Get to know Amit Jain, M.D, M.B.A, a leader and innovator in spine surgery. He is an expert in cervical and lumbar degenerative spinal surgery in adults, and complex scoliosis surgery in children. His research focuses on health economics, quality and safety in musculoskeletal care. He has published more than 250 scientific articles. He is a Principal Investigator for a NIH R01 grant to develop the next generation of surgical robotic devices. He also serves as Medical Director of Value Based Care in Office of Population Health at Johns Hopkins Health System, where he works on value-based care delivery and care continuum strategy. He is a member of the HBHI Executive team.
Hi, Dr. Jain. Thanks for speaking with us today. So, let’s start at the beginning: where did you grow up? Where did you study?
I grew up in India until I was 11 years old, and then moved to the US with my folks because they wanted us to be educated here. We lived in Northern California, in the Sacramento area, where I went to middle school and high school. I went on to Berkeley, where I studied engineering, thinking I wanted to follow in the footsteps of my dad and my uncles and so on, who were all engineers. Along the way, I became really excited about the idea of applying engineering solutions to human health problems.
I decided to apply for medical school, and I got into Hopkins–for that, I consider myself really lucky. I thought I would just come from the West Coast to the East Coast for four years for medical school and then move back. But I loved it here - I loved Baltimore. I met a lot of great people who became mentors. I quickly gravitated toward the field of orthopedic surgery.
Orthopedics is engineering of the body. We think about mechanical issues that arise in the human body and how we fix them mechanically. So, I became an Orthopedic Surgeon. Along the way, I began to realize how complex healthcare is because it's not just about being able to take good care of patients, but also being able to understand a lot of factors such as quality, costs, equity, access, and how that interplays with the patient experience.
Skipping forward to now, my day job is being a surgeon–I love doing surgery and really enjoy taking care of people. My passion outside of surgery is thinking about value in health care and how we can generate value for patients.
Operating on people's spines is a pretty intense responsibility. Do you think there are unique qualities that some people have that draws them to become surgeons?
I think that's an interesting question. I think surgeons are people who like to see immediate change or receive immediate gratification from their work. Having said that, I think surgery also draws people who are willing to dedicate themselves to a cause and focus on improving a certain skill set over time. A minority of people, like with any art or any skill, can be naturally talented, but then the majority of people get there by countless hours of work and practice and reinforcement learning. I think a good surgeon is somebody who's willing to go through that learning process and be willing to be educated and be willing to learn from mistakes.
You seem like someone who enjoys a challenge, and trying to course correct the American healthcare system is like one of the biggest challenges there are. How do you like to frame the concept of value-based health care?
I think historically we have done a really good job taking care of people in medicine, but we've focused on the individual patient level and haven't been able to scale at the population level. Value-based care is about zooming out and asking, how can we do this better? How can we improve quality by preventing the problem from happening in the first place, or at least prevent progression? What investments can we make there? And what impact does that have on costs and equity and access? For me, that switch is really transformational because again, as a surgeon, I like to fix things. You know, if something is broken, I fix it, but with this, you have to take a step back and ask, what if it wasn't broken in the first place? What interventions can we do upstream to change the course and improve people’s health?
How did you get involved with the Hopkins Business of Health Initiative?
During COVID, I got my MBA at Carey Business School. It was perfect timing because with the pandemic and the world of surgery slowing down, I had more time to focus on learning. I started to interact with a lot of great people who were my professors at that time, and were members of the Hopkins Business of Health Initiative. I learned about some seed grant opportunities, where they were essentially giving you money, to do a fun research project. We built a team of people like myself, who were medical professionals, and some health economists, who think totally differently. We made some strides towards small projects which became bigger ideas and snowballed my involvement with HBHI.
What do you see in the healthcare field in the sector that makes you the most hopeful?
I think most doctors come from a very good place and want to do the right thing and want to help people. Further, there is a general realization that if we don't fix the problems in healthcare, the solutions we are going to be handed are not going to be very meaningful and are really not going to address the actual issues. Value-based care is a concept that I think has a lot of potential to improve healthcare. But doing it well, requires a realignment between physicians, between hospitals, between payers, and between patients. Everybody has a role to play, and everybody has to be aligned to swim in the same direction.
Naturally older individuals are going to have more interventions and experience the impacts of chronic disease, but the children are our future. How can we spend more on pediatric health in a preventative way?
My personal opinion is that we spend too much cost and time on end-of-life care, which is very, very expensive. The last 10 days of someone's life costs more than the rest of their life in terms of healthcare dollars. And part of that is because we as a society have a really hard time acknowledging that life is limited and there’s a finite endpoint. We have this consumerist mentality, and when our loved one is in the hospital and things are looking futile, we still want everything possible done to save them. We've got to tackle the tough questions regarding end-of-life planning. As an orthopedic surgeon, I don't know what the answers are but I do know there's a lot of really brilliant people who are medical ethicist and others who are working on those fields.
The thing I love about HBHI is it brings together clinicians like myself with business people, health economists, ethicists, people from different domains, and puts them in a room to have these conversations. And I feel that's super exciting. Because these are the big problems that all of us see in our silos but until we can break down the silos, it's hard to envision a solution.
You work with both pediatric and adult patients. How do you adjust your approach depending on who you're with that day or that hour?
It's an interesting thing... I have deliberately not separated these patient populations. I may be seeing a five-year-old and then the next patient will be 95 years old. It's exciting for me to kind of have to switch back and forth in my mindset. For kids, it's all about straight forward communication. You want to be able to communicate in a fashion that really resonates well with both the child and the parent. With adults, it’s more about goal and expectation setting. I think children are genuinely enjoyable to work with because they actually understand so much. You can tell them something and they just get it right away, while adults may view that information through their unique lenses and life experiences that can change their interpretation.
What do you like to do outside of work?
I love spending time with my two children who are ages six and three. One interesting fact about them is that my daughter, the six-year-old, is trilingual: she speaks English at school, at home we speak Hindi, and then her third language is Spanish thanks to our nanny. When my wife (who is a cornea surgeon) and I get home from work, we just want to spend the hours that we have left in the day with our kids. One of the best ways we’ve found to do that is through cooking. We cook our meals together and it's great because it engages them in a hands-on way, and as we cook, we end up getting to learn about their day. It's just fun.
