Step up: Leading in a time of crisis and uncertainty

Initially, I thought I was being forced to see the COVID-19 patients because I was one of the youngest in the department and the unlucky hospital medicine fellow.

My first encounter with COVID-19 brought a mix of emotions. I was paralyzed with fear of contracting the virus, frustrated by the lack of medical treatments available, and saddened by the futility of the grim situation. But over the course of working 42 days straight, without a single day off from the hospital, I transformed from a terrified young doctor only a few months out of residency into the physician lead for COVID-19 in the Division of Hospital Medicine at Yale New Haven Health Bridgeport Hospital.

In residency we are taught how to be good doctors. But we are not taught how to be physician leaders. Rather, residents are expected to adhere to the protocol of the attendings for both clinical and nonclinical matters. Just over a year ago, when I was a resident, I found it frustrating and disheartening that my co-residents and I had our ideas cast aside and our input was not considered.

However, my longing to lead was challenged by my fear during my first encounter with COVID-19 on March 23. Initially, I thought I was being forced to see the COVID-19 patients because I was one of the youngest in the department and the unlucky hospital medicine fellow. Frustrated and terrified, by day three I approached my supervisors and asked to be taken off the COVID-19 team immediately.

To my surprise, they thanked me for my service and praised me. They heard my concerns about the staffing and patient distribution, and they agreed to implement widespread use of continuous oxygen monitoring. They recognized my urgent pleas to expand the rapid-response team due to the rapid patient deterioration. My mentor, Dr. Monique Misra, who serves as our chief of the Division of Hospital Medicine, said to me, “Rajiv, you're finding solutions to problems we haven't thought of before. We need you.”

In that moment, my entire perspective and purpose changed. Over the course of those 42 days, I led the first non-ICU COVID-19 medical unit, where I worked alongside our dedicated nursing and leadership teams. We improved patient workflow, expanded our rapid-response teams and protocols, and implemented hospital-wide continuous oxygen monitoring. In addition, I sat on numerous committees throughout the hospital and Yale New Haven Health system providing input on COVID-19-related matters. In early May, my mentors agreed to end my fellowship early and I began my new full-time role as an attending unit medical director leading the last remaining COVID-19 medical unit until September 2020.

As I reflect on my journey, I realize that my growth is due to my supportive mentors who provided me with the platform to succeed and empowered me with great responsibility. A crisis is the perfect time to accelerate the leadership development of young physicians who want to prove themselves. Young physicians are motivated, hardworking, and eager to step up on the front lines, but they need that opportunity. As the COVID-19 pandemic continues, and uncertainty abounds regarding the possibility of a second wave, we must build our next generation of physician leaders.