How This Dell Med Student Is Fighting Hunger

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Zack Timmons integrated business and medicine to take on a social problem facing his community. [Show summary]

Zack Timmons, a fourth-year medical student at Dell Medical School at UT Austin, combined his passion for medicine with his background in business to create Good Apple, an Austin-based produce delivery company on a mission to end food insecurity. Listen to the conversation >>

A med student and social entrepreneur on a mission to alleviate food insecurity in his area [Show notes]

Zack Timmons is a fourth-year medical student at Dell Medical School at the University of Texas at Austin and co-founder and CEO at Good Apple, an Austin-based produce delivery company on a mission to end food insecurity. Since launching Good Apple in November 2019 as a third-year medical student, Zack and his team have delivered over 540,000 pounds of healthy food directly to the doors of over 17,000 people facing food insecurity.

Prior to medical school, Zack attended Rice University where he studied the cognitive sciences and was premed. He later worked for two years as a business analyst at Deloitte Consulting. He plans to pursue an emergency medicine residency, where he hopes to leverage his patient stories in the emergency room to continue building programs and organizations to meet the health needs of our community’s most vulnerable residents.

Can you tell us a bit about your background outside of medicine? [2:14]

I grew up near Waco, Texas in a small town just outside of Waco called Robinson, Texas, and lived there with my younger sister and my two parents who are a huge influence on my life. My dad is a commercial tire salesman and my mom’s a social worker. I think they’ve really instilled the importance of getting to know people and service in the community. They’re a huge influence on me.

I always really enjoyed the outdoors. I think that’s something I still enjoy today, from downhill skiing to long-distance backpacking. Most recently, my partner and I completed about 300 miles of the Pacific Crest Trail in California. Cooking is also a huge hobby. I spent a little bit of time in the Northeast prior to medical school and got to know Marc Vetri, who is an incredible pasta chef in Philadelphia. So have recently been making a lot of homemade pasta, which is great.

When did you decide to become a doctor? [3:38]

Probably when I was a senior in high school, I made the decision that I was at least interested in medicine. I will say one thing is that my passions for medicine have definitely changed and matured the more I get into the field. I think there are so many reasons to be excited about healthcare today. But I think initially, the way I started off was maybe a pretty simple story. I was really interested in the sciences and loved the application in helping people. That was kind of the initial impetus to my path. When I got to Rice University where I went to undergrad, as you mentioned, I had this incredible opportunity to work as an emergency medicine technician, and I actually gained my advanced certification through a course at Rice, which is really cool. So I did that for three years during undergrad.

I really always had a passion for emergency medicine. Initially, it was a lot around loving the pace of the field. I loved the opportunity to make an immediate impact on patients’ lives. But I think more recently, I’ve really appreciated newer things about emergency medicine: the opportunities to solve some really complex clinical challenges. In emergency medicine, we see a lot of undifferentiated patients, which is such an exciting thing to take care of, and then more systems-based. I think we see a lot of the problems in the healthcare system, both medical and social problems, things like housing and education that really impact people’s health. That’s my new passion in medicine: How do we create these health centers that also provide medical care? Medicine is such a vast field. There’s so many incredible ways to get involved and make an impact in the community, both on the individual patient level, as well as the systems level, which has kept the fire burning.

You were an EMT, you graduated from Rice, and then you spent two years as part of Deloitte Consulting. Was this part of your grand plan, or were you just testing out your interest in business? [6:01]

My biggest takeaway for any student is just to always be open to new experiences. I think that’s really hard because I think a lot of the path with medical school is pretty prescribed. Sometimes it takes a little bit of a leap of faith to try out new things. I’ve been fortunate that I feel like a lot of those have influenced the physician I want to be today. But to your question, I actually had an incredible opportunity the summer before my senior year of college to live abroad in Northern Argentina, where I worked with a small healthcare NGO. I was really struck by the work they did. It was a maternal and pediatric center, and they had pediatricians and OBGYNs. So they were providing medical care, but they also provided things like afterschool education and were really actively involved in the small, 3,000-person community they worked in and making sure people had economic stability.

It was the first idea I’d had about physicians playing this role bigger than just providing healthcare. I came back from that summer super fired-up about systems thinking. One of my friends had just finished up a consulting internship and said, “Hey, I think a lot of these same skills that I worked on over the summer are applicable to some of the issues that you’re interested in solving.” So really on a whim, I started learning more about consulting and wanted to gain that skillset. The rest is history.

When you took the job with Deloitte, were you thinking, “This might be the path for me,” or were you thinking, “I want to acquire this experience before I go to medical school?” [7:49]

I was trying to stay open to the opportunities. I think as a former EMT, patient care is just some of the most rewarding work that I’ve probably ever done in my life. So I knew it was going to be, I think, pretty hard to swing away from not going back to medical school, but I wanted to have that open mindset and explore and be curious. I kind of knew that I wanted to go back to med school, but I learned so much at Deloitte Consulting. It really influenced the physician that I want to be today and the things I’m able to do because I learned so many skills that maybe I wouldn’t have had the opportunity to build in med school.

In what sense do you see yourself being a different physician because you worked with Deloitte? [8:36]

I think this is something all of us as medical students and future physicians are going to have to grapple with. There’s so many big problems in healthcare that influence the physician-patient relationship that have nothing to do with the moment of being in that exam room. I think physicians are really well positioned to solve those problems, but we have to have an understanding of the frameworks to do that. We have to understand not only the language of the business of healthcare, but also how you take big, hard problems and break them into smaller problems that you can solve. I think that was probably the overarching skill that I learned and the types of things that I’m hoping to work on as a future emergency medicine physician.

What was the hardest part of the med school application process for you? [9:36]

It was probably one of the hardest application processes I’ve ever been through. It’s such a marathon. I go back to when I was applying to consulting positions as a senior in college: I applied for the role on Monday. We had first round interviews on Tuesday and second round interviews on Thursday. By Friday, we knew if we had a job or not. It was great. But med school applications are not like that, I think for good reason. I think there’s a lot of pros to being able to have that additional time to reflect in writing personal statements and understanding who you are as a candidate and why you want to embark on this very difficult journey, this long journey.

The hardest part for me was just the fact that there’s so much time between the time that you start and the time that you find out at the end. I’d say the second thing is, it is a pretty emotionally draining process sometimes. I think you’re having to answer big questions about why you want to commit your life to a certain path. I know coming out of undergrad as a senior, I don’t know that I had those answers. I think that was actually something that I came to through my consulting experience and time off was that it was okay that I didn’t have those answers. But I needed to have that experience to really understand who I was and what I wanted. It is a challenging application process, but also one that I think is super rewarding and I think does the right thing for students.

How did you handle the demands of being a consultant while you applied? How did you handle the sheer amount of work, the waiting, the emotional drain? Anything that you did that you found helpful? [11:26]

I had a very, very unique experience because at the time I was actually working abroad in Ireland as well. I was working all week and then I was living in Dublin on the weekends. So I would go over, I remember, to my desk in the Trinity College library in Dublin. I would just sit there and write. It was so hard because like I said, it’s such an emotionally taxing process of getting the essays in and then writing your personal statement and doing your secondaries and making sure that your CV is spotless. I was very fortunate that I was also going through the process with my partner as well. So having a team around you or someone who understands, maybe someone who is applying with you at the same time, to have that accountability and have someone who really understands the difficulty of the process was invaluable for me then. My partner was also accepted. We actually are both fourth year medical students here at Dell.

What do you like best about the Dell Medical School? [12:55]

This was definitely something stressed to me during my consulting interviews, but maybe is just now starting to become expressed in the medical application process: It’s really important to not only show your fit with the program, but see if that program is a good fit for you. I think that’s a really undervalued piece of application process. As pre-medical students, don’t be afraid to have to ask the hard questions and try to figure out what these institutions stand for and make sure that those mission statements really align with the type of physician that you’re hoping to be. When I thought a lot about that, Dell Med just checked all the boxes for me, and I was really excited to come here.

A little bit of background on Dell Medical School: The taxpayers in Travis County, which is where Austin is, actually voted to raise the property taxes to fund a good portion of the medical school, which is pretty much unheard of. It was going to be the first medical school added to a tier-one research institute in over 50 years. So it was this huge community investment to bring the school here and even make it possible. But because of that, we have a very direct mission to give back and serve the community here in Austin. That was something that was really powerful to me. It provided a very clear direction for the goals the med school hoped to achieve.

That’s been super reflected in my experience as well as during our first week of school. We not only learn about biochemistry and biostatistics, we also learn about the social drivers of health and how those affect people here in Austin, things like institutional and systemic racism. Austin unfortunately has a difficult history with that. Many of those issues are still present here today, but those are the things that were in our curriculum and that the school felt like were important for us to learn. That’s coupled with the fact that our curriculum itself is pretty innovative. We actually have an entire third year off to pursue a community project or special passion. Given those things all combined, it was just a program where I really felt like I could have a truly individualized experience that would allow me to explore some of these interests that I had prior to medical school.

What could be improved at Dell? [15:37]

There is definitely a startup vibe around here. We are constantly changing things. I think that creates a lot of uncertainty for students sometimes. I think especially as premed students, we’re used to having a little bit more of a regimented schedule and understanding of how things will be. There is a little bit of that at Dell. You have to be along for the ride and know that, thankfully, the administration here is just fantastic and understanding of student feedback. But that’s definitely been one of the challenges, trying to handle that ambiguity that comes with being at a new school. But I’ve been really impressed with the leadership. Dean Johnston and Dr. Sue Cox, who are just legends in the field, have created something super special here, which has been amazing to be a part of.

Good Apple was your third year project. How did you come to found it? [16:34]

Quick background: Good Apple is an Austin-based produce delivery service on a mission to end food insecurity. For every box that a customer buys from us, we deliver another box of fresh food directly to a family in need. At Dell Med, we’re really focused on the social drivers of health, the things that affect people’s health that are outside of the doctor’s office, where they go to school, what sort of housing they live in, their access to healthy food.

I was really fortunate to take a course very early on in my education, again because of the flexibility in the curriculum, here at the LBJ School of Public Policy. It was taught by Dr. Michael Hole, who has become one of my most incredible mentors since I’ve been here at Dell Med. It was called Solutions for America’s Children in Poverty. We walked through all of those different social determinants of health and tried to understand the history of them. Also, at the end of the course, we had an opportunity to pair up with a community partner. So I worked for an entire semester with the Texas Hunger Initiative, which is an organization here in Texas that works on helping unlock certain federal programs for local communities. Ones that you may be familiar with are the free and reduced lunch program, which is an incredible program, as well as the summer food service program. It was awesome to get to work directly with an organization working on such important work.

It was the first time that I’d realized what an issue food insecurity was here in Austin. Even amid some of this incredible technology innovation we have, we also have some of the highest rates of food insecurity in the country. One in six people in Travis County, including over 50,000 children, are unsure where their next meal is coming from. For me, that was just a staggering statistic, and knowing what we know about food insecurity and its impact on health outcomes, it was something I was really passionate about solving.

I had that foundation that I built up in first year, and then second year, I went back into the clinics and similarly continued seeing issues. I was taking care of patients with diabetes, and a core tenet is diet. Unfortunately for a lot of patients, it’s hard to have access to healthy food. So I came back to my third year and really wanted to work on this issue of food insecurity. Ultimately after talking with a number of clients about why was it that they were struggling with food insecurity and asking how we could help, I found that there are actually almost 60 food pantries in Austin alone, which is the most of any Texas city. There was this interesting disconnect between all these amazing resources that were available and all of these people who were still struggling with food insecurity. It was unsurprising that when I talked with my patients, my clients, transportation barriers are huge to accessing fresh food. The location, where you live. And a lot of food pantries have pretty limited hours. If my grocery store was only open between 8:00 and 11:00 every second Thursday of the month, that’d be very difficult to get food.

That’s how we ended up landing on Good Apple. We really wanted to focus on this idea that everyone deserves access to home-delivered food, which is I think pretty radical and something we’re really pushing for. I’ve been really excited to see some of the federal policies start to move that way as well, which is exciting. But that’s what we’ve been doing to date. It’s been really exciting work.

Did the focus on food delivery predate COVID? [20:21]

Yes, that predated COVID. We launched the program in November 2019. So we were continuing the one-for-one model. We were seeing some good results from clients as far as accessibility and usability. Then by about February, we were delivering somewhere between 50 and a hundred boxes a week to families in need, which was incredible. We were so excited about that. It really felt like we were making a difference.

Then COVID hit. We were just so uncertain about what was going to happen. Fortunately, what we’ve seen is some incredible partnerships flourish around a time when the need for food access is also rapidly increased. We’ve leveraged our existing knowledge and institutional understanding, as well as partnered with different people across the city of Austin to really ramp up our programs. Like I said, we were doing between 50 to a hundred deliveries a week at the beginning of February. By the end of March, we were doing over 1200 a week.

It was an incredible team effort. I started Good Apple, but I have an incredible core team of seven other people who help me, including former colleagues from undergrad, as well as other medical students. We’ve had so many partners across the city of Austin, including Capital Metro, our local transportation authority, the city of Austin, and different food pantries in the area, like Hope Food Pantry. It’s been cool to just see all these partners come together and rally behind the program. I think to date, we’ve been able to make a pretty big impact on people’s lives. It’s been exciting.

We work with local farmers each week to curate a CSA or community-style agriculture-type box. It’s a curated list of veggies each week that are local and seasonal. Then we deliver those to our paying customers. Then those funds, as well as additional philanthropic funds, help us to fund the delivery of another box to a family in need. All delivered. That was really important to us that, knowing what we knew about the different transportation barriers and scheduling conflicts, especially for our young working families, it can be a challenge, especially now for the elderly or people with underlying health conditions who have risks just going to the grocery store. It’s been great to have that delivery aspect for these people.

Do you have any other ideas about applying business principles in medicine? [23:43]

Historically, business has a bad connotation in medicine. I really want to try to change that. I think the core of any business is to unlock as much value as you possibly can. I think there’s a huge opportunity, especially at the intersection of business and healthcare and social impact, to unlock as much value as we possibly can.

When I say business principles, I think the things I’m hoping to apply most in the healthcare space are two different ways of thinking traditionally, especially as medical students and medical providers. There’s a very high level of research and understanding that goes in prior to making any decisions in patient care, and rightfully so. We want to make sure that if we’re giving a patient medication or having them undergo a procedure that we’re certain or with as much certainty as possible that that’s going to improve health impacts for people. Do no harm first. So I think that is an incredibly important way of thinking about health.

But there are all these other problems in the healthcare system that are systems problems that could benefit from more of a business or startup perspective. I think that perspective is, “Let’s create something and fail really fast,” which is not something you want in patient care. But in the healthcare system, I think it’s something we could try to adopt more. Let’s build the minimum viable product that they talk a lot about in business. Let’s build that first program and look at feedback from people and see what works, what doesn’t work, and then we’ll change it again. We’ll do that really rapidly.

I think we’ve started to see a lot more focus on that, especially around quality improvement and hospitals. When we think about PDSA cycles and stuff like that, it’s been exciting to see those start to come over. But I think that’s my biggest excitement and combining the two ways of thinking. I think they’re very, very complimentary.

The other thing that’s been really exciting, from my perspective, is all the collaboration that can happen between medicine and other fields. You mentioned engineering. We’ve been talking about business. I think there’s so many opportunities for physicians to have that dual expertise. I think that will only enrich the healthcare system and the health impacts that we’re able to have for patients. It’s a really exciting time, I think, to be in medicine.

How do you think your fourth year of medical school is going to be different because of COVID? [26:51]

I actually went back to the emergency department during June and did my acting internship there. I had a really fantastic experience. There’s definitely different precautions that we’re taking now. I think we’ve always been pretty focused on personal protective equipment, but there’s definitely a heightened understanding of the needs with COVID-19. So that, first and foremost, is the biggest change I’ve seen.

As a medical student, at least at our institution, there are also additional protections for students, as far as the types of patients we’re able to come in contact with. I think those things will continue to become more refined as we learn more about the virus. It could be some time, but I think I’ve been really impressed with our institution, at least here, and being able to create still valuable experiences, so the learning doesn’t stop.

The other thing that we’re grappling with, especially in my position as a fourth year medical student, in less than a year, I’ll be the one out there taking care of these patients. So I think we have to figure out the best way to start training the next generation to continue to work. But I think we’re moving every day and again. I think medical education has been very responsive and very responsible, which I think is great protecting medical students.

You mentioned earlier that you want to go into emergency medicine, and you’ve done the emergency medicine rotation. What’s the appeal of it? [28:16]

As I mentioned earlier, I worked as an emergency medicine technician for three years. So I’ve always been very drawn to the pace of medicine, but I think clinically what it came down to for me was two things. One, just the opportunity to see undifferentiated patients from an intellectual medicine perspective. That’s something that I was very passionate about, diagnostic reasoning and differential diagnosis building. For me, that was the part of medicine that I really loved.

I think I also just really loved a lot of the different rotations that I went through. The opportunity to see some of the emergency cases of the different specialties in the ED is very attractive. But I think also, and I’ve definitely seen this here at our own institution, that because of the shift-type work of emergency medicine, there’s also a lot of opportunity to get involved in projects outside of clinical work. I think they’re very tied together for me. It can be frustrating as a physician when you go in and see the same problems day after day. Maybe you don’t feel like you have a way to change them, but especially the field of emergency medicine, you have that time outside of the hospital to say, “Hey, I’ve seen this patient come in and housing’s a big issue for them. Maybe that’s something I could get involved with and advocate for, whether that’s political advocacy or building programs for those patients.” You take those issues you see in the ED and action them outside of the clinical context, which is really exciting.

What advice do you have for people applying to medical school? [30:12]

The advice I’d have for anyone, as I mentioned earlier, is just being open to the process. It’s such an emotionally taxing process, physical even, at times, and just being in tune with those emotions and the process and how it’s making you feel, and being okay if you have a bad day or being really excited when you find a new opportunity. I think that whole process is really exciting.

One thing that I was able to narrow in on is, what’s your passion? I think historically we felt like we needed to check all these different boxes as premed students. But I think what I’m seeing more and more is medical schools want to accept leaders in this field, and leaders in the field typically have a passion, and they have a deep passion. Sometimes that means you don’t do a lot of research in undergrad, but you’ve built out this incredible organization that does XYZ. So don’t be afraid to break that mold a little bit. I think it’s something that schools are really excited about now, more than ever.

Where can listeners learn more about Good Apple? [32:12]

I’d love for people to check it out. You can find us at goodapplefoods.com, or we’re also on social media at @goodapplefoods.

Do you have people calling you and inquiring about setting up a Good Apple somewhere else? Or do you have any plans to grow it outside Austin? [32:26]

It’s something we’re definitely trying to figure out right now, different operational plans and scalability. But yeah, that would be an incredible opportunity to expand not only in Austin, but to other cities as well. I think there’s a huge opportunity here. So we’re excited about helping as many people as we can.

Related Links:

Good Apples’s website
The 5-Part Framework for a Successful Medical School Application, an on-demand webinar
An MPH/Postbac Grad’s Journey Through Med School, a student interview
Medical School Admissions Consulting Services

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