Dr. Robert L. Fogerty '98 is Director of Bed Resources (DBR) and Medical Director for the Capacity Coordination Center (CCC) at Yale New Haven Hospital (YNHH). His professional path was marked by a serendipitous series of events, but has resulted in a very fulfilling career. Of late, his role and work have been particularly challenging and enormously important.
Fogerty entered Hotchkiss in the fall of 1994 as a prep, after having looked at and considered several prep schools. In his first year, he found biology to be his favorite class, and later on, he also found Don Mayland's economics class greatly inspiring. "I actually majored in economics in college, and I still closely follow the Fed open market meetings and other economic indicators." During his time in Lakeville, Fogerty took a lifeguarding class and an emergency medical training (EMT) class, which led to some time spent in the Sharon Hospital emergency department for a "shadowing" experience. This introduction proved very relevant in his future choice to practice medicine.
At Hotchkiss, Fogerty dabbled in a variety of athletics and extracurricular activities. This was one of the greatest aspects of Hotchkiss, he says - the incredible variety of experiences that were largely available to anyone who asked. "I played soccer for three years and then football my senior year. I also played baseball, sang with the Chorus, and studied abroad in South Africa for a semester. Additionally, I spent a lot of time in the trainer's office with Pat Kelly and Bernie Doyle, and my time in the trainer's room proved to be both incredible and valuable. This also morphed into a winter 'sport,' a selection now called a 'co-curricular project,' which remains an ideal option for some students today. I enjoyed participating in an HDA production, and spent a lot of time in Don Mayland's SCUBA club. I also was a member of the Press club, which at the time reported sports scores to newspapers, among other endeavors."
Of his decision then to pursue his Bachelor's degree in economics from Boston College, Fogerty says, "Simply put, I really liked economics. I thought it was challenging, but also interesting. I also wasn't sure I would get accepted into medical school, so if not, I wanted to have options when it came time to look for that dreaded 'first job' after college." Thoughts about medicine continued to surface while he worked as an undergraduate. "Early in my first year at Boston College, I realized that I needed to at least try to go to medical school, so before the drop/add option ended, I flipped nearly my entire course schedule to include the medical school prerequisites. (I actually enrolled in the wrong biology class, but didn't realize it until I was in the class chatting with the guy next to me. He pointed out I was in the wrong class, so I had to change again!)"
In his senior year at BC, Fogerty was indeed accepted into medical school and went on to graduate cum laude in 2002. "I applied for a scholarship program in the Air Force for medical school. Serving in the military had been a personal goal of mine nearly my entire life, so this made sense. Additionally, military service has always been important in my family. But the same month I was accepted into medical school, I was diagnosed with testicular cancer. I called my Air Force recruiter, and he told me that while I had been selected for a scholarship, this diagnosis understandably precluded my participation in the Air Force. Luckily, Northwestern University had a great deferment option, so I deferred for two years for treatment and eventually got back on track. I ended up working in industry (so that economic degree paid off!) at Genzyme in Cambridge, MA, for a time before moving to Chicago for medical school in 2004."
Fogerty earned his M.D. and M.P.H. degrees concurrently, receiving them from Northwestern in 2008. He completed training at Yale New Haven Hospital, where he decided to stay, explaining his path. "I met my now-wife, Melissa, at Boston College, and we started dating our senior year before I got sick. You learn people's true colors in times of stress, and she never flinched. It was clear that I had found my life partner. Melissa enrolled in law school at Harvard while I was working at Genzyme, but by this time I had already planned to move to Chicago for medical school. My first year of medical school was her last year of law school, so we successfully did the 'distance relationship' thing before she moved to Chicago, and we got married. Three years later, we wanted to move back to be closer to our families (both of us are from Connecticut), so I focused my residency application process called 'the Match' on the Northeast. I ranked Yale first, and I was then matched there. (The residency match is a computer algorithm process that matches one medical school graduate with one residency slot. It is a bit unnerving, as you have to agree to go wherever you are matched, but don't know where you match until after you have already signed a binding contract.)"
While in residency in internal medicine at Yale New Haven, Fogerty planned to do a fellowship in pulmonary and critical care medicine when he was done. But after having their first child, he quickly realized that three additional years of training was not something he had interest in. "This would have meant more training with continued absurd work hours. Yale was starting a small program in hospital medicine that would focus on teaching students and residents. This was back in 2011, so they hired me as a founding member of this program, the Academic Hospitalist Program. Hospital medicine is still a fairly new practice style, where we only treat hospitalized patients. I like the high acuity, the detail-oriented medicine, the breadth of disease and pathology, and I find the scheduling of hospital medicine makes it easier to integrate being a doctor with being a husband and a father of three - Kate (10), Jimmy (8), and Michael (4). I reached the rank of Associate Professor in 2016 before I took my next job."
"In my current position as Director of Bed Resources (DBR) at Yale New Haven Hospital, my role is to ensure the safe and efficient allocation of our inpatient beds. YNHH is one of the nation's largest hospitals, with 1,541 licensed beds across two campuses in New Haven. Like any other scarce resources, these beds live in a supply/demand world. As our clinical technologies continue to become more advanced and treatments become more specialized, the beds and rooms in our hospital become less and less interchangeable. My role is to maximize efficiency as patients move through their hospitalization stays, and to build systems of care and infrastructure."
"As Medical Director for the Capacity Coordination Center (CCC), our command center, my primary responsibilities include using real-time data and collaborative work to break down silos and build collaboration. We have nursing leadership, our bed management staff, the emergency department, our largest ambulance provider, environmental services, and others in a single integrated workspace; so that they can work together in real time. I serve as the clinical leader for this group to ensure their work focuses in areas that make clinical sense, both tactically and strategically."
"With the COVID-19 pandemic now here, there is great strain on our hospitals and health systems. I am still clinically active, so I see patients both with medical students and residents, and also on our non-teaching service. Early in the pandemic, the projected demand for hospital services and ICU care took our breath away. We began actively building capacity by relocating ambulatory procedures off campus, postponing surgical cases and procedures, trying to more than double the size of our medical ICU, retrofitting areas to provide inpatient levels of care, and maximizing our staffing plan. I'm responsible for coordinating our capacity operations and expansion, and I still take clinical shifts, seeing patients. We have almost 400 confirmed COVID patients currently admitted; it will only increase.
"Typically, before this virus, I balanced my clinical work seeing patients with my administrative work in capacity management. I (and the people I work with) spend a lot of time looking at data and identifying areas of unnecessary delay and inefficiency. My clinical work is built in 'blocks'; so when I'm on a clinical block (typically 1-2 weeks), my administrative work slows substantially. I find this seesaw work style enjoyable.
"We are the only hospital in New Haven (there used to be two, the other being the Hospital of St Raphael, but Yale New Haven acquired it a few years back); so we really have an obligation to meet the needs of our community. Things like emergency department overcrowding, delays in access to intensive care, and operating room efficiency are my daily worries. Flu season every year is particularly challenging, and we now have a plan to convert a conference room into an overflow ward, which we have done for two years in a row. Please, get a flu shot every year!"
Some of Fogerty's greatest satisfaction comes from seeing patients. "I find the bedside work to be enormously rewarding. At the same time, when I have my administrative hat on, I'm helping advance the care for all our inpatients, which can be nearly 1,500 patients. The micro-scale work of my clinical practice and the macro-scale work of my capacity management responsibilities definitely complement each other."
In reflection, Fogerty says of Hotchkiss, "It was there where I first confronted failure. My prep year, I struggled mightily in Spanish. Later it was physics. Robert Barker's Tudor England class was an incredible amount of work, and managing that while trying to juggle sports, clubs, and early exposure to leadership as a proctor forced me to develop independence and self-accountability skills. My semester abroad in Grahamstown, South Africa, also helped me to develop these skills. Hotchkiss, much of it through failure on my part, taught me really critical life skills like perseverance and self-reliance."
"All of these experiences impact the way I view the world, not just my work. I was a patient well before I was a doctor, so my glasses are forever colored with that perspective. This is different from some of my peers, but differences are what make effective teams." For students interested in careers in medicine and public health, Fogerty shares this perspective: "Healthcare is now a team sport, and interpersonal skills are critical. You may be asked to miss birthdays and holidays, or work weekends and long hours. But, it is absolutely worth it. There is nothing as satisfying as helping those in need."