Just Five Questions: Brian Roach ’93

Brian is a registered nurse in the Emergency Department at The Yale-New Haven Hospital. He recently became a Family Nurse Practitioner where he will specialize in emergency and wilderness medicine. Prior to his career in healthcare, Brian held a range of leadership roles in the financial services industry including a 13-year tenure as a Managing Director at Wells Fargo in the Capital Markets and Private Banking practices. In addition to his MBA from the Yale School of Management, he earned a BS from the Duke School of Nursing in 2021 and a Master of Science from the Yale School of Nursing in 2024.

1. What’s a global trend you are following where you see an opportunity or bright spot in this challenging macro environment?

I’m watching a range of innovations transforming healthcare and a range of challenges ahead for both the healthcare sector and the health of all Americans.

One innovation that’s particularly promising for both healthcare providers and patients is the ability to do a wireless ultrasound outside of the hospital with a smartphone - commonly known as point-of-care ultrasound or POCUS. Imagine the impact at point of care when you have this capability - to identify a blood clot, a fracture or a pregnancy complication in real time, wherever you are.

While most industries have the ability to conduct global operations digitally, healthcare for both privacy and regulatory reasons has been slow to mainstream point-of-care solutions that you can carry in your pocket. POCUS is a care-changer for medical care because it allows us to make very quick assessments and diagnosis and advance the correct treatment in real time. I hope that widespread deployment of POCUS will happen as quickly as providers can get trained in its use.

While I’m optimistic about the innovations taking place in patient care, there are a range of trends I’m watching that are concerning. These include: the massive patient demand for weight loss drugs for which we don’t fully understand the long-term effects; the increasing privatization and rolling up of primary health care operators; the growth and profitability pressure these roll-ups are placing on healthcare providers; and the accelerating connection between lifestyle decisions and health outcomes, particularly in the areas of processed food and alcohol and declining sleep, social connection, and physical activity.

These are all areas where education and advocacy and public private partnerships can help mitigate these concerns.

Fortunately, the federal government is catching on to the perils of processed foods and it is expected that the soon-to-be-released 2025 Dietary Guidelines for Americans will reflect that.

The PE industry’s goal to consolidate and grow the healthcare industry, in particular primary care, is something I’m watching very closely. The key is to protect the provider-patient relationship and level of care while also bringing operational efficiencies and shared resources to the sector. I’m optimistic that the pendulum is going to swing back in favor of better quality care for the patient and less provider burnout in the coming years.

2. What’s an example of how SOM’s mission informed your professional path?

It’s an ideal time to accelerate new models for progress in healthcare. Professionals who understand the promise of public-private partnerships and mission-driven education campaigns will have a major role to play in driving this progress. Healthcare is also an excellent industry for SOM graduates as understanding the role of healthcare's impact as a for-profit industry and the access and cost issues impacting society are critical challenges to solve by finding new models to solve access, costs, innovation and growth.

SOM’s mission of educating leaders for business and society is quite relevant to my goal of being an excellent emergency medicine provider.

I am using my SOM education and my business experience frequently in the emergency department. Most of the clinical leadership in the hospital and in the out-patient setting don’t have any formal business training. What may seem obvious to a SOMer is less obvious to a patient-facing physician who also has responsibility for making business and operational decisions involving patients, providers, nurses and support staff. While I am not looking to get into healthcare management, I am afraid that the need for better healthcare is going to push me back into management before I know it.

3. What’s an SOM experience that helped shape the way you understand business and society?

I really appreciate the interaction, dialogue in and outside the classroom, and connection students and faculty have always had at SOM. Besides the interdisciplinary curriculum, you just come away with the full picture of how any industry impacts both business and society. While my immediate career path was finance, I spent many years on the trading floor in a management role, making important decisions affecting a variety of stakeholders. I find that the ability to function under pressure and through several global crises has made me a better healthcare professional.

On a trading floor you need to focus on your immediate task and you need to compartmentalize. This is extremely important in an emergency room when the stakes are not dollars but people. I’ve found that the skills I learned in finance allow me to be extremely focused on my patient, do

my best work in a truly high pressure environment, and deliver the best outcome one decision at a time regardless of what else is unfolding around me. It’s very rewarding.

One of the specific things from SOM I have carried with me is from Barry Nalebuff and Barry O’Neill’s Negotiations class. I clearly remember learning how critical it is to understand what is important to the other parties in a negotiation. Now in healthcare, I try to always think about my patient and their family’s perspective whenever we discuss a diagnosis and treatment plan. Sometimes our first line treatment guidelines won’t work because of a patient-specific issue. I find myself using my negotiations class skills. What is most important to the patient? How is our plan going to work for the patient? Is there a treatment, while not medically optimal, that has a higher probability of success with this patient? In the end, this approach delivers the best outcome for the patient and a rewarding sense of accomplishment for me.

4. What’s a favorite SOM memory, faculty member, mentor or class?

Three things: the mailroom, the Hall of Mirrors, and the interaction with faculty.

When I was at SOM - before smartphones, email, and social media, the mailroom and the Hall of Mirrors were integral to our day-to-day communication across the entire SOM community. In medical-speak, they were our central nervous system. They provided an environment for authentic, in-person conversations with classmates, faculty and staff and enabled us to experience and understand personally the many geographies, sectors, experiences and orientations of our diverse cohort.

And when I compare the interaction between faculty and students at SOM vs. my nursing programs, there is no comparison. SOM faculty are present and engaged with the students outside of the classroom. We had interactive conversations in the classroom that continued into the hallways and over coffee. The collegial SOM environment was memorable and rewarding.

5. What are you excited about for the year ahead?

I have found a way to align my enjoyment of adventure and the great outdoors with my career as a medical provider. I am currently working on completing the curriculum to be a Fellow in the Academy of Wilderness Medicine which will serve as a pathway to future opportunities as a medical provider in austere environments. In January, I expect to begin a one-year residency in emergency medicine to hone my diagnosing, treatment and procedural skills in a trauma center.

In the interim, following five years of education for my pivot into healthcare, I am excited for a brief break for some adventures in the coming months. This fall will be fun. There will be a one day Rim-to-Rim-to-Rim journey across the Grand Canyon with a buddy, a trip to Egypt where I’ll spend a week scuba diving in the Red Sea and a stop in Cairo to see the pyramids, a week of rock climbing in New Hampshire’s White Mountains and a week of scuba diving in the Bahamas to complete my rescue diver credential. 

Just Five Questions is an initiative led by the Yale SOM Alumni Advisory Board. Want to learn more? Contact Lee Race ’93 with feedback, thoughts, and/or questions.