Current Master of Public Health graduate students, Lisa Jackson and Dyane Tower, recently sat down to talk with Dr. Elliott Fisher, the newly appointed director of The Dartmouth Institute for Health Policy and Clinical Practice (TDI), on what got him started in medicine, TDI’s most important health care contributions to date, and what its future might look like here at Dartmouth and beyond.
Lisa Jackson (LJ): What first inspired you to pursue a career in health care?
Elliot Fisher (EF): I decided that I would try a few things after college, so I drove an ambulance in Somerville, Massachusetts. I was interested in the outdoors and had done a lot of climbing and wanted to be able to learn more first aid to take care of friends who had gotten hurt. I began to notice the gap between the quality of care that I had received as the son of a Harvard faculty member compared to the care that the residents of Somerville received. This was part of why I chose to go to med school—so I could help improve care. (I also enjoyed providing care.) Commitment to making the world a better place was instilled in me by my father growing up.
Dyane Tower (DT): What has been your favorite TDI project that you have contributed research to?
EF: The project that was an incredible opportunity to be a part of was our look at the health implications of geographic variations in spending. It took me from being a health services researcher to someone who had to show up in Washington to explain the findings. The findings were relevant to policy in ways that I could never have anticipated and seem to be having a continuing impact on health care today.
LJ: What have been TDI’s most important contributions to health care so far?
EF: First, emphasizing the importance of engaging and empowering patients through the work done by Jack Wennberg and Al Mulley on shared decision making. Second, utilizing modern scientific methods in the improvement of health care delivery through the work done by Paul Batalden, Gene Nelson, and others. And third, working to align payment and delivery systems with the care that patients want and need.
DT: What makes TDI different, special, or unique from other public health programs in the nation?
EF: First, we are committed to asking important and difficult questions about health and health care, like can there be too much health care? Second, we have a sharp focus on understanding the failures of and the challenges facing health care delivery systems and what we might do to make them better. We emphasize an epidemiologic way of thinking about care.
LJ: Do you have any plans for further integrating TDI into the broader graduate community through collaboration with other graduate programs on campus?
EF: We are already strengthening our collaboration with Tuck. TDI and Tuck share responsibility for the Master of Health Care Delivery Science—a mid-career master’s program. We want to build on that by bringing graduate students from TDI, Geisel, Tuck, Thayer, and Arts and Sciences together to focus on creating a sustainable health system.
DT: I have heard there may be plans for a new building; would TDI be looking to move to campus in the near future? (TDI is currently located in the Centerra Business Park in Lebanon, New Hampshire.)
EF: There is a new building being built on the Dartmouth-Hitchcock campus, which is where the research community of TDI will be based. It will be a great space, and will be next to people doing all sorts of interesting things in bioinformatics and statistics. We are also committed to getting space on campus for the educational programs to increase multidisciplinary teaching. It is really important that students are a part of the broader Dartmouth community of students, and being on campus will help that.
LJ: As the new director, what is your number one priority for TDI?
EF: To build on our amazing current strengths in research and education and our strong current partnerships with delivery systems here and elsewhere to make Dartmouth the preeminent academic institution addressing problems in health care delivery in the United States.
DT: What is your favorite recreational activity when you are not working?
EF: If it’s warm enough, I will be on my bike. If it’s cold enough, I’ll be on my cross-country skis. We are so lucky to live here because of the great outdoor opportunities. Moving to Vermont wasn’t a difficult decision—it’s a great place to bring up kids and you can go right outside the house to cross country ski or bike anytime. I love the outdoors.
Dr. Fisher follows Drs. Jack Wennberg and Jim Weinstein in leading TDI, originally founded in 1988 by Dr. Wennberg. To learn more about Dr. Fisher’s goals for TDI and read his bio, please visit the TDI site.
by Lisa Jackson and Dyane Tower