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Many workers, crucial to a company’s success, are left with nothing

Physicians themselves should run medical institutions and should utilize the most up-to-date technologies. The result will be better outcomes for both the staff and the patients
Illustrative photo of doctors on their way to an emergency room, October 31, 2012. (Moshe Shai/Flash90)
Illustrative photo of doctors on their way to an emergency room, October 31, 2012. (Moshe Shai/Flash90)

When I began this blog, my intent was to focus solely on issues of medical technology. I wanted to share my personal experiences with combining medicine with the most recent technologies, and to inspire people to adopt the same attitude. Let me say with absolute confidence, that a medical institution that does not have a well-funded, well staffed, and well-respected IT team that is heavily integrated into the medical machinations of the company, will ultimately fail.

Failure in medicine, as I’ve stated in the past, is still something that can be well hidden from the public. I know of one very senior surgeon who was actively sought out for private work, specifically for surgeries on individuals who had the money to pay him. This surgeon would take $5000 or more for performing a surgery that could easily and appropriately be handled within the public system. But his customers, and I specifically call them “customers”, were convinced that they were getting a better product by submitting themselves  to this private surgeon.

During the many years that he practiced  in one of the major public hospitals in Israel, he was known for being very fast, a solid surgeon, but one who had a higher infection rate than other surgeons. Once you’ve already paid an extreme amount of money for a service, your tendency will be to justify complications from that purchase. Yes, I spent $20,000 on a 75 inch LED TV with surround sound and 3-D support, and the fact that the image seems to be a bit washed out must just be a reflection of the fact that I am sitting too close. That is our nature. Rather than admit a mistake or defeat, we will justify our unnecessary expenses. Just to be clear, buying a Batmobile is by definition worthwhile no matter how much it costs. I just wanted to establish the lines of sanity.

I used to say that the mark of a company or medical institution that will do the right thing in terms of patients, is one that has a CEO who himself or herself is a physician. I don’t care how long someone with an MBA has spent in and around doctors. There is something about the physician experience, in terms of patient interactions and dealing with the ludicrousy of inefficient medical care, that makes one appreciate where effort, money and development should be focused.

I could say that it is not the MBA’s fault that he or she does not get this, because how could they? Imagine trying to describe to someone what it’s like to climb Mount Everest versus actually experiencing it. It’s just not possible. Put an MBA in charge of setting up an expedition to climb Mount Everest is a formula for failure.

Now it is possible to have co-CEO’s where they are constantly fighting amongst themselves as to how money and resources should be distributed. But at some point, someone has to make a decision. And if the two co-CEOs cannot come to an agreement, one of them has to have the final word. You could present the arguments to the board, but unless most of them are physicians themselves, this brings one back to the initial problem of having a business person run a medical service.

It is my opinion that in the event that you have co-CEOs, the final decision should rest in the hands of the medical specialist. I fully accept that the MBA co-CEO might find this frustrating and will as such, leave the position. I personally don’t have a problem with this as, with respect to the MBA profession, there are alternatives in the employee pool to replace such an individual. Ideally, one would find an MBA whose bachelor degree is in the life sciences, like biology or physiology. This was already give the two co-CEOs a common language, and hopefully help to resolve many disagreements.

I just read a fascinating article on the Forbes website, called “I Made Three CEOs Rich — So Why Am I Broke?”.  This article beautifully summarizes the experience of far too many people, not just in Silicon Valley, but in any company that has the potential to go public or to be bought out. What is especially upsetting about this article is that the author was specifically told that there is an exit strategy and that her stock options will be worth a great deal. In the end, she got nothing. And this happened to her multiple times.

There are many such people who simply want to be able to take people at their word. The idea that someone would lie to your face, and fail to compensate you regardless of the outcome, in the event that your specific stock options became worthless, is hard for a lot of people to accept. And I am one of them. I have never felt comfortable talking about money or percentages or stock options or anything of the like.

I have never signed a contract that guaranteed me  a cut of the eventual value of the company I was working for. I am presently consulting to two startups and my deal with them is only verbal and basically is “if you succeed,  pay me what you think is appropriate”. Most people in the business world would call me a fool, frighteningly innocent, and doomed to financial failure. I can honestly say that I was the essential person to the success of a major company, that I eventually quit over philosophical differences [I believe that patient care was more important than financial bonuses].

After a legal battle, I am now being compensated for a small part of what my contribution was to the success of this company. All of this could have been dealt with far more civilly, had I simply demanded a contract that stipulated my take-home in the event that the company was sold or I left for other reasons. But I had been convinced that the company was barely covering its costs and it struck me as insensitive and greedy to demand money from a financially borderline company. When I discovered that the company was far from financially insolvent, I was enraged. But none of this helped me.

It is hard to walk off the street, no matter what your credentials are, and demand a whole suite of benefits. For the employer, it is much easier to wait until a candidate walks through the door who makes no such demands, because this is his first job and he is thankful to just be working. Of course, one of the options is to start your own business and be your own CEO. Then of course, you need to build a team and have a mission statement and get financing, and still face the reality that the vast majority of startups fail.

I have previously said that I am not a risk taker and that I am not the kind of person to mortgage my home to get the initial financing for any idea that I may have. Given what I have been reading about the tremendous backlash against EHR’s in the United States,  it strikes me that I could do very well if I applied my same development approach from my Israeli experience, to the American experience.

I would have to surround myself with people who were experts in the specifics of American healthcare, especially with all of the changes that have come about due to Obama care. But there is a way to design an EHR so that the physicians never even realize that they are recording information intended for the money counters in the back room. It is definitely possible to create a front-end that is purely clinical, but that in the background provides all of the information that the accountants and bookkeepers need to track expenses over income.

Considering that my competition would be multibillion-dollar companies with an established [but unhappy] client base, this would be an incredibly high risk venture. It would require a strong American presence, which is something I am personally not willing to do. I could hire someone to be the American representative of the company, but this is just one more person on the payroll that has to be made every month.

Could I succeed? Yes. Would there be a tremendous cost personally and financially to the success? Absolutely. Does the risk of success truly justify the cost? Not for me. The reality is that I will be relegated to the role of employee, and only if I am incredibly lucky, will I benefit from the success of the company I am working for.

I will say that one thing has changed. The next time I am patted on the back and told how valuable I am to a company, I plan to immediately turn around and demand that this be put in writing. I expect my employer to be surprised by the demand, but I will say without hesitation, that I have been burned too many times in the past by people who tell me how valuable I am, but then seem to forget that point when it comes to exiting. I can’t say that this opportunity will ever arise again, but that is my plan.

I welcome any contrary arguments to my perspective. One thing is for sure – I have no magic answers. And yes, the world is unfair and people take advantage of the kindness and sincerity of others. And unfortunately, to protect yourself from such people, you too have to become more protective and more demanding, no matter how out of character it is for you.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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