Healthcare Reform & Frequent Flyers

By Mehul Sheth D.O.

I find it fascinating when elegant solutions transcend their original purpose.

For example, Dr. Atul Gawande writes about applying a checklist to medicine. In the world of flying, the checklist is used to help reduce the number of errors. The thinking is simple-for every eventuality in the cockpit there is a flow diagram, based on best practices, to resolve the issue. They range from the mundane-taking off-to the scary-aircraft stall. Mostly because of this process airlines have taken leaps and bounds and are considered the safest mode of transportation. Dr. Gawande writes a great exposition in The Checklist Manifesto on how the same theory done prior to each surgical procedure can help eliminate simple mistakes in the OR.

As I thought about this I realized that the airline industry has yet more to teach us. As an inner city primary care pediatrician I was dragged in two directions. On the one side was the ideal of providing health care to everyone regardless of income. On the other was the lack of interest interposed with the gross misuse of the system. We have the world’s greatest healthcare infrastructure, but the utilization has been horrific. I blame much of this on a disconnect between the cost of healthcare and the value of healthcare. What I mean is that most folks, until recently, didn’t see the cost of their doctor’s visits. They paid a premium every month regardless of their utilization of the system. The value became clear if they had a cardiac bypass or other procedures, but the value of primary care was hard to gauge. In the end the more that those procedures cost, the more that they valued their healthcare.

The medical atmosphere is clear now-we need to prevent disease in order to bring down costs. The cost of our system is dragging down the country as a whole. The only question is how do you put value back into primary care medicine? By playing games! As a regular traveler, I have learned the rules of an important game-the frequent flyer program. Overall it’s pretty simple-based on your usage of a particular airline, you attain status that grant you perks. It’s simple, but folks are crazy about their status.

Translate this principle to the medical world. The more you participate in preventative care, the more “perks” you get out of the system. Everyone gets basic healthcare, but above that you could have three tiers, let’s call them silver, gold and platinum. The rules to attain the different levels need to be simple. An annual physical exam gets you to silver level. Completing all your screening tests gets you to gold. Striving for and/or achieving certain known risk factor reducers, such as not smoking and maintain a healthy weight, gets you to platinum. The tiers would relate to how much of medical costs are covered. Silver covers 50%, Gold covers 75% and Platinum 100%. In addition, the level of coverage also increases, until the top level allows you the “executive” health care plan that includes things such are personal trainers, massage therapists and other “elite” benefits. You could also bring in theories from other successful games such as Foursquare. Different accomplishments grant you badges that you can show off to other players with pride.

Although this is being done on a lower level with wellness plans and certain insurance companies reducing premiums based on screening lab test completed, the tie between the input into the system doesn’t match the output. In our frequent patient game doing things that make you healthy will grant you perks that will keep you healthy. It’s a simple concept, but anyone who flies regularly knows that it’s a powerful motivator!

About: Mehul Sheth DO is a physician executive with Allscripts and career coach. He's accessable via his LinkedIn profile and his blog at http://techpedsdoc.wordpress.com

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Nonclinical Physician Jobs & The Long Tail

By Mehul Sheth DO

As I read The Long Tail by Chris Anderson I could not help but draw parallels to the world of medicine.

In the same vein as seminal books such as The World is Flat and Connected, this book looks to make sense of the new world view introduced by the internet. The basic premise is that in a world of infinite options (movies, songs, books, etc) the blockbuster hits are no longer the only way to be profitable. With no cost to list an MP3 in iTunes, it is as profitable to sell 1 million copies of 100 blockbuster hits as it is to sell 100 copies of 1 million less popular songs. There are three main reasons the internet has helped with this shift, one of which is democratization of the tools of distribution.

This paradigm shift has affected medicine in at least two ways. One is witnessed by the super-specialization of clinical medicine. For example, within pediatrics you can sub-specialize in gastroenterology. From there you can further sub-sub specialize in nutrition and from there you can go one level deeper into feeding disorders. One of the reasons such a niche can exist is because individuals and institutions can promote these fields not only to recruit providers, but also patients who have a specific interest in that type of treatment. At the Children’s Hospital of Wisconsin there is not only a feeding disorders clinic, but also an intense 2 week inpatient program that draws patients from all over the world. This could not exist in the pre-internet world where the enchachement area for Children’s Hospital of Wisconsin would include, at best, the entire state of Wisconsin and some of northern Illinois. With the internet the cost of distribution (in this case information of their center) is not only essentially zero, but is also technically easy. You need only to look around at your colleagues to realize that the number of niches is incredible!

More interestingly, to me, is how this democratization has expanded not only clinical jobs, but non-clinical physician jobs. The contrast is exemplified by my father and I, both physicians. My father is an anesthesiologist working for 30 years at the same hospital in service of a small farming town. In stark contrast, I work as a physician executive for Allscripts, a health IT company, working from home and traveling on an almost weekly basis. As I think of physicians in my father’s cohort I find that most of them fulfilled this classic role of clinical physician. Those that went outside of clinical practice did so after years of 70+hour weeks solidifying their clinical prowess thus resulting in promotion to administrative roles that carried heavy titles. Although many of these physicians did their non-clinical role well, a number who were great clinicians did not perform so well outside of the examining room.

But a deeper dive into that generation reveals that many of them had great interest in things outside of medicine. An internist comes to mind who, like my father, has been practicing for many years in the same town, but who also regularly wins stock picking contests. The short term rate of return that he can extract from daily trading is in the triple digits. I can only think that if he had trained 30 years later he would have many more opportunities to take his avocation and turn it into his vocation, combining both medicine and financial analysis. In fact, there are numerous joint medical school programs that bestow not only and MD but also a JD, MPH, MBA, PhD at the time of graduation. And if you don’t complete your second degree before residency, many training programs allow you to get a second degree as part of their program. This has become possible with the increased distribution of information associated with non-clinic careers. There are websites, including nonclinicaljobs.com conferences, such as Medical Fusion and SEAK, and list serves, such as the drop out club, to name a few that have taken advantage of the ease of distribution to cast a large net to help physician find satisfaction in their careers. The unhappy doctor of yesteryear who found his joy in his hobbies now can find a career that combines his medical knowledge to bring about greater job satisfaction.

The internet has profound effects on the career choices of physicians, only some of which I’ve named here. I’d love to hear about other ways the ease of information distribution has helped with physicians’ career choice.

About: Mehul Sheth DO is a physician executive with Allscripts and career coach. His expertise is at the intersection of medicine, technology and social media, having used Twitter, Facebook, and LinkedIn to effectively engage with a wide variety of nonclinical jobs and opportunities. Dr. Sheth is accessable via his LinkedIn profile and his blog at http://techpedsdoc.wordpress.com

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