Observations of a primary care innovator in Atlantic City

by Andrew Schutzbank, MD

“He wants to go to Atlantic City for his research time?” must have been the question bouncing around my residency’s Area of Concentration (AOC) Committee.

Not that there is anything wrong with Atlantic City per se, but historically, our residency program generously grants three to six weeks of AOC time to allow residents to explore interests and start building careers. My colleagues have provided medical care abroad, done bench or clinical research, and worked to improve quality within our own hospital.  My path was certainly different, but has been an amazing opportunity to make improvements in health care.

Early in medical school, I came to the realization that I am to be a primary care doctor. Many of my colleagues shared this realization, only to override it and go into other fields. Despite the significant and potentially irreconcilable problems with the current practice of primary care, I was hooked. Critically looking at the field, I decided that none of the problems of primary care were actually inherent to the field, just the result of mountains of external decisions. If I could fix these problems, then I could practice the medicine I wanted in the way I wanted. And so began my journey as a primary care innovator.

Flash forward to the beginning of my second year of residency, a typical time to discuss fellowship options. I scheduled a meeting with my program director and told her that I did not think fellowship was the right next step for me. She started me down a path to find a mentor. One meeting led to another (and about 75 more thereafter) with physicians working in academics, policy, government, venture capital, consulting, investment banking, and entrepreneurship. Each meeting ended with a series of names to meet with next. One name kept coming up too often to ignore: Rushika Fernandopulle. I had decided on the Rule of 2: if any name comes up twice as a suggested meeting, I had to schedule it right away. He far surpassed that number.

Rushika, the founder of Iora Health, has been living the life of a primary care innovator, physician, and medical entrepreneur for quite some time. When we spoke, we realized we had a shared vision and decided that it might be of mutual benefit if I dedicated my AOC time to working with him. Given the inherent variability in the life of the entrepreneur, our time together involved brainstorming sessions, meeting with investors and clients to expand of the company, and the jewel of the experience: our trip to Atlantic City.

Rushika’s most recent success has been in the creation of the Special Care Center (SCC), a new model of primary care incarnated as a clinic for the most severely chronically ill—a population that is poorly served by our current health care system. The clinic is a joint venture between Local 54 (the casino workers union) and AtlantiCare Health system to take care of a subset of their shared members (hence the location in Atlantic City).

The clinic thrives thanks to its “health coaches,” community-based health workers who use close connections with patients to ensure that plans created mutually by patients and doctors are carried out. And the patient is the center of the clinic. For example, at the SCC, a physician’s permission is needed to tell a patient “No.” Imagine that: “Yes, you can see the doctor now. Yes, we can get you that medicine for free. Yes, your wife can be a patient here too.” Access is easy, the patients complex, and the work astounding. So astounding that Atul Gawande just published a piece about it in the New Yorker.

My AOC experience was not a typical one—I was playing the part of physician-entrepreneur, taking multistate road trips, attending investor meetings, and working outside of the academic realm to which we have become accustomed. If any of this interests you, think broadly about how to best use any time that your medical school and residency may offer you. If you would like to be an innovator, then you cannot simply walk the path laid out to you. You must walk your own path, of your own creation, with your own meetings, mentors, and missions. And maybe you too will end up in Atlantic City.

Andrew Schutzbank is an internal medicine-primary care resident and founding member of the Harvard Chapter of Primary Care Progress. This post originally appeared at Primary Care Progress Notes.

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