A Venture Capital Approach to Medical Education
The structure of the US healthcare system, as well as the nature of domestic medical school education, has long been a topic of fascination for me. While I have no medical bona fides and zero direct experience with healthcare policy, much of what I’ve experienced and observed during my lifetime has literally made no sense. Why is so much money spent on acute care and sustaining end of life versus preventive care? Why haven’t areas such as early childhood healthcare, nutrition, exercise and stress-coping been institutionalized nationally? Each of these issues make plain economic sense: a healthier, happier, better fed population at an earlier age with good habits borne of experience leads to better school attendance, sharper attention in class and better educational results, and substantially lowers ongoing insurance costs and the need for costly mid-life interventions. This isn’t a left vs. right issue — it’s just common sense and good policy. And the data bears this out — we in the US spend more as a % of GDP than our peers while generating materially poorer outcomes. Our healthcare system is objectively broken, and it’s time for fresh perspectives and approaches to solve the problem.
Another area that has been slow to adapt to data and our country’s needs is medical education. While it is easy to blame our broken healthcare system with misaligned incentives across insurers and providers as exemplars of a failed approach, it doesn’t take into account the fact that even within the current regime dramatic areas for improvement are possible. These gains are not a function of political ideology but of financial discipline, that just so happens to yield a set of more humane, and better, outcomes. It is one of those rare times in life where there is a point above the current efficient frontier, one where a new paradigm yields better results at a lower cost.
What is this new paradigm? One where medical students are trained not merely to be experts in biology but in the environmental and contextual determinants of health, where each patient is a distinct person with a unique history which led them to this point, and where their life circumstances, not simply their test results, impacts how they should diagnosed, treated and cared for. This is, as I think about it, a venture capital approach to medical education, where a particular investment at the beginning of a student’s medical education can yield compounding benefits to their patients and to the overall population due to lower costs, better outcomes and a higher level of care. As one of the more successful venture investors of this generation, I’m pretty good at seeing value and the possibility for exponential returns, and this is one of those opportunities.
Carin and I found such a high leverage opportunity at the Hackensack Meridian School of Medicine (HMSOM), where they created a new medical school with a clean sheet of paper 10 years ago and set out to build the best program possible for its students, its community and the country. At its core was to be a program called The Human Dimension (HD), which envisioned newly white-coated medical students being placed with individuals and families in communities under the mentorship of experienced doctors in the Hackensack Meridian Health network and a dedicated community programs team. When you think about all of the hard core work in math and science that traditional education feeds future medical students, it’s both necessary and great. But the problem is that the notions of context, compassion or humanity aren’t part and parcel of traditional educational modalities, yielding doctors who may be “smart” at the technical aspects of medicine but “dumb” at considering contextual factors in their diagnoses and treatment protocols. As a result, tests are over or under prescribed, diagnostic mistakes are made and conclusions drawn without the full benefit of context, resulting in what is often higher costs and poorer care, as well as patients who feel misunderstood, afraid to fully communicate and un-empowered to advocate for themselves. The CDC estimates that 80% of health outcomes are driven by social determinants, so this is an area where we should be problem-solving and investing far more than we do currently.
The Human Dimension directly addresses these systemic flaws. Here is a brief overview of how the program works at HMSOM:
The Human Dimension is at the heart of the SOM curriculum. Through the service-learning experiences and integrated curriculum, students come to understand the many Determinants of Health — this includes the Social Determinants of Health as well as the personal, economic, and environmental determinants. Determinants fall under several broad categories: policy, social factors, health services, behavior, biology and genetics, and access.
In the Human Dimension, pairs of SOM students are matched to families in the communities we serve. They follow these individuals, families, and communities longitudinally over the entire core curriculum, paying specific attention to three domains of health: social, behavioral, and medical.
The students develop a close relationship with the families and become involved in all aspects of family members’ health, including the individual’s life, family, and community.
Future doctors are taught to think about the full array of factors impacting a patient’s health — family history, pre-existing conditions, current symptoms and their living conditions and support systems. For example, if a patient isn’t taking their heart medication and it’s causing an array of painful and debilitating symptoms, is this because they’re being stubborn and non-adherent? Because they’re unable to open the pill bottle? Or perhaps because they’re unable to get a refill as they can’t physically get to the pharmacy? Without knowing the answers to these questions, it’s hard to figure out the right way to support such a patient. Students at HMSOM learn about asking the right questions during their first days in The Human Dimension and are put in challenging situations while supported by mentors along the way. This is how education should work — strong foundational underpinnings paired with invaluable clinical experience that parallels in-classroom and laboratory work.
Another important facet of the HMSOM proposition is the incentive to invest and build one’s career in the local community. HMSOM is tied to Hackensack Meridian Health, the largest health system in New Jersey with 18 hospitals throughout the state, as well as a dedicated research center. This results in a vast array of needs — and opportunities — for students at HMSOM.
HMSOM has constructed an innovative “3+1” curriculum, where a 4th year student can begin their residency provided they agree to work within the HMH system (and pass their qualification exams). This saves students approximately $100k in tuition and living expenses while guaranteeing them a residency slot, while at the same time securing top-flight students to work across HMH who have been trained in the Human Dimension and can spread their knowledge, empathy and skills to colleagues joining from other medical schools. In fact, the doctors who run HMH residency programs are already reporting dividends from the HD training, noting HMSOM grads are uniquely positioned to influence both healthcare culture and patient outcomes.
A further ROI-based innovation at HMSOM is the recently introduced Primary Care Scholars Program. The Program is designed to target the shortage of Primary Care Physicians (PCPs), those who are on the front lines of providing high quality preventive and contextually-aware care for patients, while also generating massive benefits for society by helping to create a healthier population who, on balance, costs less to insure, medicate and provide care over time.
Primary care physicians are critical to the health and well-being of our state and country. Research shows that having a primary care physician (PCP) can help individuals live longer by focusing on preventive measures and health maintenance to detect health problems early, before they turn into life threatening diseases. The strong foundation of a primary care physician yields better health outcomes overall, greater equity in health care access, and lower per capita health care costs.
The United States ranks last among wealthy countries in life expectancy, and our failure to address the primary care shortage puts our country’s health in serious jeopardy. “Given the new findings, it is clear that both sustained and increased investments in training new physicians are critical to mitigating projected shortfalls of doctors needed to meet the health care needs of our country,” said AAMC President and CEO David J. Skorton, MD.
The Hackensack Meridian School of Medicine (HMSOM) is taking steps to address these issues by attracting, training and recruiting primary care physicians right here in New Jersey and offering a select group of students free tuition and cost of living awards through the new Primary Care Scholars Program. The School of Medicine’s goal is to attract high-quality applicants interested in pursuing primary care specialties through a special incentive that will waive their tuition and provide living expenses in return for their commitment to practice primary care medicine at Hackensack Meridian Health. The expected impact of this program includes:
● Increasing the number of primary care physicians in the state,
● Growing a pipeline of physicians within the Hackensack Meridian Health (HMH) network who have been trained in the School of Medicine’s pedagogy that promotes the study of the social determinants of health as the building blocks of patient’s health and well-being,
● Establishing a competitive advantage for our school to recruit high academic achievers of diverse ethnicities, cultures and genders, and
● Initiating a legacy where students are enabled and empowered to follow their passion for primary care medicine.
The Primary Care Scholars Program was rolled out in April 2024 to five incoming students who were offered a tuition and aid package that includes:
● Waiver of all tuition and fees,
● A $2,500 monthly stipend ($30,000 annually) to cover qualified higher education expenses, and
● A one-time $7,500 loan advance upon enrollment.
Factoring in three years of tuition and fees, the cost of living and the opportunity to begin practicing one year earlier, students stand to save more than $360,000 on their medical school education.
As a venture capitalist, I look at these steps and say “Why isn’t everyone doing this?” Part of the reason is that change is hard, and HMH had the vision, guts, leadership and opportunity to create a medical school from ground up, one designed to provide our medical leaders and caregivers of the future, not simply rolling forward the training and acculturation offers by the “leaders” of the medical establishment. This isn’t about prestige — it’s about the product. And the HMSOM, through The Human Dimension and programs like the Primary Care Scholars Program, are showing us what the future looks like to create a healthier, better understood, better cared for, less medicated population. Further, these benefits will drive down the costs of insurance, the need for as many acute and expensive procedures from preventable diseases, fewer sick days and more money allocable to productive uses across society (say, like more early childhood education and more robust childcare benefits?). There are rare times in life when win-win-wins are possible, and this is one of those times, with patients, doctors and society all benefitting. And our support of HMSOM and The Human Dimension program is clearly one of the best returning investments this VC has ever made.
