Northwestern Alum Dr. Melani Shaum Navigates Medicine and Business
A patient of 25 years described Dr. Melani Shaum’s brilliance as shining through by her unending ability to extend and save lives. As a leading oncologist in Los Angeles, Shaum manages a medical practice of 13 doctors along with a staff of 90 and, equally as impressively, passionately follows her alma mater Northwestern University’s football team. She knows not just every major cancer drug available to her patients, but also the point spread on Saturday’s game.
During a 40-year career as an oncologist at The Angeles Clinic, an affiliate of Los Angeles’s Cedars-Sinai hospital, Shaum, a Feinberg graduate, has been at the forefront of treating the critically ill. She frequently provides her patients with a lengthy lifeline through extensive medical care programs and, with her expertise and care, is able to provide them with hope. Shaum has weathered the changes and challenges of our healthcare system and has provided daily in-person care to her patients throughout the pandemic.
Shaum began her journey in medicine in Northwestern’s then innovative, six-year medical school program, matriculating at Northwestern in 1974. The Honors Program in Medical Education (HPME), which was discontinued in September of 2020, allowed her to spend two years on the Evanston campus and four years at what is now the Feinberg Medical School campus in downtown Chicago.
At medical school, Shaum studied a wide breadth of courses all while pursuing her personal interests. She attended every football game, despite the onset of Northwestern’s 33-year losing streak, and felt she truly connected with Northwestern. Shaum also became involved in the on- campus orchestra, playing the violin.
“I was at Northwestern when they built Pick-Staiger Concert Hall and I played in the orchestra. There was a lot of rehearsal time but because I was in this 6-year program all the pressure of being premed wasn’t there. I knew the world wasn’t going to end if I got a B. I played in the inaugural concert at Pick-Staiger,” Shaum said.
Upon graduating from Northwestern, Shaum travelled to UCLA for her residency. Forty years later, she still lives in Los Angeles, running a hematology and oncology practice affiliated with Cedars-Sinai Hospital. Along with 12 other doctors, she treats cancer patients, many of whom are critically ill and require years of care.
Over the course of her career, Shaum’s interaction with patients has changed little. Patients still require frequent medical attention and in-person and phone consults. However, she says the business of managing her practice has changed and become significantly more difficult. Because medical school education is not geared towards learning business practices, learning to run her business has been a trial and error process. Shaum says two major developments have changed the business model for her practice over the past decade.
The first change is somewhat unique to oncology. Oncologists are responsible for administering extremely expensive chemotherapy drugs to their cancer patients. Some drugs can run as high as $30,000 per dose and a four-dose course per patient requires the oncologist to spend $120,000 over 12 weeks on a single patient. Oncologists are almost entirely dependent on insurance companies for reimbursement, which generally takes many months after treatment is administered. Shaum’s practice requires well over $1 million a month in chemotherapy drugs.
At best, this drug purchase process creates a cash flow problem, as payment for the drugs far precedes reimbursement. At worst, given the sizeable outlays, failure to receive reimbursement leads to insolvency. With the dramatic increase in drug costs over the past 10 years, Shaum’s practice merged with Cedars Sinai Hospital in 2014. Dr. Shaum said, “There is no longer a single oncology group in Los Angeles that has not been forced, in order to survive, to merge with a deep pocketed entity who can better withstand these swings in cash flow”.
Another major change is due to the Affordable Care Act’s requirement that medical records be electronic by 2014 in order to obtain full reimbursement from Medicare. Migrating physical records to electronic records was time-consuming and cost Shaum’s practice upwards of $2 million. Shaum said she and many of her colleagues did not have the typing and computer skills to keep up with their medical records and required “medical scribes;” to sit in on patient visits and maintain electronic records. Scribes are efficient, but costly, and the process of documenting patient visits is still onerous for doctors.
“Almost every day is a 15 -hour day. And then on weekends it’s an 8 to 9-hour day. I do feel it will likely cause me to retire at least 5 years earlier,” Shaum says.
The pandemic has also led to new challenges for Shaum’s practice. Unlike other medical specialties, oncologists cannot effectively treat patients by waiting to administer drugs and other treatment. Shaum says her group is dealing with the frustration of being unable to administer COVID-19 vaccines despite most of their patients having compromised immune systems.
Shaum says, “I am proud of the fact that my oncology group, with the help of Cedars-Sinai, was open every day since the pandemic began and it has continued every patient’s medical care program without interruption.”
For current Northwestern students, Shaum emphasizes the strong training the university provides, saying students should be confident to take on medical school. However, Shaum also says she feels that it’s unfortunate that more real-world business experience isn’t taught in medical school. Since professors in medical school often are not experienced with the business aspects of medicine, this isn’t something that is easy to change.
Shaum continues to feel a huge commitment to Northwestern.
“It is special to us; my husband went to Northwestern Business School and my oldest child went to Northwestern as an undergraduate. We continue to try to support the school in any way we can,” she says.
