inventivemedicine

a
Can a hip, tech-
savvy 33-year-old
Brooklyn doctor
fix what ails
American health
care? Jay Parkin-
well-dressed young man son doesn’t see
with tousled hair recently why not.
struck up a conversation
BY MICHAEL WEINREB ’94 Com
with a barista at a Brook- PHOTOS BY NOAH KALINA
lyn coffee shop. The
barista had seen the man quite often in recent weeks, and she asked him what he did
for a living, and that was all it took, the man would say later, for him to sense an open-
ing. He said he was a doctor, and then he took it a step further: He asked the barista if
she had health benefits.
In this day and age, and given this woman’s job, Dr. Jay Parkinson figured the
answer was obvious. And he was right: She did not. In fact, it could be argued, given
the unconventional trajectory of his career to date, that Parkinson’s marketing
instincts may exceed his instincts in medicine. He has made his name by approaching
a conventional problem—the costly, inefficient, and impersonal monstrosity that is
modern American health care—in an unconventional way. This was why he asked the
question in the first place.
And this was why Parkinson ’02 MD Hershey returned later, during the barista’s
break, and personally laid out his methods and philosophy. He told her about his new
primary-care practice, Hello Health, which had recently opened a few blocks away, on
Berry Street in Williamsburg, next to a liquor store and several bars, in a district of
Brooklyn that has earned a reputation as the epicenter of New York’s young, culture-
obsessed “hipster” crowd. Parkinson told the barista that Hello Health charges a $35
monthly membership fee, and a flat fee for appointments: $100 for a simple visit, $150

March/April 2008 THE PENN STATER 37

 for issues of moderate complexity, and $200 for
more time-consuming issues. For a smaller fee—
as little as $50 in some cases—she could get con-
sultations by more unorthodox means, like
instant message, video, and e-mail (sending a
photo of a suspicious-looking mole, for
instance). She’d have access to cheaper generic
drugs and more affordable specialists. She could
make all of her appointments online, a rarity in
an industry where nearly all business is still done
on paper. And she didn’t need insurance,
because Hello Health doesn’t accept it.
Parkinson walked the barista through the
math, until he convinced her that he would take
care of her much more cheaply than any doctor
who subscribed to the traditional methods of the
American health-care system and insurance
industry ever could. For a young and relatively
healthy person, Parkinson argued, the cost of
monthly membership and one or two annual
consultations or visits is a fraction of what she’d
pay through an employer-offered health plan.
“Thirty-five dollars a month—that’s like four
hours she has to work,” Parkinson says, describ-
UNPRETENTIOUS: The Hello Health ing the encounter. (Yes, the barista signed up.)
storefront feels as much like a coffee
shop as a medical practice. “But we’re going to take care of her, because she
has problems.”
Here, laid bare, is the essence of Parkinson’s
enterprise: People have problems, and many of those people
are either unwilling or unable to pay for health insurance to
diagnose or remedy these problems. Because of that—because
he harbors such disdain for the methods of insurance compa-
nies, the frustrating limitations of their physician networks,
their seemingly arbitrary means of determining what will and
won’t be covered—and because he sees how rising costs (for
malpractice insurance, or for maintaining endless mountains
of paper records) have forced primary-care physicians to take
on an absurd number of patients just to maintain salaries in
the mid-to-high five figures—he has chosen to rebel.
In the past few years, Parkinson, 33, has been refining his
method of skirting the system, of integrating the Internet into
the practice of medicine and making a profit at the same time.
In September 2006, he started a one-man practice without
the expense of an actual brick-and-mortar office; he ran it
entirely through his iPhone and MacBook laptop, advising
and diagnosing patients by e-mail, text message, and video-
conference. He did not accept insurance. If a patient needed
medication, or an X-ray, he would comb the city for the
cheapest options, gradually building a network of empathetic
pharmacies and specialists along the way. If his per- with three years ago remain intact. A link on the prac-
sonal attention was required, he made house calls. tice’s Web site—hellohealth.com—reminds potential
Along the way, both because of his unusual approach patients that, “Once upon a time, going to your doctor
and his leonine good looks, Parkinson became some- was simple. Then things started to change … we now
thing of an online celebrity. He was profiled and inter- have to contend with … insurance premiums … deduct-
viewed in both newspapers and influential blogs, earn- ibles, HMOs, OTC drugs, specialists.” Hello Health,
ing himself several nicknames (including Dr. IM, as in goes the pitch, is the friendly neighborhood doctor you
“instant message,” and Dr. Skinny Pants, a reference to may or may not remember from your youth, only now
the retro-fashion trend among the hip- with an iPhone in that black bag.
ster crowds), as well as a great deal of Parkinson’s prac- For a doctor who was all about play-
attention, both wanted and unwanted. tice might only ing David to the Goliaths of the
At one point, the catty gossip Web site reach one corner health-care industry—he regularly
Gawker linked to the Flickr.com page rails against insurance companies, Big
of Brooklyn, but
for Parkinson’s amateur photography Pharma, and ineffectual government
hobby, which included a photo of the
his premise—less at blog.jayparkinsonmd.com—hook-
doctor, sans shirt. institutionalized, ing up with a private health-technol-
Parkinson claims to have “never more tech-savvy ogy company raised eyebrows. A med-
really thought of myself as part of that” health care—could ical trade magazine put him on the
hipster culture, but there was little apply to everyone. cover with the headline Jay Parkinson
doubt that his approach was targeted Sells Out? Parkinson would claim that
to such an audience—the young, the healthy, the urban what he has done is nothing like selling out. Myca, he
uninsured, many of whom rely heavily on the Internet says, is a privately funded company that acts essentially
to guide their decision-making. Targeting such a nar- as an R&D firm for his ideas; it has a team of software
row audience made him an easy target for naysayers; engineers working to improve the Web site and Hello
but then, don’t millions of Americans lack affordable Health’s ability to provide services outside the tradi-
health care? Hasn’t the new president made digitizing tional insurance-based system. But Parkinson insists
the nation’s medical records a pillar of his plans for that the creative concept remains very much his own.
health-care reform? Parkinson’s practice might only He says he is filling a niche, offering affordable health
reach this small corner of Brooklyn, but his premise— care to those who can’t get it any other way.
the benefit of a smarter, less institutionalized, more But he also recognizes that the people he’s marketing
tech-savvy approach to health care, for patients and himself to are looking for a different kind of experience
doctors alike—could apply to everyone. than what their parents or grandparents might expect.
Indeed, though Parkinson acquired about 300 The personal barriers between doctor and patient, the
patients in that first practice, he had always dreamed of gruff bedside manner, the hurried visits—those things
something bigger than a one-man medical practice. He don’t work with a generation that lives an increasing per-
figured he couldn’t change the entire health-care sys- centage of its life online and no longer sees inappropri-
tem, but maybe he could change a piece of it. He also ateness in blurring the line between personal and profes-
figured all the media attention would allow for further sional. This is why the doctors Parkinson has hired so far
opportunities. at Hello Health list their hobbies and favorite books on
Again, his entrepreneurial instincts were correct. the Web site alongside their bio. And it seems to have
worked: Parkinson claims one of the docs has gotten sev-
eral patients who requested him because he named The
Last May, Parkinson abandoned
that initial stab at an
individual practice and partnered with the Canadian
Big Lebowski as one of his top films.
This philosophy, one would assume, is also why Hello
Health’s first office (there are plans to open others in
firm Myca to launch Hello Health. He has an office different New York neighborhoods eventually) feels as
now, and shares the practice with three other doctors, much like another Williamsburg coffee shop as it does a
but the digital accessibility and anti-establishment phi- medical practice. It can be disconcerting to walk into a
losophy (not to mention marketing savvy) he started doctor’s office and immediately come face-to-face with
March/April 2009 THE PENN STATER 39

WEB SITE LITE: The unadorned, user-friendly vibe of Hello Health’s Web site
reflects Parkinson’s philosophy of health care.
an actual, real-life, practicing doctor, but this is part of
the ethos of Parkinson’s venture. It is a small and nar-
row space—this is New York, after all, where rents are
exorbitant—with varnished hardwood floors, black
cylindrical light fixtures, and exotic green plants sprout-
ing on tables. The music is left-of-the-dial FM rather
than the typical waiting-room AM. On a silver mantel-
piece, several stethoscopes dangle from hooks, and it is
difficult to tell whether this was done for practicality or
for artistic reasons. The doctors sit at circular desks a
few feet from the front door, and work on Apple laptops.
There is no need for administrative staff, in part because
Hello Health does not accept insurance (though they
will give patients with insurance the proper forms, so as
to submit their own claims), and because all payments
and appointments are made online.
“Check this out,” Parkinson says, and he leads me into
a partitioned room cluttered with computers and equip-
ment. He opens a cabinet, and inside is a veritable
bonanza of prescription drugs. This was a problem for
Parkinson when he practiced on his own; he often
40 THE PENN STATER March/April 2009
found himself trolling the city’s independent phar-
macies in search of the best deals on prescription
drugs for his patients. Now, he pays such rock-bot-
tom prices that he’s able to give out about 200 dif-
ferent medications for free when patients require
them. “You go to Walgreens, they’d charge you $40
for this,” he says, brandishing a bottle of amoxi-
cillin. “It’s collusion among the whole industry.”
It is these little victories, these subversions of the
mainstream—he is still working to broaden a net-
work of specialists who will provide competitively
priced care—that seem to give Parkinson the most
pride. He was educated within the system, but his
vision for reforming it came while serving a resi-
dency in preventive medicine at Johns Hopkins
after earning his medical degree at Penn State.
Parkinson’s master’s of public health program at
Hopkins included a yearlong stint with Public Citi-
zen, the consumer advocacy group founded by
Ralph Nader. Working for the organization’s
Health Research Group, Parkinson wrote to the
FDA urging “black-box” warnings or even outright
bans on high-risk medications.
“We’re really the only group in the country that
does full-time monitoring of the drug industry,”
says Dr. Sidney Wolfe, longtime director of the
Health Research Group. “The residents who come
here have a certain passion about changing things,
making things better. Jay did a very good job here. He’s
a very bright and interesting guy.”
After completing his master’s and a pediatric resi-
dency, Parkinson broke away and began his nontradi-
tional, house-call-based practice. By now, he has grown
accustomed to criticism from the medical establish-
ment, and he is unafraid to respond directly. It is not
unusual to find him going back and forth with his critics
in the online comments section of various articles writ-
ten about him. At times, his responses can seem defen-
sive and ego-driven, but in person, Parkinson exudes an
unmistakable charm—he sometimes softens his
strongest declarations with, “Y’know?”—that burnishes
his image as a different sort of doctor.
Still, he gets rankled at certain criticisms, like that of
Dennis Scanlon, a Penn State associate professor of
health policy and administration, who is one of many to
compare Parkinson’s practice to that of “boutique”
health-care providers—doctors who essentially hand-
pick patients, usually wealthy ones, who are willing and
able to pay for better health care. “He’s hitting a niche,”
Scanlon says. “There’s a need to address some of the
fundamental problems in the health-care system—
Dr. Jay’s faves
When he’s not decrying the inefficiencies and injustices of
transparency of price, transparency of quality, lack of
insurance companies and Big Pharma, Jay Parkinson uses
time spent with your doctor, being able to get your
his blog (blog.jayparkinsonmd.com) to promote online
questions answered. But it’s not feasible for that kind of
resources—for health care, and life in general—that share
model to work on a widespread basis.”
his user-friendly, avante-garde philosophy. In these sites
While Parkinson agrees that his model may be more
and others, Parkinson sees the seeds of a smarter, health-
of a Band-Aid than an overarching solution, he doesn’t
ier world. Here are some of his recent favorites. —MW
see a commonality between his practice and those bou-
tique practices that cater to the wealthy.
E-Patients: e-patients.net
“We’re not going after that stupid market,” he says. “I
An online clearinghouse, founded by the late physician
don’t really care about rich people—they can buy what-
Tom Ferguson, who coined the term “e-patients” to
ever they want. I care about people who are struggling.”
describe empowered medical consumers. Links and arti-
In truth, his theories are an odd marriage of populism
cles—like a recent post on how hospitals that replace
and libertarianism: He believes a single-payer, govern-
paper records with computers have lower death rates—
ment-run health-care system would be a disaster, and
strive to back up Ferguson’s stated goal of health care
while he believes there should be a way to cover the
as “an equal partnership between patients and health
poor, he thinks the free market often provides the best
professionals.”
method for getting there.
But as proof of his inherent altruism, he returns to the
DKMS: dkmsamericas.org
tale of the barista at the coffee shop. These are the peo-
DKMS was started in 1990 by a German man desperate to
ple Parkinson believes he can reach: young workers
find a bone-marrow donor for his wife, afflicted with
who fall through the cracks of the system, who cannot
acute leukemia. The site strives to match potential bone-
imagine doctors as people who are a lot like them.
marrow donors with patients, and allows patients and
Already, he is working with a marketing firm and with
potential donors to register right on the site.
local business owners to craft advertisements and con-
cepts that will appear to the denizens of the neighbor-
Mon.Thly: mon.thly.info
hood; one concept is “Shots and Shots,” at which
A free, online calendar that helps women to track their
patients would be able to purchase a flu shot and receive
menstrual cycles.
a coupon for a more potent type of shot at a nearby bar
(wheat-grass shots would be available, as well).
E-Factor: efactor.com
Parkinson still sees a small number of patients on his
A social network geared toward entrepreneurs and
own, but he’s more focused on expanding the Hello
investors, E-Factor also offers basic health insurance with
Health concept, on the future of the business of medicine
the purchase of a $24.95 per month premium member-
rather than medicine itself. He often attends confer-
ship. “Fascinating concept—social networks becoming
ences and trade shows—like one last fall where he spoke
pools for health insurance,” Parkinson says. “What if Face-
in front of 4,000 family-practice doctors in Madrid—to
book offered a whole slew of low-cost insurance premi-
spread his message, and that very morning, when we
ums to their members?”
spoke in his office, he’d been in meetings with his mar-
keting firm about ideas that had him so giddy he could
MedGadget: medgadget.com
hardly wait to share them with his partners. It’s the lat-
Billing itself as “the Internet journal of emerging medical
est twist in the story of a physician who has no real inter-
technologies,” MedGadget is written, edited, and pub-
est in doing things the way the system would like him to.
lished by a group of MDs and biomed engineers. A wrist-
“I think it’s being a doctor,” Parkinson says. “It’s just
band that will measure walking patterns to pick up early
being a new kind of doctor.”
signs of dementia? An iPhone app that can help stutter-
ers? As the site’s tagline says, “the Medical Revolution will
Michael Weinreb is a freelance writer in New York City. His
be blogged.”
ESPN.com profile of Bo Jackson was included in the 2008
collection The Best American Sports Writing.
March/April 2009 THE PENN STATER 41