Our childhood defines us in some ways. There
are things we learned from our childhood that
we keep with us, and there are things that we
have to unlearn and let go of. Talk to me about
your childhood. What are some things you have
kept with you and what are some things you've
had to let go of? Gosh, that's a great question.
And maybe a little bit of background about my
childhood or where I grew up. So I was born and
raised in San Francisco. like truly in San Francisco
proper. And I'm the son of an immigrant family.
My parents actually immigrated from Burma, now
known as Myanmar, but from a Chinese culture.
And so I lived with my parents. I lived with
my two brothers and sisters and my grandparents.
So in some respects, we had a sort of a traditional
Chinese family that was always sort of proper,
I'll say. You have to wait your turn, you have
to exercise your manners to the highest degree,
always respect your elders, and be in place.
And I would say that those aren't bad things,
of course. You want to be respectful. You want
to honor the wisdom of people who have more experience
than you. And at the same time, I think that
some of that feels a bit restrictive, right?
Because you always have to do things in sequence,
wait your turn. be confined to some of those
roles. But thinking about where I am today, if
I had not branched out or reached out or done
things outside of the box, I would not have had
the great experience that I've been able to experience
throughout my career in enjoying the ability
to express my creativity and my innovation and
making the impact that I feel like I would have
otherwise not been able to make if I sort of
stayed confined within sort of I feel like a
box that a traditional Chinese family might put
myself in. So that's some of what I think about
in response to your question there. And I'm happy
to expand if that's something we want to take
take down the road here. If you go back to, say,
your 20, 25 year old self when you were starting
med school, what did you think your career trajectory
would look like? And how has it differed in reality?
Oh, gosh. Back then, you know, when you're when
you're early 20s, you think you know everything
already. Because, gosh, two decades on this planet,
gosh, you know everything. You know where your
career is going to go. You know what your family
is going to look like. And there are so many
twists and turns that have come up along the
way that the vision that I had when I was 20
is actually quite different than what's actually
happened in reality. And quite honestly, I wouldn't
change a thing. But back then, I was thinking,
I'm gonna go to med school. I'm going to specialize
in internal medicine, which I did. I'm gonna
be a primary care physician, which I have been.
And that's what I was gonna do for my entire
career. I was really interested in having that
sort of longitudinal care that primary care physicians
get to have with their patients. um, to be expert
in a lot of different conditions, the broad breadth
of what internal medicine has to offer. Um, and
I've really enjoyed doing that part of medicine.
Um, and I've done that for, for many years actually,
but along the way, I was blessed with the opportunity
to expand outside of that. Um, and you know,
one thing that happened early in my career, after
I finished residency was that my medical group
deployed EPIC, the electronic health record,
one year into my practice, which was, I would
say, life -changing in many ways and life -changing
for a lot of people because, of course, you're
no longer docking on paper. You're putting everything
in the electronic health record now. But it was
not long after that happened where the inefficiencies
of dealing with electronic health record became
very apparent. Don't get me wrong, I would never
go back to paper. There's so many advantages
of having things in electronic format that we
would never go back. I would never go back. And
the quality of care that we deliver now is so
much better because of that. But as we all know,
working within an EHR, all the clicks, all the
keystrokes, all the different screens and all
the administrative tasks that we're dealing with
now, they became into play when the EHR was introduced.
And so I saw opportunities early on after the
deployment of the EHR around being able to improve
the efficiency of which I was operating within
the EHR and to help my colleagues who were equally
struggling with getting through their day. Not
only were they now faced with having to provide
excellent care to their patients, they had to
figure out, well, how do I get this ordered in
the system? How do I place this referral? How
do I do any of these electronic tasks now that
are in there in a quick way so that I'm not spending
twice as much time in front of the computer as
I am, you know. in front of a patient. So along
the path, I got to program tools into the system
that improved our efficiency, that made us get
through our day more quickly. I developed a program
that went viral across my medical group very
quickly, actually. And it's still actually used
today. within the Kaiser Permanente where I was
practicing in the past. And that was sort of
my foray into creating technologies or leveraging
existing technologies to integrate into the practice
that allows us to get through our day more quickly
with as little friction as possible. So, you
know, it's been very fulfilling but at the same
time, gosh, there's just so much more that can
be done that I can see. And that's some of the
work that I'm still doing now, even though I'm
no longer with the current microgroups I'm at.
I'm still doing work in technology, technology
integration within healthcare. This transition
from clinical medicine to physician, innovator,
entrepreneur, and leader, was it? You following
your natural curiosity at that point or was it
something more planned? And something you had
to train yourself to excel in I Would say it
was not planned You know, there are some people
out there. I think that have a grand master plan
You know the the moment they were born or the
moment they went to high school or college or
med school wherever and they have a grand vision
of this is where I need to be, this is where
I want to be. Things for me kind of happened
organically and naturally over a period of many
years. And I have to give thanks to the many
mentors that I had along the way who saw potential
in me, who pushed me, who gave me opportunities
to do things that they felt I could do that I
even know I could do myself and helped me develop
and help me grow into having those abilities
to be able to do more than just clinical care.
Now, I kind of hate to say that because just
clinical care, oh my gosh, it's such a noble,
important thing to do. And at the same time,
There are other things that can be done to help
at a larger level, at a larger scale, which I've
been fortunate enough to have those opportunities
to do along the way. I would say it wasn't necessarily
kind of, I wasn't born with that. It wasn't innate
in me, but I learned that through the practice
of what I was doing. educational courses that
I attended, and of course the mentors that I
had along the way who helped educate me, teach
me, and build on what I had I think as the foundational
aspects of what I could accomplish to where I
have come today. For the physicians listening,
A lot of them would like to cut back on clinical
medicine and expand their scope in non -clinical
sidekicks. What's stopping them is the immediate
loss in income that you often see. What advice
do you have to those physicians, and what made
you take this leap into non -clinical medicine
and be okay with the short -term loss in income?
Yeah. Well, my leap into non -clinical medicines,
like I mentioned, could happen over a long period
of time. I started as a ten -tenths primary care
physician, did that for a number of years, and
over time, say, went from nine -tenths to eight
-tenths to five -tenths, and so on. And I'll
say that it was always important to me to continue
to practice medicine because it was always, that
was my goal coming out of medical school, to
be a doctor. And even now, I still see patients
because it's such a fulfilling part of what I
do during my week, during my month, during the
years. And it's such an important part of what
I do in my non -clinical. because being able
to see patients and understand the challenges
and the joys of clinical care allows me to have
a better understanding of how to shape the technology
that I'm working on that is helping hundreds,
tens of thousands, and hopefully hundreds of
thousands, even millions of other clinicians
out there eventually to be able to sustain their
practice, to continue to build on their clinical
careers. You didn't ask this question, but I'm
going to opine a little bit here around why are
people looking for side gigs and trying to get
out of clinical medicine? And I think it's because
clinical medicine is so hard. And it's hard for
a number of reasons. It's hard because the demands
of knowing all this information and trying to
apply it to the best care delivery they can to
the patients they're taking care of, it takes
a toll. And that's why I actually am so enthusiastic
about technology and artificial intelligence,
because those are things that can help offload
the cognitive burden of clinical medicine aspects.
But on top of that, of having to deal with the
clinical aspects, there's these whole administrative
aspects that clinicians have to deal with, which
when I was in med school, I didn't think about
that. I didn't think about prior authorizations
and clinical documentation and all the notes
that we have to, things like that. I didn't think
about that, but they're very readily apparent
in today's clinical world that there are so many
administrative burdens placed on clinicians that
I think that's one of the reasons why they're
very willing to try to give up some of their
clinical time, even though it is as rewarding
as it is to find things outside of clinical medicine.
So advice that I would give, well, be true to
why you're wanting to venture outside of clinical
care. Because if it's to make money, as you just
mentioned, there are probably better ways to
do that. Or at least short -term because being
a doctor, being a clinician has its financial
rewards as well. But if you're not true to yourself
and you aren't following your passions, what
you stand for, what you believe in, it's going
to make it that much more challenging. And for
me, as I sort of decrease the amount of time
I spent at the clinic, I felt like there was
a a higher calling, a higher level of responsibility
that I could have to have an even bigger impact
aside from the individual patient that I was
seeing within the office. And so putting that
all together has continued to drive me to do
the work that I do to have a larger impact across
healthcare, across society. Another thing that
physicians struggle with I think it's balancing
finances, retirement planning, and lifestyle
creep, especially as we get into our late 30s,
40s. How do you think about these things when
you make career decisions? And what is your general
outlook on financial planning as a physician?
Yeah, you know, I think it's hard to generalize
because everyone's different in terms of their
income earning potential, as well as what their
lifestyle is. And if I, you know, it's funny,
I talked to my wife this time, for good or bad,
our lifestyle is fairly similar to when we first
met in residency and we were working on a residency
salary. compared to when we both became practicing
physicians and had a much higher salary to live
off of. And even at that, having had two kids
now, we still live a fairly modest life. I mean,
you know, we take our vacations, you know, and
we like to enjoy the time we have with each other,
you know, things like that, of course. And so
for me, the financial aspects of it are obviously
important. You know, we had to pay off school
loans and, you know, we still need to take care
of two kids and plan for their futures as well.
But thankfully, because our lifestyles aren't
necessarily extravagant, we're able to get by
with what we've been doing. Now, I think it's
absolutely critical, though, to do financial
planning, because again, everyone's different.
And if you have certain things that you want
to accomplish in life, you want to do goals that
you have, and they're expensive. you have to
think about what you're going to do with your
work and your earning potential. And I think
of where I went in terms of my career, or if
I had just stuck with being a primary care physician
and my decision to go into primary care, if I
had larger loans that I had to pay off, in deciding
which residency to go into, which specialty to
go into, I may have picked a completely different
path. I may have tried to go into orthopedic
surgery or become a cardiologist, some procedurally
based specialty that pays more than a primary
care physician. But thankfully, I was able to
balance the finances of it. and my interests
and my passions to pursue a career where I thought
would be professionally satisfying. And that's,
again, how I ended up in primary care. So it's
a tough question because everyone's different,
everyone has different goals, and the situation
varies from person to person. How do you think
about balancing your personal life and your career
life? Specifically with kids as well and there's
something I've learned with kids is you can't
be more Efficient at parenting because what kids
want is your time And you know, you can't spend
time You know, you can't spend ten minutes with
them in a better manner they need more of your
time every day, ideally. So how do you think
about balancing your personal and career life
and where does happiness lie for you on that
spectrum? Wow. So you're right. I mean, kids,
family, those are first and foremost the top
of my priority. You know, talking about sort
of traditional Chinese family. It was always
family and health. Those are the two sort of
untouchables. We always talked about that. And
then it was like, well, how are you going to
make a living? So that was secondary. And I think
as you asked earlier, what have you carried into
sort of adulthood and into your career? Those
are things that I think about. And the things
that allow me to find balance in my career and
in my family life is having variety, I think,
is one of the biggest things. Having variety
and having challenges. Because let's talk about
variety here. I mean, doing the same thing over
and over, I think it'll be easy to get bored.
And if you want to do something for the long
haul, for an entire career, for your entire life,
having that variety is, I think, one of the most
important things to keep in mind. And I think
that's one of the things and one of the reasons
that I kind of took the leap of faith of leaving
my practice of what I had for 20 years to do
something different, to join an AI startup company,
to work at a medical school, and to still maintain
some clinical practice is that within my work
life, I've got a variety of things that I get
to work on that I feel like I'm having a positive
impact on, either at an individual level, at
a larger organizational level or the future lives
of physicians or students who are training to
be physicians. I always believe that if you're
doing something fun and exciting at work, it
often doesn't feel like work. It's just that's
what you're doing during your day. And I feel
like a lot of that is what I get to do during
my professional time. But in terms of my family
time, my time away from work, I've got two kids.
They're both teenagers now. And you talked about
time and spending time with them. And as I think
about my daughter, who's 16, a junior in high
school, my gosh, it's going to be like a year
and a half before she's off to college. And the
time that I get to see her every day and get
to spend time with her and talk to her every
day and to see her continue to grow into adulthood,
that time is shrinking. It's sad to see, but
also so exciting to have her be able to develop
into her own and explore her own future. So just
trying to cherish every moment that I have. with
my 16 -year -old daughter, 13 -year -old son,
with my wife, at home, traveling, experiencing
different cultures, forming those core memories
that hopefully they're going to remember the
rest of their lives, where they took that trip
with mom and dad, and they can tell their grandkids
or great grandkids about, and just sort of...
building that legacy for the future. Those are
the things that I think about. I'm jealous of
you and correct me if I'm wrong, but it sounds
like your natural inclination is family, health,
and then career. My natural inclination is career,
family, and then health. And that's caused quite
a bit of grief and a few episodes of burnout
in my life. And I'm working really hard to change
the order of that, too, as you said, family,
health, and then career. I guess my question
is, what piece of advice do you have for me?
And people like me, and the people in the startup
ecosystem are often like this. And as an investor,
I look for founders, and maybe I shouldn't, who
put their startup above all. So what advice do
you have for me? And is that your natural inclination?
Or have you had periods in your time where, and
I'm sure you have, where your career asked you
to compromise your family or your health, or
you had opportunities which may lead to financial
freedom in three, four years? but they would
come at a cost of family and health. And how
do you think about these things? Yeah. So you're
spot on and very observant about what I feel
like my priorities are. And, you know, I don't
think these are necessarily fixed in place at
all times, just as you mentioned, because there
have been times where I've had to prioritize
my career so that I could take care of my family.
There are times that my health unfortunately
has suffered because either I didn't get enough
exercise, my diet was terrible, I just didn't
have enough time for sleep because I was focusing
on the career aspects and making sure that that
piece was successful. And I'm not gonna say that
someone who prioritizes and has their career
at the top, and then career, family, and health
in that order is wrong. I don't think it's wrong.
I think it depends on... I think it's wrong.
You think it's wrong? Okay. Yeah, go ahead. I
think it's where you are in your life and where
you sit and what your perspectives are, and I
think people can have different perspectives,
and I think it can be right. But the way I see
it is this. If you don't have your health, And
maybe I'm making a case for health being on top,
but if you don't have your health, you're gonna
have a much harder time taking care of your family.
And if you don't have your health, you're not
gonna be optimally performing at your job. And
over the past several years, I've been very interested
in lifestyle medicine and thinking about how
physical activity, diet and nutrition, stress
reduction, sleep, avoiding unhealthy substances
and social interconnectedness, those pillars
of lifestyle medicine play into family and work.
And so I recently became board certified in in
lifestyle medicine because I have such a strong
interest in it and want to apply that to my own
health and my own family, but also impart those
principles to the patients that I see and the
people that I work with. And so if you don't
have your health, it just makes it more difficult
to do those other pieces that we talked about.
And the family aspect, I've had disagreements,
fights with my immediate family. I think all
families do. And I remember a time where I was
probably in my early 20s and I had a big argument
with my brother. I've got two brothers, one sister.
And I didn't talk to that brother for months.
And my mom, she's like, well, you know what?
He's your family. You're not going to build other
brothers. She was done with having kids. She
wasn't going to have any more brothers for me.
And your family is your family. And when it comes
down to it, at least within our culture and our
family, there's no one that's going to have your
back like your family. There's no one that's
going to be there who's going to support you
in your time of need. And there's no one going
to be that is in tune with who you are, how you
grew up, the culture that you are part of to
be able to to have that level of support that
others may try to give you. So I feel like that's
why the family aspect is such an important piece
of sort of that layering that we talked about
here. Let's talk a bit more about lifestyle medicine.
And, you know, lifestyle medicine and longevity
medicine, they both still have somewhat of a
bad rep in the academic and the clinical world,
although I find it is changing slowly. What are
some biomarkers that you thought were, you know,
fufu, and when you did lifestyle medicine training,
you've kind of changed your mind on? and you
know maybe you'll surprise me and say cortisol
levels but talk to me about because this is something
I'm interested in as well and I think a lot of
physicians are starting to get interested in
there's a big push towards hormone balancing
And you know, like if you're testosterone, and
I'm used to the older scale is nine, which is
within the normal range, like if you want it
to be 1450, and you feel better, that's fine.
But if you push it beyond the normal ranges,
and then we can get into you know, well, how
do the normal ranges exist? Is it based on a
specific Western white male population? And does
that apply? Like as a normal range of testosterone
different for a different population at different
age groups and um, you know, we just don't have
the data for a lot of these things or maybe We
do and i'm stuck in my med school Days or residency
days. So talk to me about lifestyle medicine.
What are some Some things you've um changed your
mind on um by learning more and training in lifestyle
medicine Yeah, um, so I mean I know you asked
about sort of biomarkers and hormone levels and
things like that and you know, when I think about
lifestyle medicine, I don't, honestly, I don't
think as much in terms of those terms as what
I'm about to say that I think of in the terms
that I consider lifestyle medicine. And some
of the bad rap I think that you hear about or
you think about that's out there is like, oh,
it's just about, you know, eating plants and
vegetables. You know, and it's about being Zen
and just sort of disconnecting from all the evils
of society. I'll just throw that out there. But
there's real evidence around being able to use
lifestyle medicine to treat diseases, to prevent
diseases, and to reverse diseases. And so what
we're talking about here are things like chronic
diseases in general, obesity, diabetes, hypertension,
heart disease, cancer, dementia, all those things,
all those conditions, if we were able to fully
realize the potential of lifestyle medicine,
we could likely eliminate 80 % of those chronic
conditions. We could save millions of lives,
really, by practicing those pillars of lifestyle
medicine. And there is real data. Like you think
about studies in New England Journal of Medicine,
animals internal medicine, JAMA, different things
like that. There's real studies that have been
done to show that I'm not I'm not just speaking
fluff here. There are peer -reviewed journals
that have shown the benefits of lifestyle medicine
here. And so if we could impart even some of
these principles to more of what we do in the
care of our patients, I think we'd be so much
better off. And I'm not also not saying we don't
need medicine and we don't need procedures and
you know that's definitely not the case. Putting
those things in place and complementary with
you know and then looking at the patient in a
holistic manner we need all of that to take care
of patients because despite our best efforts
We're going to need medicine. We're going to
need procedures to help treat and protect our
patients. One thing I've noticed anecdotally,
I've been prescribing with a lot of us, a decent
amount of GOP1, Ozempic, Manjaro, Wigovy. is
sarcopenia. And for those listening who are not
medical, sarcopenia is this phenomena of muscle
loss or loss of muscle mass as we get older.
And it's been shown to be linked with mortality,
morbidity, dementia, and muscle mass is very
important, especially as you get into your 80s
and 90s and maybe even 70s. What are your thoughts
on And, you know, I'm asking this more as a personal
thought because I think the evidence is still
kind of out there of GLP -1 inhibitors. Are they
the lifesaver that we think they are? Or are
we going to get more data? And do you think it
will kind of fizzle out? Gosh at the trajectory
that it's been going in it's hard to imagine
it fizzling out At the rate that we're going
at right now with all the benefits that we are
seeing with the GOP ones So much chronic disease
out there is related to obesity and being overweight
And that's why I'm a believer of lifestyle medicine
too. I know it's it's it's you know, perhaps
not as easy as, you know, prescribing a pill
or prescribing an injection to help lose weight,
but as patients do lose weight, you know, the
diabetes disappears, the hypertension disappears,
and we know what those conditions can lead to
down the road after years and years of having
that, or even not even that long of having those
type of conditions. So I'm very much encouraged
by what the GOP1s have been able to do. And sometimes
we just, you know, the shortages that are seemingly
easing up, but the cost is still very high. And
so I worry a little about sort of the equitable
distribution of these type of medications that
we can apply to our populations. With that said,
too, sort of the beautiful thing of medicine
and academic medicine is that we are constantly
learning. And the longer we use these type of
medications, the more patients who are out there
who have been exposed to them for a longer period
of time, we'll learn more. There are potential
side effects, as you know, of course, to these
medications. And we'll find out potentially more
side effects as the years pass. I like to bring
up the example of FenFen. We thought it was such
a great treatment for weight loss but it was
shown to you know cause valvular issues with
the heart and then so we you know we obviously
no longer use that combination of medication
but hopefully the GOP1s are not going to have
that fen -phen moment and continue to prove to
be safe and effective and life -changing in many
respects. And talking about equity and medical
treatment and care being equitable, and excellent
medical care being ubiquitous and equitable worldwide,
it seems like one of the costs of medical care
that's been targeted is us as physicians and
our salaries, which is entwined with our length
of training. With the rise of NPs, it seems like
there's a growing sentiment that maybe we're
overtrained, overpaid. And with AI now and AI
agents, there is also a growing trend that physicians
should be replaced. So I'll ask a two -part question.
What do you think is the role of physicians the
next five to 10 years? And the second part is,
if AI can replace us with the same accuracy for
treatment and diagnoses, should it? Wow. That's
going to be probably a billion dollar question
here with respect to that. And the role of physicians
over the next five years, I don't see the role
of physicians. We're all I will as a physician
maybe I'm biased but I think that we're always
going to need physicians someone that has additional
expert training in being able to Understand the
disease processes and to be able to treat patients
Can a computer do that Yes to degree but can
the computer develop the empathy and understanding
and sort of put in and compute aspects of a patient's
situation that a human could do. I don't think
you can do that at this point here, right? What
if it can fake empathy? Is there a difference
from the patient perspective if they can't tell?
if the empathy is fake or real. Because our perception
of reality is reality. And objective reality
is hard to discern. Yeah. It's a good question.
Because you're probably aware of the studies
that have been done, too, around where some patients
felt like the chatbot was more empathetic than
the human physician. And so I think there's more
to learn. um around there and um part part of
I think that um the mission is some of the empathy
that I think human physicians uh want to provide
and can provide is based on some of the time
constraints that um we're faced with some of
the burnout issues that we all have and if we
were able to use technology to offload some of
those things that we, again, we don't have to
do. I think the burnout will be better, the time
screens will be improved. And I don't know, maybe
I'm being a little old school here in thinking
that we're still gonna need physicians. I really
believe we are. Even as technology advances,
as AI agents are out there looking at all this
data, processing all of it, going out and doing
tasks for us, and then bringing things back.
I think when it's brought back, I really do believe
there needs to be that human in the loop that
we talk about, that needs to have that trained
clinician with years of experience who went through
medical school, who have seen you know a patient
in the past that reminded them this is what we
need to look out for or this we need to take
into consideration as we're treating this patient
in front of me here and and taking that say AI
agent recommendation and applying it as it has
come back or tweaking it because you know this
patient and you've treated this patient for 20
years and and understand what their goals are,
their beliefs are, and how they would want to
be treated as a patient, which I think is hard
to plug into a computer algorithm and to be able
to put that all together. If your 16 -year -old
daughter came to you today and said, Dad, I want
to be a primary care physician, what would you
tell her? I would say follow your dreams. And
in fact, she has told my wife and I that she
wants to be a doctor. She's 16. She's got time
to think through whether that's the right choice
for her. But I would love to support her in that
decision, because I have had an amazing, fulfilling
career being a primary care physician. I know
that's not always the case. And I know there
are a lot of doctors out there who said who would
say don't go into primary care and don't become
a physician. But I think it's such a. You know,
you can give so much and you can get so much
back. And you're you've got so much opportunity
that you can. being a primary care physician,
like where I went with my career, being able
to see patients, being able to integrate other
interests around things like lifestyle medicine
and technology into my practice and into the
work that I do, and being able to affect patients
on an individual level or at a population level.
And having that impact, and as I reflect on the
career that I've had, um it's it's been so gratifying
and if she wants to do that um whether it's a
small part of that or a large part of that uh
i would fully support her i'm mindful of the
time do you have time for one more question yeah
yeah sure If your 30 year old self saw where
you were at from a career perspective today What
would they think and where do you see yourself
in 10 years from now? My 30 year old self um
You know I I I mentioned earlier that I you know
someone in my 20s or 30s a they wouldn't know
what was coming or what would have happened here
today. I think they would have been impressed.
Like, gosh, you thought you were going to be
on this particular career path, but you got to
do so much more, experience so much more effect
and have that impact that I would have never
imagined. And so I feel like I am so fortunate,
so privileged to have been able to go through
what I've been able to, and to affect the lives
that I've been able to make the people healthier,
people happier, people be able to get through
their day better. And where do you see yourself
in 10 years? Gosh, I've been really enjoying
what I'm doing now. It's hard to imagine doing
something different than I'm doing now. But,
you know, I'm basically mid to getting to the
latter part of my career. And as long as I'm
having fun and feel like I'm making an impact,
I'm going to keep on doing what I'm doing. Thank
you so much for joining me today. This has been
a little bit of a therapy session for me as well,
so thanks for doing that. Me too. Yeah, this
has been amazing. Thanks, Ed. Thanks so much
for having me. I appreciate it.