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Alumnus brings social perspective to post

Yale Medicine Magazine, 2011 - Autumn


New York State’s new health commissioner will apply lessons learned in public health.

When Nirav R. Shah, M.D. ’98, M.P.H. ’98, HS ’01, was a medical student, he found a research paper that proved to be such a useful study tool that he left a photocopy at the library’s front desk with a note urging his classmates to use the paper.

Yale’s teaching philosophy, with its emphasis on collaboration rather than competition, “was extremely useful for learning,” said Shah, who is now applying the same principles to his new job as New York State Commissioner of Health. “It’s fundamental in public service,” he said. “You all have a common goal, and you have to figure out how to advance your shared agenda, so working together as a group is key.”

Shah, the youngest person as well as the first Indian-American to be named to the post, became commissioner in January 2011. Before that, he had been an attending physician at Bellevue Hospital Center in Manhattan, associate investigator at the Geisinger Center for Health Research in central Pennsylvania, and assistant professor at the New York University School of Medicine in Manhattan.

Shah’s medical career got off to an inauspicious start during his first week at Yale when he met Ralph I. Horwitz, M.D., FW ’77, chair of the Department of Internal Medicine, with whom he hoped to collaborate on research related to work he had done as a Harvard undergrad. Shah was so nervous that he spilled Horwitz’s coffee on his desk.

Despite that ill-fated introduction, Shah and Horwitz had “a phenomenal working relationship”—one that pres-aged Shah’s interest in public health and led to his staying at Yale for his residency in internal medicine. Shah’s research, which explored better methods for answering clinical questions as well as the comparative merits of randomized controlled trials and observational studies, was published in The New England Journal of Medicine in June 2000. “Everyone thought observational studies are fatally flawed, but we showed that in fact you can get great answers,” Shah said.

Shah’s interest in bringing a population health perspective to interactions with patients took root while he was at Yale. He offered this example: “You know that tobacco is the number-one killer—but your patient who is a smoker has three or four complaints he wants you to address, and tobacco probably isn’t one of them. What do you do?”

Shah is grateful that Yale allowed him to spend his fourth year earning a public health degree. “Gaining a population and public health perspective helped flavor the type of doctor I became and the kind of questions I ask.”

Shah’s other area of interest is caring for the medically underserved—a highly germane field of expertise in a state where nearly one in every five residents receives Medicaid assistance. “At Bellevue it was the urban immigrant poor,” he said. “At Geisinger, where I spent nearly half my time, it was rural underserved elderly patients.”

Those experiences helped prepare Shah for the challenges he faces in his new job. As New York’s top health official, his mission is to rein in a Medicaid bill that amounts to one-third of the state budget, or about $1 billion a week. “We’re taking an all-hands-on-deck approach,” he said. “It’s going to be a transparent process that engages all aspects of the health care system.”

Shah again credits his Yale education with giving him the tools he needs. While at Yale, he organized a conference against gun violence. “We had community, clergy, police, gang members, and affected family members all around a table together,” he said. While the conference was a success, Shah’s subsequent plan, a gun turn-in program, failed for administrative reasons. “Understanding the various stakeholders’ perspectives and all of the lessons I learned through that experience factor into what I need to know as a state health professional,” he said.

Shah, his wife, Nidhi, and their two young children recently moved from Manhattan to Albany for his job. “One reason I was able to do this is because of the phenomenal support I’ve received. My wife changed her life in support of this shared vision.”

Only two months into his new job, he and Governor Andrew Cuomo began to tackle Medicaid. Cuomo got the hospitals and unions—two historic adversaries—to agree to work together for improved health care at a reduced cost. Meanwhile, Shah traveled the state listening to people and gathering more than 4,000 ideas on how to achieve this goal. “We heard from a woman who asked why she left the hospital in an ambulance, which cost $400, rather than a taxi, which would have cost less than $40,” Shah said.

The list of suggestions was boiled down to 79 and submitted to the legislature for approval. This reform agenda was approved by the legislature in the spring, and Shah said that, if enacted, the suggestions could reduce the state’s Medicaid budget by $2.3 billion in the first year alone.

Shah knows the goal is ambitious, especially for somebody who is still learning the bureaucratic intricacies of Albany, but he said he’s ready for the challenge. “What can I say? I’m an optimist.”

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