPH; and Guenevere Burke, MD, MBA, an assistant professor of emergency medicine at SMHS.

Our university’s potential is so much greater than what’s within its walls,” Burke says. “As we watch residents learn and shape health policy, we see a reawakening of the foun- dational reason why they went into medicine, which is that deep sense of caring about others and the community.

Data and Research

The Mullan Institute is home to two health workforce research centers funded by the U.S. Health Resources and Services Administration (HRSA). One center is focused on establishing equity in health workforce training and education, and the second is focused on understanding emerging health workforce issues. Together, the centers provide topical research to strengthen understanding of challenges facing the health professions and to inform policy discussions at the national, state and local levels. The centers work on 10 HRSA-funded projects each year.

Research is the basis of understanding the cultural problems related to diversity and inclusion, Mullan says. By conducting research on emerging issues faced by those in the health professions, researchers can better understand how underserved communities access health care, the quality of the care available and any health dispari- ties that may exist. “It’s not just studying the workforce for the sake of studying the workforce; it’s really taking a position on how the workforce should be oriented,” Pittman says. Pittman expects the Mullan Institute to grow tremendously over the coming months and, looking toward the future, is examining how research can delve into areas such as behavioral health, maternal and child health, reproductive health and care for aging populations.

“We’re shifting from a profession-specific orientation to a focus on the health needs and developing the workforce to meet those needs,” Pittman says. “It’s a different way to slice the pie, so to speak.”

Convening

As the only public health school in the nation’s capital, GW provides unique oppor- tunities to gather together academic scholars, health care experts and policymakers. The Mullan Institute utilizes the school’s location to enrich its work by hosting the annual Mullan Workforce Equity Summit, a daylong event hosted at Milken Institute SPH that convenes experts, scholars and the public on popular topics related to health disparities, equity and the workforce.

The first summit, held in June, focused on how the health workforce could address and combat the growing reproductive health crisis in the nation. Experts from across the reproductive health field participated in panel discussions, and Leana Wen, MD, former president of the Planned Parenthood Federation of America, gave the keynote speech. She emphasized Mullan’s influence in her work as a health professional, sharing the story of how they’d met at a conference when she was 18 and how he had been a mentor to her throughout her career. Wen joined Milken Institute SPH in September as a distinguished fellow in the Mullan Institute and a visiting professor of health policy and management.

“Dr. Mullan’s work and unmatched legacy have never been as important as they are right now,” she says, “when the stakes for public health in our country—including reproductive health care—are higher than they have been in decades.”

The Mullan Institute also addresses the pillar of convening through the Beyond Flexner Conference, where health profes- sionals and students committed to an equitable health workforce gather to learn new ways to integrate social justice into education and medical practice.
Mullan organized the first conference in 2012, which was held in Tulsa, Oklahoma. Since then, the conference has grown, and the Beyond Flexner Alliance of individuals working toward health equity continues to grow each year.

Chen, a pediatrician who worked under Mullan’s leadership and has built an illustrious career in health equity, including time spent as the director of the Division of Medicine and Dentistry in the Bureau of Health Workforce at HRSA, leads the Beyond Flexner Alliance for the Mullan Institute.
“Our basic idea is that in the space of health equity there are a lot of individuals and organizations engaged, but there is still not enough,” Chen says. “We must continue to partner and work together to support and highlight the good and inno- vative work in progress.” The next Beyond Flexner Conference will be held in Arizona in April 2020, and more than 500 individuals from universities and health professions are expected to attend.

Education

It’s crucially important that the next generation of health professionals are trained to understand workforce equity, Mullan says. The Mullan Institute houses several educational programs that work to educate future leaders. Established in 2016 through an initial $6 million award from The Atlantic Philanthropies, the Atlantic Fellows for Health Equity is an international, multi- disciplinary leadership program that brings together health professionals to work on issues related to health equity, says Burke, an emergency room physician who has also pioneered residency programs in health policy in Southern California. She worked with Mullan to develop the fellowship and now leads the Atlantic Fellows program.

In 2018, the Mullan Institute received an additional $18 million from The Atlantic Philanthropies to expand the fellowship program and operate it through 2026. “I never envisioned I would be doing this work but Fitzhugh has encouraged me to take on opportunities I could not have imagined,” says Burke. “W ith the fellow- ship, he opened an opportunity to share the vision of what it could become, and it has been really special to see the program grow.”

The yearlong program is one of seven global fellowship programs funded by Atlantic Philanthropies. It has successfully recruited three cohorts of fellows from the United States and worldwide, including Uganda, the Philippines, Brazil, India, Argentina and Sierra Leone. Participants include health activists with expertise in law, economics and medicine.

“I’ve seen our fellows sustain one another, and they’re the champions of causes that other people write off as hopeless,” Burke says. “As we grow, I hope to see our fellows continue to build connections among themselves and the broader group of Atlantic Fellows.” Aside from the Atlantic Fellows program, the Mullan Institute houses the Residency Fellowship in Health Policy and an elective class in health policy. The residency fellow- ship, started by Mullan more than 15 years ago, allows medical residents to learn outside the classroom and hospital walls by visiting with health care experts and policymakers from across W ashington, DC. More than 400 medical residents have participated in the program. Its goal, Burke explains, is for medical residents to use their newfound knowledge of health policy to become better advocates for themselves and their patients.

“Our university’s potential is so much greater than what’s within its walls,” Burke says. “As we watch residents learn and shape health policy, we see a reawakening of the foundational reason why they went into medicine, which is that deep sense of caring about others and the community.”
Altogether, the three pillars of data and research, convening, and education guide the Mullan Institute toward its future.

The Mullan Institute furthers its work by collaborating with other schools across the university, including the Schools of Nursing and Business, the Graduate School of Education & Human Development, and the Trachtenberg School of Policy and Public Administration.

“The ideas of workforce and equity have turned out to be the north stars of my professional life,” Mullan says. “To have those two come together in an institution that will bare my name after I’m here is an honor and as gratifying a gesture that can be made to a person.”

Argentinian Physician Reflects on Experience in Altantic Fellows Program

Jonatan Konfino, a physician and public health professional in Buenos Aires, Argentina, was one of 15 fellows in the 2018 cohort of the Atlantic Fellows for Health Equity fellowship program. Konfino was drawn to the fellowship program because it offered opportunities to improve his leadership skills and his understanding of health equity from a global perspective.

“The fellowship was a great opportunity to connect with colleagues from the U.S. and countries who are also fighting for a more equitable health system from their own viewpoint but facing the same barriers and challenges,” he says. The fellowship program included three in-person meetings of the fellows and continued engagement through online learning. Konfino says many of the fellows in his cohort have become dear friends, and working with faculty like Fitzhugh Mullan and Polly Pittman helped him envision how he could help shape the health system in Argentina. The fellows also visited communities impacted by health workforce and equity issues and learned how public health leaders helped improve their quality of care.
“I left more convinced that achieving health equity and social justice is possible,” Konfino says. “There is definitely a before and after in your personal life and professional career with this fellowship.”

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