Sramana Mitra: Let me actually question a few things on the more specialized learning in the medical school process. In terms of the different specializations, how much coverage have you accomplished so far? This is a very intense body of simulation and content that you need to be able to deliver.
Norm Wu: Our company is only three years old. i-Human Patients was formed in November of 2012 but we actually absorbed the technology from a predecessor company that our founders had which made standalone clinical and physiological simulators. What we did was integrate all of these standalone simulators together into a complete interactive multimedia-intensive patient encounter. Then we overlaid on top of that an authoring system.
We don’t have nearly as many cases as we would like to have eventually, but we have way more than anybody else out there with any sort of virtual patient program. We have approximately 350 different case scenarios and about 200 different programmable avatars. We have three or four configurations of each case scenario. We started off hitting the big ones – Internal Medicine and Family Medicine. We’re about to launch a major case bundle in Emergency Medicine and Psychiatry and we will expand from there. Of course if you’re dealing with Internal Medicine, that actually covers a lot of subspecialties as well.
Sramana Mitra: The business model for this part of the offering is also the same as the other business model discussion we had earlier?
Norm Wu: Yes, everything we do is a SaaS model. We have professional services associated with the subscriptions when we are brought into a new school. Each school may have slightly different learning objectives so they will ask for our assistance in tweaking case scenarios to meet their particular learning objectives. Sometimes, they have different kinds of IT infrastructure.
They may need things like single sign-on or auto-provisioning of students. We have schools that have up to a thousand students on-boarding every single month using the platform. They don’t actually want to have to go through a traditional user registration process. They want us to automatically register those new students as they access our platform from within their internal school system.
Sramana Mitra: Let’s talk about the nurse practitioner piece now.
Norm Wu: Nurse practitioners are really interesting and it’s a major growth area for us. As you may be aware, fewer and fewer medical students are going into primary care today. Earlier, 50% of med school students would choose primary care. Now it’s in the low single digits. That interest in primary care has been destroyed by the fact that under the insurance reimbursement model, the primary care physicians have to work really long hours, see lots and lots of patients for shorter periods of time to make the economics work.
These students exit medical school with a ton of debt. They make the least amount of money in primary care and it’s just not worth it to them. Very few are choosing primary care as a career unfortunately. What has happened is both nurse practitioners and physician assistants are stepping up to fill the gap. If you think about nurse practitioners, they’re RNs and you give them two years of additional training. Then they become nurse practitioners who are now licensed to diagnose and treat patients and write prescriptions.
With nurse practitioners, it takes only two years versus seven years of training for a physician. It’s a way to start to address our shortage of clinicians, especially in the primary care area. One of the challenges of nurse practitioner schools is that all their students have day jobs. They’re all RNs. If you look at the nurse practitioner schools, they are going heavily towards online education programs either 100% online or blended programs where it’s 90% to 95% online in contrast to medical schools which are primarily on-campus schools using us to augment their curricula.
The nurse practitioner schools are using us in a total online environment. If you think about online education, you think about the need to give the students any sort of practical experience. We turn out to be the perfect product–market fit. One of the challenges with nurse practitioner schools is they don’t have enough educators to meet the rapidly growing demand from students and they don’t have enough clinical placements. We address both of those in an online fashion. That segment of our business is growing dramatically both in terms of the number of schools as well as the size of each school. Some of the schools that we work with are actually growing at 40% per year themselves.