Why physicians must lead the next wave of innovation

People decide health care based on three things: quality, cost and access. Right now, the U.S. health care system is failing in these areas. And no one is more surprised than me that I embarked on a journey to change this.

I am the daughter of a surgeon, the niece of two surgeons, my brother and my husband are surgeons, and I too am a general and vascular surgeon, with more than 25 years in practice under my belt. This is and always has been my world, but the barriers between patients and doctors are maddening.

Changes across the policy and insurance landscape have fundamentally altered the doctor-patient relationship, from HMOs, through state reforms, through ACA, and now significant changes to Medicare and Medicaid. Health care policies have driven patients and physicians further apart.

Why we’re stuck

Insurance restrictions, referral requirements, and prior authorizations frequently block care delivery, even while claiming to do the opposite. Studies show that it takes patients anywhere from a few weeks to nearly a year (sometimes more) to see a specialist. Such delays put patients at risk and ultimately drive up health care costs, as conditions worsen while waiting for an appointment. This also makes physicians’ work more complicated, as easily treatable cases can spiral into conditions that require more invasive procedures or protocols to remedy.

But doctors depend on reimbursements from insurance. We’ve always relied on carriers for payment, and our patients (and their employers) pay a lot of money to ensure that health care is financially manageable through insurance. In 2023, the average cost of health insurance for a family of four was over $23,000 a year, and they still might wind up paying a lot of money out of pocket for a simple checkup. This is crazy!

If we’re honest about employer-based health insurance, it’s a holdover from the World War II era, when it was created to retain workers. It continues to be positioned as a benefit, but I caught myself asking, at what cost? Employers and insurance companies are dictating who gets care and where they have to go to get it, often compromising quality in the process. This is devoid of common sense.

The industry has failed to evolve in a world where patients are more informed than ever. They want — and deserve — a say in their treatment. Concurrently, doctors should have full and equal access to patients rather than relying on abstract determinations of who’s “in network” or who works best for an insurance company’s claims process.

An unexpected entrepreneur

I always wanted to be a surgeon; I never aspired to step out of this zone. But issues of quality, cost and access became so important to me as a human and a practitioner that I could no longer ignore the systemic problems doctors and patients face. I was called to do something.

I had an idea (which became UBERDOC) to prompt change, but it would require a lot of support from family, friends and colleagues to make it work — along with a lot of capital. And I learned very quickly that the medical community is not set up to foster innovation. Creating, developing and building solutions isn’t viewed as doctors’ work. Such a view is a mistake.

Doctors have unique insights to the problems that plague our practices and patients as well as the issues that cause us to lose sleep. We have a lot to contribute to the evolution of health care, and as a group, we tend to be high achievers who are naturally curious about how things work. We like to test our skills to enable things to work better.

Opening new pathways to innovation

Every doctor I know is sitting on an idea that could improve care. Imagine what could happen if everyone had the time, space and ecosystem that could help them bring it to life. This could be transformational.

Programs like the CharmHealth Innovation Challenge, where UBERDOC participated in 2021, show how physicians can share and refine ideas that address real problems in care delivery. Conferences, gatherings and online platforms are expanding these opportunities by connecting clinicians, technologists, investors and partners who share a vision for more accessible, patient-centered care. These growing ecosystems will be vital for the future of health care. We are at our best when we collaborate — whether on a patient’s case or on solving a long-standing challenge in care delivery.

I would encourage all of you to ask yourselves what you would fix given an opportunity. I challenge you to step out of the operating suite or exam room to figure out how to fully realize a solution. Incorporate “innovation” days into your schedule. Engage with not only other practitioners but patients, admins, nurses and the larger ecosystem to see where you can contribute meaningfully.

Being a doctor and becoming an entrepreneur don’t have to be mutually exclusive. Systems change when we are both. It is not easy, but it is worth it.

Paula Muto, M.D., CharmHealth evangelist and UBERDOC founder, is a practicing vascular and general surgeon. She is a member of a family of physicians and surgeons who have collectively practiced medicine in Massachusetts for over 50 years. She is an outspoken advocate for patient care and is passionate about women’s health issues.