These are challenging times for any medical professional hoping to impact public health, let alone one facing a budget crisis, radical changes to Medicaid and the implementation of the first phase of health care reform. Yet the first thing you notice when speaking to Nirav R. Shah, M.D., M.P.H., New York’s 15th Commissioner of Health, is just how excited he is about tackling the state’s health issues. “We are at a particular time of crisis,” Shah acknowledges, “but I’ve spent nearly two decades learning to understand population health, how to translate research into quality care and practice medicine with a patient-centered perspective. I’ve been preparing to solve problems like these for a very long time.”
His confidence is the natural outgrowth of a brilliant career shaped, in part, by exposure to legendary mentors and exceptional opportunities to explore the best ways to conduct research and provide health care. Most recently an internist at New York’s Bellevue Hospital Center, Shah, a former Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholar (2007-2010), Clinical Scholar (2001-2003) and RWJF Health e-Technologies Initiative grantee (2004), explains that he is tremendously grateful for the lessons learned not only from leaders in his field, but also from his patients.
“I’ve watched my patients struggle to stay healthy while facing unemployment, poor nutrition and poverty,” Shah said. “Working at Bellevue, I developed a special interest in the effects that limited resources have on the health of the poor.” In addition to his work in Bellevue’s urban setting, Shah studied the health care needs of Pennsylvania’s rural, elderly residents as an associate investigator at the Geisinger Center for Health Research. Combining these experiences has given Shah a set of skills well-suited to meeting the health needs of the people of New York state.
Hard Work, Careful Guidance and Good Fortune
Shah, who at 38 is the youngest person and first Indian-American to hold the health commissioner position, is the beneficiary of a rich cultural heritage, an “idyllic upstate childhood,” and what he refers to as “a type of success that can only come from standing on the shoulders of giants.” From medical school, through his early academic career and RWJF fellowships, Shah generously credits his vast understanding of how to turn research findings into applicable, effective health policy to the guidance provided by his many mentors.
“First there was Tom Chalmers, M.D.,” my mentor at Harvard,” Shah recalled. “He was the father of meta-analysis and he got me hooked on research. He taught me all that he could about the structure and value of randomized controlled trials. He also encouraged me to continue my studies at Yale, where I worked with Alvan R. Feinstein, M.D., and one of my RWJF mentors, Ralph Horwitz, M.D. They were experts and pioneers in the design of observational studies. I learned the two extremes of medical research from the best in each field,” said Shah, who eventually published, along with Horwitz, “Randomized Controlled Trials, Observational Studies and the Hierarchy of Research Designs,” in the June 2000 issue of the New England Journal of Medicine. The study found that less costly observational studies could be structured to produce results as useful as randomized controlled trials.
“From the bow-tied atmosphere at Yale, I went on to become a Clinical Scholar at the University of California at Los Angeles where I learned new things from Bob Brook, M.D., Sc.D., a professor and the director of the Clinical Scholars program,” Shah said. “There, you could show up in shorts and sandals if you wanted to and in some ways, I think that contributed to our creativity and helped us to develop cutting-edge projects. That’s where I really learned how to translate research into meaningful, relevant policy and also appreciate and learn from the perspectives of multiple stakeholders.”
“I have been tremendously fortunate because I have had phenomenal mentors at every stage of my career, including Hal Sox, M.D., who was so helpful to me during my term as a Physician Faculty Scholar,” Shah said.
“My first large grant was an RWJF Health e-Technologies award. That study allowed me to investigate the best ways to reach out to patients with chronic diseases in their homes,” said Shah. His more recent work as a Physician Faculty Scholar was, “Outpatient Cardiovascular Guidelines Applied in Practice (GAP),” a study exploring the effective delivery of care for cardiovascular disease, using automated guideline-driven care.
As an outgrowth of these projects and many others, Shah is now considered a leader in the use of electronic health records to improve the efficiency of care, developing and implementing programs to help health care systems transition to lower-cost, patient-centered care.
Protecting New York’s Health
“Working with the Robert Wood Johnson Foundation’s priorities and focus helped to give me a deep understanding of the problems society faces: access to care, the need to increase coverage, meeting the needs of patients with chronic diseases—things that the Foundation cares deeply about,” Shah said. “That experience helped me craft my vision for New York state. As commissioner, I intend to focus on improving quality of care, safety, access and prevention for the state’s residents.”
“I want to encourage our hospitals—through policy—to move toward greater community engagement and a whole-patient approach to care. I also hope to achieve a more efficient and cost-effective Medicaid system, working with the Governor’s Medicaid Redesign Team, but accomplish that while preserving and improving care for our most vulnerable citizens,” Shah added. An expert in the use of systems-based methods of improving patient outcomes, Shah is also aware of the potential trials ahead. In his first speech to the state, he spoke of our “rapidly changing health system, frustrated providers and patients and the state’s crumbling public health infrastructure.” But he sees a solution: “I truly believe we have the knowledge, minds and ideas we need to reshape our system,” Shah said, “without ever losing sight of our responsibility to the patients we serve.”
Of his years with the Foundation, Shah added, the “Robert Wood Johnson Foundation’s Human Capital Portfolio is one of the best investments they’ve ever made because there’s no other model for training the next generation of health leaders in every area—nurses, physicians and patient care workers. The Foundation has really helped me become who I am today and I look forward to working with them to make sure they can continue this work in the future.”
The Robert Wood Johnson Foundation Physician Faculty Scholars program provides research opportunities for junior physician faculty members through mentoring, protected time, networking and the opportunity to gain valuable research experience. The program produces academic leaders who are creative and well-positioned to improve the nation’s health and health care. The Robert Wood Johnson Foundation Clinical Scholars program advances the development of physicians who are leaders in transforming health care through positions in academic medicine, public health and other roles. Both programs are part of RWJF’s Human Capital Portfolio.