What makes the physician entrepreneur such a valuable person to be a founder is, by virtue of their education and training, and then helping patients, they have developed a prepared mind. They’ve seen patterns in patient problems and the delivery of care. Because of this experience, they are most equipped to identify the existing solutions where they work and where unmet needs remain. Today, host Jeff Smith focuses on how the physician entrepreneur can identify problems and develop therapeutic solutions to help their patients and improve healthcare.
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The Physician Entrepreneur’s Journey: Identifying The Problem And Scaling Medtech Solutions
On this episode, I speak about the specific task of choosing a problem that you are seeking to solve as a physician entrepreneur. I get into some of the important considerations, and specifically talk about the time it takes to bring a product to market, and ultimately exit. I hope you enjoy the episode.
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This episode is going to be a little different in the sense that we don't have a guest. What I'm talking about now is the physician entrepreneur’s journey. A big focus of my career has been working with physician entrepreneurs that, through their training and their experience, have a unique perspective on the problems in healthcare. That's been most of my career, and it's the thing that I find I'm most passionate about.
The task of creating a company, developing a product, filing intellectual property, raising financing, building a team, and ultimately trying to scale the solution to help patients, that's the thing that gets me out of bed in the morning. For specific focus today, we're going to talk about selecting which problem to pursue. You'll notice that I talk about the problem versus what I often see and a mistake I've made is having an idea for a product, and then looking for a problem that it would help.
Starting at the beginning, what makes the physician entrepreneur such a valuable person to be a founder is because by virtue of their education training, and then helping so many patients over, whether short, medium or long career, they have developed what people refer to as the prepared mind. They see the patterns in the delivery of care. They see the patterns in patient problems. Because of this experience, they know the existing solutions, where they work and where there remains unmet need.
For the purpose of this discussion, we're going to talk about the therapeutic solution, meaning this is either some type of biologic, a drug, a medical device or diagnostic. I'm very passionate about digital health and any type of electronic solution, maybe the plumbing, you could say, the infrastructure of how healthcare is delivered. For the purpose of this discussion, we'll focus on patient has disease. The pathology is either well or poorly understood, and the physician entrepreneur has an idea for a specific way to help that patient.
The success or failure of the venture has a lot to do with how passionate the founder is about the specific problem.
The first thing that I look for when I meet with physician entrepreneurs, either to be a co-founder, advisor, a board member or an investor, is how passionate is the physician entrepreneur about this problem? Peter Thiel describes it as what's the secret that the founder knows through his or her hard work in the field that nobody else knows? There are certainly people, and I've been this person, that are really passionate about starting something. That's where the core of the passion lies, “I want to create a company. I want to raise a financing. I want to be a founder and I want to bring something to market.” I think that's great enthusiasm, and it's important for what it's worth.
However, the success or failure of the venture will have a lot to do with, in my opinion, how passionate the founder is about the specific problem. If the problem is not really what gets you out of bed in the morning, it's more about being successful in having a company, when the inevitable challenges and obstacles are presented, it could be harder to keep that enthusiasm up.
A place to start in my opinion if you are a physician entrepreneur, is in your day-to day treatment of patients, if there's a part of the delivery of care, the whole continuum. I think that's important to look at. This has been referred to by Marc Andreessen of Andreessen Horowitz, the venture firm. Much of US healthcare is disease care, and the solutions are really focused on the end stage when everything has gone wrong. I referenced the continuum of care because what many physicians tell me is the way we can improve healthcare at a macro-level is to look earlier, and preventative care being a core of improving overall the population's health.
If you look at a specific patient, let's just say it's a patient with diabetes or a patient with some type of coronary disease or heart failure. One of the ways to find inspiration and patterns is to look at the beginning of the disease progression, where the key points are where the disease actually gets a lot harder to manage, and when are current interventions typically used.
Let's just use the example of an interventional cardiologist. This particular physician entrepreneur by virtue of her specialty is routinely doing stents and angioplasty balloons because patients have developed coronary disease. If you think earlier in the continuum of care, maybe that patient had some type of Statin therapy or something to reduce their cholesterol and minimize the risk of atherosclerosis. You have this arc of care where patients, through genetics, lifestyle, they start to show risk factors for coronary disease in the form of blood tests.
The primary care physicians see that their lipids are not right. They prescribed some type of medication that has been proven to reduce the risk of mortality or coronary disease. Then there's this gap. The patient is not controlled, their LDL remains high. At some point in the next step, they require stenting because their vessels have so much plaque that it's closed.
It's easy to look at that continuum, that whole patient journey and say, “That's fine.” The patient presents through standard of care tests. Their lipids are not right where they need to be. They're offered some type of pharmaceutical intervention, suggested that they have lifestyle modifications. Unfortunately, many of them will go on to require an intervention. They may get a relatively, minimally invasive surgery or a procedure like a stent or an angioplasty. Many of them are well-served by that, but then some group of them will go on to need a larger intervention, and they're not commonly performed anymore, but maybe they need a bypass surgery performed by another surgeon.
One of the patterns that I look for, and I would encourage other physician entrepreneurs, because this is where you have a systems awareness and it’s connecting, is if I'm the internal medicine physician, when I refer to the cardiologist, there is an opportunity. Sometimes, in the transition from one provider to the next specialist, because the specialist is by design focused on a very specific set of interventions and treatment modalities, the cardiologist then recommends an interventionalist who then may lead to recommending a cardiothoracic surgeon. Somewhere in that chain, and part of it has to do with the design of our system where we're always referred to the next person.
We typically have to be seen in order. If you're feeling like maybe you have high blood pressure, you don't meet initially with the cardiothoracic surgeon. By the way, medicine is referred on to specialist. Also by the very nature of specialty medical training, there are seams. A lot of the opportunities for bringing new solutions to market could be just simply improving the collaboration between the referring specialists. It could be some type of intervention, a device, a diagnostic that would allow one specialist to do one more additional thing before referring on to the next specialist.
We see this certainly in orthopedic and neurosurgery where a typical neurosurgeon, maybe when he or she holds a clinic, if they see 30 people, many of them will be recommended to continue conservative care because they're just not surgical candidates. That usually results in them being referred back to somebody. Maybe they start with their primary care physician and then offered some interventional procedure like an injection. They get imaging studies, and then they go to the surgeon.
The surgeon might determine that their disease hasn't progressed to the point where surgery is indicated or will help them. Then they bounce back somewhere. Often, the pattern I see is in those transition points. It’s an example for physician entrepreneurs of where you might see inspiration, but I guess the point that I'm making is that there are patterns and places to look at the seams of healthcare, where there is unmet need.
Going back to this beginning, my belief is that as a provider, what are the things that frustrate you the most? Where are the obstacles every day, the daily irritations that are in grind? Where do you routinely see patients unhappy, or their experience is something that you regret, and couldn't be better? It's those areas that I believe are a great source of inspiration, especially the more frustrated, sad, annoyed, that this problem exists.
If you can really connect to just how deeply you feel about that problem, I think that's an important well of motivation as you start what can be the very long and arduous journey. That would be step one. Then, it can serve as a springboard for inspiration and ideation. You think about what would it be like if it was different? One of the things I routinely hear from physician entrepreneurs, which is a watch out, and I think it's very self-aware, is that the very nature of medical training, much like legal training, is based on predicate.
Many opportunities for bringing new solutions to market could be simply improving the collaboration between the referring specialists.
The way many physicians are taught medicine and encouraged to practice is based on what has been done in the past and been shown to be effective and safe, which makes total sense. That mindset is the same mindset that can also inhibit new ideas and cause some providers to be reluctant to consider the new thing because it's not based on precedent.
To review it, one, you have this observation that there's a part of the patient journey that is routinely under-serving the patient. As the provider, it's frustrating for you. It's regrettable that the experience, the outcome is not better. You can connect deeply with fixing that problem. Now, through ideation and brainstorming, you can start applying all that energy and creativity to a number of different solutions. It starts to get really fun because the why is, “Why am I doing this? Why am I putting in all this work? I'm tired. My family is doing things. I'm busy at work already. Why am I spending time on this? It’s because I really want to fix this problem. The world will be better. Healthcare will improve. Patients will be happier.” Then the ideation starts.
What I was taught, and I think is the right approach, is don't think why it won't work in the ideation stage. Often, good ideas are shot down. Think about what would it be like if things were different, and the constraints that could easily cause us to say, “Let’s not pursue this further. Let's start working on that.”
Most of these are not my ideas. It's just things that I've read and been taught and practice. The next phase in the ideation stage is the underlying technology upon which your solution is built. Ideally, it is an exponential technology. A great example would be based on microprocessors that got twice as fast and half as expensive every year. It’s the famous Moore's Law. Or something where billions of dollars are being invested by huge companies to accelerate the growth curve. Something like cloud storage or machine learning. What you have is you're benefiting from this growth curve of an underlying technology that you and your partners are not having to finance.
What it also could likely ensure is that one of the technologies that you're building upon is going to continue to get better, less expensive each year as the greater marketplace adopts it, and does a lot of the hard work investing in it. A great example of that would be mobile. If you look at the growth that Facebook was able to achieve, and really all the apps, Uber, they didn't have to develop the iPhone. They didn't have to make iPhones ubiquitous and Android devices. They didn't have to invest in cellular towers to 2G to 3G, 4G and 5G, all of that existed.
They were building a mobile solution based on this enabling technology of ubiquitous mobile, really broadband internet in the pocket of up to 4 billion people worldwide. It was really a choice. Uber is different. Facebook made a critical decision to pivot from web to mobile, and that went really well for them, but Uber is a native mobile app. That's another thing to consider.
Back to a more of a healthcare solution, many solutions that are therapeutic will likely have a digital component. I was always taught and believed in trying to get back to first principles when thinking through a new idea. What is the underlying technology we're building upon? What is the potential trajectory of that fundamental technology, accelerating its curve, its adoption, consumer enterprise belief in it? If that technology were to continue to accelerate, what could be possible with your solution that you wouldn't actually have to fund and finance?
In conclusion, this is going to be a very specific succinct style. For the physician entrepreneur, make sure you're absolutely obsessed with the problem. It could be because you're so frustrated with it or you're just so disappointed that patients have to suffer, but really make sure that you have that well of motivation.
Next, try to look for inspiration in the scenes of healthcare, where the continuum of care has little break points. The third is as you start the ideation process, consider the underlying technology that you're building upon. Finally, don't worry about where things are now. Don't, in the ideation process, be constrained. I always joke with our teams like, “Let's not let something like physics get in the way of our ideation.” In all seriousness, think big, as cliché as that may sound. In the brainstorming stage, don’t be constrained by what is possible today.
Hopefully, that will help. In wrapping up the episode, I would just say, please look for more of this type of content in future Unmet Need episodes. I’m still very excited to have a roster of guests that we have planned and scheduled, but in an effort to really be succinct and share some of these key physician entrepreneur starting points, we're going to do a few of these episodes occasionally as well. I hope you enjoyed the episode.