One Doctor's Entrepreneurial Quest to Reinvent Medicine
All great entrepreneurs feel lost at some point. For Jordan Shlain, it came on a hot June day in 1998, as he wandered up Montgomery Street in San Francisco. He just needed to walk. Shlain was at a turning point: He had just lost (actually quit under duress…) his job, yelled at the person that he had hoped would be his medical mentor and angered his father (also a doctor), who was furious with him for blowing up a lucrative, straightforward career path. But Shlain gathered himself and decided to go into the Mandarin Oriental hotel for a cup of tea—a cup of tea that changed his life.
A year earlier, Shlain had agreed to serve as an always-on-call, entry-level doctor for an older doctor who agreed to transition his practice when he reached his planned retirement. He spent the next 11 months on call every night and threw himself into advancing the practice with the promise that at the end of that year he would have a solid base of patients from which to build a business. The retiring doctor changed his mind in the 11th month, and Shlain felt duped.
So he immediately quit and several hours later sat at the table stewing. There, Shlain noticed the steady stream of well-heeled hotel guests approaching the hotel concierge in the lobby. Curious and confident, he walked over to the head concierge and did what all burgeoning entrepreneurs do—he asked a question.
“Who do you call when a guest gets sick?”
Just hours after losing first job out of residency, Shlain was looking for a problem to solve. The concierge on duty, Charisse Fazzari, looked at him like he was from Mars.
“And who are you?” she asked wryly.
“I could be the doctor who takes care of your sick guests,” he said.
For starters, he did not look old enough to be a doctor. And it seemed a bit presumptuous and bold to infer that he could serve the needs of her five-star hotel’s paying guests. “Everything we do, we do our best to make it five-star service—top, top service is a must,” she explained to him.
Fazzari, who 20 years later is a key member of Shlain’s multifamily office for health and medicine, Private Medical, says “he kept asking smart questions, and he seemed earnest and open to feedback, so I agreed to have tea with him to discuss what my guests needed. High-quality healthcare was a top priority for my guests, and I was always looking for ways to ease the difficulties of dealing with medical issues while traveling. I had no idea that he was a rookie, but in retrospect I think it allowed him to think differently and to approach problems differently. I also did not realize then that he was a great practitioner and a relentless fixer.”
Shlain turned his initial question to Fazzari into a business, San Francisco On-Call Medical Group, that grew to $3 million in revenue in three years. When I met Shlain at a dinner party hosted by my friend Giuseppe Taibi, I was struck by his approach and how much it differed from the norm. I came to understand that he not only views medicine through the lens of an elite concierge, but that he has infused that approach as religion into everything he does. As a parent and someone who has helped people deal with cancer diagnoses over the years, l have had to navigate the current medical labyrinth. I have not run into any practitioners who live by this credo except for Shlain. In starting his new business, his approach borrowed liberally from a concierge approach and was relatively simple:
- Listen more than you talk
- Follow through relentlessly until customer joy and the desired outcome is achieved
- Always be available
- Be well dressed and put together
- Anticipate rather than react
In short, outperform all other medical providers by “out-caring” them and by creating environments that lead patients and their families toward healing and peace of mind. “Just as software startups maniacally look to pull friction out of user experiences, from the beginning, we pull tension, fear and anxiety out of the medical experience—from symptom to diagnosis to treatment,” Shlain says. “It is really hard to heal when stress is part of the equation. Traditional medicine asks, ‘What is the matter with you?’ We ask, ‘What is the matter with you, and what matters to you?’ Personal outcomes are all that really matter.”
Most traditional doctors were amused by him, but he did find a tribe of caregivers who felt the same way. They lived, breathed and slept that philosophy. As a team, they internalized it, held one another accountable and the business grew rapidly—eventually serving over 100 businesses. Then Sept. 11, 2001, happened, and the stock market crashed. People stopped traveling, and the business imploded within months. Shlain had to start over yet again.
Once again, he found himself sitting alone—having laid off all but one doctor and one staff member—this time in his large Union Square office, when the phone rang. A man asked if he was taking new patients who lived in San Francisco. The man on the phone was the executive assistant to a high-profile Silicon Valley entrepreneur that Shlain had helped out in a pinch at the Mandarin Oriental hotel years ago. Now that executive had moved to San Francisco and wanted to know what the annual fee for the practice was.
Shlain didn’t have an annual-fee mode, but quick on his feet, he told the gentlemen on the phone that his annual fee was five figures for an “all in” membership practice, which meant no other fees for doctor visits, phone calls, texts or emails.
Although his business has just crashed, Shlain stayed true to what he had learned: Focus on a quality experience for patients as they traverse the anxiety laden healthcare system. But could he rebound and build a scalable business around that core tenet?
“This was a hard time for me,” Shlain says. “Having to start over again was daunting, yet I had the vision and core belief system that integrated expertise, humanity and humility. I had a vision for a new, relationship-based business as opposed to the transactional house call business. The traditional medical system forces doctors to mostly serve as transactional brokers and sadly forces patients to navigate a byzantine medical system, all while dealing with illness. My pediatric partner, Dr. Yan Chin, and I internalized that one size does not fit all and that medical guidelines were just that, guidelines. They were not a monolithic commandment. We knew that our success would be to focus on patient outcomes and their overall healthcare experience. We were determined to rebuild and grow something new but work at a speed that guaranteed quality, not quantity. We were compelled to take care of entire families.”
Shlain realized that finding the right doctors to join his team was key. He looked for quality-centric caregivers with the following traits:
- 7-10 years experience
- Pedigree in their college, medical school and residency mix
- Exemplary problem-solvers
- Empathy in everything they do
- Team players
- Detailed list makers and excellent at follow-through—no detail is allowed to fall through the cracks
- Great communication skills
Shlain’s team next dove into reinventing every interaction. They paid particular attention to the anxiety that accompanies a visit. He uses communication architecture as his secret sauce.
“An interaction with a doctor has historically been no fun—it’s filled with anxiety,” Shlain says. “We identified every step that caused anxiety and worked to eliminate it, if at all possible. For instance, we never deliver bad news electronically, and when we did send good news, we made sure to put ‘Good News!’ in the subject line. When people visit the doctor, they are at their most vulnerable. They need a trusted advisor and a health advocate who is focused on their needs 100 percent of the time in every interaction. It’s hard to advocate for yourself when you’re sick.”
Shlain’s key insight is to honor anxiety by being every patient’s “health fiduciary,” a simple but powerful formula that is found only sporadically on the medical landscape. He and his team at Private Medical have built a new model for the delivery of primary care.
The Enemy: Incrementalism
The current medical system strives for efficiency—providing incremental solutions that move patients through the system as quickly as possible. Incrementalism seems to remove the human element of finding the right individual outcomes for patients.
“Above all else, medicine and the healing arts are a human profession. I am 75 percent doctor, 10 percent psychologist, 10 percent priest, 4 percent bartender and 1 percent friend. We really try to look 10, 20, 40, 50 years down the road for the patient. Physiology and pathophysiology are very predictable, much more so than markets. If we tended to our health asset the same way we managed our investments, we would all be amazed at what the data and risk models for health show. People’s eyes get really wide when they can realize how much vitality and lifespan they can achieve by making small adjustments.”
My time with Shlain made me realize that there is a lot of money to be made by letting people die slowly by patching things up over and over again instead of fixing them. It feeds an ever-growing medical industrial complex that shows no signs of slowing. I am encouraged by Shlain’s team’s relentless entrepreneurial approach. I am also encouraged by the simplicity of emerging smart tools like my friend Jeanne Pinder’s ClearHealthCosts, which lays bare wildly different pricing for the same services—an inherent problem that the system has created and must fix. Insurance has become a hedge against bad things in a marketplace where middlemen are the only guaranteed beneficiaries.
There are other entrepreneurial solutions out there like Eat REAL, the not-for-profit Shlain and his colleagues started to combat what he calls the “metabolic food terrorism” being thrust on the masses. We need more thoughtful approaches as fast as we can find them, or more pointedly, as fast as medical practitioners can create them.
Looking Back to Go Forward
After graduating from UC-Berkeley, before his medical training began, Shlain spent 10 months in a remote Kenyan village without electricity or running water teaching high school biology in Swahili. He watched women walk miles with huge jugs and containers that they used to collect and transport water. Their trek was long and tiring, and upon arrival the wait was extremely long, yet they persevered weekly to ensure that their family’s needs would be met. In his fifth month, they installed a completely novel and foreign object: a water spigot with a faucet in the middle of a field. He discovered that the women only had the spigot 1/4 of the way open because they have never tried to turn it more. When he raised his amazing insight with an elderly woman, she shook her head.
“What’s the rush?” she said, “This water represents work: cleaning, cooking, laundry, bathing and this is social hour for us…why would we want to speed this up?”
Jordan’s western belief system that faster is better was shattered. When he reflected on this conversation now, Shlain realizes, “It was my first lesson in quality over efficiency. I only truly understood it years later.”
Jordan’s patients are happy the lesson was remembered. It is an entrepreneurial insight that deserves scale in the most important of fields.