One Physician’s Non-Linear Path to a Wildly Successful Membership-Based Medicine Practice
Intellectual Humility, People First, Failing Forward Fast
Every good story has a backstory, and few physician entrepreneurs are as talented and energetic storytellers as the guest of a recent episode of the ROAMD podcast, Dr. Jordan Shlain. Dr. Shlain is the founder of Private Medical, a highly successful, membership-based medical practice with four locations around the country and counting. He shares his wit and wisdom with Dr. Scott Pope on the pragmatic philosophy and serendipity that put him on his current arc of success. This is an episode that deserves to be heard.
“I’m the accidental membership-based doctor. I liked innovation, technology, design, My father was a surgeon – ‘cut it out and fix it’ – and my mom was a PhD in psychotherapy\ – ‘let’s sit down and talk about it forever.’ I have these two influences in my life, as well as two sisters that are artists. And my dad told me I had to be a doctor. So, I had to figure out how to make medicine and art and design into something that was bigger than just taking care of people.”
Dr. Shlain describes the magic of his success as an iterative process that comes down to placing a premium on how the staff at Private Medical treat each other. “We really value culture. We live in a world where we want to be the best doctors we can be. We want to avoid drama. We want to challenge each other in an intellectual curiosity way, not in an ‘I’m right you’re wrong’ way.”
He describes “a culture of care,” where he and his colleagues take care of each other first. “If I don’t take care of my partners and my colleagues and my staff, how am I going to take care of my patients? Everybody thinks patients are the number one thing you have to focus on, but if you’re building an enterprise, you have to focus on each other, so that then you can take care of people.”
Intellectual Humility in Complex System Design
At a company offsite a few years ago, he arranged for a lecture on intellectual humility, which permeates the attitude throughout the organization. “What you believe and who you are are different things. As far as what you believe to be right – if you’re humble, you understand it’s just a hypothesis. And you could be wrong. I argue like I’m right, but I listen like I’m wrong.”
He describes his culture-building as a complex system, wherein he is focused on ensuring the highest fidelity of ‘communication architecture’ as a means of reducing anxiety internally and towards patients. He cites pediatrician John Gall and Occam’s razor to describe a process of simple systems that work well, which together comprise a larger, complex system. “This is a 20 year journey for me, it didn’t come out of nowhere. This is the composite of bits and pieces I’ve absorbed over time…if you try to build a complex system from scratch, you’ll fail.”
Dr. Shlain is adamant about one piece of advice: Hire for character. He describes starting his journey in membership-based medicine by himself, then adding a naturopathic doctor, then a nurse, then a patient care coordinator. “Then you realize – oh, there are conflicts here. It’s not like you put it together and it magically works. You have to work through dissonance at every interaction. A lot of it is personality driven….A lot of the advice I give anybody hiring anybody is,’Character is destiny.’ The character of the person you’re hiring – if they’re really smart but they’re sharp elbowed, you’re going to get sharp elbows…You have to think about equity, equality, fairness, when bringing people in. Is the person you’re hiring a team player?”
An Unconventional Career Journey
While a written summary will not do Dr. Shlain’s journey full justice, here are the highlights (though we encourage you to listen to the conversation in its entirety!) In college, he studied pre-med for four years, and then spent a year teaching high school science in West Africa, where he learned Swahili and had a formative experience embedding himself as closely as possible in the local culture. He continued on to med school at Georgetown, and then moved back home to San Francisco.
Due to regulatory changes happening in the HMO world, finding a fully employed job the year he graduated residency proved challenging. So, with help from his father, a renowned surgeon, the younger Dr. Shlain accepted an internship with an elderly physician with his own private practice. He describes a handshake agreement wherein a paragraph in his employment contract said that for the first year, he would make about sixty grand while covering call duties for one week every month. After that, he would transition to take over the practice while the other doctor entered retirement.
Unfortunately, the doctor reneged on his word in the 11th month, infuriating a young Dr. Shlain. Again, he insists that character is everything, and the fact that his colleague broke his promise was a dealbreaker. He stormed out of the meeting and walked around downtown San Francisco to blow off steam. This was in the late 90’s, before the city had developed to the point it has today. He walked into a cafe and ordered a cup of tea to calm down, and the rest, as they say, is history:
“I literally just walked into a restaurant, which turned out to be this cafe in the Mandarin Oriental hotel. I noticed all these fancy people coming out of the hotel. So, Innovation by Irritation, right? I walked up to the concierge desk and just asked the concierge, ‘Who’s the doctor here?’”
The concierge informed him that everything they do is 5-star, and while the young Dr. Shlain might be 5-star smart, his industry has 1-star service. So if he wanted to be a doctor to these patients, he had to do two things: Prove he was a doctor, and provide 5-star service.
“I came back 2 weeks later, I built what looked like a medical chart: My medical school resume, residency, letters of recommendation. She brought me under her wing and taught me the 5-star methodology, which by the way is all about listening, it’s about follow up, it’s about follow through, it’s about doing what you say you’re going to do, and being attentive. Executing on that is hard. That’s where I got the seeds of design. Soon I was making $300/housecall… I was making as much doing housecalls in a week as I was in a month at the old practice.”
Dr. Shlain repeated the same routine at Ritz Carlton, and then “wound up running the table, getting every hotel in San Francisco.” Smoothing his path to success: this was in the height of the dot com days, so by providing his e-mail address and cell phone to the wealthy traveling crowd, he was able to create access that people were willing to pay for. He soon had seven doctors working for him, in a company that was then called the San Francisco On-Call Medical Group, making millions of dollars a year.
Find Your ‘Doctor’s Lounge’
Twenty years later, Dr. Shlain has expanded his footprint and matured his business model into the finely-oiled machine that is Private Medical, with stints in digital health, food is medicine, and other ventures along the way. He attributes some of his success and encourages newcomers to having that network of like-minded physicians.
“Ultimately what we want is collegiality, camaraderie, where we can share ideas. We started early, but this market is exploding. Doctors who want freedom, and who want to be the best doctors they can be, are moving to membership based medicine. It may seem scary, it may seem like you’re jumping into a gigantic hole that you can’t see the bottom of, but I’m telling you, there’s a ledge, one foot down. It’s honey and pillows at the bottom of that thing, soft and sweet. But it’s going to seem scary at first.”
“By providing the forum that ROAMD does, you give doctors who are just starting or at the middle a chance to learn from doctors like me, or Matt Priddy, or all the other doctors who have been doing this for a while, because common things are common – Occam’s razor. The mistakes you’re going to make, I’ve made. Let me help you not make them.”
Dr. Shlain encourages focus, and stresses the value of learning from mistakes: “When you’re entering this space…there are all these shiny objects everywhere. I’m here to tell you – some of those objects are easter eggs, some of them are landmines. Some of the ones you’re convinced are going to be great for you will blow up in your face. And some of the ones you’re going to dismiss as a bad idea, are the best things ever. How do you know which is which? You want to make all those mistakes again? I do believe that you learn best from big fat things blowing up in your face.”
But he also encourages those who don’t want to go through that painful experience to reach out to ROAMD, which he generously describes as a modern-day doctor’s lounge for membership-based medicine. For more information about joining our community, make sure to visit us online and check out our other podcast episodes to hear from doctors who’ve taken the leap into membership-based medicine.
Dr. Jordan Shlain founded Private Medical in 1997 and still serves as a managing partner. He believes that good medicine and great health come only from a deep understanding of people, data, and science.
Dr. Shlain studied physiology at University of California, Berkeley. He then participated in the Phillips Brooks House service organization at Harvard University and taught high school chemistry, physics, and biology in Kenya with WorldTeach.
Dr. Shlain earned his medical degree at Georgetown University School of Medicine, where he also created inner city drug education programs, and completed his residency in internal medicine through UC San Francisco at California Pacific Medical Center. He has founded several companies and served as an expert advisor for numerous healthcare-related businesses.
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