January
2004
Volume 28 •
No. 1
Gastroenterologist Harvey Young, has worked as both a faculty member, running the medical center's Endoscopy Unit, and is now in private practice. He is interested in developing a dialogue on the structure of the volunteer clinical faculty.
Gastroenterologist
Young crosses street
And brings experience to Medical Board
Harvey Young, a gastroenterologist with a two-decade history on Stanford's medical staff, faculty and most recently in the independent practice community, believes his new seat as an at-large member of the Medical Board is a venue where he can make a difference. "It's all about communication, and I received a good introduction to that at my first Medical Board meeting in November. That day we were asked to take action on a conflict of interest policy required to be signed by all doctors on the staff.
"I do think the conflict of interest policy is straightforward, sound and reasonable, but this is the kind of issue that should have had widespread awareness among all categories of medical staff - before it came up for a vote at the Medical Board. [See December's Medical Staff Update for a brief overview of the policy]. "However, this was the first time I had heard of this policy as applied to the entire staff.
"On the Medical Board I hope to be part of fostering a dialogue not only among my colleagues, but among colleagues, medical staff leadership, the hospital and the medical school. For example, we need to improve effective communication between the medical school and hospital in restructuring the status of volunteer clinical faculty. With experiences in both the community and faculty camps, I hope to bring some balance to such a discussion - and it is indeed discussion that will lubricate the machinery that will lead to a solution."
Young said he was approached more than a year ago to run for the Medical Board but declined because of other commitments. He had served on a variety of committees, such as the Ambulatory Care Committee, and the hospital's enterprise-wide computer task force. Nationally he has served on the Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy, (1994-1996 and 1999-2001). He presents widely at national and international conferences and has published extensively in a range of academic interests.
When the opportunity to run for the Medical Board came up again in 2002, Young agreed, finding it might be an opportunity to work with colleagues to find win-win solutions that will help the hospital and foster the interests of physicians practicing in a variety of models.
"I hope to work with my colleagues to maximize the rich array of communication options available to us as physicians -e-mail, newsletters, mailings, meetings, events, informal events. The staff needs to know as much as possible about issues affecting them. We can't leave that to a small group. Often the rationale is that 'doctors don't have time to deal with these issues.' Well, we don't have enough time, but we also don't have enough time to fix unexpected and unwelcome decisions that occur because we were not involved in the discussion that created them.
"We should be able to nurture our practices - whether faculty, independent or group - by acting in an informed manner. Being blind-sided is just plain toxic."
He noted that some departments, particularly psychiatry, have active physician organizations that bring together the faculty and community practice groups for a dialogue. He would like to see that sort of "town/gown," researcher/clinician interaction throughout the medical staff.
Also, Young believes a wider group of physicians should have access to Stanford Hospital's online communication, especially now that technology and security barriers are becoming available to provide secure access outside the hospital's own network.
(Ironically, Young is technology savvy and uses e-mail regularly but consciously avoids using e-mail for medical practice communication).
Young is in a unique position to view Stanford practice from both the faculty and community perspective. While other medical board members also have broad practice experience on the faculty and in independent settings, Young has practiced at Stanford throughout his professional life. He came to Stanford in 1982 from a residency at Northwestern, where he attended medical school. He completed his gastroenterology fellowship at Stanford.
Young joined the faculty in 1986 and directed the Endoscopy Unit at the VA for two years before becoming the first regular director of the Endoscopy Unit at Stanford. He was promoted to associate professor in 1993. In a decade he saw the number of patients rise from some 800 procedures to 5,000 procedures per year. When he left in 1998, about 40 percent of procedures were performed by community physicians.
He entered private practice in 1998 and continues to perform his higher-end endoscopic procedures at the unit he formerly directed. Young also teaches one full day per week as an adjunct faculty member, working with a senior fellow.
"My practice, including my teaching, is very similar to what I did as a faculty member," he said. His practice is focused on endoscopic intervention and diagnosis of gastrointestinal illness.
"I still carry on a referral base similar to when I was on the faculty and see myself as somewhat of a conduit for referrals to Stanford from all over Northern California."
Young hopes he can play a role in facilitating town/gown discussions, including the issue of voluntary faculty appointments. "I believe I have some insights into what some of the usual misunderstandings are between the two groups.
"For example, community physicians may look at faculty practice as not being user friendly, and that the focus is all on research. That is only partly true," he said chuckling. And the faculty looks at community physicians as a group uninterested in research.
"I think the latter is not really true at Stanford. I think our community practitioners are generally interested in supporting the research endeavor.
"As a practical matter, community physicians usually are not going to take the lead as primary investigators, but they can contribute by participating, by recruiting. Overall they also round out the clinical programs of departments by providing care for the 'bread-and-butter' cases which keep our community healthy. By working in close proximity, the two groups are improving skills and knowledge in cutting edge medicine.
"When I make a referral of a patient to a colleague who is the leader in a field, particularly for complex care, I'm helping my patient. This colleague may either be on the faculty or in community practice. Providing and locating excellent care and reassuring my patients that they can count on me ultimately benefits my own practice."
The long-term incentive for both faculty and community physicians is to ensure that the medical center is viable.
"While access to facilities is an issue, I really believe that it is one issue that hospital administration should take the lead on solving, because if it is done properly, everyone benefits - the faculty, independent doctors and the hospital. I think the hospital is addressing these issues, but I do also think communication between the hospital and practitioners of all types can be worked on.
"We all need each other. The faculty cannot grow to a critical mass that will be able to serve all of the numbers and range of patients that will keep the endoscopy unit viable. And I think that model applies in other services as well.
"For 20 years Stanford has talked about developing a group of practice-oriented faculty members to handle the bread-and-butter cases. But the problem is how do you offer incentives to such faculty members; how do you distinguish them from practicing community physicians? Community physicians can and are fulfilling this role."
An alternative, he said, is to turn the hospital into a purely tertiary facility. "This has been discussed for years at Stanford, but financially it doesn't appear to work. And in any case, where would more routine cases find treatment in our community?
"Balance in a diverse practice group of physicians is the best business model - and it produces a winning formula for cutting edge care."
Young has traveled far to settle into his current career at Stanford and Palo Alto.
"I have a typical Chinese immigrant experience," he said with a bit of irony.
Four generations of his family studied and worked in the United States but because of immigration laws returned to China to raise families. Young went to high school in Hong Kong, "where almost literally I had three choices for a career - liberal arts, where there wasn't much potential, engineering if you liked physics and math, or medicine if you enjoyed chemistry and biology."
He went to the University of Illinois, in a state where he had family connections, and graduated in biology in 1975. He went to medical school "up the highway" at Northwestern in Chicago.
Young was headed for a career in endocrinology but became fascinated with clinical research and the hands-on demands of surgical procedures. He was asked by his chief of surgery in medical school to sign on to a surgery residency. Young said he declined because he could not get up at 5 a.m. to make rounds with the surgical team. Gastroenterology offered the best of all worlds. "It seemed like fun," Young recalled. "Instead of doing pure bench research, I could combine research with clinical activities, and eventually 'hands-on' interventional skills in the endoscopy suite." Now he's combining intervention, research and general clinical duties with leadership.
"The common ground is to create an environment where physicians can do their translational research and where doctors can take care of local citizens," he concluded.
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