At Nomad, we believe that clinical knowledge and experience can be essential tools for improving how healthcare is structured and delivered. We are energized by clinicians who are able to flexibly balance their careers in medicine, along with their passion to make positive impacts in the broader healthcare landscape.
That’s one of the many reasons why we’re so inspired by Ryan Schwarz, MD, MBA. As the Chief Operating Officer of Possible Health, a nonprofit organization that delivers healthcare to the world’s poor, he and his team have been working hard toward integrating government hospitals, clinics, and community health workers throughout Nepal into a high-quality, low-cost healthcare system. Back in Boston, he is also a faculty member at Harvard Medical School and Brigham & Women’s Hospital Division of Global Health Equity, a role he says continuously informs his work at Possible.
In this month’s “Doctor And…” feature, we talked to Dr. Schwarz about his path as both a doctor and a nonprofit leader, and why he thinks clinical practice is key to good healthcare policy.
What drew you to medicine?
I was not very young when I decided to be a doctor. First, I had a failed attempt at being a molecular neuroscientist. (Upon graduating, I took my first job in a lab and realized that this was absolutely not what I wanted to do with the rest of my life.) In parallel to that, I had been working with a lot of social advocacy organizations. My father is a physical therapist practicing in Appalachia, so I had grown up in a family where finding ways to get patients the healthcare they needed even when they couldn’t pay was a natural part of my environment. But it wasn’t until the first career didn’t work out and I was finding myself spending all my time on social justice projects, many of which involved healthcare, that a grounding in medicine started to make sense.
And what about business?
Specifically, I found myself working in East Timor, South Africa and and Botswana at a time when HIV therapy wasn’t yet available there. Grappling with the multiple systems and implementation challenges that surrounded roll-out of these programs as they became available made me realize that being able to understand healthcare policy and implementation would also be critical to help lead the improvement of healthcare systems, whether domestically or abroad, for the most marginalized.
How did you begin to bring the two together?
I chose Yale for both my MD and my MBA because it’s a very different type of institution. The business school tended to attract very open-minded people, so the culture fit well with my policy interests, and offered a great background in management of nonprofit and public sector organizations. The medical school was connected to a free clinic for undocumented migrant workers (New Haven is a sanctuary city), and I was able to run that for my first two years of school. It was a wonderful and humbling experience that’s very much been a model for me in my current work.
And this was when Possible started as well, right?
Yes. In 2006, Nepal emerged from civil war and many Nepalese were looking for ways to help move forward in what was a new and exciting democratic environment. At Yale, I met a number of Nepalese students, and by 2008 the team was able to begin working with a community in one of the most remote parts of the country that had virtually no access to healthcare. This work evolved to today where we have multiple public-private partnership (PPP) contracts with the Ministry of Health, and has been my work for the last nine years.
How would you describe Possible today?
Through a PPP, our team directly provides care for over 150,000 people per year. We were one of the first PPP contracts in Nepal, and a lot of our work now focuses on supporting the government to create the necessary financing, regulatory, and accountability frameworks to leverage the PPP business model as an opportunity to improve access to healthcare for Nepal.
You’ve also kept up a clinical career, how does that fit into the picture?
My faculty appointment is through Brigham & Women’s Hospital in Boston, and I work clinically at one of the community health centers Massachusetts General Hospital runs as an internal medicine and pediatrics physician. In this capacity, I work in the equivalent of a community emergency room for about 50 days per year.
How has your role as a clinician contributed to your work at Possible?
Being a clinician is critical to my understanding the challenges our patients face each day. It would be difficult to develop our organizational strategy, to support the MOH in designing their healthcare system, or support our Nepali team in designing health programs for the patients we serve without being in some capacity directly patient-facing. Serving patients directly helps me to understand their challenges, the systems we need to solve those challenges, and ultimately to bring the lessons each of my patients teach me to our organizational strategy, and the policy tables.
Reflecting on your experience and what you know now, what would you say about the role of clinicians in policy work?
I don’t think there are nearly enough clinicians at the table with policy makers. Understanding our patients’ challenges is tremendously important to policy. All providers can have a voice in the healthcare systems we build by supporting our policy makers to understand the perspective we have the privilege of gaining every day from the patients we serve. To that end, I would encourage more people to look into flexible career pathways – in the clinic, and leading the institutions that design the healthcare system and policies.
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