Beyond the Dome: Rupal Malani

Published in Aequanimitas - Aequanimitas Spring 2019

Rupal Malani (Osler, Longcope, 2005) always knew she wanted to become a doctor. Born and raised in Chicago, she would sit mesmerized as her immigrant parents—both M.D.s—shared stories about their experiences, in graphic detail. “They seemed happy and intellectually satisfied,” she recalls. People in Malani’s community would often tell her how grateful they were for her parents’ care.

A graduate of Wesleyan University, Malani later earned a medical degree from the Icahn School of Medicine at Mount Sinai, then went on to obtain a master’s degree in biostatistics at Columbia University’s Mailman School of Public Health. After completing her M.D., Malani matched with the Osler Medical Training Program at Johns Hopkins. Following her residency, she returned to Columbia for a master’s degree in mathematical finance.

Since 2009, Malani has been a partner in the health care practice at McKinsey & Company in Cleveland. She advises health care delivery organizations on strategic and operational topics.

Malani also serves on the board of the nonprofit Partnership for Families and the Osler advisory board. She’s among Osler alumni from across the country who share diverse insights to inform Osler program leadership. Malani and her husband, Amar Krishnaswamy (Osler, 2003; ACS, 2005), a cardiologist, live in Cleveland with their 5-year-old twin daughters, Mira and Asha.


How did you become interested in the business side of medicine?

I've always been intrigued by systems and delivery of care, and the economics around them. As a resident, I often thought about how much a test costs and who was paying for it. The critical juncture came at the end of my residency, when I had to decide if I should continue my medical career in Cleveland (where Amar had matched) or follow my business passion. Charlie Wiener (Osler program director emeritus and president of Johns Hopkins Medicine International) asked the right questions and connected me with a ton of folks. Nearly everyone suggested McKinsey. I decided to give it a try and do it until it wasn’t fun. I’m still here!


How does your Osler training inform your work?

Completely. I’ve always worked hard, but the Osler residency taught me what ownership, leadership and teamwork at their best look like.


Do you recall a specific anecdote that left a lasting impression?

Yes. In early July of our internship, one of my co-interns admitted a patient overnight, correctly diagnosed cellulitis and started a sulfa drug. The patient was already improving by morning rounds—by all measures, a success. But during rounds, my co-intern was asked about the neuro history and exam, which he hadn’t done. I wouldn’t have either, given the patient’s chief complaint and diagnosis. But that wasn’t the point. Taking ownership of the patient meant completely understanding their history and the full physical exam—and then putting all the information together. That rigor was all around us at Hopkins—among the attendings, fellow residents, nurses, pharmacists and social workers. It was ingrained.


After a decade at McKinsey, do you feel a greater disconnect between your medical knowledge and business acumen?

In terms of medical knowledge, a huge disconnect, yes. But the experience of being a frontline caregiver has shaped how I think about care delivery. I have a better understanding of what's needed to drive real change.


What’s a typical day on the job like?

I really enjoy the fact that there’s no such thing as a typical day. On most days, I help clients tackle their most pressing issues. I coach my teams about potential solutions to these problems. I spent a lot of time learning about issues in health care delivery. Right now is an incredibly exciting time and requires lots of new capabilities for health systems. For example, as patients bear an increasing share of each health care dollar spent, health care is undergoing a retail revolution. Providers will need to develop a solution that meets expectations set by leading technology companies. It’s my job to intepret what they mean for health systems.  


Do you think medical training covers the business of medicine enough?

No, not even close. Before long, physicians will be expected to understand and manage cost of care. If you’re a primary care provider, you’ll be managing the total cost of care for your patients. If you’re a specialist, driving real health care value—better outcomes at lower marginal cost—is likely to be a competitive differentiator.