Posted on Dec 14,2017
George Dover, M.D., first set foot on what then was the All Children’s Hospital campus about 20 years ago. He didn’t expect to be back.
But the seeds for a new approach to graduate medical education were planted. He just didn’t know it yet.
Dover was the director of the Johns Hopkins University School of Medicine Department of Pediatrics and the Johns Hopkins Children’s Medical and Surgical Center. He joined Ron Werthman, vice president of finance at The Johns Hopkins Hospital, for the trip to St. Petersburg, Florida, at the invitation of All Children’s Hospital leadership, which was interested in enhancing its academic program.
Dover was impressed by the clinical care at All Children’s and noted how the hospital, which opened in 1926, achieved it without heavy reliance on medical students and residents covering clinical responsibilities.
“There was something absolutely unique,” Dover says. “It was very apparent to me from the very first time I came down here that this was a freestanding children’s hospital that was functioning at a very high level as far as medical care was concerned without relying on trainees.
“I saw phenomenal opportunity here.”
Dover, who became a resident at Johns Hopkins in 1972 and then joined the faculty, had seen little change in resident coverage of hospital-based services medical education in the decades since he started. As the focus of pediatric specialties shifted away from hospital-based care, he wrestled with how to train physicians for outpatient duties when hospitals’ training programs relied so heavily on them for clinical care.
All Children’s would offer that opportunity.
But not yet.
The business of medicine was reorganizing and all agreed that All Children’s needed to address other priorities first. It needed a new hospital facility and to bring private practice physicians in-house to become a health system.
An academic push would have to wait.
Fast forward to 2009. Dover and Werthman were invited to St. Petersburg to renew the discussion about enhancing the All Children’s educational mission.
Much progress had been made with a new hospital building set to open in January 2010, many physicians on staff and a sound business plan. It was time to explore the educational expansion further.
Dover and Werthman invited the hospital’s leadership and Board of Trustees to Baltimore, Maryland, to see how a top-flight academic health system operated with clinical, educational and research missions integrated. Faculty treated patients, taught residents and conducted research. Each complemented the other.
“The obligation of an effective leadership group is to make sure all three parts of the mission are nurtured at the same time,” Dover says. “You can never make a decision about one without considering how it affects the other two.”
Dover suspected the commitment was more than All Children’s leaders had bargained for. He thought the conversation might end there.
Where do we sign up?
Instead of being spooked, All Children’s leadership wanted to work with Johns Hopkins more than ever.
In fact, it wanted to join forces.
Dover quickly became an advocate. He saw excellent clinical care, a beautiful new facility, an area with many children in need of a top-flight academic health system and a campus with room to grow.
And he saw an opportunity to bring innovation to graduate medical education.
“My mission within Hopkins was to sell that this was an opportunity that was absolutely unique in American medicine,” Dover says. “In my mind, what was the most attractive part of Hopkins coming here was the opportunity to begin to develop residency education programs with less dependence on covering hospital based medical services 24/7.
“That was one of the real exciting opportunities that Hopkins could gain here. It wasn’t the only one, but it was the one that turned me on.”
In 2011, the hospital joined Johns Hopkins Medicine and began its evolution into Johns Hopkins All Children’s Hospital. Jonathan Ellen, M.D., became vice dean and later president and CEO. Sylvia Powell became assistant dean of administration. Raquel Hernandez, M.D., M.P.H, became the director of the office of medical education. Together, they and others embraced the blank canvas and developed leadership programs and rotation schedules that were new to graduate medical education. Physicians and nurses embraced the educational vision, and talented trainees signed up.
“They’re the ones who are 99 percent responsible for the last five years of accomplishments,” Dover says of the group that developed and implemented the innovations.
The inaugural class of the Johns Hopkins All Children’s Residency Program graduated in June. The hospital offers fellowships in pediatric surgery, neonatal-perinatal care, palliative care and hospitalist medicine. Dover says those programs can build on the new thinking developed in the residency program.
After 20 years as pediatrician-in-chief for Johns Hopkins in Baltimore, Dover stepped down in June 2016.
He came back to St. Petersburg.
“My job now is to push the people to be as innovative as possible and not fall back on the tried and true ways of training residents,” Dover says. “What I do now is to stir up this idea of innovation and keep it moving as much as possible.”
This article first appeared in Leading Care magazine. Visit ome.allkids.org to learn more about graduate medical education at Johns Hopkins All Children’s Hospital.