MSHQ 029 : Interview with ZDoggMD, Yes – He is a Real Doctor

Session 29

Session 29

In this episode, Ryan talks with Dr. Zubin Damania, a.k.a. ZDoggMD, a hospitalist, healthcare visionary and internet personality as they talk about his path to medicine, his struggles, and the exciting Downtown Project in Las Vegas, Nevada.

Here are the highlights of the conversation with ZDoggMD:

When he knew he wanted to become a doctor:

  • Born to parents who are doctors
  • Doing medicine as a rebellion to spite his parents but liking science at the same time
  • Having the idealism at the back of his mind to make a difference by helping people
  • Finding the actual practice as disconcerting

The negative side of medicine:

The stress of running your own business when you’re not trained to do

His medical school years:

  • Going to UC Berkeley as an undergrad in 3 years
  • Nothing as conceptually too difficult
  • Not getting prepared for his first clinical year during the third year – Pass-Fail-Honor
  • Faking his way through the process as he was getting incredibly depressed
  • Finding the importance of getting support from colleagues
  • The haphazard system of having varying degrees of experience

His three-year undergrad experience in Berkeley:

  • Major in biology and minor in music
  • Starting to get tired of college by his second year
  • Spending his fourth year at Berkeley lab doing genetics research that he liked
  • Realizing research wasn’t something he wanted to do and reaffirming that going to medical school was the right answer
  • Describing his Berkeley experience as the most brutal in terms of competition
  • The ultimate goal as better patient care

Choosing his specialty:

  • Being influenced by a GI doc he knew
  • Entered internal medicine residency with the intent of doing a GI fellowship
  • Realizing he didn’t like GI and the primary care setup
  • Not having a job plan after residency, taking a time off, and going back to clinical medicine
  • Taking a hospitalist job at Stanford

The trends he’s seeing in medicine:

  • The super-specialization as a reaction to high debt loads and high pay
  • Reimbursement, level of respect, and basic job structure as the main drivers for people staying away from primary care

His ideas of fixing primary care:

  • Fair compensation with a job structure where they could help people
  • More precision functions taken over by other entities like nurse practitioners or health coaches
  • Taking insurance out of primary care and basing it on a flat fee membership model

Ways to motivate patients to go to a doctor:

  • Taking away any transactional barrier
  • Paying for the relationship with the team rather than a transactional, episodic visit
  • Fixing the current service fees system and replace it with a more sensible one for both providers and patients

Zubin describes their exciting project in Las Vegas: A three-tiered model

    • Starting with a 7,000-sq.ft. clinic in downtown Las Vegas
    • First piece: Financial disruption – Get insurance out!
  • Funding through the flat-fee membership of patients
  • Second piece: The care team – The village-type scenario
    • Other community programs like yoga, meditation, and nutrition classes as part of the membership to tie all clinic members and the patients with the community they’re in
  • Third piece: Proprietary EMR they’re developing with their partner

Links and Other Resources:

ZDoggMD YouTube Channel

Downtown Project Homepage

Ryan’s article on Tiger Woods and the pre-med gunner mentality – KevinMD.com

Free Will – Book by Sam Harris

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  • You’re a good man, Dr. Damania. Almost everything you’ve said here also applies to the profession of pharmacy. I hope people realize the value in your honesty and take what you’ve shared here to heart. I’m impressed with your commitment to improve the concept of healthcare and I truly hope you succeed.

  • virginiajim

    Somewhat related to the Downtown Project is this Brookings lecture with a free e-book and PDF: “…Dr. William A. Haseltine, author of Affordable Excellence: The Singapore Health Care System (Brookings Press, 2013)[free PDF from here]
    argued that there are alternative models to the current health care
    system in the United States… He noted that the country should look
    around the world at other health care systems in order to make sense of
    the best practices and efficient allocation of finances to adopt for the
    U.S. system. Singapore was one nation that particularly stood out in
    Haseltine’s research. …while the United States should not strive to
    adopt a health care system identical to Singapore’s, Americans can learn
    from its model. In Singapore, health care consists of both public and
    private systems. Multispecialty care is often delivered in public
    hospitals, while primary care is delivered by private sector
    physicians….”

    Thanks.

    Jim
    Smithfield, VA

  • virginiajim

    OK, links don’t transcribe, so here’s the lecture: http://www.brookings.edu/events/2013/06/13-healthcare-costs-singapore

    And here’s the link to the free PDF: http://www.accessh.org/Books.aspx#.UbyowZyWzgU

    Jim

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