David 0:00

Physicians are beginning to pop up in industry places that are far from their traditional practice models. What does this mean for patients and for the industry as a whole? We'll find out on this episode of Shift Shapers.

Announcer 0:14

Change either paralyzes or energizes. The choice is yours. You're listening to the Shift Shapers podcast. You're about to learn firsthand from businesses and entrepreneurs who have successfully shaped the shifts in their industries. Get ready to become the change you want to see. This episode is brought to you by Shift Shaper Strategies. In sales, if you confuse, you lose. Clarify your message so you win more clients, crush your sales goals, and build your practice. Learn more at ShiftShaperStrategies.com. And now here's your host, Storybrand Certified Guide and Chief Transformation Strategist at Shift Shaper Strategies, David Saltzman.

David 1:06

You know, when we think of physicians, most of us think of physicians who see patients or who consult or who are surgeons. But these days, physicians are branching out into lots of different areas. And it will ultimately, I think, strengthen our industry and give us some depth that maybe we don't have today, and certainly some perspective that we may not have today. And we wanted to explore that topic. And so we've invited Shad Faraz, who's at Harvard Business School, and hosts a podcast called Physicians Off the Beaten Path. And it it talks all about what other things physicians are doing and what the impact of that is. So with that, welcome, Shad. Glad to have you.

SPEAKER_02 1:47

Thank you, David, for having me and really appreciate the invite.

David 1:50

Tell us a little bit about your journey, how you ended up doing what you're doing.

SPEAKER_02 1:53

Absolutely. I think the best place to start, David, would be from the very beginning. You know, I grew up in Bangladesh, the youngest of three brothers and sisters. I was born over a decade actually after my older brother, so I kind of grew up like an only child. We moved to Canada when I was 13, did middle school, high school there. Absolutely loved it in Canada. You know, Canadians are stereotypically very polite and nice and welcoming people, and I found that to be very, very true. But I've been in the States for about 11 or 12 years, went to college in Atlanta at Emory, went to medical school at Cornell, and then did a couple years of surgical residency here in Boston before coming to business school here at Harvard. I've also worked a little in consulting at BCG as well as doing some venture capital investing right now. But, you know, David, I think I realized relatively early on in my residency that my interests were a little bit broader than that of my surgical colleagues. My surgical colleagues are brilliant. They really are. But what's funny is after a 30-hour shift in the hospital, they would come home and keep talking about surgery. And that's sort of the last thing I wanted to do. I was interested in, you know, healthcare innovation and policy and investing. So I knew I was a little bit different early on, not better or worse in any sense, but just different in my interests. And so my program actually lets folks take time off during residency to go do some research. But I ended up applying to business school and coming to HBS. I think it's worth mentioning, if I may, for a minute or two about my time here at HBS. It's really been a transformational time personally for me. I know it's slightly hokey, but I kind of liken it to 1970s, you know, New York City. That's sort of when and where punk music, hip-hop music, salsa music was born. And it's not because New Yorkers were naturally more creative than other people, it's because it was a place where it was one of the most professionally, ethnically, culturally diverse places in the world. People from all over the world came, shared ideas, and moved the world forward. And HBS, and I think broadly, Boston sometimes feels like a microcosm of that. My classmates are engineers, doctors, lawyers, veterans, policy junkies, entrepreneurs, investors, all in one small, tiny area. And I think that's sort of the most powerful thing about this place. And I'll just finish off my story by saying through my time at HBS, I've just gotten the freedom, the latitude, so to speak, to explore system-level problems in the American healthcare system. Something that, as you mentioned in your intro, not a lot of docs have historically gotten the opportunity to actually do in medical school and and beyond. And that's ultimately why my friend and I started our own podcast, sort of geared towards other docs, which you know, we can talk about at some point. But that's a little bit of a background about me and and where I am today.

David 5:12

So I completely understand. So let's level set for the audience. Today, as we sit here, as a physician, if you look out over the landscape, what does it look like? It doesn't, as you alluded to, it doesn't look like necessarily the traditional paths all the time. What are docs looking at?

SPEAKER_02 5:28

Yeah, so I think there's a lot of things that docs are currently looking at. You know, I I sort of liken clinical medicine, historically at least speaking, like like a tunnel. And sometimes it feels like there's no light at the end of the tunnel because, you know, you you're pre-med, then you go to medical school, then it's residency, then it's fellowship, and so on and so on. And don't get me wrong, clinical medicine is very impactful. It's a noble job, but it it's it's a full-time job. And so residency, for example, sometimes feels like you just have your eyes closed, you're in a tunnel, and you're just focusing on your patients, and everything else is just goes by the wayside. And eventually, hopefully, you'll emerge out of that tunnel and have a life. But I think people are realizing that that's not sustainable. That's not really the best way for docs or other clinicians to have the most impact in in the 21st century. So I spend, along with my co-host Alex, we spend a lot of time thinking about what it means to be a physician in the 21st century. And I'm talking to people who have a broader conception of what success or impact actually means. Whereas 20, 30 years ago, it was about taking care of patients or doing the best surgeries or doing the best research. Nowadays, people think about, you know, innovating in the way that they actually deliver care to their patients or figuring out how big pharma or or biotech can be made more sustainable for patients with an eye towards lower cost of care for patients. So those are the things that people are actually starting to care about. I know I'm in the Boston sort of ecosystem where docs are doing anything and everything. I have mentors who are in investing, who are in large med tech companies or biopharma companies. I have folks who left clinical medicine, became entrepreneurs, folks who are practicing part-time and are in consulting firms like BCG or McKinsey. So anything is really an option. We one of our guests in our podcast, Steve Miller, who just retired but was the COO of Cigna and Express Scripts, he mentioned that the medical degree is one of the most flexible degrees in the world because you don't necessarily it it gives you a certain level of transferable skill sets that you can use in a lot of different ways. So I know doctors who ended up being journalists, who ended up being travel bloggers full-time, who ended up writing books. You can do a lot of things. One thing I will say though, David, is I've realized because of the lack of direction off the beaten path that people get during medical school or residency, folks who want to explore beyond traditional medicine or research domains are left confused a lot of the time. They just don't know where to start. And so I'll take, you know, three or four calls every single week with doctors who are at various stages of their quote unquote development, meaning interests off the beaten path. And sometimes it'll be just like, hey, I'm interested in consulting, but I don't know what consulting is. Can you explain it to me? So I have to start from the very, very beginning. Whereas other folks have really, really thought about it. Maybe they've been watching your podcast or my podcast for a few months. Maybe they've read a couple of books by doctors who've gotten off the beaten path, and they have an idea of that they want to be, let's say, entrepreneurs, but they just need a little bit more help and more direction as to how to actually do that. So I would just say to summarize, almost anything and everything is possible for doctors nowadays. And more and more doctors, I think, are stepping up to the challenge, but there still is an information gap and an information asymmetry for some docs. And that's ultimately why I think you know, podcasts or, you know, your show, my show, things like that are incredibly beneficial for clinicians.

David 9:09

There are, and is this is something that comes up frequently on the podcast, there are a lot of misaligned incentives, misalignment in the system in general. Do you believe that as docs get out into other allied fields, that that might level some of this out and take away some of that misalignment? Is that something that you you see physicians playing a role in who are outside of normal practice modes?

SPEAKER_02 9:31

That's a very good point. And I certainly hope so, and I certainly think so. I remember the second year of residency, right before I came to business school, I was working in my hospital's uh quality improvement committee, and it's a committee made up of not only clinicians, but also hospital administrators. And some hospital administrators are clinicians, but some are not. And I saw that there was almost a breakdown in language, not because both of those groups didn't care about patients or didn't want, you know, the hospital to succeed in doing what it needs to do, but they just spoke a completely different language. Clinicians are used to thinking about, you know, X, Y, and Z. They care about their patients, they care about their own sustainability, burnout, things like that. Whereas hospital administrators are looking at the problem from a slightly different lens. And oftentimes they're just talking past one another. And one of the most beautiful things I've realized about coming to business school, and especially with docs who have MBAs, are that they act as translators, so to speak, between the medical world and the non-clinical world. There's so many non-clinicians who are working to improve the American healthcare system, whether it's administrators or folks working in pharma or biotech or investors or, you know, whatever it is, folks who are working at PBMs or payers, all of this ecosystem is necessary in moving this very complex, somewhat clunky system forward so that it's better for patients. But I just realized that sometimes on the perspective of clinicians, and it's not all of them, but but sometimes there's this pessimism that you know folks who are working at pears or folks who are working at big pharma just are you know evil or bad people or they're acting with malintent. And that's not necessarily the case. I think everyone is just blinded by their own incentives, and everyone thinks that they're doing the right thing, they just can't see the bigger picture. And I think the only way to get beyond that is to just bring all these different people into one room, learn the same language, develop some shared understanding of what's going on, and move forward. And for me personally, I mean you don't need another degree to do that. I think it's just sort of based on experiences. But for me, these two years have given me some breathing room to meet different types of people within the healthcare system so that I can understand those incentives a little bit better.

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David 13:01

Well you've mentioned two things that I think go together. You talked about getting calls on a weekly basis from physicians who say, gee, I want to consult. What is that? Or I want to do X, what is that? And also, you know, when you talked about the committee and people kind of talking past each other because they weren't speaking the same language. Does this point to an educational deficit in the physician community? Is that something that med schools are are starting to address or are they still being pretty parochial?

SPEAKER_02 13:28

I think you hit the nail on the head, David. I think it is an information gap and somewhat an education gap. You know, medical students have a pipeline, so to speak, of some of the brightest, most creative people in the country. You know, some of our smartest, most intelligent, most thoughtful, most caring high school students go into college wanting to be pre-med, and and then the ones who do really well end up going to medical school. But I think there's something about the system that turns them into a little bit turns their creativity and directs it overly narrowly towards certain clinical interests rather than a broad understanding of the healthcare ecosystem. So I certainly think that the medical curriculum needs revamping. It's funny that you mentioned that because so much has changed in medical technology, in the tests that we can run for our patients, in our understanding of diseases. But if you look at the hospital, it doesn't seem like our physician's office, it looks the same as it looked like 20, 30 years ago. And so I think there's a lot about the medical system, how physicians actually approach patient care, how physicians think about non-clinical players. I sometimes I think, you know, I'll be the first to admit that I didn't have an appreciation of the importance of non-clinicians in actually moving healthcare forward. Not because I thought they weren't doing a good job. It's just something that was never taught to me or something that I never really thought about. And so I think taking some of the brightest minds in our country and shaping them to be a little bit more holistic about what's happening within the healthcare system would do not only them clinicians, but also patients and the country a lot of good.

David 15:13

I know one of your interests is in something called digital therapeutics. Don't get too geeky because, you know, we're layman out here. But what is that and why do you think it matters so much?

SPEAKER_02 15:23

Yeah, no, I thank you, David, for giving me that opportunity to chat about digital therapeutics. It's something that I actually care, as you mentioned, a lot about. And I'll try not to get too geeky. It's it's hard for me sometimes, but I think the space is relatively nascent, but it's changed a lot in the last five years. I'll give an example. It started off with sort of repurposing traditional mechanisms of action like cognitive behavioral therapy that you could easily digitize and then put it in the form of an app and then give it to patients. What's different about digital therapeutics versus the health and wellness apps that have been around for a while is that digital therapeutics theoretically are clinically validated, evidence-based, go through trials and are FDA approved and then get prescribed by clinicians, by physicians. And so it's it's think of it as sort of a hybrid between those health and wellness apps and traditional pills. Hybrid in the sense that it's still in the form of a software, but it should go through the rigor, the traditional rigor that a pill goes through when it tries to get approved. So that's sort of how prescription digital therapeutics started around five to seven years ago by digitizing these traditional mechanisms of action like CBT. I think these were then used for behavioral intensive chronic diseases like major depressive disorder or substance use disorder, for example, by paratherapeutics, which is sort of the leader in the prescription digital therapeutic space. But I think more recently and moving forward, we're gonna start to see a shift. There's gonna be an increasing focus on novel mechanisms of action that you can't necessarily target with just that you can't necessarily target with traditional biotechnology-based therapeutics. So Achille Therapeutics, I think, is a good example of this. They've developed a video game for that teaches children with ADHD to multitask or to ignore distractions or to shift attention between different tasks. And that's an example of a relatively novel mechanism of action. And I think stuff like that is going to be increasingly prevalent. And if I may, because sometimes people wonder, okay, that's all well and dandy, it just sounds like a shiny new toy, but what's the actual benefit to patients and to the healthcare ecosystem? And I think there's several fold benefits. First of all, I think the development of PDTs, as we call them, prescription digital therapeutics, they're less expensive compared to traditional biopharmaceutical products. One stat I read recently puts PDTs at four to five years of development, 40 to 50 million dollars, versus biopharma product can take 10 to 12 years, 1 to 3 billion dollars. Another thing is that I think the regulatory path moving forward is going to be a little bit more established and accessible for PDTs. Right now they're regulated as a what's called, quote, like software as a medical device, and it's a framework that's been roughly adopted from uh hardware medical devices. But the FDA is revamping the process and making it a little bit more flexible and amenable to the iterative changes that you would that can be done on software. So hopefully you can improve it in real time. I think another benefit, David, is that traditional pills can't speak. Pills can't communicate, but PDTs can. There's this bilateral flow of information that you just don't get with traditional products. Patients get access to 24-7 care, providers get access to data, hopefully actionable data. You can deploy algorithms to personalize therapy in real time much faster than you can do with pills. You can also connect a PDT app to a wearable or a monitoring device that can gather what's called digital biomarkers, like your activity level or your voice or your weight, whatever it is, and all hopefully to improve the clinical effectiveness of the therapy that it's providing. And my answer by sort of pointing to some of the barriers that are still out there for digital therapeutics. I think broadly speaking, the largest barrier by far is around reimbursement. Many pairs and PBMs, I think this will be of a particular interest to your audience, they still aren't overly familiar with prescription digital therapeutics. You know, pair therapeutics does these surveys every once in a while where they survey PBMs and pairs, and they show that there's still a lot of room to go. I think the last survey that they did showed that 80% of pair and PBM reps just had little to no exposure on PDTs. And of course, naturally, their institutions didn't cover PDTs. But the 20% that did overwhelmingly covered these digital therapeutic products or were in the process of actually covering them. So I think what gives me some hope is that I think there's some agreement as to how PDTs would be covered amongst the 20% that actually know about them in terms of processes. There's an understanding that you need these digital formularies, you need the prescription and therapy committee to sort of start being comfortable with assessing the clinical data that comes out of digital therapeutics as opposed to traditional therapeutics, and then start covering them. I think the the second barrier is also physician adoption and clinician adoption. It's been a little bit slower than I would have liked, but there's an ongoing generational shift, I think, and that's introducing digitally native practitioners like folks that are my age to the workforce. And we're a lot more comfortable with these solutions than I think the older generation was. So I think it's a space that I'm really, really excited about, but there's there's a long way to actually go to giving it to reach the broad clinical utility and adoption that we actually are looking for.

David 21:05

And that's a great place to end our conversation today. Shad Farros, I hope you'll come back as your journey continues because I'm interested to see where you find yourself a year from now or two years from now in what direction you're going in. So you have an open invitation anytime. It's been a fascinating conversation. Thanks so much.

SPEAKER_02 21:22

Thank you so much, David. I'd love to come back anytime.

Announcer 21:25

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