- Michelle Hofmann
1. During the COVID-19 pandemic, you found your way to public health. You started as a manager of the healthcare-associated infections and antimicrobial resistance program and were subsequently appointed Deputy Director of the Utah Department of Health. Can you tell us more about this work, and how you got involved?
My clinical role at the start of the pandemic was as the sole pediatrician at NeuroRestorative Utah, a skilled nursing facility where I cared for a dozen children with medical complexity, mostly dependent on ventilators. I recall the first few days of the pandemic, sitting up all night absorbing everything I could about infection prevention and control. We were wholly unprepared. I drafted a COVID-19 preparedness plan I shared with several others on the SOHM listserv. As a pediatric hospitalist, I was familiar with CLABSIs and CAUTIs, but for nursing homes around the world, COVID-19 was rapidly becoming the deadliest healthcare-associated infection we have known. I started attending state COVID-19 calls for healthcare facilities. Each call I would ask what was being done to prepare nursing homes. Within a few weeks, a task force dedicated to long-term care was formed and I was invited to serve, helping to inform strategy, issue guidance, and engage stakeholders across the care continuum.
In August 2020, I was asked to consider replacing the retiring physician manager of the healthcare associated infections and antimicrobial resistance program. I took the leap. Leading a capable and committed team of infection preventionists and epidemiologists through the worst part of the pandemic, Utah has been a leader, with one of the lowest mortality and highest vaccination rates for COVID-19 in long-term care facilities in the nation. In December 2020, another physician retirement led to a vacancy in the top physician position in the agency, and I was appointed by our state’s new governor in February 2021 as Deputy Director, Chief Medical Advisor, and State Health Officer. Immediately, I was thrust into a leadership role in Utah’s COVID-19 vaccine response, with a focus on closing equity gaps. As a member of the Executive Director’s Office, our next big challenge will be leading a weary and traumatized public health workforce through a consolidation with our state’s Department of Human Services. COVID-19 has shined a light on our fragmented system of care for those most in need and the challenges that have long contributed to inequities in health outcomes and determinants of health. I am honored to be in a position that capitalizes on this moment to tackle some of the greatest health challenges of our time.
2. You said “leaving hospital medicine was one of the hardest but also best decisions of my career.” Why do you think that is? What skills from PHM are you able to utilize in your current job?
As a pediatric hospitalist, I always introduced myself as a pediatrician who cared for hospitalized children. Almost a decade ago, while overseeing a community PHM program, I simultaneously started to care for children at NeuroRestorative. Caring for the same patients over years, forming long-term bonds with the children, their families, and the dedicated staff caring for them, it was the first time I truly felt like a pediatrician. As PHM was becoming a subspecialty, I started to have an identity crisis. Was I a pediatrician, a pediatric hospitalist, both? I made the difficult decision to leave PHM and exclusively care for children at the nursing facility while also enrolling in the Master of Healthcare Delivery Science Program at Dartmouth. Over the next 18 months, I would gain an academic foundation in the very leadership, teaming, operational management, communication, and strategic thinking skills that I had been learning as a pediatric hospitalist leader for more than a decade. I watched classmates move into new leadership positions and leave patient care behind, but I couldn’t yet imagine that for myself. I graduated in February 2020 with a new role in population health for our health system, while continuing my patient care at NeuroRestorative. Then of course, COVID-19 hit. Having recently left PHM, it honestly made it easier to take the leap into public health. Years ago, a mentor told me I would find my greatest joy serving populations not patients. When I reflect on my 20 years as a pediatrician and pediatric hospitalist, I have meandered through hospitals, health systems, and nursing homes and found a new home in public health.
3. You were previously the Pediatric Medical Director at NeuroRestorative Utah, a skilled nursing facility caring for children with ventilator dependency. What advice do you have for hospitalists caring for children with medical complexity?
Imagine life when the children are well! Sometimes it can be pretty emotional caring for children with medical complexity in the hospital. Caregiver stress can make for difficult encounters. Evidence often eludes us for the care we find ourselves delivering and questions of medical futility arise. When I first ventured out of the hospital to care for children with medical complexity at NeuroRestorative, my lens on what quality of life means, for the child and for the family, completely changed. When I would round at the hospital, I started asking families to show me photos of their children when they are healthy, and our team would get a sense of what life looked like for these children out of the hospital. We would become unified around restoring health and that sense of shared purpose transcended any challenges we might be facing as providers and caregivers.
4. Palliative care is a difficult area for some pediatric hospitalists as we often don’t get much training. You have your Certificate of Palliative Education from the University of Utah School of Medicine. Why did you decide to pursue this? Is it something you would recommend hospitalists consider?
When I was a hospitalist, we were so fortunate to have palliative care specialists as members of our PHM division. They were a joy to watch with families, building rapport during the most trying of circumstances and framing difficult decisions with ease. They made it look so simple. The certificate of palliative education gave me the skills to have difficult conversations, to communicate in a way that formed bonds with families quickly, to think beyond what we were doing ‘to’ the child (medical interventions) but ‘for’ the child (goals). I have come to equate patient-centered care with palliative care. All care, whether at the end of life or not, should be centered around goals. I believe these skills are essential for all pediatric hospitalists.
5. You have been involved with many professional community activities including chairing the Utah Asthma Task Force and sitting on the board of directors for Envision Utah, Breathe Utah, and Utah Clean Cities Coalition to name a few. How did you get involved? What advice do you have for others looking to get involved in their community?
Go where your passions are, where you will be inspired! As a new physician, I vividly recall the morning I drove home from a busy night shift at the hospital overlooking a Salt Lake valley blanketed with air pollution. Connecting the dots between our poor air quality and the rush of patients with acute respiratory illness I had been up all night caring for, at first all I wanted to do was something to protect my young son with asthma. That urge turned into a decade of community advocacy and engagement with public and environmental health professionals addressing Utah’s air quality challenges. Honestly, all it really takes is showing up, and through these experiences, you will hone transferable skills for physician leaders. I still remember sitting around a table with the chief executives of all the major oil refineries in the state. It was me, a couple of government officials, and the top polluters in Utah. What the heck was I doing there? Physicians are respected for their thoughtful, evidence-based approach and their intentions, to protect health, are pure. Community advocacy will teach you skills in navigating conflict, defining problems before jumping to solutions, and uniting around a shared purpose to execute meaningful change.
6. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Be true to yourself. Like so many others, I have worn many different hats as a pediatric hospitalist, moving from one challenging project or role to the next, and usually wearing my heart on my sleeve. Pediatric hospitalists are known for their compassion and their ‘can do’ nature, creating new roles for themselves every day in a challenging, complex health care delivery system. Not every role will be successful, and some will be exasperating and burn you out. Don’t be afraid to walk away. A mentor once told me to always have 3 questions top of mind: Why me? Why now? Why this? This has stuck with me and I hope it sticks with you too.
My clinical role at the start of the pandemic was as the sole pediatrician at NeuroRestorative Utah, a skilled nursing facility where I cared for a dozen children with medical complexity, mostly dependent on ventilators. I recall the first few days of the pandemic, sitting up all night absorbing everything I could about infection prevention and control. We were wholly unprepared. I drafted a COVID-19 preparedness plan I shared with several others on the SOHM listserv. As a pediatric hospitalist, I was familiar with CLABSIs and CAUTIs, but for nursing homes around the world, COVID-19 was rapidly becoming the deadliest healthcare-associated infection we have known. I started attending state COVID-19 calls for healthcare facilities. Each call I would ask what was being done to prepare nursing homes. Within a few weeks, a task force dedicated to long-term care was formed and I was invited to serve, helping to inform strategy, issue guidance, and engage stakeholders across the care continuum.
In August 2020, I was asked to consider replacing the retiring physician manager of the healthcare associated infections and antimicrobial resistance program. I took the leap. Leading a capable and committed team of infection preventionists and epidemiologists through the worst part of the pandemic, Utah has been a leader, with one of the lowest mortality and highest vaccination rates for COVID-19 in long-term care facilities in the nation. In December 2020, another physician retirement led to a vacancy in the top physician position in the agency, and I was appointed by our state’s new governor in February 2021 as Deputy Director, Chief Medical Advisor, and State Health Officer. Immediately, I was thrust into a leadership role in Utah’s COVID-19 vaccine response, with a focus on closing equity gaps. As a member of the Executive Director’s Office, our next big challenge will be leading a weary and traumatized public health workforce through a consolidation with our state’s Department of Human Services. COVID-19 has shined a light on our fragmented system of care for those most in need and the challenges that have long contributed to inequities in health outcomes and determinants of health. I am honored to be in a position that capitalizes on this moment to tackle some of the greatest health challenges of our time.
2. You said “leaving hospital medicine was one of the hardest but also best decisions of my career.” Why do you think that is? What skills from PHM are you able to utilize in your current job?
As a pediatric hospitalist, I always introduced myself as a pediatrician who cared for hospitalized children. Almost a decade ago, while overseeing a community PHM program, I simultaneously started to care for children at NeuroRestorative. Caring for the same patients over years, forming long-term bonds with the children, their families, and the dedicated staff caring for them, it was the first time I truly felt like a pediatrician. As PHM was becoming a subspecialty, I started to have an identity crisis. Was I a pediatrician, a pediatric hospitalist, both? I made the difficult decision to leave PHM and exclusively care for children at the nursing facility while also enrolling in the Master of Healthcare Delivery Science Program at Dartmouth. Over the next 18 months, I would gain an academic foundation in the very leadership, teaming, operational management, communication, and strategic thinking skills that I had been learning as a pediatric hospitalist leader for more than a decade. I watched classmates move into new leadership positions and leave patient care behind, but I couldn’t yet imagine that for myself. I graduated in February 2020 with a new role in population health for our health system, while continuing my patient care at NeuroRestorative. Then of course, COVID-19 hit. Having recently left PHM, it honestly made it easier to take the leap into public health. Years ago, a mentor told me I would find my greatest joy serving populations not patients. When I reflect on my 20 years as a pediatrician and pediatric hospitalist, I have meandered through hospitals, health systems, and nursing homes and found a new home in public health.
3. You were previously the Pediatric Medical Director at NeuroRestorative Utah, a skilled nursing facility caring for children with ventilator dependency. What advice do you have for hospitalists caring for children with medical complexity?
Imagine life when the children are well! Sometimes it can be pretty emotional caring for children with medical complexity in the hospital. Caregiver stress can make for difficult encounters. Evidence often eludes us for the care we find ourselves delivering and questions of medical futility arise. When I first ventured out of the hospital to care for children with medical complexity at NeuroRestorative, my lens on what quality of life means, for the child and for the family, completely changed. When I would round at the hospital, I started asking families to show me photos of their children when they are healthy, and our team would get a sense of what life looked like for these children out of the hospital. We would become unified around restoring health and that sense of shared purpose transcended any challenges we might be facing as providers and caregivers.
4. Palliative care is a difficult area for some pediatric hospitalists as we often don’t get much training. You have your Certificate of Palliative Education from the University of Utah School of Medicine. Why did you decide to pursue this? Is it something you would recommend hospitalists consider?
When I was a hospitalist, we were so fortunate to have palliative care specialists as members of our PHM division. They were a joy to watch with families, building rapport during the most trying of circumstances and framing difficult decisions with ease. They made it look so simple. The certificate of palliative education gave me the skills to have difficult conversations, to communicate in a way that formed bonds with families quickly, to think beyond what we were doing ‘to’ the child (medical interventions) but ‘for’ the child (goals). I have come to equate patient-centered care with palliative care. All care, whether at the end of life or not, should be centered around goals. I believe these skills are essential for all pediatric hospitalists.
5. You have been involved with many professional community activities including chairing the Utah Asthma Task Force and sitting on the board of directors for Envision Utah, Breathe Utah, and Utah Clean Cities Coalition to name a few. How did you get involved? What advice do you have for others looking to get involved in their community?
Go where your passions are, where you will be inspired! As a new physician, I vividly recall the morning I drove home from a busy night shift at the hospital overlooking a Salt Lake valley blanketed with air pollution. Connecting the dots between our poor air quality and the rush of patients with acute respiratory illness I had been up all night caring for, at first all I wanted to do was something to protect my young son with asthma. That urge turned into a decade of community advocacy and engagement with public and environmental health professionals addressing Utah’s air quality challenges. Honestly, all it really takes is showing up, and through these experiences, you will hone transferable skills for physician leaders. I still remember sitting around a table with the chief executives of all the major oil refineries in the state. It was me, a couple of government officials, and the top polluters in Utah. What the heck was I doing there? Physicians are respected for their thoughtful, evidence-based approach and their intentions, to protect health, are pure. Community advocacy will teach you skills in navigating conflict, defining problems before jumping to solutions, and uniting around a shared purpose to execute meaningful change.
6. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Be true to yourself. Like so many others, I have worn many different hats as a pediatric hospitalist, moving from one challenging project or role to the next, and usually wearing my heart on my sleeve. Pediatric hospitalists are known for their compassion and their ‘can do’ nature, creating new roles for themselves every day in a challenging, complex health care delivery system. Not every role will be successful, and some will be exasperating and burn you out. Don’t be afraid to walk away. A mentor once told me to always have 3 questions top of mind: Why me? Why now? Why this? This has stuck with me and I hope it sticks with you too.