Administrative fellowships are often portrayed as linear ladders—grad school, fellowship, promotion, and permanence. Rachel Gerhardt, MPH’s path is proof that great careers are rarely straight lines. She began on the phones and at the front desk of Boston Children's Hospital neurology clinic, earned her MPH at night, jumped into a Johns Hopkins Medicine fellowship, took an interim leadership role earlier than planned, chose exploration over early title, led operations at UPMC through COVID, and now steers system integration strategy at Beth Israel Lahey Health in Boston. Along the way, she kept coming back to one north star: values. As she puts it, “the MPH…aligned with my values,” and later, “the value of the fellowship is…you do get to experience every area.” This is the story—and the playbook—behind her rise from patient services to system strategy.
Rachel Gerhardt is a Boston-area native who launched her career at Boston Children’s Hospital as a patient service representative in the neurology clinic; that frontline role—and the people she met—set everything in motion. In her words, “I ended up…starting at Boston Children’s…in June of 2013…doing a lot of scheduling…answering the phone…that first point of contact for patients.” She didn’t know healthcare administration was a career. “I had no idea what I was getting into,” she admits, but proximity to patients, nurses, and physicians gave her a panoramic view of access, quality, and cost.
That day-to-day exposure did two things:
-It revealed how much administrative work shapes the care experience. -It showed her leaders’ typical educational paths, nudging her toward graduate school.Crucially, a supportive preceptor opened doors: “My preceptor…said, oh, you should apply to these entry level positions at the hospital.” If you’re early in your journey, emulate that: shadow operations, ask naïve questions, and notice which degrees and roles keep appearing in the org chart.
Because it aligned with her values and practical reality. Rachel chose BU’s part-time MPH to keep earning, keep learning, and build toward leadership. “I needed to keep working full-time, so I was looking for a program that I could do part-time,” she explains. The content matched her interests—child development, community health, the social determinants, and the (still relevant) Triple Aim. “The MPH…aligned with my values…what I was interested in,” she says.
The cadence was gritty and sustainable:
-One class at a time → then two → then three when possible. -Commuting from clinic to campus: “I would take the bus from Children’s over to BU…sometimes I would walk…[and] slowly chipped away at my MPH.” -Three years of persistence, plus relationships with faculty she still keeps today.For rising leaders, the lesson is simple: choose a credential that fits your life and mission. Value alignment beats brand-chasing. And don’t underestimate the compounding power of steady progress.
She found fellowships the unglamorous way: by searching. “Honestly, I came across fellowships by just doing my own research…on the BU Public Health website,” she says. What sealed it was access and breadth. “There was just an opportunity to explore so much as part of a fellowship and to interact with the executives of a hospital…mind-blowing.”
Her “why” mixed ambition with curiosity:
-Accelerate development through rotations across operations and strategy. -Build executive visibility and mentorship. -Pressure-test passions before specializing.Rachel compiled a national list—academic medical centers, children’s hospitals, coast to coast. If your program isn’t hands-on with fellowship prep, adopt her approach:
-Mine your school’s career site and alumni networks. -Identify faculty champions (Rachel later found Prof. Chris Lewis at BU). -Cold-reach programs early; track deadlines, formats, and criteria. -Practice telling your story—values first, résumé second.It was rotational, relationship-rich, and—by chance—accelerated. She began with exposure to Hopkins’ Children’s Center because of her background. Then timing created an opportunity: “Toward the end of my first year, the assistant administrator…was leaving…[and] I was approached about stepping in interim to that role.” She said yes.
That meant true accountability: inpatient operations for a 205-bed children’s hospital, leading director-level teams, and learning at the steepest possible slope: “I jumped into that role as the interim assistant administrator…overseeing the day-to-day operations…[and] I learned so much.”
Should you take an interim step-up if it truncates rotations? Rachel’s answer is nuanced:
-Yes, if it gives first-line leadership experience you don’t yet have. -Yes, if the window won’t open again soon. -But… keep checking against your original “why.”Which leads directly to her next move.
Because her “why” demanded exploration, not early anchoring. “I decided to pursue a fellowship to really get exposure to the full health system,” she says. “The value of the fellowship is not just that you get a job…it’s that you do get to experience every area…if you take advantage of it.” She recognized the risk of being typecast as “pediatrics ops,” however prestigious.
So she pivoted—intentionally—toward enterprise strategy. “I met with [Dr.] Lisa Ishi…a newly SVP of health system operations…working directly with [the] president of the health system…And I said…‘I want to work with you.’” That choice—hard in the moment—maximized learning, diversified her network, and broadened her brand.
Takeaway: When an early title conflicts with long-term range, you’re allowed to choose range. You can be loyal to your organization and still loyal to your development.
That community accelerates growth and resilience. Rachel says it plainly: “It was the best decision I ever made… I loved Baltimore.” Her small class (three fellows) became an immediate support system—dinners, scooters (it was the year they hit the city), and rec-league sports. The point wasn’t nightlife; it was belonging. “We really just created this great network of people…you have to put yourself out there.”
If you’re relocating for a fellowship:
-Treat social planning like project planning—make the list, set the cadence. -Join a league, meetup, or volunteer shift within 30 days. -Cross-pollinate with other fellowship programs at conferences; the national network is real. -Remember Baltimore’s nickname: Charm City—and go find its charm blocks.Geography isn’t destiny, but choosing to build community is a leadership act. The relational capital you bank outside work pays dividends inside it.
COVID’s timing, a cross-city relationship, and a compelling role at UPMC all converged. “Turning [Hopkins offers] down was the hardest decision…,” Rachel says. But the method mattered as much as the outcome: “Talk to your people about it…be open…you don’t really want anyone to be shocked.” Her mentors modeled healthy sponsorship—supportive even when her path diverged.
Her rubric for good mentors is worth copying:
-They can be disappointed and still champion you. -They separate institutional preferences from your best interests. -They stay in your corner after you leave.And if someone weaponizes your choice? That’s data. “Those aren’t the mentors that you want in your life.”
UPMC gave her scope and stewardship. She entered as a director of operations with direct reports—through the chaos of early COVID—and later became division administrator for General Internal Medicine. The people side was the crucible: “Managing people…is the most challenging thing.” That’s why early management reps matter for future executives.
She also rejects a false dichotomy: “You don’t have to pick [ops or strategy] and you can go back and forth.” Operations is strategy-in-action; strategy without operational empathy is theater. For fellows and early leaders:
-Seek roles where you own a P&L slice and contribute to system priorities. -Ask for projects that tie capacity, access, and patient experience to growth and quality. -Measure your success by changed outcomes, not just completed tasks.In short, become bilingual. Speak both Gemba and boardroom.
Family, mental health, and timing drove the move; professional fit sealed it. “It was really a personal reason,” Rachel shares. With a young son, no nearby family in Pittsburgh, and the pull of home (and Baltimore as a close second), she and her spouse chose proximity over continuity. The happy complexity: “I married that fellow…we now have two children.”
Professionally, Beth Israel Lahey Health offered enterprise strategy during a pivotal phase. “I am now more in a strategy role…working across the health system,” she explains of her Director of Integration remit within a relatively new, 14-hospital system that merged just before COVID. Like a mini-fellowship, she works with senior leaders on “where we’re going, how we’re getting there, and what it looks like.”
For executives, that translates to:
-Post-merger integration: governance, operating model, and service line alignment. -Access and growth: site-of-care strategy, capacity management, and referral pathways. -Outcomes and experience: standardization that respects local realities.The throughline remains values and relationships—plus the humility to let life stage influence strategy stage.
Be authentic, be curious, and do the work. “People just at the end of the day wanna connect with like a real person…so just like be yourself,” she says. That doesn’t mean passivity; it means initiative with humanity. “Make an effort to get to know people. Make an effort to get to know your organization and put yourself out there.” Authenticity earns trust; effort earns opportunity.
Practical ways to operationalize that:
-In interviews/personal statements: share what you value and why. -In rotations: ask for feedback, volunteer for the messy projects, close loops. -With executives: come with a point of view and a question—not just a calendar invite. -With peers: build the dinner list, organize the run club, be the glue.And when choices get hard? Return to your “why,” as Rachel did—repeatedly.
Here’s a quick checklist distilled from Rachel’s journey:
-Frontline first. If you haven’t worked in access, ambulatory, or inpatient flow, find a way to get close. It sharpens your empathy and your strategy. -School–work fit. Choose programs that match your life and values; part-time doesn’t mean part-quality. -Research like it matters. Fellowships won’t find you. Build a tracker; start early. -Titles aren’t trajectories. Take interim roles for reps, not résumé lines—and be willing to pivot back to your plan. -Mentors who stay. Be transparent with sponsors; retain the ones who honor your goals. -Ops ↔ Strategy fluency. Learn to toggle; seek roles with both execution and design. -Community is a competency. Your off-hours network sustains on-hours performance. -Life stages count. Family, health, and place are strategic variables, not afterthoughts.As Rachel reflects, “It’s not that easy…there’s definitely hard moments,” but alignment beats autopilot.
If you remember only one thing, make it this: careers compound when values lead and curiosity drives. Start where patients are; study what aligns; use fellowships to widen—not narrow—your horizon; say yes to reps, no to boxes; and keep choosing the mentors, moves, and cities that let you be both human and high-performing. Or, as Rachel puts it, “be yourself…work hard…put yourself out there.” Do that consistently, and the path from patient services to strategy becomes less a leap and more a series of intentional, values-backed steps.
