Medical Leadership & Operations Fellowship

Program Overview:

The Medical Leadership and Operations fellowship is designed to provide operational and management experiences in both in-hospital and ambulatory settings for graduates of EM residencies. Our goal is to provide the skills and experiences necessary to lead medical enterprises of the future.  Our faculty mentors currently have leadership positions in hospital administration, urgent care center management, telehealth, and medical entrepreneurship.  Our Emergency Medical enterprise has a robust innovation practice with over 30 revenue-generating projects ranging from international ventures to R&D to telemedicine.  We are looking for ambitious, well-qualified emergency medicine physicians who are interested in shaping the future of medicine. 

The healthcare industry is changing rapidly, and we recognize that the success of future leaders will be dependent on skills beyond simply being the medical director of an ED.  We believe that those who will accomplish maximal success will develop a deep understanding of hospital operations, ambulatory operations, and the remote delivery of healthcare through technology, and then leverage that knowledge to develop impactful innovations after graduation.  Future academic leaders must also understand and initiate research and this fellowship will provide experience in these areas.  

The fellowship co-Directors are Randall Lee M.D. and Robert Shesser M.D.  Dr. Lee previously worked on Wall Street for 10 years prior to his career in medicine.  He has investment and advisory experience in multiple industries including MedTech.  Within the innovations practice others have experience in all aspects of business including start-up and patent experience, cooperate R&D, and previous employment at management consulting and large accounting firms.  We also have relationships with the GW Office of Innovations and Entrepreneurship.

Dr. Shesser is the Department Chair who has led the Department for over 25 years during which time, the number of covered hospitals has quadrupled, the faculty size has tripled, and a large number of new programs developed.    

The program is based in the Department of Emergency Medicine at the George Washington University with resources and opportunities provided by its clinically affiliated emergency departments and other areas within the University, faculty practice, and related institutions. 


The fellowship’s curriculum is divided into 6 sections

ED and EM academic departmental operations:

  1. Demonstrate expertise in core aspects of emergency department operations.
  2. Develop and analyze operational metrics to optimize emergency department processes and outcomes
  3. Create, employ and evaluate emergency department  quality improvement initiatives
  4. Understand the budgeting process for clinical and academic departmental operations
  5. Understand the essentials aspects of emergency physician coding and billing
  6. Identify the elements of a budget for an academic department of emergency medicine
  7. Recognize essential elements of an emergency department risk management program; understand the processes that occur when a claim is made
  8. Understand the essential elements of a physician evaluation and compensation program

Hospital Medical Direction

  1. Understand the structure and responsibilities of the Hospital Medical Staff
  2. Understand the Hospital’s credentialing and privileging process
  3. Understand the Hospital committee process and become a member of the Hospital Peer Review committee
  4. Understand the major Medicare-related quality initiatives
  5. Understand the role of JCAHO and local health departments in the Hospital’s accreditation process
  6. Understand the ED role in Trauma, Stroke, and Cardiac certification processes

Ambulatory Operations

  1. Understand the  basic management and fiscal  challenges or running an outpatient, longitudinal, ambulatory practice
  2. Understand the basic management and fiscal challenges of running an outpatient, episodic urgent care center
  3. Understand the metrics of outpatient practice
  4. Understand the billing and coding of outpatient encounters
  5. Understand the development of quality metrics for outpatient longitudinal and episodic practice


  1. Understand the basic structure of a telehealth program including both the hardware and software support necessary
  2. Understand the and participate in the delivery of care through telemedicine
  3. Understand the billing, regulatory, and qa aspects of a telehealth program

Business Innovations/MedTech

  1. Learn how to create a business plan.  Ideally, identify a unique revenue opportunity, create a business plan, pitch a new business line to mentors and leadership
  2. Work with and complete programs within GW’s Office of Innovation and Entrepreneurship
  3. Integrate into one or more of the current innovation practice business opportunities
  4. Using your medical knowledge and developing business experiences, develop the skills necessary to provide advisory work to external organizations or start-ups


  1. Design and successfully complete a scholarly project related to emergency department or ambulatory operations that is publishable in a national peer-reviewed journal.

Educational Program

Curriculum Highlights

  1. Fellow will be funded to attend three phases of ACEP’s Emergency Department Directors Academy during the two-year period.
  2. Fellow will work directly with  the Chief Medical Officers of George Washington and Fort Washington Hospitals (EM trained)
  3. Fellow will be a member of a minimum of two committees at either the Hospital or MFA (multispecialty group practice) levels
  4. Fellow will be involved in the monthly mortality and morbidity meeting by reviewing and analyzing cases.
  5. Fellow will attend the Department of Emergency Medicine joint Fellowship seminar series.
  6. Fellow will be involved in the department-run business innovations group
  7. Funded MBA (optional)

Clinical Responsibilities

May vary according to the fellow’s clinical background and visa status, experience, and education.  In general, fellows who are residency trained in EM and employable in the US will work as ED attendings in the Washington VA Hospital, United Medical Center, and possibly other locations.

Generally, a fellow will be scheduled for 700 clinical hours in the given academic year. Generally, shifts are nine hours long, but vary at each site.

Educational Responsibilities

The fellowship curriculum will provide a comprehensive exposure to the broad scope of healthcare-related operations as elucidated above.

Most fellows complete the fellowship in two years.

In addition, Fellows will be expected to:

  1. Present on one residency-wide didactic presentation of grand rounds per year
  2. Present at least two class-specific presentations per year
  3. Participate in the residency interview process in the fall of each year
  4. Attend 50% of the faculty meetings

Each fellow will be expected to conduct a research project during the time of their fellowship; expectation will be to submit two abstracts and one article during a two-year fellowship when applicable

Academic courses associated with an optional MBA

Each of the following subjects is 3 credits:

Each of the following subjects is 3 credits:

Fall 2021: Financial Accounting, Marketing

Spring 2022: Decision Making and Data Analysis, Global Perspectives

Summer 2022: Organizations and Human Capital, Operations Management

Fall 2022: Business Ethics and Public Policy, Perspectives on Leadership, Finance

Spring 2023: Managerial Accounting, Microeconomics for the World Economy, Strategic Management

Summer 2023: Electives

Other 27 Credits of elective will be added based on the fellow interest. 

Requirements and Contact information:

The term for the fellowship is generally from July 1st to June 30, with potential start date flexibility in July. Fellows accepted into the program must have completed an ACGME accredited EM residency and be eligible for (or have successfully completed certification by the American Board of Emergency Medicine. 

Core text

Strauss and Mayer’s Emergency Department Management by Robert Strauss and Thom Mayer, McGraw-Hill Education, 2014.

Supervision & Evaluation


  • Dr. Shesser will supervise the ED and Ambulatory administrative sections
  • Dr. Petinaux will supervise the Hospital Medical Directions segment
  • Dr. Lee and Sikka will supervise the Telemedicine section
  • Dr. Pourmand will supervise the Research section

Evaluation and Assessment

  • Self-assessment through regular meetings with the Program Directors
  • Formally every 6-months by one of the Program Directors
  • Direct feedback from fellowship directors (weekly)
  • Final formal performance review by the Program Directors

Effective Dates & Application Requirements:

The duration of the ED operations and administration fellowship is generally two years, although exceptions have been made. The academic year for the fellowship is generally July 1st – June 30th, although there is sometimes start date flexibility in July.  Fellows accepted into the program must have completed an ACGME-accredited emergency medicine residency and be eligible for (or have successfully completed certification by the American Board of Emergency Medicine). The current application requirements include a copy of your curriculum vitae, a letter of intent (1-2 pages in length - expressing your interest in our program, career goals, your expectations from the program, and the strengths that you would bring to the fellowship), and three reference letters, including one from your emergency medicine residency program director.  Please let us know who will be sending references and have the reference letters mailed directly from the author to either fellowship director. 

Applications welcome starting July 1st.  Please email the aforementioned requirements to the fellowship directors listed below. 

Please contact us with any questions.  We are excited about creating innovators and leaders in emergency medicine.  Thank you for taking the time to consider our unique program!

Randall Lee, M.D.
Fellowship Co-Director
2121 L St. N.W. Suite 450
Washington, D.C. 20037

Robert Shesser, M.D., M.P.H.
Fellowship Co-Director
2121 L St. N.W. Suite 450
Washington, D.C. 20037