The Yale Journal for Humanities in Medicine

From Consultant to Care-giver:
The Road to Medical School 

Stefan C. Weiss 

When Stefan Weiss was a Yale College student, he worked with me trying to show how placebos affected visible brain function. Our ideas were beyond the technology then available, and Stefan went on to Duke Medical School, where he frustrates his hope to get degrees in law and medicine by forays into other fields. Here he briefly reacts to a stint in what might be called "management."

  As a student in college, fulfilling my pre-medical requirements and studying philosophy, I was uncertain of what to expect in the future. Although I always intended to enter medical school, prior to graduating I decided to pursue other opportunities. This shift in focus brought me to the world of consulting. Consulting initially presented as a rather amorphous concept and having been a member of the profession for one year, I am still not confident that I could explain to someone precisely what a consultant does beyond the patently obvious: consult. Yet, the intangibility of the job does not discount the value of the experience.

  My year as a business analyst, although frequently frustrating, exposed me to forces that shape healthcare delivery beyond traditional caregivers. I gained a greater understanding of a complex system, recognizing the need for change. As an undergraduate, the world of medicine was alluring. I looked towards the day when I would insert a tracheotomy for the successful resuscitation of a patient, just as it is performed on television. My appreciation of the mechanism of health care financing was no less naïve then was my appreciation of my role in healthcare delivery. But the juxtaposition of my year in consulting with my years on the hospital wards has begun to define a picture with much greater clarity.

  Medicine is no longer a cottage industry. A system that allowed costs to grow unchecked has been forced to become accountable. This accountability, and the ensuing development of affordable healthcare systems, have jeopardized the quality of US medicine. The task of balancing cost and quality is difficult, but not insurmountable. Many of the healthcare institutions seeking to achieve this goal have looked to consulting firms for both the necessary expertise and strategies.

  Healthcare delivery systems have experienced rapid vertical integration. Through joint ventures, pharmaceutical companies are becoming direct and indirect healthcare providers. Managed Care Organizations (MCOs) have partnered with pharmaceutical companies to deliver disease management programs. Third party vendors are emerging as niche players providing services such as demand management. The process of establishing these alliances is difficult and consultants have been sought to ease the transition. Throughout my year I interacted with leaders of firms actively involved in each of the above areas.

  As a fledgling consultant, I was presented with extraordinary opportunities. At the very onset of my tenure, I was asked to share some of the analysis of my team regarding disease management with a senior vice president of a pharmaceutical company. The need to integrate clinical medicine with sound business practices was evident. The two prior decades witnessed the extinction of the physician who made housecalls. Into the next century, we will likely witness the extinction of the sole practitioner. Medicine is becoming organized, not just politically, but economically. Sitting in the offices of top executives, I helped contribute to this healthy evolution.

  As a college student, it is easy to philosophize about the constancy of change. It is quite something else to watch it, shape it, and accept it. The future healthcare delivery systems have yet to be molded and many parties are competing to assume the role of lead sculptor. As a consultant, I was part of a group of facilitators scripting messages that demonstrate the value of novel approaches. We developed analyses that illustrated areas where competing interests might work together for mutual benefit and we helped executives target previously unexplored opportunities. In my year as a consultant, I appreciated the broader significance of organic chemistry: learning to synthesize unknowns from a variety of reagents.

Published: February 1, 2000