Exploring Physician-led Innovation through Entrepreneurship and Intrapreneurship

Exploring Physician-led Innovation through Entrepreneurship and Intrapreneurship

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Hi good morning, everybody. Welcome to the AMA future of health immersion program. My name is Laura fritchey. I'm project administrator on the digital health team here at the AMA.

Today we have a panel, various positions that are representing different health care environments. We have private practice, health system and company perspectives that you'll get to hear from today. We'll start off with my introduction. We'll move to the panel discussion.

And this panel is really looking at how these physicians have moved into kind of entrepreneurship and then entrepreneurship effecting change and innovation from within their organizations. And we have a Q&A. You're welcome to ask questions throughout the panel. And if we have time for them at the end, we can surface those to the panelists and then I'll do a wrap up and close for our moderator, we have Dr. Vimal Mishra. Dr. Mishra is vice president of digital health at Uc Davis, and he is also the Director of Digital health at the American Medical association, and he'll be moderating the panel.

So, Dr. mishra, I will pass it to you to kick things off. Thank you. Thank you so much. I really am excited and want to welcome the esteemed panelist here. I want to just kind of really start with the statistics here for physician leadership and physician entrepreneurship.

So there's an article published a few years ago from MIT, and they did a survey of 33,770 physicians in Massachusetts. This was only for Massachusetts. And it came out that the total 19.2% physicians had founded at least one business, whereas 33.9% of physicians graduated between 1974 to 1978 had founded a business. So the question is, is the physician entrepreneurship going down? And I think we have the best panelists here to talk about this a little bit more and explore their journey.

So with this, I would want to open this panel and conversation with just asking everyone if they want to take unmute themselves and talk about introduce themselves and tell us what you do and drive and what drives your entrepreneurship, spirit and type of environment you work in. So let me ask I see Dr. Eugenie salad. Next So if you want to unmute and talk about yourself. Thank you, Vimal.

Hi, everybody. It's my pleasure to be part of this panel discussion. My name is Eugenie. I'm an internal medicine physician in clinical fermentation.

Currently work as vice president of innovation and CMO for Uc Davis Health. And I think in our role and Uc Davis health, we are trying to create an environment where we not only help our clinicians and physicians to learn about the tools that are available for them or the internal optimization and the work on the projects and the passion project, but also to create an environment where they can learn about the potential way to monetize their generated IP through the transfer office or potentially even join some of the early teams that may be working across the industry if they're interested in some Advisory capacity. And I think the critical part here is across the medical innovation, there is nothing that's can substitute the clinical experience. What I mean is if we go through the funding for the last decade, funding significantly increased.

And fortunately, despite that, a lot of the companies still struggle to actually find a market fit and to end up selling to the incorrect customers or actually potentially exiting the business. And a lot of the time, it's actually come up from the lack of understanding of not only health care system, but actually of a clinical problem they've been working with. So at Uc Davis, through our collaboration colab, we are working with our clinicians to find internal opportunity as well as partner them with external companies so they can explore together.

And try to solve the health. Dr. Jeff brand if you want to introduce yourself and talk about what you do, what drives your entrepreneurial spirit and what type of environment you work in.

Yes, absolutely. Thank you for having me and having us discussing this really interesting topic. So, AJ brown, I'm an internal medicine physician. I'm a second year clinical informatics fellow at the University of Illinois in Chicago. To me, you know, the interest in the entrepreneurship field, especially in health care, started back in my residency time.

So I did my medical school in Damascus, Syria, moved overseas here to Chicago to do my residency. And I was really fascinated by the entrepreneurship ecosystem in Chicago and in the US and how even physicians are encouraged to, to, to be entrepreneurial, to solve problems and to approach problems from within. If you want to talk about entrepreneurship or start their own business. So, you know, I was exposed to these new ideas. And I learned about the clinical informatics fellowship, actually, which really combines the entrepreneurship part, leadership, data science and, and process improvement.

So so that all led to, to me going through that route and, and exploring these possibilities. And then now, I mean, I can further talk about the projects we're doing, but that's actually one of the eye opener to me, too, to learn that there's this path for physicians and residents and students. Great so it's so fantastic. And welcome, Dr. nagata. What's your story? Though a little background on me.

I'm a physician by training, trained at Penn and wash. Serial entrepreneur. Before I went to Med school, I started a company called psychology. So if any of you guys have little ones, you may be using psychology today, and I'm sorry about all of the messages you receive, but we're in about 55% of schools in America, 20 million users, 130 countries.

We went public in 2019. And most importantly, I was a caregiver for my dad. And, you know, that experience of being a doctor and a caregiver was one of the hardest experiences of my life, took care of him for the last nine years of his life. And really what inspired me was that my dad came to this country as an immigrant. No formal education worked his way up. All three kids went to Ivy League schools like a legitimate American dream.

But unfortunately, he had access to health insurance, but not health care. The legacy health care system failed him, and it failed my family because you didn't get to reap the benefits of all of the hard work that he had put in. And at the age of 53, because of undiagnosed sleep apnea, he had a heart attack at the age of 60. He was bedbound and he passed in 2021 from heart failure. And, you know, I had this big exit, had to make decisions about my own life. And at the same time, we saw, you know, what was happening in the pandemic.

We saw in this last quarter 117,000 doctors leaving the legacy health care system. And I think that we're sort of at a watershed moment. Either the legacy health care system starts making changes or new models are going to emerge. And they'll be like Sears.

They're building really nice buildings, but we'll see where it actually ends up. And so, you know, I'm I will tell you from the beginning, I am the contrarian on this panel. I will consistently push back on anything that seems to be within what is the most expected. I actually the reason why I'm doing this, the reason why I'm inspired and the reason why we build resilient and we've raised about $10 million is because the only solution out of this is innovation.

And it really comes down to will it happen within the system or outside of it? That's fantastic story. That's very inspiring story as well. And Dr. brown, I think I would just kind of put this data forward.

And I think EMA previously for the first time, it was noted after 2020 that more physicians are employed than they are. They have their own practice, which is, you know, something which is astonishing for lots and lots of physicians. And you are doing something which is private practice. So love to hear your story.

Thank you. Yeah Dr. francavilla. And I'm a family physician and obesity specialist, and I think my entrepreneurial spirit seems to be a little bit in my blood.

My family seems to not be able to avoid starting businesses, but I resisted it. I thought if I was a doctor that I could just have a steady job and quickly realize that was not for me. And I think my entrepreneurial spirit comes from this place of like, I can do this better. And when you have this feeling or this idea of something that can be improved, it's often very hard to do that within a system. And you do have to be innovative and you have to find your own path.

So I very quickly in residency was like, I think I need to be independent, to be able to practice medicine the way I want to. I thought about starting my own practice in residency, but was a little overwhelmed with the logistics. So I was employed by a small practice for a year and I always like to share. I started my practice one year out of residency, seven months pregnant, had just bought a nice House and number one, I couldn't really fail because of the circumstances. I had to make it successful. But I also like to share that because I think if I could start a practice, probably anyone can.

People use all those things as excuses why they can't start a business. I really think that we can do this as physicians and that we should be starting our own practices. So my practice has grown. I have three physicians who work for me as contractors and we just had an NP start with us and now I'm trying to get other people to start their own practices.

So I have a course for physicians who want to implement obesity medicine into their practice. And I've also started doing consults and Master Minds, for clinicians in the obesity medicine space. So I think once you get the entrepreneurial bug, you start seeing all the possibilities. And when you see something and you think I can do this better, you find that path.

How can I do this better? What would that look like? So that's been sort of my journey. This has been super inspiring from all of the panelists here, from leading from innovation at an enterprise level to leading entrepreneurship. What Dr. Gibran is doing to really digital health innovation, what Dr. Ngata is doing and what you are doing as a private practice, this has been super exciting.

So, you know, I want to open this question to all of you as at what point in your medical career you decided and I think some of you have already answered this. How did the transition look like? So I will just open this up to the panel. And if you want to just kind unmute yourself and talk. Yeah for me, it was pretty, pretty obvious from the beginning. I mean, I'd already done a start up before. Came from that space and again was just completely unimpressed with how we were delivering care to our patients and completely, I think, disenchanted by the current legacy health care systems.

And I worked at some of the best ones. Right and so, you know, or at least we claim to be. And so it was very obvious that they weren't going to be able to put me in the normal box, which, trust me, I really wish I could be. It's much easier.

But that was just my experience. So I would say I knew before I even started residency that I wasn't built for, you know, for the normal, normal life experience of a doctor. How did that transition for you look like? It was muddy. It was not simple.

It was know, I think everyone around me was like, you're an ear, nose, throat surgeon. What are you thinking? And, you know, it's nice to have the last laugh, but it wasn't I wasn't laughing, always. And so I think that ultimately there is and I will say the greatest lie ever told to doctors is that we can't be good at business. It is like literally the greatest lie.

And by the way, it is told to us by our peers, the number one person to tell you. And this is the saddest part. I wish I could blame the administrators, but it's actually each other that we should be blaming the first person that will tell you. Are you sure? Do you really want to do this outside of your parents? Possibly are other doctors. And I think that it is incredibly sad because if more doctors stop listening to those lies, you know, we actually have some real solutions for health care because the administrators most of the time don't know what the hell is going on in the clinic.

And so I think it's legitimately a self-inflicted wound. But again, I'll stop there. No and I think I would certainly kind of vouch for that. It's very true.

And also, if you look at the medicine curriculum, medical school curriculum, we do not teach about entrepreneurship. We do not talk about the business of medicine. We do not talk about how can we contribute to make the health care better.

So not I could not have said that better. Dr. francavilla, what you know, this transition and you talked about that you after residency within seven months, you said, hey, I'm going to go open my own private practice. I'll do obesity medicine.

Just talk to. Talk to us about. I think everybody wants to know, how does this transition look like? What should we prepared as a physician to, you know, brace ourselves as so that will be very helpful. I think that you will have people who will tell you your vision is not possible.

I had a way that I thought I should run my clinic, a way that I would do it. And I got encountered often by other physicians who were like, well, that's just not going to work. I was like, well, let's see.

And, you know, seven years later, it's working, right? And so I think you will get those people and you have to be confident enough in your belief that you can implement your vision. And then for me, because financially, I had debt with a House. And my student loans, you know, a new child on the way. I did have to be creative with having a second job.

That was not my dream job as a physician, but it was something that didn't take a lot of mental work. And it was just it was sort of shift work where I could leave it at the door and then I could focus on my business. The other days of the week. And so, you know, there was sacrifice as well, right? Where, you know, to get to my dream, to get to my vision, to do what I felt like I was meant to do. I did also have to do a little bit of work, but in the long run, you know, that has paid off and allowed me to practice medicine really on my own terms.

And I think hopefully start pushing other people to be able to do that as well. That's that's so true. And Dr. Eugenie salad, you have been know, you have a career transition and trajectory which which is really unique as well.

So we would love to learn from you as to how you transition into medicine and transition into entrepreneurship. Thanks from all. So as many of my panelists mentioned, a lot of us got the entrepreneurship bug very early and I've been doing innovation and having a web development studio through the My medical school.

And I think the part of that is not necessarily that you have to absolutely have a company right to run a business. The usually the key part is ability of a clinician to actually focus and proactively work on the problem they discover. Right and I think that's what very often distinguish people who just talk about things versus people who are truly going in building the companies. Because you see the problem, you start to build. And then you go to validate. And ultimately, no matter how successful it is, right, there is something that you can learn from that part of the experience.

And that's ultimately shape your careers because the next time when you encounter, you already have a new better type of a skill sets that you can apply now to this area, in this area. And I think that's part was tremendously helpful and I think a lot of that that's also a combination of luck, right? Because at the time when I was doing medical school and learning was a time of a great growth and adoption of a technology, app technology. Right and then later stage careers, mobile technologies.

But I think at some point you always will have this very excruciating hard decision of do I take a very comfortable, higher paying job, right. Versus I take a risk. And that's something you have to be very frank with yourself, with your family, with people around you. Because if you know where your passion is, then you take the risk. Because very often, even if you fail, you fail up, you will find something that is significantly better, right? You'll see new opportunities. It's not a guarantee.

That's why it's a risk. But at least, you know, you try. And I've been blessed of pretty much going through the good path, right.

And selecting retrospectively a good path to move forward. But, you know, a lot of the path is transitioning, for example, from after residency to the informatics fellowship that was not yet popular the way it is right now. And the field of informatics was not yet a board. Certified board. Right was something that's puzzled my internal medicine program director, but ultimately help to build a lot of the domain expertise or, you know, taking some of the risk of a different kind of a job in medical information management instead of going to die fellowship, which was my family, for example, because that's what I worked towards too, for a long time. And there is a lot like all of us have this small stories, but I think the most important part is when you see the inefficiency, where you truly see the way the health care needs to be.

As mentioned in his experience, that's how the true innovation happens, right? That's where when you look on thinking like, I can do better, I will try. I, I have enough energy in me, right, to convince other people to invest money to work on that. And the entrepreneurial path is not an easy path.

Right I can tell you as a person who speaks weekly, whereas a dozens of innovator, most of them question their decision, especially early on, because you have to work long nights, you have to be that person, right, that's keeping the team together. But ultimately, the vision and the impact is something that drives you further. So be brave, know what you want then. The plan I had.

So Dr. At what has been your experience? You know, to me, I really can't agree more with the rest of the panel. I also in my second year in internal medicine residency, I, I applied to MIT hacking medicine, which, which is one of the biggest hackathons. And they had a collaboration with the American College of Physicians. And when there no expectations, I didn't really know what to do that there are other physicians. But I was pleasantly surprised that there's a lot of interest in that regard.

And I was fortunate to win that hackathon. And that was really that was, of course, ages. Before you look at it, it's before the pandemic and which is not really long time ago, but the pandemic may made it seem like this.

So after that, I, I started exploring what are the other options to, to pursue other than the traditional clinical path in terms of subspecialty. After my residency, I remember I started sending emails to clinical informatics departments in Chicago and the program doctor at UIC shout out to him. He's my current program director. I remember he replied to me while I was in residency. He said, you know, maybe this year is a bit too late after the cycle.

But I will definitely encourage you to reapply next year. It seems like you're really interested about achieving that, that path. So to me, that really opened a lot of options.

So so as a physician, it's always important to have options in terms of what you want to do later on, whether you want to go the entrepreneurship route, whether you want to stay purely clinical, there's nothing wrong with staying clinical or being or doing academic medicine or focusing on research. It's all about having options and supporting these options with skills and expertise. So, so the more you position yourself, you know, do the fellowship. Gaining this skill sets to if you want to do something other than the traditional route, do an MBA.

If gaining the skill sets. If you want to do your own business, which is not a requirement, but it gives you a further option. So so it's all about positioning yourself to, to have these skill sets and choose your passion to, to continue further. So, so to me, always follow your passion. If you're interested in entrepreneurship, try to learn the skill sets to achieve that path. Clinical thematic fellowship is one of them.

Doing an MBA is another of course, having mentorship, so on and so forth. So yeah, it's the main message is all these options are possible for doctors currently in 2023. And if you're passionate about this, I really encourage you to achieve and pursue these reps.

That is fantastic. If I may a little bit react to just some of that. At some point I'll of primary care physician we're interpreters, right? All of them run their primary practices and then we kind of started your transition to centralization, right? So I think the whole notion that clinicians need potentially additional training or anything else around that is to a certain degree not created, but right now kind of perceive because of a growing complexity, right? With this multi-stakeholder groups, we all can run practices and parallel businesses. So I think if there is one thing I would like, everyone who participating that in today's webinar to remember is like you can run any amount of companies, you're already extremely intelligent and you will figure it out. And this level.

I'm sorry. Go ahead. Yeah, I was going to say that this level of insecurity comes from, you know, that this is like the stuff that they put us through. Oh, you've got to get this extra training for this. Sorry gibran, I don't mean to.

Gibran, I don't mean to, like, jump in more, but, like, this is actually part of the challenge that like through training, we've been told that the only way for us to do this is more training. Just as a heads up, the only training of building a good business is building a business. That's the actual problem with doctors right now that we're going through is this is the stuff that has been put down into our heads that you need to keep training and keep training.

And, you know, what we're doing is risk stratifying. We're saying we're literally trying to convince ourselves that there will be a magical moment, which, by the way, anybody will tell you there will never be that magical moment. There is no magical moment where you will feel comfortable of starting your own business or taking the leap. It will always feel like a pit in your stomach. You will always, because it's not this guaranteed salary. By the way, this guaranteed salary approach is what's killed medicine.

Sorry, I know there are some health system people here, but it's actually what has hurt medicine more than anything else is because it's this beautiful little blanket of safety. And you know what's funny is that doctors were the first entrepreneurs before anybody else. Doctors open up their shingles and they started actually going out there and building businesses.

You know why doctors feel like crap these days is because we have 0 autonomy. That's actually why 90% of doctors feel like crap. That's why 117,000 out of a million doctors quit medicine.

Do you know how much money we make? Do how crazy of an irrational decision that is so kind of, you know, just sorry. Just to go back to Dr. salam's point. I think the problem is that we're looking for this magical moment. It will never come.

And if you're looking for that moment, you will people will never take that leap and they don't take that leap. I bet you they will go into early retirement like the rest of the other doctors. Sorry just sorry.

I know I have a saying in some defense of people. Right who may select and prefer to have a consistent salary. It's a choice, right? There is nothing wrong about that. You risk stratify for yourself.

I am. I want to maximize my potential future income or my independence and freedom of decision making versus right. I want to have this consistency and lower potentially financial stress. Right but maybe work stress is higher.

There is nothing wrong with that. None is not better as long as you actually transparent with yourself. Yeah so the last thing, a lot of thing I mentioned is the management skills and I'm talking as an MBA, right? Like if it all depends on the skill, if you're planning to run dollar company and every thing or try to grow in a high level executive in the health care system, then MBA will give you enough skill and direction to self learn. But if you're trying to start a smaller practice, if you're trying to work on some of your startups as an issue person, your experience is what matter because MBA will not solve and frankly, it may harm you because you will actually go into this overanalyzing stream and say, oh, there is so much competition, I'll never do any of that. Now that's such a fantastic point. I think it was guys have really set this up going the segue towards what the Golden handcuffs for physician look like and really wanted to learn a little bit more go a little bit deeper because in the audience who are listening to this conversation, you guys are entrepreneurs.

You guys have proven yourself that you have done something. And the transition, of course, is very rocky. It is it's full of, you know, fright and insecurity is financial insecurities. So maybe if from you all we can hear for the audience as to how did you balance this? I heard from Dr. Frank. Frank and Villa is that she did job and then she started the practice. But how did you think through that? Did the financial work so that you can support your family, your career and you still built? I'm happy to start.

Being upfront with your family, what's the plan? And on your path is key. Why we're blessed as a physician is because we're probably one of the few specialty who has such an amazing opportunity for moonlighting no matter where we are. It's very hard to find another specialty with so much additional flexibility to do a side gig at and have this kind of research. So this also opens tremendous, a lot of opportunities. For example, when I was debating, frankly, the transition to my informatics fellowship, the way I justify it right in my internal NPV calculation was I'm going to work over the weekends, I'm going to take night shifts.

Right and from that perspective, you own your path. And it's when you take something that's ultimately pay you less compared to all of that, the Golden handcuffs that you talk about. It's not that, you know, your family should suffer, especially if you have loans and everything. It's mean.

That's your decision. Mean that you may need to work harder if that's a part of your decision. And then another thing I would mention, what was very helpful for me is always be extremely frugal with expenses because I think there is a very big cultural pressure that's potentially maybe part of a golden hunger to push physicians outside of their financial needs right by bigger houses, bigger car.

That's what you expect to drive. Decide it for yourself. There is no need for a lot of that.

That's that's how you get some of your freedom back. Yeah I mean, I can't imagine as many may know, you know, the Golden handcuffs are very heavy in your nose, throat surgery. And they were not easy to let go of. But for me, it was I was in a very different position because I'd already had a company that had already exited. So it kind of made things a lot easier.

So I think even without that, the decision had already been made. I think the bigger. Perspective here is what people don't realize is that every day as a doctor, let's say you're in clinic. You know your face with a patient that's coming to you with the problem and you're solving problems.

We are born to do this. And so literally from the moment, every moment of training, we're literally solving problems all day. And so everybody, just like Dr. salata was saying, everybody should think about their risk.

Think about that. Just make this a problem that you want to solve. Right the problem is that you.

Let's say you want to be an entrepreneur. I'm not the guy to help you. I never thought I could get it done.

And I appreciate people that can. It just takes a special kind of person. And clearly, as many people can tell, I'm not that person. Right and so let's say that you want to be an entrepreneur and get out of the system and build outside of the system.

Then you've got to just say, OK, what is the Adam Grant has a really good he was one of my professors at WashU at Penn, and he had a really, really good approach, which is start with the end in mind. So you say, OK, this is where I want to be. And you know, Dr. francavilla brown, she kind of mentioned she knew what she wanted. So she said, OK, this is where I'm going to get up. And you can mention it more.

But, you know, you start with, OK, I want to do this. Nothing is going to stop me from doing this. Be as vigilant about that ending as you are about taking care of your patients. Do you give up when you take care of your patients? The answer is most doctors don't. Then why do you give up on yourselves? And I think that sort of you'd be surprised if you can imagine listening to me. A lot of doctors are super Fed up, will come to me and they'll say, hey, danish, what do I do? I'm like, well, where do you want to end up? You're the best person to chart your path.

And along the way you the key. Dr. salad what he was mentioning for me, it was talking to my spouse and telling her, hey, babe, I want to do this.

And that was a hard conversation. And we got there, right? And so once we both, as a family figured out this is where we want to end up, then it was just charting the path there and it's never going to be as pretty and beautiful as you want it to be. But at least we know how to solve problems.

We get patients across that finish line all the time. We do it every single time, so why can't we do it for ourselves? That's how I would approach this question. Others in the panel. Yeah I mean, I, I feel like we share a brain, doctor not to like everything you've said. I agree with 100% And, you know, I think that idea that business doesn't need a special skill set necessarily, right? Like we are tremendous problem solvers as physicians. And that is what business ultimately is.

And I do think someone had said, look, you can get hampered by that. Va when I started my practice, I had people left and right saying that my ideas wouldn't work and I was like, well, why write? Like, I've thought it through to the end. And I think it will work.

And like worst thing that happens is I have to change my direction, right? So when I think about business is what I always coach other physicians on is think about how many small businesses there are out there that are started by people who maybe don't even have a college degree, maybe don't have a high school degree. Immigrated here. I think of my drycleaner that I've gone to for the last 15 years. They struggle to spell my last name brown, and they've had a successful business for 15 years.

Right it's meeting their needs, you know, like, are they a multibillionaire company? No but they are able to have all that autonomy of a small business. And so I think we overestimate the skills we need to start a business. And I think part of that is because there are so many skills we need to have as a physician, you know, we never feel like we have all the information we need to be a physician. We're always learning.

We can always get better. But not everything in the world is like that. And I think when we have that mindset towards business, we are really hampering our ability to innovate and take step forward because we don't have to know everything. Like your business can be successful with a 50% effort.

I'm going to be honest, it's not like being a doctor. You don't have to be perfect at everything to have a successful business. And I think we are hampered by our mindset sometime as a physician and by our training as physicians and limit our ideas because of that.

And to be innovative, we have to think differently than our training as physicians and realize that we don't have to be perfect. We can try things and that there's really no perfection in business. And just highlight that point. If you look through the funding, especially early FUNDING lot of the digital health companies, you'll find most of them are not started by physicians.

A lot of them are college graduates who just seeing a lot of inefficiency and boldly entering. Then they validate the idea, raise the money and hire physician. I'll stop here. But that's. That's tell us something.

This is this is all great. So, you know, Dr. solid and Dr. Nada, you guys kind of talked about this a little bit.

The question probably we can talk about is, how did you raise money? Did you raise money? And what was some of the issues you faced or struggles? Can you share something with the audience here? Yeah I mean, I can start with that. So hilariously and this is not on purpose. But there's another. We just finished another round. It's just.

Well, we finished it a while ago, but the announcement is I just had to get on LinkedIn during this and, and post it as well. So Yeah. So even in this fundraising environment, doctors are getting money, which which is kind of ironic if you think about it.

But it's really the way to think about it is people don't invest in doctors, people invest in businesses, view your business as a business and build a good business in the beginning. There's different portions. And I can kind of I mean, this is a much longer conversation. But, you know, there's a lot of think of it as like fitness tests. That's how they actually talk about it.

First, you start with is there a fit between the confounder of that company and the market? Doctors naturally have found our market fit right. We know what's going on. Often there is something that gets us going, but there's a few people out there.

And by the way, don't talk to any of those people. They're not worth your time. There's enough investors out there. I wouldn't worry too much about these people, but there are few investors out there that say, hey, doctors aren't good at business.

If you meet an investor like that, they're not good for you. Just just go to the other ones, because there's too many doctors that have built $1,000,000,000 companies. Now, it's not even worth that conversation. So, you know, this belief and again, it's the greatest lie ever told to doctors, which is we're not going a business. I think the whole world is waking up to this.

Imagine Abu zayed, who's built incredible health. It's dollar company and by the way, it's dollars in the middle of a recession. Right and so it gives you a sense of there's a lot of doctors that are doing great right now. So founder market fit is where doctors can do well, but then after that, they have to actually build a solution to a real problem, which is called solution market fit. And then they have to actually build a product that solves that problem and the market actually likes the solution and, and the product which is product market fit.

So there's all of these different steps, but the 0 to 1 of a doctor going out there and raising money right now and I'll tell you this right now, in this environment, doctors have a huge advantage. There is a flight to safety. What Dr. Stallard was mentioning that most health tech startups happen to be some person that builds and tries to hire doctors. I can tell you that somebody who walks in as a doctor and says, hey, I've lived this problem, by the way, I'm willing to do this instead of just being another doctor.

That is actually a very compelling argument as investors fly it to safety. So this is actually a really good time to be a physician founded again. Bias but but I'm seeing it myself. And Dr. brown, any thoughts from your perspective, creating a practice? How did you raise money? I took out a loan, so I took out a standard practice loan from a big bank and also was very lean.

I was very, very focused on making a profit. So I really did everything as efficiently as possible. Minimal staff, minimal office space.

When you take insurance, the big challenge is unlike other businesses where you can control how much you get paid, we really cannot control that when we take insurance, which is a very unusual business to be in. And so we really can only control our overhead. So just being very efficient and sometimes that means doing things differently than what you saw in a big box clinic where maybe their budget is a little different and thinking about how to be streamlined, efficient and focus on what patients need as opposed to maybe what you've seen before other places.

So what I'm hearing is we can do it better. What I'm hearing is there are people who are going to fund you with the right idea, creating value and solution. And what I'm hearing is there are several ways of raising money, including traditional loan and investment. So this is fantastic from your perspective. And Dr. Jabra and I want to kind of start with you here.

Is are there any courses or mentorship kind of which is available for physicians to take this path? You know, I am really enjoying listening to this conversation. It's there's a lot of perspective. And then I love the enthusiasm.

You know, it's so obvious that you're super driven and, you know, super excited about what you do. To me, I think it all comes back to self awareness. You know, you might be, you know, driven individual, willing to fail multiple times, learning along the way, you know, succeeding at the end.

You might be interested in doing your own practice, continue doing as an academic medicine or even research and a PhD. There's nothing wrong with any of these decisions. So to me, it's all about having the option to do what you're passionate about and what you're interested in, and to do this to have the leverage and the ability to choose these options. I think wherever you position yourself, whether being an active member in a society or if your internal medicine calls a physician, if you're, if you're into the informatics, AMIA HIMSS. Go out there, meet people.

Learn from people. Networking is key. Having mentors throughout my training and, and currently I have so many mentors to go back to ask them questions, pick their brain about certain problems I'm trying to solve, whether now during my training within my organization or some future plans.

So to me, mentorship is key because you don't want to do the obvious mistake that you can avoid with mentorship. That's one second to me. I think I might present it in a different aspect or I misrepresented when I said, you know, fellowship or MBA.

To me, the core thing about this is knowledge. So so some people, they learn via structured program like MBA or fellowship. Some people, you know, now knowledge and data are becoming more and more commodities. You can Google anything you want to learn about. You can check it on YouTube.

You can like online, you can find anything you want. So so to me, it's just the hunger for knowledge to learn more and give yourself the opportunity and leverage to, to, to execute. There's a lot of courses available.

Of course, we're lucky through our program we have access to, to, to unlimited courses via Coursera is a really affordable and good, good courses if you want to learn specific skill sets, you know, through throughout all these online courses. But you know, it's all about self-awareness and the hunger for knowledge to actually achieve your dreams. That's that's fantastic.

And I just want to add here, Dr. gibran, that, you know, Dr. salad and I went to business school, right? So here there is a, you know, a variation. So certainly that's a well taken point. I would also want to encourage the audience to ask questions from them, ask questions from the panel.

I think this is a fantastic opportunity to kind of engage. But, you know, I'm going to pass it along to other panelists in terms of if there are courses or mentorship which are available to physicians, which you thought were very helpful. So I'll do my role at the AM poster child and say I've learned more from going to am meetings for the last 15 years than anywhere else. So I read the resolutions for each meeting.

I go to the testimony and I have just learned so much about how health care works, all the different policies that we never get taught formally in our education about how medical boards work and how insurance work, and pharmacy benefit managers that were just not taught. And if you don't understand how the health care system works, it can be hard to innovate, disrupt, have a business in it. And so, you know, I've learned I absorb things from my environment. I've learned a lot through my participation in the AMA and for starting practices, you know, they have some resources that they've gotten more robust with in the last few years that I think have been a really big support. And then I think we just heard about networking.

You know, the community around you, finding the right person to answer your question is often easier than taking a whole course. And so for me, my local medical societies have been a resource of who's the lawyer that I need to ask this question, who's the accountant? Who's going to understand my business? Who's the physician that I can go shadow and see how they run their clinic? So you can get so much education from people who've been there through networking and just asking that question of like, who do you use? What do you use? Can I see it? And then I take a lot of meetings. Any time I see someone who's interesting on LinkedIn or Facebook or any sort of product, whether it's a new EMR or a new software, you know, I'll schedule a meeting with that person and see what I can learn from what they're doing. I always get some sort of idea from those engagements. So that has been my self-education in the process.

Wonderful anything danish, Johanna, you want to add? Yeah, I mean, the biggest and again, I think when we talk about formal education versus mentorship, I will always be on the side of mentorship on this. I mean, again, especially as pertaining to individual physicians out in practice and building a startup. So if you're a founder, if you're interested in building a startup, which is a very different, you know, different experience than what Dr. Brown mentioned with building a practice,

building a startup, there's nobody better to talk to than a physician founder. There's many of us out there, a lot of us are know each other. It's a very small community, but it's a very connected community. And again, there's a very unique experience that physician founders go through that people can kind of mentor on. I think mentorship is by far the best way to get feedback is, you know, and again, I think it's important to know that there are other people there are other people that have gone through this experience. I had a physician, mentor, physician friend who mentored me through it.

He'd already built a startup and it was a robotic startup. And I spoke to him about it. And I mean, everything that he said was going to happen ended up happening, which is so funny, like across every domain. So it's, it's super helpful to talk to people who've gone through the same thing. Yeah so I'm relentless learner.

I literally have access to all the courses and everything. I trying not to do anything that I do not operationally can start using. I think that's part is key, right? Because otherwise I know a lot of clinicians who spend time trying to code and go into machine learning. Right and then never actually apply any of that. So your application is key.

So whatever you learn, all of the courses, especially from good platform right now, are very high quality. Just set up the clear path and understand why. Right and I think the clear answer is because I enjoy the process is also an answer, right? So just keep that in mind. It doesn't really have to be extremely, practically applicable all the time because that's how you fighting burnout by doing something you enjoy, but ultimately don't also feel that you need to complete every course for certification. Right I think that's where a lot of that's getting confusing because you put some hours.

Right and let me get to yet another situation at some point, no matter what you're planning to do to raise money or anything else, additional number of certification, and that will not really make that much difference. So focus on answering the practical questions you have. That's that's great. And if the audience and you all are not a part of physician innovation network, I would highly encourage it.

It's a mentorship connection platform for physician entrepreneurs, and that connects not only physicians but also the industry member and stakeholders together so that there is a conversation, there are new opportunities, which is also posted there, for example, if a new startup is looking for physician consultations and others. So certainly something to look out for. We have a lot of resources from piece to physician Section around how to start a physician practice, what needs to be considered for a physician practice, similarly for launching a startup and others. So we try to certainly create, but of course, I think by far what the panel here talked about, learning how the business works, learning how the medicine works is the fantastic thing. I'm going to go switch gears a little bit and talk about what do you guys, the panelists think about physician of the future look like in this new digital enabled care model? So what would we as physicians you think we will be contributing to or what should be leading? Well, that's a tough question. But I think if I can dream a bit, right, I think we will focus on the part of the medicine that's actually not only clinicians and physician enjoy, but what patients actually remember the most.

Right so I think we hopefully by progress of technology, will be liberated more to spend time with our patients. Right, to provide and treat them. We're more empathy and a lot of bureaucracy that's raised, especially during some of the digital transformation, will become very silent in the background base because at this particular point, technology is getting good enough in data entry. Right and we should actually go back to the roots and practice in a way a lot of that was designed and technology just enable new channels, right.

And provide more asynchronous access. But the connection will be driven by clinicians. Yeah to me, it's 2 to roots should go hand in hand. One, we all know where we're heading in terms of technology, and especially now with the new generative AI and all these possibilities.

That's that's great. As a doctor, you need to be up to speed with all these technology. And there's the saying that I would not replace doctors, but doctors with knowledge about AI will replace Doctors Without a knowledge about the AI. So so that's I think it's key. I think the other thing that that's really not goes hand in hand with that picture is the ethical aspect of health care and being a doctor.

So, you know, different to any other industry. We can't really run fast and break things in health care because that will cost us patients' lives. So we need to be really vigilant about the ethical aspect of health care and how to maintain that in the age of AI and technology. Because at the end we're humans and Human ethics and interaction is key in that development. Say a Catalan. Danish? yeah, I can add what I think.

I mean, I agree with Dr. Gibran that physician physicians that use machine intelligence will clearly replace physicians that don't. There's no more room for Luddites in medicine. It's just not something that will work. I think we've seen it obviously accelerate during COVID. But, you know, I wanted to take this a different direction in terms of just technology is one part of it.

But something very specific is happening in health care right now that I think it's sort of if you talk to people in 2000 people, people at that time would say there is no way that the internet. Right, like the bust, there's no way that the internet is going to replace the big box retailers. There's no like, you know, Amazon was like nothing at that time. And I think that we're actually at a similar moment, the trough of disillusionment, of care delivery. And there's this belief that there's no way that private practice will ever be the big health systems. And actually, I think that the doctor of the future is independent.

I think that and I know that I'm speaking Frank and I are agreeing on this, but I actually think it's because there's something really big happening that technology is making the big box, Health care less and less relevant because they can't chew off their own arm. They can't get rid of their heads and beds mentality. I know Dr. salad is fighting the good fight internally to help them understand that something existential is coming, that their physical infrastructure is what's going to kill them.

Just like that kills Sears and Kmart. That's like legitimately what's happening right now. They can't get out of their own way right now. And so there's something incredibly exciting happening around the independence.

So now that what we were calling intact, the rails are going down because all these infrastructure companies that are coming up, a doctor that works for a private practice, will have just as much power of reach that a doctor that works at the Mayo Clinic would. And that's a very crazy thing that's occurring right now. And so does that make the Mayo Clinic irrelevant today? No, but it does kind of bring the question, how is the Mayo Clinic going to remain relevant when Dr. Brown can reach just as many patients and just as much amount of time? It's a crazy world that we're about to go into. And I, by the way, is the great equalizer for that world. And it's incredibly exciting, in my opinion.

Sorry I can't hear you. I apologize for mom. Yeah, sorry.

I think you're on mute. If you just wanted to encourage Dr. Frank brown, any last minute comment there? I think in terms of the thing I'm most excited about on my world, so I was using telehealth televisits for years before the pandemic hit, helped a lot of people implement it. And I think the next step forward and what patients are wanting is more asynchronous communication with their physicians.

So that's something I started using pretty heavily a year ago and it can be used wrong. And I think it will be used wrong by big box and it can be used to abuse employed physicians. But when set up in the right dynamic, being able to message back and forth with your patients in a HIPAA compliant text like fashion has really improved my patient engagement and improved my satisfaction.

I'm able to take care of my patients no matter where I'm at. It gives me a lot more flexibility with my personal life while also being there for my patients. But it has to have the right guardrails.

It works great for private practice where you can create those. I think it has the potential to be abused elsewhere. But I'm loving this, this sort of asynchronous communication with patients that I'm well established with where I can take care of their needs in a much, much more timely matter. So that's my big technologic excitement. Thank you. We're at the top of the hour.

That hour flew by. But I want to thank all of you so much for joining. This was super invigorating. I'm sure we'll have additional conversations. I'm pushing just here. This is our contact information.

If you want to reach out to myself or Stacy Lloyd about the program. And Thank you all so much for joining and have a great day.

2023-04-03 20:11

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