Medical

Q&A with Dr. Emma Stanton, Psychiatry, Population Mental Health

Dr. Emma Stanton is a psychiatrist and Regional Chief Partnerships Officer at Beacon Health Options, a company which is uses a data-driven approach to work with mental health service providers across the US. She is also CEO of its international subsidiary Beacon UK, co-founder and director of the mentorship network Diagnosis, and a General Advisory Council Member at The Kings Fund.
Dr. Stanton obtained her medical degree from Southampton University (2000), completed her MRCPsych from the Royal College of Psychiatrists (2005), and obtained her MBA at Imperial College London (2009).
Prior to working at Beacon Health Options, Dr. Stanton completed her clinical training at the South London and Maudsley NHS Foundation Trust. She has also served as Clinical Advisor to the Chief Medical Officer at the Department of Health in London, which included placements to BUPA and the World Health Organization.
Between years 2010-2011, Emma was a Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, and is now a senior associate at the Institute for Strategy and Competitiveness, Harvard Business School, USA. She was nominated by the Health Service Journal (HSJ) as one of the most inspirational women in health and also one of the HSJ Top Innovators in the NHS.
Dr. Stanton’s publications include Clinical Leadership: Bridging the Divide (Quay Books 2009) and MBA for Medics (Radcliffe, 2010). Her research has been published in Epidemiology and Infection, Health Service Journal, and the Journal of the Royal Society of Medicine.
When did you first decide to become a physician? Why?
When I was in secondary school, we had to choose a work experience placement for a couple of weeks. Because my academic performance was good, I was encouraged to consider placements in either law or medicine. I wasn’t sure what either of those roles involved, so I decided to undertake work experience in both. For my legal work experience, I spent a lot of time reading papers, which I found quite dull. In my medical work experience, I had the good fortune to spend a couple of weeks shadowing a paediatrician who was incredibly inspiring, dynamic, clearly loved her job, spent time playing with sick children, and seemed like she was genuinely making a difference to the children and their families. Following that work experience I decided to apply to medical school, not necessarily to be a paediatrician, but to be a doctor.
How did you choose the medical school you attended?
I went to Southampton University. I remember looking at a lot of different syllabi at the time, and what sold me on Southampton was their “Early Patient Contact” scheme, whereby they encouraged medical students to spend time with patients right from the early years of medical school, rather than spending years in lecture theatres. This wasn’t the case in many medical schools at the time.
What surprised you the most about your medical studies?
It’s often hard to know what to expect until you’re immersed in these kinds of vocational training programs. As a medical student, your university experience is often quite different from other degree programs, in that you have a very clear sense of what you’re going to be doing once you graduate. It was just assumed that all of us would go on to be practicing physicians after we graduated, whereas none of my friends who were studying geography or history really knew what their plans were following graduation.
During the final year of medical school, you really start to feel like a physician-in-training because you’re actually seeing people, you’re doing on-calls, you’re part of a firm. I don’t think that surprised me, but it was certainly different from other non-medical students’ university experiences.
Why did you specialize in psychiatry?
I initially wanted to specialize in surgery. In fact, the whole way through med school, I thought I was going to be a surgeon. I liked it because, as a medical student, you could really get involved. You could hold retractors, play a role in the clerking, get involved in the operations from start to finish, learn to do some of the suturing. Quite early on in my training, however, I realised that the surgical career path is all about “the more operations you do, the better you will get to be as a surgeon”, and that’s essentially what you do decade after decade. I found it really hard to imagine that that would be the entirety of my professional experience, so I became much more interested in some of the complicated people that we would see in the emergency department. For example, I would see many people presenting with abdominal pain for which there was no underlying organic cause that a surgeon could fix. Those individuals were clearly in pain and distressed, but there was nothing we could do. So, ultimately I made the decision to switch from surgery to psychiatry. This sounds relatively unusual, but I’ve met several people who have made that transition.
Psychiatry is an endlessly intellectually interesting field. There’s so much we don’t know about how the brain works. For me, it was a decision I made after graduation. I don’t think psychiatry was, and is, particularly well-taught during medical school training. In fact, I don’t remember being inspired by any of my placements on acute psychiatry wards. Frankly, I often found the psychiatry wards quite intimidating and frightening places to be as a medical student. However, I had a very different experience during my postgraduate training. People often come to psychiatry later because it sometimes requires a more mature approach, professionally and personally, to deal with potentially emotionally distressing cases.
Psychiatry is such a broad area that really allows you to spend more time with patients and to take a biopsychosocial approach. It also allows for more flexibility, such as a career portfolio approach, in a way that some of the more technical specialties don’t.
Has being a doctor met your expectations? Please explain.
Yes, being a doctor opens the door to an incredibly rich variety of career opportunities.
Describe a typical day as a doctor—walk me through a day in your shoes.
While I was in the UK from 2011 to 2014, I practiced clinically in the NHS one day a week. Since 2015, I have been based in Boston, USA, where I work for Beacon Health Options full-time.
My last NHS clinical placement was in a community-based addiction team in South London. Here, I would assess people that were addicted to alcohol, or multiple other drugs, who were either on maintenance therapy or who needed some kind of community-based withdrawal management.
I was part of the multidisciplinary team, and patients largely visited our clinics on a drop-in basis. Case managers would call me about people they were particularly worried about, either because they needed a different type of dosing that varies from protocol, or because they had other psychiatric issues, such as hearing voices or feeling suicidal.
I was fortunate to work for an inspiring and experienced psychiatrist in that role who taught me a lot about addiction.
What do you like most about being a doctor?
The feeling of knowing that you are actually making a difference, or at least trying to make a difference to people’s lives. That really matters to me in terms of what I choose to do with my life.
What do you like least about being a doctor?
Frustrations in the system that make it difficult to do the right thing for the person sitting in front of you.
This is ultimately what drove me to take on a system leadership role from a population health perspective, as opposed to only seeing patients individually.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
When I first started practicing, I assumed that being a doctor was a bit like stepping on to an escalator which would continue to go straight up in a stepwise manner. However, I have benefited personally and professionally from stepping off that escalator, and following a slightly different path. At the beginning of my clinical training,I said to myself: You may not be doing this forever, so make the most of every day that you spend with your patients and your team. As it turned out, my full time clinical work has only been one chapter in my professional journey so far.
What part of medical training itself prepared you best for business leadership?
My medical school and clinical training exposed me to the front lines of what it’s like trying to care for people and their families when they are very distressed.
This direct patient-facing experience is a unique perspective that I, as an experienced clinician, bring to my current business leadership role.
Tell me more about how you first got involved with healthcare business?
I did my MBA as an executive student, while still completing my clinical training. I chose to do an MBA because being an effective systems leader involves a lot of skills that you’re just not taught as a doctor. I saw in a lot of senior clinical colleagues that no one had taken the time to teach them about how to write a business case. An MBA gave me a broad understanding of business principles in an efficient and structured way. I didn’t want to do a healthcare-specific MBA, as I wanted to learn more about a variety of industry sectors internationally.
It was while I was completing my MBA at Imperial Business School that there was a role advertised for junior doctors to become a clinical advisor to the Chief Medical Officer. Prior to that, I was doing full-time clinical training. I worked in the Department of Health for a couple of years before I then had the opportunity to become a Commonwealth Fund Harkness Fellow based at Harvard University, which gave me international policy experience. Ultimately, it was a series of steps that led to my transition from being a full-time clinician to now being in healthcare management full-time.
Describe a typical day as Regional Chief Partnerships Officer —walk me through a day in your shoes.
Most days are made up of a mixture of racing between meetings, in person and on the phone. I usually have time before and/or after work to catch up on any email correspondence, and frequently, I’m involved in giving external presentations. At the moment, I’m leading Beacon’s efforts in Massachusetts’ Accountable Care Organisation (ACO); this involves planning with our partners what accountable care means and how we can drive improved outcomes at a population level.
I am based in Beacon’s offices in Boston, USA, but I spend quite a lot of time meeting with community-based providers, which I like because it’s much closer to where care is delivered.
What do you like most about being involved in healthcare entrepreneurship and leadership?
In 2011, I was employed by Beacon to set up a new company in the UK to drive improved mental health care in partnership with the NHS. Over the last few years, I have really enjoyed building the Beacon UK team and we now have several contracts with the NHS. I’m incredibly proud of what our teams are delivering every day.
In my current US role, Beacon looks after over 50 million people, with a presence in every state across the US. I love being involved in the population health aspects of behavioural health with the potential to drive improvement in outcomes across the system.
What do you like least about being involved in healthcare entrepreneurship and leadership?
I dislike it when the role of behavioural health is marginalized as a “Cinderella specialty”. That is undermining to the hard work that we, as leaders, do every day, and most importantly to the people whose lives are devastated by serious mental illness. I sometimes fear being spread too thin and not really making enough of an impact in any one domain as a leader because you’re constantly being pulled to different areas, meetings and different topics.
On average, how many hours a week do you work? How many weeks of vacation do you take annually?
I’m just back from a week in Sicily which was glorious. People vary in how much vacation they take. I tend to take more of my vacation in the summer.
I don’t really count my working week in hours. Most of my meetings are between 9-5, but a lot of additional work inevitably happens outside those hours. Overall, it’s pretty flexible.
How do you balance work and your life outside of work?
For me, exercise plays a big role. I like doing Pilates, and last year I competed in several triathlons. I also make sure I have time to see my family and friends and spend quality time with them. When I’m not travelling too much, that usually works out pretty well.
What types of outreach/volunteer work do you do?
Beacon is a mission-driven organization, so I’m fortunate that I can combine outreach and volunteering with my job. One of my reasons for working at Beacon is my ambition to make a difference in mental health. That’s a shared aspiration amongst many of us choosing to work here. There’s a significant amount of outreach and volunteer work involved on an advocacy basis.
From your perspective, what is the biggest problem in healthcare today? Please explain.
The rise in costs, without a corresponding increase in outcomes. I would love to see the Value Based framework for health care delivery being taught in medical schools. Students need to be thinking about what these big problems are, and what role each of us can play as clinicians in addressing them.
Where do you see healthcare in five years?
One of the most exciting innovations in health care delivery is the increasing role of technology, and cell phones in particular, as a way to engage and empower individuals when they become unwell. It can be used to access expertise but also to track health outcomes. The role of technology is eminently disruptive, and really promising.
What is your final piece of advice for students interested in pursuing a career in health management/entrepreneurship?
If we think that one of the biggest challenges facing healthcare today is the increase in cost without a commensurate increase in outcomes, then it is inherent upon us as doctors to better understand how healthcare costing works and how we can do a better job of measuring outcomes.
What my colleague Claire Lemer and I endeavoured to achieve with the “MBA for Medics” book that we wrote was to take some of the key lessons from an MBA and summarize them, as we recognized that most doctors who consider doing an MBA ultimately won’t. It’s expensive and time-consuming. Not every doctor needs to do an MBA, but there are components of an MBA, such as a comprehensive understanding of accounting and financing, which are valuable to all clinicians.
Therefore, I would encourage you to find ways to get involved in and exposed to health care management or entrepreneurship whilst you’re at medical school or at some point during your clinical training.
Ultimately: when making career decisions, make them based on what you enjoy and what you find most interesting. This is where you will make your most meaningful contribution and be the most fulfilled.