From Medicine to McKinsey to Main St

This is post 3 in a series highlighting my journey from physician to consultant to entrepreneur

I write this in a period of reflection — when I try to figure out what’s next for me as I reflect on my career to date.  My calling is the fixing of our broken health system.  However, as but one individual, how to do so in a way that allows me to build something of immediate value while taking care of my family is a complex challenge.  My goal is writing this is to help highlight my somewhat strange career path, as I’ve been contacted by a number of physicians at all stages of their careers.

While applying for medical school, my goal was to be a preventive medicine pediatrician: I wanted to keep kids healthy and make sure they never got sick.  This perspective, even in interviews for medical school, got me in trouble…great doctors were supposed to be tremendous diagnosticians with ability to memorize vast facts and prescription/ procedure options.  I never really understood why…for me the challenge was in understanding how to change basic behaviors early…so the bread and butter things that impacted the majority of people either occurred later or never.  I questioned the impact of the things we spent 80% of our time on…and needless to say it didn’t make me popular in an environment where people were conditioned to jump through professional hoop after professional hoop.

It all crystallized for me in a few places:

1. I had a pediatric orthopedic surgery rotation with a bunch of “SCFE” kids.  SCFE stands for Slipped Capital Femoral Epiphysis.  Basically, these kids were so fat (and they were a bit more than “husky”, that their growth plates attaching the ball (in socket) part of the hip bone with the leg part of the hip bones cracked…and needed to be pinned to keep the kid’s leg in place.  What I saw was extraordinary technology to get the leg pinned and some followup with rehab.  What I didn’t see was any effort to get the kid’s weight under control (it is horrifying to see that a 12 year old is on the verge of type II diabetes)…although they did note they would put them on insulin if they tipped into diabetes.  I was pretty disgusted with how doctors were trained to view the world.
2. I had a 5 yr old 110 pound girl (and no, that’s not a typo) on an ENT rotation in for a tonsillectomy to clear airway so she could breathe.  The ENT was executed beautifully.  The child’s health?  That was someone else’s concern…surgeons must move on to their next case once a patient comes off the table.  When I bothered to try and figure out in my busted Spanish what was going on, it all made sense.  The child was 110 pounds and had no teeth because her parents thought soda was better for her than water.  This was the moment I decided I didn’t want to practice in a system that defines success in a way where the patient may not have survived.
3. I came across the book “Demanding Medical Excellence” by Michael Millensen.  This was my first concrete exposure to the inanity of a health system where better results (on a cost-plus basis) often equate to a bankrupt organization.  The need to change business models in health to reward EFFECTIVENESS vs. EXPENSIVE ACTION dawned and me…and has become the cause to which I’ve dedicated my career.

Late in my 3rd year, I decided not to apply to residency.  It came with much heartache and second-guessing at the time, but while doors closed others have opened that have led to a passionate-filled and interesting start to my career…

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