An Ivy League-educated oncologist is bringing his expertise to southern West Virginia.
A thought experiment is helpful when trying to understand one of the largest, if most basic, shifts in the health care industry that’s happened in the last decade. First, think of health care as a product. Like any product, it has to be delivered to the people who want and need it. But how? With the traditional model, it’s simple: A patient sees a doctor and is maybe sent to one specialist, then another, and perhaps referred to another provider for therapy after the fact. “We could look at it in terms of a vertical structure,” says Anshu Jain. “We could say the product starts in one place and then goes to the patient.”
But over the last several years another model has come into favor—a more collective, collaborative approach. Think of all kinds of health care providers huddling in a circle, with the patient in the center. “We can focus on a center of excellence,” Jain says. “We can form a center of excellence around, say, oncology, in which we pull physicians and service providers from other disciplines, and get them all together in a horizontal structure where they all are focused on the overall comprehensive care for the patient.” That means getting a lot of physicians and health care professionals—everyone from surgeons to nurses to occupational therapists—to talk to one another, regularly and often. It’s a tricky proposition in any setting, but especially in rural areas, where geography is a barrier. In big hospitals in cities, physicians are assigned to teams that follow individual patients or come together regularly for meetings. In rural settings partnerships tend to be more informal, which means they can be harder to build and maintain.
Jain, a radiation oncologist, has taken a special interest in this, what he calls the “organizational design” of health care—he’s researched and published academic papers on the health care system and what makes for good leadership within a health care team. And he’s watched the way large academic medical centers are trying to revamp organizational design in urban hospitals: Jain did his postdoctoral training at Harvard University’s Massachusetts General Hospital and Columbia University Medical Center’s New York Presbyterian Hospital. “I got to see firsthand and be a part of the way care is delivered there, and all the decisions that are made as far as physicians, nurses, patients, and how all those factors interact,” he says. “What I didn’t have a sense of is oncology in a rural community and what challenges are faced by those rural communities in terms of delivering care. How can we use some of those tools that larger medical centers are using?”
So when his residency at New York Presbyterian came to an end, Jain didn’t rush into a job at another large medical center. Instead, he returned to his hometown in Ashland, Kentucky, just 16 miles from Huntington, to take a job at the Ashland Bellefonte Cancer Center, and he took his dedication to rural health care one step further by joining the Logan Regional Cancer Center in Logan. “It was an opportunity to practice in the community that raised me,” Jain says. He’s now working with his father, a medical oncologist who has been practicing in Ashland for three decades. He’s also a clinical instructor at the Yale University School of Medicine, and travels to Connecticut a few times a month. Returning to his hometown isn’t necessarily a reflexive choice for such an accomplished young physician—Jain says his friends thought he was nuts not to stay in the big city, or take a job at a larger health center—but after a lot of debate he decided it was the right thing to do. Jain wants to spend his professional life doing something that matters, and he thinks there’s more room to improve the system we use to deliver care in rural settings than in urban ones. Plus, with his rural Kentucky upbringing and Ivy League pedigree, he’s uniquely qualified for the job.
Since he returned to Appalachia in August, Jain’s been working on building informal partnerships with health care providers in Kentucky and southern West Virginia. He wants to have a short list of “enthusiastic and passionate” people who he knows are ready to see patients in their own communities. He thinks that, with those partnerships in place, the Logan Regional Cancer Center and other rural centers can offer care for most patients that rivals what they would receive in larger urban hospitals. “If I can make people feel more comfortable about staying at home for treatment I think we’ll have accomplished something important,” Jain says. “I never undervalue the psychological aspect of being in your community and being surrounded by friends and family as you go through something like cancer. For something that is so fundamentally transforming a patient’s life, I think we owe them that.”
Written by Shay Maunz