Julien Pham, M.D. ’04, is a nephrologist, but some of his most influential work includes the development of technology platforms. His latest venture is called RubiconMD. RubiconMD allows primary-care physicians to ask specialists around the country simple questions about symptoms and medications, and they receive answers within a few hours. The HIPAA-compliant platform also allows physicians to quickly upload medical records, including EKGs, photos, x-rays and labs, for the specialist to review. Another mark of success: the nearly 100 primary-care physicians who use RubiconMD are reporting better physician-patient experiences, and the 70 specialists are requesting more consulting opportunities.
Prior to RubiconMD, Pham founded RHINNO (Rapid Health Innovation), a virtual lab that helps clinician-entrepreneurs develop technology-based ideas into usable prototypes. Using design thinking and Lean StartUp methodologies, the RHINNO team has developed a number of apps now in use. One of RHINNO’s most successful apps is SQ. SQ is a resource that provides accurate knowledge about sexually transmitted infections, nutrition, substance abuse and mental health on college campuses.
How did you decide on a career in medicine?
There is the official and unofficial story. I’ll reserve the unofficial (somewhat fun and unusual) story for another time. It turns out, I am a second generation doctor. As a child, I was really inspired by my father, a former “trauma surgeon” for the South Vietnamese army, who was imprisoned after the war, made his way to France to rebuild another life with his wife and first child at the time, went into primary care, and has now practiced medicine for over 40 years with no sights on wanting to let go anytime soon. Growing up, I would play with the medical equipment in his exam rooms, check the med samples in the file cabinet and try to read their posology, and even walk around and talk to his patients in the waiting room. What stuck the most was how his patients had the utmost respect and esteem for him. Everyone always thought he was such a kind, wise, and compassionate doctor. Big chip on my shoulder there. But it all made sense for me personally when I started volunteering on medical mission trips to Vietnam with him and have continued to do so for the past 20 years. To me, medicine has to be a vocation. You just feel it deeply.
What does an “average” day look like for you?
I wake up early and explore what’s new in the world. I consume information, as much as I can, through as many sources as I can, and across multiple industries, cultures, and languages. I try to process all of it and share on social media, @jlpham and on Facebook and LinkedIN.
I hop on Slack and my email to see what’s happening with RubiconMD, participate in discussions and share my opinions. Then I have all kinds of meetings and calls about various things for the company, but also try to allocate time to stay plugged in to my own ecosystem of physicians and physician entrepreneurs, in Boston/Cambridge and elsewhere. I try to advise and mentor through my learned experiences so far. I try to maintain a good work-life balance and avoid skipping meals. In the early years of RubiconMD, I had a hard time disconnecting, and found myself doing the same thing I was doing when I was in academia. Now I try to be more present, and have the clarity of mind to be effective. I meditate regularly. It’s also easier now that we have more resources and a bigger team to delegate tasks.
One weekend a month, I moonlight for a private Nephrology practice in the South Shore area. I’ve been doing this for years and I really like the experience and the group. It’s very different from academic institutions. I also semi-volunteer and have set up a Renal clinic at a community health center in Dorchester, with a population that predominantly speaks Vietnamese.
What issues do you currently face and are trying to solve?
At RubiconMD, internally, it’s the rapid scaling of the company. We are hiring a lot of people and processes now need to be formalized more so that knowledge is transferable and shareable in a more efficient way. It’s much easier (and also harder) when the company is just 3 founders. We are now around 20 people.
At a higher level, the challenges that I think about all the time are 1) how to continue to engender trust in the interactions between Primary Care and RubiconMD specialists. Trust and engagement really drive the platform. And I believe that trust will drive adoption, and adoption will allow us to improve the quality of the exchanges. And 2) how to measure quality through the data we collect. We have some solid and consistent data that shows for example that 45% of eConsults through the platform lead to avoided referrals, but these are reported outcomes. We want to be able to get more hard data to truly measure meaningful outcomes, and we will start to do so as we partner with systems and plans. I really believe that we should not compromise quality and outcomes for the sake of technological efficiency and cost-savings. All these can happen at once and technology should serve as a catalyst. In the long term, part of my vision is to create deeper partnerships with academia in order to explore and co-publish some of these findings.
How did you see the need for a technology like that RubiconMD provides? How did you get started?
Gil pitched a similar early idea in March 2013 at a MIT [email protected] Medicine event. I was mentoring various teams at the time and the table where Gil and Carlos were sitting at seemed to be working on something quite audacious (but whose business model I thought was not the right one at the time). In all honesty, I didn’t really have a solution either (nor the business experience I have now) but putting on my clinical/physician hat, it was very clear to me that having patients tap into KOLs directly for medical opinions (traditional telemedicine) was not going to happen for so many logistical and “cultural” reasons. Gil reached out to Carlos and I after the event. We had a few conversations, and I really thought that if anything, this was going to be a phenomenal team of smart, driven people who could actually make something happen, and a team I would be excited to build something with.
The second part of the story is how we pivoted to the current innovative delivery model. It happened at another hackathon, Tufts’ Medstart this time, literally a month later. It was there, with a completely different team around the three of us that it dawned on me that what RubiconMD should be doing, rather than patient-facing telemedicine, was primary care to specialist eConsults. The fun anecdote is that it dawned on me as I was trying to come up with a cool tagline and came up with “care traffic control”. To this day, I still wish we would use this tagline but I think what’s more important is that through the process of being creative, we pivoted the model into one of “triage” and eConsults, where the PCPs are empowered to provide better, more cost-effective, and efficient care with the support of an on-demand network of specialists. That was the birth of RubiconMD. We started building and piloting various prototypes, collected some great data with a very strong discriminating signal, and it just became an opportunity I couldn’t pass up.
How much of an impact has RubiconMD had on helping physicians in the workplace?
From the feedback we hear, it has had tremendous impact. This is especially true for solo or small practice providers in rural or isolated areas (such as urban community health centers) who lack access, either by geography or because of referral wait times. At the end of the day, any clinician who’s interested in entrepreneurship should go into it, not because of the lure of an easy opportunity for financial security (it is so far from the truth), but because you want to have an impact that’s “greater” or maybe different from the impact you already have as a clinician. I feel that users of the RubiconMD platform, whether they are PCPs or specialists, are able to see that greater purpose and are engaged because they feel their contribution, through the use of this technology and service model, has and can lead to positive outcomes for their patients and themselves.
RubiconMD is a platform that aligns PERFECTLY with the Quadruple Aim. It empowers PCPs, encourages knowledge exchange professionally and collegially, and gives an opportunity for specialists to participate in care delivery in a more efficient way, while making a bit of extra cash doing something they used to do for free. In fact, each time we’ve had to pitch the model to clinicians, they get quite excited (once we prove to them we can actually execute on it) and say that the model makes total sense. When generally skeptical people get behind you in such a way, you know they also see the same potential for impact.
What important issues do you think modern medicine faces today?
We are going through a cultural revolution of sort. Society has changed in a way that technology and science is so prevalent that it has completely changed the dynamics and the expectations for doctors. No more are doctors the all-knowing, wise, compassionate saviors they once were when various remedies and options for care were limited, and we alone held the key to that knowledge. In a world that wants more transparency and accountability, physicians will have to evolve the way they practice and organize themselves. Unfortunately, though I worry a lot about the state and delivery of care in our country, I also worry about the status of physicians who are embarking on this difficult, life-altering journey against not only disease, but also against a broken system that does not work “with” them. Physicians today are overburdened by more and more administrative tasks, come into training with different attitudes and perspectives, are trained differently, seek different experiences professionally and personally, and often leave the profession burned out. Our ethos is changing radically and we run the risk of losing our identity as doctors (or providers, whichever you prefer). At the same time, in such times of crisis, there becomes an opportunity for modern clinicians to transform themselves. I view entrepreneurship as this great opportunity to reinvent oneself, but also the profession. I am very excited to see so many clinician entrepreneurs coming out of the woodworks. Because I feel most of us are hardwired to care, be compassionate, and want the best for our patients and society. So ensuring that we encourage “our types” to become entrepreneurs, creatives, leaders, and agents of change will really define the future of medicine and our profession.
What advice do you have for students aiming to get involved in your field?
Finish your clinical training. Have a beginner’s mind. Be proactively curious about everything. Train your mind to act, not just think. Activate your network early. Learn to be a leader. Be a team player. Don’t be an asshole. Be kind, be nice, especially with yourself and the people you care about. Participate in the ecosystem. Be inclusive. Get included. Start with something small. Associate yourself with people who have the right attitude. Get out of your comfort zone. Be passionate. Never lose your empathy and your enthusiasm.