Super Doc?

On the surface, it would appear that business and medicine don't mix. Business is buying and selling. Medicine is diagnosing and curing. In clinical practice, technical skills are paramount, while the interpersonal skills that bring success in business can be lacking in some physicians. Medicine says to "first, do no harm." In business, it's "look out for number one."

After years of shrinking reimbursement, most physicians have, however reluctantly, begun to pay more attention to those aspects of their practices that, a generation ago, would have been left to accountants, financial planners, human resources, and marketing experts. They need to in order to keep their practices viable.
But many coexist successfully in the worlds of medicine and business -- some of them maintaining medical practices while manning the helms of companies, nonprofits, and foundations whose goals are, in various forms, to improve patient health and the delivery of care. They look at it as an opportunity to expand their skills and to affect more lives than they could seeing 25 or 30 patients a day.

It's not that they grew disdainful of medicine or weary of patient care. "I absolutely loved seeing patients. I knew why I went into medicine when I took care of them," says William Li, MD, a former internist who is now full-time president and medical director of the Cambridge, Mass.-based Angiogenesis Foundation. "But," Li adds, "I also felt strongly that I wanted to do something on a larger level that would change what medicine can offer patients."

The business-savvy physician may also be better prepared to survive in the increasingly competitive healthcare landscape, according to David Reis, MD, of Norwalk, Conn., who divides his time between his cardiology practice and a consulting position with human resources outsourcing firm Hewitt Associates.

Reis notes that when teaching residents, he "perceived a tremendous lack of knowledge. The medical residents, while brilliant about the medicine and the biology -- the clinical part of medicine -- were not really exposed to what they would experience from the marketplace."

So maybe business and medicine can, in fact, be a powerful union. To whatever degree they do so, stepping back from their full-time role as patient caretaker and taking on the role of business owner or CEO requires a steep learning curve for most physicians, including those who've done it successfully, like the doctors profiled here. But the result has been positive for them, their patients, and their communities.

Giving Life, Giving Answers
Marisa Weiss, MD

Radiation oncologist Marisa Weiss' foray into the nonprofit world started with a revelation nearly a dozen years ago.

"I was starting out in practice at Penn [University of Pennsylvania], and I realized that, despite all the training and hard work over the years, I was unprepared to answer so many questions women were asking when their [breast cancer] treatment was finished: 'How do I get back into a life that is meaningful and enjoyable? How do I navigate through the psychological, social, legal, and financial issues?'" Weiss recalls, "I asked myself, 'Isn't the whole point of finding breast cancer early and treating it effectively to give life after treatment is finished?'"

Knowing that it was, she started Living Beyond Breast Cancer, a nonprofit, national education organization "offering a full range of educational programs -- mostly in the Philadelphia region -- conferences, newsletters, workshops, train-the-trainer, and a help line," according to Weiss. During her time as president of the organization, Weiss also wrote a book, Living Beyond Breast Cancer (Random House, 1997).

Fast-forward to the Internet boom of the late 1990s, when Weiss launched her second venture, breastcancer.org, aimed at helping women wade through the reams of information on the disease that overwhelmed patients and occasionally even eluded physicians.
"I could see the amount of medical information on breast cancer was accelerating," she says. "There were all these great discoveries being made, yet women had less time with their doctor to find out about them. I could see these women being overwhelmed and confused by the information and feeling panicked. Even the most well-educated people couldn't deal with all the complicated decisions and choices they had to make."

And like Living Beyond Breast Cancer, breastcancer.org was born of a realization that the status quo wasn't quite working. "What good are all these treatment options if the women who need them can't get access to them?" says Weiss.

Admittedly, there are other Web sites devoted to disseminating information about breast cancer and every other imaginable disease. But, says Weiss, "Most of the other breast cancer organizations address the psychosocial issues, or they look at early detection issues, or they deal with political activism. All that is critically important, but when it comes to having a nonprofit organization that takes the medical information that's available from the research labs and hospital research sections and translates it into an understandable form for the people who need it, we're one of very few in that niche.

"We specialize in putting the medical information about breast cancer into plain English. It's all for the consumer. It's not for a zillion audiences -- the doctor, the nurse, the scientist, the patient. We also have a very big community of people holding discussion boards and connecting with each other. We've got the best professional advisory board of docs, physical therapists, nurses, and social workers from all over the world. We do things in a very respectful, down-to-earth style," says Weiss.

Risky rollercoaster

Like other physicians who have added "businessperson" to their already lengthy CVs, Weiss says she works much harder now than when she was seeing patients full-time. That may be an understatement.

"I have three very long clinical days a week, starting at 6:15 or 6:30 a.m. until around 7:30 at night, then every night and other full days, and often on the weekends, I work for breastcancer.org. I travel around the world and am constantly involved in developing new programs. ...I work a lot with the digital divide issues and try to give all women access to the information they need."

Compared to what she calls the "conventional, slow-moving" world of academia, Weiss says the business world is not for the faint of heart - nor should a decision to go there be made lightly, particularly by physicians, who tend to be unseasoned in the skills that are required for running a successful company.

"It's very risky and fast-moving. You have to be able to ride a rollercoaster and have safety belts to hold on with. People-management is a big thing I had to learn, and the leadership issues are enormous. How do you lead a group of talented people into the future, where so much -- these women's health -- is at stake? The potential gain and the impact we can make is so great. But the fundraising is so hard -- it's constant."

In addition, Weiss says, "The value system is entirely different from the academic medical practice world. There's a price tag on everything, in the for-profit business world, anyway. In the medical world, we spend so much time that's not billed for, that's given away. It's goodwill."

But Weiss continues to think like a physician who simply wants to do more for her patients -- and to lend balance to her own life. "If all you do is take care of people with serious illness all day, every day, the burnout rate is high. You need to do something to provide some creative balance, something resourceful to balance out the hardship. Breastcancer.org gives me an enormous reach beyond my own practice."

Despite having left the university setting, Weiss credits her academic background for her success and points out that the type of work she is doing with breastcancer.org facilitates the bench-to-bedside endeavors of medical teaching institutions.

"There are a lot of ways to make a difference. People at universities can do that in basic science research, in clinical research, but there also need to be people dedicated to translational medicine where you take the information out of the laboratory at the university and translate it to the individual," she says.

Changing Healthcare Delivery
Adam Singer, MD

"If you or a family member has ever been hospitalized, you understand the chaos," says Adam Singer, MD. And he's working to change that. As CEO and founder of IPC, The Hospitalist Company, Singer is leading what he calls "a sea change in the way care is being delivered."

The term "hospitalist" made its debut in a 1996 article in the New England Journal of Medicine, and refers to physicians -- mostly trained in general internal medicine, family practice, pediatrics, or subspecialties like pulmonary medicine -- who focus exclusively on caring for hospitalized patients. The benefit? Their colleagues can concentrate on office-based care, and they provide an intensive, exclusive relationship with the sickest patients.

When people are hospitalized, Singer says, "They still need someone to manage the care, manage the home health needs, talk to the pharmacy, talk to the health plan, arrange the durable medical equipment.... Somebody's got to be in charge of that." That's the role of the hospitalist, who is "responsible 24/7 for that patient and is not encumbered by other duties. That gets at better outcomes and lower cost. It's just a better way to deliver care," he says.

It appears many hospitals agree. On the Web site of the newly named Society of Hospital Medicine (formerly the National Association of Inpatient Physicians, www.naiponline.org) users can find a listing of leading institutions with hospitalist programs, including Brigham and Women's, Emory University, University of Michigan, and University of Pennsylvania. In Massachusetts alone, Singer claims, "42 percent of all beds are being managed by a hospitalist."

Most physicians who decide to go into the specialty, says Singer, are looking to relieve the strained schedules involved in maintaining both an office-based practice and doing hospital rounds. During a 10-week training program, "We train these doctors to become the quarterbacks or CEOs of each patient in the hospital who is under their care," he says. "They don't just go around and order medicine, they fix the delivery system for the betterment of that patient. Compare this to the classic delivery system where a doctor runs in in the morning, then runs to his office, and is not available for the sickest patients during the day."

Balancing act

Despite the growth of his company, Singer, who went to the Chicago Medical School and completed a three-year residency in internal medicine and a pulmonary fellowship at the University of Southern California, still operates his pulmonary practice.

"I still maintain those patients that I have a long-term relationship with and keep some office hours to see them. I feel committed to them," Singer says. "I just stopped taking any new patients in 1997. My long-term patients know what I'm doing, of course. I told them. I didn't shut down my practice, I let it dwindle down."

That he still practices medicine is a plus in his role as leader of IPC. "The fact that I practice as a hospitalist and take call really stops a lot of the conversations like, 'You don't understand what I'm doing' that employees sometimes come up with. I'm a working manager. I understand what it's like to be on call; I was there last night. It allows me to have credibility as a leader and to have a better conversation with the employee-physicians."

Straddling the worlds of business and medicine requires balance, but Singer says he will most likely eventually tip completely toward the business side. He believes that it will allow him to make a bigger difference.

"When I started [the company], I was a doctor. I could see 20 patients a day, and that's the impact I could have," says Singer. "What I've been able to achieve by applying my medical knowledge to business is building a better enterprise where everybody wins. I feel like I still am a doctor as a CEO -- I'm just executing that care through several hundred doctors who work for me. The role is just a little different."

Reaching Minority Patients
Hilton Hudson II, MD

When it comes to juggling a full-time cardiothoracic surgery practice and running a growing publishing company, Hilton Hudson II, MD, relies as much on the talents of others as on his own drive. His overarching goal is lofty: "To make sure that all aspects of the practice as well as the publishing proceedings are perfect."

Achieving perfection, says Hudson, requires "a real good team -- not just my medical team, but just as importantly my publishing team. I surround myself with superb people."

Hilton Publishing was established in 1996 "as the only national publishing company that does minority health books and pamphlets for lay people," says Hudson. Titles include High Blood Pressure: The Black Man and Woman's Guide to Living with Hypertension; Hope and Destiny: A Patient's and Parent's Guide to Sickle Cell Anemia; and Saving Our Last Nerve: The African American Woman's Path to Mental Health.

There is a great need for such targeted patient education materials, says Hudson. "There is such a disparity when it comes to reading material on minority health in general, especially directed toward the lay audience. Minorities and Latinos are the fastest-growing sectors in the United States, especially when it comes to medical needs. Millions of dollars are poured into it." Unfortunately, he adds, diagnosis and treatment of diseases often fall short among these patients. For example, the Kaiser Family Foundation recently released findings of studies from 1984 to 2001 examining racial and ethnic disparities in cardiac care. Eighty-four percent showed whites were more likely than other groups to receive appropriate care.

Responding to that, Hilton Publishing operates under three simple objectives. "Number one is educating minorities," says Hudson, "taking a no-excuse approach: 'This is what you need to do and can do to better control your health, your outcomes, and your life.' Number two is to make the books medically accurate and superb and also culturally sensitive and relevant. Last, to make the books easy to understand and navigate."

Hudson adds: "We're not a vanity press. In order to get Hilton Publishing's seal on it, it has to be peer-reviewed."

The company's materials are distributed directly to the consumer through retail and government channels and via partnerships with pharmaceutical companies, community health organizations, and churches. "We are at every major bookstore, majority- and minority-owned," says Hudson. There is also a burgeoning not-for-profit arm, The Hilton Minority Health Foundation, whose objective, says Hudson, "is to act as a clearinghouse to get health information for minorities from all across the country -- so if we don't write it or print it, we find out who does and we will be distributing [it]."

Community allegiance

Hudson says he spends the vast majority of his time running his practice and performing 150 to 200 cardiac surgeries a year. He completed his training in cardiothoracic surgery at Ohio State University and has been practicing almost nine years.

When he wears his publisher's hat, he's "mainly in charge of the editorial calendar, developing topics, and maintaining relationships with other doctors that need our books," he says. "Everything else -- from finance and accounting to contracts and writing, peer review, book production, and sales -- is run by other people. I think it's the best way of running a business." Hudson believes new businesspeople make the mistake of trying to be "the manager, the secretary, and the accountant. That's why businesses often fail. Something's got to go." At the beginning, he admits, he made a lot of mistakes. "My biggest growth period was learning that I can't do it all."

Of his two-career schedule, Hudson says, "I just work harder and longer - and you can, if you have a team that can do the other stuff." And he believes that by expanding his focus to include medical practice and business, he is "able to be a better doctor. When I use my talents as a physician in other ways and those other ways are satisfying, then I can really concentrate on being a surgeon and not getting into the political arena, and the pressure is off financially."
Hudson also believes that what he's doing in the business world benefits the larger medical community.

"Anything that helps the public image of a physician -- a good physician -- is going to help the local hospital also," he says. "It increases public awareness, it helps to attract and retain good people. Patient education is always a missing link; doctors don't have time, or don't take the time, to talk to patients. It's just an added touch that, if used and marketed the right way, health systems benefit from. Patients want to come to you. I've had patients [travel] to me because they read a book, or they knew of me. If health systems promote [physicians'] growth, they're really promoting the growth of their own institution that way."

Extending the ED Walls
James D'Orta, MD

If James D'Orta, MD, had just one interesting biographical fact to tell a stranger, it might be that he was the first volunteer firefighter and paramedic in New York to become a doctor -- and likely the first physician to be named an honorary fire chief, too. As unusual as that may sound, it makes sense when you view his career path from a wider angle.

"I've had a passion for emergency medicine and pre-hospital care for many years. When I lived in New York, I was part of the Garden City Park Fire Department, and they allowed me to enroll in the first paramedic class at Beakman Downtown Hospital in New York City," D'Orta recalls.

"I was at Pace University in downtown Manhattan, right across from the hospital, so I was exposed to that pre-hospital care, the ED and EMS, while I was in college. I originally entered college to go for a business degree, but found as I got more involved in medicine, the idea of going into medicine became paramount. After my graduation from medical school in 1981, I was made honorary fire chief for Garden City Park, Long Island," he says.

D'Orta then entered into a conjoint residency between Georgetown University, George Washington University, and University of Maryland Shock Trauma, where he graduated in 1986 as a board-certified emergency physician. One recurring experience during this time put him on a path that eventually led to his current life as a physician-turned-businessman.

"It was pretty tragic to see so many people die of cardiac arrest prior to coming to the hospital," he says. "It's a staggering statistic to think that over 300,000 people die of this -- that's about 1,000 people a day. The reason they died was because they weren't defibrillated, or shocked, early enough. It's almost impossible to get an ambulance to someone within that crucial four minutes. This was very disturbing. So I became very interested in how to deploy these defibrillators into the commercial and consumer space to decrease the morbidity and mortality of sudden cardiac arrest."

That interest is now his vocation. D'Orta is full-time chairman and CEO of LifeLink MD. The company, he says, is the support services and fulfillment provider for automated external defibrillators [AEDs] throughout the U.S.

"What we found was that if the defibrillator can be distributed to the community we would decrease the [mortality rate]. So we set up a nationwide network of board-certified emergency physicians and cardiologists to serve as the community overseers for AEDs and the protocols and all of the FDA requirements to allow the lay person or corporation to have these in their office buildings, on airplanes, or in schools."

The company now has 160 such physicians nationwide and well over 15,000 defibrillators installed in various public places and institutions.

For D'Orta, getting out of the day-to-day pressure cooker of emergency medicine was necessary for his long-term peace of mind. "I do not believe that I would be effective as a clinician in the front line of an emergency department after 10 years," he says.

"You become overwhelmed doing 60 hours a week in that intense kind of practice. You have to recognize when you enter into emergency medicine that you need to exit emergency medicine as a clinician. And there are only a few avenues in the traditional world that you can exit under."

But he didn't want his exit strategy to be the end of his days in the medical world -- or of helping people. He sees running LifeLink MD as a way to "extend the walls of the emergency department ... and bring the patient into the ER alive." 

Shepherding a New Science
William Li, MD

Whether illustrating scientific textbooks during his undergraduate days or overseeing a research foundation today that is "advancing medicine by shepherding a new science through...to become practicable, everyday treatments for patients," William Li, MD, comes from what he calls "an inspired background."

"I have always had a lifelong entrepreneurial drive," says Li. "Throughout my premed, medical education, and training, I have always been involved in creative, entrepreneurial activities involving business areas that are either not related to medicine at all, such as graphic design and architectural restoration, or those that are highly related to medicine."

While at the University of Pittsburgh Medical School, where he graduated in 1991, Li took two years off to complete a full-time surgical research fellowship in the laboratory of Dr. Judah Folkman, the renowned medical researcher often called the "Cancer Warrior."

According to Li, "That's very relevant to where I am now."
These days, Li is president and medical director of the Angiogenesis Foundation, a 501(c)(3) nonprofit organization based in Cambridge, Mass., whose mission is "to improve health by facilitating the development of an entirely new field of medicine based on angiogenesis, or medicines and technologies that can restore health by controlling the blood supply," says Li. "That's where Dr. Folkman fit in because that's an area he founded.

"During my training in his laboratory, I had a firsthand view of how tremendous scientists could generate groundbreaking research that could reach all of the major scientific journals," he says. "But translating that into a practical treatment that could reach patients really was an enormous gulf that involved more than just research and clinical testing, but a whole host of issues -- regulation, industry, competitiveness, innovation, funding."

Li says he began to focus on bridging the gulf between the lives of real patients and the groundbreaking medical research being conducted in angiogenesis so that the scientists' work would truly have meaning for the end user. "In other words," he says, "how do you make angiogenesis a household word for the patient?"

Offering patients more

Even during his days as a practicing physician, Li was thinking about how he could make a difference in the "bigger picture" of medicine.
"I practiced for three years, until 2000, at the Veterans Administration in Manchester, N.H. My role there as an internist included both a primary-care practice as well as inpatient care and teaching of residents from Harvard Medical School and Dartmouth. Also, for one year I ran an emergency room and served as an attending physician in the medical intensive care unit," he explains.

During this time, Li had set aside time to devote to the work of the Foundation as well -- but there came a point at which he had to make a decision about where his energies would be focused.
"I absolutely loved seeing patients," says Li. "I enjoyed learning and developing the relationship with the patient. But I also felt strongly that I wanted to do something on a larger level."

In moving to that larger level, Li began looking at the end-goals of treatment -- and the approaches used to get there -- a little differently. "The practice of medicine is to repeat the best of what is already known over and over again. In some ways, that is antithetical to inventing new approaches to medicine, which is what I was excited about," he says. "Rather than treat cancer by using chemotherapy drugs, can we convert cancer into a chronic disease by using safer drugs that don't target cancer cells directly, but starve them of their blood supply?

"I recognized that the traditional excellence in science is by developing specialization -- you find what makes disease processes different from one another. I became interested in what makes diseases the same. What do they share? Angiogenesis is one of those common denominators."

Of his career, Li says, a common theme has been moving forward, a "gradual, consistent evolution" -- which included the decision to leave medical practice for an endeavor he believes in. Part of his decision "comes out of the fact that modern clinical medicine -- the bread and butter work of practicing physicians -- really has become all-consuming. Even in the academic setting, which is where I come from, the concept of being the 'triple threat' -- the teacher, the clinician, and the researcher -- has become widely acknowledged as difficult, if not impossible, to achieve or maintain successfully."

Still, Li cautions that making such a career move should not be done lightly or without forethought. "Going into a nonprofit was not for a profit motive. I didn't leave because I didn't like practice," says Li. "I had a good dialogue and explained to my patients why I was leaving. They supported me, my colleagues, my mentors, and my family supported me. I feel very good about what I do."

Joanne Tetrault, director of editorial services for Physicians Practice, can be reached at jtetrault@physicianspractice.com.

This article originally appeared in the July 2003 issue of Physicians Practice.