I am a neonatologist, which is a subspecialty of pediatrics. For many years I practiced neonatology in an academic setting as well as in a private practice setting for many more years. I enjoyed the thrill of going to the delivery room and saving a baby that was in trouble, seeing the joy and pride in parents eyes, nursing them through the postnatal hospital course and eventually seeing them go home. I have always been inspired and impressed by the resilience of babies and children and the unconditional love of parents, grandparents, and the whole extended family, for a child that was born either totally healthy or with medical conditions that were many times life-threatening and lifelong. These experiences informed my attitudes about life as well as many aspects of my parenting style. The few times that there was a neonatal death was always very challenging but more times than none I was inspired by the faith of the parents, and the willingness to always accept any outcome as God’s will without question.

When I became a mother, the high of rushing to the delivery room and saving the day (and the baby) began to quickly loose its luster. When my second son was born, the luster had burnt out. Being present in their lives for kindergarten activities, after school activities, and even establishing a routine reading bedtime stories became a challenge. At one point I realized after having to rush to the hospital in the middle of a bedtime story for the umpteenth time that I was really not able to make any promises to my son, who I always left crying in disappointment. This was a turning point for me. At the same time, medicine was becoming more regulated as managed-care companies had a growing presence in my practice as well as in the practice of my primary care colleagues. It was at this time that I had my first foray into managed-care. I was offered the position of regional medical officer for a health plan that was a startup in Houston Texas. I found a new way to achieve professional and personal satisfaction with this managed-care job that was not available in private practice. I made the pivot from patient and family care on the individual level to population health in its early stages and I found it fascinating, challenging, and it afforded a new dimension and meaning to my career. My hours were 9-5 with occasional night meetings, I had paid time off for vacation and for CME I had my weekends and nights off my nights off and by this time my kids were in school so our schedules were in sync and the quality of our family life exponentially improved.

I had a brief experience as a general pediatrician in California practicing for a managed-care company that biased me against the concept of managed care. The edict was that a patient had to be seen every 12 minutes in order to keep the productivity numbers at an acceptable rate. I found that very intrusive, and I felt that I was rushed and I was wishing parents and kids to get to the point of their visit quickly so that they could leave within the 12 minute mark and I would have time to do my charting. That didn’t last very long. I subsequently did a fellowship in neonatology and practiced neonatology until I had young kids, as previously mentioned, and the rest is history.

The next foray into managed-care this time as a regional medical director made me realized two things. First that managed-care was here to stay, and physicians have two choices – to manage or be managed. My personality type is to manage. The learning curve was steep but I found it exhilarating, full of challenges that stretched my comfort zones in every direction, and the new emphasis on population health broadened my horizons in a way that made my career much more meaningful.

I was still able to take care of babies and their mothers but on a population health basis. I traded the technical skills of intubation and putting in umbilical lines to the population health skills of developing programs and measuring quality of healthcare delivery that was improving and saving lives on a different stage. In college I made better grades in math than I did in some of the science classes, and I always really liked math. There’s a lot of math in measuring healthcare quality as well as the financial operations of healthcare and measuring the effectiveness of programs which was really exciting. There’s also a lot of math in neonatology, with the tiny baby’s doses and the many ratios that have to be calculated based on the baby’s weight and gestational age however this was different and just as important. I had to learn financial ratios including medical loss ratios, a lot of epidemiology which made all of my training in medicine, public health, and later business administration come together.

I hope you will find, like I did, that learning the fundamentals of managed care is imperative as long as you’re practicing medicine in any of the many scenarios that there are to practice. If you are a provider, it is important to understand the parameters of measuring healthcare outcomes and to participate in the discussions of how those outcomes are measured. and translating that knowledge into the field, whichn not only improves healthcare for your patients but provides a tremendous improvement in your revenue stream as medicine is changing from the fee for service payment model to value based payment models. If you aspire to become an employee of a managed care organization and rise up the ranks, it’s very important also to understand the fundamentals and the intersection of population health management, healthcare payment models, and the quality metrics that support and dictate the outcome of these variables, and the ultimate grading of your organization’s performance in relation to standardized benchmarks and the performance of your peer organizations.

There’s not a more appropriate time or exciting time to start this journey as the healthcare landscape is changing tremendously according to many factors including the payers – Federal and State governments and managed-care organizations, members or patients medical and mental conditions, behavioral patterns of self-care and seeking care as well as the many environmental and now newly recognized genetic conditions that impact the quality and length of life of the citizenry of the U.S. and the world we interact with.

No matter what station you are at in your life and career in medicine, I promise that you will find this course worthwhile, and hopefully advocate for courses like this to be taught in medical school to better prepare you to navigate the new and changing landscape of practicing medicine, which inherently will make you a more prepared and better physician, while achieving the life-work balance that your family really need – even more than the money that you will earn.