In the latest installment of Ropes & Gray’s Alumni @ RopesTalk podcast, health care partner Ben Wilson interviews Erin Abood, senior university counsel at Stanford University. Erin was a health care associate at Ropes & Gray for five years before joining the in-house team at Stanford in 2010. Her practice focuses on digital health, international medicine, fraud and abuse, and privacy issues for Stanford Medicine. In this interview, Erin discusses her transition from Big Law to a small in-house team, what her team at Stanford values most about outside counsel, how her secondment to Stanford while still an associate helped smooth the path for her, and the phenomenal training she received at Ropes & Gray that she feels was critical to her development as a lawyer. She also reflects on the dramatic shift to digital health during the pandemic, and offers advice to associates who are considering an in-house move.
Ben Wilson: What does your job look like on a day-to-day basis?
Erin Abood: That's changed pretty dramatically since the onset of the pandemic, largely because I'm responsible for all the digital health advice that we give to Stanford Medicine. As you can imagine on day one of the shutdown here in California, and we preceded the rest of the nation, we did a dramatic shift to digital health and taking our ambulatory visits at the hospitals and turning them into telehealth visits from virtually none to 70-80%. That was a great lift for all of our operational teams as well as for legal to roll out. I think I have 15 iterations of advice that I've given over the last three years about what we can do, what we can't do, and it continues to evolve.
One of the starkest differences between your life as an associate at a law firm and in-house here is that we're very flat in terms of structure. There's no one below you and no one above you, and so we do everything here. We give the most high-level legal guidance—spending many hours on the phone—but at the same time, I can do the most simple and basic agreements that you would normally turn to a young associate to do because we just aren't staffed with all of the levels and personnel to do that, and so we become these great generalists. We do try and specialize, in particular, areas amongst our team here so that we can each develop some expertise in select areas—but at the same time, we take everything and anything that comes in, and it really runs the gamut. It's a very different day than you might find at the law firm, where you might be focusing on a few select matters and really diving in in-depth, and giving that incredibly thorough advice to your clients.
Ben Wilson: Now that we're hopefully reaching the tail end of the pandemic, do you think telehealth is something you're going to continue seeing and will be a facet of the in-house health care lawyer's role?
Erin Abood: Yes, certainly here in Silicon Valley, we anticipate that it is here to stay. We've watched our numbers obviously skyrocket in March, the initial month of the pandemic, and then they've come down, and we see them fluctuate a little bit with waves. But we seem to be plateauing here, and I think we can anticipate that going forward, a certain percentage of our visits will be via telehealth. Of course, for academic medical centers like Stanford and many of our peer institutions, it's incredibly challenging for both providers and patients that we now have the technology to see patients anywhere. For AMCs—particularly AMCs here, West of the Mississippi—we might be the only provider for many hundreds of miles or for several states with a particular expertise. Yet, the laws haven't changed, largely, that would allow us to see patients anywhere. We're still very much stymied by state licensure laws, which is something we discuss here constantly. It's something that I discuss with my peers at other AMCs, and something that our physicians just pull their hair out over, because they want to do what's right for their patients. Right now, state law is not allowing that to happen, so it's a frustrating time. We're all trying to figure out, "How do we move forward?" We'll see.
Ben Wilson: I imagine you're continually trying to find solutions to problems you didn't even know would exist five or 10 years ago.
Erin Abood: Yes, it's a constantly evolving practice, and just staying up-to-date is challenging. I think at the law firm, you do a much better job of that. You can carve out the time, or you have a certain associate that might write an update on particular matters. You've got partners who are just to-the-minute ready to go with certain information. Here, we're always so busy—it’s really hard to stay up-to-date, so we appreciate very much our law firm partners and the updates we receive.
Ben Wilson: Do you have any other advice for outside counsel who are looking to work with you—things that they can do help partner in that way? You mentioned helping stay up-to-date.
Erin Abood: Yes, I think those updates are phenomenal. In my time at Stanford since I left Ropes, I think our own practice has evolved, and our use of outside counsel has evolved. We try and reserve our use of outside counsel for that expertise that you might have that we don't possess, rather than for just getting work done. We are obviously very cost sensitive—we're universities, and our budgets are tight—and so we really try and be judicious in our use of outside counsel. In our partner law firms, we try and keep a really good handle on who's truly the expert in something. I think advice to outside counsel is when you're dealing with AMCs, obviously be cognizant of the fact that we do look at bills closely, and it may impact how you want to staff a matter. If we're coming to you, certainly here at Stanford, we're coming to you because you have some expertise that we don't have, and we're not just looking for someone to churn out some work for us.
When I first was first seconded here almost 20 years ago, we were a floor of one. Now, we actually exceed two floors of attorneys, just to give you a sense of how we have staffed up. I think that thereby reduces our need to just turn to a law firm to help us get contracts out the door, but it certainly doesn't reduce our need for that really complex legal advice and opinions, and you guys can be great thought partners. One thing we value is "What are other people doing?" I think practices like Ropes & Gray have a wonderful handle on what other AMCs are doing. If we're interested in going that direction, what would it take? It's that thought partnership that we really value.
Ben Wilson: In addition to your secondment and your work with Stanford while at Ropes, were there other experiences at the firm or particular areas of exposure that you found particularly helpful as you moved into the in-house role?
Erin Abood: The training I received at Ropes was critical to my development as a lawyer. The patience and the brilliance of the Ropes partners in training me and my former class at Ropes was just phenomenal. I had the incredible privilege of working very closely for Nancy Forbes, who has since passed away. I remember just sitting and listening to her brainstorm issues. At Ropes, not only did you learn how to approach things, how to issue spot, how to turn out a good contract, how to manage through a deal if it might go into the late hours of the night, or how to prioritize—so much there—but also how to communicate. I remember listening to Nancy, thinking, "I don't know that I'll ever be half the communicator that she is, but maybe some day I'll be part of the way there." It's phenomenal training across the spectrum at Ropes. It's hard to put into words, but it really was remarkable. Not to mention, also your peers—Ropes is able to recruit such phenomenal associates so that you're not only learning from the partners that are training you so well, but also your peers. It's a really wonderful group.
Ben Wilson: Do you have any advice for people who might be considering a move in-house—things that they should be aware of or experiences they should seek out?
Erin Abood: I think getting the broadest experience possible, because although of course we become specialists in certain areas, I think in most institutions, and certainly here at Stanford, you do need to be a generalist. I was certainly no privacy expert at Ropes. I'm increasingly needing to dive in because everything you do involves so many different issues. I think the best advice I would have to any associate is to be open to all sorts of work across the spectrum, to get the broadest base that you can and as much exposure as possible to so many different issues, so you can at least issue spot and have a sense of what you don't know and when to go get more help from someone who does, because we deal with so many different issues. It's wild.
Ben Wilson: Particularly as things change, new laws are coming out constantly, new areas of the industry are really taking off now—telehealth and health technology, in general—what are some of your go-to sources for information as you're looking to get up to speed and stay up to speed on these items?
Erin Abood: I don't know that it's that different from being at a law firm. I do every once in a while dig into the commentary and the regs—we love to avail ourselves of law firm memos that come out when new changes pop up—but also much more collaborative in-house, even outside of the legal office. I find particularly since the pandemic, and as we move into all these digital health initiatives, I work much more closely with my colleagues in risk and in privacy than I did certainly 10 years ago, where it used to be you either had the legal work, privacy work or malpractice work. Now, we're faced with such novel new directions, pilots and technology that I find it necessarily should be a much more collaborative thought process. As we weigh out risks and benefits, so often we're dealing with very gray areas now and not wanting to run afoul of the laws, but also not wanting to stymie innovation, and so just trying to think through the different issues and where our risk lies. I find that as often as I speak with my own colleagues within our general counsel's office, I'm also collaborating with my colleagues at the hospital, who oversee privacy and risk.
Ben Wilson: I wanted to ask: Any favorite Ropes memories from your time here? Did you carry the old patient-care beeper ever?
Erin Abood: I definitely didn't carry a patient-care beeper. I wouldn't say the hours were any worse than they are in-house, because I will never cease to be amazed that our senior leadership will respond at 11:00 at night to anything you send out. I think my fondest memories are really the people. Ropes is such a collegial environment of team members who are supporting each other at all levels. As I think I mentioned before, not only are the partners the most phenomenal teachers, but my own associate class was an outstanding group of individuals. Ropes really put in a lot of effort to bring us together. I was based in San Francisco, but I had the opportunity, whether it was flying out for the ball or for various health care gatherings, to really get to know the larger health care group, which functions as one group, and to get to know my classmates within that health care group very well—that I look back on as really some of the best parts of being at the firm.
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