My Long Game is Public Health.

I’ve written a little about my career plans recently. Setting up my own lab at MECMC, so that I can be a director instead of an advisor. Currently, I live in a strange no-man’s-land where I’m doing quality improvement work – some my own and some part of other people’s projects – and also PI of a grant-funded research project. And the research would be happening even if I didn’t get the grant. It’s just that now I get to have student interns and a small slush fund.

I’ve also written about how my desire is to get systems engineering (specifically computer simulation of healthcare delivery) published in the medical literature. I want to do this because my belief is that without physician and surgeon buy-in to the concepts of engineering in care delivery, we won’t be able to make the kind of impact on hospital care that is possible with the kind of work I do. Which I believe is significant in both the sustainability and quality arenas.

But all of that is short-term to mid-term in the sense of how long it takes to accomplish. I think I’ll have my own directorship within two years. I know I can publish in the medical literature, I’ve done it several times now. And the effects I’m hoping for – systems engineers being brought in to improve health systems – had begun before I got here. I like to think I’m making a positive impact on that, but the truth is, I’m a very small voice. I’m hopeful that it’s growing. I’m just conceited enough and just insecure enough to want my voice to matter.

But I was thinking this morning about the long game. I look around at other disciplines, and I see a lot of long games and big dreams. Oncologists who work so that one day, most cancers will either be curable, or rendered chronic, mild conditions. Robotics engineers and computer scientists who aim to build intelligent transportation systems that minimize consumption and eliminate catastrophes. Science writers driving public engagement to inform and inspire, and bolster support for research and discovery. Ecologists who seek to preserve and restore crucial natural systems. Physicists who look to unify field theory and understand the origins of the universe. Energy engineers building new ways to end our reliance on carbon-producing energy.

Thanks to twitter, I know and interact with people who are doing these things, writing about these things. People in the trenches solving proximate problems, leading to broad questions and bold solutions and eventually to improved lives. It’s exciting. And I wondered: what’s my long game?

My long game is public health. Health care is utterly unsustainable right now. Not just here. Everywhere that values human life, and believes that access to health should be a basic right has to make grueling decisions about how much care to provide and for whom. Because innovation is expensive. Every time a brilliant cardiologist invents a new intervention to treat a heart condition, it results in patients who used to die suddenly being offered a chance: someone pays enormously for the procedure, or they die.

We’ve decided, it seems, that the default answer is that regardless of cost, people should have the right to treatment of treatable conditions. There are exceptions, of course, but in general, the refrain is: “No one should go bankrupt paying for health care.” And that’s a laudable and supportable goal, and as a theoretical principle, I endorse it. The problem is, new innovations are abundant. And new treatments and medicines are always very expensive. They have to be to justify the investments made in their discovery. But even single-payer systems face the same dilemma. How much can the system bear in expense to justify providing exorbitant treatments?

And so we will always, always, be faced with that same dilemma. How much can we justify paying to save lives? To improve lives? Because there will always be new and expensive treatments. Because no one is giving up, and deciding that healthcare innovation is done. And no one should.

So my long game is public health. By doing the work at MECMC, I hope that I am improving our delivery model and our sustainability. By publishing in the medical literature, I hope that I am providing basis and justification for these models to be adopted elsewhere. And when they are, I hope that leaner, more efficient, improved delivery systems are able to treat people less expensively and with greater success. With shorter delays.

I see a system where the basic level of care is accessible to everyone. Where “basic” means “excellent”. Where intelligent performance measures and evidence-based quality improvement yield sustainable policy.

We will always have to make trade-offs for care in terms of affordability. My goal is that those trade-offs occur in the context of excellent care for all. That the difficult decisions are made on the margin, the blinding edge of innovation. And that basic, excellent care is widely available and affordable, whomever is paying – patient or insurance company or government.

What’s your long game?