A Conversation with Michael Shen

00;00;08;01 - 00;00;39;12 Jeff Byers Hello and welcome to “Health Affairs Pathways”. I'm Jeff Byers, senior content marketing manager here at Health Affairs. On today's very special episode of “Health Affairs Pathways”, we have an interview with Michael Shen, the author and producer of “A Disproportionate Share”, the first of two “Health Affairs Pathways” series in 2023. If you're listening to this episode, you've probably listened to “A Disproportionate Share”. 00;00;39;12 - 00;01;00;18 Jeff Byers I don't have to tell you how great it sounds, how much work Michael put into it, but enough from me. I hope you enjoy our conversation with Michael Shen. Michael Shen, welcome to the program. Nice to have you on. 00;01;00;18 - 00;01;02;11 Michael Shen Hey, Jeff, Thank you. Great to be on. 00;01;03;16 - 00;01;21;04 Jeff Byers Yeah. Yeah. So one thing I wanted to, I assume that listeners have probably heard your series. If they're listening to this episode, it's safe to assume, but you can't always assume. So for those that may have listened to the second episode, not the first, etc. Can you give us a quick overview of your series? 00;01;22;04 - 00;01;34;24 Michael Shen Yeah, totally. My series is about safety net hospitals in America, what that means, how they're defined, what kind of care they provide, and really importantly, how we pay for that care. 00;01;36;00 - 00;01;58;21 Jeff Byers Okay, great. Yeah. One of the things that struck us in your application process was that it was a really well thought out idea that you're trying to accomplish with your podcast series. So we've, you are, were part of the second cohort where we did the fourth and fifth series, and we've learned a lot from that process. 00;01;58;21 - 00;02;12;19 Jeff Byers But we could really tell that you had a passion to tell this story that you did over the course of three episodes, but in your own words, can you give us a little, can you tell me a little bit about, like, what excited you about this story? What were you trying to tell? 00;02;13;14 - 00;02;59;05 Michael Shen Yeah, thanks for saying that. I, you know, I think I was and I am still really passionate about this subject, and it's because I, like many, you know, doctors trained in a safety net system. And it's still the system where I work now. And through that training, you know, all the things that I bring up in the podcasts really come from my experiences, like working in this system of seeing a lot of the disparities in health, at the inequity in health care that we provide in this country, of wanting stuff to get done for my patients, but maybe not being able to. 00;02;59;28 - 00;03;20;16 Michael Shen But then, you know, going across the street and having all the resources that I could ever want, you know, that's the difference between the public, you know, a public hospital system, a safety net system and other systems. And I was, like, curious about that difference. You know, I was like kind of like, why? Why do I have to fight? 00;03;20;22 - 00;03;30;17 Michael Shen Why do I as a doctor have to feel that way? Why do our patients have to go through that? So I was just kind of curious about that. And I'm glad that the passion for it came through. 00;03;31;02 - 00;03;51;24 Jeff Byers Yeah, let's pause on that health equity bit. So for those that have been listening that may or may not be aware, Health Affairs has a big health equity push that we're going for, head up by the Director of Health Equity, Dr. Vabren Watts, and his department. But you brought up the topic of health equity there. 00;03;51;24 - 00;04;15;03 Jeff Byers So one of the things I wanted to ask you about is when we go from the theoretical to putting health equity in practice. You know, you mentioned that was a big part of your series. How do you as a clinician look to those theoretical ideas of health equity and put it into your practice? 00;04;15;12 - 00;04;35;19 Michael Shen Yeah, that's a great question. I think, you know, there's so many buzzwords now. Right? I think “equity” is one of those buzzwords. The, I, you know, all this stuff that we like to talk about in theory and to intellectualize about. But the truth of the matter is that, like a lot of people just aren't getting the care that they deserve. 00;04;35;29 - 00;04;56;29 Michael Shen And I think it's important to learn kind of the back story of that. And so that's why I touch on kind of the, you know, what I learned, you know, through making the podcast, the historical underpinnings of like structural racism in our system that lead to what we see today that have always existed in what, you know, in the health care system. 00;04;57;25 - 00;05;24;12 Michael Shen And then bridging that to like how we might care for people. I think I don't have an answer to that, really. But I'll tell you that I feel like, you know, our system and safety net systems in general, you know, as a kind of like a good safety net system, your mission is to try to bridge those gaps as much as possible. 00;05;25;21 - 00;05;54;25 Michael Shen Right now, I, you know, again, I work in our public system in Brooklyn, New York. I run a small clinic that's dedicated to treating people who experience homelessness in New York City. And while I can't say that, again, I haven't found the answer. You know, we haven't found the answer as a system, we're striving for that and we're trying to meet people where they are. 00;05;56;15 - 00;06;05;26 Michael Shen And podcasts like this help, you know, like this Health Affairs program, like, can help bridge those gaps, I think. I think that educational piece is really important. 00;06;06;29 - 00;06;12;17 Jeff Byers Yeah. So you're saying that you weren't able to solve equity issues with a three episode podcast series? 00;06;12;26 - 00;06;14;15 Michael Shen Yeah. Yeah, of course. 00;06;15;24 - 00;06;42;06 Jeff Byers Going back to the process, getting into the podcast, so we worked together for about seven months, I believe it was. So before you were starting, you have a lot of background in media creation and being an artist yourself. You work on the podcast “Core IM”. What were you excited to learn through this fellowship process and your, you know, telling the story? 00;06;43;01 - 00;07;19;05 Michael Shen Yeah, I think I was just really excited to be able to have access to, you know, editors from Health Affairs who have so much experience with, you know, health policy related publications. To be able to hear how the editorial process works, you know, in a place like Health Affairs was really useful to me. Like you said, I have a lot of experience with podcasting in general from a creative, you know, from the creative side and production side. 00;07;19;05 - 00;07;48;14 Michael Shen So, you know, the technical stuff that really wasn't as much what I was looking for. I felt like I had that kind of to begin with. But yeah, it was kind of the expertise of how do we craft, you know, more diligently stories related to health policy. You know, are there other journalistic kind of tricks or, you know, strategies that I can learn? 00;07;48;23 - 00;07;52;06 Michael Shen And that's kind of what I wanted to get out of this fellowship. And I did. 00;07;52;23 - 00;08;12;09 Jeff Byers Glad to hear that. So you're on the other end of this. By the time that this interview comes out, the whole series will have been aired. When you reflect on this process, and it doesn't have to be about what you got out of the fellowship, it can be about the story, it can be about, you know, putting it all together, 00;08;12;09 - 00;08;14;06 Jeff Byers What did you find really rewarding? 00;08;15;11 - 00;08;53;24 Michael Shen I was really happy that I finally got the chance to, in a fairly legitimate way, really explore all those questions I had in residency and in my training about all the things that I talked about in the podcast. And by legitimate, I just mean that, like, I had the opportunity to interview people that maybe I wouldn't have been able to interview before or the opportunity to, like, just get some face time with certain people that had deeper knowledge than I did. 00;08;54;12 - 00;09;20;25 Michael Shen I mean, you know, I think that all knowledge should be free and, like, you know, everybody should be able to talk to who they want to. But it definitely helps to say you're going to record for a Health Affairs podcast. You know, so I think all that extra knowledge that I gained from just talking to folks from that platform was really, really cool for me. 00;09;21;04 - 00;09;35;28 Jeff Byers So by the time that you and I have been speaking, so it's January 20th, two of the episodes have gone live. Has anyone reached out to you? Have you heard, you know, from your community any thoughts on the series? 00;09;36;02 - 00;10;04;16 Michael Shen I have. Honestly, I have. And it's been great for me. Like, I've been really, really surprised actually by how many people have heard it already. I had a friend from residency who's now doing a hematology fellowship and a concurrent MPH program, and he said his MPH professor just pulled up my podcast and used it to generate discussion. 00;10;05;05 - 00;10;32;17 Michael Shen Yeah, which, I was just kind of blown away by that. That was just really quick. But I was happy to hear that because, you know, the first episode, which is the one they pulled up, you know, talks a lot about Medicaid and Medicare and the political kind of differences between the two in terms of, you know, who deserves that kind of care. 00;10;32;17 - 00;10;56;10 Michael Shen And I just thought that that was something that was really amazing, that I got to talk to Professor Brietta Clark about, who's a health law professor. And I'm glad that that knowledge is now being used in a classroom to talk about inequity that's baked into health law. So, yeah, that's been awesome. I've had other friends who've also texted me saying they've listened and really enjoyed it. 00;10;56;10 - 00;10;59;14 Michael Shen So I feel very happy about that. 00;10;59;21 - 00;11;33;11 Jeff Byers Thank you for sharing. And that's, we love to hear it as well here at Health Affairs. And I do want to give a quick shout out to your employer, NYC Health and Hospitals. I thought the level of giving you access and sharing some information was great and helped the series along. Helped the series and, like, put a lot of, like, I hesitate to say real world example, but it gave a very real, real world example. 00;11;33;15 - 00;12;07;11 Michael Shen No, no, it's really true. Like, I'm very happy to have a wonderful culture here. You know, in our system where I can talk to leaders in our system about these things. There was no hesitation whatsoever, you know, because these are important things that need to be talked about. And for a lot of, like, people to learn about, especially clinicians who I, you know, had in mind because I'm a clinician myself and I wanted to learn some more bigger picture, you know, system issues. 00;12;07;25 - 00;12;12;06 Michael Shen So I think it's great that I was able to talk openly. 00;12;12;24 - 00;12;27;03 Jeff Byers We kind of touched on this already, but I feel like I'll just go ahead and explicitly ask it. Like when you when you think of a listener checking out this series, what do you hope is the one thing that they take away? 00;12;27;22 - 00;12;52;04 Michael Shen That's a great question. I think that it's a curiosity. Like, I want them to take away a curiosity about where our current health related laws come from. Like, where's that rooted? Because I think there's a lot of things that I was surprised by. All the things that we take for granted right now in the health care, not for granted in a positive way, like, that 00;12;52;04 - 00;13;15;02 Michael Shen We, you know, kind of acknowledge just exist. They didn't have to be that way necessarily. We don't need to have a fragmented health insurance system. We didn't, we never needed to have a place where, you know, be in a country where some people can get care in one place but not another, that none of that needed to happen. 00;13;15;03 - 00;13;28;27 Michael Shen So I think it's, I think what I found most kind of, what I want people to take away is just be curious about where it all came from and where it's rooted. There's always a reason. 00;13;29;15 - 00;13;49;03 Jeff Byers Fantastic. Curiosity. I love to hear that. For those that aren't aware, Michael, you're an artist, so what is next for you besides, you know, taking care of patients? Do you have any other media projects or any other exciting things that is on the horizon after this? 00;13;49;27 - 00;14;24;26 Michael Shen Yeah. Thanks, Jeff. Yeah, thanks for asking. I continue to work with “Core IM”, which is our internal Medicine/Medical Education podcast, and I'm working on a podcast about climate change and health right now. Yeah, I don't think I have any concrete plans for like, you know, any new podcasts, but I'm always interested in creating podcasts that link health policy with kind of on the ground work, clinical work. 00;14;26;00 - 00;14;41;03 Michael Shen And then, yeah, I continue to do, like, editorial illustration for the AMA Journal of Ethics. What I really want to concentrate on is expanding my clinic and making it as good as possible. 00;14;41;17 - 00;14;46;05 Jeff Byers And final question, where can people find you if you want them to find you? 00;14;46;26 - 00;15;00;03 Michael Shen Yeah, you can look me up on Twitter. I'm @mikeshenmd. That's “Shen” with an “s”, “h”, “e”, “n”. Hit me up. 00;15;01;06 - 00;15;02;21 Jeff Byers Michael Shen, thanks for joining us. 00;15;03;09 - 00;15;17;17 Michael Shen Thanks, Jeff.