A Shout Out to Adam Singer, Physician Entrepreneur of the Year

Modern Physician just named Adam Singer, the founder of IPC-The Hospitalist Company, its first annual Physician Entrepreneur of the Year. Adam and I don’t always see eye to eye, but I want to congratulate him and highlight some of his contributions.

When the hospitalist field launched in the mid-1990s, Adam was there – I recall seeing him at virtually every hospitalist-related meeting during the early years. He struck me as a bit awkward – maybe a tad insecure – but he was brimming with passion and a near-religious fervor for the hospitalist concept. He had just started his company, whose business was to organize hospitalist programs and place them in hospitals, first in So Cal, and later in other regions. In essence, IPC was really the first “rent” (vs. buy) hospitalist solution, and it quickly found a market niche.

Adam’s vision was unique and deeply held. He frequently scolded me for what he called an overly traditional and “academic” view of what a “real hospitalist” should be. To his way of thinking, hospitalists should be relentless managers of the inpatient stay, less about traditional views of physicianship and more about driving teams and technology to make hospitalizations more efficient and increase adherence to practice standards.

The use of technology was critical to Adam’s ability to bring his vision to fruition. Adam had a fundamental problem to solve: he needed data to run his business, but getting information from all of his client hospitals was nearly impossible. As Adam once told me, “if I need to get clinical and billing data from each hospital, I’d be spending all my time in hospital IT meetings.” So he built IPC’s infrastructure around home-grown handheld devices that allowed his hospitalists to collect detailed patient data; the devices synced up with a central data repository daily. Not only did this give IPC the ability to measure and articulate their value to client hospitals, but it gave Adam – a self-described control freak – a detailed window into the daily practice of dozens, later hundreds, of his hospitalists without having to leave his North Hollywood office. I remember him demonstrating the system to me one day, including the tough, sometimes boorish notes he would tear off to those docs who seemed to be underperforming. It wasn’t my idea of an attractive management style, but one couldn’t doubt his commitment to his vision and his ability to disseminate this vision across an increasingly vast enterprise.

Perhaps most impressively, Adam focused like a laser on post-discharge care, well before it was fashionable. At a time when few saw the business case to do this, Adam developed a sophisticated (and expensive) system of post-discharge follow-up phone calls, aided by his handheld technology system. He found that, by calling every patient soon after discharge, his nurses were often able to troubleshoot and avoid unnecessary re-hospitalizations or harm. “All part of our value equation,” he told me when I asked him how he could afford to do this, and there was no doubt that it was a marketplace differentiator for IPC. Today, everybody is thinking about readmission rates and filling the post-discharge black hole. Adam was all over it a decade ago.

I’ve had my disagreements with Adam over the years, and continue to harbor concerns about some aspects of IPC’s clinical and business model. I also wondered whether he would suffer “Founder’s Syndrome” – he has the kind of high energy, confrontational personality that is perfect for the early, free-wheeling days of a start-up, but sometimes gets shoved aside when the company matures, replaced by a smoother consensus-builder. To Adam’s credit, that hasn’t happened, in part because he is a great judge of talent, bringing in others who have played Robert Gates to Adam’s Rumsfeld.

And you can’t argue with success. IPC’s net revenue now exceeds $200M/year. And last year his company became the first hospitalist enterprise to go public, earning he and his shareholders considerable wealth (which they have retained, despite the market conditions). Others will doubtless follow, but this event was external validation of Adam’s leadership and, more broadly, the hospitalist idea.

So hats off to Dr. Adam Singer, Physician Entrepreneur of the Year. Whatever one thinks of his unusual style, there is little doubt that Adam has been as responsible for the growth of the hospitalist field as anyone.

10 Responses to “A Shout Out to Adam Singer, Physician Entrepreneur of the Year”

  1. adam October 7, 2008 at 6:57 pm #

    Bob,

    Thank you for your congratulatory blog posting.

    I have a deep and on-going respect for what you did and do for the field of Hospitalist medicine. It is true that we disagree on what you describe as rent versus buy Hospitalist programs. I have a fundamental argument with anyone that feels a hospital should employ their physicians. This is especially true when the expressed reason for their desire to employ is to control. Doctors should not be under the control of anyone other than their own commitment to provide high quality care. To sell that idea even when the risk is minimal for less call duties and a higher base salary is something that I do not respect. IPC can and does support both programs through the use of our technology. It is not a matter of business but a matter of philosophy. In this regard I am not a “maverick”. (a nod to Sarah/Tina Fey) What I do is exactly the same as my father before me and the majority of physicians do in this country today. We take care of patients in private practice without the risk of influence from an exogenous party. In this way we are equal partners with the hospitals that we serve to design and manage the highest quality delivery system we can muster.

    It has been an honor to be even able to have a conversation with someone of your stature and influence. It is only through healthy and honest debate that we reach for better truths in life. I have survived the transition from passionate entrepreneur to public company CEO becoming secure rather than insecure, balanced rather than awkward, a teacher rather than a control freak, prudent rather than tough, respectful rather than boorish, inquisitive rather than confrontational and lastly unique rather than unusual.

    I look forward to a future with a better manner of care for our patients.

    Thanks,
    Adam Singer MD
    CEO IPC The Hospitalist Company

  2. docanon October 7, 2008 at 7:53 pm #

    Good lord. Forget damning with faint praise. Woe unto him who receives your next “shout out!”

  3. bev M.D. October 7, 2008 at 9:02 pm #

    Well I am not going to comment on the business model but it’s HIGH TIME someone with an M.D. took an interest in managing the patient’s hospitalization efficiently and increasing adherence to practice standards! Hospitalists have inherited this job by default since no one else was doing it. Not a good reflection on our system.

    retiredpath

  4. Doctor DAK October 14, 2008 at 6:35 am #

    I respect Dr. Singer as a pioneer and a visionary, but I don’t like his vision. I worked for IPC for two months and left for slightly greener pastures. I felt that the emphasis with IPC was more on the number of encounters than on quality care and physician well-being.

    I have worked for two other nationwide contract management companies. I have never had the sense that I or my patients received tremendous value from any of these entities.

    What do shareholders and venture capitalists bring to our table as hospitalists? As I see it, the pie is finite. Profit taken from our efforts means some combination of less time to have the life side of work-life balance and less time to give our patients what they need.

    Yes, some of that profit is invested in follow up call banks and web sites to help with billing and diagnostic coding. However, I found IPC’s web site to be slow and cumbersome, and their follow up process was anemic. On site administrative support was non-existent at a contract with 140 encounters a day. The quality of care delivered by our group was considered mediocre, and indeed that was the norm. Before I came to the site, Dr. Singer had bullied physicians and the hospital with threats of legal action if they formed their own group. If he is such a believer in his company and his product, why wouldn’t he welcome competition?

    I hope for a future where less of our health care dollar goes to overhead and profit for investors, and more goes to those of us in the trenches and our patients who are hungry for quality care and a caring presence at the bedside.

  5. medstudent October 15, 2008 at 1:47 am #

    Hi Dr. Wachter,

    Accidentally found your blog while searching “facebook.” I am a 3rd year med student at UCSF and recently finished my rotation in medicine at moffitt. :) Excellent blog, well-written and thoughtful. It’s funny, however, that I was most impressed by your use of the phrase, “shout out.”

    See you around UCSF,
    Stephanie

  6. hospitald October 15, 2008 at 2:43 am #

    Doctor DAK’s experience is unfortunate.Dr Singer has done some wonderful things in the field of Hospital Medicine. His Vision and IPC’s reputation may need some adjustment. IPC Doctors in our area focus more on encounters than the patients. It might be good for investors in the short run, but it certainly isn’t good for healthcare.Maybe that “Founder’s Syndrome” needs treatment. A name change may be in order. “IPC”… ” I Progress note for Cash”. Where did all the doctors go?

  7. DZA October 16, 2008 at 1:20 pm #

    “IPC”… ” I Progress note for Cash”.
    SNAP! (in the parlance of our times)

    “Where did all the doctors go?”

    All the doctors work for someone else; business people other than Dr Singer. As the mighty bob (dylan) says “you gotta serve somebody”. If you are lucky, and have (relatively) benign management, “it may be” the patient :)

  8. jfsucher October 17, 2008 at 12:17 pm #

    The hospitalist concept is in and of itself neither good nor bad. Like anything we do or any technology that is deployed, it can be implemented well or poorly. Having a physician group that is devoted to inpatient management with goals of improving quality of care and efficiency is a good thing. How to best implement this strategy AND accurately measure its effect is a whole different challenge. I suspect that there are some IPC groups that are better than others, just as there are some individual physicians that are better than others.

    Ultimately, what troubles me most is taking this company public. The biggest challenge with these healthcare entities moving into the public realm is that the market is focused on short-term successes. Money drives this entire equation, not quality. Some argue quality will equal success and translate into the money, but this is simply not true, especially when it is very difficult to define and collect what quality means. To me, having this company go public is akin to insurance companies (publicly traded). Does anyone believe that the insurance companies are driven by quality or bottom line money? Where do the billions of dollars find themselves in these entities? Haven’t we all been nauseated by the greed of many of these CEOs and their administrations?

    Dr. Singer, I am not saying that you, individually, are greedy or unethical. You clearly are a respected physician and leader. I personally believe in the need for good hospitalists. Physicians who are focused in the hospital can devote the time and attention needed for the acutely ill, versus trying to split time between the office and multiple hospitals (a task that in the 21st century is simply no longer feasible). I simply have reservations about healthcare entities that choose to grow via the public trading investment route.

  9. Bob Wachter June 13, 2009 at 3:55 am #

    Last week, Adam did a long (about 20 minutes) interview with Matthew Holt, who edits The Health Care Blog. It’s pretty interesting — he talks not only about hospitalists, but about medical training, the future of primary care, bundled payments, visa restrictions for internationally-trained docs, and more. As always, Adam is thoughtful and has strong opinions — many of which go against the grain but all of which bear hearing given his experience and unique vantage point. It’s worth a listen if you have a little time:

    http://www.thehealthcareblog.com/files/adam_singer.mp3

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