We interview a few clinicians in HTN on their journey transitioning from traditional clinical career paths to more “startup” environments.
TL;DR: we interview a few clinicians in HTN on their journey transitioning from traditional clinical career paths to more “startup” environments.
As a next step to keep the conversation going, we are taking the opportunity to host a live discussion to give the clinician community a chance to meet, network, and ask questions of our interviewees. If you're a clinician and want to continue this conversation live on Dec 2nd with a group of clinical peers and the interviewees, join us here.
As we’ve observed over the last few years more and more venture capital flowing into digital health broadly, and specifically health care delivery models, we’ve also seen a significant rise in interest from the clinician community in working with these companies. We hear from a growing number of clinicians interested in migrating from traditional careers in medicine to more “startup” oriented careers in the digital health community. As a starting point for more dialogue on this topic, we thought we’d ask a few HTNers who have been on this journey themselves about their experiences.
We hope this article serves as a thought starter for the clinician community seeking new perspectives and advice for making that transition from the traditional healthcare system clinician to the health tech world. We’re quite certain that the more clinicians we have actively participating in healthcare innovation, the better.
We’re grateful for our interviewees, Sara Gallo PA-C, Dr. Ivan Beckley, Dr. Afnan Tariq, Dr. Ziad Farah, and Dr. Aman Dhawan for taking the time to share their personal experiences and perspectives on what it has been like navigating their personal journeys from clinicians to the world of health tech - whether that be as a founder, employee, advisor, and more.
Please note: We’ve compiled a selection of their responses to a series of questions below, with light editing for clarity and brevity.
Note for the reader: If you are interested in fuller backgrounds of our interviewees, you are welcome to check them out in the appendix at the end of this article below.
In the context of the startup world, we certainly agree with Sara’s perspective that “viewing clinicians as product testers and advisors is shortsighted”.
Sara: “I think it is surprising when I talk to startups about their solution and realize that maybe they should have consulted with a clinician earlier. Often the patients that solutions should be designed inclusively for are not accessible since they often are not from privilege and those who often are involved in the design of the product aren’t those who really have a wide breadth of perspectives to drive the most inclusive solution… For a health care system or provider/patient problem, it is shortsighted not to involve and elevate a clinician to drive the product and be infused into its design, because ultimately clinicians and patients come with the widest breadth of perspective and are really good at seeing through the fancy and only adopting solutions that were the most informed in their design and experience.”
Of course, there are an increasing number of startups that were founded by and/or have clinicians among their leadership teams. However, we think that there should be greater transparency among companies demonstrating (very tangibly) how clinicians fit into these organizations from the earliest stages.
Ziad: “If you look at the lay of the land now, it is hard to decipher the degree to which a startup organization is including the docs or clinicians as it forms its strategy and designs its operations, even when a physician is at the helm. As knowledge in managed care, healthcare finance and leadership is getting democratized, I expect to see more of that physician ownership or sponsorship of new concepts and startups.”
As clinicians increasingly look to move beyond traditional roles in clinical medicine, there is a natural evolution and expansion in skills and knowledge that these clinical entrepreneurs will need to succeed. Aman highlights this point:
Aman: “Most physicians are given almost no business management training while in medical school and residency. It used to be that private practice was where physicians learned business and management skills. With the decline of private practice, startups have offered a new pathway for physicians to learn new skill sets as clinical operators and founders. Physician employees will naturally gravitate towards businesses led by physicians, so it is advantageous to build strong physician leaders from a strategy perspective.”
Beyond needing to take the time to develop these new business management skill sets, there is also an element of challenging more deeply ingrained behavioral traits.
Afnan: “I think clinicians are often viewed, and often view themselves as the product testers and advisors in the world of innovation, both from traditional medical devices and the digital startup world. In my mind, this has a lot to do with the fact that physicians are historically risk averse, and have spent a lot of time deferring income to invest in their human capital. It’s a big leap to ask a clinician to step outside the clinical realm to take risks as operators/founders. Clinicians who are high achievers have to be willing to embrace the risk of failure… I’d love to see more physicians step out of their comfort zone to enter the startup role.”
Ivan’s journey highlights the ability for clinicians to drive more impact by embracing some of the risk that Afnan described:
Ivan: “For me, my experience of clinicians in tech was really of people who were using their clinical skills not as the main value proposition, but as the almost multiplier of other skill sets. What I mean by “multiplier” is that at my first startup, the CEO was a General Practitioner, but he did an MBA and so he came into deals with the CCGs [HTN note: these are payor entities within the NHS] saying I know why we need to measure outcomes better because of this story, but this is the business metric behind it… The greatest impact for clinicians is where they use their clinical experience and use it in combination with another skillset to really then almost make that skillset more valuable in the healthcare domain, because fundamentally there is complexity in industry in the same way there is to insurance, and to finance, and to all the regulated industries that operate. And so coming with that context helps to weed out the noise and to also understand fundamentally what’s really important to patients because you’ve been there or you’ve been exposed to it in a way that if you were solely a business person coming from the industry you would need a lot of learning to get up to speed.”
In some instances, the complexity and difficulty of building businesses in healthcare can be a challenging adjustment for clinicians as Ivan highlights:
Ivan: “When you’re in practice and when you’re in medicine, rarely do you build things. Normally you follow protocols, you maybe will do some research, but those things have a defined path, but in startups everything is undefined. And I think that experience or awareness of what it takes to go from nothing to something is definitely a surprise. I think there is a lot of failure, there are a lot of missteps, but I think that is part of the journey, and I think that is definitely a surprise for a lot of medics.”
In another regard, Ziad shares his thoughts on a broader misconception of how traditional healthcare views new ideas:
Ziad: “There is a general sense of cynicism around newly emerging ideas and how they are going to truly make a difference in clinical care. Hierarchical medical training makes you a late adopter to some degree in general. It always takes decades anyway to embrace new therapeutics or newly published evidence based practice. Some of that cynicism is probably healthy in terms of right sizing the opportunity and not getting distracted by social media propaganda. But it can also lead to adoption paralysis. The other misconception is pertinent to the culture. There is the overall sense that this new world of digital health can be transient or “the fashion du jour” without real substantive changes in care delivery. I think traditional care delivery has failed the patient and the taxpayer. And so, slow and steady change at the right doses is inevitable, mostly post COVID.
The way to push back on these misconceptions is to first acknowledge the concerns and bad examples out there while highlighting the evolutionary nature of this shift in the healthcare system. That it is going to take several cycles for the new players to get it right and mature their systems. Personally, I am still bullish on the Mayo Clinics, the Cleveland Clinics and the Mass Generals of the world. History gives them an operational edge over newly developing companies and many of them are well capitalized and already investing outside the four walls of their system, in network and in community, so they can always buy it vs. build it.”
Another misconception we have heard from all corners of the clinical world echoes how clinicians perceive the intentions of the tech world building companies in the space.
Afnan: “One common misconception that clinicians have is that the tech world is really only building things that make it more complicated for them. The perception is that each digital “tool” that is added to the clinical armamentarium is to drive revenue on behalf of their employers while taking them away from direct patient care.
Going back to the last topic, I’d love to see clinicians enter the creator/founder/operator realm more. I think as we see more practicing clinicians do so, we will see tools that actually consider the clinician and seek ways to improve the clinician-patient relationship.”
Sara: “ I think there’s a lot of misconceptions that clinicians have about the tech world, especially the intentions of those who create the products. Yes, there might be some people driving technology and solutions that create more healthcare waste and overly simplify health care delivery. If you really dig deep into healthtech startup organizations, most of the time I see people trying to create better efficiencies and find some way to regain that time they get with their clinician which clinicians especially can align with. I also think that the tech world has a lot to offer to the healthcare system and that traditional healthcare really needs human centered technology and tech industry culture. It has the potential to create a better atmosphere for all healthcare workers, especially for the ancillary staff to sustainably continue to support it.
[To challenge some of these assumptions] I think we need to elevate the right people that have a progressive mindset and reframe the way that healthcare should be experienced or could be experienced, given the regulatory restrictions that still will exist to protect patients. I think that we need to share examples of what skills that clinicians should have in order to be successful at building solutions for our healthcare system, and the tech world may be able to help design a way to set clinicians up for success when they transition. Too often, tech organizations assume that because clinicians have the rigor to excel in healthcare that we automatically know other industries and how to operate in them. By providing a much better structure in which clinicians can approach that transition, the faster the tech world will have the right people collaborating on products and solutions and will make this world a safer place to be sick and a place that can promote health.”
We are seeing an increasing number of clinicians express interest in leaving their medical practice entirely for careers in tech – do you see this at all as cause for concern given the existing provider shortage we face today? How does this play out in the future?
Looking at the provider shortages healthcare systems face globally, there is of course a level of concern seeing the increasing migration of clinicians away from clinical roles and into other fields – such as tech, consulting, and more. However, to understand how this might play out over time, it is worth acknowledging a few of the fundamental reasons we are seeing this trend persist.
Sara: “It’s a really deep, cultural mindset that has kept us in these dysfunctional workplaces for so long. The pandemic really pushed everyone to reassess the value of their work in the context of their lives in the short time they have in them…”
As with employees across many industries, there has been an increasing internal questioning happening with folks trying to identify alternative employment options as folks reassess values and work-life balance. This is particularly true for healthcare workers who have faced surmounting burnout and fatigue during the Covid-19 pandemic.
Ivan: “When you compare professional lifestyles of clinicians with other professions with similar levels of intensity, there is a stark difference, across all parameters: flexibility of work, dynamism of the work, autonomy, everything that you need for work to feel fulfilling is lacking in medicine and that’s because of how we’ve set things up and the system hasn’t really moved to accommodate for this new body of clinicians that know they have more choice.”
While the traditional healthcare industry needs to take some time to reevaluate the various systemic issues raised here, it’s also worth noting that the actual choice between working in healthcare and in tech is not necessarily mutually exclusive, as Ziad highlights:
Ziad: “I don’t think the two choices are mutually exclusive. There is so much efficiency to be realized in clinical medicine from participating in tech and other aspects of healthcare system thinking… We are dealing with so much imperfection in the system we inherited. So it is only natural for physicians and clinicians to go upstream and participate in change. I see their tech involvement as a way to cope and combat the misaligned incentives in the healthcare system. At the core of delivering health is this sacred relationship between a patient and a provider. Generally, we have ignored the voices of clinicians in designing systems and solutions that focus on what matters most. So this is an opportunity to bring that relationship back to the center and advocate for the right tools. Medicine remains a practice at the end of the day. By enabling clinicians to participate in building the systems they work within, we could appeal to future generations of care providers and thus expand the workforce.”
In a way, we start to think about this dynamic as a short versus long term view. In the short term, we will continue to see the provider shortage persist as clinicians jump to other industries. However, over the longer term, there is a hope that clinical workflow technologies being built today can expand and augment the reach of providers.
Afnan: “I would love to [see] a shift from top down implementation in provider technology to a bottom up, clinician led deployment. No one understands the workflow issues more than practicing physicians. My hope is that one provider can leave the 60 hours a week of direct patient contact in order to enable 10,000 providers to better deliver optimal care for many more patients. I do think practical experience is really important in designing those solutions, and this is where practicing clinicians may have an important advantage compared to medical students or pre-medical students who leave the field at an earlier stage.”
A primary piece of advice we gathered from a few of our interviewees was to – before anything else – evaluate your risk tolerance when considering joining a startup. It requires a good amount of self-reflection and soul searching when it comes to anyone joining a startup from a structured environment, let alone a longitudinal career like clinical medicine.
Aman: “First step is to look in the mirror at your risk tolerance. Physicians are generally risk averse and startups are risky. If my company disappears tomorrow, will I be okay? I would look at [the] company’s financial backing and strategic advantages in the marketplace. For example, are we the first mover in the space or entering an already crowded space[?]”
Ivan: “First things first, ask yourself do you really want to work at a startup? It’s exciting, but the reality of the chaos could put them off completely. Best way to understand if you need more structure or not is to spend time in startup environments – preferably contributing as an advisor (either paid or unpaid). Find a way to create a process to figure out how I can use my clinical skills to supplement something very tangible in a startup?”
As you’re in the actual process of researching potential companies to join, Sara offers a helpful perspective on what to look for in a company:
Sara: “The first thing I recommend for a clinician looking to join a company outside of their traditional clinical role, is to ask themselves if they think the organization understands them not only as someone with medical knowledge and a degree but also as someone with transferable skills relating to patient behavior, a deep understanding of complex industry incentives, a network of colleagues that can add to their perspective, and an interest in entrepreneurship, system change, and learning new skills that the healthcare system traditionally would not help them develop. I think this is important, even if a clinician is trying to just explore opportunities.”
On the other hand, if you are a clinician looking to start your own company, Afnan provides an interesting perspective on looking inwards:
Afnan: “Along those lines, if I'm a clinician looking to start a company, I would encourage you to look deeply inside yourself, your family, and ask yourself whether you are willing to take that jump - to challenge all of your assumptions, to reinvent yourself, to build something, risk failure, build something again. If you are, go for it. Take a chance on yourself.
Finding the right co-founder is so challenging for physicians, because we spend so much time in the hospital, or in clinical practice. I would say to keep your eyes open, to push yourself to open up to new environments. Try some hack-a-thons, join digital health communities (shameless HTN plug), expand your horizons. In the end, I found my co-founder through a personal network.
What was important though, as I talked to a bunch of other people, was to find someone who was complementary to me, was aligned in vision, and had a shared passion for building something transformational. For me, also, it was unbelievably important to be genuine. Mutual respect is foundational, and helps build a culture. You want (or I did, anyway) someone who is going to challenge you to be the best you can be.
For those of you who have watched the Netflix show “Indian Matchmaker”, this is not the time to listen to Sima Aunty and settle for 60-70%.”
In a couple of interviews we had, we noticed a theme around clinician-led startups being more attractive to other clinician prospects. It seems clinicians serve as a strong recruiting tool for these organizations, acting almost as a risk mitigation factor for clinicians looking to join the company.
Ziad: “Being led by a physician/clinician is a reassuring start. But you always need to look at how decisions get made at operational and strategic levels. It can be difficult to navigate this during an interview. You might ask a specific question about a strategic initiative or relationship with outside partners and see if the physicians were consulted or were represented there.
I would try to measure the startup work against that concept of the sacred relationship between a patient and a provider, most importantly the primary care, and see if the startup work poses any risk to that. There are a lot of short wins “right-in-the-moment” mentality in startups. So, I would try to measure it by the degree to which it helps strengthen a patient's connection to their ecosystem, avoid further duplication and fragmentation and build sustainable long term solutions. “
While we received a couple of notable responses to this question, our takeaway is it’s still not clear. We haven’t yet seen enough stories with a defined view of success to peel back the layers to see what structures worked to achieve that “success”. Much of this comes down to how comfortable you will be within the organization, coupled then with, are you comfortable and impactful, or just comfortable?
Aman: “I feel the dyad healthcare model is best. It fills the operational and financial expertise missing in the clinician. There are rare birds that can fill dual roles, but that is not the norm. As mentioned before, an organization with a physician CEO will have an advantage to attract physician talent.”
Ziad: “I have reported to both the COO and the CMO throughout my career. I am biased and generally think the medical folks need to report to the CMO. It’s a faster path to escalate matters pertinent to the clinical model. But I see this org structure as a reflection of a larger framework and culture in an organization in terms of how it operates and how it defines scopes and responsibilities.”
For clinicians looking to join a startup and are either in the process of interviewing or might be starting interviews in the near future, Ivan shares a couple frameworks his company uses to evaluate clinical candidates. While every company will of course have a different set of interview processes, we found these frameworks and questions helpful to consider for any candidate.
Ivan: “For those who are operators, we measure them how you would measure any other operator, but with an awareness that they bring an “extra special sauce” is what I call it – which is some context or awareness that they know the reality of what we are going to be delivering or operating. And that does help. [Another thing] that we realize is that these people, and it sounds funny, have to be fluent with tech. And a lot of clinicians, and this is across all age spectrums actually have a difficult time with this. Normally when clinicians come in, they’re like ‘[Wow!] You have so many systems.’ There is a task manager, there is a follow-up, there is a reviewer, there is a marketing process…there’s bloody Slack. Normally, in [clinical] practice there is an EHR and someone emails. So the first thing we ask them is how do you feel getting up to speed with different technology platforms? And then the next thing we help understand is how much are they willing to go beyond their clinical role? We want clinicians to give us feedback, not just see patients and go home. How much do you want to be involved in the product development cycle? Do you want to be in our marketing? Do you want to be [in] those other aspects? We need feedback between our clinical team and our product team, and there needs to be this symbiosis. One of the biggest barriers we’ve found is that clinicians have this mental block about changing things. Like if they see a problem, they’ll end up just doing other things to overcome it, because that is what they are used to. And so really just reengineering to say if you see a problem, that’s an opportunity and we can fix that through our product. So on the clinician side I would say it’s their ability to be fluent and pick up new platforms and their willingness to contribute to change. We need those two things for a clinician to be really effective at a company.”
While there are many instances of successful transitions of clinicians moving into startup and operating structures, it is also, of course, important to consider how transitions might not go as smoothly. You’ll see a common theme around issues arising when there is a lack of role clarity and transparency:
Afnan: “One way I’ve seen this become an issue is with not being clear on expectations. Some clinicians want to be involved in product development, others want to take more traditional routes. The trouble arises when the expectations are not the same for all parties.”
Ziad: “Lack of clarity in roles and authority to lead, inconsistent flow of information from executive leadership, lack of clinical strategy, disempowerment, lack of feedback loop in order to allow the clinical leaders to share their knowledge and expertise.”
Aman: “I have seen it difficult for physicians in a leadership role where reporting physicians feel as though the physician leader is ‘puppet’ for the ‘suits’. These physician leaders lack authority and quickly lose the respect of their physician colleagues.”
In many industries outside of healthcare, technology has streamlined processes and improved experiences at an incredible pace. Within healthcare, we have seen a slightly different story play out. Technology, in many ways, has brought great and necessary change to the industry, but also presents critical and important risks to patients, which must be carefully considered.
We often see a tension between the “move fast and break things” culture of the tech world and the highly regulated, delicate, and legacy structure of traditional healthcare. Within that tension, there is a meaningful conversation that needs to take place to find balance between the two conflicting cultures in order to ultimately see progress forward.
Afnan: “I think this is actually one of the best ways to frame the importance of the role of clinicians as founder/operators. Clinicians understand better than most the level of risk inherent when dealing with patient lives. One of the issues with only involving clinicians as advisors later in the process is that they can often tell you why something will fail, or what is wrong with it. I think an important differentiator about moving clinicians into founder/operator roles vs. traditional consultant/advisor roles is that they would actively have a hand in creating the solution, within the boundaries of safety. I love to see what happens when people collaborate and brainstorm, defer judgment, encourage wild ideas, and most importantly, BUILD on the ideas of others. I think a clinician who can help build on the ideas of others is the kind of creator/founder/operator I’d love to see more.”
Aman: “The rise of consumerism in healthcare has introduced new risks for patients. It may be necessary for government to step in at times to require entrants at a certain size to abide by certain financial and clinical standards. It would be best for new healthcare entrants to devise a plan for the long-game. To have longevity, you will have to [demonstrate] consistent superior category outcomes measured in years and not quarters.”
When it comes to communicating the often challenging realities of healthcare without seeming unenthusiastic about change, Ivan offers a very insightful answer.
Ivan: “One of the great ways that we have found with people who [have]... non-healthcare [backgrounds] is to put them in healthcare environments…Often what inspired clinicians to go into healthcare was because they saw the reality, but they also saw how meaningful it is to the patient.
…To talk about the problem without talking about what that does to someone’s life, I think misses why a lot of clinicians get into it because they know when things go right how amazing it is in someone’s life. This is like why they are jumping…if you could fix this, what this does to every person’s life to interact with is amazing. And so I think often the commentary about how bad healthcare is misses the whole side of the patient experience and how amazing healthcare outcomes can be for people. And I don’t know how you do it other than placing people bang smack in the reality of it.”
In our process of interviewing some amazing clinicians turned health innovation enthusiasts, we were excited by all of the knowledge, stories, and advice they had to share. Of course, each of these initial conversations sparked even more questions for us, and we are hopeful they will for other clinicians evaluating similar journeys. As a next step to keep the conversation going, we are taking the opportunity to host a live discussion to give the clinician community a chance to meet, network, and ask questions of our interviewees.
Join us on Friday, December 2 at 12pm ET for a HTN Virtual Discussion - Clinicians In Health Tech Speeds Meets event. Please note this discussion is for clinicians only. Clinicians can register for the event here.
Sara is a PA (Physician Assistant/Associate) with over 12 years of experience as a primary care provider focusing on value based care, mental health codiagnoses, and social determinants of health barriers. She believes that health care can be reframed to empower patients of all lifestyles, especially for underserved and marginalized populations. She is passionate about inclusive care delivery models that meet patients where they are and prioritize patient and provider experience. She has held multiple roles at startups, leading business development, product design, and healthcare policy and advocacy. Sara now works as the VP of business development at Medicaid-focused telehealth startup Care on Location Building innovative telemedicine care delivery models for the Colorado Medicaid population to close access to care gaps throughout the state.
Ivan is the CEO and co-founder of Suvera, a virtual chronic condition management company. He received his medical degree from University College London and has been a clinical entrepreneur at the UK's National Health Service since 2017. Ivan completed internships at companies including Google’s DeepMind, AdaHealth, and Outcomes Based Healthcare. He serves on the board of Barnet, Enfield, and Haringey Mental Health NHS Trust. Ivan is also the Presenter of Biased Diagnosis, an Audible original podcast uncovering why race matters in healthcare.
Afnan is a lawyer by education and a physician by training. He trained in Internal Medicine at the Brooklyn Hospital Center, , Cardiology at UC Irvine, Interventional Cardiology at Lenox Hill, and Structural Heart Disease at NYU Langone Health. After working in private practice, he was chosen to be a founding Interventional Cardiologist at the CRF-Edwards Lifesciences innovation team where he worked to identify unmet clinical needs and develop novel solutions. Since then, he remains active in clinical practice, engaged in leading roles in national cardiac societies, and has been developing digital health solutions to enable patients and providers.
Ziad is a geriatrician and a palliative care physician by background. He started his career as a hospitalist in a DSH hospital in Massachusetts (Lawrence General) in 2010. After helping to start an interdisciplinary palliative care service at the community hospital, he took on managing various clinical and delivery system transformation initiatives. He worked his way up to become CMO of the hospital and eventually made the leap into startups, landing in the home care space at ConcertoCare. Ziad now works as the New York Market Medical Director at Cityblock Health.
Aman started his family medicine career in private practice for five years. He went on to start two fee for service primary care practices for two local Chicagoland health systems. In 2016, he joined Harken Health, a health insurance startup operating under UHG as the Des Plaines Clinic Medical Director, eventually transitioning to the Harken Chicagoland Market Medical Director. Following Harken’s closing in 2017, he joined Northwestern Medicine and has been working on developing a new primary care model for the high risk and Medicare populations.