Session 29

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

When ZDoggMD 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 idealism at the back of his mind to make a difference by helping people
• Finding the actual practice to be disconcerting

The negative side of medicine:

His medical school years:

• Going to UC Berkeley as an undergrad in 3 years
• Nothing was conceptually too difficult
• Not getting prepared for his first clinical year during the third year: Pass-Fail-Honors
• 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

[Related episode: A Burnout Story and What You Can Do to Avoid It]

His three-year undergrad experience at Berkeley:

• Major in biology and minor in music
• Starting to get tired of college by his second year
• Spending his fourth year at a 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
• Entering an 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 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 salary differences
• Reimbursement, level of respect, and basic job structure as the main drivers for people staying away from primary care

His ideas for 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 overall 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

ZDoggMD describes the Downtown Project in Las Vegas

• 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 together all the 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
• Free Will (book by Sam Harris)
• My article on Tiger Woods and the Premed Gunner Mentality (at KevinMD.com)
• Related episode: What I Wish Every Premed Student Would Know
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