Margee Louisias, MD, is a 2014-2016 Harvard Pediatric Health Services Research Fellow at IHI. She specializes in Allergy-Immunology at Brigham and Women’s Hospital in Boston, MA. She shared these reflections on her fellowship with Vicky Minden of IHI’s marketing and communications team.
Margee Louisias, MD
2014-2016 Harvard Pediatric Health Services Research Fellow: Allergy-Immunology
Brigham and Women’s Hospital, Boston, MA
What was your journey to your fellowship?
Ever since I decided to become a physician, I knew I wanted to work with underserved populations. Initially I pursued global health, which seemed to be a path to finding areas with the most need.
Throughout school and my medical training, I did a series of projects in Africa — Ethiopia, Ghana, South Africa, and Cameroon — focused on different diseases and issues, including determinants of prenatal care, sickle-cell disease, tuberculosis meningitis, and gestational diabetes in HIV-positive pregnant women.
In parallel to these experiences abroad, I was gaining exposure here in the US to underserved populations, seeing really for the first time the disparity and inequity in our own health system. I did my residency in a hospital system in New York City, my home town, that provides care to people of varied socioeconomic backgrounds, and what was striking to me was caring for those with very low incomes, no insurance, and no support systems.
After residency I worked for a year doing primary care in shelters throughout New York City, treating people in really bad circumstances, on the lower rungs of society. Being able to provide the quality medical care some of them had never had was very fulfilling for me.
These experiences led me to Allergy-Immunology as my specialty — mostly because of asthma, a disease extremely prevalent in underserved communities. I also realized I didn’t have to leave the US to find people in need of health care services; there’s plenty of work to do right here.
What brought you to IHI at that point?
When I arrived at Brigham and Women’s Hospital in Boston for my Allergy-Immunology fellowship, my goal was to find support for research on fixing health inequities, and I knew I needed good mentorship. I ended up finding the Harvard-wide Pediatric Health Services Research fellowship and applied.
Through the interview process I met with several faculty members, one of whom was Don Goldmann [IHI’s Chief Medical and Scientific Officer and executive lead for fellowships]. We had a great conversation, and it made me realize that IHI would give me exposure to a different area that could really help me in my work. I learned there was one slot in the fellowship program for someone to work both at the Harvard hospitals and at IHI. I applied, and I was elated to get the position.
Part of the fellowship has been getting a masters’ in public health at Harvard. But it’s also been about excellent mentors guiding my work — both from IHI and Harvard. It’s been really rewarding.
What's one thing you've learned already?
The key overarching lesson I’ve learned is that improvement work can be research. In medical school and residency, it seemed to me that people didn’t perceive improvement as rigorous science. But my work at IHI has shown me that it can be — and really should be an integral part of the work that we do as physicians.
What's something that has surprised you?
I’ve been surprised by how welcoming the IHI community has been and how much support we get as fellows. To be in an organization that does so much wonderful work and find that people are so down to earth has been a terrific experience for me.
In terms of my work, I’ve been surprised to find a growing level of interest in improvement and implementation research in the medical community. What tends to happen to physicians who decide to do academic research is you get pushed into traditional research pathways of basic science or clinical research. I knew I wanted to do clinical research, but the work I had been doing so far wasn’t fulfilling. I wanted to improve processes and systems, to make changes I felt were needed so I could have an impact.
When I found the [Harvard] health services research fellowship program, I was surprised and excited to learn about a field I didn’t know existed that’s all about changing the infrastructure of health care to make it better. And that there was a group of physicians actually doing this work in a rigorous way and getting funding to support them.
What are you most excited about going forward?
I’m really excited about the project I’m working on, which is essentially to develop a school-based asthma management program here in Boston. It’s still in the early stages, but I’ve made connections with the medical director and the nursing director of the Boston public school system, and they’re very interested in working with me. I’m starting small, with a pilot project in one school. But the goal is by next year at this time, in the second year of my fellowship, things will be up and running. I’m really looking forward to seeing how this will evolve and come to fruition.