Robert Holman was dutifully rotating through surgical training at Georgetown University on a path to follow his father when the medical passion that would drive his career crystallized in his mind.
Surgery was precise and mechanical. But investigating infectious disease and diagnosing maladies was like solving a mystery.
“I love what we try to do with medicine; we are presented with some information for a person who is asking for help,” said Holman, who has brought his fascination with analyzing medical dilemmas to his job as medical director for the D.C. Fire and EMS Department.
For nearly three years, Holman has trained his diagnostic skills on identifying what has ailed the department’s delivery of medicine, its training standards and ways to handle the city’s massive 911 call volume.
As medical director, Holman is one of the principal engineers tasked with restructuring a system that had strained staff and repeated high-profile failures that resulted in poor response times and untimely deaths.
Holman said he took the job for a simple reason: It presented a chance to help a large cadre of patients.
In his head, he “heard a lot of whispers saying ‘Holman, take this job. It might be interesting,’ ” Holman, 62, said. “I thought this would be a good way to serve in a wider context.”
His appointment was an unorthodox selection, given that he had no background in EMS care or delivery. He concedes “the learning curve was rather steep.”
Fire Chief Gregory Dean said Holman’s medical and teaching background, along with his having spent several years treating patients in the District, has made him a good fit for the department.
“Dr. Holman has garnered the respect of the people he works with. Holm an’s a people person, he’s a carer ,” Dean said. “We’re fortunate to have someone with such a rich background.”
In his early days at the department, Holman said he would be in meetings where EMS acronyms were used so often he could barely distinguish nouns from verbs.
His deputy’s EMS experience allowed for a smoother transition for him.
As he adjusted in his public sector job, Holman drew on 24 years of patient care at Virginia Hospital Center, where he learned how to organize a large operation, and then three years at Unity Health Care in the District, where he learned about community health needs.
The city’s health challenges he saw at Unity foreshadowed the issues he sees straining the city’s emergency system, where too many of the District’s most vulnerable patients turn to a trip to an emergency room for care.
“They were in a real habit of going to an emergency room. I carried that with me to my arrival at D.C. Fire and EMS,” said Holman, whose tasks now include trying to bolster benefits from a nurse-triage line operating at the city’s 911 call center that aims to help assess and redirect non-life-threatening medical calls away from city ambulances and to primary care doctors and clinics.
That effort is in its early phase.
A quicker success has come in improving the readiness of bystanders to step in and help someone having a heart attack by having city medics train more than 50,000 people in a “hands-on-heart” CPR procedure.
“What’s fun for me is to see we can make changes for many numbers of people,” Holman said.
Holman comes from a line of doctors and a household he said made science come alive in ways that sparked his imagination as a boy.
His father was a general and vascular surgeon. Holman’s maternal grandfather and uncle were physicians.
In one of his first biology experiments he helped his brother, Steve, dig up the deceased family cat, Greypuff, so they could glue the bones together for Steve’s fourth-grade class project.
“The nun, his teacher, was thrilled,” Holman said. “That didn’t seem like an unusual story for me. My mother thought it was a normal thing.”
Growing up with eight siblings, he played sports on sandlots in Monrovia, Calif., and hiked in the High Sierra near Yosemite.
He attended the University of California at Davis to try to get as far away from home as he could, he said, while staying an in-state student, then chose Georgetown for medical school in part to move out from his family’s shadow, Holman said.
He interned at Emory University in Atlanta before returning to Georgetown for his residency.
“I came to Georgetown for medical school, and I got stuck,” Holman recalled. “I decided to try out Washington for four years and stayed for 40.”
Holman said he loved that the city was small when he arrived, with little traffic and lots of diversity and culture.
His experience includes teaching Georgetown medical school students and later becoming an associate dean in the program.
One afternoon a week, Holman still sees patients in private practice in Arlington.
“I love treating patients. I think it’s important for me to maintain my skills so I can continue to be a real doctor,” Holman said.
He has never married and remains close with his siblings. He spends his off time swimming, biking or running or hanging out with friends around his Northwest Washington home.
And once a week he still plays chess or dominoes with residents at Missionaries of Charity Convent in Northeast, which cares for a homeless population and people with HIV, and evolved from a hospice.
Holman began his service there in the 1990s, when he provided free medical care for many who faced terminal diagnoses and mirrored much of the health needs he saw at his practice.
“It was very dramatic and crucial work,” Holman recalled.
Now that treatment for these patients has advanced and expanded, his appearances at the convent are focused on social engagement rather than medicine.
“The sisters let me volunteer,” Holman insists. “I try to keep everybody happy and help the nuns.”
Holman is the third medical director for Washington’s Fire and EMS since Dean became chief in 2015.
He was selected after a blistering resignation letter from his predecessor, who accused Dean and the department of scuttling changes to assessments of EMTs and warned that the city’s decision to add private ambulances for emergency runs to improve how often units are reliably available was a Band-Aid fix for a serious wound. The letter contained dire warnings about the risks to lives if more changes were not made quickly in the response system.
The department has not witnessed any such failures due to problems in medical treatment or with availability, and city officials insist the use of private ambulances helped stabilize the system.
“I think the system has fragile stability, but I would call it stability,” said D.C. council member Charles Allen (D-Ward 6), who chairs the oversight committee for the fire department.
Deputy Mayor Kevin Donahue said the resignation of Holman’s predecessor put the department in a precarious spot. No other person within D.C. Fire and EMS had a medical license, which was required to provide ambulance and medical services. And no one seemed to want the job. “We had to get creative,” Donahue recalled.
Officials expanded their medical-director search to doctors with skills outside emergency care, including those who treated the chronically ill and those with teaching experience. And because the mayor’s chief risk officer, Jed Ross, knew Holman from his work at Unity Health Care, Donahue contacted Holman and asked him to take the job on an interim basis.
Holman was confirmed as the director in June 2017.
Allen said he ultimately supported Holman’s nomination — and pushed through legislation offering an exemption to enable him to be hired despite lacking EMS expertise — because Dean and the mayor insisted Holman was the person who could help implement reforms. Allen said he is confident Holman was the right choice.
“He strikes me as someone who is smart, thoughtful, collaborative. He doesn’t get bogged down in process,” Allen said.
Holman’s teaching background has been a boon and a big reason the firefighters union backed his appointment, said Dabney Hudson, the union president.
“One of the things that we lacked on a whole was training, professional development. He’s in on training, job-focused training, not check-the-box training,” Hudson said.
He added Holman also is keenly aware of “provider burnout” as firefighter EMTs and paramedics routinely face hour after hour of racing to calls with little downtime because of the continuing volume of 911 calls for often minor issues.
Hudson said the director understands the stresses that call volume place on staff, and he can assess the difference between employee errors and errors due to failures in the system.
“The only thing we ask for is access. Holman’s good about that. He’s got a critical eye, but he’s still willing to listen,” Hudson said. “He’s willing to address those systemwide failures. I think it’s worked so far.”
Holman has spent much of his time meeting with fire chiefs and field supervisors, consulting with the training academy and with counterparts from the Department of Health and the Office of Unified Communications that handles the 911 call center.
Dean said he hopes Holman can collaborate with a training school, so the department can begin to train its own medics, rather than turning to outside sources for the education.
For now, Holman said one of his key focuses is the 1,800 or so members who provide medicine on a 24-hour basis and making sure they can do so appropriately and without being overtaxed in ways that can lead to serious consequences.
“I want to make sure they are showing professionalism and compassion and appropriate care for everybody,” Holman said.