You gotta love this 21st century. When a doctor tires of his clinical routine and goes looking for a new work life, what does he do? A Google search.
“It’s true,” says Matthew Patterson, MD, of the epiphany he had in 2007, when he was a surgeon for the U.S. Navy. “I literally typed in ‘I don’t want to be a doctor anymore.’ And up popped a chat forum with people discussing post-medical career options—there weren’t as many then as there are today—and a lot of talk about consulting.”
Several people mentioned the consulting company McKinsey, which he’d never heard of. But in a couple of years Patterson was working for McKinsey, advising health care delivery systems about how to deal with the challenges of health care reform and trying to convince them to take on more risk. (“Everybody laughed at me,” he recalls.)
Patterson’s career has since taken him where many medical directors of health plans have also ventured—into the world of health tech. Today he is president of AirStrip, a San Antonio-based software company that markets “mobile interoperability solutions.” If you streamed video of Apple’s announcement about a new operating system and native apps for the AppleWatch, you heard the crowd’s roar of applause when the watch monitored and played the sound of a baby’s heartbeat, thanks to an AirStrip app called Sense4Baby.
It’s not that Patterson was champing at the bit for a life of bits and bytes. It’s just that the knowledge-hungry surgeon was looking for direction in a world where the signs all pointed to health care going electronic and digital. “I didn’t want to spend the rest of my life treating one patient at a time,” he says. “It dawned on me that I was more passionate about the transformation of the entire health care delivery system to improve access, connectivity, quality and efficiency.”
Ambitious dude? You bet. Unusual these days? Not really. In society at large, the one-job career has become a museum piece. Similarly, many doctors are finding that there’s a new chapter, during or after their years of practice, which may involve not just the old options of teaching or administration at a hospital or insurance company. Today’s medical directors or chief medical officers (they may not even have those titles) are busy venturing into every species of tech-heavy enterprises, ranging from developing apps to massaging Big Data to treating patients via telemedicine.
“It’s an opportune time for forward-looking physicians who’ve been in private practice to put their big-picture thinking cap on and move into industry,” says Henry DePhillips, MD, chief medical officer of Teladoc. That 13-year-old company bills itself as the country’s first and largest telemedicine provider, offering phone or HIPAA-compliant online video consultations with board-certified physicians. Its mission isn’t, after all, all that high-tech: It’s for people who can’t conveniently get in to see a doctor, the early 21st century twist on the old-fashioned house call. But it does represent the use of technologies, old and new, for an alternative method of health care delivery.
DePhillips says there’s a future in the health tech sector for physicians with clinical acumen and “reasonable business skills.” His own story is Exhibit A. After 10 years in private practice as a family physician, he got tired of spending roughly half his time on “non-compensated” administrative work in his practice and moved into health insurance. There he became senior medical director at Independence Blue Cross in Philadelphia, and learned, he says, about “the flow of dollars in health care. After eight years I thought, ‘I’ve done everything I’m going to do here.’” Tech beckoned.
Before joining Teladoc, DePhillips was chief medical officer for MEDecision, a clinical care management software company; Medem, a physician-hosted website and personal health record firm (which sold its PHR business to MedFusion in 2009); PDR Network, an electronic patient safety communications company, and Audax Health, a consumer engagement technology company. “I’ve been a serial entrepreneur in health care information technology,” he says. “And I am having a blast.”
For many doctors, he says, entering the world of tech begins with identifying a need in one’s own patient population. (Of course, if a doctor serves as a health plan medical director, the observable population will be much bigger and certain needs much clearer.) Next comes finding a way technology could provide a product or service to meet that need—and trying it in the marketplace. The test, says DePhillips, is whether somebody is willing to write a check for that product or service. And prospects are ripe right now because of both growing economic pressures and the growing array of tech tools at hand.
“In any industry, there’s a gap between the technology that’s potentially available and the technology that’s actually being used,” says DePhillips. “In health care, that gap is the largest of just about any industry. Today, for example, health care is very provider-centric. It needs to become more consumer-friendly.”
Like DePhillips, Ray Fabius, MD, entered the health tech world by way of managed care organizations—and like Patterson, he had an epiphany. It happened one day back in the ’80s, when he was a practicing pediatrician. His practice was visited by the medical director of a managed care plan with which it had a contract. “I found out that that medical director knew more about my practice than I did,” he recalls.
“The very next day, my partner and I began developing a rudimentary patient management and electronic medical records system, so that nobody would know more about our practice than we did.” When the medical director next visited, Fabius was able to tell him, “You only know about my patients who are in your plan. If you’d really like to know how my practice is doing, I can show you a much bigger population.”
That was heady stuff 30 years ago, and the medical director was so impressed that he ended up hiring Fabius as a medical manager. “I realized I had another calling—to help manage populations of patients,” he says. “When I joined the organization that became U.S. Healthcare, there were about 350,000 members in that plan. At the time U.S. Healthcare was sold to Aetna, there were 9 million. But obviously you can’t do hands-on care for 9 million people. You have to make the transition to utilizing data to a much greater extent.”
Fabius went on to corporate medical leadership work for General Electric and Walgreens and to become chief medical officer for Thompson Reuters Healthcare (now Truven Health Analytics), which he calls arguably the nation’s largest medical database. And in 2009 he cofounded HealthNEXT, which helps employers beat medical inflation, using software and other tools to create a “culture of health.”
Fabius sees an “incredibly bright” future for MDs in medical informatics, which uses health information technology to inform and improve health care—but with one caveat. He’s troubled by the recent trend of newly minted MDs going straight into data or tech jobs without a previous stint of treating patients like the one he put in. “It’s difficult for a medical informaticist to be a true functional member of the medical team without a full appreciation of what it takes to identify a patient’s needs, make diagnoses, establish a treatment plan, try to get those patients to actually adhere to the treatment plan, and comply with the medical guidelines so that outcomes can improve,” he says. Before going into that branch of health tech, he says, a doctor should practice direct patient care for at least five years.
But many are called to careers in technology these days, and while Fabius’s advice may not fall on deaf ears, they may be in too much of a hurry to listen. The fact is that there is a growing cadre of physicians who enter the tech world without first having labored in the vineyards of clinical care, let alone managed care.
Jaan Sidorov, MD, has the kind of resume that Fabius would appreciate. Now the chief medical officer of MedSolis (“We are the health care & technology experts,” the company’s website claims) and a member of Managed Care’s editorial board, Sidorov became a part-time medical director for Geisinger Health Plan in Pennsylvania while he was still practicing. His experience studying and improving outcomes there for chronic conditions like asthma and diabetes gave him expertise that took him to Hewlett-Packard (after the Carly Fiorina era).
“I don’t personally know how to set up informatics architecture in the background,” he says. “There are programmers who know that, just as there are finance people who know how to monetize a value proposition. But I know enough about informatics and statistics, and I know about clinical outcomes—that’s the value I brought to the team.” Like many doctors who’ve ventured into the tech world, he was bitten by the entrepreneurial bug. After his stint at HP, he and some colleagues from the company decided to start a health tech company; that’s how MedSolis was born.
Could tech be an escape hatch for doctors or medical directors who’ve grown weary of the hassles of medicine today? Take care there, warns Sidorov—despite what restless Navy surgeon Patterson typed into his Google search a few years ago. “I have yet to run into anyone who’s a refugee from the challenges of clinical care who has succeeded in health tech,” he says. “Physicians who thrive in this business tend to be the ones who like all the turmoil and innovation going on in health care.”
Tech isn’t exactly what Paul Grundy, MD, is known for. Instead, this Paul is an apostle of the patient-centered medical home, today’s primary care-based model for making care delivery more coordinated, accessible, proactive and efficient. He’s the founding president of the Patient-Centered Primary Care Collective, a coalition of more than 1,000 organizations and individuals that includes employers, health plans, hospitals and consumer groups. But those efforts rely on data, and his business card identifies him as global director of health care transformation for IBM.
“At IBM we have between 40 and 50 physicians,” says Grundy. One colleague, he recalls, left an internal medicine training program and joined the company to work in coding. Another was trained as a surgeon and then, says Grundy, “decided he could have more of an impact, given his interest in technology, working with tools like IBM Watson.” That’s the “natural language” question-answering computer system that embodies what IBM calls cognitive computing, and that in 2011 defeated two former champions on TV’s Jeopardy. Cognitive computing is more suited than traditional computing to the enormous complexity and nuance of health care, argues Grundy: “It’s massive parallel processing combined with natural algorithms.”
Health care needs to cease being a “master builder” industry in which excellence depends on a mysterious clinical acumen that resides largely in the practitioner’s head, Grundy argues. “The drama in health care that I saw when I started this journey is that we were wrong about one third of the time, and the errors we made were predictable,” he says. “We made mistakes because we didn’t have time to check what was in the record. We made mistakes because we chose a path too early, didn’t look back, and continued on that path because it was the path we were on.” He hopes cognitive computing will be part of the revolution that changes all this.
Data crunching wasn’t a big stretch for Grundy; his early training was in preventive medicine and public health, so he’s long been accustomed to dealing with populations. But even for him, the world of tech requires a kind of culture shift. “The dilemma for those of us in health care in companies like IBM is that our bosses fundamentally don’t understand our sick care industry,” he says. “How could they? Sick care is still a mom-and-pop and master-builder industry, and my bosses are already decades ahead of us in thinking about health care as a system.”
Grundy’s advice to docs and medical directors pondering a shift to health tech? “Follow your heart. Go where you think you can have the most impact.” That’s what he’s done, though his own path had an unusual starting point: He grew up in West Africa as the child of Quaker missionaries, and he sees the Quaker influence in his choices today. “It’s really important to me that whatever I do, I do it in the name of making a difference,” he says. For other MDs who think like that, regardless of their tech background, the path may be similar.
But if physicians are driven to save the world with tech, they also recognize that their role as MDs is often to serve as a brake, making sure business advances and interests never interfere with quality patient care. “In hiring me at the board level, Teladoc is placing patient safety first,” says DePhillips.
Adds Sidorov: “One of my charges as a medical director is to make sure these new population health gadgets and apps fit into population care and first do no harm to the doctor-patient relationship.” A doctor in an organization, he says, “can act as a counterweight in what otherwise might threaten to become a commoditized transaction. You know, it’s not like selling pancakes. We really are taking care of people, and people can end up being hurt if you don’t take good care of them.”
So where does that leave Patterson, our Navy surgeon turned AirStrip president, the man who Googled his future? Improving quality in health care is one of his missions, but he insists that some of the mechanisms for achieving that goal are changing radically, not so much because of what technology can do as because of what it must do. And what he says may shock some docs.
“Let’s imagine a person having chest pain at home,” says Patterson. “Pretty soon, you’re going to be able to work up your own chest pain at home and determine whether or not you should go to the emergency department. Five or ten years ago—even today—most people would say that’s reckless and goes against everything that’s good in medicine. But the reality is that economic circumstances are going to require that we’re able to do that, because payers will no longer tolerate the old costs-be-damned approach. And you can’t do it without technology tools.”
That’s how important tech is—and, some would argue, how much the tech world needs physicians to keep it on track. But Patterson doesn’t see technology as an end in itself.
“If you have a clinical background and a little bit of tech savvy, that doesn’t necessarily mean you’re going to drive the next generation of tools in health care,” he says. “You may make some cool things, but I’ve seen lots of cool things that don’t end up doing much of anything.”
On the other hand, says Patterson, a sound grasp of economic trends in health care can prepare a physician or medical director to make a big contribution to the technology of tomorrow. “If you’re a doctor who understands where health care needs to go to be more sustainable, accessible, cost-effective or convenient for consumers, you’re the one I want to hire,” he says. “I can teach you all the technology you need to know.” After all, haven’t the experts always said that computers are only a tool?