When I designed Sherpaa over 6 years ago, I wanted to create a new life for doctors. Even though all of our doctors are employed by Sherpaa, I’ve always viewed them as Sherpaa’s customers just as much as I think of our patients as customers. If you don’t have happy doctors, you can’t have happy patients. It’s that simple. So, with that in mind, we set out to address the challenges traditional PCPs face in the outside world. Here’s how we did that.
Doctors simply want to care for people in the best way they can imagine and make a living doing that.
They want to communicate effectively with people, get at the problem, treat it successfully, and get confirmation they’ve solved problems. In order to do this, you have to redesign how doctors communicate with patients. If doctors and patients can communicate with each other as simply as an email or a phone call, doctors can know their intervention is working and patients can reach out with updates that may or may not change the strategy. When a patient steps out of an exam room, traditional doctors do not have an easy way to understand how the patient is doing. That’s a terrible and frankly unsafe process. Most importantly, both a doctor and a patient must have the ability to initiate communications from anywhere at any time.
Doctors do not want to deal with the business side of things
They just want to show up, simply care for people, and get paid. Doctors are not trained to deal with accounting and the operations of a business. So don’t expect them to be anything more than just doctors. Sherpaa doctors know what shifts they have to work, and they log in and care for patients. If a doctor will be late, they text one another asking for help with coverage. All of the doctors look out for each other. It’s a true team that, together, built a functioning new kind of 24/7 practice. This is their baby and they care for it. And they are completely shielded from the operations of Sherpaa.
Doctors want professional support
I thought practicing medicine, one-on-one with patients, was pretty lonely. I also felt that, if I didn’t know what was going on, I had to wing it as best I could. I couldn’t, in real time, ask other doctors to poke in and help me figure something out. And the interactions you do have with other doctors is often quick conversations in between patients. By no means is primary care a team sport. I thought that was wrong and needed fixing. So, with Sherpaa, in complicated cases, the doctors flag weird cases and ask other Sherpaa doctors for help. So, patients get second opinions baked in rather than the opinion of a solo doctor. And, since they’re all working together in a room, when complicated situations arise, they talk amongst themselves, gain a consensus, and one of them then gets back to the patient. There’s safety in numbers with quality assurance baked in.
Doctors want flexibility
The internet has enabled so many people to work from wherever. Doctors, too, want the flexibility to work from wherever when it’s convenient for them. Sherpaa doctors work in 8 hour shifts, from 8am EST to 4pm EST and 12pm to 8pm EST. Most of the time, the doctors are working together in the same space. But, one of our doctors has a summer home in Maine and she works from Maine all summer long. Another one of our doctors is married to a man who lives in Vienna. So, 6 months out of the year, she’s treating patients here in America from Vienna. And nearly every one of our doctors are women, often with young children. They want to continue being talented doctors, but also want the opportunity to spend more time with their children. If a doctor is tied to a physical office, they simply could not lead these diverse, unique lifestyles.
Doctors want meaningful connections
Our doctors are always asked “don’t you miss seeing patients?” While it’s very true that our doctors never see our patients in person, our doctors still develop relationships with people over time. When you’re always working with the same doctors, you get to know each other. It’s not in the “I can look in your eyes kind of way,” it’s more that we’ve written to each other back and forth so much over the last 2 years that I understand what motivates you and what you’re looking for. And I’ve also seen that you’ve had these 12 cases and I helped you and I’m proud of what I’ve done for you and your life. There’s important meaning, even if it’s not an in-person relationship. There are also massive companies built in a decentralized way, like Github. Their employees communicate and solve problems and they don’t have to look each other in the eyes to solve the vast majority of problems. We’ve got so many means of communication available to us. Let’s use the best ones to solve problems the fastest.
Doctors don’t want to be scribes
Traditional doctors spend ~50% of their day documenting interactions with patients in their electronic medical records. When care is delivered primarily via messaging, the conversation is the documentation. That, in and of itself, makes Sherpaa doctors literally 100% more efficient than a traditional doctor.In fact, Sherpaa’s platform doesn’t allow our doctors to document anything the patient cannot see. It’s full transparency.
Doctors don’t want to do the mundane
There are three big time sucks for traditional doctors:
- Asking detailed questions of the patient about their situation
- Communicating the plan
- Documenting the interaction
When doctors are taking a history, they ask the same questions over and over to each patient who presents with the same symptoms. And then patients want to best describe what’s happening, but the answers can get long-winded. Then, when doctors are describing treatment plans like what to do about your sinus infection, they’re saying the same thing to most patients. With patients asking more questions about their treatment, this takes time. Because this is an oral conversation in traditional doctoring, there’s no way to automate this. But with asynchronous messaging conversations, 90% of both of these time sucks can be automated. And once they’re automated, they can learn to be more efficient. Documenting an oral conversation has already been covered, but this automated process tackling these three areas leapfrogs traditional doctor productivity.
Doctors want technology that makes their job easier
Today’s EMRs are designed to maximize reimbursement from insurance companies. Because this is the problem EMRs solve for healthcare, this is antithetical to doctors’ wanting clear, concise, only clinically relevant information available to them in the most insightful way with the least clicks possible. Doctors are forced to use technology that makes their jobs harder. In their quest to maximize their pay over the past few decades, they’ve enslaved themselves. Paying doctors to communicate and solve problems rather than paying them for maximizing volume and maximizing things they do to patients frees them to use technology that makes their jobs easier. Here’s what an EMR looks like when doctors are paid to communicate and solve problems, rather than get paid for more office visits and procedures.
Doctors want to be part of the solution, not the problem
The vast majority of doctors are exceptional people stuck in a system that incentivizes them to do the wrong things. And because the culture of medicine teaches us from day one to not question our authorities, we get really good at following the pack. But every doctor knows the system is broken, and most do not have the resources to fundamentally change healthcare. Doctors, by nature, want to be the solution for problems. It’s in our nature. This is what I talked about in 2011. Six years later, it’s more important than ever.