“2022 is well underway, and we are still unclear about exactly where this virus is headed and what the lasting impact it will have had on all of us. We have self-driving cars, drones delivering food, and most of us spend our entire day on video calls, and the rest on social media. Who knows what innovations will emerge next year (or, to be cynical, the next pandemic). I am all for the conveniences offered to us by innovation and forward-thinking companies, but I hope we can come to an understanding that a ‘one size fits all’ approach to health care should be a non-starter.
While it may work for some people in some situations, trying to make every aspect of health care as virtual as possible will likely lead to disillusionment, uncertainty, or indifference – not things anyone should experience when discussing their health care. And to put aside all technical or logistical concerns, some people just appreciate the importance of touch and connection.
It is, as they say, what makes us human.”
Shruti Singal is an emergency physician and health care executive.
She shares her story and discusses her KevinMD article, “Virtual care is convenient, but is it better for everyone?”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.
Today on the show, we have Shruti Singal. She is an emergency physician and health care executive. Her KevinMD article is titled “Virtual care is convenient, but is it better for everyone?” Shruti, welcome to the show.
Shruti Singal: Thank you. Happy to be here.
Kevin Pho: We’ll get into the article in a little bit, but first off, share your story and journey to where you are today.
Shruti Singal: Yeah, I’m happy to. So I’m an emergency medicine physician by training. I worked at Emory until probably about mid-2018. I had some thoughts going into 2017 about next steps. I love my job, I love seeing patients, but I really wanted to explore my options. I went on to work at Anthem Blue Cross Blue Shield here in Georgia, which is where I still am, I’m in Georgia, and then I got my MBA at Georgia Tech and started to see that business side of life. I wanted to really use the skills I had learned and combine them with, of course, my clinical background, and I went on to work at First Choice Health. I’ve been here for almost two years, and I’m their chief medical officer.
Kevin Pho: Tell me about the transition from clinical medicine to industry. What was it like?
Shruti Singal: Yeah, so I actually did it slowly. I started at Anthem Blue Cross Blue Shield at the end of 2017, and I continued to work about a shift a month, because I had heard some horror stories about people moving over and then going, “Oh my gosh, no, this isn’t what I wanted.” I was really pleased with how I felt, even after the first month, because I think the first six months was such a challenge, and I’ve been doing the same thing for about 20 years. So I think there was that excitement of learning something new and putting my skills to use in a way that I had never done.
And I think, being an ER doc, my job had been so focused on just one thing, where I didn’t get to really learn about other parts of the hospital or owning my own business, like private practice stuff. So it really opened up my eyes to how much was out there for all of us.
Kevin Pho: Now, for those other clinicians who may be listening to this podcast and interested in making that transition outside of clinical medicine, you mentioned you did get an MBA. Is an MBA necessary to make that transition?
Shruti Singal: You know, it’s always hard to answer a question like that after you’ve gotten one, because you’re like, “Did it help?” So it’s a good question. I think about it a lot. My transition initially out of the ER was without an MBA. What had happened was I realized that even though the first six months of that initial job was super challenging and there was a lot to do, the job changed, the role changed, and I realized that it started to become a little bit common day to day. And so I was like, “Well, what do I do to add to my skill set and challenge myself?” I thought about a lot of different things, and I really just honed in on that MBA. I’m in a city with a lot of good universities.
But what I will say is that for this next transition, so what I do now, I think the MBA was imperative for me, because I didn’t have that business background. But again, I think if you’ve owned your own business, if you’ve done other things throughout your career, it may not be as important.
Kevin Pho: Now, through your journey so far, what would you say is the number one tip you could share with clinicians who may be interested in following your footsteps?
Shruti Singal: That’s a good question. I think this sounds really trite, but take the risk. Do it. Because I think that if you’re feeling that at all, and I’ve been feeling it on and off for about 10 years, I met somebody along the way who had been nonclinical for a bit, and she really pushed me to talk to somebody who worked with physicians and helped them create a resume and not a CV. For me, that was the turning point in finding a career outside of clinical medicine.
So I guess, answering my crazy thoughts, it’s find a person to help you with that transition from your CV to a resume, and really understand what that looks like. Because all of us, I think, have always done a CV. It’s very based on our papers and what we do with all of that. And then you realize, “Oh, no, that’s not important in this situation.” It’s that clinical knowledge, yes, but that understanding of what you’re going to do with it is going to be very different.
Kevin Pho: So just to be clear, what is the difference between a resume and a CV?
Shruti Singal: Really, a lot of it’s just words. I mean, it was so interesting to speak to the person I spoke to, because he’s like, “You have to have certain words in your resume that you typically wouldn’t have in your CV,” because of exactly what we do when we see patients and what’s important. Maybe it’s the papers we’ve written, maybe it’s whatever those things are. Those things that make us really good clinicians sometimes don’t translate in that world of industry, whatever that is.
And so I think it’s really understanding, first of all, what industry you want to go into, because I didn’t know when I first thought about what I wanted to do. I’ll be honest, I had no clue what was out there. I had no idea. And it wasn’t until I spoke to somebody who was not really fully clinical anymore, and she was like, “Well, what do you want to do?” And I was like, “Are there a lot of options?” And there actually were a lot of options. And I think we’re really lucky in that, as the years go by, there are actually more and more options for us.
Kevin Pho: All right, let’s transition into your KevinMD article. It was written back in April. It’s titled “Virtual care is convenient, but is it better for everyone?” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Shruti Singal: Yeah, so I mean, we all know COVID happened, and it seemed like, and I did this as well, but it seemed like a lot of people went on to, and I’m talking about the clinician side, working for companies as their physicians or for telemedicine, or they were getting on to different sites and seeing their own patients via some kind of video. It just seemed like it was everywhere. And it was so important during COVID because of access, and people not wanting to leave the house, or they couldn’t, or they were quarantining, or whatever. So it was so important and so necessary.
But I started to feel like it was the only solution that was really being discussed, and we were trying to fit everything into the box of just virtual health. And it got me really nervous, because for all of us who have trained and worked for years and years and years seeing patients, touching patients, I was like, “There’s got to be a line.” There’s got to be a point, either in the journey of that health care, where you know that you need to send the patient to be seen in person, or are there certain people for whom it’s just not going to be enough? And how do we figure that out as clinicians and see those small nuances of how the visit’s going, to know, “Well, this isn’t working for this patient”?
And I think it’s really hard, and I alluded to this, that we really need access for behavioral health and mental health. But I think sometimes those are the times where that connection can’t be made because of just that personality. I think it’s just person-dependent and provider-dependent. And so that’s really what I was trying to drive with that article.
Kevin Pho: So if virtual care isn’t for everyone, what are the other pathways that we can pursue? What are some of the other options?
Shruti Singal: Yeah, I mean, I think that’s the big question. I actually worked for chat-based health care, and I think there’s that for people who are really probably on the other end, who maybe lose that connection because they don’t want to be on video. So I definitely think there’s that. I think we still always will have phone calls and things like that. But I think for some people, it’s going to be going in.
And again, I don’t think that it even means that you have to go in for every visit. I think about behavioral health, mental health. Sometimes you have to create that relationship with an in-person visit, and then you can transition to virtual care. So I think it’s just understanding and being able to not put everybody in the same box. That’s really what I’m thinking about for the future in terms of telemedicine.
Kevin Pho: So I’ve talked to some psychiatrists who say that telemedicine or virtual care is actually a boon to them, because they’re able to give patients access where otherwise they couldn’t, because, as you know, there’s such a shortage of behavioral health clinicians. So how do you resolve that tension? Because I’m hearing kind of both, and I understand what you’re saying about how you can’t build that in-person relationship through virtual care, especially in behavioral health conditions, where that relationship is really needed. How do you resolve that tension?
Shruti Singal: Yeah, I totally agree with you on that. I think that’s what makes it the stickiest of all, because of the access issues and also because of just how much we need it. I feel like the need for those who practice in that field has just grown so much, to the point where, as you know, there are so many apps and so many different things, starting with coaches. There’s that patient journey, from somebody who’s more available all the way up to how we then slowly get them to see the psychiatrist.
So I think it’s just knowing your patients, and I think that’s the beauty of it. I do think that most practitioners, most providers, most psychiatrists, know when somebody isn’t being reached. I always wonder if it’s actually the coach level and the level above it, whatever that is, based on the app. I worry about those levels really being able to filter the patients upward as needed, and then eventually, like we talked about, figuring out who does need some kind of in-person visit.
And I think it’s actually probably the younger generation sometimes that is hard to engage anyway, whether it’s via Zoom or otherwise. And I think the people who want to engage and want to see somebody for whatever they’re feeling, their anxiety, their depression, are going to look for that engagement anywhere. So I think a lot of times it’s going to be a constant tension going forward.
Kevin Pho: Where do you see virtual health’s role in the next year or so?
Shruti Singal: Well, I hope it doesn’t go away, because I think it’s absolutely necessary. I really am concerned, because I actually think that overall virtual care usage has gone way down, and so that means people are back in the offices and doing all of that. And I’m sure you know this as well: I am just shocked at how hard it is to get an appointment these days. You want to see somebody, and you may be three to six months out. Somebody told me the other day that the next appointment for whatever they were looking at was in 2023. And so we definitely need to keep virtual care around. It’s so important for access, for streamlining what goes into the doctor’s office, and all of those other things. But I think it’s just being able to suss out what belongs there and what doesn’t, and transitioning people one way or the other depending on where they are.
I know I haven’t really used a lot of virtual care. Granted, maybe I’m also not in the doctor’s office that much, but it hasn’t really become part of my daily life. How do we change that? Is it education? How do we get people to use it for the little things, and keep the doctor’s offices there for the things that, like I mentioned, really should be in the doctor’s office? And we say the same thing in the ER, for all those years: How do we get the people in the ER who need to be there, and keep everybody else where their place of service should be?
Kevin Pho: No, I definitely understand what you’re saying, because I have patients, and I’m in primary care internal medicine, who would rather wait six months to see me in person than see me next week for a virtual visit, or the next day for a virtual visit.
Shruti Singal: Yeah, I think it’s just human behavior. It goes back to some people just really need to be in the office. They need you to see them; they need to see you. But I totally agree. And I’ll be honest with you, the couple of times that I’ve called to make an appointment, I haven’t been offered a virtual visit. And so it makes you wonder, what is that back-and-forth education around virtual visits? And in some cases, should that be the only option, so that people are kind of forced to at least start off there, and then it’s the decision-making of the physician, “Why don’t you just go ahead and come in”? And so it leads to a triage, almost.
Kevin Pho: Now, you mentioned behavioral health is one area where virtual care may not be for everyone. Any other conditions or areas where you feel that virtual care may not be suitable?
Shruti Singal: I think it’s best used for primary care. I think any kind of problem where you’re, like, my husband’s an eye doctor, he’s an ophthalmologist, and it’s just not that easy. Everything they do is really, really technical. I really think it works great for primary care, or “I have this one thing wrong,” or what I think would typically go to a really quick visit in the office, or something that would go to the urgent care. I think that’s that first layer that I think about that does really, really well on virtual care. And like I said, I think that behavioral health can do well, as long as those nuances are picked up, and you know when there’s just no engagement, and you can move on from that and figure out another way.
Kevin Pho: We’re talking to Shruti Singal. She is an emergency physician and health care executive. Her KevinMD article is titled “Virtual care is convenient, but is it better for everyone?” Shruti, what are some of your take-home messages that you want to leave with the KevinMD audience?
Shruti Singal: Well, one of the things that I thought about when you and I connected earlier was what is driving my passion these days and what’s top of mind. Working at a TPA, one of the big things I think about is the providers. Before that, being at a payer, it was really typically about the members, and so it’s been a really interesting transition for me, thinking about the providers.
So I would say what’s top of mind, or what I’m thinking about these days, is really how we get providers giving the members, or the patients, the care they need without a lot of oversight by a third party or an insurance company, or in our case, a TPA. So maybe not a word of wisdom or anything really crazy, but I think that’s really top of mind for me, and something I’d love to talk about another day: just prior auth, how is that affecting end users, or really the patients, which is all of us? And what does that mean for our physicians and our members and the overall cost of health care?
Kevin Pho: Shruti, thank you so much for sharing your time and insight. Thanks again for being on the show.
Shruti Singal: Thank you. Take care.
