Dr. Bill Fera: Family Medicine Physician and CMO of Ernst & Young LLP’s Advisory Health Care Practice

Dr. Bill Fera is a family medicine physician and the Chief Medical Officer of 
Ernst & Young LLP’s Advisory Health Care practice. With a personal interest in health care quality improvement, he has more than a decade of clinical and information technology leadership experience at academic, community and ambulatory medical centers prior to joining EY. In this interview, he discusses the motivations behind his career path, as well as his views on the importance of implementing and optimizing electronic medical records (EMRs) for quality improvement.

Can you tell me a little bit about your background? Where did you go for your undergraduate studies and what did you major in?

I went to undergrad at the University of Pennsylvania. I was in the Wharton School as well as the College of Arts and Sciences, and received dual degrees in economics and biochemistry.

Why did you choose to go to medical school? Did you have any unique experiences during your medical school that influenced your current career path?

I thought that my first career would actually be in business but I had a series of personal and family health-related crises. As a result, I had a lot of exposure to the medical community and started to develop a passion for medicine. However, I wanted to take the discipline and learning that I got in business school, and apply it to medicine, especially in terms of total quality management and continual quality improvement.

I matriculated at the Medical College of Pennsylvania (now Drexel), and was in the second class of their problem-based learning track. This curriculum gave me exposure to a pilot with the Institute of Health Care Improvement. I was very excited about bringing those quality principles to medicine and thought that it was a complete natural fix. However, I was disappointed to learn that continual quality improvement was very hard to do, because there wasn’t enough data available. I would talk to colleagues who worked in business and they said everything was automated. They could do analyses of anything. But in medicine, I couldn’t tell if we were practicing evidence based medicine in the hospital, or exactly what quality of care we were providing in the practice.

This led me to a path of trying to find ways to acquire data and automate information flow, even if it was just a small project of medication reconciliation using our pharmacy system at our hospital. I later had the opportunity to deploy electronic medical records, in both outpatient and inpatient settings. I actually thought electronic medical records were very difficult to use, and not intuitive, but it was absolutely necessary if we were ever going to get a handle on what was happening in our hospitals and practices. That was the only way that we were going to be able to measure what we were providing in terms of quality, and what we were achieving for our patients.

Why did you choose to pursue family medicine after medical school? 

There were probably two main factors. One was just an overall belief that it was the best way to provide medical care to folks at a holistic, family-based level. Getting to know an entire family and everything about them – to understand them as people, appealed to me. If you are taking care of a family unit, you have a much better chance of impacting their overall health by knowing their family dynamics. If, on the other hand, somebody’s already got a disease, and it’s progressed to the point where they’re seeing a specialist, then often times you’re just kind of putting a Band-Aid on things. It’s much harder to stop or reverse things at that point.

Secondly, there was the aspect of adolescent medicine that appealed to me, especially the counseling. Adolescence is when people start making big decisions about drugs or alcohol, smoking, seat belts and sexual health.  It just seemed to me that that’s when you could make a big difference in somebody’s life, more so than when they were in their 50s, 60s or 70s.  It was about the degree of impact that you could have.

I think that’s when you start making the lifestyle choices, in your exercise and diet, that don’t seem like they’re a big deal. Those habits begin forming during that time.

If we’re seeing someone fairly regularly and they are pre-diabetic, adolescence is when you can stop them, by getting them on a diet and exercise program. There are so many people who don’t understand that you sometimes can actually “cure” your diabetes or prevent it from ever happening in the first place with the proper diet and exercise. I think most people think about diabetes as a disease, that you’ve inherited it and you’re doomed to insulin shots. Whereas if you exercise, lose weight and eat properly, you can very often return to a non-diabetic status.

I think it’s really unfortunate that family medicine isn’t more popular these days because it really is such an important field.

I remember when I was making my decision; I really thought family medicine was going to be the future of medicine, and that everybody would really start to see the benefit of a primary care physician being the “quarterback” of a care team – many of the same concepts that we see today with Patient Centered Medical Homes..  That was when health care reform was on the verge of being passed the first time around in the early ‘90s.

With immense medical school loans, the fee-for-service financial model pushes students into more procedure-based fields. But, hopefully, with these health care reforms, it will get a little better. 

It needs to be. We’ve got such a shortage of primary care physicians. Somebody, I can’t remember who it was, but he said, take 80% of the doctors in the US and send them to Africa, and vice versa, and you’d make both systems better. Our reimbursement system really has contributed to an overabundance of specialists and a shortage or primary care doctors.

Could you elaborate a bit on quality measures? I think one of the big problems in health care is maintaining a consistency in the quality of the care that providers give.  Are common quality metrics like morbidity and mortality really good measures of health care quality? What I’m really asking is, “What is the quality of common quality measures?” 

That’s a great question. Often times the quality measure are really process measures which end up being surrogate measures for the most part.  Those are what people chose to measure because that’s what was widely available to collect. The only electronic data that people could reliably draw were admission, discharge and transfer systems, or billing systems. You would get the quality measure of doing a hemoglobin A1C, because that’s all people could measure.  But there was nothing in there about what the actual hemoglobin A1C level was – or if it was improving, getting worse, or stable.

Right. For example, for diabetic patients, why is there no data on their medication compliance? How many times did they go to the pharmacy and fill out their prescriptions? Those data points could be important in applying to the bigger clinical picture of health care quality that we’re trying to calculate.

I totally agree, and I think they’re starting to. Ironically, if you went to an insurance company, they have that kind of data, because the member paid for the prescription. If we were to share that information more with the providers, like the way we are starting to see things move with accountable care that will start to create a better picture of somebody’s health.

The first time we tried a managed care approach to health care, it was all based on a financial construct. It actually had to be because that all the data that we had available to track at that time. This time around, we have more clinical data available. As we get more digitized clinical information, we can actually start to collect quality measures in a meaningful way, like you’re suggesting. We need to move away from the surrogate financially based markers and into true clinical markers.

This is from my readings, but I saw that most of the papers about health care quality were talking about morbidity, mortality, readmission rates, etc. But these metrics seem superficial, because they don’t reflect the deeper issues that can account for the quality of health care. However, the deeper issues are difficult to automate, because you know they are not automatable. 

If people adopt the electronic medical records more completely, then we will get closer to getting the information that isn’t available right now, to better understand health care quality. When my partner and I began implementing electronic medical records, it was always about quality. We were always benchmarking and reporting back the improvements. We were able to show the improvements once we started measuring.

What did you do after your residency? What kind of work were you doing leading up to your position at EY?

After deploying multiple electronic medical records systems, my partner and I were being asked all the time to consult with vendors or other hospital systems. During that time, I was also on quality boards at the University of Pittsburgh Medical Center and at the UPMC Health Plan. I had great exposure to many large health care systems through this work.

All of those activities ended up creating a lot of competition for my time, and so I eventually began to practice medicine part time. I was doing more strategic consulting in terms of how the electronic medical records and technology would solve business problems.

About five years ago, I was hired by the University of Pittsburgh Medical Center to run their interoperability program, and help launch their consulting business in Europe. I also helped with commercialization of intellectual property through multiple vendor partnerships.  With all the travel and the time constraints, I just didn’t think that it was fair to practice medicine anymore. I was a family practice doctor and it wasn’t fair to my patients. It became a big conflict for me, but I eventually decided to stop practicing medicine.

Then about three years ago, when EY was rebuilding its health care practice, I became aware of a potential opportunity there.  It was intrigued because I thought it would provide an opportunity to make an impact on a wider scale. . I ended up taking the job to become Chief Medical Officer for in the Advisory Health Care practice.

Can you talk a little bit about your position at EY? What you do on a day-to-day basis?

This actually ties into why EY appealed to me, because it was the only practice that had an integrated payer and provider practice. We have one health care practice, and we’re really focused on getting payers and providers to work more closely together. If you go to most other consulting houses, there are separate payer and provider practices, with separate P&Ls (profit and loss). However, here, we have a totally integrated practice.

On a day-to-day basis, I’ll be working with either payer or provider clients. It’s usually in the context of helping the payers and providers to work better together, to share data better, and build analytic platforms together. We work to create new payment mechanisms that make sense and align around quality. That’s the exciting stuff that I do, and then I have some administrative things that I have to take care of on a daily basis. This work can include helping to monitor the progress of our practice as a whole, or the financials of a specific job. Another fun thing that I get to do is work on leadership materials, such as helping to craft our point of view and our approach to the market, really vocalizing what we’re trying to accomplish as a practice and in the greater scheme of health care reform improvement. I’d say ninety percent of my job is fun and ten percent is the administrative stuff.

How do you think your clinical training and your medical school education play a role in your day-to-day work experiences?

I think having a true appreciation for how difficult it is to be a physician, how difficult it is for payers and providers to find common ground, and how difficult it is to work with these systems. It’s given me a deep understanding that translates into credibility with clients. I have worked in it from both sides.

The other advantage is that I had many roles during my time in practice. I was a medical director at a nursing home.  I was president of the medical staff at a rehab hospital. I did house calls. I was a hospice medical director. Not only did I get to see health care from the standpoint of a hospital and a physician’s office, but I also got to see the different spaces, such as skilled nursing facilities and independent living facilities, that are getting to be more and more important. All of those aspects are becoming more crucial with the financial crisis in health care. I was very fortunate that in my practice, I got to experience all of those different types of care.

How do you think your nonclinical career path has created value for you? What value does it add that clinical medicine might not have provided?

You can feel like you don’t have the ability to impact and improve the system when you’re working in a practice or in one hospital system. With my position, there’s an opportunity to impact things on a much broader level. EY has the potential to truly impact the health care system, and help influence the creation of a system that makes more sense.

What is your advice for medical students who are interested in possibly doing the kind of work that you do? How can they get involved? 

Look for opportunities in the practice setting and in the hospital setting to do quality improvement projects to be exposed to administration.

Find things that you’re really passionate about. Concentrate on those areas and be open to the other kinds of experiences, and put yourself in a position where you can be involved in those things and see if it’s something that appeals to you. Use your passion to pursue the right career.

When you transitioned from a more traditional clinical path, where things are more set up, to something that was maybe a little less structured, were there any difficulties in that transition?

Depending on who your mentors are or whom you’re surrounded by, people may doubt the more nontraditional paths that you’re taking. You just have to trust your instincts.

When I told the director of my program, who is a fantastic guy, that I was going to pursue a career in consulting around electronic medical records, he said, “Well, once electronic medical records are implemented, then what are you going to do?”

Implementing electronic medical records is just the start of all the improvements that we’re going to make and now we have to do telemedicine, use the information to create whole new payment systems, etc. Electronic medical records are the foundation of it, not the end of it.  So take people’s advice and respect them, but also temper their opinions with your own views and beliefs. Just be true to that vision that you have for yourself.

I can’t say it was difficult. I had great support from my wife and family.  It was a gradual transition and every step I took made sense. There were some that people would have called a little risky. There’s a leap of faith or two as you pursue a new career that you’re going to have to take.

Dr. Ted Eytan: Family Medicine Physician and Director at the Permanente Federation

Ted Eytan - Kaiser Permanente Center for Total HealthDr. Ted Eytan is a Family Medicine physician and a Director at Kaiser Permanente for the Permanente Federation. His work is based at the Kaiser Permanente Center for Total Health. In this interview, we chatted about the importance of telling people what you’re looking for in a career, why living in the right city makes a huge difference in your life and in your career, and how Kaiser Permanente is working to catalyze innovation in healthcare with their Center for Total Health. Read his eponymous blog here.

Where did you go to med school? What interested you about medicine?

I’m from Arizona and I went to the University of Arizona Medical School. I wanted to be a family doctor at the beginning and I wanted to be one when I finished medical school, so during my medical school years, I wanted to see how versatile my career could be. I took a year between my third and fourth years and went to UC Berkley to get an MPH. It was the perfect time in my career to discover the world of public health. After that, I graduated medical school, did my residency in Family Medicine, and then I went into fellowship at the University of Washington for two years.

What kind of fellowship did you do?

I did the Robert Wood Johnson Clinical Scholars program. The cool thing about that is that you don’t have to be any kind of speciality. So I can use it to work with people who have trained in different ways. I did it in Seattle which I don’t think is a site anymore but the Robert Wood Johnson Foundation is amazing.  They have the best thinkers, access to the best people. They taught me leadership and how to work in the community.

Why did you want to become a doctor in the first place?

You know it’s funny that you say that because just yesterday, a colleague of mine asked about my fellowship personal statement. So I pulled out my personal statement from my fellowship 12 years ago out. I read it and realized I’m actually doing now what I wrote about.  I wrote that I wanted to be solving problems for patients and communities. When I think about what I am doing now, I am a family doctor and I help solve society’s health problems in America.

What did you do after the fellowship?

I did the fellowship and got my first job. My first job was very non-traditional.  A lot of people who did my kind of fellowship stayed back in the university to do research.  I got a job in IT. I was really interested in doctors working with patients online so I worked at a non profit health system, Group Health Cooperative of Washington State. I was one of the first doctors hired in that kind of role so I had to make up work for me and for them. We did a lot of great work together. I was there for 8 years.

How did you know that a job like that would be available to you after fellowship?

I didn’t. This is what happens in life – I just called someone who was working on a project and I asked if there was anything available there that I might be interested in. She talked to someone, who talked to someone. Eventually they got back to me that there was something available and we got together to see if it was a fit.

We all go through medical school, and it’s a lot of training and a lot of work. When you are all done, you wonder who is going to hire you. It’s hard because it doesn’t always work out the way you want it to and sometimes people are not banging down the door to find you.  What I would suggest is: you just have to keep letting people know this is what I am interested in. You may tell 100 people and one person will get back to you with what might be your dream job.

Also, treat every person you work with as someone who could potentially help get you to that next step in your life.  You just never know. We have all known people who didn’t treat us the way we wanted to be treated. But always remember, all of the people you work with and no matter what level they are at, they could actually make your career. They could make it wonderful.  So treat everyone with compassion, it will definitely come back to you.

Can you talk a little bit more about what you did at this first job, for 8 years?

For 8 years was this exciting idea that no one had thought of before. It was all about patients emailing their doctor. No one thought it could be done and no one thought it would work. My job was to help 800 doctors in a non-profit health system get up to speed on email technology with their patients. It was basically making our health system more accessible to people online.

On a daily basis, what kind of work were you doing? Were you applying your clinical knowledge and how developers would be building the technology? How did your healthcare training help you in this job?

I thought they are going to want my clinical expertise and make sure everything is accurate. But it turned out that one of the most important things a doctor can do is lead change.  For many people, changing the way you do things can be hard. It turns out one of the best things about doctors is that they listen to other doctors.

At the beginning they were sending me to all the medical enters and I was speaking to the doctors. The doctors were really excited about the future, the prospect of emailing patients and communicating with technology.  I remember saying to my bosses, are you sure this is what you want me to be doing? It’s really fun but I want to make sure this is valuable to the company. They said this is very valuable, keep doing it.  I didn’t realize until six months later that it really did make a difference.

What did you do after 8 years at the Group Health Cooperative of Washington State?

My position eventually became the Medical Director of Informatics. I was doing more than talking then, I was helping set direction. The clinician part was important, but the judgment part was more important. It helped to know what the doctors needed to be successful.  After this job, I took a year off again. I did a sabbatical in Washington D.C. around understanding the use of health records for underserved people for a year. Then, I got the job that I have now, with Kaiser Permanente.

How did they find you or how did you find them?

I had gone through leadership training through Kaiser Permanente when I was at the Group Health Cooperative and I met with the CEO of the company I am in now. He brought me in and we talked. It looked like a good fit so he hired me.

You make it sound so easy.

I think you need to believe that it will always work out. The right opportunity will come to you. There was a year during which I didn’t have a job. I had a great job that I left and I wanted to live in Washington D.C. I just said you know what, I am going to find something once I get there, and it’s going to be great.

Was there a reason that you were you looking to do something different after Group Health Cooperative? Why did you decide to change jobs?

It was literally the best job in the world, no question about it.  I wanted to live in Washington D.C. I didn’t move for a person or for money. I moved because the cities are so different. When people come to me and they say I am looking for a job, the first question I ask is: where do you want to live? The world is not flat, where you live has a huge impact on everything in your life.  The people you see in the morning, where you walk down the street, it’s everything. I think it’s important to not have the best job but live in a great city than not to have both.  For me, where you live is the most important thing.

You’re right, the right city makes a huge difference.

It’s not just about how easy it is to live, it’s the kind of people who live there. If you are an innovative person and you really like to do things on your own, then California is great.  If you are social and want to work with big groups of people, and you want to be near the center of government, then D.C. is great. If you are not here, then you can’t simulate it.  You can’t simulate it by being in Chicago.

It’s very true, that is very good advice.  Speaking of Washington D.C., can you talk a little bit about what the Center For Total Health is?

The Kaiser Permanente Center for Total Health is in Washington D.C, and it is relatively unique in healthcare.  It’s a place to talk about health. People from all over the world and all over the country can come here and have conversations and interact with high-tech displays and devices. People can get inspired about health as something greater than just healthcare or medical care.

What the mission of the center? Who is the center for?

The center is for people who are trying to change health and healthcare. There are not a lot of places for you to go and just have a conversation about your ideas, your innovations, to share innovation, to learn innovation, to meet people not like you. Often healthcare can be very onto itself; it doesn’t really interact with other industries that we can teach and learn from.  It’s high tech but it’s a very neutral environment. Our large video touch panel is one of the biggest in the world.

Do you guys change the display on the large panel on a monthly basis or does that just stay with one exhibit? How does that work?

Well it’s extremely interactive so it’s hard to actually get through all of it in one run. It’s very technically complicated so that one hasn’t changed for a year.  We are also adding some augmented reality to one of the rooms.

So would the center be more geared towards providers and healthcare professional than medical students?

There are also community leaders, national leaders, business leaders. There is a lot more to changing healthcare than doctors and nurses who want to improve the health of Americans. Large employers want their workforces to be healthy and this is a place for them to come learn about what we are doing and what are the best innovations. They’re not medical professionals but we can bring that exposure to them.

How did you get involved with this?

I work for the medical groups of Kaiser Permanente. There are 9 of them across the country when you include Group Health Physicians. My organization supports them and helps them to succeed. This facility was opened up about a year and a half ago and so there was an opportunity. The thing about Kaiser Permanente that makes it so great is that it is run by physicians and non-physicians together in partnership.  So in the name, Kaiser Permanente, Kaiser is the business side of healthcare and the health plan. They finance the care;.  Permanente are the physicians. Everything is in partnership; our medical offices are run by physicians and non physicians or business leaders and medical leaders together.  We complement each other and that’s why we are successful.

Can you tell me a little bit about your job as the Physician Director of the Center for Total Health? What do you do on an average day?

This is a facility almost like a medical office. I have a partner who is the Executive Director and we plan the operation of the facility..  We are like ambassadors. There are 17,000 doctors here at Kaiser Permanente, so we help bring those doctors’ work forward.  All 17,000 physicians are doing amazing things; they are all doing new things every day. Our mission is to find those things and bring them to other people so they can learn.

Do you have speakers come into the center? What sort of events do you put on?

Yes we do. Last week we did corporate recess for an hour, where we learn play in the work environment..  We have large events with speakers, we have code-a-thons where people come and write apps.  We have small discussions with bloggers. Basically anything that anyone is interested in to learn about health, we will do. What we don’t do very well is PowerPoint slides. We are trying to create a no PowerPoint zone. It’s very cool because in the way the space is laid out, it’s hard to do PowerPoint.  People want to learn by talking to each other. We network them to each other and we network them to Kaiser Permanente and we network them to the rest of healthcare.

It sounds like it is a commutation hub. Is there anything else like this in the world? I don’t think I have heard of anything like this before.

There are other centers like it. We have a sibling center in Oakland, California called the Garfield Center, which is online.  UPMC in Pittsburgh has a Center for Connected Medicine.  The Center for Connected Care, which is a little bit similar to ours.  So there is a few of them.

Just to finish up, I want to mention how much I like your open-minded statements about medical school. Because you’re right, most people don’t quite see the medical world like that, about exploring the variety of opportunities that can come to you should you be looking for them. 

They should. If people have those questions, they should find a mentor. Also, explore different areas. I went to public health school and found this other pathway that was so exciting to me. Once you see that it can happen, everything falls into place from that.

Dr. Geeta Nayyar: Rheumatologist and CMIO of AT&T

Dr. Geeta NayyarDr. Geeta Nayyar is the Chief Medical Information Officer (CMIO) for AT&T, where she works to guide the AT&T ForHealth portfolio strategy. She has been named one of the “Top 25 Minority Healthcare Executives” by Modern Healthcare and one of Fierce Healthcare’s “Top 8 Women to watch for in Healthcare,” among many other accolades. Dr. Nayyar also holds memberships and committee appointments in the American College of Rheumatology and the Association of Medical Directors of Information Systems.  Read her top Health IT blog.

Can you tell me a little bit about your background? Where did you go to school and what did you major in?

 I got into medical school at 17, straight from high school. I went to the six-year medical program at the University of Miami Then I did my internal medicine residency at George Washington University  (GW) in Washington D.C. and stayed on to do my rheumatology fellowship. While I was a fellow, I did an MBA at GW.

When I was in the six-year medical program, I tried to do as many non-medical things as possible. I majored in biology but I minored in political science and English. I tried to have a well-rounded experience. I ended up in D.C. because I worked there during college. I did an internship with the American College of Preventative Medicine. Back in the day, I worked on items like the smoking cessation policy and the McCain bill. I loved it. I loved D.C. – it is an amazing city where a lot of the direction of what was happening in healthcare was starting. I was really drawn to the policy but also the business, because policy is ultimately affected by economics and what is feasible from a revenue vantage point.

I was drawn to MD-MBAs, MD-JDs, MD-MPHs. I found people within my past who were doing different things. I’d spend time with them and ask them for career advice. But I never found a clear path. I was also very active in different organizations like AMSA and AMA. I gravitated towards organizations that were doing things outside of academics.

What made you want to pursue healthcare from a business perspective?

It was very much by happenstance. When I started medical school at 17, I wasn’t aspiring to become the CMIO of AT&T, that was nowhere in my vision of where I would go. I always wanted to do something a little bit different with my clinical background, but I just was not sure how to get there.

Coming from a medical family and in my own practice, I always felt like there were these external factors that affected the doctor-patient relationship, whether it was policy makers, the legal team, hospital administrators. There were always people external to the practice of medicine that influenced how doctors practice. I felt that this was very backwards. How could an attorney or a policy maker understand what we do in day-to -day practice?

When did you apply for business school? Why did you choose to apply?

At the end of my fellowship, I thought, ‘How am I actually going to do something to impact the practice of medicine from outside?’ There was so much going on with all the changes in the past 5-10 years. So I decided to pursue an MBA, and would take my beeper to class. Again, I did night classes. If I got paged out, I would walk out of the lecture.

The GW MBA program was very cooperative; they were thrilled to have a physician. The professors were terrific. They never took it personally if I walked out of a lecture that it was any reflection on their lecture.

After my fellowship, I took a job with a company called APCO Worldwide, a communications firm. While I was doing the MBA and working at GW and APCO, we were going through our electronic medical record (EMR) implementation. I think because I was doing the MBA, I understood revenues, accounts receivable, etc. I was thinking about what all those things meant and how they affected how we practice. And I thought this EMR could really improve efficiencies and the quality, and make the lives of doctors and patients easier.  I became the physician champion within our department and helped craft rheumatology templates and made the EMR work better for the doctors. I helped with the training and worked with my peers to make that happen. I had a lot of fun doing it. It was gratifying to see this change happen while I was there and practicing. We went through this whole paradigm shift while I was there.

When I took the job with AT&T, part of the reason was to move closer to my family in Florida. I heard they were starting a healthcare practice and they needed a physician’s perspective on the work that they were doing.

I’ve been the CMIO for a little over a year now and I’ve really enjoyed working for AT&T because it’s a company with so much breadth and scalability. There’s a lot of opportunity to make an impact on the industry in a significant way. It’s been great because my role is a new role, so it’s been fun to craft it and shape it.

There’s been an incredible will internally within the company in terms of the commitment they have made in healthcare. I have a nurse on my team, we have other people from the industry from the provider side, the patient side — you name it. As a company, we’re very invested in healthcare and I feel fortunate to be part of that. We have quite a number of customers – Indiana Health Information Exchange, one of the largest health information exchanges (HIE) in the country is using our HIE solution. Texas Health Resources is doing a pilot study that looks promising. We completed four pilots with 600 individuals who basically said we love the mobile health tools; we feel engaged and feel they are making an impact on our diabetes. It’s just been fun.

What is your daily schedule like? How many days do you practice clinically? Amount of time spent at AT&T?

I still have my faculty position at GW and I’m starting my practice at Florida International University down here. They have a brand new medical school and a brand new ambulatory care center. I’ll do about two clinics a month and continue my role with AT&T.

It’s hard, but I’ve always done it so I don’t know any different. I did it when I was with APCO and with Vangent.

And it’s because of the technology I can. Whether I’m traveling, even if I’m not physically on site at the clinic, I’m able to look at my patient’s chart, give them a call, and set up to bring them back to the office. I’m not sure how I would do it in a paper-based world. It’s fortunate that both GW and FIU have EMRs and believe in technology as a way to better connect doctors and their patients.  It’s not easy; I wouldn’t be completely honest if I said it’s no big deal. But AT&T has been great in saying, ‘We want you to practice and stay relevant.’

How did you feel about doing your MBA? Have you felt that what you have learned in business school has been applicable? Did you feel that it was a good supplement to your medical training for the role you play today?

For me, it was well worthwhile. If nothing (else), it gave me a different way of thinking. After medical school, our creativity is almost completely stifled because you’re forced to think more as a scientist, as a medical person. It’s a completely different way of thinking than in business school.

In business school, there was more encouragement to be creative and entrepreneurial. It also helped me to understand the language of business. I do think of myself as a creative person; however, after 10 years of training in medicine, I think that part of my brain may have been completely shut down. I think business school kind of opened that up again. How do we think about this problem differently and how would we solve it? So in those ways it was useful.

If I were to go back, and in today’s present environment with all the resources available, I think I would try to get more experience as opposed to formal education. Like the internship I did on the Hill with the American College of Preventative Medicine If Health IT vendors were looking for a medical student or a resident, I would look for opportunities like that, or opportunities to shadow a CMIO at a company.

In today’s modern world with Twitter, blogs, and LinkedIn, there are so many different ways to connect with people outside of medicine. I don’t know if I would need to go to business school. You could learn the terms online. But I think it depends on the person; if you’re that proactive, you’ll go out there and teach yourself.

I think the advice I would give someone is that you have to know yourself. If you’re the kind of person who is creative, entrepreneurial and will put in the time to educate yourself, you can definitely do it without a MBA. If I spent two years getting experience, that would have been great. At the time I was into my career, I didn’t know how to connect the dots and the MBA really helped me connect the dots in a way that I had been trying to do throughout my formal medical education. So in that way it really helped me.

What were some of your other influences on your career path?

I found mentors; people who were instrumental in helping me make the transition. It’s really about mentoring and networking. It’s all about having mentors who spend time with you and are willing to help you out. Many mentors have helped me to get where I am.  They’ve been really instrumental in helping to give me feedback and continue to be. We talk all the time and they’ve always been very supportive. Now, many AT&T executives have been instrumental in saying this is where we want to help you. I think networking and mentoring are important.

In medical school, time is so precious. For a savvy doc in training, there are ways to reach people that weren’t there when I was a fourth-year medical student. Now there are different ways to do it. There are more and more companies, businesses, policy makers saying we need clinicians who can think outside the box. It’s a different landscape than it was before.

Atul Gawande wrote an article in the New Yorker called “Cowboys and Pit Crews” and in it, he stated that “medicine’s complexity has exceeded our individual capabilities as doctors” because we now have tens of thousands of diagnoses, more than six thousand drugs, and four thousand medical and surgical procedures. How do you feel about this? And how can technology help?

I agree with that wholeheartedly. One of the things that has really struck me is that clinical medicine is all about cutting edge technology. We’re always looking for the cure to cancer, HIV, or a way of doing noninvasive surgeries. What’s ironic is that you have surgeons doing robotics and laparoscopic surgery, where they’re able to go inside the body without penetrating the body cavity, and then they turn around and write up the whole case on paper.

They should just attach the Da Vinci to a Twitter.

Right. I think Atul is spot-on in saying that the delivery has definitely changed. There are technologies available that weren’t before – the ideas of mobile health, remote patient monitoring, the ability to take the office visit outside the four walls of the office. Things are definitely changing. I think that’s where companies like AT&T have their value proposition.

The reality is that doctors who are just starting now, they’re thinking about where they’re going to practice. Are they going to go to a hospital system who doesn’t embrace EMR? These are the issues that physicians are going to have to decide because they are now part of your practice decisions. This is part of the future and now I have to think about this when I choose where to work.

With your experience in HIT, what do you think is the most important change that the healthcare system needs to undergo in order to streamline their practice?

I really think it’s about shifting the paradigm from the traditional office and hospital setting and meeting the patient where they are, in their home or community. The reality is that healthcare today is not experienced in the physician’s office and hospital, but patients experience their diseases most of the time outside of the hospital. Being able to give insightful clinical data points to patients and providers in their homes and community will be important.

The industry is going towards a place where our current model of care is not economically sustainable, nor sustainable from a healthcare outcomes standpoint. The quality of care we deliver is a traditional model that is poor and very expensive. Companies like AT&T and others in the industry are now offering solutions that help integrate points of care that are not yet integrated today. If you, as “Doctor A’, want to do what ‘Doctor B’ or ‘Hospital A’ has done with your patient, (technology) let us help you make this connection points happen so you can get to the business of practicing medicine better and faster.

What can medical students do to adjust to the changing practice of medicine?

In medical education, it’s about building the car as you’re driving it. I think it’s happening. From working with residents and fellows, I see that they always bring their smartphones and tablets. They tell me about apps, like the stethoscope app that’s out there. One of my residents showed me that.

The doctors of your generation get technology and they use it. It’s almost going to be natural when you start fully practicing. When you start residency or fellowship, you’ll realize how inefficient your day can be. The way you use technology for other things, even things that have nothing to do with healthcare, will make you realize – if I could just do this thing on my smartphone or tablet, if I could just send my patient a secure text message, it would be so much more efficient.

Conversations with doctors who ventured outside the hospital