From the Operating Room to the Board Room

Gates Merriman is a former Associate at Oxeon Partners, having recently left the firm to pursue a medical degree from the George Washington University School of Medicine & Health Sciences. While at Oxeon, he became intent on learning more about doctors who made the move to business. To that end, Gates spoke with Oxeon placements and clients Russ Richmond, CEO of Advanced Practice Strategies, and Bill Kerr, CEO of Avalon Health Solutions. As former practicing physicians, they shared their insights into the ways they understand impact, care, and the value of a medical degree in their careers. Gates can be reached at jgmerriman@gwu.edu. “That is not enough. You need more pressure.” I’m reluctant. I’ve used a power drill before, but never to get through a shinbone. My expertise with the tool to this point has been limited to hanging curtain rods. Despite a generous helping of local anesthesia, the patient is getting uncomfortable, and I along with him.

“More!” implores Dr. Bvuma, and suddenly the sound of the drill shifts from a distressed churn to the high-pitched whir that lets me know I’m through the tibia. I look sheepishly at the patient and for some reason give him a thumbs-up, as though I’m complimenting him on a golf shot and hadn’t just drilled a metal rod through his leg. I wouldn’t particularly blame him if he took a swing at me, but instead he nods and smiles and after setting up his skeletal traction, I smile too. I know that after the pain of recovery, I will quite literally have had a hand in improving this man’s life. And this is at the core of why I am leaving Oxeon Partners and going to medical school.

It is also at the core of my internal dialog about whether I may be making an irresponsible decision. If my goal is that the sum of my daily efforts amounts to preserving and optimizing the health of others, am I going about things all-wrong by pursuing an MD? Am I maximizing my usefulness to others?

If there’s one thing I can take away from my tenure at Oxeon Partners, it is that the responsibility of caring for patients extends far beyond the clinicians on the front lines of medicine. My job as an Associate is to connect with and recruit talented executives to lead healthcare organizations that touch thousands of lives, if not millions. In all, the executives that Oxeon places are able to drive impact on a remarkably grand scale. And if the goal is impact, does it matter if it is direct or indirect?

So I find myself firmly entrenched in a utilitarian quandary. Fortunately, I’m not the first to face this. The healthcare IT and services space is not lacking for former practicing physicians who have made the move from the clinic to the C-suite. The question of impact was underscored in a recent conversation I had with Russ Richmond, CEO of Advanced Practice Strategies (APS) and a physician himself. In discussing his progression from practicing medicine to trying to revolutionize the way it is learned, he reasoned, “it doesn’t take much time practicing to know there is a real role to play in the laying on of hands, which is really an incredible thing. But then, it’s also a much less leveraged model.  In my current role I think we are impacting hundreds of thousands of people, more people than I could ever see if I were practicing.”

It was no sooner that I hung up the phone with Russ than I got an email from my future medical school, George Washington University, outlining the anticipated cost of attendance for my first year. After retrieving my jaw from the floor, I began to understand what Russ had meant when he described the decision to leave medicine as the hardest he has ever made. The level of mental, personal, and financial commitment necessary to complete a medical degree is staggering, and it’s hard for me to imagine putting forward that investment and then changing gears.

In hearing Russ’ story, however, it becomes clear that the path of the doctor and that of the healthcare executive are anything but separate. His experience as a medical student and a resident in Internal Medicine and Pediatrics is intertwined with the efforts he currently spearheads at APS:

Even as a medical student and a resident rotating around clinics and different parts of the hospital, one can see how differently medicine is practiced in different areas. We know now that there shouldn’t be variation in many instances; that is bad care. Medicine is moving from the guild-based model where physicians had latitude to practice in varying ways to much more of a professional service that has standards and has a best way. The secret to that is education, you have to know what is the right way to practice. You can incentivize all you want and pay people differently, but at the end of the day there should be a standard and people have to understand what that standard is. At APS we think that we can elevate the practice of the craft of medicine by educating around the standard and supporting physicians to achieve the highest levels of mastery of what they do.

Bill Kerr, CEO of Avalon Healthcare Solutions, entered medicine with the same aim: to make physicians’ lives easier. The son of a doctor, Bill grew up working summers at his father’s practice and experiencing first-hand the hard work and complexity inherent in a medical career. To that end, he was methodical in his approach to gaining exposure to various aspects of the practice of medicine.

Bill relayed to me a particularly poignant anecdote that was instrumental in shifting his focus from research and individual patient care to a macro, systemic concern. While training in pediatrics, he found himself charged with the care of a six-year-old girl with liver cancer. Compounding the difficulty of her medical condition was the fact that her parents had entered the US illegally from Mexico in search of better care for their daughter. Bill could treat her as an inpatient and her treatment was covered by the state, but when it was time to discharge her, his hands were tied. “I had to explain to her parents through an interpreter that nobody would treat her in the outpatient setting because there was no funding available. Let’s be clear, she had a tough disease, but there were therapies that one could give. For her parents to say  ‘but my daughter is going to die’ and have to tell them ‘there’s no one to pay for care--therefore nobody will give it,’ I started to realize that it’s not just ignorance of disease that goes into the limitations of what we can do. I started to realize that every day there are literally millions of people struggling to balance cost, quality and access in our delivery system and our healthcare financing system."

Bill began practicing as a primary care physician while realizing he was not going to be a career clinician. He followed by getting his MBA, and then entering the managed care world to gain a better understanding of the system that he had set out to improve. In 2013, after holding executive roles of increasing responsibility at BCBS Florida, WellCare, and CareCentrix, Oxeon recruited Bill to be the CEO of Avalon Healthcare Solutions. Avalon significantly impacts laboratory spend for payers and employers by eliminating unnecessary and redundant tests, optimizing the network, and proactively identifying medically appropriate tests that are currently underutilized in order to improve clinical quality and outcomes. Through its comprehensive suite of laboratory benefit services, Avalon enables providers and patients to navigate an increasingly complex and clinically challenging testing landscape.

While my tendency had been to think of the difference between the clinical and the business side of healthcare in terms of patients, Bill presented the contrast in other terms: patience. "Patient care has a very short feedback loop and almost all of it is very gratifying, and that is a pretty satisfying way to spend your time. When you move into larger scale operations, whether it is research or a business, the feedback loops are much longer.  So you have to be able to practice delayed gratification."

At this stage in my career, I think back to that patient's weary smile and it drives me to develop both the technical and personal skill to impact patients’ lives as directly as possible. I hope for a career where I can be of service to people at the critical moments of their lives. For now, I want to impact one patient at a time, but my experience at Oxeon and the conversations I’ve had with great executives like Russ and Bill have opened my eyes to the multitude of avenues to improve care. Both Russ and Bill began with iterations of that same notion of human connection and had the flexibility to let their goals evolve through the course of their careers. Through their respective recognition of immense opportunity, entrepreneurial drive, and a passion for leveraging clinical expertise to conceive innovative solutions, they’ve stayed true to a simple objective: helping people.

So here I sit, packing my bags for a move to Washington D.C. I feel incredibly grateful for the world to which I’ve been exposed while working at Oxeon and excited to know that if I can make it out the other side of medical school, I’ll be entering a field where impact in medicine is now understood in more creative ways than ever before.