This
edition’s cover story details the career paths of three physicians, Dr. Charles
Cho, Dr. Han Choi, and Dr. Doug Yoon, and their thoughts on the evolving
relationship between and beyond their clinical roles.
1. What was your major reason for
attending medical school? Why did you want to become a physician?
[HAN] As with many other Korean
families, my parents played a big role in my going to medical school. My mother
was one of the first women to have a faculty position at a major teaching
hospital in Korea in the 1950s right after the Korean War. She was very
dedicated to her academic practice, even putting off starting a family until
she was in her mid-forties. Her influence was so strong that she convinced me
to do a six-year accelerated B.S.-M.D. program, which led to my becoming a
doctor when I was 22 years old. My age ended up being a problem when I started
my general surgery residency because patients would take one look at me and
say, “you’re just a kid, there’s no way you’re operating on me.” So, after
getting my medical license, I decided to take some time off from my residency
and became a public health officer at the U.S. Centers for Disease Control and
Prevention. While at CDC, I ran public health and health policy programs both
in the U.S. and in Africa, which is where I first developed an interest in the
non-clinical side of healthcare. From there, I decided to go back to school and
became an attorney with the intention of doing health policy work at the
federal or international level afterwards. However, I ended up joining and
eventually leading the licensing and business development functions for two
multi-national pharmaceutical companies where my medical and legal backgrounds
were useful in structuring and negotiating licensing deals and company
acquisitions. Then 13 years ago, I was recruited by a hedge fund to manage
their pharmaceutical and biotechnology investments, which is where I am today.
[CHARLIE] As a young child (a very
long time ago), I enjoyed the excitement of looking for then discovering
something interesting and seeking new experiences. This manifested in many ways
during my young life, but also over my educational and career choices. I
studied and majored in History, Geology, and Literature during my undergraduate
education; then, went on to seek a more basic science post-graduate schooling.
After starting a career in Investment Banking, I applied to and attended
Medical School, Residency, and Fellowship subspecializing[1]
in increasingly more specific desperate diseases. With each differentiating
step, there was a growing awareness of need, not just medical care delivery,
but also for diagnostic and therapeutic solutions for diseases without adequate
cures. Each patient was a mystery needing a solution, and these investigations
led to diagnosis and cures.
[DOUG] I lost my ability to walk due
to a rare bone disease when I attended elementary school as a second grader. My
mother had to carry me on her back to and from the school every day for three
years. It was a difficult situation for anybody. One bright aspect of it was,
however, that it forced the young boy in a small fishing village to think about
the future path relatively early. One day, when I was left alone in the
classroom during a physical education class while other friends were playing
outside, I gave up the idea of becoming a fisherman because I was not sure that
I could walk again. Instead, I made up my mind - “I will do something to fix
this kind of embarrassing disease.” I guess that was the beginning of processes
that led me to a medical school eventually
2. Please introduce your current
profession in the clinical and/or nonclinical setting. What experiences have
motivated you to pursue your current profession? What are the long-range career
goals with your profession?
[HAN] I am currently a Principal at
Oracle Investment Management, which was the first sector-specific healthcare
hedge fund in the U.S. Although we invest across all subsectors of healthcare,
my primary responsibility is to manage our investments in pharmaceutical and
biotechnology companies. The last few years have been a great time to be a
biotech investor. The pace of clinical research has been staggering, and I
consider myself fortunate to have seen many small research-focused companies we
invested in mature and grow to become very profitable multi-billion dollar
commercial-stage companies. What is even more encouraging is that I am seeing
more and more Korean biotech companies attract interest from both the big
multinational pharmaceutical companies as well as from U.S. and European
institutional investors. There is a lot of cutting-edge research being done by
Korean universities and companies that I think will lead to tremendous growth
of the Korean biotech sector in the coming years.
[CHARLIE] As a clinician, I am a
Professor at the Stanford University School of Medicine Department of
Neurology. As a Neuromuscular specialist and Director of the ALS Clinic, I see
a focus of patients with truly devastating and life-threatening diseases. I
used to also run large multi-center clinical trials to seek curative therapies
for these diseases but have stopped this part of my practice a decade ago,
primarily due to my desire to seek more creative solutions and invest in a
broader range, and hopefully have a bigger impact in healthcare. My other
professional focus is as a portfolio manager at a Hedge Fund, investing our
collective funds into promising healthcare companies in the US, EU, and Korea.
The areas of interest include drugs, biologics, devices, and diagnostics. Over
the last 9 years, we have deployed over $3 billion into public companies in
these three regions. This mission is similar to my clinical activities in that
they both are investigating the basic and clinical science technology and seeking
treatments and cures to extremely serious diseases.
[DOUG] I currently work as the Chief
Scientist at Washington Scientific, a health science consulting firm that I
established in the Washington metropolitan area after working for five years at
a large NASDAQ-listed science consulting company. Washington Scientific works
on the intersection of medicine and epidemiologic principles. We often are
involved in controversial issues such as unwanted effects of drugs or chemical
compounds, association vs. causation, and cancer cluster claims. Before working
in the non-clinical setting, I practiced medicine for 18 years in a large
academic hospital system in Korea. Evaluation of the epidemiologic evidence
behind the clinical decisions was one of the tasks during that era. That’s when
I developed further interests on systemic[2]
reviews and evidence-based medicine. I decided to earn a degree in public
health focused on those areas during my sabbatical year. When I finished my
degree in epidemiology, I decided to take a job that might present more
opportunities in which I could utilize both of my clinical and epidemiologic
training. As a founder of Washington Scientific, I want to see my company grow
from a mere consulting firm into a think tank that helps society navigate into
the future. As a society, we are facing many issues currently overarching
scientific principles and clinical practices. Health insurance system issues,
discrepancies between scientific evidence and real-world clinical practice, and
misuse of societal assets in healthcare areas are just a few of them. I dream
that Washington Scientific will provide critical guides to the society in
overcoming those issues.
3. Especially for your non-clinical
career experience, have you identified any advantages and/or disadvantages of
being a physician?
[HAN] Being a physician is an
advantage anywhere within the healthcare industry because doctors will always
make the majority of diagnostic and treatment decisions for their patients.
That said, there are an increasing number of dual-disciplined physicians these
days including M.D., Ph.D.s, M.D., M.B.A.s, and M.D., J.D.s., including on Wall
Street. In the investment management field, being a physician is an advantage
because a significant part of our due diligence on companies involves speaking
with thought leaders across all specialties about ongoing clinical trials,
practice trends, and reimbursement models. Being able to engage thought leaders
as peers is often useful in these discussions and having first-hand clinical
experience is also helpful in determining whether a healthcare company’s
business model is sound or flawed.
[CHARLIE] It is during times of
extreme change and distress that the measure of someone’s true character
becomes apparent. Personally, I’ve witnessed dramatic changes for the worse
sweep over my field of Neurology over my 20-year medical career. For example,
programs in Alzheimer’s disease taking a decade to develop continue to fail,
not even in curing, but in even slightly helping memory and function. Dozens of
studies in ALS fail, leaving absolutely no curative treatment for this fatal
disease. Not to mention hundreds of Neurological diseases in children and
adults that also remain untreatable despite advances in science. Then, there
are the logistic changes in medicine that are unfunded mandates of
reimbursement hurdles, litigation risk, documentation requirements, service
practice laws, etc. As a physician, we live these tectonic shifts to the field
of medicine that an average (or even extraordinary) investor may not be able to
appreciate, let alone understand in any detail. My most recent appreciation of
the medical background in the investing world was during FDA discussions about
a cancer drug’s potential black-box warning. There are nuances to the story,
but basically, Wall Street discounted the drug’s possible approval or eventual
adoption into doctor’s treatment algorithm due to the potential black-box. My
understanding of the existing treatments, and the exceedingly dire need of the
patient’s with this type of cancer suggested that a black-box would have no
bearing on patients or doctors’ decision to use the drug. This is a classic
mismatch of non-medical investors and doctors. Eventually, my thesis proved
true and the drug was both approved and became the standard of care with
widespread use throughout the world.
[DOUG] Understanding science behind
the disease and hands-on experience in clinical settings are critical assets in
my work. People often overlook scientific evidence and epidemiologic principles
behind the clinical practice. Being a physician with extensive clinical
experience provides a unique perspective when you examine the situations
overarching scientific principles and society, especially on controversial and
sensitive issues.
4. Currently, many doctors are
demonstrating their knowledge and skills around the world beyond clinical
fields. Do you think this can evolve into a trend? How do you foresee the
landscape of the healthcare professions in the future?
[HAN] Healthcare is very different
from all other industries because there are so many stakeholders involved. In
most industries, supply is generated by a provider of a good or service and
demand is generated by the consumer of that good or service. In the healthcare
industry, although the patient is the one receiving the good or service, they
are not empowered to decide when and which good or service they will get, which
is decided by their doctor. Furthermore, that good or service is usually paid
for by an insurance company or a government program whose incentives are often
misaligned with the patient as well as the doctor. On top of all this,
healthcare is a highly regulated industry because it involves public safety.
With so many different stakeholders involved, there are multiple segments of
the healthcare industry that go beyond direct patient care. I think more
physicians will continue to become leaders in these non-clinical segments,
which is a positive trend that will benefit both physicians and their patients.
[CHARLIE] Medicine requires a lot of
time and dedication, perhaps 10+ years after college to just finish training,
then more time and effort to acquire experience and domain knowledge to become
a great doctor. Some would argue it is a lifelong pursuit of a singular skill.
For these and other personal intangible reasons, most doctors choose to
dedicate their professional skills to the clinical fields. However, with these
shifts in external factors that affect medicine, such as reimbursement and
litigation risks, our skill sets may allow more individuals (rather than huge
trends) to deploy their skills in other ways that also contribute to society.
This article’s other featured doctors and I are just a few examples of
alternative professions that benefit from the medical background, but there are
certainly many other possibilities.
[DOUG] I think that more and more
doctors will work on the issues beyond the clinical area. This is a trend that
is only getting stronger regardless of the region. Two trends are evident in
the healthcare system. First, the modern healthcare system is getting more
complex. Working in the healthcare system now requires more skill sets and
broad understanding of the healthcare system than ever before. Some people say
that artificial intelligence will replace doctors soon. The people who think
such thoughts don’t understand the complex processes and interpersonal skills
that doctors are using in a seemingly simple patient encounter. The doctor’s
role in the healthcare system and outside of clinical practice will increase
and be more diverse. Second, there is a growing trend of seeking efficiency as
the modern health insurance system expands. That, in turn, often poses
restrictions on clinicians. Insurance companies love efficiency and directing
patients to the cheapest facility available. That means healthcare will be more
fragmented and less humanistic unless we, as a society, step in. Finding a
right balance between efficiency and humanistic medical care will be a new
trend. In that trend, doctors will have more roles in leading society than
merely seeing patients.
5. Do you have any comments or advice
for current medical students as well as those who aspire to become a doctor?
[HAN] I think becoming a doctor
involves such a substantial commitment of time, resources, and effort that it
only makes sense for those who want to treat patients. That said, many
physicians split their time between seeing patients and other administrative or
executive roles usually in some business-related aspect of healthcare. The one
constant in the rapidly evolving healthcare industry is that physicians will
never be rendered obsolete in the clinical setting so the opportunities in
adjacent segments can only grow.
[CHARLIE] These are very exciting
times for young doctors and doctors-in-training. Science and technology are
evolving at an accelerated pace and we may witness amazing new treatment
options for our patients. Future doctors will have the great honor of treating
the terrible diseases that is not possible today, eradicate cancers, reverse
dementia, cure aging. In addition, there will be so many options for clinician-scientists
and entrepreneurial endeavors to start companies, join industries and assist in
healthcare legal activities including patent law, healthcare IT, services,
regulatory sciences, sales/marketing. Also, the investment side that I
participate will always be available, either at the earlier venture stage or
later public stages.
[DOUG] Congratulations. You are
among the selected group of people or those about to be selected. However, do
not stop thinking about the future and your potential. Only you can set your
full potential.
6. WKMJ has readers from over 10
countries globally. Please share your final words or thoughts with our readers.
[HAN] The other unique aspect of
healthcare is that although basic human anatomy and physiology are universal,
the delivery of healthcare services varies tremendously between counties and
sometimes within different parts of the same country. There is no one country
who has the best healthcare system, and I have always found it fascinating to
see how differently healthcare works across the globe. As physicians around the
world continue to share advances in cutting edge research for the benefit of
their patients, I think it’s also incumbent on physicians to share best
practices for the nonclinical[3]
aspects of healthcare as well to improve the overall delivery of healthcare in
each country.
[CHARLIE] My focus has been the
translation of basic science to important clinical therapies, hopefully in
diseases that currently have no other treatment, or perhaps diseases that only
have symptomatic medicines. This focus was both through the practice of
medicine but also by investing and providing capital to companies that I felt
would have the highest impact and chance of succeeding. This approach carries
many scientific, trial, regulatory, and marketing risks. Instead, for many
other countries, a medical background may be better focused on transfer of
existing technologies/drugs, and perhaps either generics or biosimilar
therapies that lower costs to society. There will always be alternative career
choices with a medical background, but the specific opportunities may not be
the same from country-to-country. I believe by treating patients, teaching
(leveraging your knowledge by spreading it to the next generation), investing
(multiplying the leverage by using knowledge to potentially treat
thousands-millions of patients) scientists and doctors can contribute to
society and make a huge difference to the future of healthcare.
[DOUG] Regardless of the region in
the world, the healthcare system is a big issue that everybody has something to
say. Whatever the issue, in the end, I believe the scientific principles and
humanity should prevail. I encourage the readers to look beyond the issue you
are looking at.