Even as a young child, Amanda Angelotti dreamed about becoming a doctor. Five years after graduating from college, she enrolled in the University of California, San Francisco medical school.
But by her third year, Angelotti couldn't shake the feeling that something was missing. During a routine shift at the hospital, making rounds with her fellow students, Angelotti said her thoughts kept drifting.
"I was supposed to be focused on the patient's vital signs and presenting a summary, but I was consumed with thoughts about how to improve the process of rounds," she said. Most striking was the patient's absence from the discussion. "I kept asking myself, 'how could we change things to involve the patient more?'"
Just a stone's throw from UCSF Medical Center, a small group of entrepreneurs at Rock Health, a new accelerator program (and now a venture firm), were thinking about how to shake up the health care process with technology. These startups were developing new wearable devices and mobile apps to help patients take more control of their own health.
The timing was right to bring new ideas to the sector. By 2012, hospitals around the country were rapidly moving away from paper-based medical records to electronic systems, a first step to moving health care into the digital age.
Angelotti graduated the following year, but she did not apply for any residency programs at U.S. hospitals. Instead, she applied to work at Rock Health as a researcher and writer before joining the new medical review site Iodine, one of an exploding number of digital health startups in San Francisco.
By the end of that year, Rock Health projected that digital health funding had exceeded $1.9 billion, a 39 percent jump from the prior year.
The Rising Tide of Doctors Turning to Entrepreneurship
Angelotti is far from alone in making the leap from medical school to digital health.
Students from around the Bay Area and the country are increasingly dropping out of residency programs and instead going into careers in high-tech start-ups.
“We’ve seen that many of these Bay Area-based medical students are drawn to startup opportunities — it used to be biotech, and now it’s more often digital health,” said Jeff Tangney, CEO of Doximity, a physician-network that generates data for the U.S. News Best Hospitals rankings.
Tangney said many of the top digital health companies are more than willing to hire new grads straight out of medical school, who lack years of clinical experience.
Dropout doctors are well-positioned, he added, for a career in digital health as they have an insider’s view of the industry — and ideas about how to fix it.
As Sean Duffy, the CEO of Omada Health and a Harvard medical school dropout put it: "I wanted to understand what's in the trenches, so I could redefine the trenches." Omada Health offers an online program to help people change their behavior and avoid the onset of diabetes.
Duffy is part of a private Facebook group called "dropout doctors," which includes some of the biggest names in digital health. It functions as a support group, of sorts, and meets every few months for dinner or drinks. Some members, like Angelotti, said they find solace in the group as it can be difficult and lonely to opt out of clinical medicine and follow a different path.
The membership includes Angelotti, who now works at primary care chain One Medical; Duffy, CEO of Omada Health; Connie Chen, the cofounder of Vida Health; Shaundra Eichstadt, medical director at Grand Rounds; Abhas Gupta, a health-focused venture capitalist with the firm Mohr Davidow; Molly Maloof, a medical advisor to DoctorBase; and Rebecca Coelius, the director of health at Code for America.
'I Never Thought I Would Leave Medicine'
Experts say it's both 'push and pull' effect that is motivating young doctors to seek out opportunities with the growing intersection of technology and health care, rather than pursue brick and mortar medicine.
Many of the students at the top Bay Area medical schools, Stanford and UCSF, are exposed to entrepreneurial thinking during the course of their education, which can be a major draw.
"I never thought I would leave medicine," said Eichstadt, who now works at Grand Rounds Health, a San Francisco-based startup that helps patients access second opinions from top medical experts online. "But there's such a rich opportunity at companies here."
Eichstadt graduated from Stanford and pursued several years of residency, specializing in plastic and reconstructive surgery.
"I realized that the system isn't designed for doctors to make the real change you would like to for the patient," she said. Eichstadt said she believed that she could make a bigger impact elsewhere.
Many of the dropout docs expressed a desire to improve the doctor-patient experience. In interviews with KQED, several said they spent very little time administering care during medical school, and they felt that patients were too often kept out of the loop.
A recent study found that doctors-in-training spend an average of just eight minutes with each patient. This is a drastic decrease from previous generations and is linked to more record-keeping requirements and restricted on-duty hours.
Connie Chen still practices medicine a half-day each week. But shortly after medical school, Chen co-founded an app called Vida, which connects people with chronic diseases to virtual health coaches, like nutritionists and nurses.
Chen said she learned very little about nutrition at medical school. But digital health opened up opportunities for Chen to educate herself about wellness, so she can help patients stay healthy.
"Traditional health care is really oriented to make the life of the provider easier," she said. "Your patients cycle in and out of the hospital, and very often, no one makes enough of an effort to communicate with them."
Lack of Opportunities
Other dropout docs said they felt pushed out of medicine, due to the lack of career opportunities or earning potential. Family practitioners, who serve at the front lines of health care, are paid the least.
Recent studies have also shown rising levels of discontent among primary care doctors. Nearly half of 7,200 doctors who responded to a Mayo Clinic survey in 2012 said they felt a lack of enthusiasm about medicine or cynicism about it. A decade ago, one quarter of doctors reported feeling burnt out.
"I loved working with patients but I looked around me and realized that I didn't want the jobs of anybody who had 'succeeded' as a clinician," said Rebecca Coelius, who graduated with an MD from UCSF.
Coelius now advises a number of health-tech startups, including Doximity and previously worked for HealthLoop, which was founded by another entrepreneurial MD, Dr. Jordan Shlain. She's also worked for the government as a medical innovation officer.
"Tech culture is very appealing when juxtaposed against the hierarchy and myriad hoops to be jumped through in clinical medicine," she explained.
Correction: An earlier version of this article contained data from Doximity on the percentage of Stanford and UCSF medical students applying to residency programs. Doximity says it failed to factor in medical school graduates who pursue further post-graduate studies and that the Stanford information it provided was inaccurate. Stanford officials say Stanford has a 95 percent rate of medical students pursuing residency after graduation.