A Physician in Charge: Gawande’s New Role Has Doctors Applauding

The choice of surgeon Atul Gawande to head the health care plan for Amazon, Berkshire Hathaway and JPMorgan Chase is a big boost to the concept of physician leadership.

Physicians and other clinicians are in the trenches of health care, day in and day out. And many experience and speak out about the myriad problems, waiting to be heard. To find solutions. To disrupt a system in need of change.

Atul Gawande, MD, MPH, the well-known surgeon, researcher and writer, has been fortunate and talented enough to express his concerns and offer potential solutions in national publications. And he has been heard — so clearly, perhaps, that he has been handed the reins of which might be the biggest health care venture in a generation.

Gawande was hired June 20, 2018, to oversee the health care partnership being developed by three corporate giants, overseeing coverage for about 1.2 million employees. His new bosses — Jeff Bezos (chairman and CEO of Amazon), Warren Buffett (chairman and CEO of Berkshire Hathaway) and Jamie Dimon (chairman and CEO of JPMorgan Chase) — are asking him to disrupt health care as we know it, bring down costs, and improve care. They hope these changes can be applied industrywide.

Because Gawande is a physician, many physician leaders around the country are saying he’s the right person for the job.

“The decision to place such a visionary physician at its helm implies the founders are prioritizing expertise centered on patient experience and improved outcomes,” says Karen Weiner, MD, MMM, CPE, the CEO of Oregon Medical Group.

“One physician leader cannot do this alone, however. My hope is that the philosophy of placing physicians in leadership roles permeates throughout this joint venture,” says Weiner, an American Association for Physician Leadership member since 2013. “The current health care system is fundamentally broken, and physicians are uniquely positioned to champion meaningful, patient-centered change. Disrupt away.”

Raksha Joshi, MD, MBA, MS, CPE, chief medical officer for Monmouth Family Health Center in Long Branch, New Jersey, suggests there can be no substitute for the experiences a physician leader can bring to such a high-profile post. Experience at all levels of health care, including costs, preauthorizations and third-party payers, will benefit him.

"He has a unique perspective as an insider — if I may use the word very [respectfully] — that he has seen the actualities of health care delivery," says Joshi, an AAPL member since 2007. Gawande brings "insightful perspective as well as management tactics and strategies," she says.

Gawande’s 2009 book, The Checklist Manifesto, helped develop protocols that are now followed by doctors. He has raised awareness about end-of-life issues in his 2014 book, Being Mortal. Many of his ideas were shared in articles he penned for the New Yorker magazine, including a 2009 piece, “The Cost Conundrum,” which examined why care was more expensive in some U.S. areas than others, despite little difference in quality.

“Dr. Gawande has championed change among physician peers by example and with inspiration,” Weiner says. “He has helped us to think differently about the care we provide; whether through presurgical checklists that have decreased post-surgical mortality, rethinking approaches to end-of-life care, eliminating unnecessary interventions or championing evidence based practices. His stated goal is to ‘make it simpler to do the right thing.’ ”

Quint Studer, a former hospital president and health care consultant, appreciates the disruptive approach the three megacompanies are seeking.

“The key, of course, is, is he a great leader? I find early on that, while a title helps, it moves quickly to: Can they do the job?” Studer says. “Personally, I like the choice. It brings a person in who understands it can’t be business as usual and is not wed to a large capital-intense campus. This means a variety of ways to deliver care will be looked at. The company has the resources to back the different approaches.

“I also feel he is close enough to physicians and the burnout issue that [his] approaches will take into account how to make providers’ lives better with a clear understanding of the need for better patient outcomes and overall community health.”

The new position adds to Gawande’s long list of activities, including teaching at Harvard and operating on patients at Brigham and Women’s Hospital in Boston, writing for publications, and serving as chairman of the Boston research think tank he founded, Ariadne Labs.

“Dr. Gawande is a multifaceted renaissance individual with many talents,” says AAPL President and CEO Peter Angood, MD, FRCS(C), FACS, MCCM. “Exceptional leadership comes in a host of styles and from personalities that often do not fit the stereotypical mold delineated in the leadership literature. For centuries, health care has always benefited from exceptional physician leadership to help accelerate the industry toward a better future.

“Dr. Gawande is a contemporary example for how physician leadership will, once again, demonstrate to the industry how leveraging the combined strengths of clinical excellence, insightful thought leadership, and a passionate vision can stimulate innovative environments to create higher quality and value in patient care outcomes.”

Gawande plans to give complete attention to his new position, but will continue with his other activities: attending to patients, teaching at Harvard, writing for the New Yorker and serving as chairman of Ariadne Labs. | Tim Llewellyn/ atulgawande.com

At the Aspen Ideas Festival in Colorado, shortly after accepting the position, Gawande was intentionally vague about what comes next for plan, originally known as the ABC (for Amazon, Berkshire and Chase) plan.

“We are going to come up with a name, it’s one of my first jobs,” he joked to interviewer Judy Woodruff of PBS NewsHour. (The plan was later named Haven.)

At another session, he told the New York Times’ David Leonhardt that he “had no idea” how many employees would eventually come to work for the organization, although it will be a standalone, not-for-profit entity.

But Gawande did talk at length in both appearances about his approach to the new initiative.

“The largest concept here is I get to have a million patients that I, as a doctor, get to add to my responsibility,” he said Saturday. “And my job to them is to figure out ways that we are going to drive better outcomes, better satisfaction with care and better cost efficiency with new models that can be incubated for all.”

The changes won’t come quickly, but he hopes to eventually find ways to make health care more efficient and the solutions exportable.

“The opportunities are as long as my arm,” Gawande said. “So all we have to do in this new venture is pick a few of them and try to bat them out of the park.”

His decisions will be watched closely by physicians and physician leaders.

“Only time will tell, but having a physician at the helm is certainly a good start,” commented Petar Bajic, MD, an Illinois urologist, in a recent Twitter post.

“I’m excited for the possibilities,” Weiner says.

Rick Mayer and Andy Smith are senior editors for the American Association for Physician Leadership. Information from Kaiser Health News was used in this report.