Nevadan at Work: Clinic network boss set to lead as health care shifts to future

Even when he was a student, Dr. Sherif Abdou thought of himself as an American born in the wrong place.

After he complained long and loud about life in his native Egypt, his father finally handed him an airline ticket to Los Angeles as a graduation present for earning his medical degree at Mansoura University, near Cairo. Abdou finished classes three days early on Aug. 28, 1985, and boarded the plane the next day.

Although this meant working in a convenience store to learn English and local customs in a dangerous part of downtown L.A. -- a co-worker was shot at one point -- he pressed ahead with his goal of becoming an American physician.

"Failure was not an option," Abdou said.

After six months his father called to remind him he still had a car and apartment in Egypt.

"I said, 'Dad, there is no back,' " Abdou recalled. "He thought it was just one of those rebellious things I would get out of my system."

Now, as president and CEO of HealthCare Partners of Nevada, the largest general practice clinic in Las Vegas, he faces a task that might require even more stamina and determination: trying to reshape the health care system. The Patient Protection and Affordable Care Act promises sweeping changes, but faces a U.S. Supreme Court challenge and still must be fleshed out with volumes of regulations. Even experts can only guess at the end results.

Many independent doctors view clinics such as HealthCare Partners of Nevada, a division of Torrance, Calif.-based HealthCare Partners Medical group with 52 locations in the state and about 240 doctors on staff, with a mixture of fear and dread. Following a national trend, the group has grown by absorbing numerous sole practitioners and small groups that decided independence was no longer worth it. Doctors also often deride the large groups as assembly-line medicine.

Abdou, however, sees HealthCare Partners of Nevada as a participant in an irreversible push to reform the medical system in ways that will improve treatment quality while slowing or halting rising costs.

"The people who resisted HillaryCare in 1993 (the Clinton administration proposals that died in Congress) believed the system was good, believed there was no need for change, believed the act of change would break the system," Abdou said. "These people today would say it's not working, it's broken, it needs to change. We might disagree on what change that needs to happen, but they are accepting, embracing and willing to celebrate the change."

Question: At this point in your career, are you a doctor or a businessman?

Answer: I am a physician leader. We are moving from a cottage industry to more institutionalized structure. My belief is that we need somebody that has been at the bedside to provide the right amount of leadership to make it more patient centered. I think the last patient I saw was in 2002-2003.

Question: Physicians are notorious for not being good with money. What prompted you to switch to the business side?

Answer: Really, it wasn't about the money as much as I was working hard and seeing 10 patients a day, then 20 patients a day, then 30 patients a day and 40 patients. I guess it's in my right-sided brain nature that thinks about how I can an impact on a thousand patients a day, 10,000 patients a day. It was by taking a leadership role and being able to impact 10 doctors then 20 doctors then 1,000 doctors, so every single day I am impacting tens of thousands of lives.

Question: Some doctors, including a previous president of the Clark County Medical Society, have likened corporate clinics to mass production, saying it may be good for hamburgers and fries but not for medicine.

Answer: I don't think that we are doing mass production. Our doctors do not see any more patients than the solo practitioners. On the contrary, they actually see fewer patients but we have a bigger team to take care of the patients.

Question: Still, don't a lot of other doctors see the big clinic as an enemy?

Answer: We have 52 locations. All of our locations are built around one or two doctors. What we do is coordinate and create a system of treatment. We don't pay people less than what they make outside. We don't have mass production. We have the ability to coordinate, integrate and hold people accountable to quality outcomes. So, it's population management.

The episodic, random encounters patients have with the small practitioners that do not have the infrastructure to coordinate the care, which Las Vegas has been known to be a safe haven of, resulted in the lowest ranking in quality and access in the United States in 2006, 2007 (according to the Commonwealth Fund use of Medicare data).

Since we started putting this together (HealthCare Partners of Nevada), we have moved up nine notches in the rankings, to 42nd. HealthCare Partners' and my goal is to be in the top 25 before I retire.

Question: There is a lot of romance attached to the sole practitioner with the black bag who knows all his patients by name. Is that going away?

Answer: No. When you go to a HealthCare Partners office, there are just one or two doctors. Everybody knows their patients, and the grandkids and Uncle Buck and Aunt Jenny back on the Iowa farm. They talk about that with the patients and also have the extra infrastructure to coordinate the care.

Question: Businesses of your size generally like to plan a few years ahead. How can you do that when so many aspects of medicine are uncertain, starting with how the U.S. Supreme Court will rule on the new health care law?

Answer: Whether the current affordable act stays in effect or others come along, I think the path to the future will go through groups like ours. We started before the health care reform, we lived through the conversation of health care reform and we are growing through the implementation of health care reform.

Question: Assuming the current law stays in place, what do you expect will be the end result?

Answer: I think the patients will be better off because it will force a lot of coordination and hold the providers and hospitals and institutions accountable to outcome quality and value added. I think we will go through a stage of sausage making. There is going to be a mess. When you change an industry as big as health care, some people will resist change, some people will drive change and some people will try to twist change to their own benefit. But I believe patients will be better off in the end.

Question: Over the years, there have been a number of reform attempts that espoused that same goal and didn't pan out. Will it work better this time?

Answer: There is a lot of money in health care. A lot of companies and people are making a lot of money out of the broken health care system. Sadly, it is almost more profitable to provide mediocre, inefficient, ineffective care than it is otherwise. And these forces will do everything in their power to derail any attempts at reform.

Question: Despite the hurdles, are you an optimist about the future of health care?

Answer: I am. We have one of the greatest systems in the world for innovation and technology and dedication of highly skilled providers. But we have let it become entrepreneurial run amok, without social conscience and social responsibility. I believe the vast majority of providers feel bound by that contract and want to do the right thing. But because they lack education about the system and it is so big and complex, they get lost.

Question: How long to you plan to keep at it?

Answer: I am definitely committed for at least the next 15 years.

Question: Do you think a significant number of these changes will happen before you retire?

Answer: Yes, I do. You will see changes that are like the changes in technology. What we have seen in the past 10 years is greater than what we saw in the previous 100 years. I think that's what will happen.

Contact reporter Tim O'Reiley at toreiley@reviewjournal.com or 702-387-5290.