Kristen and Ryan Roth
Ryan Roth once seemed like an unlikely candidate for medical school:
He was a self-described “super geek” who started his own software service company after graduating from CU Boulder.
He was squeamish. “My best friend was an EMT, and he was always watching those trauma shows. I thought ‘I could never do that.’ I couldn’t stand being in the same room with those shows.”
He has some issues with the way medicine is practiced in this country.
So what’s a guy like Roth doing with a residency in internal medicine? He can thank an injury that was both disabling and depressing.
A competitive mountain runner, Roth badly hurt his hip, spent several months seeing doctors and physical therapists, then finally was diagnosed with torn cartilage between the hip socket and femur.
“I’ll never forget waking up from surgery and asking the nurse, ‘Did (the surgeon) fix it?’ She said yes … and I started crying. She was super concerned that I was in pain but I was not. It was tears of sheer thankfulness.
“It was that day I started thinking about what it means to be a physician – not just to help people but to interact in a more meaningful way than what I was doing.”
When his girlfriend, Kristen French, returned from a trip to Europe he told her he was considering medical school. She surprised him by saying, “Me, too,” he remembers with a laugh. It was the first time either of them had mentioned the idea. Both finished their prerequisites, entered CU School of Medicine, got married last fall and have couple matched at University of Wisconsin Health in Madison. Her residency is in emergency medicine.
Roth, 31, chose internal medicine because it seemed the most effective way to address his concerns with the practice of medicine, partly by relying on his experience as an entrepreneur.
“I’m a dreamer. People who start companies fail a lot. They anticipate that, and that’s the road I’m on. It’s a giant system and it’s not easy to shift or change in big ways – or even small ways.”
He says he was candid in his residency interviews about his views on the current system and his ideas for addressing its problems:
1. Reform how doctors and hospitals are paid.
“The sicker people are the more we get paid,” because physicians are reimbursed per visit, he says. “The financial incentives aren’t there to create a healthier person, though that doesn’t mean physicians don’t want patients to be healthier.”
He envisions working in a payment model that rewards physicians for healthier patients. “Wouldn’t it be powerful, if some of my diabetic patients lived in the same neighborhood, if I could have a class where I taught about diabetes, and they could get to know each other and hold each other accountable?”
2. Encourage health care providers to become more invested in their communities.
When Roth was doing a rotation in San Luis, he helped start a program called “Walk with a Doc.” Every Thursday, he and the local doctor invited community members to go for a lunchtime walk. The tradition continued after Roth left. He points out that hospitalizations cost thousands of dollars, but taking time to change lifestyles would cost far less.
“Or let’s talk about food. The World Health Organization reported that the No. 1 risk factor to our health is the type of food we eat. Why couldn’t I get a community kitchen in my clinic and bring in a dietician and chef that I can refer my patients to? Or why couldn’t I go to (a patient’s) home, to their kitchen to see how it looks and make suggestions?”
3. Use new technologies to improve Nos. 1 and 2.
“Let’s say I have a patient with high blood pressure. The prescription medicine is $80. What if instead I write a prescription for walking 10 miles a week? I’m a techie right? So I could develop a system that allows both the patient and me to accurately track their physical activity; the system could keep me informed outside of their normal patient visits.
Technology could help patients monitor their own health, too.
“I could give a patient I was worried about a watch that would monitor their pulse, blood pressure or potentially even their glucose. Thus I could be alerted before the patient decompensates. If I get an alert, I could contact them and say ‘Could I come to your house? Could you come in? Can I send someone?’”
He says he’s inspired by the multi-pronged campaign against smoking, which has more than halved the nation’s smoking rate since 1950.
“It wasn’t just one thing that did it – several things happened including a ban on smoking in public places, higher taxes and aggressive advertising.
“There are a lot of people thinking about (health care) reform now. I’m going to have to be super patient, but you can tell I’m a guy who is passionate.”