Converge Cast | A Physician’s Prescription for the Business of Healthcare: Gaurov Dayal, M.D.
In this episode of WittKieffer’s Converge Cast, Dr. Gaurov Dayal, Chief Executive Officer of Axia Women’s Health, talks with WittKieffer’s Shelly Carolan and Linda Komnick...
In this episode of WittKieffer’s Converge Cast, Dr. Gaurov Dayal, Chief Executive Officer of Axia Women’s Health, talks with WittKieffer’s Shelly Carolan and Linda Komnick about his commitment to revolutionizing healthcare in the U.S. with appreciation for both its business challenges – and the opportunities that exist.
As a physician, Dr. Dayal has always mixed a passion for helping others with a fascination for finance, economics, and the dollars and cents of running a business. Medicine is more of an “individual sport” and business is a “team sport,” he says, but they can coexist and inform each other for the benefit of patients and healthcare delivery organizations. A challenge for some physicians-turned-leaders: getting comfortable with ambiguity. “It definitely requires stepping out of your comfort zone and the need that many of us as physicians have to control every variable,” he says. “You just cannot do that in business.”
Dr. Dayal is an optimist about the changes coming for healthcare, including the incorporation of artificial intelligence. It’s not only a means of improving healthcare and the business of healthcare, it also empowers patients to take control over their own health and well-being.
(Full transcript available below)
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WittKieffer is the premier executive search and leadership advisory firm developing impactful leadership teams for organizations that improve Quality of Life. We welcome you to the WittKieffer Converge Cast where we bring together the brightest minds in healthcare, life sciences, and education.
Each episode, we invite experts, innovators, and voices from diverse backgrounds to share their insights and discuss the challenges that affect the health and well-being of our communities. Together, we’ll navigate the complexities and discuss the tangible benefits and hurdles associated with the shift towards improved consumer experiences and better patient outcomes.
Shelly:
Welcome to the WittKieffer Converge Cast where we bring today’s most influential executives from the Quality of Life ecosystem who have a unique vantage point on the forces and trends that are shaping healthcare and wellness in our communities. Our co-hosts today are myself, Shelly Carolan, Managing Partner of our Investor Backed Healthcare services practice here at WittKieffer and Linda Komnick, Managing Partner of our Physician Integration and Leadership practice.
Today’s guest is Dr. Gaurov Dayal, Physician and Chief Executive Officer of Axia Women’s Health, a women’s healthcare practice with more than 150 locations that serve more than a million patients each year. Prior to his role with Axia, Gaurov served as the President and COO of Everside Health, the nation’s second largest direct primary care provider. Gaurov also served as President, New Markets and Chief Growth Officer at ChenMed, one of the nation’s leading value-based care primary care groups focusing on underserved seniors.
Gaurov has over two decades of experience in population health, physician group, health plan, and hospital operations. He has also served as Senior Vice President at Lumeris, where he created and implemented operational solutions for large health care systems and provider groups transitioning to value-based care delivery. Earlier, at SSM Health Care, a large multi-state integrated delivery system, Gaurov served as Chief Medical Officer, Interim CEO for SSM Wisconsin Hospitals, and President of Health Care Delivery, Finance and Integration. Prior to SSM, Gaurov held senior leadership roles at Adventist Health Care and served as a consultant at McKinsey and Company.
Gaurov completed his undergraduate education at Johns Hopkins University, his medical degree from Northwestern University, and completed residency training at Washington University in St. Louis.
But I think one of the things I’ve found in getting to know you, Gaurov, is just what genuine and personable person you are. Gaurov, it is an absolute pleasure to have you join us today.
Gaurov:
Thank you, Shelly, it’s a pleasure being here. Your intro makes me sound like I’m very, very old, but I’m looking forward to a good conversation with you and Linda and look forward to talking about my experiences. Thank you.
Shelly:
Right, well, let’s start by having you tell us a little bit about your career journey and what experience has shaped you into the executive you are today.
Gaurov:
If I think of a theme in my career or my profession that brings everything together, it’s my innate curiosity and also my interest in just problem solving. And when I was an undergraduate, I was very interested in pursuing a career in medicine, but I was equally interested in economics and just understanding why and how the world works the way it does.
And over the subsequent, I guess almost 30 years since then, I’ve tried to intermix both of these interests around, “How do we solve problems? How do we improve things? And what’s the intersection of healthcare with the ‘business of healthcare?’” And hopefully I’ve made some contributions around innovation and improving the system and will have the opportunity to do so in the future with my teams.
Linda:
Just adding on to that, Gaurov, how has being a physician helped you advance into leadership?
Gaurov:
It’s a great question, Linda. I think that people go to medical school for a reason, right? They’re compassionate people. They want to help people and people go to business school for a different reason. They may be compassionate, want to help people, but it’s much more about dollars and cents. I think that as I’ve progressed in my “business career,” one thing I feel is the significant advantage about being a physician is having native fluency in a second language. You know, you understand, you speak. If you start speaking a language as an adult, you’ll never be good as if you learned it as an infant or as a child. And I feel the same way as being a physician as I look at my career. There are just certain things we are able to understand innately because we were doctors, are doctors, and have learned the jargon and learned the complexity of providing healthcare delivery. I think in many ways it’s difficult for non-clinicians to ever overcome that, for lack of better word, language barrier.
Being a physician, I think also has helped me probably more in thinking about the impact that we can have on the lives of patients on what really, really matters. I mean, of course it’s important for businesses to be successful, but it’s a lot more important for healthcare businesses to be providing exceptional care and good access. I think also, it helps me relate better to a lot of the issues that providers face in this country. It’s a tough job and many times it can be a thankless job. And I think that having some understanding of the complexities of being in the front line of care delivery\-, either as a doctor, as a nurse, as a physical therapist or a dentist -I think those things are valuable in these roles when you’re leading. And overall, I think it just gives me a good balance between the dollars and cents of running a business versus the moral imperative of care directly.
Linda:
So, I’m going to talk to you about it from the opposite side. Then conversely, when you think about that, what are the challenges in developing into a leader as a physician? And what do you see are the biggest challenges for physicians today to evolve into executive leaders?
Gaurov:
One of the biggest issues, Linda, is t in many ways, I think the genotype is different between doctors and business leaders. And there’s some overlap and some commonality. And sometimes you can find people who are interested in both. But most folks go into medicine for a reason. They want nothing to do with business. In terms of my own development, I’d say the biggest development need I had was moving from a very hierarchical structure where you as the physician, are the “leader” and make most of the decisions. And also, in one in which individual performance and contributions are really the benchmark for success. And moving from that to, I’d say a much flatter organizational structure where consensus building is really the secret to success and your own personal contributions have to be put in context of the broader team’s goals. I think there’s also some level of ability to work in a team that surprisingly is not taught in medical school, or at least maybe a bit more so now. But medicine is quite the individual sport and business is much more of an “A-team” sport. And I think that there’s significant differences in that.
To your question around what skill sets physicians need to be successful in healthcare as leaders, first of all, I’d say it’s a great time to be a physician leader. When I think back of, you know, over two decades ago when I started transitioning into more leadership positions, the opportunities were actually fairly limited – join a hospital system, join an insurance company or, you know, or join academic medicine. Now, there’s just been an explosion of opportunities for physician leaders. You have, you know, startups, you have IT companies looking for doctors. You have obviously a new arena, private equity venture capital. So, it’s one of I would say, and I, I get called a lot by doctors or younger doctors looking for career race. And typically, my first question to them is their ability to be comfortable with ambiguity. Practicing doctors are very comfortable with ambiguity within the confines of what they’re doing.
So, if you’re delivering a baby or if you’re doing surgery– neurosurgery, reading an X-raythere’s a lot of ambiguity in those situations, but you control the ambiguity dramatically. Business is the exact opposite. Every given day there’s unknowns that happen. Sometimes you’re not even aware of what the issue of the unknown is, but you’re expected to make a decision quickly. Some of that may be innate. It definitely requires stepping out of your comfort zone that many physicians have to control every variable. You just cannot do that in business.
I think another maybe broader skill set needed is an understanding of finance. I’m sort of embarrassed to say this, but I had never used Excel until I went to work at McKinsey. I mean, I think some would have been overstatement, but barely. And Excel for is pretty much, you know, mandatory skills to have, I think, if you’re leading a business and also broader concepts around finance. I earlier mentioned working in teams, but more importantly, I would say realizing that you are you in isolation. The teams in business,versus in medicine, isstill a very hierarchical structure and maybe for appropriate reasons doesn’t work in business.
One thing that I also think is different in business, which maybe some people, some of the listeners, will find surprising as physicians, still even now with consolidation and corporatization, you’re still pretty free to do what you want in terms of accountability as long as you’re seeing your patients. There’s no scorecard really unless you’re on the extremes, versus in business, there’s a scorecard all the time, like what’s your weekly performance, what’s your monthly, quarterly performance. And I think there’s some level of that, that’s required by physicians transitioning into business to be very comfortable with being held accountable and often for things that you don’t fully control, which goes back to the team point, it’s not just what you did with your patient, but what happened with this department, and you can’t control every variable.
So I think the accountability and, finally, I would say stepping out of a very individualized problem-solving approach, i.e., the patient to a systems, the best business leaders are the ones who can think broadly, but also then jump in and do a deep dive on what’s the most important factor in that moment. And I think that there’s some struggles sometimes with physicians who are very, very focused on one problem appropriately. So that’s what I want my doctor to be doing when they’re operating on me. But in many ways, businesses are really thinking about multiple problems in parallel, which are not restricted to just one set of concerns.
Linda:
Thank you. I appreciate the length of that answer and really hitting a number of points I think are very interesting and helpful for others to understand. To switch gears a little bit, since you’ve had a number of experiences, how would you compare leading in the for-profit and the not-for-profit setting? What do you think of the different qualities and competencies that are required in each of those?
Gaurov:
Yes I think they’re very different and for the listeners or physician listeners who are looking at pursuing careers in either the for-profit or the not-for-profit space almost put it similar to, you know, we all pick different specialties in our medical school and there are personality types for those specialties. And I think there’s almost a personality type difference in the not-for-profit space. And the for-profit space, again, you can crossover, but I think people tend to gravitate in one direction or the other. And I think the biggest differences in my mind are around culture and mission. Not-for-profits are embedded in the community versus for-profit that tend to be more, at least the larger ones, operating at a national scale. And because of that, I think the stakeholders are very different not-for-profits stakeholders, the community members, and they have a much longer-term view about their contributions tothe community.
For-profit stakeholders are much more around their investors and obviously by definition creating a profit. And I think that leads to a different dynamic in the work environment. Most notably, I’d say the pace is very different. I find, you know, the for-profit space is very quick moving, very reactive, potentially at times too reactive and the not-for-profit space is not. And I think that because of that, the for-profit space I think does afford probably a bit more opportunity to advance rapidly because companies tend to be faster growing. But at the same time, you have to be to my earlier point, very comfortable with ambiguity in the for-profit space versus the not-for-profit space.
Overall, in terms of skill sets, look, I think that the core skill sets are very similar. You have to be a good leader; you have to be astute. Some of the other topics I brought up earlier, but I think that fast moving, innovative people may find themselves better suited to for-profit and folks who are more interested in the long-term impact that they have in a community and also looking more at a longer-term investment in care delivery would find themselves better suited in a in a not-for-profit.
Shelly:
So as a physician, Gaurov, how do you think that has impacted your leadership and how you think about your business approach at Axia Women’s Health?
Gaurov:
I think that as a physician, to the earlier point, I think we have an understanding, all of us have a better understanding of and a better perspective on what the core focus of a business should be. And in our case, at Axia, it’s to provide exceptional care regardless of what their issues are. From my end, I believe that we have a high focus in this country around core care coordination and creating more connectivity in the care delivery ecosystem. And to a larger extent, I think I’ve been able to push the envelope at Axia on those arenas.
So for example, postpartum depression is a big challenge. Getting access to behavioral therapists is a big challenge. We’ve done a lot of great work on launching behavioral therapy as part of our care delivery offering. Even though most people would think that’s outside of the realms of traditional women’s health. We have looked very closely at how we can better monitor postpartum hypertension, especially in black women, which is a big challenge. And also, we spend, I think, a lot more time thinking about access issues as well as overall cost of care issues, which are very relevant for everyone. And I think that having an understanding of what the clinical drivers are and how these outcomes can be impacted by different care delivery models is a benefit that I have as a physician.
Shelly:
There’s such an interesting dynamic happening right now with technology and AI and the impact within healthcare. Onone side you’ve got patients wanting to have more access to their data. They want to have more connectivity points to their physicians, to their care providers. And on the other hand, you have many physicians coming forward and saying, you know, there need to be clear boundaries if it’something that AI can have input and guidance and something where physicians have control of patient care. So, you know, very broad question, but as things are developing with data and AI capabilities, where do you stand in that conversation? What is your viewpoint on that?
Gaurov:
I tend to think that this is a significantly transformational tool in many ways. I think it’s going to be. I think many of us are likely underestimating the impact that AI is going to have on all aspects of our lives, but especially in healthcare because we tend to be very slow moving as it relates to technology in healthcare. However, I think the accessibility and ease of use of AI and the fact that it can be plugged into many realms of healthcare delivery, both clinical as well as operational, I think is going to be a game changer. So, my overall view is that we should be very accepting of this. We obviously have to be very cognizant of the challenges that it brings from a privacy perspective as well as an autonomy perspective. But overall, I’m very positive on it and I think it’s going to be a transformational tool. I also think that, you know, I think it’s Bill Gates who said that we that we overestimate change in the short term, but we underestimate change in the long term. I don’t think that AI is going to change anything dramatically by next year. I’m very certain in the next decade we’re going to see huge leaps and bounds because of AI.
I think that the other thing that we need to realize is that we as clinicians and as healthcare delivery organizations don’t control technology in the sense that technology has its own trajectory. And many of our patients are going to be accessing technology regardless of what we want to do or don’t want to do. And I think there’s going to be a huge revolution in patients being activated and managing their own healthcare in a much smarter way. You know, I mean, doctors get irked by Dr.Google because patients look up something and come in with a laundry list of issues that are not curated versus AI, which can give you very precise diagnosis. I mean, you may enter a doctor’s office knowing exactly what you have and what the treatment should be. And I think we have to be prepared for that. I also think that it could be very helpful to humankind, especially, you know, we talk a lot about challenges in accessing healthcare, especially outside of this country. This could be a very transformational tool.
I think that it can also enable folks to take much better control of their own well-being. As it relates to healthcare and physicians, I would look at it in two major buckets. One is around overall operational efficiency, and the other is clinical. On the operational efficiency, I think some of the use cases are already here and in fact we’re already looking to launch two of them. For example, how do you use AI for better revenue cycle management which is a very laborious human process that can be automated and be much more cost effective and quicker? All of us have probably used call centers. I think what many of us may not realize a lot of call center efficiencies already being driven by AI where they summarize the note based on the conversation that was had.
Again, very laborious process which can be automated. We are about to launch a pilot with some of our doctors around AI enabled transcription. So rather than, you know, most patients and most doctors hate the fact that when they’re in a room, there’s a screen between them, there are products that are developed, they’re early stage with they are developed whereas the AI is smart enough that we can have a conversation and as we’re talking, the medical record is getting populated appropriately.
Again, these are early-stage things, but keep in mind that this technology was nonexistent a few years ago. So, just imagine where this is going to be in 10 years. On the clinical side, I think that we are already seeing applications of AI in our business in mammography reads. Everyone’s read about how the AI bot did better than on the LSAT, the M cat, every board.
Shelly:
No, it’s the first thing I think of.
Gaurov:
Hopefully, it’s not replacing all of us anytime, but I think that one interesting arena I read about recently, I think it was last week, which I found very intriguing was behavioral therapy. If you think about what happens when you talk to a therapist, it’s a back and forth. Based on their experience with a lot of people and your personal thoughts being relayed to them, I think it’s quite possible, at least this this author was proposing that behavioral therapy could over time be done by AI. I don’t know if that’s true or not, but the possibility exists. I think also it goes back to the consumer centric issue here that many people don’t go to a behavioral therapist for three reasons. One is access, one is cost, and one is they don’t want to share their personal feelings with somebody else. You could hit all three of those arenas within AI enabled behavioral therapist.
I say this not because I think this is happening anytime soon, but that we should be very open-minded about this technology. And you know, 15 years ago, if we were having a conversation about cell phones, we would never believe, you know, because the iPhone had just come out or was about to come out. We would have never believed where we would be with mobile technology and how it’s transformed the world. That’s only a decade and a half the pace of technology innovation and speed, which is compounded by the fact that AI gets smarter and smarter. Itleads me to believe that we’re going to see massive leaps in cognition, these long large language models in the next five years or so. And I think that we are underestimating the impact that this will have
Linda:
It’s so exciting. You think about the transformation of healthcare, right?
Gaurov:
Right.
Linda:
Just I mean, and what I believe is that physicians 10 years from now, we won’t even know, right?
Gaurov:
Correct. Well, again, I’m not saying it’s all positive. There’s concerns out there which are valid. But think about, you know, our day-to-day in healthcare, a lot of it is around labor force challenges. It’s around: there’s not enough doctors out there, there’s a lack, the cost keeps going up. Automation, when used correctly, could be a significant supplementation to all of these issues and can help us be more efficient and also provide us much more knowledge.
None of us are supercomputers I can look at like we don’t like. Just think of a basic, one basic fact I bring up all the time is how many phone numbers do you remember? I think I know two, I probably used to know maybe twenty. And it’s because you don’t need to know, right? There’s access tothis information. So, you use your brain space doing more productive things, like looking at Twitter and cat videos or whatever we do. But the point is, hey, I can so dramatically supplement our knowledge in real time that I think over time will lead to much better care for people. And it’s, as you can probably hear my voice. I’m quite optimistic about it as long as we can have appropriate guardrails as we draw near the end of our time together.
Linda:
What advice do you have for physicians considering transitioning into leadership roles?
Gaurov:
My advice is do it. I think that there’s such a shortage of physician leaders. Going back to your opening question about why I did this, you know, I was shocked when I was a medical student resident, how few doctors were actually in leadership positions outside of the academic setting. That’s changed a lot in the last few decades, but still, we’re still a small, small group. So, I think that we should not underestimate how much good impact we can have as physician leaders. The only other thing I would add to that is: do it for the right reason. Though I often get called by folks who say they’re tired of practicing medicine and they want a “death job.”
Leadership is something that should be done because you want to jump in and make a change, not because you’re running away from something else. And I think the best leaders are the ones who proactively and preemptively have jumped in because they want to make a contribution to the betterment of healthcare delivery in this country. And I think that,to me, is always a question. I also like to ask, why are you doing this in the first place? And then finally, I would say that jumping into leadership from being a practicing pphysician requires some level of humility. The fact that you went to med school, you’re back to basically being an intern. When you enter a leadership role, there’s a whole learning process. You have to learn the environment, the culture, the tools, the language, and require some humility. It requires being patient. And just like it takes, you know, eight to 10 years to get a license to practice medicine, it takes about a decade to be a seasoned executive leader. So, just for the folks who are interested, who have the right attitude, who are motivated, I think the possibilities are limitless. So, I hope to see many more .
Shelly:
Dr.Gaurov, thank you so much for giving us your perspective, sharing your experience and your insights. We very much appreciate it. It’s been a very just a great conversation. Thank you.
Gaurov:
It’s been a pleasure, Shelly.
Linda:
Thank you.
Gaurov:
Thank you, Linda, it was a lot of fun and thank you for the great questions.
Outro:
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