This week, our very own Dr. Daniel Novinson interviewed Dr. Faisel Syed
(@DrFaiselSyed), ChenMed's National Director of Primary Care. ChenMed believes the doctor-patient relationship is at the heart of primary care. You can learn about ChenMed by visiting chenmed.com, or visit the upcoming ChenMed Physician Career Fair on November 18, 2021.
This week, our very own Dr. Daniel Novinson interviewed Dr. Faisel Syed
Dr. Novinson: Well, good morning, good afternoon, everybody. My name is Daniel Novinson. I’m a doctor here at Doximity, and I’m pleased to be joined by Dr. Faisal Syed. Faisal, tell us a little bit about yourself.
I feel that the ChenMed message needs to be shared with all doctors who are passionate about primary care. The current primary care delivery system, it can be modified, it can be completely transformed into one that is holistic, into one that is based on relationships.
Dr. Syed: Well, nice to meet you. It’s great to be here. I can’t really remember a time when I didn’t want to be a doctor. I was raised by an inventor. My father is a retired inventor. So, he has the patents for -- he has over 20 technical patents. He’s got the patents for caller ID, voice recognition, flash memory, just a lot. It was a great childhood. Imagine when you grew up in a home where your father’s got a lab in the house, you get to tinker as a child. I mean, we always had the latest and greatest computer; 8088, 8086 processors, 286, 386, 486, Pentium, and all that stuff. And his heyday was the 1980s, that’s where the patents for voice recognition and flash memory, it was in the 1980s. And he worked at the lab that invented the silicon chip. So, it was called the think tank for the country, AT&T Bell Labs. So, I have great memories as a child playing with that equipment, especially the voice recognition. You can imagine in the mid-1980s there was a show on TV called Night Rider. And I remember having the Knight Rider car toy, you know, the black car that you’re taught to the kit. And playing with this technology where you’re talking to a computer and the computer is understanding what you’re saying, basic commands.
So, I remember my dad never really being satisfied with the hardware, or the software at that time in the 1980s. This was before windows. So, the software was like a DOS, everything was DOS-based, these DOS-based platforms. And he had these thoughts at that time, about having technology that you would see like in the 1960s sci-fi, from that time, like talking and seeing a face on the screen and interacting with this face and asking a computer for some help with something and the computer gives you the response. That was what he wanted in the 1980s. So, I grew up in this environment where I felt like nothing was off the table.
And then I also had the other extreme with my mom. So, my mom and my dad have several degrees. My mom was really passionate about just natural remedies. Even right now my oldest son has an ear infection, and so my mother has a lot of the Indian influence with the natural remedies with the ginger, the garlic, using honey and making teas and things like that. And I remember, as a child, my mom would question the doctors. She would question everyone. So, although growing up, I had this extreme of like -- we had the best and latest technology, but I also learned about how these natural remedies could help improve your quality of life. And even the way that doctors interacted with my mother, I remember just how patient they were with her. And that meant a lot to her. She was questioning them not because she didn’t respect them. I mean, she was concerned about us as we’re kids. Most of the time medical things were to us, and I know that that definitely shaped me with my views around the doctor-patient relationship. We need to restore that relationship. It wasn’t that long ago when doctors and patients had this intimate understanding of each other’s place in society and in each other’s lives.
Dr. Novinson: Yeah. And many doctors feel the loss of that, absolutely. On a personal note, I remember as a kid, I had a Mickey Mouse calculator, and I became very mathematically inclined and it was my favorite toy. I don’t know. It’s terrifying as a new parent myself, it’s kind of terrifying how these seemingly smaller choices create this butterfly effect.
Dr. Syed: Yeah, because you just never know. I mean, my youngest, he’s turning four this month. And to him, this is not technology. I mean, this is just an extension of their experience. This is an extension of their humanity. But in our world, at least with many of the people who are making the decisions for healthcare delivery, this is still considered high-tech. And unfortunately, technology comes in the way of the doctor-patient relationship, rather than being an extension of it.
Dr. Novinson: Yeah, that’s a key question, how not be a solution in search of a problem, but actually be making people’s lives easier instead of another add-on, for sure. Well, Faisal, why did you decide to pursue a career in medicine?
Dr. Syed: Well, I mean, several reasons. I think life kind of propels us for good or for worse. I knew that I enjoyed helping people. I knew I always wanted to help people. But it bothered me that the access to care was so difficult for so many people. And it bothered me how complicated the system was. I mean, when you get sick, even now, it’s complicated. Like, what do you do? My son had an ear infection, and it’s just like, oh my gosh. Like, we got to go through this whole process to get this COVID test, a flu, and strap and all this stuff. Like, how do you navigate through all this? And I knew it didn’t have to be so complicated. So, my thoughts were, first of all, with people not having access to medical care. That just bothered me. How can it be that we’re like the greatest country in the world, I’m a product of that, my father lived the American dream. You know, my brothers and I had a great childhood. And even now as we’re raising our own families, and seeing our parents enjoying the children, I mean, we’re definitely a product of this American dream.
Like many other third-world countries, you get to know people to be able to get ahead in life. And here in America, you can really do anything. There are no limits to what you can do. So, I knew that we could apply some common sense to healthcare delivery. And it had to start with the basics, like with the people who are the frontline of receiving people when they have some medical need. It didn’t make sense to me how siloed healthcare delivery was. If there’s a crisis, a medical health emergency, you think about the Public Health Department. If you need antibiotics or some pain medicine because you got hurt or whatever, you think of like, okay, quick care, I got to go to the urgent care. And then what’s left is the wellness visits, referrals to see specialists, and refilling that -- Oh, primary care, does wellness, referrals for specialists, and refilling medications. So, I just knew that we could have a system where it could all be done in one space. Like, let’s redefine primary care. And so I wanted to be a primary care doctor for people with little to no resources.
Dr. Novinson: Well, maybe that dovetails into talking about ChenMed. And I’d love to learn more about it, and I’m sure our users would as well.
Dr. Syed: Well, after I completed my residency training, I joined a very large community health center in Tampa, Florida. At the time, Hillsborough County in Tampa had some of the worst maternal mortality rates in the country. And actually, in fact, it was even worse than many third-world countries. And it was just basic, just not having access, not having access to someone to just put their hands on the belly, just basic, basic medical attention. So, that’s what drew me to Florida. And it was while I was at Tampa Family that I randomly actually came across ChenMed. In the community health center world, our average patient is much younger than the patient population that I now have at CheMed. My average patient in the community health center ward is like 37-38 years old, so they’re not very medically complex. They have a lot of social issues but the medical complexity isn’t there. So, you could afford to have maybe three, four nurse practitioners for every one doctor.
And so ChenMed, it’s a kismet. I met at a conference actually trying to recruit a doctor and it was while I was there, so I was in the mindset of meeting people and I’m looking for the right combination of someone who is mission-driven, someone who is humble, someone who’s got that grit, you know what I mean, dealing with the underserved and dealing with all the issues with social issues. I mean, home insecurity, food insecurity, transportation issues, I mean, you name it. And most of them are on fixed incomes. It takes a special type of doctor to look after these populations, and then to support -- to work with the nurse practitioners, and all the support teams who are looking after these populations of people, it takes a special type of person. So, I was in the mindset of really just kind of looking for the right doctor.
And that’s when I first saw ChenMed. And I couldn’t believe it, really. I mean, I was just in doubt. Like, wait, wait, wait. So, the ChenMed centers are in the same neighborhoods as a federally qualified health center? Typically, you don’t see these wonderful operations going into the neighborhoods with -- And you’re focused on the elderly? So, you’re in the neediest -- the populations that need the most care, most attention, and you’re focused on the most vulnerable from that population. And you’re really focusing here with like -- I mean, when our average patient is 37-38 years old, even if they’re on fixed incomes, they can still find some work to do to make some money. The average ChenMed patient is 72-74 years old. So, when they’re on fixed incomes, they’re really on fixed incomes. And you can take all the issues with the home insecurity, food insecurity, transportation issues, it’s just amplified, just much, much more challenging situation.
And then the ChenMed world, I couldn’t believe it. Okay. So, you have ChenMed doctors give their cell phone numbers to the patients. You know, the ChenMed patients get daily text messages, weekly phone calls. I mean, it just sounded like this concierge type of practice that you have to pay a ridiculous amount of money for and it’s and it’s being done with the underserved. So, I just felt like the model just sounded too good to be true, really. And actually, I walked away from it. I said, well, what about the people who don’t have insurance because, at the time, almost a third of my patients did not have any insurance. It was a huge, huge chunk of our visits. And the recruiter said well, we only see people who have insurance. And so I was like, oh, this is just another one of those money-making opportunities. I just walked away.
And she said, wait, wait, wait, they all have Medicare. And I said okay. Okay. So, they all have Medicare. And I said well, how are you going to have this model where the doctors don’t bill? And she said well through Medicare Advantage. So, ChenMed only partners with insurance companies who allow the organization to take on full risk, so then the conversation went further. It took a big chunk of my time and my doctor’s time, the nurse practitioners, were with the documentation for reimbursement. And I just couldn’t imagine that a system existed outside of DPC, direct primary care, where the doctors weren’t involved in billing. Like, a big chunk of my day, I was spending two, three hours a day just charting for billing, it was all for billing.
Dr. Novinson: It’s really exciting to hear. And I mean, you’re right, that historically, a lot of primary care innovation has been in the easiest demographic to crack, young, healthy, employed. And so to implement in a different demographic, and with a far more complex medical history is very impressive, for sure.
Dr. Syed: And with the same patient population too. I mean, that I couldn’t believe it. I couldn’t believe that these beautiful centers, you’ve got all these services, even offering transportation. I remember seeing -- So, at the time -- When I first met, there was just one month in the Tampa Bay area. And I remember seeing the vans driving around the city thinking what in the world, yeah, like they’re transporting patients. That didn’t exist in our city.
Dr. Novinson: Well, congratulations. It sounds like you have lots to be proud of. Switching gears a little bit, what does it mean to you to be part of the physician community like Doximity?
Dr. Syed: Doximity allows us to very easily network with people that -- you know how life is, especially after residency. So, I first registered with Doximity while I was a resident. And when you’re in residency, kind of like with medical school and just like with life, you always feel like the people that you’re surrounded with, oh, like, these are people that you’re going to be with, these are your people. And then life starts happening and you go all over the place. And I think it’s unique, probably more unique to doctors, and especially when we’re in residency it’s like, really our lives start to happen like right around that time right after residency. You know, we settled down, we have kids and all of this. And that’s such a huge change from when it’s all about learning and knowledge and all this. And then suddenly, like, you become responsible… And so life happens. And I never thought that I would get disconnected from people that I was so intimately connected with.
And so I remember with Doximity, that was the first -- being reconnected again with people that were incredibly influential with my journey. I know that there are several times, I mean, we all have stories in residency where it took several people to help get through some of the difficult moments. And then they too, you know, there’s nothing, it happens. They too settle down as well. They get busy in their careers and our careers are very demanding. I trained at an unopposed family medicine program. There’s a great residency program in Columbus, Georgia, at the Medical Center. We delivered babies, we did the trauma, we admitted the patients, it was great, we did a lot of procedures, and all that stuff, it was wonderful. So, after completing that program, you have residents kind of getting out and doing so many different things. And they get into their careers and their lives. And Doximity allowed me to reconnect with these people very, very, very, very easily.
Dr. Novinson: That’s great. Sounds like of the different umbrellas and tools and platforms, it sounds like where you most benefited from Doximity was the networking aspect.
Dr. Syed: The networking was tremendous. Seeing what my friends are interested in, how their thoughts have shifted from when we were younger to now, that’s great.
Dr. Novinson: That’s cool. I haven’t heard the bit about kind of seeing people change over time, and that makes sense. I wanted to ask about the pandemic. How has that affected the way that you work?
Dr. Syed: Well, the pandemic had a huge impact on, of course, my life personally, and our organization. We learned even early on in the pandemic that seniors are the ones who are most at risk. We are talking about patients getting admitted to the hospital, the mortality risk, and all that. We knew, early on in this pandemic, that seniors were the ones that are most at risk. And that’s our world. Our average patient is 72-74 years old. And in all the states we exist, we are fully capitated. Meaning, that we are fully responsible for every single patient. So, every medication, every specialty visit, every emergency room visit, every hospitalization, I mean, we take on all of that. So, here, there’s this pandemic and our patient population is the one that’s most at risk, and we’re a fully capitated organization. We had to make some big changes. And we did. We were able to make the switch from -- Let me just go back, rewind a little bit, talk a little bit about the model.
So, our model is a high-touch model. On average, each patient sees their doctor on a monthly basis. I mean, so that’s a routine follow-up is monthly, and there’s a percentage of our patients are really medically complex, a routine follow-up is every two weeks. So, it’s a very high-touch model. Our doctors have small patient panels that we cap our doctors at 450 patients, so they can have these regular visits and they can build these strong relationships. Every patient has their doctor’s cell phone number, every patient gets a daily text message. Every patient gets a weekly phone call from our staff. So, it’s a very high-touch model. And so with this pandemic, we realized that we had to make a switch, so we switched to virtual. And I remember thinking it would take weeks to make this transition to virtual. We’d be lucky if we could do it in weeks. And actually, the transition happened in less than a week, it took about six days. In six days, all our centers, all the operations folks, and the doctors were able to work together and transition from this high-touch in-person to this telehealth solution.
We have a lot of freedom being fully capitated with being able to make that sort of transition because we’re not concerned about the billing for each interaction of every phone call. Because that’s off the table, we’re able to be very flexible, including doing things like if the patients need their groceries, we can help them with their groceries. If they need diapers, we can help them with that. Toilet paper, we can help. So, as an organization, we switched from this high-touch model in-person to a virtual model. And since then, we have this hybrid approach where we still have, we’re able to connect with the patients frequently. One of the best things about connecting with patients in a virtual way is with everyone being forced to kind of get into this world that we’re in right now, with these video meetings, thank God for grandchildren. Thank God for grandchildren. Yeah, because of grandchildren, people who were resistant, populations of people who were resistant to this sort of interaction, because of grandchildren, they embraced connecting with them through FaceTime or through these video chats.
In six days, all our centers, all the operations folks, and the doctors were able to work together and transition from this high-touch in-person to this telehealth solution.
And so when we started connecting with patients in this virtual way, we kind of got lumped in with that category of people. I mean, many of the patients didn’t even video chat with their own children. But you get the grandchildren involved, and then the doctors getting lumped into that, it was incredible, because now I got to see where they live. I was able to see the risks that hey, this thing over here, you’re at risk, you could trip over that. Or they would take me to the fridge and say, I don’t understand why can’t I see what’s in your fridge? And then I see the soda in the fridge and I see all the unhealthy stuff. I say, okay, well… Oh, okay. It allowed for a different level of intimacy that I never saw before unless I did a house call which was very rare. Before most of the healthcare delivery that I was involved in was face-to-face in the primary care ecosystem. It was an exception to go to a patient’s home, but because of this pandemic, suddenly, I felt like that old-fashioned doctor like just getting into the patients’ homes. And there was a different level of intimacy. I don’t know how to explain that, but there was definitely a different level of intimacy that happened because of being able to see them in their homes.
We do a lot of workshops on how to transition from the fee for service healthcare delivery system -- 95% of the country still operates in this fee for service system -- towards one of being fully capitated, taking on full risk.
Another chunk of what we do as an organization is medical education. We do a lot of workshops on how to transition from the fee for service healthcare delivery system -- 95% of the country still operates in this fee for service system -- towards one of being fully capitated, taking on full risk. A lot of workshops and medical education, plus with the residency programs, intro medicine and family medicine, so that all had to stop. We stopped doing it in-person, and we started doing them virtually, which was a big transition for all of us to make. I didn’t have social media before the pandemic. But because of this, last May, I had to open up Facebook and Instagram and Twitter and all this stuff, and really get active connecting with people in this virtual manner. I remember my son was laughing, the oldest. My oldest is 14 years old now. And so he was into TikTok and stuff like that and he’s like, “Really, Dad, you’re getting onto social media?” I was like, “Well, I’m doing it so I can connect with doctors and for educational purposes.”
Dr. Novinson: I think the point that you made about telehealth opening up an ability to evaluate social determinants of health is a really interesting nuance. And it almost makes you think you don't complete every part of the exam for every single patient, not testing cranial nerves for somebody with a sniffle necessarily. But could some part of a home evaluation be a component of a standardized exam when clinically or situationally indicated: an interesting thought.
Dr. Syed: Yeah, sure. I mean, we have to use it all the time. When you’re taking on full risk, you know, I had this mentality of just like, okay, being fully responsible for -- If I’m dealing with a diabetic, before I had the standard things I would say with a diabetic patient. No sweets, no rice, no bread, no pasta, no sugar. We had our things that we would say and the patients were looking at me, like -- And then we’d prescribe some medication, okay, we’ll see you back, we’ll do some labs. And I would feel like, "okay, I am a really good doctor," you know. And now, I don’t have those types of conversations with patients. Patients want to know, okay, you’re telling me, no rice, no bread, no pasta. Okay, what am I supposed to eat? And so now we have the time to really get into their day-to-day lives and make some suggestions. When we talk about things like, say with cauliflower rice, that you can get cauliflower rice from the grocery store for $1. And we talk about the numbers. They say how much does it cost, $1 and a half, $2 for this frozen little packet of cauliflower rice, and you can get it from these stores. That is huge for the patients.
And well, why are you recommending this? Well, it’s got 90% fewer carbohydrates than regular rice. Doesn’t taste exactly like rice, but it tastes similar enough. Like, this is the main thing that’s driving your blood sugar to go very high. If you make this switch, that will help bring your sugar’s down. You won’t be needing to take the medications after most meals. The use of artificial sweeteners was another huge one. I remember with the patients who love, the diabetics who love drinking soda, them being able to make their own sodas with the artificial sweeteners and seltzer water, which was much more cost-effective. It had a profound impact, their blood sugar started to drop, and many of them didn’t need to be on the medication in the first place.
Dr. Novinson: Yeah, that’s cool that to be able to see into a patient’s home allows you to drive closer to the proximate cause of illness. As opposed to logging, like chasing a food diary, reports, and good luck getting somebody to fill that out reliably. So to actually see what’s in the fridge is huge. That’s interesting.
Dr. Syed: It was a game-changer for me and for our doctors and everyone in the healthcare delivery team to be able to have that -- Because we know that 70, even 80% of modifiable health outcomes are based on lifestyle. And if we know this and we know that medical therapies, you’re talking 10-20% impact, if we know that most of the impact is made based on lifestyle changes, then we’re more focused on being influencers of positive behavior change based on what the patient has in their life, what they have access to.
Dr. Novinson: Yeah, that makes a lot of sense. Well, I want to make sure to give a chance to ask about your endeavors. So, we can start with Faisal and Friends. Tell me about the Faisal and Friends show, tell me about what people can expect from it.
In just 6 HOURS @DrDanMcCarter and I will be going LIVE with guest Dr. Shane Purcell to discuss “Unlocking the Magic of DPC.”— Dr. Faisel Syed (@DrFaiselSyed) November 2, 2021
Bring any questions you might have to the conversation and we’ll do our best to bring them into the LIVE show. pic.twitter.com/lN92oErZdA
Dr. Syed: Yeah. So, the podcast, the idea for that started with a conversation I had with Dr. Dan McCarter (@DrDanMcCarter). So, Dr. Dan is our national director of primary care advancement, and we have wonderful conversations. We always have wonderful conversations. We’re always trying to figure out ways to educate medical students and residents to think differently; having that shift in mindset. So, we’d put together presentations and we’d present to them and practicing physicians as well. We’d meet with independent physician associations and help them make these steps. It’s a huge mindset shift to switch from the fee for service mentality of the -- Basically, everything is based upon the patient’s chief complaint, right? A patient could be in between COPD exacerbations and still smoking, and you know they’re a ticking time bomb. They’re like another cigarette away from having, potentially another exacerbation but their chief complaint was low back pain. And so I spent the entire visit just going through the history, the reviews, so everything is around them. And I didn’t have time to address the main thing, like what worried me was the COPD exacerbation.
Dr. Novinson: Yeah, it’s that negotiation.
Dr. Syed: And so making that mindset shift from the patient’s chief complaint to the doctor’s primary concern is a huge mindset shift for all of us. For all physicians, nurses, I mean, everyone that’s involved in the healthcare delivery system. And so we would have these great conversations, and he said, “Hey, would you mind having these conversations openly on social media?” And like I said, “In what way?” He said, “We can go live.” And I remember, I was like, “We go live all the time.” And that’s where the conversation started. So, we started on Instagram, going on for about a half an hour over lunch on Fridays. And we’d be talking about common issues that were coming up while we were giving presentations and lectures about value-based care. And the full risk. I mean, there’s a lot of good people who are working in a system that the ultimate goal, in the fee for service system, the ultimate goal is to generate revenue by billing. It’s an RVU-based system, it’s a transactional system.
Pre-COVID, half of the medical care in the United States was delivered in the emergency room setting, with the emergency room rates. And we don’t want primary care being delivered by specialists.
In the full risk world, the ultimate goal is prevention and early intervention, improving health. We don’t want primary care to be delivered anywhere, like, definitely, we don’t want primary care being delivered in the emergency room setting. And pre-COVID, half of the medical care in the United States was delivered in the emergency room setting, with the emergency room rates. And we don’t want primary care being delivered by specialists. And quite frankly, most of primary care, doesn’t even need to be delivered in the primary care setting the way that we see it today. Most of it can be done in the patient’s home, using what my three-year-old uses here with communicating with most of my relatives. We can do a lot more. So, we need to shift primary care, outside of where it’s being delivered right now.
And social media allows us to connect and network with people in ways that we never even dreamt up before. So, it started with going live on Instagram. And then from there, we started going live on LinkedIn. LinkedIn became a very popular platform. We went from not knowing anybody on LinkedIn to suddenly there were 15, 18, 90,000 people. I mean, it’s unbelievable, these doctors and people who are passionate about learning about different models of care outside of the fee-for-service system. And so LinkedIn gave a live account. And once that happened, we were able to broadcast live on LinkedIn, on Twitter, Facebook, and YouTube. And we did that for some months. And from there, we decided to extract the audio from these weekly shows and put them on all the major podcast platforms, and it’s become a wonderful tool to connect with people and to educate them about a form of healthcare delivery that is completely outside of the billing model.
Dr. Novinson: That’s cool. Well, it sounds like you’ve touched on a lot of this already. But just to give you a chance to list out all the different platforms, telegram, carrier pigeon, all the different ways that people can engage with your content reach you.
Dr. Syed: Definitely, I mean, ChenMed.com. We created a website that it’s both physician-facing and patient-facing. So, for the physician-facing side, to really be able to see and feel what the culture of healthcare delivery can be like. It doesn’t need to feel like the sterile transactional one that most doctors know today. And we have a relationship-based healthcare delivery system and you definitely feel that culture when you come to our website. It’s designed by doctors, everything about our organization has been designed by doctors. Our CEO is a physician. Chris Chen, he’s a cardiologist. So, when you have a physician-led organization in a fully capitated model, you really get to feel that culture through the website. And then from the website, you can navigate to our blogs. We have a lot of educational content about issues that we feel -- we’re very passionate about, social justice issues. We feel that everyone deserves access to quality primary care regardless of their ability to pay. And so addressing all the social issues like home insecurity, food insecurity, transportation issues, loneliness. We have a lot of content on our website, specifically designed for doctors to see that, hey, there are ways to address these issues, and really make an impact on the patients’ lives. And if we can do this with the most underserved, just imagine what we can do with people who have some more resources.
Dr. Novinson: Great. Well, I wanted to leave time and open the floor up to you if there’s anything you wanted to make sure we touch upon or address.
Dr. Syed: Well, I feel that our message needs to be shared with all doctors who are passionate about primary care. The current primary care delivery system, it can be modified, it can be completely transformed into one that is holistic, into one that is based on relationships. And so my final thoughts would be, please learn about what we’re doing. Please connect with us on social media, and we’d love to address and answer any questions that doctors have. I mean, we need to have a healthcare delivery system that is focused on taking care of that doctor-patient relationship, and everything else comes after that.
Dr. Novinson: Great way to end. Thank you so much for your time, really enjoyed kicking around both some big-picture ideas and more of the daily grind issues as well. And I guess both are part of being a doctor. Well, Faisal, thank you again. We really appreciate your time here at Doximity today.
Dr. Syed: Oh, it was a pleasure. Thank you so much.Back to Blog