Doctors in startups?

Nate Holbrook Founder / CEO at Lilac

October 2nd, 2015

A good friend of mine is currently in the process of hiring a Doctor for his healthcare startup, but he is very worried that he/she will not be able to transition easily from a rigid Hospital to the ever-changing startup life. What qualities should my friend look for during his recruiting process in order to ensure the Doctor is capable of working in an entrepreneurial environment?

Florian Pestoni

October 2nd, 2015

I've worked with physicians before, and have found that they are OK with the uncertainty of startup life: most physicians are used to a level of "controlled chaos", if you pardon the oxymoron, and many are small business owners/entrepreneurs running their own practice.

In my experience, the biggest challenge that physicians face is thinking in terms of user-centered products and understanding the risk-reward trade offs for startups. There are obviously many exceptions, and I'm sure I'll be called to task by others on this thread, but since you were asking a pretty open question, I'm using a broad generalization.

I would look for a physician that has had more direct business experience. For instance, a Medical Affairs director at a pharma company is going to have a better understanding of "pushing product" than, say, an ER doc. Some have also made a transition to consulting (particularly in the medical devices field) and may have been exposed to more aspects of the business. Lacking that experience, a physician who also has an MBA (there are quite a few out there) could be a better fit; at least they will have a basic understanding of everything that goes into managing a company -- although most MBA programs don't really prepare you for running a startup.

Hope this helps your friend.

Brett Wayn Sabbatical

October 2nd, 2015

I'm a former MD with experience in both hospital medicine and general practice. I have also worked in tech for the last two decades - teams with fewer than 5 and leadership roles in the C-suite leading hundreds of people. Multiple product launches, brand launches, board meetings, product outages and crises ... you name it, we've all seen it. Nothing in tech comes even close to the pressure of watching someone die and trying to save their life, knowing that what you do really will make a difference. Or telling someone that they have cancer and have a few months to live. Giving someone a diagnosis of HIV or diabetes. Being the sole resident in a rural hospital late at night with hundreds of sick patients, your beeper constantly pinging you and it's not because you forgot to upload the deck to Dropbox ;) In the past I have sometimes said in tech, when stuff looks really hard and people are melting down "Hey folks, take a deep breath. This isn't brain surgery. I know, because I've assisted in brain surgery." So the first assumption I'd challenge is that a hospital environment is rigid - in my experience it's anything but that. Some further thoughts:

Practicing medicine is a real privilege and the intimacy of the doctor/patient relationship teaches you a tremendous amount about people, what motivates them, what they are afraid of, sometimes hearing their closest secrets. You also see patients and their families at what are sometimes the most awful moments in their lives - and if you pay attention and look and listen, you learn so much from being on the journey with those folks. I have many, many times working in tech teams small and large drawn on my professional experience as an MD. I have met many people working in tech especially here in the Bay Area who live in a tech bubble, haven't had broad life experience, really don't understand how to motivate and manage but who - dangerously - think they know much more than they do and they are empowered by their arrogance or by a failed company culture. Instead I find it much more interesting to have team players who have vastly different life experiences and when I hire, I'm always looking for the stuff that's "off the books" as it were. What do people bring to the game apart from their domain expertise. What formed them as a human.

On the more intellectual side, doctors are trained in the scientific method and diagnostic and therapeutic medicine is basically a big-data problem with a relational database of symptoms and signs and investigative results that you carry around in your head. You are trained to do probability analysis and pattern matching on the fly. You form hypotheses and then do experimentation to see which hypothesis is valid and which can likely be discarded. So whilst I have no CS degree and I am not an engineer, I have often found common cause with engineers and PMs in the way they think about problems. As a humanist, seeing how "ordinary" people are sometimes so mishandled and confused by the experience of being a patient, also makes you a better product manager and sensitive to product design and user experience issues.

I hope that is helpful and happy to chat to you or your founder offline.

Sean MD CEO - ITphysicians | Executive Director - Allied Medical Training

October 3rd, 2015

The hospital isn't necessarily a rigid environment. Most practicing physicians tend to have a fair amount of flexibility in managing their day - they see patients, document, order tests, etc according to their personal style and the way they were trained. There isn't usually one set way of doing things.

Success in a start-up position would come down to the individual. I think that most physicians would do well in such a position provided there are clear objectives established. Physicians are accustomed to working long hours, researching topics thoroughly and efficiently, and quickly learning large volumes of information. This is why top management consulting firms such as McKinsey and BCG specifically recruit physicians to join as MBA-equivalent consultants, even without any business experience. Finding someone who has a great attitude, is a saavy tech-user, and has knowledge/passion about the field of the start-up is a good start.

If your friend is having trouble finding more MD candidates, try posting a job ad with the DOC club (dropoutclub.org). It's comprised of a network of 10,000+ physicians looking for non-clinical work and it's one of the best ways of reaching this type of applicant. Having recently posted a work opportunity with them, I had many qualified applicants start contacting me the same day.

Elizabeth Sigston Surgeon, CEO & Entrepreneur, ASOHNS Board Member, Telstra Business Women Awards Finalist, Researcher

October 6th, 2015

As a surgeon and a successful entrepreneur I appreciate the insight and foresight of the question.
Be clear about the personal values each party has: these cannot be taught and are difficult to change.
Look at how they run their current Unit/ Private Practice
Find out from their patients and other non medical staff they work with how they communicate.
What is their life experience outside medicine.
Be very clear on corporate structure and the roles each person is to play in the venture.
Have agreed exit strategies that can be implemented if everything goes pear-shaped.
Don't engage anyone who can not or will not come to the table to discuss these things upfront.

Sameer Gupta

October 2nd, 2015

Well As a doctor I think that that most docs can adept to change pretty easily if they have the right background . Most doctors are hard working . The question is do they understand business / financial issues ? Do they understand product market fit ? If they have some of that business background they will be an asset to the company . If they have worked prior to Medical school , that helps. If they have varied experience in the medical field like working for both a small practice and a larger organization it can help them to understand different financial incentives for the various groups involved in healthcare . If the person has specific questions have them feel free to email me for more specific inquiry . Hope this helps ! Sameer Drsameergupta@gmail.com

Carl MBA CEO

October 6th, 2015

My best physician hires have been purpose-driven individuals who worked very hard to reach the high standards they set for themselves.

Earlier in my career, I underweighted the importance of hiring good team players. Our training emphasizes competition and individual performance - being superstars versus supporters.

Depending on the position, don't assume that an "expert" will also have the needed creativity for new solutions.

Colm Murphy Cardiologist, Cofounder at Zen Medical Innovations

October 2nd, 2015

Hi Nate,

Being a physician founding a start up myself I would say there are a few things that your friend should ask:

1. Will there be a clear delineation between the time spent on clinical versus startup commitments. Clinical practice at times can be all consuming. Patients do demand a lot of time and do not not get sick at convenient times. If the doctor has a lot of call responsibilities or is hospital-based, he or she may be up at different hours of the night and this requires time to recover from. Doctors who perform research-clinical career find that they are most effective at research when they have dedicated research time. The same would apply for a start up.

2. Is the physician willing to risk devoting time to a start up recognizing that he or she will be risking stable, and often significant income? The appetite for this financial risk will vary between individuals and will be influenced by their financial situation - i.e. mortgage, dependents, debt, including school debt - which here in the US can be in the hundreds of thousands. The doctor should fully appreciate that start-ups carry significant risk, and may not yield a financial return on investment of time. I would try to understand their motivation for being involved in the start up. If it is primarily financial then I would be cautious.

On the flip side, physicians bring a number of great qualities to startups. First they are generally hard working and have proven their ability to see things through having been able to get through often taxing residency programs. They have a tendency to "undersell" because by nature of their evidence-based training, especially when dealing with patients. This is in contrast to business training where I have found from personal experience that the tendency is to "upsell" or over state, and sometimes you get bullshit instead of real substance. That being said, selling is a key component of a business and so physicians need to learn this art. Finally, many will have adopted mechanisms to handle stress and to think clearly under pressure, depending on their speciality.

I have seen many physicians start successful startups. The Stanford Biodesign program for instance has had many successful medical device startups which pair physicians and engineers. Physicians are increasingly interested in technology and its role in medicine, and I think strong partnerships with those in business, engineering and medicine will ultimately lead to successful startups - each discipline bringing its own strengths.

Best wishes.

Doreen SPHR Recruitment, Recruitment Process Outsourcing, Startup & Technology Recruitment, HR & Recruitment Expert

October 2nd, 2015

It sounds like your friend recognizes how significant this one particular hire is to her business on all levels. Her concern is likely due to the understanding that she is betting the success of her business on this hire. And I believe she really is. There are about 12 characteristics that occur naturally in varying degrees in an entrepreneur. She would have to become an expert in interviewing for these characteristics in order to make this determination, and she does not have the time or bandwidth to do it. There are assessments for this. I would be happy to help her with selecting an applicable assessment for her situation, if she would like. I can be reached at djaress@mysuccess.com. I am also an editor for "Today's Practice" magazine.

Dina Destreza Digital Content Manager at Keyideas Infotech

October 3rd, 2015

Hi Nate,

I would suggest you to spend some time probing the doctor and observe him or her in a period of 8 to 10 days. If he or she is pro-active and doesn't fall to the conventional way of practicing medicine in an organized healthcare-setup, you can be the right person for your startup but make sure that the doctor is showing interest from his end.

Peter Johnston Businesses are composed of pixels, bytes & atoms. All 3 change constantly. I make that change +ve.

October 8th, 2015

Short answer for John.

Biotech and medical is hot currently for startup companies. Many seed and VC funders have specific divisions working in this field and many University based funding arrangements really focus on medical and pharma - their IP based, slow methodologies suit this type of product/application. For example, One-Start (http://onestart.co/about) claims to be the world's largest healthcare accelerator. And here in Oxford there is a £300million fund for spin-offs from the University, much of it aimed at showing the commercial value of academic research, much of it in health. They call it the Pathway to Impact.

We are even taking things a stage further. We recognise that many people enjoy their academic life and are loathe to leave it for a startup focusing on a single product or idea. We are creating a system whereby the creator can effectively licence the idea to a team who can make it happen in a hands-off manner, with the creator taking a mentoring role but getting on with their life in their own field.

The recommendation I would give to you is to go to a University which partners with a teaching hospital and explore what help is there. And join some startup groups (oh - you are already doing that). Through both you will find some people on the most exciting area of all - the boundary between disciplines where innovation occurs. Put the skills together and watch the sparks fly!

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