Amanda Angelotti (left) and Connie Chen (right), both graduates of UCSF's medical school, made the transition to digital health.

Amanda Angelotti (left) and Connie Chen (right), both graduates of UCSF's medical school, made the transition to digital health. (Josh Cassidy, KQED )

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Even as a young child, Amanda Angelotti dreamed about becoming a doctor. Five years after graduating from college, she enrolled in the University of California, San Francisco medical school.

But by her third year, Angelotti couldn’t shake the feeling that something was missing. During a routine shift at the hospital, making rounds with her fellow students,  Angelotti said her thoughts kept drifting.

“I was supposed to be focused on the patient’s vital signs and presenting a summary, but I was consumed with thoughts about how to improve the process of rounds,” she said. Most striking was the patient’s absence from the discussion. “I kept asking myself, ‘how could we change things to involve the patient more?'”

Just a stone’s throw from UCSF Medical Center, a small group of entrepreneurs at Rock Health, a new accelerator program (and now a venture firm), were thinking about how to shake up the health care process with technology. These startups were developing new wearable devices and mobile apps to help patients take more control of their own health.

Amanda Angelotti and Connie Chen developed a passion for digital health while at medical school 
Amanda Angelotti and Connie Chen developed a passion for digital health during medical school (Josh Cassidy, KQED )

The timing was right to bring new ideas to the sector. By 2012, hospitals around the country were rapidly moving away from paper-based medical records to electronic systems, a first step to moving health care into the digital age.

Angelotti graduated the following year, but she did not apply for any residency programs at U.S. hospitals. Instead, she applied to work at Rock Health as a researcher and writer before joining the new medical review site Iodine, one of an exploding number of digital health startups in San Francisco.

By the end of that year, Rock Health projected that digital health funding had exceeded $1.9 billion, a 39 percent jump from the prior year.

The Rising Tide of Doctors Turning to Entrepreneurship

Angelotti is far from alone in making the leap from medical school to digital health.

Students from around the Bay Area and the country are increasingly dropping out of residency programs and instead going into careers in high-tech start-ups.

“We’ve seen that many of these Bay Area-based medical students are drawn to startup opportunities — it used to be biotech, and now it’s more often digital health,” said Jeff Tangney, CEO of Doximity, a physician-network that generates data for the U.S. News Best Hospitals rankings.

Tangney said many of the top digital health companies are more than willing to hire new grads straight out of medical school, who lack years of clinical experience.

Dropout doctors are well-positioned, he added, for a career in digital health as they have an insider’s view of the industry — and ideas about how to fix it.

 

Harvard Medical School dropout Sean Duffy addressing a group from Kaiser Permanente
Harvard Medical School dropout Sean Duffy addressing a group from Kaiser Permanente (Omada Health )

As Sean Duffy, the CEO of Omada Health and a Harvard medical school dropout put it: “I wanted to understand what’s in the trenches, so I could redefine the trenches.” Omada Health offers an online program to help people change their behavior and avoid the onset of diabetes.

Duffy is part of a private Facebook group called “dropout doctors,” which includes some of the biggest names in digital health. It functions as a support group, of sorts, and meets every few months for dinner or drinks. Some members, like Angelotti, said they find solace in the group as it can be difficult and lonely to opt out of clinical medicine and follow a different path.

The membership includes Angelotti, who now works at primary care chain One Medical; Duffy, CEO of Omada Health; Connie Chen, the cofounder of  Vida Health; Shaundra Eichstadt, medical director at Grand Rounds; Abhas Gupta, a health-focused venture capitalist with the firm Mohr Davidow; Molly Maloof, a medical advisor to DoctorBase; and Rebecca Coelius, the director of health at Code for America.

‘I Never Thought I Would Leave Medicine’ 

Experts say it’s both ‘push and pull’ effect that is motivating young doctors to seek out opportunities with the growing intersection of technology and health care, rather than pursue brick and mortar medicine.

Many of the students at the top Bay Area medical schools, Stanford and UCSF, are exposed to entrepreneurial thinking during the course of their education, which can be a major draw.

“I never thought I would leave medicine,” said Eichstadt, who now works at Grand Rounds Health, a San Francisco-based startup that helps patients access second opinions from top medical experts online. “But there’s such a rich opportunity at companies here.”

Dr. Shaundra Eichstadt made the transition from medicine to digital health.
Dr. Shaundra Eichstadt made the transition from medicine to digital health. (Shaundra Eichstadt )

Eichstadt graduated from Stanford and pursued several years of residency, specializing in plastic and reconstructive surgery.

“I realized that the system isn’t designed for doctors to make the real change you would like to for the patient,”  she said.  Eichstadt said she believed that she could make a bigger impact elsewhere.

Many of the dropout docs expressed a desire to improve the doctor-patient experience. In interviews with KQED, several said they spent very little time administering care during medical school, and they felt that patients were too often kept out of the loop.

A recent study found that doctors-in-training spend an average of just eight minutes with each patient. This is a drastic decrease from previous generations and is linked to more record-keeping requirements and restricted on-duty hours.

Connie Chen still practices medicine a half-day each week. But shortly after medical school, Chen co-founded an app called Vida, which connects people with chronic diseases to virtual health coaches, like nutritionists and nurses.

Chen said she  learned very little about nutrition at medical school. But digital health opened up opportunities  for Chen to educate herself about wellness, so she can help patients stay healthy.

“Traditional health care is really oriented to make the life of the provider easier,” she said. “Your patients cycle in and out of the hospital, and very often, no one makes enough of an effort to communicate with them.”

Lack of Opportunities 

Other dropout docs said they felt pushed out of medicine, due to the lack of career opportunities or earning potential. Family practitioners, who serve at the front lines of health care, are paid the least.

Recent studies have also shown rising levels of discontent among primary care doctors. Nearly half of 7,200 doctors who responded to a Mayo Clinic survey in 2012 said they felt a lack of enthusiasm about medicine or cynicism about it. A decade ago, one quarter of doctors reported feeling burnt out.

“I loved working with patients but I looked around me and realized that I didn’t want the jobs of anybody who had ‘succeeded’ as a clinician,” said Rebecca Coelius, who graduated with an MD from UCSF.

Coelius now advises a number of health-tech startups, including Doximity and previously worked for HealthLoop, which was founded by another entrepreneurial MD, Dr. Jordan Shlain. She’s also worked for the government as a medical innovation officer.

“Tech culture is very appealing when juxtaposed against the hierarchy and myriad hoops to be jumped through in clinical medicine,” she explained.

Correction: An earlier version of this article contained data from Doximity on the percentage of Stanford and UCSF medical students applying to residency programs. Doximity says it failed to factor in medical school graduates who pursue further post-graduate studies and that the Stanford information it provided was inaccurate. Stanford officials say Stanford has a 95 percent rate of medical students pursuing residency after graduation.

Bay Area Doctors Quit Medicine to Work for Digital Health Startups 24 July,2015Christina Farr
  • Chris Stewart

    I have to chuckle a little reading lines like “insider view to medicine”. I can tell you from first hand experience that to truly gain an insider view you need 2-5 years post RESIDENCY experience to truly understand patient/medical care delivery issues. Sticking around another 5-7 years post medical school will only help these talented individuals to be significantly more impactful.

    • Dr. Laura Davies

      As someone who also went to medical school at LAC-USC (which is much more “real” than UCSF, where I did my residency), I wholeheartedly agree with Dr. Stewart.

    • fismat

      Totally agree. Medical school just teaches the language of medicine. The true study of the literature, as it were, takes place in residency.

  • David Konerding

    The premise that doctors who don’t see individual patients, and work on digital health aren’t doing medicine is false. If I were a doctor I would never see an individual patient- the opportunity to have a larger impact requires stepping back from individual patients (I know many doctors who would disagree vehemently, but I believe that’s due to their individual patient bias)

    • David B. Karpf

      I understand what you are saying, but when you or your partner or your kid is admitted to a hospital in severe distress, I assure you that you will want a well-trained physician who cares for “individual” patients. Just sayin’….

  • ER

    This article is a bit vague about exactly what these “dropout doctors” are doing, other than “developing apps and wearable devices”. May I suggest a “day in the life” following one of them around and noting what they are doing? Otherwise, it sounds like they are working for a tech company or two, without really telling us how what they are doing is improving health care.

  • Joe Chang

    A similar thing happened during the first internet boom in the late 90s. Many of my friends put med school or residency on hold to join startups. Once the bubble burst, every single one of them went back to medicine. So there’s actually not much to worry about here. If digital health startups do well, then we won’t need as many doctors as technology will give us more leverage per doctor. If they don’t, they’ll just go back to practicing medicine.

    One interesting thing that I found interesting regarding the tech culture thing. Many of the MD folks I’ve known that have tried to go into tech have actually struggled with the reduced hierarchy. They weren’t used to having anyone but fellow doctors question them and had troubles dealing with others challenging their expertise or authority.

    • fismat

      Perhaps that used to be the case. Today’s docs are part of “integrated health care teams” and are much less likely to be hierarchical. Or so it seems.

  • Edward Fotsch

    This is the equivalent of housewives buying investment real estate in 2006- ‘a grossly over-hyped market. Not sure what these kids will do when the VCs pull the plug on their health IT start-up… except learn about markets the hard way.

  • Gregg Masters

    I may be old school, but that sucking sound of docs into digital health who lack or present with limited clinical experience may be a fatal blow to the materiality of digital health’s upside. We already have direct practice and concierge medicine tapping the declining corps of primary care physicians, not to mention the billions of dollars invested in graduate medical education to assure the best and brightest minds continue to serve. This ‘diversion’ may simply enable otherwise talented and capable ‘docs’ to exit the system, tap the target rich low hanging fruit, and return cash to risk bearing investors but add little systemic homeostasis to our collapsing house of cards healthcare system, aka ‘the borg’.

    Some of these digital health innovations may produce material changes in workflow, favorably impact health status, drive improved experiences of care, and even the quality of life for clinicians (the so called triple aim plus 1), but we’re early in the game and much innovation to date is hardly earth shattering. At mhealth Summit in 2013 the talk was of the ‘validation decade’. The time to demonstrate value is now….

    There is something to be said for paying ones dues. Denying privileges on a credentials committee, serving as Chief of Staff, forming an IPA, MSO or PHO, vetting and building preferred specialty referrals networks or slogging through complex relationships with institutional healthcare providers (hospitals) or configuring value amidst the disorganized long term, post acute care ecosystem are just a few.

    Look I know many of these talented MDs (who woulda thought that an MD would NOT mean ‘a real doctor’/), they’re smart and obviously making life choices. I do NOT walk in their shoes, so I can not judge. But I think this is an impending disaster and a rip off of tax payer funded medical education.

    Who knows, I may be wrong here. But in the bottom half of the 1st inning (at best) in the digital health revolution (code for tech as the holy grail to save dysfunctional medicine), I doubt near docs (MDs who bail) will have ZERO credibility with the clinical peers.

    Just sayin….

    • Sarah Collett

      If it’s “taxpayer funded medical education,” why do I get so much mail from FedLoan? Just sayin…

      At least these individuals stayed in the medical field. My “education” was a $20k lesson of why I don’t trust “modern” medicine (and I read med news & info for fun). I graduated with honors and passed certification through AMA on 1st try. But in my opinion, my CMA is more valuable as kindling or toilet paper.

      One last point – most MDs (established) are quickly losing credibility with their patients. Patients are tired of the runaround, specialist bounce (pass the buck), being forced to endure expensive testing & med roulette to never get any real answers or truly helpful help. Today’s medicine is like trying to cure a volcano with a bandaid.

      • Gregg Masters

        Data brokers? Everything is for sale, fwiw. 7 milliseconds after you buy, like, search or engage in digital your preference data is sold, aggregated, data mined and used to sell you more shit you don’t need. There are plenty of distruptors making a difference inside the belly of the beast. Yet, the allure of digital health ‘promise’ is compelling and as I’ve said, this is target rich environment with low hanging fruit guaranteeing early ‘niche exits’, generating a new class of rich entrepreneurs and while adding little if any value to a collapsing healthcare ecosystem. The VC community MUST look at and seriously re-evaluate their investment thesis and first and foremost ask whether the disruptive tech, platform or biz model creates sustainable community benefit or merely enables a ‘see you later sucka’ exit.

        • Dr. Paul Mozen

          As someone who spent 25 yrs practicing solo primary care medicine, I got to witness the ‘digital revolution’ from it’s inception. I completely agree that Hierarchy and ultra-specialization is at the root of the dysfunction in medicine. I also witnessed the slow and inexorable change from a primary care dominated system (when I first started) to a specialty dominated system. All the Docs who saw the huge income differential went into specialty’s 30 yrs ago. We now have a system that is top heavy. I believe the answer is to get the primary care Dr back to his rightful role as director of care.Otherwise every headache will get an MRI. Digital medicine may be the way to do that. Unfortunately, it is also dominated with specialists and insiders. If we can find a way to connect patients and their PCP’s with minimal interference and easily, Perhaps.

          As for me, I’m out. No way for me to care for my patients and comply with a govt and health insurance system who are bound and determined to drive me out of business.

  • Eric Strong

    Referring to people who complete medical school and then do something other than residency as “dropout docs” is ignorant and borderline offensive. Not everyone who makes the decision to attend medical school has the intention of becoming a clinician from the start. Would you refer to someone who goes to law school, and then becomes a lobbyist or consultant or politician as a “dropout lawyer”?

  • Brian McMillen

    I should point out that Nobel Laureates, Michael Brown and Joe Goldstein (UTSW in Dallas) both earned MD degrees and then never saw a patient. They met at NIH when they headed there to do research post-graduate. However, I don’t know how much knowledge of health care delivery a medical student gains without having done residency and some time in practice. Practice of medicine at a school like UCSF has no relationship to the real world.

  • Dr. Laura Davies

    Nobody has addressed the fact that medical school is a scarce resource and, despite the outrageous tuition, underwritten by Medicare/Medicaid. Going to medical school is a privilege, and taking a spot that could go to someone who would actually care for patients but then abdicating that responsibility is selfish.

    • fismat

      Fair point, but plenty of docs also pursue careers of research or pharma development, which also use that same scarce resource to non-direct care ends.
      That said, if the resource were truly that scarce, it would be reflected economically in the pay of clinically active docs.

      • David B. Karpf

        @fismat,
        Please don’t conflate med-data start-ups with either medical research or drug development. When I left the faculty of medicine at UCSF to run the FIT fracture trials with Fosamax at Merck, I have no worries that I provided a much greater benefit to patient care than if if I had remained a pure academic. I still see and follow patients, but also know that my work provided a wider choice of therapies for patients, as previously the only approved drugs for osteoporosis was estrogen and injectable calcitonin…..And to those MDs who worked on life-saving drugs such as Gleevec or the PD-1 inhibitors, many thanks! Not so much for someone who gets an MD from UCSF or Stanford and then goes into high-tech….. .

        • fismat

          As a pharma researcher myself, I definitely understand your sentiment. That said, I do believe that there is value for docs in tech, if for no other reason as to keep EHRs from going off the rails. 🙂

    • rphunc

      This is a fairly ignorant statement. Would you say the same about women who finish medical school, then decide to work only part-time (or no time) to have kids? They’re both lifestyle decisions. I know MANY more of the latter than the “dropout docs” for health tech.

  • LoofaLOOFA

    can’t blame these kids, technology is much more exciting, laid back, and potentially rewarding, if you graduate from a top school you can always go back to residency if things don’t work out in the tech field. but missing out on tech boom in healthcare is not a good idea. being a physician who deals with patients and social issues staff and general resentment from all the people around you requires very thick skin and is not for everyone.

  • Leslie Kernisan, MD

    I agree that completing residency makes a big difference in understanding “the trenches” — even though teaching hospitals are very different from community practice — as does doing at least a few years post-residency.

    I wonder if it would make a difference to have more part-time clinical opportunities. Right now that’s available mainly to doctors who are clinician-researchers, or in administration.

  • Vidyaguy99

    Let’s carry this thinking through to its conclusion: just think of how much the practice of medicine would be improved if all Med school graduates were to avoid the sacrifice and disillusionment of practicing real medicine under current restrictions and requirements, and just use their legendary inexperience to putatively “improve medicine” by going for the money in the sterile theatre of med-tech applications. Combined with the inevitable physician shortage secondary to treating forty million more individuals with concomitant falling Med School graduation numbers, this should truly help us experience what third-world medical practice is really about. Hoo-rah…

  • Vish Banthia

    As someone who has actually completed medical school, residency and fellowship (including stanford and ucsf) – and also having practiced for over 15 years, I can tell you that digital health / med-tech can have a positive impact for patients and providers in terms of finding creative solutions for big problems. I do agree that having actual clinical experience in a field beyond training is really the only way one can truly understand the pain points of medicine — as I started my company, zendyhealth, only after experiencing first-hand the issues patients have been and are facing and also after living thru the growing challenges of running a medical practice.

  • Karen Sibert MD

    We should be glad they’re not applying for residency positions. There aren’t enough to go around any more, since residency positions haven’t increased in number at the same rate that medical schools have expanded. At least they’re leaving positions open for people who actually want to take care of patients. There are still some of them around, I hope.

  • viking116

    This is hogwash. What these students want is to make a killing in a start-up, even more of a killing with less work long-term than if they went into plastics. When you graduate medical school you know virtually nothing about patient care and interacting with patients; you only know what you think you know.

  • Dallas Thompson

    This article will take a look into how to apply for citizenship and point out some tips to help you through the citizenship process. See more how to apply for residency.

Author

Christina Farr

Christina Farr (@chrissyfarr) is the former editor and host of Future of You. She was previously with Reuters, covering digital health and Apple and before that, she reported for Venture Beat. Christina was born and raised in London and has graduate degrees from University of London and the Stanford School of Journalism. Farr’s work has appeared in a variety of publications, including the New York Times, the Daily Telegraph, the Bay Citizen and SFGate.com. She has appeared as a featured expert on NBC, ABC and Reuters TV, among others, and frequently speaks at health and technology conferences. She is also co-founder of Ladies Who Vino, a networking group for women in technology and business.