MD/MBA Careers in Entrepreneurship

Highlights from the Association of MD/MBA Programs (AMMP) 8th Annual Conference.

Joseph Fastow, MD, MPH (President of Physician Management, Ltd.) spoke about entrepreneurship this afternoon. He became an entrepreneur after completing an internship (and decided he didn't want to be an internist or an intern). He spoke about the organizational requirements and entrepreneurial orientation surrounding emergency medicine.

Enterprise

• Meeting a need
• Indepdendence
• Initiative & Innovation
• Organized skills 
• Bsuiness acumen
• Competition
• Scalability

Economic Gain

• Personal
• Institutional 
• Societal

Risk

• Financial
• Professional
• Personal

3 Pillars of Health Care and the entrepreneurial approach:

1. Quality  - better
2. Access  - faster
3. Cost  - cheaper

Health care is going through some radical changes. So how about emergency medicine? What gives this field an entrepreneurial orientation? We see a high prevalence of malpractice. We also see an intense level of competition for physicians and contracts. Documentation remain problematic. So, how do you develop something that's better, faster, and cheaper? Let's look at a few examples:


Documentation remain problematic. A few ER docs developed the T-system (check list and documentation form)

• 120 million ER visits last year and the T-system has over 40% of the market. 
• The founders are successful entrepreneurs

Overcrowding is a problem. How about Minute Clinic?

• Patients lack insurance and patients lack access to primary care. The need for access to primary care is not going away.
• Beds are running out and there's a problem with the transfer of responsibilities.
• The Minute Clinic adds an algorithm for specific symptoms. Staffed by PAs and NPs, so the hours are convenient and the costs are low. 
• Grew to 74 clinics in the midwest. Saw 750k patients. Needed more VC funding. CVS was confident in the concept and they invested in the concept. 
• How about quality? We're starting to see published data that suggests that it's good and cost-effective for routine visits.

Hospitalists

• The need for inpatient management
• 75% of hospitals now have hospitalist programs
• Rapid assessment and treatment, decreased length of stay, discharge planning, and improvement in hospital efficiency
• Society of Hospital Medicine membership growing rapidly

So, why do entrepreneurs fail?

• Finances
• Naivete (often about finances)
• Competition
• Incompetence (failure is a lesson)

Future needs

• Workforce evolution
• Comparative effectiveness (we have a huge amount of waste)
• Chronic disease management
• End-of-life care (there must be a better way)
• Behavior modification

Future opportunities

• Technological: EHR, patient monitoring, communication, administrative, diagnostic & therapeutic devices
• Organizational: accountable care organizations (ACOs), demise of fee-for-service

Behavior modification

• The health care system is bloated with waste and abuse. How will you make a difference?  Will you come up with something better, faster, and cheaper?

Questions from the audience

• How will ERs evolve? Patients are shifting from one ER to another. 
• Discussions around the Minute Clinic.
• How can medical students get involved? Start a clinic?

These are some great examples of medical entrepreneurship. Make sure to return in a few weeks to find a hyperlink to Dr. Fastow's slide presentation.