…Health and Healthcare Disparities: In the United States, minorities and low-income individuals do not have equal access to health care and suffer from disease and chronic illness disproportionately. Until we address these inequalities, our performance will continue to rank poorly compared to other developed nations.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. Nicole Rochester. Dr. Rochester is a board-certified pediatrician, private health advocate, TEDx speaker, author, and the CEO of Your GPS Doc, LLC, an innovative company that helps individuals and their family caregivers navigate the healthcare system. Dr. Rochester was inspired to start her company after caring for her late father and witnessing the complicated healthcare system from the other side of the stethoscope. She is committed to transforming our healthcare system through the education and empowerment of patients and family caregivers.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
My two older sisters and I cared for our father (now deceased) for three years. He had multiple chronic health conditions, including diabetes, high blood pressure, heart disease, dementia, and end stage kidney disease. While we all pitched in and did whatever was needed, as the physician in the family my primary responsibility was to manage his healthcare needs. I learned very quickly that despite my extensive experience practicing medicine, I knew very little about the complexity of our healthcare system and the innumerable barriers that exist between patients, family caregivers, and healthcare providers.
On multiple occasions, I had to fiercely advocate for my dad to ensure he received appropriate and timely medical care. As a family caregiver, I often felt invisible and ignored until one day I mentioned I was a physician. I began to realize that my medical expertise and professional influence allowed me to cut through a lot of the red tape and improve my father’s experience with the healthcare system. While this benefitted my family, I often thought of the 40+ million family caregivers in the U.S., most of whom do not have a medical professional in the family. As a result, I felt compelled and spiritually driven to launch a health advocacy company, blog, social media, and speaking platform that allow me to share my inside knowledge with others so that they can receive optimal care from healthcare professionals.
Can you share the most interesting story that happened to you since you began leading your company?
There are so many interesting things that have happened to me since starting my company! One of the most interesting and exciting things was delivering a TEDx talk in March 2019 at TEDxGreatMills. Becoming a TEDx speaker had been on my bucket list. Over the course of 1 month, I went from being a guest on the Speaking Your Brand podcast, where I received on-air coaching regarding my topic idea, to applying and being accepted as a speaker! It all happened so fast and I am still in disbelief. Having the opportunity to share my thoughts about healthcare on a TEDx stage was magical and I look forward to continuing the dialogue.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I have over 20 years of experience in the healthcare industry as a physician. For 10 years of my career, I was in a leadership role as a Medical Director and had the opportunity to work collaboratively with clerical staff, nurses, physicians, and hospital administrators. I am also a Clinical Assistant Professor and have extensive experience educating medical students and physicians-in-training (residents). As a former family caregiver, I possess a unique set of experiences and skills as well as a degree of empathy that can only come from firsthand experience with our complicated healthcare system. I use those experiences to inform my activities as a professional health advocate. Lastly, I am a thought leader committed to developing and facilitating innovative ways to bridge the gap between healthcare providers and the patients and families we serve.
What makes your company stand out? Can you share a story?
I am one of few healthcare advocates in the United States who is also a physician. My company is also unique because I made a choice from the beginning to extend my influence beyond individual clients and one-to-one consulting. My blog, speaking engagements, and social media presence allow me to disseminate important information broadly, allowing me to influence patients and family caregivers throughout the country and even the world. I have had many people reach out to me on social media or on my website, letting me know that they watched one of my videos or read one of my blog articles and how it helped them advocate for themselves or their loved ones in healthcare settings.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
In my TEDx talk, “Overcoming Invisibility, Improving Healthcare and Restoring the Doctor-Patient Relationship”, I shared my experiences as a family caregiver attempting to maneuver our healthcare system. I discussed the pervasive issues surrounding patient dissatisfaction and the epidemic of physician burnout and suicide. It is my opinion that our biggest healthcare crisis is not cost, but rather the erosion of the doctor-patient relationship. At our core we are humans who need to be connected to one another, but the current system does not allow for this basic necessity. As a result, patients don’t trust their doctors, doctors are disillusioned, and the care being provided is often suboptimal. My proposed solution is the #90SecondEncounter. I am challenging physicians to spend 90 seconds of every patient encounter genuinely connecting with their patients (and their caregivers). A simple gesture that includes asking the patient about their family, job, last vacation, or the last great book they read can open the door to a meaningful and enriching relationship for both parties. It’s a win-win! We cannot and should not wait for sweeping health reform and things will never go back to how they were 50 years ago. What we (physicians) can control is how we interact with patients and how we behave on the other side of the exam room door. No one can regulate that. During a time when doctors and other healthcare providers are being asked to do more in less time, I am asking us to all pause, take a deep breath, and remember why we are doing this in the first place.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
- You can have more than one life purpose.
I have known I wanted to be a pediatrician since I was 8 or 9 years old and I was laser-focused on that singular goal until completing pediatric residency training in my late 20s. I loved being a pediatrician, medical director, and educator and truly felt my last place of employment was my dream job. More importantly, I knew I was fulfilling a purpose bigger than myself. I never dreamed of doing anything else until after my caregiving journey ended. I began thinking about how I could help other caregivers, but I had reservations because of the enormous amount of time I spent becoming a physician and the conflicting emotions associated with leaving my comfort zone. I now realize that health advocacy is also my life’s purpose. I receive as much joy and satisfaction helping patients and family caregivers navigate the healthcare system as I did while caring for pediatric patients.
2. Buying your own health insurance is incredibly expensive!
As a health system and hospital employee I always had great health insurance for myself and my family. When I left my full-time job in July 2017, my husband was also self-employed so we had to purchase health insurance for our family of four on the ACA marketplace. We were not prepared for the cost of unsubsidized health insurance and continue to be amazed by the increase in our healthcare spending and out-of-pocket expenses.
3. Done is better than perfect.
I spent the first year in business undoing many of the mindset blocks I acquired as a medical student, resident, and practicing physician. In medicine, there is no room for mistakes. Every decision is analyzed and calculated. This does not work as an entrepreneur. I spent a lot of time reading books and doing “research”, trying to figure out the best way to move forward. It turns out, you have to take the leap and just do something (anything), then tweak it as you go along, learning from your mistakes. I’m still working on this one but I get better at it every day.
4. Podcasts and audio books are a wonderful way to learn!
I listened to my first podcast approximately one year before starting my business and I was immediately hooked. I later added audio books to my arsenal. I have learned so much from this form of content and the ability to maximize my efforts by listening while I exercise, wash dishes, and even while I shower in the mornings has been mind-blowing!
5. You impact the world one person at a time.
I am humbled by every email, text message, and social media post I receive from someone who attributes his/her success navigating the healthcare system to my health advocacy work or who attributes his/her leap of faith to my personal journey. When we are empowered and inspired, we uplift others. This magical power moves from person to person until you can no longer figure out where it started or where it will end. We each have a responsibility to change the world for the better and it happens one person at a time.
Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
- Health and Healthcare Disparities: In the United States, minorities and low-income individuals do not have equal access to health care and suffer from disease and chronic illness disproportionately. Until we address these inequalities, our performance will continue to rank poorly compared to other developed nations.
- Fragmented Care: We have a very fragmented system in which patients receive care in a variety of settings by numerous providers plagued by faulty communication channels. We do not have a universal electronic medical record and doctors routinely make decisions based on incomplete (and sometimes inaccurate) information. The burden of information integrity rests with the patient and his/her caregivers, during a time marked inevitably by stress and overwhelm.
- Private Health Insurance: While single payer health plans are not without flaws, our current chaotic maze of private and government-funded health insurance is incredibly complicated. Private insurers have garnered unprecedented decision-making power and have largely removed the authority of physicians to practice evidence-based medicine.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Place patients and family caregivers at the center of every healthcare team.
In the midst of electronic health records, quality measures, and efforts to improve efficiency/productivity, the needs of patients and their caregivers have been largely ignored. Physicians and other healthcare providers need to remember their “why”. Most of us entered the medical field to improve the health and lives of our patients. However, the administrative tasks associated with practicing medicine distract us from this primary purpose. Everything we do and every decision we make needs to serve our patients and their needs.
2. Limit the authority of health insurance companies.
There is no question that we need to control healthcare costs in the U.S. However, allowing insurance companies to deny payment for prescribed diagnostic and therapeutic services and forcing physicians to choose between spending quality time caring for patients vs. spending time on the phone appealing these decisions has created a conundrum. The “balance of power” needs to be shifted to the clinicians who know what’s best for their patients. Frontline healthcare providers should be included in the development of insurance guidelines regarding appropriateness of care and in the creation of policies and practices that curb healthcare spending.
3. Strengthen the primary care workforce.
It is predicted that there will be a significant shortage of primary care physicians by the year 2030. While the number of medical students matching in primary care residencies is increasing, the number of available residency positions will need to increase in order to bridge this gap. We need to ensure that patients throughout the U.S. have access to quality preventive medical care.
4. Improve the diversity of the physician workforce.
The United States is plagued with health and healthcare disparities. These disparities are partially due to low health literacy and poor access to care, but implicit bias also plays a significant role. There are numerous studies that show patients are more likely to receive quality medical care when they share race, ethnicity, language and/or religious experience with their providers. U.S. medical schools need to make a formal commitment and develop programs to increase the recruitment and retention of ethnically diverse students.
5. Address rising healthcare costs and out-of-pocket expenses.
Americans are having to make difficult choices between managing expenses for food and shelter and those related to healthcare. Due to rising prescription drug costs, many patients are rationing medications or not taking them at all. Individuals are delaying and deferring health care because of large deductibles and out-of-pocket costs. The end result will be an unhealthier America. The Affordable Care Act made sweeping, necessary changes and insured millions of Americans. However, health insurance does not equal health care. We must make healthcare more affordable.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
Health systems and hospitals can incentivize patient-centered care and improve the value of the doctor-patient relationship. Employers can perform end-of-year performance reviews of the health insurance companies with which they contract by speaking directly with employees and gathering information about their experiences and challenges obtaining and affording appropriate care. Medical schools and supporting institutions can create pipeline programs for high school students in underprivileged and ethnically diverse communities to prepare students for a career in medicine. Prescription drug companies can explore opportunities to reduce the cost of medications and increase discount programs offered to those in need. These are just a few of the things we can do to begin transforming our healthcare system.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Book: An American Sickness (Elisabeth Rosenthal)
I was intrigued by this inside look at our healthcare system and the many ills that prevent patients from receiving the care they deserve.
Book: Being Mortal (Atul Gawande)
Like myself, Dr. Gawande experienced our healthcare system as both a physician and as the adult child of an ill parent. In this book, he shares the invaluable lessons he learned about the importance of putting patients first and the gaps between what patients get and what they need from our healthcare system.
Podcast: What the Health?
This weekly podcast is how I stay abreast of the latest updates and developments in health care policy. It is timely and informative.
Podcast: Fixing Healthcare (Robert Pearl & Jeremy Corr)
I am always inspired by the guests on this podcast who share their innovative ideas about transforming our broken healthcare system.
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!