What's It Like to Be an NPC Fellow?

Our current and previous fellows share some inside tips

As the National Pharmaceutical Council (NPC) opens the application process for the 2020-2022 NPC-Duke Margolis Health Policy Fellowship, we asked our current health policy fellow, Taruja Karmarkar, PhD, and her predecessors, Ilene Hollin, PhD, MPH, Assistant Professor at Temple University’s College of Public Health, and Chuck Shih, PhD, MS, Director of Public Payer and Health System Strategy at Biogen, to share a few insights about their experiences. We asked about what they learned during their fellowship, what they hoped to achieve, and their tips and advice for prospective NPC fellows.

NPC’s current fellow, Dr. Karmarkar, graduated in 2018 with a doctorate in health economics and policy from Johns Hopkins Bloomberg School of Public Health. Her NPC fellowship in partnership with Duke-Margolis Center for Health Policy ends in July 2020, and while she is working to finish research on step therapy and value-based payment models, she is actively considering the next phase of her career.

Following her 2016-18 NPC fellowship in partnership with the University of Southern California Schaeffer Center, Dr. Ilene Hollin became a tenure track Assistant Professor in the Department of Health Services Administration and Policy at Temple University’s College of Public Health. Her primary responsibility is to conduct investigator-initiated research, as well as help train future health policy professionals and leaders. Dr. Hollin’s research focuses on improving the patient experience, which includes patient preferences, patient-centered outcomes and patient access.

NPC’s inaugural health policy fellowship was in partnership with the Milken Institute School of Public Health (Milken Institute SPH) at George Washington University. Today, Dr. Chuck Shih is Director of Public Payer and Health System Strategy, part of the U.S. Market Access & Reimbursement team at Biogen. Dr. Shih’s responsibilities include engagement of public payers to ensure patients have access to therapy. He also leads internal strategic initiatives to prepare Biogen for changes in the health care landscape, including new federal and state policies.

What did you hope to achieve during the fellowship? Did you achieve that goal?

TK: I had two main goals for the fellowship. First, while I recognize the value of the academic perspective, I wanted an opportunity to step out of that bubble – to better understand how data-driven research informs the development and implementation of policy solutions. Second, as part of my professional development, I wanted to expand my network – meet people who wear different hats, better understand their perspectives, and inform my next steps.

IH: I also wanted to gain exposure to and conduct applied policy research in a real-world setting, focusing on skills that you can’t learn in the classroom. I wanted to gain exposure to varied perspectives on identifying priority research questions. I did achieve this goal – the fellowship exposed me to specific stakeholder groups and areas of interest that allowed me to diligently focus on that applied piece.

CS: I joined NPC at a unique time when the drug spending debate was just starting to happen, so there were interesting policy questions to be addressed. Knowing what I wanted to do long-term, it was an interesting area to get into. Coming from a PhD program, it is easy to feel as though you are in an academic program bubble. I met a lot of people on the commercial side of industry through the NPC fellowship, so I picked up a different perspective.

What did you want to do long-term? Did you achieve your goals?

CS: Finding topics where there is a need for useful research and dialogue is exactly where I want to be. Drug spending and patient access are still ongoing policy issues, and I enjoy working with stakeholders who have different perspectives that stress the right balance between price, access, and innovation. I want to be active participant in that dialogue.

I’d say I achieved my goals. It’s hard to understand how manufacturers make those decisions [about price and innovation] without being a part of it. Being at NPC was critical first part of that.

TK: I can see the clear connections between my research and its policy implications – the research questions were informed by the need for evidence to demonstrate the cost/benefits tradeoff of certain policies and regulatory changes. I chose to work on projects that can equip me with the tools I need to make a meaningful contribution to ongoing policy discussions.

How did the fellowship inform where you are now?

CS: There is a balance of rigor and pace in conducting research. On one end, there is academic research and policy work on the other. A big question for the fellow is where on that continuum you want to spend your career. NPC understands the needs of different audiences and the level of research required to address those needs. Policy is such a hard thing to figure out, and the fellowship is great in helping to develop skills to work through these complex issues.

IH: Although I didn’t know my long-term career aspirations when I started, the fellowship provided me with many skills that I now bring to academia that I wouldn’t have had otherwise. For instance, when I’m trying to determine what research question to ask – the first question I ask myself is, “Does anyone actually care about the answer to this?” One of my NPC mentors advised to start with the end in mind. This is something I return to frequently. Other skills I gained that I have found beneficial and that I use often include thinking about every issue from multiple angles (i.e., different motivations) and having that ability to keep my head on a swivel.

Furthermore, research is a continuum in terms of rigor, and it there is often a tradeoff between rigor and relevance. The fellowship helped me realize where I fit on that continuum and what type of research I wanted to conduct.

CS: While research is a big part of the fellowship, it was the first time I was exposed to the communications side, as in how do I get my research out there and how do I influence decision-makers? It was eye opening to see that there are different tools out there, like Twitter and other types of communications--I’m now seeing the value of that.

IH: For me, other aspects of the work NPC does were new – like the structure of an association, how associations represent member needs and perspectives, and the impact associations have on policy. Associations are pervasive in D.C., but I had no exposure to how they worked prior to my NPC fellowship experience. I don't think that many researchers understand the role associations play in health policy.

What was the most satisfying part of the fellowship?

TK: I’ve had the opportunity to present my work in several places in front of diverse audiences – from academia to policymakers to industry. It often takes a long time to get from research question ideation to publication, so being able to present my work and my ideas to different people not only helps me to share the expertise I have developed, but it also builds confidence.

These opportunities also serve as interim milestones throughout the fellowship – while critical to getting your work out there, you can’t only measure your successes in publications. These presentations serve as great networking opportunities, too -- audience members often come up to you after your talk to ask questions or hear more about what you are doing. Your network continues to expand in this way.

IH: It’s a nontraditional fellowship because the NPC fellow receives exposure to real-world health policy issues that researchers typically do not get elsewhere.

CS: The connections I made during this fellowship helped me to land my position at Pew, and more recently, at Biogen. Now that I’m at a member company, people know of me because of my time at NPC!

TK: I’d add that NPC and Duke-Margolis are involved in a lot of these organizations and initiatives. They have a big presence in these circles – teams at both organizations are knowledgeable about where the work fits in and making the connections to people who want to hear about it.

What was the most challenging part of the fellowship? Any surprises?

IH: One of the most challenging parts was also the best part: understanding issues from different angles. That flexibility and open-mindedness at all levels is challenging. The fellowship provided me with a greater appreciation for that.

CS: Policy is hard – there isn’t a single right answer, so there are tradeoffs – how you capture that is part of the learning process. Making policy a linear process is really difficult.

TK: I’d agree with both Chuck and Ilene – but those challenges are why I applied. There are widespread implications and several different stakeholders involved in health policy. No two days are the same in policy work.

What was the experience like working with the academic partners alongside the experts at NPC?

TK: The Duke-Margolis Center is an ideal partner for this fellowship – the D.C.-based team functions like a think tank, but still operates under the larger Duke University umbrella. So you have all the real-time interactions with other policy stakeholders here in D.C., but also have access to faculty at Duke University in Durham who are interested in this applied research. NPC’s policy work makes it an applied research group so it’s a perfect fit. While there is some overlap in areas of focus, the fellow gets exposure to how these two organizations work and the different perspectives each team brings to policy issues. The combined mentorship from both organizations has helped to guide me throughout the fellowship.

IH: I had two distinct projects, one for NPC and one for USC [the University of Southern California], so there was less overlap between the two organizations. It was nice to have an academic mentor to make sure my research was geared toward the academic job market. My mentors worked with me to make sure my research portfolio covered all potential paths of future employment to keep my options open.

CS: Knowing I didn’t want to go into academia, I didn’t leverage the academic partnership as much. That being said, the value for me was being part of an ASPE-funded [Office of the Assistant Secretary for Planning and Evaluation] project examining the impact of payment on innovation.

Is there anything you would have done differently during your time in the fellowship?

CS: I would’ve come up with my research projects more quickly! I enjoyed having drinks and coffee and meeting people.

IH: I took advantage of some of the opportunities to meet people and network, but I would have liked to do more of that. I often was buried in my work but I could have been more like Chuck and scheduled more drinks and coffee meetings.

CS: I wanted to be like Ilene!

TK: I’m a little bit more like Ilene – if I have a number of research items to get done, everything else will usually come after that. The fellowship has given me a chance to get out of that comfort zone.

IH: I didn’t plan to work for [the biopharmaceutical] industry, so I never shadowed anyone from an NPC member company. I should have done that to have a better understanding of their perspectives. It’s pragmatic to focus on where you want to go next and how the fellowship can help you get there, but it’s also beneficial to the long-term to take advantage of the experiences that are available to you at any given point in time.

What advice do you have for other aspiring health policy graduates?

IH: Use your time wisely because it flies by. Take advantage of opportunities to meet with other stakeholders. Immersion in the real world helps you to understand that no health policy issue is black and white.

TK: I agree with Ilene, probably because at some point she gave me this advice so I’d pass it on to the next fellow as well: meet everyone and anyone who is willing to chat with you. When you reach out and introduce yourself as the fellow, people are usually quite receptive and willing to give you their time. This is how you begin to learn and think about health policy from all different angles.

CS: Stay out of the D.C. policy swirl. It’s easy to get caught up in over-thinking things. There is value in getting out of the D.C. environment to think about the questions that really matter. And take the opportunity to visit a manufacturer – I didn’t do that when I was a fellow, but you should do it.

IH: Find out where you fit on the research continuum. The idea of research is to strip away the complexity and figure out causal relationships. The appeal of the NPC fellowship was thinking about causal relationships in the thick of muddy policy discussions.  I spent a lot of time thinking about how to balance narrow research questions against broad policy relevance.

TK: This is not what you typically think of when you hear “post-doc.” The focus is still to develop your research skills – but you can take opportunities to network, attend conferences, participate in local policy meetings or forums in D.C. You have to recognize that is essentially part of your job – to go out and have these different experiences.

CS: It’s interesting to see that Ilene and I are on different ends of the job spectrum, so it’s a testament to what can happen through a fellowship.

TK: I feel like we should have a special handshake for fellows! Or maybe just meet for drinks.

Interested in applying to the fellowship? Check out NPC’s website for further details. The deadline to apply is January 2020.