Founded in 2010 by a passionate group of emergency medicine physicians, CityMD is the leading urgent care provider in the New York metropolitan area. In 8 years, CityMD has grown from one Manhattan practice to more than 100 total locations while treating over 5 million patients.
TAP-NY had the chance to sit with Dr. David Shih, co-founder, former Chief Medical Officer and EVP of Strategy at CityMD to learn more about the company’s rapid growth and his experiences leading up to CityMD.
Can you introduce yourself?
I’m Dr. David Shih, co-founder of CityMD and former Chief Medical Officer and EVP of Strategy at CityMD. Prior to CityMD, I worked as a Board Certified Emergency Medicine Physician at Northwell’s Huntington Hospital. I’m also currently the CEO/founder of a medical education company called Master Clinicians, an advisor and investor for several startups, and proud member of the Mets Fantasy Camp family.
I was born in Taiwan and grew up in Taipei until the age of 7 when my family immigrated to Flushing. I come from a family of farmers and merchants but my parents were the only two that graduated from college in their family and became journalists. Despite being a horrible student in Taiwan, with my parents’ support I was able to catch up quickly in the US and achieve high grades in school.
My life has had a recurring theme of second place. It’s funny looking back now, but I was disappointed when I told my dad I only got into Bronx Science because I was aiming for Stuyvesant. This happened again when I found out I was going to SUNY Binghamton instead of Cornell, again when I got into SUNY Downstate instead of NYU Med School, and yet again in emergency medicine residency when I got into Long Island Jewish Medical Center instead of Jacobi Hospital. But it’s funny how life works, because this was my fated path. If I had strayed from this path, I actually would not have become an ER doctor and thus would not have met my CityMD partners.
At SUNY Binghamton, there was a prestigious EMS club that a lot of folks applied for. I remember being disappointed when I didn’t get in, and as a backup I decided to volunteer at the local ER every week to get that experience. Interestingly, most other volunteers didn’t actually show up for work, and rather just got their volunteer credits signed off on. To my surprise, a few months in, the ER charge nurse offered me a paying job as a nursing assistant as I was the only volunteer who actually did their hours.
Till this day, I credit my medical career to nurses who trained and taught me in the beginning. ER nurses are probably the best group of people I’ve worked with. It’s hard to explain the feeling when you are working to save a life, and a team of selfless, motivated and hardworking nurses are by your side as you hold the urinal for drunk patients, clean diapers, transport the deceased and wipe blood off the floor.
This was the experience that shaped and solidified my aspiration to be in the medical field. From these days, I learned a lot about compassion and humanity, witnessed pain and suffering and recognized that life is short and unfair. Medicine now had a meaning, and became forever a part of my life. This was also when I realized that life is as you make it, and when I heard I was accepted into a residency on match day, I cried out of joy for the first time.
Can you tell us the story of how you founded CityMD?
I was the overnight doctor working alone in the Emergency Departments for over 7 years. While it was a stable job, it also affected my physical and mental well being given the dysfunctional overcrowding of hospital ERs. The environment and climate became toxic, and I began searching for a better way and a better life. While risky, the idea of starting an urgent care became popular as I saw some of my colleagues depart the ER to create their own practice. So I reached out to my friend, Dr. Richard Park (now the CEO and founder of CityMD) who was my colleague and mentor at LIJ ER to get some advice from him since he had an urgent care practice in Long Island.
Richard was thinking about opening an new type of urgent care in the city, and at the time, urgent care was traditionally seen as only doable in suburbs. In total, there were ten of us who got together and to found the company between 2010-2011. We had no outside investors during this financial crisis, so each partner had to come up with significant amount of cash for this to work. Personally, I was over half a million in debt and could have lost everything had this not gone the right way. Together, we raised enough capital to open four sites (Upper East Side, Upper West Side, Columbus Circle and Flatiron).
As this urban model was completely new, we had no playbook going in, but we knew what NOT to do from Richard’s 5 years of experience. We also moved away from a traditional individual owner model into a corporate model where everything was under one united brand.
Richard appointed me as the first Chief Medical Officer and gave me a blank canvas to create our medical operations and policies for the whole company. Not having any administrative or management background, I had to learn quickly: how to recruit and manage doctors, train medical staff, create systems and policies for our clinical operations, manage quality and compliance, and maintain quality outcomes.
My colleague and close friend, Ned Shami, became COO and laid the foundation for our non-clinical staff hiring and training, general operations, finances, and real estate development. Calvin Hwang was our Chief Experience Officer and developed the CityMD brand, changing the perception on how healthcare can be advertised and marketed. The four of us along with our partners were like the Bad News Bears, each individually with our own weaknesses and faults, but complementing each other to become stronger together. Someone once told me that the best bet you take is when you bet on yourself. That’s essentially what the ten CityMD founders all did: we bet on ourselves to make this work.
What was the day-to-day like and how did that evolve over the life of the company?
It was pretty rough at the beginning since we were obligated to work 3-4 days at the sites without pay for the first year. At the time, I still had to work in my ER job for the remaining 3 days to make a living. I joke about it now, but I was one of the few partners who slept overnight at our CityMD sites. Today, our staff often wonder why there’s a shower, sofa bed and TV in the staff lounge at our Columbus Circle site. Essentially, that was my home for many nights during the early days. All the founders then worked alone for long 14 hour shifts to deliver exceptional care. During flu season, we each saw a hundred or more patients a day.
As word of mouth spread, we knew success was dependent on making service faster, better and easier for patients. Drawing from our frustrations from the ER, access and convenience was key to success since no one enjoys waiting weeks for a PCP visit or waiting hours in the ER waiting room. We actually simulated patient experience exercises by roleplaying as patients: standing at the front door, walking in and noting all of our observations. What do we see? What do we hear? What do we smell and feel? How can this be better? Like retailers, we focused on improving the customer experience.
In order to grow, we had to build more sites and hire more doctors. As CMO, my task was to build a scalable way to deliver a quality clinical experience. Since I couldn’t clone our partner doctors, I had to design systems and processes so that every doctor and employee could replicate what we did. Like Starbucks, we needed a system where patients would get the same treatment and outcome across all CityMD sites. To that end, I created CityMD Academy which delivered a standardized training for all the physicians and medical scribes we hired.
Not too many people know this, but CityMD is also one of the largest trainer and employer of medical scribes. It’s one of the reasons why our doctors are highly efficient and why our patients have an exceptional experience. Our curriculum can train any college student into a functional clinical staff member after a few weeks.
I also centralized our Aftercare program to provide standardized care after the patient visit. This foundation eventually led to our massive call center which now handles referral management, ER diversion programs, care coordination, safety checks and population health initiatives. Having these systems in place were crucial in allowing us to grow quickly but safely. Today, research has shown that 40% of millennial women in the NYC area have visited a CityMD.
Over the last few years, my role at CityMD slowly transitioned from CMO to EVP of Strategy. As we grew, we needed to focus on external affairs, and I essentially went from a “Secretary of State” role to an “Ambassador” role. Instead of dealing with our internal processes and physician practices, I had to work externally and dealt primarily with our health system partners, provider partners, payor partners, and government partners. I also became more involved with media and public relations, while also working more with our strategy team on designing CityMD’s next innovations.
What are your thoughts on the future of healthcare? Any thoughts on millennials shaping that direction?
Healthcare is changing rapidly and going from a fee-for-service model to a value-based model. It’s one of the industries in America that remains inefficient, expensive and where outcomes continue to trail other leading nations. Because of this, low cost quality care have become the focus for many. Healthcare is also undergoing a transformation as it adapts to the digital world. Millennials are expecting immediate access to care and full transparency. Millennials now discover and make decisions from online reviews and searches. I see convenience care options like telemedicine and urgent care continuing to grow rapidly as the rest of healthcare catches up. At the same time, traditional practices will no longer be able to hide their prices and neglect quality of care because of online reviews and price transparency will be the norm. Healthcare is now realizing that because of technology, patients can now make better decisions and can choose who they go to. In time, only truly patient centered models will succeed.
So far, healthcare is the only field where technology has made things slower instead of faster. Unfortunately, medical records still are not talking to each other like an ATM card would work anywhere. I believe this is changing as companies look for a universal EMR (electronic medical record) solution and a universal health information exchange solution. Large companies like Apple and Amazon are slowly entering the healthcare space as well. The IoT revolution, artificial intelligence and wearables will play a big part in the future, and due to all these new possibilities, I became very interested in advising and investing in new healthcare startups.
What does 2019 have in store for you?
After seven years of working in the hospital, I left the ER and began my journey with CityMD. Eight years later, I am now again at a crossroads – this year I’ve been blessed with my first child and have begun spending more time with my family.
Looking back at the sacrifices I made for work, I’ve come to realize this is the right time to focus on family, and to that end I’ve recently stepped away from my role at CityMD to focus on my child and my family. CityMD will always be my first child, but it’s grown up and now going to college – it’s time to let go. This also gives me an opportunity to work on side projects from home; investing, advising and mentoring, while doing the things that I enjoy and having time to improve my personal health and fitness. I’ve always believed in the “Four Burner Theory” and that balance is important. As a Taiwanese immigrant who has achieved the American dream, I’ve been very blessed, making the best out of whatever was dealt to me. 2019 will be a year for reset and rest, and I plan on reading and learning for self growth, getting back in shape and spending lots of time with family and friends.