Introduction
Purpose of the Guide: Choosing a healthcare administrative fellowship is one of the most important early-career decisions in healthcare administration. This guide provides an in-depth, honest breakdown of how administrative fellowship program structures fundamentally shape your experience in the field of healthcare management.
Why Program Structure Matters: The structure of your admin fellowship will shape your exposure to departments, determine how much project ownership you have, influence your career trajectory, and either accelerate or limit your professional network in healthcare administration. Understanding structural differences ensures you can select a program that matches your learning style, strengths, and ambitions—rather than defaulting to prestige or location alone.
Overview of the Main Types
Rotational Fellowships: Prioritize breadth of experience, exposing admin fellows to multiple departments and leadership teams in a fixed cycle. Best for those who want to see the full healthcare system before choosing a specialty.
Project-Based Fellowships: Prioritize depth and ownership, embedding fellows in one or two major strategic projects, often with executive mentorship and visible outcomes. Ideal for those with a clear area of interest in healthcare management or who thrive on measurable impact.
Hybrid Fellowships: Combine the best of both, starting with rotations for holistic exposure and ending with a focused project or interim management role for real-world results. These are optimal for those seeking balance and the opportunity to both explore and specialize in healthcare administration.
Understanding Administrative Fellowship Structures
Defining program structure in the context of healthcare administrative fellowships is foundational to understanding what you’ll get from the experience—and what you won’t. Structure determines how and where you build your skills: Will you develop technical, managerial, or strategic abilities broadly across the organization, or go deep in a single specialty? Are you exposed to the inner workings of the enterprise as a whole, or immersed in the details of a particular department like human resources or information systems?
The structure also dictates the size and diversity of your professional network—will you gain executive visibility and work across functions, or develop expertise within a focused area? The frequency and depth of mentorship, and how much actionable feedback you receive, can dramatically change based on the structure as well. Crucially, structure shapes the degree of ownership and accountability you hold. Are you a core driver of outcomes, or an observer at the periphery? It influences not just the speed of your career development and leadership readiness, but how well the experience fits your natural learning style—whether you prefer exploration and variety, or crave focused, long-term projects.
As you rotate (or don’t), the administrative fellowship program will test and build your soft skills, especially as you step into new teams, cultures, and stretch assignments. In the end, structure is about acculturation—how you internalize the values, professional ethics, and culture of healthcare administration itself. According to the ACHE, fellowships are intentionally structured to allow fellows to observe, learn, and do, with the ultimate goal of preparing them for ethical leadership in the healthcare industry. As Lauren Gregory, MHA (Duke Regional Hospital Fellowship), put it: “Fellowships are all about fit. I was very intentional about applying only to places where I could truly see myself—not just inflating my list to boost my odds.”
Rotational Administrative Fellowships
A. What is a Rotational Fellowship?
Definition: A formal program that moves the admin fellow through multiple predefined rotations across the organization to provide a panoramic understanding of how the healthcare system functions.
Core characteristics: 3–8 rotations, each 6–12 weeks; breadth over depth; shadowing c-suite executives complemented by rotation-specific projects; direct exposure to executive decision-making in hospital administration.
Typical design: Rotations commonly include Inpatient Operations, Ambulatory & Outpatient Services, Finance, Strategy, Quality & Safety, Human Resources, Supply Chain, Information Systems, and Support Services (EVS, Nutrition). Most programs schedule 2–3 months per rotation with clear learning objectives and deliverables.
B. Advantages of Rotational Fellowships
The primary advantage of a rotational fellowship is its unparalleled breadth of exposure in healthcare management. Fellows have the opportunity to move through a wide array of departments—from inpatient and ambulatory care operations to finance, HR, supply chain, and even support services like environmental and nutrition services. This diversity of experience gives fellows a panoramic understanding of how a complex health system operates, not just in theory but in practice. The result is a holistic, system-level perspective that most early-careerists would take years to develop if they remained in a single department.
Rotational fellowships also catalyze cross-functional skill development. By working with a variety of teams and healthcare executives, fellows learn to adapt to different management styles, tackle challenges across different functions, and understand how departments interconnect to drive organizational outcomes. Networking opportunities abound: fellows interact directly with medical staff officers, board members, c-suite executives, and frontline staff. These relationships don’t just expand a resume—they become a powerful support system and open doors for future leadership roles in healthcare administration.
A rotational model isn’t simply about “sampling” departments; the strongest programs, like those at Duke, UPMC, and UT Southwestern, are intentional about the order and content of each rotation. As Maggie Reyes, MHA, of UT Southwestern explains: “Our fellowship is intentional down to the order of rotations. It’s designed to build on each prior experience, so we’re not just rotating—we’re evolving.” Many fellows, like Chesna Panicker, MHA (UPMC), highlight how this structure provided “full exposure to a health system—hospitals, outpatient, everything.” In top-tier rotational programs, the level of executive access and the pace of responsibility increase rapidly, often compressing five to seven years of typical career growth into a single program cycle.
C. Disadvantages of Rotational Fellowships
While rotational fellowships offer a broad survey of the healthcare system, the tradeoff is often a lack of depth in any single area. Admin fellows may spend only a few weeks or months in each department before moving on, which can make it challenging to develop deep subject-matter expertise or see the long-term impact of their efforts. This can also create a sense of discontinuity—just as you start to understand one function, you’re quickly pivoting to the next.
Another common challenge is the potential for a lack of true ownership. Because fellows are consistently transitioning between teams and projects, it can be harder to claim responsibility for major outcomes or to see a project through from start to finish. The rapid pace of movement requires adaptability and the ability to get up to speed quickly in unfamiliar environments. As Sahana Sundaram, MHA, of Baptist Health notes, “One thing they really reiterate in our fellowship is being comfortable with being uncomfortable. You’re going to be uncomfortable a lot of the time, and you just have to ride the wave and trust that everything will work out.” Embracing that uncertainty and discomfort is essential—rotational programs are as much about developing resilience and flexibility as they are about gaining operational exposure in healthcare management.
D. Typical Length
Rotational fellowships most commonly run for one to two years, which allows fellows to fully immerse themselves in multiple areas of the healthcare system without losing momentum or continuity. Some organizations structure their programs as a traditional 12- or 24-month experience, while others use creative timing—such as a 13-month fellowship with a one-month overlap between incoming and outgoing fellows. This overlapping model allows for direct knowledge transfer, smoother transitions, and a sense of continuity within the organization. For example, the Methodist Hospital System in Houston offers an 18-month fellowship with two overlapping start dates each year, so new fellows can learn from those further along in the program. Regardless of the specific format, the typical length is carefully chosen to balance breadth of exposure with enough time to gain meaningful experience and start contributing in a substantive way to hospital administration.
E. Real-World Applications and Examples
Rotational fellowships are especially valuable for early-career professionals or those looking to build a comprehensive understanding of how large, integrated healthcare systems work. This structure is ideal if you are unsure about which area of healthcare administration is your long-term destination, or if you want the perspective and credibility that comes from seeing how every function in the organization connects. For those who want to eventually pursue system-level or C-suite roles, a rotational fellowship lays the foundation for strategic thinking and complex problem-solving across multiple domains.
Take, for example, the Lahey Hospital & Medical Center Administrative Fellowship—a one-year program that exposes fellows to departments as varied as surgical services, ambulatory care, HR, finance, and quality & safety. Each rotation is paired with a project, allowing fellows to both observe and contribute to ongoing initiatives. Boston Children’s Hospital Administrative Fellowship offers another excellent model: fellows spend two months in each clinical and non-clinical department, taking on key projects ranging from developing billing workflows to conducting market analyses. As Elizabeth Case, MHA, of the UC San Diego Administrative Fellowship described, “I think it really is a unique experience to survey the entire health system—not only to understand how each piece works individually, but how each piece comes together as a whole.” This perspective is what makes rotational fellowships so powerful for future healthcare leaders who need to understand not just the parts, but the system as an integrated whole.
Project-Based Administrative Fellowships
A. What is a Project-Based Fellowship?
Project-based fellowships immerse participants in high-impact initiatives where they take full ownership of one or more strategic or operational projects in healthcare management. These fellowships are defined by deep responsibility—fellows often serve as project leads, managing timelines, deliverables, and cross-functional teams while enjoying direct executive sponsorship. The design is intentionally immersive: fellows embed in a host department yet collaborate across the organization, moving through the complete project lifecycle from assessment to planning, execution, and evaluation. Many programs also build in an interim management stint, giving fellows the chance to truly “try on” leadership roles and manage people, not just processes. Typical durations range from 9 to 18 months, with clear milestones and regular presentations to steering committees or executive sponsors.
B. Advantages of Project-Based Fellowships
A project-based structure is ideal for those who want to develop deep expertise and make a tangible impact in a focused area of healthcare administration. The sense of ownership is real—fellows see their ideas implemented and can point to clear deliverables at the end of their program. Because these initiatives are usually executive-sponsored, the fellow receives high-level visibility and mentorship, often participating in board meetings, educational conferences, and system-wide events. As Maggie Reyes, MHA (UT Southwestern Fellowship), puts it: “The interim management role lets us try on leadership, not just observe it. It’s about testing yourself in the deep end—with a lifeguard watching.” In programs where the work isn’t an afterthought but part of the job description, fellows accelerate their leadership trajectory. Madeline Cremin, MHA, describes it as an opportunity to catapult yourself into that “40-years-from-now version” and return with insight into senior leadership and decision-making most early-careerists never get.
The most impactful fellowships compress years of traditional advancement into a focused cycle. At places like UT Southwestern, the model includes core rotations, electives, and a three-month interim management assignment, all culminating in substantive system-wide change and a robust project portfolio.
C. Disadvantages of Project-Based Fellowships
While project-based fellowships offer unmatched depth and ownership, they may limit exposure to other parts of the organization. Fellows risk missing out on the big-picture perspective that comes from seeing many departments in action. There’s also an inherent risk if the project’s scope shifts, is deprioritized, or ends early—something outside the fellow’s control. Sahana Sundaram, MHA (Baptist Health Fellowship), notes that these fellowships aren’t always highly structured, meaning “you have to seek out projects, create your own momentum, and find ways to add value without being told what to do.” Success depends as much on initiative and flexibility as on technical ability in project management and performance improvement.
D. Typical Length
Project-based fellowships generally run from nine months to two years, sometimes as a standalone experience and other times as part of a longer program that also includes rotations. Some organizations structure these as segmented phases of eight weeks or more, allowing fellows to lead one project to completion before moving on to another strategic priority. This format ensures that each project receives adequate attention and that fellows accumulate a portfolio of diverse, meaningful experiences in healthcare administration.
E. Real-World Applications and Examples
A project-based structure is best for those who have clarity around their interests and want to build a portfolio of measurable impact in healthcare management. Fellows who choose this route are often looking to develop advanced leadership skills quickly and position themselves as experts in a high-priority domain. For example, the UCLA Health Administrative Fellowship places fellows in a 12-month, project-focused role, leading enterprise-wide initiatives under the COO’s sponsorship. Northwestern Medicine’s Harrison Fellowship allows fellows to “build their own adventure,” selecting and leading projects such as improving radiology turnaround times, designing new outpatient facilities, or launching process improvement initiatives.
Across top programs, project assignments are as diverse as healthcare itself. Fellows might be responsible for:
1 – Implementing new billing workflows to increase revenue capture in outpatient clinics (Boston Children’s Hospital)
2 – Leading market analysis and business development for a new service line (Northwestern Medicine, UCLA Health)
3 – Redesigning patient flow to reduce wait times in the emergency department
4 – Managing strategic planning or accreditation readiness for a major clinical expansion
5 – Overseeing supply chain optimization projects to cut costs and reduce shortages
6 – Coordinating a root-cause analysis and action plan to address patient safety incidents
7 – Developing onboarding programs or leadership development initiatives for clinical managers
What sets these fellowships apart is the expectation that fellows are not just observing—they are leading initiatives that matter to patients, staff, and senior leadership. As Smirthy Ganesan, MPH (UCLA), puts it: “Fellowships are about education and mentorship. The projects are a value-add—for both you and the organization—but the real win is being in the weeds, learning as you go.”
Hybrid Administrative Fellowships
A. What is a Hybrid Fellowship?
Hybrid fellowships blend the best features of rotational and project-based models, providing both the breadth of experience and the depth of ownership in a single program. Typically, these fellowships begin with exploratory rotations—four to six assignments, each lasting between four and eight weeks—that allow fellows to build a broad, system-level understanding of the organization. After this initial phase, fellows transition into a capstone project or interim management role, which generally lasts six to twelve months.
This second phase emphasizes taking ownership, leading teams, and delivering measurable results. Most hybrid fellowships span 18 to 24 months and include additional elements such as tailored learning plans, professional development, community engagement, and dual mentorship from both operational and executive leaders in healthcare administration.
B. Advantages of Hybrid Fellowships
Hybrid fellowships offer a rare combination of flexibility and structure in healthcare management. Fellows benefit from a wide network and exposure to diverse departments, but also have the chance to specialize and drive real change through their capstone projects. This format encourages fellows to explore different aspects of the organization before settling into an area where they can make a unique impact. As Moneal Desai, MHA, from MUSC shared, “The structured flexibility of our fellowship meant I could focus on ambulatory operations but still dive into supply chain or hospital ops. That freedom helped me find what truly interests me.” Hybrid programs often include unique features such as “administrator-on-call” experiences, executive mentorship, and curated reading lists, making them well-suited for individuals who want to balance exploration with ownership.
Programs like UT Southwestern and Penn Medicine structure their hybrid models to ensure frequent feedback and tailored learning at every stage, supporting career development and providing a comprehensive mentorship program.
C. Disadvantages of Hybrid Fellowships
The very flexibility that makes hybrid fellowships attractive can also present challenges. With so many options, there is a risk of losing focus or struggling to develop deep expertise in one area if the program is not well-structured or if the fellow does not actively manage their own learning path. Success in a hybrid fellowship requires self-direction, strong organizational skills, and comfort with ambiguity.
As Julia Hefty, MHSA, who completed her fellowship at the nation’s largest health system, explained, “I really like the opportunity to kind of have a cushion as I’m learning and feel comfortable enough to push myself a little bit outside of my comfort zone without necessarily having to be in an environment where it’s going to make a huge impact if I screw up.” In hybrid programs, fellows are supported as they stretch themselves, but they must also take responsibility for charting their own course in healthcare administration.
D. Typical Length
Hybrid fellowships usually last between one and two years, with the experience segmented into multi-week intervals or phases. Some organizations feature overlapping fellow cycles, ensuring continuous knowledge transfer and mentorship as new fellows join while others are finishing their capstone projects. This structure provides both continuity for the organization and a robust learning environment for the fellows in healthcare management.
E. Real-World Applications and Examples
Hybrid fellowships are particularly effective for those who want to explore different career paths before committing to a specialty, but who also value the opportunity to deliver tangible results. Early-careerists seeking to develop both a broad understanding of healthcare organizations and deep, project-specific expertise find this model especially rewarding.
The Penn Medicine Administrative Fellowship exemplifies the hybrid structure, offering a two-year program that blends short- and long-term projects, interim management roles, and project selection aligned with both organizational and fellow interests. The David Joseph Administrative Fellowship at Lehigh Valley Health Network follows a similar path, starting with planned rotations and project work across campuses, followed by an immersive leadership role such as interim project manager for a major organizational initiative.
This spirit of legacy and improvement is summed up by Ben Akoa, MHA, of UCHealth: “Whatever change we make to the fellowship—it won’t benefit me, but I know it’s going to benefit someone else after me. That’s the mindset we have.” In hybrid fellowships, fellows are not just building their own careers—they’re shaping opportunities for those who will follow in healthcare administration.
Comparing Administrative Fellowship Structures
No matter which structure you choose—rotational, project-based, or hybrid—most fellowships are intentionally designed to blend observation, hands-on learning, and professional acculturation. The goal is to give fellows opportunities to experience the organization from multiple vantage points, while also contributing to real projects and strategic decisions. All three models, as illustrated above, can be tailored to your goals, whether you want broad exposure, deep ownership, or a combination of both in healthcare administration.
The table above provides a direct comparison of the major models, highlighting their core focus, primary benefits, potential drawbacks, and which types of candidates each is best suited for. Reviewing these differences in the context of real program examples can help you identify the structure that fits your ambitions and learning style in healthcare management.
Ultimately, what makes these experiences so transformative is not just the rotations or projects themselves, but the pace and proximity to senior leadership. As Anthony Stanowski, MBA, MS, DHA, observed from his own experience, “The great thing about being a fellow is you get years of experience in just one—because you step into boardrooms and strategy sessions most people wait decades for.” (CAHME & Joint Commission Fellowship)
Conclusion
Choosing the right fellowship structure is not just an academic exercise—it’s a practical, career-shaping decision that sets the trajectory for your growth as a healthcare executive. Whether you are drawn to the breadth and network-building of rotational programs, the depth and tangible impact of project-based fellowships, or the balanced approach of hybrid models, understanding the differences allows you to make a choice aligned with your learning style, goals, and ambitions in healthcare administration.
Ultimately, the best fellowship for you is the one that fits—not just your resume, but your vision for your career and the way you learn and lead. Take the time to look beyond prestige, location, or reputation, and honestly reflect on what type of environment will stretch you, support you, and accelerate your readiness for the next level. Seek out programs where structure matches your needs, and remember: the right fit is what will allow you to maximize both your contribution and your development in healthcare management.
For further exploration, consider reviewing detailed fellowship program websites, listening to real fellows’ stories on AJHCS podcasts, and connecting directly with current and former fellows through informational interviews. These firsthand perspectives will help you get a true sense of what different program structures feel like in practice—so you can move forward with clarity and confidence in your healthcare administrative fellowship journey.