Freelance MD's Kiva Lending Group For Third World Entrepreneurs

Freelance MD's Kiva lending group for micro-loans to Third World entrepreneurs.

Kiva, a non-profit website that allows you to lend as little as $25 to a specific low-income entrepreneur across the globe. You choose who to lend to—whether a baker in Afghanistan, a goat herder in Uganda, a farmer in Peru, a restaurateur in Cambodia, or a tailor in Iraq—and as they repay the loan, you get your money back. Here's the Kiva about page.

I've been a member of for a while now. In fact, my daughtter and I started her micro-loan fund a few years ago. Since she started with $100, Maddy's lent to 33 different entrepreneurs and groups around the world and her fund is $500 or so. She re-invests the money with new entrepreneurs as the loans are repaid.

We've created a lending team for Freelance MD members.

Once you're a part of the team, you can choose to have a future loan on Kiva "count" towards our team's impact. The loan is still yours, you choose who you loan to and repayments still come to you—but you can also choose to have the loan show up in our team's collective portfolio.

If you'd like to join our lending team we'd love to have you. We'd love it even more if you were to blog/post/tweet/invite your friends. For $25 you can help change someone's life.

Physician Leadership and Pornography

Physician Leadership and Pornography: we know it when we see it.

Let's Do Better Than Justice Stewart

In the most frequently quoted Supreme Court opinion on obscenity, Justice Potter Stewart remarked, "I shall not today attempt to define the kinds of material I understand embraced within that shorthand description (pornography); and perhaps I could never succeed in intelligibly doing so, but I know it when I see it...

Justice Stewart was tasked with looking at a fair amount of pornography before coming to his conclusion (no pun intended). Physician Leadership, like pornography, may be hard for some of us to define, but most of us recognize it when we see it.

Let's take a look at one such leader and see what we can learn. Are there defining skills of Physician Leadership and, if so, what are they? We'll outline some these skills in bold italics as we proceed. Maybe we can do better than Justice Stewart did with pornography and begin to define Physician Leadership as we see it.

Two weeks ago, at the Leapfrog Group's 10th anniversary gala, Virginia Mason Medical Center (Seattle,WA) was designated the "Top Hospital of the Decade". This prestigious award was given in recognition of VMMC's public commitment and acheivements in reducing medical errors and innovations and improvements in patient safety and quality of care. These accomplishments were due, in great part, to the physician leadership of VMMC's CEO Dr. Gary Kalpan.

No one would have predicted that VMMC would win such an award when Dr. Kaplan took the helm in 2000. The system had been in the red for two consecutive years, its outcomes were inconsistent, and it was struggling with quality control in its far reaching outpatient clinics in the Puget Sound area. Having read the two disturbing reports from the Institute of Medicine: To Err is Human and Crossing the Quality Chasm, Gary recognized the he would need to change the status quo.

In his initial review, Gary, perhaps due to his training as an internist, came to the realization that, while he might have been charged with stopping the financial hemorrhage, he needed to address the underlying cancer causing the hemorrhage: suboptimal quality. He was determined to define quality and measure it objectively. He was able to think prospectively, "how do we become better at what we do?" rather than retrospectively, "how did we get into this mess?" He was able to articulate and sell this perspective to his Board of Directors and his staff. He had vision.

To achieve his goal of measurable excellence in quality, Gary looked for models already in place in the best of America's healthcare systems. He traveled extensively, spoke with other physician leaders and inspected their facilities. He concluded that none of them had what he was looking for. While others in his position might have been dejected, Gary remained optimistic and determined to reach his goal. His creativity enabled him to look outside of healthcare for his solution and he found it, surprisingly, in the car manufacturing industry with Toyota Corporation's lean thinking. Gary began systematically sending VMMC's leaders to Japan for training and began implementing lean principle's in VMMC's everyday operations. 

No great stories end without a twist. A major challenge to Gary's "quality first" mantra occurred in 2004 with the death of patient due to the inadvertent injection of a toxic cleansing solution during an interventional radiology procedure. While others might have settled this matter quietly and discretely, Gary went public. He recognized that leadership demanded accountability and transparency. He saw a system failure as an opportunity for further improvement. E-mails were sent to the staff acknowledging the error with the recognition that this would immediately become public information. The family was informed and a formal apology was issued. The anniversary of this patient's death is acknowledged system wide as a reminder to all of the importance of the "quality first" mission.

Hats off to Dr. Gary Kaplan and VMMC in this accomplishment. Let's begin to recognize and define the leadership skills he has demonstrated: vision, determination, prospective thinking, creativity, optimism, accountability, dissatisfaction with the status quo, and the ability to see failure as an opportunity. Let's begin to develop a cadre of physician leaders who can master these skills. Let's do better than Justice Potter did with pornography, let's define Physician Leadership.

So You Want to Be an Investment Banker?

Career counseling for IB wannabees

An investment bank, e.g. Headwaters, www.headwatersmb.com, where I advise the life sciences group,  is a financial institution that assists individuals, corporations and governments in raising capital by underwriting and/or acting as the client's agent in the issuance of securities. An investment bank may also assist companies involved in mergers and acquisitions, and provides ancillary services such as market making, trading of derivatives, fixed income instruments, foreign exchange, commodities, and equity securities. http://en.wikipedia.org/wiki/Investment_banking

If you have been toying with the idea of being an investment banker, you should understand how you get from here to there.

The rules and procedures for how to become an investment banker are mostly determined by FINRA, the Financial Industry Regulatory Authority. To get a broker's license, you need to pass the Series 79 exam, a 5 hour exam which consists of 175 multiple-choice questions.

The questions are broken down based on the major job functions of investment bankers and include collection, analysis and evaluation of data; underwriting/new financing transactions, types of offerings and registration of securities;mergers and acquisitions, tender offers, and financial restructuring transactions; and, general securities industry regulations.

The first step in your career pathway is to identify a member firm willing to sponsor you. Member organizations must investigate the good character, reputation, qualifications and experience of personnel who they intend to register with FINRA and submit an application to register for the exam on Form U4. In addition, if you have past transgressions or violations, you might be statutorily disqualified from taking the test.

Upon notification, you will determine when you want to take the test at a regional computer testing site. You will get immediate notification whether you have passed the test or not. If you fail the test , the first time or second time, you must wait 30 days before taking the test again. If you fail the test the third time, you must wait 6 months before taking it again.

If you do not have experience or have not worked in this industry before, my take is that sitting for the Series 79 cold is like taking your board exams without ever having seen a patient. You can study, go to prep courses and cram, but there is a reasonable chance you won't pass. In addition, unlike other career alternatives we have mentioned on this site that are suitable to those who want to continue to practice on a part-time basis, investment banking requires your full attention. What's more, licensed investment bankers are required to follow rules that might conflict with your medical interests, for example, conflicts of interest or reporting outside non-investment banking income.

Investment bankers have a reputation for making lots of money and working outrageous hours. Some do. Others are now out of work and thinking of going to medical school.

If you have a head for numbers and analysis, are good at research and due diligence and like finance, investment banking might be your ticket. In the final analysis, however, banking is a relationship business and your job is to understand the needs of your client , be creative about solving their needs and problems, and helping them execute a plan to get there. Sound familiar?

Medical Travel: To Play or Not to Play

More of your patients will be looking for care overseas.

According to a recent research report, over a million Americans will be getting care overseas and the number is expected to grow by double digits for each of the next 5 years. Suppose a 34 year old  amateur tennis player presents to you with shoulder pain. You take a history, do your exam, explain that the MRI shows damage to her joint, and that you recommend an arthroscopic repair. She asks, politely, "But doctor, what will all of that cost?"

Take a deep breath and assess your options. If you are one of the fore-sighted few who has negotiated a package rate with your hospital, imaging, clinical labs and anesthesiolgists, great. Quote her the price.

If you are like most docs and have no clue what the combined cost of her care will be, tell the truth and explain that you can ask your business manager to discuss your surgical fees, but that will only be part of her total bill.

Your budding Williams sister then explains that she has a very high copay, has not met her deductable, and is thinking of getting care from a doctor in Mexico because she found an Internet site that posted cost comparisons and she requests that you help her with preoperative and postoperative care.

Most doctors I talk to deal with this circumstance in three ways.

The "You've got to kidding "approach, characterized by disdain, disgust, frustration and, with a noticeable increase in vocal pitch, they refuse to help.

The "Well I guess that's how things are these days" approach, where the doc helps the patient transmit records, is available for consultation by the operating surgeon, and offers to see the patient in follow up.

Then there is the "Brave New World" approach, where the doctor takes a proactive stance, embraces global healthcare referrals, understands that medical travel is a two- way street, and encourages visits from foreign patients as well.  A recent article in a transplant journal, in fact, reported a significant increase in business to a border state transplant program from Mexican patients when all of the services were offered in Spanish. What a surprise.

The globalization and commoditization of care  changes a lot of  the rules. They are forcing another round of reassessment of physician liability, professionalism, ethics , and continuity of care. Do yourself a favor and think about how you will deal with the medical tourism trend before it walks into your examining room tomorrow.

Non-clinical careers for Millenials

A user's guide

Among the many joys of working with medical students, particularly Millenials,  is how they push back. Generation Y, the Echo generation, typically refers to those who came of age around 2000 and are typified by their techo-comfort, the fact that they still live with their parents, and that they all expect a trophy just for showing up. In addition, cultural monitors and demographers predict that Echo kids will switch jobs, if not careers, more often.

Medical educators, like me, who ignore this demographic trend do so at great peril. Millenial's expectations are different than those of former students, and they demand more options, feedback, decision making and rewards. Here are my suggestions for the care and feeding of Millenial medical students when it comes to non-clinical careers:

Give them a place to play

Unsatisfied with traditional career pathways, students want options that satisfy their work objectives and work-life balance requirements. In addition to rotations on surgery, medicine, ER and the ICU, students should be offered elective rotations in biotech, medical device, diagnosic development and healthcare IT.

Recruit faculty who are experienced and can serve as role models

We're all familiar with the copy of the recruitment add for the new chairman, seeking someone with extraordinary clinical achievements, scientific and clinical research reknown, teaching awards and awe -inspiring leadership skills. Did we mention we want someone from industry with product development experience?

Stop playing games during the admission interview

Medical student applicants should be encouraged to tell the truth about their aspirations and career objectives without fearing retribution from admissions committees looking for "real docs". More and more students come to medical school with business, entreprenerial and technical backgrounds. It is obvious that they will want to leverage those  talents when they graduate.

Do a better job of measuring the impact of dual-degree programs

Joint MD/MBA programs are now offered by a great majority of US medical schools. Few have measured their impact, particularly as it applies to bioentrepreneurship and whether they make any difference.

Create opportunities to practice medicine and pursue non-clinical careers at the same time

We're heard from others on this site about the sources of physician dissatisfaction and job stress. Teaching students that they can have elements of both careers might lead to less cynicism, dissatisfaction and more joy.

Engage them in the conversation

Freelance MD should recruit student and resident authors.

The Trophy Kids want more, they want it now and they want a say.  We should help them get what they want.

Out of your mind

For some new ideas, ignore what you've learned

I've been invited back to my alma mater as a visiting lecturer to talk about, among other things, the value of a liberal arts education. One of the founders of Dickinson College, Dr. Benjamin Rush, thought it would be a good idea to create a school that trained the leaders of the newly formed nation, after the signing of the Treaty of Paris ending the American Revolution in 1783. The backbone of this revolutionary educational model is a solid foundation in the liberal arts. This “liberal education” teaches students to embrace new ways of thinking, solve problems creatively and address important social issues purposefully.(http://www.dickinsonson.edu). I think the main benefit of my liberal arts education has been learning to connect the dots, see patterns and leave space for the unexplainable.

Most of you who are reading this are technical, linear, analytical, left -brain, ESTJ's who have been taught that the shortest distance between a problem and a solution is a straight line.  You know the drill:

• Problem Definition - including problem analysis, redifinition, and all aspects associated with defining the problem clearly.
• Idea Generation - The divergent process of coming up with ideas.
• Idea Selection - The convergent process of reducing all the many ideas into realistic solutions
• Idea Implementation - Turning the refined ideas in reality.
• Processes

For 192 ways to solve a problem, check http://www.mycoted.com/Category:Creativity_Techniques

Unfortunately, research indicates and experience teaches us that innovation doesn't work that way most of the time. The technology push-market pull model proposes that success happens when, during a deliberative, data-driven process riddled with MBA's and spreadsheets, a problem is matched with a solution.  Magic happens when technopreneurs meet market perceivers. The "structured serendipidy" model, on the other hand, is closer to reality. Ask the guy who discovered penicillin.

In his book, Where Good Ideas Come From: The Natural History of Innovation (http://www.amazon.com/s/ref=nb_sb_ss_i_0_29?url=search-alias%3Daps&field-keywords=where+do+good+ideas+come+from&sprefix=where+do+good+ideas+come+from Steven Johnson discusses how serendipity works in innovation, along with six other patterns throughout history: the adjacent possible, liquid networks, the slow hunch, error, exaptation and platforms.

The common thread is that the roots of innovation are anything but linear or predicable, but , instead result from a combination of everything from evolving networks, the rise of the modern city, to happy accidents.

Unfortunately, sitting around waiting for the "Ah-hah" is not the best use of your time. Follow the recommended steps for developing your innovation, but reserve some space in your cerebral cortex for ambiguity, the unexpected and luck. Recognize that your agonizingly prepared Plan A is unlikely to be what ultimately succeeds, so reserve space for Plan B, C or whatever works.

It's too bad Dr Rush isn't around any more. He would have been a great blogger on Freelance MD.

FX

FX is not science fiction, but it's just as scary.

Dr. Jones and her family are finally ready to take that well -deserved vacation in Italy. She's made call coverage arrangements, rechecked her passport and reserved a place at the local Doggy Daycare for her Shetland sheepdog. The final thing to do is get some euros so she will have some cash on arrival at Leonardo Da Vinci Airport.

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