Dr. John Patrick Co and Dr. Jason Morris of Mass General Brigham

Summary

Becker’s Healthcare Podcast: Strategic Growth in Graduate Medical Education at Mass General Brigham

Release Date: July 6, 2025

In this insightful episode of the Becker's Healthcare Podcast, host Erica Carbajal engages in a comprehensive discussion with Dr. John Patrick Koh, Vice President of Education, and Dr. Jason Morris, an Emergency Medicine Physician at Mass General Brigham. The conversation delves into the health system's strategic approach to graduate medical education (GME) growth, highlighting the unique integrated residency and fellowship programs that set Mass General Brigham apart in the evolving landscape of U.S. healthcare.

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1. Understanding Integrated Residency and Fellowship Programs

Dr. John Patrick Koh begins by explaining the concept of integrated programs within the context of Mass General Brigham’s overarching vision. He emphasizes the historical foundation of the integrated approach, dating back to the formation of Partners Healthcare in 1994, which unified Mass General and Brigham Women's Hospital.

“Integrated programs leverage the expertise and resources of multiple institutions, ideally all our institutions within the system, and provide a breadth and depth that would really be hard to achieve at any single institution.”
[01:07]

Dr. Koh underscores the strategic intention behind these programs to create a synergistic effect, where the collective offerings exceed what individual institutions could provide independently. This integrated model aligns with the system's mission to excel in patient care, research, teaching, and innovation, ensuring that each aspect complements the others for optimal training outcomes.

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2. Dr. Jason Morris’s Perspective on the Integrated Model

Dr. Jason Morris shares his firsthand experience in the integrated emergency medicine program, highlighting the profound impact of cross-institutional training on his professional development.

“The first big bucket is really just patient demographics... you see different demographics of patients, some more types of care, some less specific care, some different racial groups and ethnic groups.”
[03:59]

He categorizes the benefits into three main areas:

1. Diverse Patient Demographics: Exposure to varied patient populations across different clinical sites enhances clinical acumen and cultural competence.
2. Varied Emergency Department Operations: Training in different ED settings allows residents to understand diverse triage methods, available resources, and institutional practices.
3. Access to a Broad Array of Faculty: Interaction with a wide range of faculty members engaged in diverse aspects of emergency medicine, from research to community health, enriches the learning experience beyond clinical skills.

Dr. Morris emphasizes that this integrated approach not only broadens clinical expertise but also fosters a supportive environment where trainees can explore various career niches within medicine.

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3. Operational and Cultural Challenges in Integrated GME Programs

The conversation shifts to the operational and cultural challenges of maintaining integrated GME programs spanning multiple institutions.

Dr. Koh addresses the delicate balance between respecting existing institutional cultures and fostering an environment open to evolution and improvement.

“We need to have people thinking and being open to different ways of thinking.”
[07:59]

He highlights the importance of strong leadership structures that facilitate open discussions and informed decision-making, ensuring that changes are well-coordinated and data-driven.

Dr. Morris adds that the integrated residency program benefits from intentional design elements, such as shared leadership and synchronized responsibilities across sites, which contribute to a cohesive training experience.

“Our residency leadership boards are based out of both sites... and there's been very intentional design built of our deck that curriculum to help feature speakers from both sites.”
[13:09]

This seamless integration not only enhances operational efficiency but also promotes a unified culture that values cross-institutional learning and improvement.

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4. Key Lessons for Sustainable and High-Quality GME Growth

When discussing sustainable growth in GME programs, both Dr. Koh and Dr. Morris emphasize the importance of innovation and adaptability.

Dr. Koh advises health system leaders to approach program development with a mindset akin to building from scratch, allowing for creativity and the utilization of system-wide resources without being constrained by traditional methods.

“Approach it by considering all the resources available throughout our system and consider picking the best blend of those to create the best programs possible and not be constrained by how we've thought about training before.”
[11:36]

Dr. Morris underscores the value of resident feedback in shaping and refining GME programs.

“Actively soliciting resident feedback and acting on it is kind of pivotal to making those changes of success.”
[16:39]

By fostering an environment where continuous improvement is driven by both leadership vision and resident input, Mass General Brigham ensures that its GME programs remain both high-quality and responsive to the needs of trainees and the healthcare system.

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5. Navigating the Federal Cap on Medicare-Supported Residency Slots

The discussion also touches upon the challenges posed by the longstanding federal cap on Medicare-supported residency slots, a critical issue affecting GME growth nationwide.

Dr. Koh acknowledges the importance of government funding in sustaining GME programs and highlights how integration provides opportunities to optimize resource utilization amidst financial constraints.

“Our integration efforts now provide us an opportunity to rethink and improve our training in this context of where resources are becoming even more constrained.”
[14:44]

He emphasizes the commitment to maintaining educational excellence and mentorship despite funding challenges, leveraging the integrated system’s scale to identify efficiencies and innovative training approaches.

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6. Practical Advice for Expanding Residency Footprints

In concluding the discussion, both experts share practical insights for health systems aiming to expand their residency programs.

Dr. Morris advocates for incorporating resident voices in program development, ensuring that changes are grounded in the realities of clinical practice.

“Listen to people who are actually on the ground doing work.”
[16:39]

Dr. Koh echoes this sentiment, stressing the importance of evaluating both the benefits and potential unintended consequences of program expansion.

“Getting the voice of the trainees is critical and really taking a step back to say, what are the things that we'll gain and what are some of the challenges that growing our programs might present?”
[18:19]

By prioritizing resident feedback and maintaining a balanced perspective on growth, health systems can expand their residency footprints in a manner that enhances educational quality and operational sustainability.

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Conclusion

This episode of the Becker's Healthcare Podcast offers a deep dive into the strategic growth of GME programs through integration, as exemplified by Mass General Brigham. Dr. Koh and Dr. Morris provide valuable perspectives on the benefits of integrated training, the challenges of maintaining such programs, and the lessons learned in ensuring sustainable and high-quality education for future healthcare leaders. Their insights serve as a blueprint for other health systems seeking to navigate the complexities of GME expansion in today’s dynamic healthcare environment.

Transcript

[Erica Carbajal]

Hi, everyone. Thank you so much for tuning into this episode of the Becker's Healthcare Podcast. I'm Erica Carbajal, an editor with Becker's Hospital Review, and today I'm joined by Dr. Jason Morris, an emergency medicine physician, and Dr. John Patrick Koh, vice president of education at Mass General Brigham. Dr. Koh. Dr. Morris, welcome. Excited to have you on the podcast today.

[Dr. Jason Morris]

Thank you. Excited to be here.

[Erica Carbajal]

Yeah, yeah. We're going to be chatting about the health system's strategic approach to GME growth, which is a major topic right now. So I'll start with the health system's unique approach, if you will, to graduate medical education. I know the system now hosts around 60 integrated residency and fellowship programs, which makes up around 20% of the system's overall GME portfolio. So to start us off, can you explain a little bit about what an integrated program is, what makes it different from a traditional residency, and what's the strategic thinking behind building and scaling this type of model?

[Dr. John Patrick Koh]

Great. Well, Erica, first, thanks for having Jason and I here on the podcast, and I think that's a great question to start. So I would say having an integrated residency or fellowship program should be considered in the context of the vision and direction of the health system overall. You know, the one that they're part of. You know, back in 1994, Partners Healthcare was formed, bringing together Mass General and Brigham Women's Hospital to create an integrated health system. And soon after that, we actually started forming integrated programs across our two academic medical centers. So having the integrated programs isn't new for us. And even at its inception, we've thought about some of the advantages of having an integrated approach to training. As you also know, in 2019, partners became mass General Brigham, which emphasized the system's vision evolution towards building the premier integrated academic medical center for the future with patients at the center. You know, healthcare has changed a lot, even in the time between partners, inception and 2019. So I think our way of thinking was that we needed to evolve our way of doing things across all our missions. Our missions include patient care, research, teaching, and innovation. And although they are separate, they really are interrelated. So, for example, when we're redesigning patient care and operations to optimize care and efficiency, we really should be considering how that impacts the delivery of all our missions, including our training, so that we deliver the best training possible. So integrated programs leverage the expertise and resources of multiple institutions, ideally all our institutions within the system, and provide a breadth and depth that would really be hard to achieve at any single institution. And Our hope and our vision is that if we do this in an intentional, coordinated way, the whole can be greater than the sum of its parts across all our missions, including education. And I hope that we deliver on that. And I'm sure Dr. Morris will talk more about his experience in that system.

[Erica Carbajal]

Yeah, it's definitely interesting to hear. So it sounds like residents get experience, as you mentioned, across the breadth and depth of institutions. So multiple clinical training sites. Dr. Morris, from your experience in the integrated emergency medicine program, what effect did this cross institutional model have on your training? What was your experience?

[Dr. Jason Morris]

So just for context, I'm finishing up my fourth year of a combined emergency medicine program, both at Mass General and Brigham primarily. And I can say it's been a pretty profound experience, as I'm sure most residency programs are. I think I categorize kind of the impact of this integrated model into three main buckets, some of which are specific to emergency medicine, some are more broadly applicable. Just for a little bit additional context, emergency medicine is very geographically linked. Patients often come to their nearest hospital or when they trust the most, seek different after care, particularly in emergency. So the first big bucket is really just patient demographics. I work primarily at Mass General as well as Women's Hospital, which are across town, both in Boston. But even just across town, you see different demographics of patients, some more types of care, some less specific care, some different racial groups and ethnic groups and kind of all that patient experience. And also they bring different pathologies to the ed. So you get a really, as he was saying, a really wide diverse in the patient population and a really good depth in each individual component. And then secondly, each ED actually runs quite differently from the way they triage patients, which tests are available to which consulting services available to really get to see how this practice emergency medicine in a variety of different practice settings and see what is like true evidence based medicine and what are the sort of institutional practices kind of help differentiate those two kind of categories of patient care. And then thirdly, kind of extra clinically. We have such a diverse broad array of faculty, both at NGH and Brigham, who do everything you can possibly imagine in emergency medicine, from research to social determinants of health, to like community interventions. Being able to access all those faculties is amazing things to talk about your extra clinical space.

[Erica Carbajal]

Yeah, Dr. Morris, thanks for calling that out. I think I imagine, you know, getting that experience across, as you mentioned, just the difference in demographics and two institutions across town and seeing patient populations with, you know, a wide variety of conditions and different pathologies really helps build that Confidence too, as a new physician.

[Dr. Jason Morris]

Absolutely.

[Dr. John Patrick Koh]

Well, I would also just like to add that I think there's the patience and the demographics and just the breadth and depth there. And there's also that for the faculty. And what we really want to encourage in our trainees that come here is to find that real specific niche that they want to have as part of their career. And with such a. A vast number of sites and also faculty which they work with, we really do believe that that provides them the best chance of finding the exact career that they want to have in medicine, which I think is important in the long term for them to be able to practice medicine in the way they want to in the long term.

[Erica Carbajal]

Yeah, that's a great point, Dr. Cohen. I imagine, like finding, you know, different interests in leadership is a big part. Part of that as well.

[Dr. John Patrick Koh]

Yep. And we have so many physicians here and really just providers who have very non traditional paths of training. I'm sure Jason can think of many people who he's worked with and he's looked at and said, wow, I didn't know that someone could have a career specifically in that area. And the amazing thing is that I think across all our specialties, we have that. And I think it's a fantastic opportunity for trainees that is really hard to see in a lot of other institutions.

[Erica Carbajal]

Well, Dr. Koh and Dr. Morse would love to hear from your experience too, maybe what types of operational cultural challenges arise when designing and maintaining these integrated GME programs that span across multiple institutions? How have you addressed them at Mass General Brigham, Dr. Koh, and maybe how, you know, the direct experiences of trainees have spurred any shifts?

[Dr. John Patrick Koh]

Yeah, so, you know, I think culture is something that, you know, often is cited as both of a strength of an institution, but also as a barrier to change. And, you know, I think there is a way to respect existing cultures without preventing it from not being open to evolving their way of thinking around, you know, everything they do, including for training. I think a lot of times when we talk about culture, we're basically referring to let's just keep doing the things the way that we've done them because they seem to have worked, like resulted in good outcomes. And actually I don't debate that the way things have been done often have resulted in great outcomes, but it doesn't mean that there isn't another way to do it that might result in something even better. So that's. In terms of culture, I think what I would say is we need to have people thinking and being open to different ways of thinking. And then operationally what's critical is to have the proper leadership structure that you know, really hardwires opportunities for discussion and ultimately decision making. You know, I think with any, any decision you're considering, there's often advantages and challenges. And so really a key thing here is to know and be clear how we're making decisions and know how and when to course correct. And this again gets back to leadership structures, you know, data and even metrics. And I think Jason's program in particular has been really great in terms of having good, strong leadership, clear leadership structures to optimize the care delivery, but also the training.

[Dr. Jason Morris]

Yeah, I Definitely agree with Dr. Koh. Our residence was founded at both sites. It's actually always been integrated. So as resident actually it's built very smooth. That progressive responsibility kind of when we hear is like synced up at each site. And we go back and forth to Mass General as well as to Brigham for our weekly conference and we have like faculty sponsorship and our leadership at really both sides of the town, which is really cool. I think operationally it's actually been a really cool experience these past four years because while our residency has been always been integrated, our leadership and our departments themselves have not been actually moving towards that while I've been here. That's been a really cool experience to watch and that kind of affects everything in kind of big and small ways. I'll never forget is about a year ago one of like the high up leadership at MGH had his first shift at Brigham and I was one of his residents. And like halfway through the shift he kind of goes, oh my gosh, that's so cool. And I'm all nervous. I'm working with like some big wig. He literally just looking at kind of like the central monitoring for like our rhythm strips and he just looks up and realizes that there's actually just labels by each individual strip which doesn't happen at mgh. Like this is so much easier and this is so smooth. That's the first thing I'm going to go bring back to mgh. And it's like kind of like, like you were saying that like cross cultural learning both of practices and culture kind of lets both institutions be a little bit better.

[Erica Carbajal]

Yeah, that's great. Thank you both. Thanks Dr. Morse for sharing that example. I think yeah, it really just goes to show the culture of like seeing something done differently on the ground as a leader and taking that back. I want to talk about key learnings and lessons. So maybe what's one key lesson that You've learned about growing graduate medical education programs in a way that is both sustainable and high quality for residents and clinical teams. So I think that that's a challenge that often comes up in conversations with health system leaders when we're talking growth with graduate medical education.

[Dr. John Patrick Koh]

Yeah, you know, I think Jason gave a really great example of, you know, a situation where someone, you know, saw something they hadn't seen before and said, wow, that's a great way to do it. I never, I never would have thought of that because the person was, you know, in a situation where things seemed fine and, you know, things were probably going well in terms of patient care and other and otherwise, but they just hadn't seen something different. And it wasn't so much they were avoiding it, but they just hadn't seen it. And in terms of growing our GME programs, I think the key related to that is starting from a perspective almost of sort of building things from scratch so everything is possible. There are all sorts of possibilities in developing the curriculum rotations and not be bound to the way we've been doing things before, specifically for programs. What I've said to our leaders is to approach it by considering all the resources available throughout our system and consider picking the best blend of those to create the best programs possible and not be constrained by how we've thought about training before. And in that way, I think we would be more likely or most likely to create a program where the whole is greater than the sum of its parts. And that's really what we want to achieve.

[Dr. Jason Morris]

And I think from the resident side, I think again, our program was kind of founded as an integrated program and it very much feels like one combined program, not a resident mgh, not a residency at Brigham, that you're kind of shuttling back and forth. For example, we have residency leadership boards who are like based out of both sites. Our co director actually works at both sites and goes back and forth. And there's been very intentional design built of our deck that curriculum to help feature speakers from both sites and sponsorship from both sides. And then as well as there's been a design of the shifts and responsibilities that are equivalent at both sites that you kind of feel every year as you're just moving up in the program at both sites rather than going one and the other and back and forth.

[Erica Carbajal]

Yeah, certainly sounds like it really does feel like one cohesive program from your perspective, Dr. Morris, and from the perspective of folks going through it. Building off this question too, I just want to talk about the long standing federal cap on Medicare supported residency slots. It's something that leaders often and increasingly, I would say, express concern about, especially when you think about just the ongoing financial pressures that are facing health systems today. Some have expressed concern that that does raise the risk of residency program cuts across the country. You know, they're still relatively rare. I think at Beckers we covered instances, a handful, maybe four or five cuts or closures to programs in 2024. But you know, they do generate a lot of interest and attention when they do happen, given their value in helping grow the physician workforce. So any thoughts on that? Do you see that as a real concern and how does the cap influence the health system's long term GME strategy?

[Dr. John Patrick Koh]

Yeah, you know, so I'd say government funding for our GME programs is crucial, you know, for serving our mission. And really the same is true probably across all academic medical centers in the country. We're going to remain committed to all our missions, including training the future leaders and healthcare providers in our system. What I would say too is that with our integration efforts now, it does provide us an opportunity to rethink and improve our training in this context of where resources are becoming even more constrained. And I think because we're thinking of it at the system level, I think it will allow us to think about new ways of doing things, including efficiencies that we wouldn't have been able to think about if we were operating a separate institution. So we still will prioritize the learning, the mentorship, creating a great learning environment for our trainees, and we certainly will consider resource constraints as we're evolving our healthcare system. But we remain committed to our educational mission.

[Erica Carbajal]

Yeah, for sure. And it certainly sounds just like the becoming more and more integrated is kind of the foundation of being able to do more with less, so to speak, and drive those operational efficiencies. Well, lastly here, for health systems that are looking to expand their residency footprint, what practical advice would you offer? And Dr. Morris would love to hear from you as well. And maybe something you think systems should keep in mind or prioritize from the start when thinking about the trainees experience.

[Dr. Jason Morris]

I'm not going to reinvent the wheel here. I think residents can be the people who have their boots on the ground who are like really seeing like a lot of the patients have the most time in the hospital. So I think especially as we're trying to make significant changes and change systemically how the residency functions, really actively soliciting resident feedback and acting on it is kind of pivotal to making those, those changes of success. We have this constant stream of feedback where the PD gets fed back to us, and we're constantly making changes to our own program to keep improving. And we are aiming for a moving target and be successful. Listen to people who are actually on the ground doing work.

[Dr. John Patrick Koh]

Yeah, And I would echo Jason's comments. I think, you know, as we're thinking about potentially growing programs, we're often thinking about some of the advantages. You know, for instance, maybe more sites, maybe being able to do things at scale, having more of a critical mass of trainees with. With the advantages, there could also be unintended consequences. Right. And oftentimes, you know, the residents are the ones that. That really know what those are. They can identify them because they are the ones experiencing the trainees. So, for instance, maybe there are certain procedures or sites which might, you know, constrain growth past a certain point without it negatively, you know, impacting the trainees, the existing trainees in our program. So I think getting the voice of the trainees is critical and really taking a step back to say, what are the things that we'll gain and what are some of the challenges that growing our programs might present?

[Erica Carbajal]

Yeah, absolutely. Well, Dr. Koh, Dr. Morris, thank you both so much. It was great connecting and chatting about this with you both. We appreciate your insights.

[Dr. John Patrick Koh]

Thank you so much.

[Dr. Jason Morris]

Thank you for being here.

[Dr. John Patrick Koh]

Yeah, thank you.