Stepping off the clinical track to work in digital health
Hi! I’m Kaeli, an MD making my way in the world with no residency. I’ve worked in startups (Akido Labs, The Human Diagnosis Project), in the federal government as a White House Presidential Innovation Fellow, and am now leading a clinical product team at Accolade.
The decision to forgo residency was both exciting and nerve-wracking, and something about which physicians or physicians in training are often interested. I’m asked — “When did you decide not to practice clinically?”, “Do you ever regret your decision?”, and “What does your day-to-day work entail?” For those who may find it helpful, here is my story:
As a Chinese-American born into a family of doctors, going into medicine was always on my radar but not a foregone conclusion. In college, I was drawn toward computer science courses and considered it as a major. Though, I was a bit intimidated by classmates at Stanford who seemed far ahead of me in the field. After waffling about it for a couple years, I chose Biology so I could complete the pre-med requirements and finish a major on time.
VA Palo Alto: Introduction to clinical informatics
My first job out of college was as a Clinical Research Associate at Veterans Affairs (VA) Palo Alto. I had decided to pursue medical school, but hadn’t yet taken the MCAT and wanted some time off of being a student. Luckily, I landed a job combining my interests in medicine and technology: working with a research group developing clinical decision support applications for the VA electronic health record.
What was originally a gap year(s) filler job turned into a completely pivotal role for me. There, I was introduced to clinical informatics / decision support and was awed by its power: for example, an application developed by our small team influenced tens of thousands of hypertension medication decisions during a pilot implementation. So cool! Not only did this type of work have great potential for impact at scale, but it also offered at least a partial solution to the problem of care gaps from reliance on clinicians manually keeping up with new evidence.
My team at VA Palo Alto was led by Dr. Mary K Goldstein, an esteemed researcher and geriatrician. She and many of her collaborators were MDs who no longer practiced, who instead leveraged their clinical knowledge for clinical informatics work full-time. These folks became my career role models, and I set my sights on clinical informatics as an end game.
Keck School of Medicine: “Silicon Beach”
My medical school, Keck USC, was an excellent place to dive deeper into health technology. At the time, they offered an innovative “Health, Technology, and Engineering (HTE)” program, which paired USC PhD engineering students with medical students to collaborate on health tech projects. This program had spawned Akido Labs, a Y-Combinator-backed startup co-founded by a Keck medical student.
With the help of HTE Director Dr. George Tolomiczenko, I connected with the Akido Labs team and began working with them part-time during my first year at Keck. Through this role, I was exposed to new areas of health technology, including interoperability, Meaningful Use, and the FHIR HL7 standard. I also got hands-on experience with non-clinical, non-academic aspects of operating a startup/business, including developing product value propositions, recruiting and managing teams, crafting sales pitches, cultivating thought leadership, and more. I started to see there was work to be done in digital health that didn’t require a high level of clinical expertise.
Toward the end of first year, a revolutionary thought struck me: there was no reason I HAD to do residency! Yes, it is the typical next step after medical school, but I was by no means bound to take it. Up to that point, I’d been struggling to get excited about any particular specialty, and was mostly looking forward to getting residency “over with” so I could get back to building digital health tools. As soon as the idea occurred to me, I felt a huge wave of excitement, relief, and anticipation for the future. It felt right.
Medical school hiatus
I started to go through medical school with a new outlook: instead of stressing about becoming a top residency applicant, I approached studying with curiosity and gratitude for the rare opportunity to learn about the human body. I soaked in my clinical rotations, knowing they’d likely be my last experiences in those settings.
Still, part of me was afraid my decision might be a mistake. Would I be valuable in digital health without more legitimate clinical experience? Would the work be as fulfilling as I’d imagined? Would I be able to pay off my student loans? To help answer these questions, I decided to take a hiatus after third year to gain work experience and confidence in my decision.
I spent winter break of third year researching digital health companies. The Human Diagnosis Project (Human Dx), another Y-Combinator-backed startup, stood out for its mission that inspired and excited me. I LinkedIn messaged a medical student interning there to learn how I could join the team. After offering my full-time services for free — I told them I’d arrange for a research year stipend from school — I was in! That June, I moved from LA to DC to join the Human Dx team.
Startup life
The next two years were the busiest, most growth-filled I’ve had to date. The workload and pace at Human Dx were more demanding than most parts of medical school had been. Plus, I was completing a Stanford Biomedical Informatics certificate program online and occasionally returning to LA for medical school elective rotations.
I had joined Human Dx to gain experience and confidence, and that I certainly did. I got crash courses in product management, people management, organizational strategy and planning, sales/partnerships, community growth strategies, analytics, clinical informatics research, medical terminologies, and more. I learned to build products, processes, and teams from the ground up.
After a year at the company I became a salaried employee, and during my second year was promoted. I loved the work, felt valued by the team, and felt confident I’d gained skills that could transfer elsewhere. I was ready to return to LA and finish fourth year without applying to residency.
Post-graduation
I job searched and interviewed during my last rotations of fourth year. I received multiple offers, and accepted one as a White House Presidential Innovation Fellow at the VA’s Office of the Chief Technology Officer. There, I got to work on building clinical decision support for the VA once again. This time, I was on the IT side rather than clinical, and worked from VA Central Office rather than a regional VA healthcare system. This provided easier avenues toward scale and impact. My background as an MD allowed me to function as a clinical ambassador in IT-land, which helped build trust with clinical stakeholders.
After completing the Fellowship, I sought out the new experience of working with a larger health technology company. Now, I lead a product team at Accolade, Inc. that specializes in delivering products to our frontline care teams. I love building tools that let our teams focus on care rather than documentation. I’m enjoying getting deeper into value-based care, learning about business operations in the private sector, and growing as a leader in product. I’m grateful for the path I’ve taken and where it’s led me, and am looking forward to what comes next!
…
My experiences with startups and clinical informatics research groups during medical school were key to my success outside of clinical medicine. I’m interested in finding ways to help other medical students with similar interests build their non-clinical skillsets and resumes as well.
Have you or has someone you know found creative ways to get non-clinical industry experiences while in medical school? I’d love to hear about it! Please reach out to me at kwyuen@alumni.stanford.edu.
