Umbereen S. Nehal, MD, MPH, MBA’s Post

At APPNA I had a grand plan to talk to a lot of people about HER Heard and to reconnect with alumni of my medical school Aga Khan University in senior positions. Instead, I ended up spending more time with early career professionals, went to bed early on Friday instead of the alumni dinner, had a 5-hour 1:1 lunch on Saturday instead of the alumni picnic outside (in July D.C. heat), then had an impromptu tech strategy meeting Sunday morning. Now am going to go for a walk along the harbor before heading to dinner with some Pakistani Massachusetts Institute of Technology alums, some of whom are my dad's age. By choosing some stillness, deep reflective conversation, focus, time with youth (who remind me how much I have to be grateful for) and time with elders (whose conversation tends to be slower, deeper, more thoughtful) - despite the opportunity cost of things I did not do - my mind and body are in better shape. My fellow alums can be met with the next APPNA or gathering. There are times I am in that #CEO network network network mode and I get exhausted and scattered. #Founderlife is an experience of needing to reach the next goal and the next goal and the next. You don't build something from scratch nor build a scaling venture by complacency - you have to have an insatiable problem-solving drive. The need to solve whatever problem you are solving becomes like breathing. You can't not do it. That obsessive focus can exhaust and burn out. There are always trade offs. There is #FOMO of what if I made the wrong choice (with how I spent my time)? But, in fact, good choices are made from a sound mind and body, which sometimes requires doing less to do more. A few weeks ago when I bounced between MIT MIT Computer Science and Artificial Intelligence Laboratory (CSAIL), to Microsoft Nerd center talk, to MIT Sloan Fellows MBA Program pass the torch ceremony, to Emma Willard School reunion near Albany, to #Dallas, then back to Boston and a conference at Northeastern University, doing 16-hour days starting at 6 a.m. with a dying computer (which then fully died), I had depleted my tank. The way I recharged was taking a few long walks where I stopped to observe the water (the Charles). Everything started to make more sense and my motivation, energy, and optimism came back after that. Also, from the networking and pitching, people joined the team and took up a work stream or took on the work of organizing our to dos into chunks. #Team matters. I could think about the many "shoulds" that I did not do. Instead, I know I did what filled my cup. I followed intuition more than a "must do" or rigid plan. How I spent the last few days reminded me of how my having had time to reflect during my MIT Sloan School of Management #MBA was transformative. The insights I've been able to surface, from within myself and by synthesizing learning from others, allows me to have an overflowing cup from which I can pour into others and can water and grow a new #venture.

Though it meant getting up at 5 a.m. to travel from Boston, was glad to be a part of APPNA young professional panel to advise early career physicians of Pakistani origin. The U.S. is a country of immigrants and a melting pot. On the 4th in Boston we listened to the 1812 overture, a Russian war tribute while watching fireworks that come from an ancient Chinese invention. Immigrant physicians are the backbone of American #healthcare, ranging from serving in #ruralhealth, to leading on #publichealth, to innovating new therapies or ventures, to being published in esteemed journals like JAMA and NEJM. The grit, resilience, drive, and service-orientation of IMG physicians are unmatched. The secret to my success in the U.S. is found in my Pakistani roots, Pakistani education, and Pakistani family. While being sent away from the U.S. at age 19, leaving Wellesley College to go straight to med school, was hard in many ways, it changed me from a bit of a bratty mopey self-absorbed American kid to a service oriented systems thinker with #empathy and #compassion for suffering of others. Like many children of immigrants, I had been struggling with identity and was muddled on many fronts. At 19 I was “undecided” and when asked, “maybe film?” as a major. Now I am a #doctor, former #insurance medical director and former Chief Medical Officer, launching a #FemTech #venture out of Massachusetts Institute of Technology to use #AI, including #LLM and #TikTok style videos, to educate and empower women. When women engage for #education, they generate #data that can be utilized to build better #algorithms with women-specific #data. To stay motivated, I use #genAI to envision a world where women are queens/sultanas, in charge of our own health. Empowering women to have control over our bodies and #health follows in the footsteps of Pakistani female role models on my family who are #gynecology surgeons, like Dr. Nusrat Shah and my late great-aunt, Dr. Naseem Bano or Aga Khan University Dr. Anita Zaidi. Yesterday met smart, motivated, young women who are future leaders in medicine like Dr. Aniqa Baloch and Dr. Rosheen Jamil and several others. They will be applying for residency in the near future and will be seeking pre-residency career growth opportunities, so keep an eye out for them. Looking forward to contributing to Dr. Ahmad Khan MD’s podcast as a guest. Thanks to Dr. Adeel Ahmad, M.D., MBA, FCAP, Dip. Derm (U.K) for including me in the panel and for accommodating my flight mishap and Dr. Muhammad Siddique Khurram for co-moderating. Dr. Neelam Khan was kind enough to direct me to the right room as she saw me dragging my suitcase as I came straight to the airport to the panel. She’s an accomplished leader in her own right, in #dermatology. It’s always an honor and a pleasure to be with colleagues and mentors like Dr. Khan Siddiqui, MD Dr. Nushmia Khokhar MD Dr. Faisal Khosa. We are stronger, as Americans, because of immigrant talent and contributions.

Rewarded for not showing emotions but instead being pleasant, calm, eager to deliver or please, those suppressed emotions used to turn into inflammation and migraines. Now there is research to validate why self silencing and self suppressing are toxic. https://lnkd.in/ei-uc8Cz I have done self work to reconnect to emotions as well as even to feel pain from my body. Part of HER Heard is to first help women hear ourselves. Perfectionist women rarely can hear our own selves as we seek to meet every external standard. These emotional and physical feelings are important #data and signals to heed.

Great reminders

At 37 I was told I was in near #menopause (premature impending ovarian failure) as I also received my first #diagnosis of #endometriosis, stage 4, that I likely had since I was a teen. I spent 5x more money on egg freezing due to resistant ovaries, had exposure to much higher exogenous hormones of unknown long term effects, I had three pelvic surgeries, and I had to have one ovary removed. Every day thousands of teens, whose #menstrualhealth symptoms could be appropriately believed, evaluated, addressed, instead are dismissed. Simultaneously, Centers for Medicare & Medicaid Services cuts to reimbursement cause hospitals to shut down #reproductivehealth services to focus on higher margin service lines. Meanwhile, post Dobbs especially, religious zealot politicians also are driving fear by policing girls and women by creepy period #data #surveillance, like in Florida and Texas. #Fertility is not just a #gynecology issue but needs to start in #pediatrics. In the last year, have tried to find ways to activate my board certifying body American Board of Pediatrics (ABP) to address the massive gap in #medicaleducation in their materials regarding #child & #adolescent ovarian, uterine, menstrual, and pelvic health. There is also a gap in American Academy of Pediatrics and in pediatric residency materials. Every day thousands of teens are seeing pediatricians for care and learning that doctors - when we ourselves are misinformed by gaps in our education - “don’t listen.” Menstruators of the most marginalized communities most lack access and are the least believed. Personally, despite being a physician, the way my bosses, HR, or peers did not believe me on my physical symptoms is partly why I learned not even to try to seek care or try to be believed. Linda Griffith addresses that in this NPR interview: https://lnkd.in/ehU7fyMi To acknowledge having a human female menstruating body at school/work is to be seen as “lacking #professionalism”, often seen that way by fellow women. As a grad student managing, a #startup founder, a career changer I have not been able to devote the time to persist through the layers and layers of slow bureaucracy to make a difference within my own field of #pediatrics to address the knowledge gap among doctors. It is frustrating to feel powerless to be effective on behalf of teens today who we could still help, as compared to my being first diagnosed close to 40, when it was already too late. The Wall Street Journal, as Halle Tecco, MPH, MBA points out, there is a lot more to this story that you missed. Fertility needs a #systems approach and whole person perspective. Colleen Kraft James Perrin Sophia Yen, MD, MPH Elizabeth Garner Mary-Ann Etiebet, MD, MBA Somer Baburek, MBA Jane van Dis, MD Vineet Arora MD MAPP Kameron Matthews, MD, JD, FAAFP Uché Blackstock, MD Oni Blackstock Scott Becker Kevin Pho, M.D. Joel Bervell Elizabeth Elfenbein Shannon Cohn Melinda French Gates Oprah Winfrey

“a single hospital merger equals an average of 39 lost jobs and $6 million in lost wages. *It also increases insurance premiums due to the increased cost of health care services rendered by the merged hospital system in the setting of no competition.” Unfortunately, the ACA has been part of driving this consolidation via preference and perks for bigger players that gobble up local (often lower cost) clinics and hospitals. A decade after it being passed (despite its expansions of coverage) I regret my unquestioning support for it. Only expanding options for coverage, without addressing access, competition, pricing, and cost to the consumer? That fails. A decade ago I was early to mid career, had not yet had major executive roles, and I was swept up in the excitement of invites to the White House. I was quick to dismiss the older, seasoned physician crowd as too cynical, out of touch, or even “self serving” when their many more years of experience were informing them much better than my idealism. Within capitalism everyone is out for themselves. The assumption of pro-social collaboration is naive within a hyper-individualistic culture of maximizing profit. In theory, if everyone collaborates, we can achieve that 🌈🦋🦄 nirvana. In reality, in game theory, all sides need to choose “cooperate” for the mutual benefit. But if some act per “collaborate” while even one player chooses compete” or “winner take all” actions, the most aggressive stakeholder wins.

In a country where already the # 1 cause of personal bankruptcy is unpaid #medical bills, a conservative #SCOTUS just took away #regulatory checks on big business and pricing. Will this help small, community-based practices or solo clinicians who are being driven out of business? Unlikely. Their regulatory and administrative burden remains.

Differences in the clinical data collection result in less effective algorithms and prediction modeling. #AI #healthcare

Truth. Capitation did not improve #quality. At a Harvard business course a professor shared how to hack doctor brains: none of us like to be told we are “average” so if you show a doctor data or a graph of “average” or “below average” (on RVUs) they will do their best to get into a top quartile. This describes precisely how my managers set priorities or “motivated” via shaming of “you are not pulling your weight.” Those with MBAs who spent their 20s partying are a lot savvier than those of us who spent our 20s on 30-hour call nights in hospitals. I was late to wisening up, getting my MBA in my 40s in order to understand American capitalism and the American #healthcare industry. In the U.S., driving outcomes it is much less about understanding molecular basis of diseases or even social determinants of health. Instread, the the key to driving outcomes at scale in American healthcare is understanding budgets, revenue, business models, operations, value chain. How do we change these perverse incentives? Typically, those currently on hospital boards set the agenda and priorities per current payment realities. Change will not come from there. The big players are big as they have business models of profit from the status quo. These big players also have the deep pockets for lobbying to buy votes, especially so since Citizens United. So government is also not a reliable source of change nor did the writers of the Constitution really want government as a source of change. As 4th of July approaches, I wonder if the founders would still consider this the same country? I used to be big on systems, that too ones that are publicly funded, to drive population health. What I see instead are unequal systems that are widening disparities. When in the public sector I saw a lot of insider vendor deals siphoning taxpayer money away from recipients to private profit. So I’ve really paused to re-examine a lot of my beliefs and assumptions as well as what that means on how I vote. I upset some friends over this. I look at outcomes over time and I examine my past beliefs and decisions to consider how to be wiser and more effective in the future.