Q&A: Policy-minded DO takes aim at inner-city health care disparities
A champion of health system reform, Jay D. Bhatt, DO, MPH, is convinced that the Affordable Care Act will help achieve health equity and improve health care delivery and outcomes. Concerned about patients’ access to care even prior to his years as a premed majoring in economics at the University of Chicago, Dr. Bhatt decided very early in his education that he would master and contribute to health care policy, as well as clinical medicine.
He remembers watching his father, a pharmacist, make weekly rounds delivering medication to people who couldn’t get to the pharmacy. “This left an impression on me,” Dr. Bhatt says. “My dad taught me early on that it’s our responsibility to take care of other people and relieve suffering.”
A 2008 graduate of the Philadelphia College of Osteopathic Medicine (PCOM), Dr. Bhatt trained in internal medicine through Harvard Medical School-affiliated Cambridge (Mass.) Health Alliance. He has also earned master’s degrees in public health and public administration, the latter from Harvard’s John F. Kennedy School of Government, where he was the first osteopathic physician to serve as a Zuckerman Fellow.
Dr. Bhatt began to make a name for himself at PCOM. In 2006, he became the first osteopathic medical student to serve as president of the American Medical Student Association (AMSA).
He is currently a geriatric medicine fellow with the University of Michigan Health System in Ann Arbor and is an associate at the Disparities Solution Center at Massachusetts General Hospital in Boston.
In October, Dr. Bhatt was appointed to the National Advisory Council on the National Health Service Corps (NHSC). An NHSC scholar and ambassador, he expects to fulfill his service requirement in inner-city Chicago after completing his geriatric fellowship.
A long-time enthusiast of bhangra, a high-energy north Indian folk dance, Dr. Bhatt touts dancing as a means of promoting health and wellness and fostering a sense of community among patients.
Following is an edited interview with Dr. Bhatt.
When did you first become interested in a career in medicine?
I became aware of health care disparities at a young age. Born in Elgin, Ill., I am the son of South Asian immigrants and grew up on the South Side of Chicago and in the city’s south suburbs. My mom was a factory worker and my dad was a pharmacist who worked primarily in the inner city on the South Side. When I was around 9 years old, I spent time with my dad in the clinic where he worked—a place where people were making really tough decisions, such as whether to go to the doctor and pay for medication or pay for housing and food.
Three evenings a week, my dad would deliver medications to people who couldn’t get to the pharmacy because of their disabilities or not having enough money for bus fare. This left an impression on me. My dad taught me early on that it’s our responsibility to take care of other people and relieve suffering.
Originally, I thought I’d become a cardiologist like my uncle, one of the people who inspired me to pursue medicine. I have always been fascinated by the heart and thought cardiology would be an ideal route for doing preventive medicine. But while volunteering for Habitat for Humanity and Project Brotherhood as an undergraduate, I became struck by the challenges and concerns regarding access to care experienced by lower-income African-American men in particular. They felt disrespected and vulnerable in the system they were trying to get care from. As a result, they didn’t access care—unless it was provided in comfortable neighborhood venues, such as a church or the back room of a barbershop.
I got a sense then of the implications of social and behavioral forces on medicine and realized the importance of community empowerment in health care delivery. These insights heavily influenced my career path. Doctoring in underserved communities serves as a vehicle for social change.
Is that why you majored in economics at the University of Chicago?
Yes. I started out as a biology major but switched to economics after those experiences, driven to increase my understanding of health care economics and the impact of socioeconomic forces on medicine. I knew I would not learn enough about these issues by simply majoring in biology and going to med school.
Early on, I also realized that I needed to take a proactive role in my own education, to seek out opportunities and mentors beyond the formal curriculum of the degree I was pursuing. While a premed, I worked with health economist David Meltzer, MD, PhD, helping him conduct research on the impact of hospitalists as a mechanism for controlling costs and improving outcomes. After earning my B.A., I went to work as a research analyst for The Lewin Group, a health policy consulting firm, and then became a health care consulting analyst for William M. Mercer Inc. These work experiences prior to beginning medical school, along with my experiences as a public health student, were invaluable to me.
What led you to your attending osteopathic medical school?
While working for Mercer, living in Stamford, Conn., and New York City, I learned more about osteopathic medicine from a DO who was my primary care physician. I was really humbled and impressed by the way he took care of his patients, the way he engaged them in conversation. I liked osteopathic medicine’s holistic approach to care and the profession’s commitment to serving the underserved and emphasis on wellness and prevention.
A graduate of PCOM, my mentor spoke highly of this osteopathic medical school, so I decided to apply there. At the time, I was also in a long-term relationship with someone who lived in Philadelphia.
When did you become a National Health Service Corps scholar and where will you fulfill your service requirement?
I applied after my first year in med school but was not awarded the scholarship. I then applied again after my second year and was fortunate to be accepted. As the president of AMSA, I led students in advocacy efforts on behalf of the Corps, and I’ve been an NHSC ambassador since 2008.
Starting next fall, I am going to be fulfilling my three-year service requirement at a community health center, likely in Chicago.
In your relationships with allopathic colleagues, do you see yourself as an emissary and advocate for the osteopathic medical profession?
Yes. In my role as the president of AMSA, I did a lot of work building relationships between the osteopathic and allopathic medical communities. We forged effective partnerships with the Student Osteopathic Medical Association, the AOA and the Council of Osteopathic Student Government Presidents, developing a collaborative three-day legislative leadership institute during my year in office.
I think my allopathic colleagues are intrigued by my approach to care and by osteopathic manipulative treatment. They are also impressed by how the osteopathic medical profession is addressing primary care workforce challenges.
When I went to PCOM, we had two required rotations at community health centers. Such requirements are critical in helping med students understand and potentially develop interest in underserved communities. Allopathic medical schools are starting to rethink their curricula and tap some of the best components of osteopathic medical education.
Do you perform OMT?
Yes, I use it on my clinic patients quite regularly. In geriatrics, it’s an incredibly useful tool because a lot of patients are transitioning from acute care—hip fractures, knee replacements and so forth—into short-term rehabilitation. The ability to think from an osteopathic perspective and use OMT really makes a difference in the rehab process. It is also important to consider the whole person when deciding on the kind of care that is appropriate for these patients, as well as those who are in need of palliative care.
What do you like about the Affordable Care Act?
For one thing, health care reform has set Medicaid reimbursement rates in line with Medicare. There is significant investment in prevention and the desire to break silos and address the social determinants of health.That’s a huge step forward.
In addition, the Affordable Care Act established the Center for Medicare and Medicaid Innovation, which is identifying and testing new models of health care delivery and payment, such as the patient-centered medical home model of care, which I’ve been working on as a fellow at the New England Healthcare Institute.
For a long time, primary care physicians have been reimbursed just for face-to-face encounters. Now there is a lot of opportunity for reimbursement to occur outside of the traditional encounter, such as for a tele- or videoconference with a patient and for care coordination with medical specialists and other health professionals.
I believe that a single-payer health system ultimately will be the best way to provide health care in our country. But I also realize that this will take time and a lot of sacrifices and change that people aren’t necessarily ready for. I think that the Affordable Care Act is a critically important step forward to help us realize the dream of universal health care coverage and the triple aim of improved population health, better quality of care, and lower health care costs.
Health reform gives us the chance to reshape some of the systems that have been entrenched for so long in health care delivery. It provides the opportunity to improve care, think outside the box, and bring different disciplines together in a way not seen in many years. I think the Affordable Care Act is a foundation for even better reform to come.
Do you like the concept of pay for performance?
I’m a supporter of quality improvement and transparency in health care delivery. But it is essential to have the right incentives in place, not misaligned incentives. Sometimes the quality benchmarks and metrics that are put forward don’t fit the best practices of particular specialties. Physicians in each specialty should be developing the metrics that they think are the right ones to follow to improve health care quality and outcomes.
We know that physicians as a whole deliver the standard of care only 55-60% of the time. That’s a far cry from other industries, which won’t even put up with a 1% error rate. Pay for performance will help us move toward improved quality and safety.
How have you used dance in treating patients?
In Cambridge, I parlayed my love of dancing, especially north Indian bhangra, into a project I call Dance Inspires Health, which is dedicated to creating a feeling of community among underserved minority and immigrant patients. Other physicians and I would dance at health fairs, and people would stop and dance with us, sometimes for two hours at a time. At these fairs, we would connect people with primary care physicians.
I also started to dance with patients at the hospital. This served as a way for people to come together and have conversations, where they didn’t need to have their barriers up. One of my patients who came to the dance class was an African-American woman who avoided getting mammograms because her mother had died of breast cancer. She told me that she was fearful she had breast cancer herself and didn’t want to know. At the class, my patient met another African-American woman who had been in the same situation, with the same fears, and eventually learned that she had late-stage breast cancer. Because of this connection, my patient decided to get a mammogram and was diagnosed with early-stage breast cancer, which we were able to treat. She is doing well.
For the geriatric patients I see now, I sometimes place my cellphone, which plays music, at their bedside and dance for them. The music and the dancing often puts them in a healing, uplifting frame of mind at a time when they are scared and vulnerable and sad about what’s happening to them.
Dance brings a sense of humanity to the care we’re providing. Our patients see that we doctors are human too.