Traditionally, many medical students use the proverbial “last summer of their lives” to conduct basic/clinical research, shadow or go abroad. If you want to be a leader in health care or are simply unsure of what to do over the summer, you should try something more exotic and unexpected — work in finance or industry.
Wall Street, big pharma and private insurers have long been the moral punching bags of clinicians and health care workers. Yet, stepping into their shoes can be valuable for two reasons. First, you will begin to understand incentives in the health care system. Second, you will become familiar with the language of business and money. Both are necessary if you plan on shaping the future of health care. Though attitudes are changing, evidenced by the rise of MD/MBA dual degrees and an emphasis on innovation, these subjects are still largely absent from traditional medical education.
This summer, I interned at a hedge fund that invests in the health care space. I found learning how other major players impact the health care system far more valuable than pipetting small volumes of clear liquids or data mining electronic health records. I don’t mean to downplay the value of such projects; I took two years off before school to do wet lab research and absolutely loved it. Just know that basic and clinical research aren’t going anywhere, and you may return with a better appreciation for how they fit into a larger health care puzzle.
My internship began with a foray into health policy. We evaluated the various ACA “repeal and replace” bills, trying to understand how they would impact the insurance, pharmaceutical and hospital industries. This was the first time I thought in depth about the drug supply chain — how a pill gets from the manufacturer to the patient. I’m curious what percentage of medical students and physicians can explain what a pharmacy benefit manager (PBM) is, let alone the financial incentives that a PBM faces. Before this summer, I sure would’ve whiffed on that one.
Oddly, my two-month foray into finance was also the first time I felt free to evaluate health policy from a truly impartial standpoint. After all, my personal feelings about the legislation didn’t hold much weight — my opinions wouldn’t move stocks up or down. Further, there were no overarching concerns about publishing my results. My future academic career and reputation wasn’t dependant on what I found. Like it or not, Nature or the NEJM won’t be wowed by negative scientific findings. On the other hand, knowing to stay away from an investment is often as valuable as deciding to pull the trigger.
We then learned how to properly evaluate clinical trials and drug candidates. Again, with millions of dollars on the line, I’d bet analysts appreciate clinical trials better than the average healthcare worker helping to conduct them. We became versed in the financials and market niches of major companies in the pharmaceutical, biotech, and insurance spaces, as well as the up-and-coming players, like gene therapy companies. By extension, we also learned the ins-and-outs of the FDA approval process, patent law, and the generics market.
Together, these lessons laid out the realities of why companies go after certain drug targets and how ideas cultivated at the benchtop are actually translated into tangible therapies. Hint – you need money and lots of it. The saying “bench to bedside” skips a few critical steps.
Now back at school, the drugs we’re learning about in class, and will one day prescribe, suddenly have narratives — stories of development, hitting clinical endpoints and eventually receiving a price tag. Asking patients about their insurance coverage and out-of-pocket costs is no longer a superficial checkbox. Slowly, but surely, the puzzle pieces come together.
While learning about how these various moving parts operate would be enlightening for any future physician, it’s downright required if you truly want to be a leader or change the system.
This is why I chose to get involved with a student group called Penn HealthX, which tries to expose medical students to some of the opportunities in health care management, entrepreneurship, and technology. Further, we aim to help students appreciate all of the various vantage points outside of clinical practice. To broaden the conversation beyond the walls of our school, the group just launched The Penn HealthX Podcast, which discusses these themes and more.
There has never been more opportunity for those early in their medical careers to make an impact. Learning to traverse our bumbling, colossal health care system is hard, but worth it. As with a patient, we must empathize with the other major stakeholders instead of demonizing them. Learn who they are, their incentives, what can be done better and how. Learn how things get done.
Behind all of these powerful companies, organizations and government bodies are just people. If future physicians don’t also become executives, entrepreneurs and policy advisors, then others without clinical experience will dictate the future of healthcare. If you’re so inclined, don’t remain on the sidelines of innovation and leadership — show us what you’ve got.
Ryan O’Keefe is a medical student.
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