Doctor faces health care challenges in downtown Las Vegas

Zubin Damania wears funny costumes and makes poop jokes on the Internet.

Under the pseudonym ZDoggMD, he uses puns, props and parody to make online videos that simultaneously celebrate and skewer the health care industry.

The videos are an outlet for the self-described megalomaniac’s comic creativity and give voice to the frustrations and joys he and countless other doctors experience while practicing medicine.

They also are a big reason Damania and his wife, radiologist Margaret Lin, heeded the call from Zappos CEO Tony Hsieh to drop everything and move to Las Vegas and "help fix health care."

Hsieh, who has been friends with Lin since they were in college at Harvard, was in the midst of creating the Downtown Project, an urban community-building effort based on bringing talented people together in Las Vegas to pursue their passions, when he first pitched the move.

In the Bay Area, Damania was doing the occasional video in between time spent as a husband and father of two and as adjunct clinical assistant professor at Stanford University and hospitalist at Stanford University Medical Center.

" ’So you want us to stop being doctors and come and be with you and work at an online shoe emporium?’ " Damania said of his initial response to the invitation. "You’re high."

The months went by and Hsieh persisted by challenging Damania to articulate what he wanted to do with his life and career, then suggesting he do it in Las Vegas.

"Tony just said, ‘Do whatever you are passionate about,’ " Damania said. "Obviously health care in Vegas has a bad reputation. Figure out what is wrong and figure out what you want to do."

Eventually, Damania relented.

New regulations had made his medical work less rewarding. And Lin, who was also taking a risk by leaving behind her own professional network, was urging her husband to follow Hsieh to Las Vegas.

"Even though you think he is crazy, he is probably onto something," Damania said, describing Lin’s logic.

So now what?

Since moving in March, Damania has been producing ZDoggMD videos he hopes will help inspire young doctors to come to Las Vegas and join whatever health care system develops downtown.

"I can make a video and reach tons of people in residency who are just forming what they are going to do. If I can get just five of them to switch to primary care and come work with us, that would be a huge thing," Damania said. "We are going to treat it as kind of a startup, incubated by Downtown Project."

But amusing skits aren’t going to fix health care in Las Vegas.

According to the United Health Foundation, Nevada ranks near the bottom of the 50 states for immunization coverage, prenatal care and availability of primary care physicians. It ranks high in smoking and lack of health insurance.

A reputation for low quality and high cost has landed Las Vegas some unfortunate health headlines over the years.

An influential 2009 article in the New Yorker by Atul Gawande, a physician and journalist, mainly focused on high-cost, low-quality care in McAllen, Texas, but also included a Las Vegas mention and laid bare some hard truths about the business of medicine and health insurance.

Chief among them, medical culture can influence cost and quality. In places where high-caliber research and collaboration-heavy providers like the Mayo Clinic do business, prices and outcomes are better, Gawande wrote.

"Just as an anchor store will define the character of a mall, anchor tenants in biotechnology, whether it is a company like Genetech, in South San Francisco, or a university like M.I.T., in Cambridge (Mass.), define the character of an economic community," Gawande wrote. "They set the norm."

In places where much of medicine is chasing high-margin services and insurance reimbursement, cost goes up and quality goes down, the article stated.

"Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet," Gawande wrote. "Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple years later?"

Damania’s medical reconnaissance mission upon landing in Las Vegas yielded similar results to Gawande’s findings. That is, health care in Las Vegas tends to look more like sick care as patients are herded between specialists who poke, prod and order procedures but don’t put more attention toward healing.

"Health care institutions are integrated around trying to do too many things for too many people at once, and they never do anything right," Damania said. "It is a quality problem."

Can he find solutions?

Even though he lacks experience in health care policy or managing medical bureaucracy, Damania thinks he is zeroing in on potential solutions to implement sound practices downtown.

He is doing it by reaching out to others looking to bring down health care costs while improving results.

People such as Samir Qamar.

Qamar is a Beirut-born U.S. citizen. His parents are diplomats, and he spent his childhood traveling the globe.

He also is the house doctor at the prestigious Pebble Beach golf club near Carmel, Calif., and founder of MedLion, a low-cost, subscription-style primary care clinic company founded in 2009. It started in Monterey, Calif., catering to laid-off Silicon Valley workers who had lost employer-subsidized insurance. It later expanded to work with businesses seeking to reduce health costs.

The idea behind the clinic is that by charging a monthly fee-for-access of about $40 to $60, MedLion can provide quality care aimed at prevention instead of ordering as many procedures as possible.

The clinics contract for low-cost lab services, and the pricing structure includes health monitoring, flu shots, sugar checks for diabetics and other routine services such as physicals.

Proponents of direct primary care say it improves quality by giving doctors incentives to keep people healthy through prevention and reduces costs by shifting insurance to something people only use for rare, high cost procedures such as surgery.

"If we can do our jobs and provide high-quality, high-impact preventative and primary care … then we can effectively decrease downstream hospital visits and specialist visits," Qamar said.

Qamar moved MedLion to Las Vegas in part because the high ratio of patients to primary physicians in Nevada means people are clamoring for quality care and also because Nevada has a better business climate than California.

He is working to open the company’s first local clinic, near U.S. Highway 95 and Summerlin Parkway, in the Longford Medical Center.

"We came here to save Las Vegas’ primary care independently," Qamar said, but he is open to working with Damania, Hsieh and the Downtown Project.

"Part of (Damania’s), I think, role in the Downtown Project is to see what health care models are out there working," Qamar said. "They liked what we had to offer. We know they are trying to produce some type of clinic. We have already told them we are prepared to help."

Damania said he still doesn’t know exactly how to proceed. He wants to get a clinic opened downtown sooner rather than later and takes inspiration from people like Qamar and other innovators.

Even though Damania hasn’t settled on a specific model for downtown Las Vegas, he is clear when it comes to describing what he wants to accomplish.

He recalls an experience on rounds at Stanford when he was assigned to care for a relatively young man dying from cancer.

Damania said the man was an engineer and aware he was dying, but he and his family couldn’t settle on a course of care.

The man’s wife sought to reduce his pain and protect his dignity.

The patient wanted to be lucid to communicate with his loved ones in his final days.

But no one, not the patient, his family or specialists who had come through the room, were able to forge agreement on a plan.

After taking time to sit and listen to the patient and his family, Damania said, they were able to settle on a balance of care that reduced pain but kept the man lucid and able to return home for his final days.

"When they left they were so happy and at peace and grateful," Damania said.

It was one of the last patients he cared for before moving to Las Vegas.

"I was thinking, remember this," Damania said. "This is what you are going there to do, even though you don’t know what the hell you are getting into."

Contact reporter Benjamin Spillman at bspillman@review journal.com or 702-383-0285.

ad-high_impact_4
News
Ron Jeremy and Heidi Fleiss React to Dennis Hof's Death
Ron Jeremy and Heidi Fleiss speak about their friend and prominent brothel owner Dennis Hof's death at Dennis Hof's Love Ranch. (Benjamin Hager/Las Vegas Review-Journal)
Nevada brothel owner Dennis Hof has died
Nevada brothel owner and Republican candidate for Nevada State Assembly District 36, Dennis Hof has died. He was 72. Nye County Sherriff's office confirmed. Hof owned Love Ranch brothel, located in Crystal, Nevada.
Las Vegas police investigate suspicious package at shopping center
Las Vegas police evacuated a southeast valley shopping center at Flamingo and Sandhill roads early Tuesday morning while they investigated reports of a suspicious package. (Max Michor/Las Vegas Review-Journal)
The Las Vegas Metro hosts the K-9 Trials
The Las Vegas Metro K-9 Trials returns to the Orleans Arena to benefit the Friends For Las Vegas Police K-9 group.
Kingman residents love their little town
Residents of Kingman, Ariz. talk about how they ended up living in the Route 66 town, and what they love about their quiet community. (K.M. Cannon/Las Vegas Review-Journal)
Service at Southern Nevada Veterans Memorial Cemetery
Twelve unclaimed veterans are honored at Southern Nevada Veterans Memorial Cemetery in Boulder City in Oct. 9, 2018. (Briana Erickson/Las Vegas Review-Journal)
Las Vegas house prices reach highest level in 11 years
Las Vegas house prices are rising But so is the amount of available homes on the market Still, properties priced below $300,000 are selling fast And September was the first time since June 2007 that the median house price reached the $300,000 mark Las Vegas home prices have been rising at one of the fastest rates in the country over the past year Recent data show the market is now less affordable than the national average
National Night Out
About 100 Summerlin residents gathered at Park Centre Dr. in Summerlin on Tuesday for National Night Out. Lt. Joshua Bitsko with Las Vegas Metro, played with 3-year-old David who was dressed as a police officer. Face painting, fire truck tours and more kept kids busy as parents roamed behind them. (Mia Sims/Las Vegas Review-Journal)
Rural homeless issue comes to a head in Pahrump
On Sept. 12, Pahrump sheriff deputies told residents of a homeless encampment on private property that they had 15 minutes to vacate and grab their belongings. That decision might face some legal consequences. (Rachel Aston/Las Vegas Review-Journal)
Remembrance blood drive on October 1
A blood drive was held at the Las Vegas Convention Center on the one year anniversary of the Oct. 1 shooting. (Mat Luschek/Las Vegas Review-Journal)
Remembrance Lights memorial unveiled at St. Rose hospital
A dedication ceremony was held at St. Rose to unveil a memorial and to read the names of those who died on October 1, a year ago. (Mat Luschek/Las Vegas Review-Journal)
1October Blood Drive Remembrance Wall
(Mat Luschek/Las Vegas Review-Journal)
1October Blood Drive
Vitalent hosts a blood drive at the Las Vegas Convention Center on Monday, Oct. 1, 2018, the first anniversary of the Las Vegas shootings. (Mat Luschek/Las Vegas Review-Journal)
1October sunrise remembrance ceremony in Las Vegas
Myanda Smith, sister of Las Vegas shooting victim Neysa Tonks, speaks at the sunrise remembrance ceremony at the Clark County Government Center in downtown Las Vegas, Monday, Oct. 1, 2018. (Chitose Suzuki/Las Vegas Review-Journal)
‪Gov. Brian Sandoval speaks to crowd at Oct. 1 sunrise remembrance ceremony ‬
‪Nevada Gov. Brian Sandoval speaks to the crowd at the Oct. 1 sunrise remembrance ceremony ‬at the Clark County Government Center in downtown Las Vegas, Monday, Oct. 1, 2018. (Michael Quine/Las Vegas Review-Journal)
Father of Route 91 Harvest festival shooting victim talks about college scholarship in his daughter's memory
Chris Davis, father of a Route 91 Harvest festival shooting victim, Neysa Tonks, talks about a college scholarship in his daughter's memory to assist the children of those who died in the shooting. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
Oct. 1 survivor Malinda Baldridge talks about life after the shooting
Malinda Baldridge of Reno attended the Route 91 Harvest festival with her daughter, Breanna, 17, and was shot twice in the leg when the gunman fired on the crowd.
Route 91 survivor talks about lack of progress in gun legislation
Heather Gooze, a Route 91 survivor, talks about lack of progress in gun legislation since the Oct 1. (Bizuayehu Tesfaye/Las Vegas/Review-Journal) @reviewjournal
Review held in death of man after encounter with Las Vegas police
The mother of Tashii Brown, who died after an encounter with Las Vegas police on the Strip, not satisfied after public review of evidence. (K.M. Cannon/Las Vegas Review-Journal)
Clark County Museum opening "How We Mourned: Selected Artifacts from the October 1 Memorials"
The Clark County Museum is opening an exhibit "How We Mourned: Selected Artifacts from the October 1 Memorials" of items left to honor the victims killed in the Route 91 Harvest festival shooting. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
Memorial service for former RJ lawyer Mark Hinueber
Mark Hinueber, the Review-Journal's former lawyer and defender of the First Amendment, died in Las Vegas on Aug. 23. Hinueber, who was 66, worked at the RJ and other newspapers for 42 years. On Saturday, his friends and family gathered for a memorial service.
Army veteran honored in Henderson event
Army Sgt. Adam Poppenhouse was honored by fellow veterans in an event hosted by a One Hero at a Time at the Henderson Events Center.
Michelle Obama and Keegan-Michael Key urge Nevadans to vote
Former first lady Michelle Obama and comedian Keegan-Michael Key urged Nevadans to vote at Chaparral High School in Las Vegas Sunday, Sep. 23, 2018. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
Nevada Task Force One Cheers Golden Knights
Nevada Task Force One Cheers Golden Knights
1 dead, 1 wounded in North Las Vegas standoff
A woman was hospitalized with serious injuries on Thursday morning after being shot inside a North Las Vegas house. Police responded about 11 p.m. to a shooting at a home on the 5600 block of Tropic Breeze Street, near Ann Road and Bruce Street. The wounded woman, police believe, was shot by a man, who later barricaded himself inside the house. SWAT was called to assist, and when officers entered the house, they discovered the man dead from an apparent self-inflicted gunshot wound.
Las Vegas Teen Makes Clothing Resale His Side Hustle
Las Vegas resident Reanu Elises, 18, started buying and selling streetwear online when he was a high school junior. Like many other young adults, the world of online resale applications like Depop and Mercari have made selling clothing online for a profit easy. Now, Elises spends his free time at thrift shops looking for rare and vintage clothing he can list on his on his shop. Now in his freshman year at UNLV as a business marketing major, Elises hopes to open a shop of his own one day and start his own clothing brand. He estimates that he's made about $1000 from just thrifted finds in the past year, which he'll use to buy more thrift clothing and help pay for expenses in college. (Madelyn Reese/ Las Vegas Review-Journal) @MadelynGReese
Fruition Vineyards Encourages Young Entrepreneurs to "Buy, Flip, Dream"
Once a month, young adults gather at Fruition Vineyards on South Maryland Parkway near UNLV to dig through a stack of rare, vintage and designer clothing that's marked down well below it's resale value. Shop founder Valerie Julian began the vent, dubbed "Fruition Vineyards" in August after running her streetwear shop since 2005. The event gives young entrepreneurs the opportunity to "buy, flip, dream" according to Jean. Meaning that they're encouraged to buy the clothing for sale and find a way to resell it for a profit, then reinvest that into whatever dream they pursue: college, a hobby or their own resale business. Shoppers lined up starting an hour before noon on the last Saturday in April for the opportunity and spoke about what they hoped to do with their finds and profits. (Madelyn Reese/Las Vegas Review-Journal) @MadelynGReese
Local man goes under cover searching for answers to homelessness
Licensed mental health therapist Sheldon Jacobs spent 48 hours under cover posing as a homeless man in an attempt to gain perspective on the complex issue.
Social Work UNLV Lecturer's Calling
Ivet Aldaba-Valera was the first person in her family to graduate from both high school and college. The 33-year-old UNLV lecturer is now pursuing her Ph. D in public policy at the school and has used her degree in social work to engage with the young Latino and Latina community of Las Vegas. (Madelyn Reese/Las Vegas Review-Journal) @MadelynGReese
Gold Point townsperson talks about why he choose to live in a ghost town
Gold Point townsperson Walt Kremin talks about the ghost town in Nevada he calls home. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
Local
Downtown Summerlin hosts its annual Festival of Arts
People crowd to Downtown Summerlin for the 23rd annual Summerlin Festival of Arts in Las Vegas, Sunday, Oct. 14, 2018. (Caroline Brehman/Las Vegas Review-Journal)
Clark County educators debate alternative grading systems
Spring Valley High School principal Tam Larnerd, Spring Valley High School IB coordinator Tony Gebbia and retired high school teacher Joyce O'Day discuss alternative grading systems. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
Grandparents on the fire that killed three family members
Charles and Doris Smith talk about the night an apartment fire took the lives of three of their family members. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
New York artist Bobby Jacobs donated a sculpture to the Las Vegas Healing Garden
Bobby Jacobs, an artist from upstate New York, has spent much of the past year creating a sculpture of two separate angel wings. He donated the sculpture to the Las Vegas Healing Garden. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
Weather will cool slightly through the end of the week
The weather will cool slightly through the end of the week., but highs are still expected to be slightly above normal for this year. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
Mayor announces new public-private partnership
Mayor Carolyn Goodman announced the creation of the Mayor’s Fund for Las Vegas LIFE, a public-private partnership that will allocate money to the city’s neediest.
Fremont9 opens downtown
Fremont9 apartment complex has opened in downtown Las Vegas. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
Fall fairytale gets cozy at Bellagio Conservatory
Bellagio Conservatory introduces its fall-themed garden titled "Falling Asleep." (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
What the house that Ted Binion died in looks like today
Casino heir Ted Binion died in this Las Vegas home in 1998. Current home owner Jane Popple spent over $600,000 to restore and modernize the home. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
Rescue Mission employees terminated
Don James, a former employee for the Las Vegas Rescue Mission, talks about the day his team was terminated. (Erik Verduzco/Las Vegas Review-Journal)
Raiders Cupcakes at Freed's Bakery
Freed's Bakery will have Raiders-themed cupcakes available in store and for order during football season. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
51s fans say goodbye to Cashman Field
Las Vegas 51s fans said goodbye to Cashman Field in Las Vegas, Monday September, 3, 2018. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
51s owner Don Logan's last weekend at Cashman Field
Don Logan, owner of the Las Vegas 51s, gives a tour of Cashman Field before the team's final weekend using the field. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
Metro Asst. Sheriff Brett Zimmerman on Aug. 8 officer-involved shooting
Metropolitan Police Department Assistant Sheriff Brett Zimmerman met with media Monday to discuss the details of the 14th officer-involved shooting of the year. (Madelyn Reese/ Las Vegas Review-Journal)
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program where community and business leaders joined to welcome students back with an inspirational welcome. Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye
Star Trek fans on show’s enduring popularity
Star Trek fans at the Star Trek Convention 2018 talk about why they think the show has stayed popular across the years Thursday, August 2, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Nonprofit provides clothing for homeless
Sydney Grover of Can You Spare A Story?, talks about how she founded the non-profit organization. (Marcus Villagran/Las Vegas Review-Journal)
Life
Celebrity photographer dedicates dance book to Las Vegas shooting victims
Behind the scenes with local celebrity photographer Jerry Metellus as he talks about his Dance For Vegas coffee book dedicated to the 58 victims of the October 1 shooting. (Marcus Villagran/Las Vegas Review-Journal) @marcusvillagran
Dreamsickle Kids Foundation founder Gina Glass talks awareness
Gina Glass, 35, founded Dreamsickle Kids Foundation to raise awareness for sickle cell disease in Nevada. (Jessie Bekker/Las Vegas Review-Journal)
The Meadows School founding kindergarten teacher retires after 34 years at the school
Linda Verbon, founder of the The Meadows School's kindergarten program and the first faculty member hired at the school, retired in the spring after 34 years at The Meadows. (K.M. Cannon/Las Vegas Review-Journal)
Kids become firefighters at Fire Station 98 open house
Henderson residents wore fire hats, learned about CPR and met firefighters at the Fire Station 98 open house Saturday, August 11, 2018. (Marcus Villagran Las Vegas Review-Journal) @brokejournalist
People from all over the world attend RollerCon 2018
RollerCon 2018 is a five-day convention focused on the roller derby community and culture at Westgate in Las Vegas. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
TOP NEWS
News Headlines
ad-infeed_1
ads_infeed_2
Local Spotlight
Add Event
Home Front Page Footer Listing
Circular
You May Like

You May Like