A bright engineer and their pedigreed partner decide they are going to capitalize on an exciting new research study which can accurately diagnose CAD by just listening to a patient read a sentence aloud. To do so, they’ll take their idea before some venture capitalists and move forward with some seed capital. They are certain this is going to be a huge game-changer in the cardiovascular space. It’s just that clinical innovation doesn’t always lead to meaningful clinical outcomes. The major disconnect here often is that a physician lead in a healthcare startup never got fully involved with the product to give the right input.
A few years can go by, many dollars spent, and finally a physician lead is brought in. Now, this healthcare startup doctor is supposed to offer their clinical input which is too late and likely ineffective.
I’ll get right to the point – you can diagnose anything early, from CAD to PVD to dementia but what value are you bringing to healthcare? What changes are you realistically expecting from this intervention?
Chances are you have a payer in mind; maybe the end consumer (aka patient) or the insurance company or a medical device company. Regardless of which, at some point, profit has to be made by someone and that’s the clinical piece which few have cracked.
You can diagnose a virus early in a pandemic but it won’t matter if the silent transmission happens before the patient even considers testing. Or, even if you have a continuous testing device which the patient can wear on their wrist and this test would show immediately if someone is positive, how much compliance can you bank on? How effective will it be for a virus which is highly contagious?
I will make the shocking statement that diagnosing CAD early in a patient won’t change their outcome. The morbidity and mortality factors will remain the same.
The Clinical Factor
I can tell a patient 20 years before they are diagnosed with diabetes that with 100% certainty they will get diabetes. Doesn’t matter. Their behaviors won’t change. And medications won’t prevent diabetes and likely not delay it significantly. With this new factoid, what’s the cost-saving to … anyone?
Physicians know what can change the course of a disease and we are the closest force to getting anyone to change. Even then, we’re not all that effective – that’s human nature for you.
Just because an incredible technology exists doesn’t mean that patients will adopt it. Somehow with antibiotics, this isn’t the case. Even though most of the effects are placebo related patients will readily take antibiotics.
For each patient group and patient population or customer base, you’ll need to know what will drive change. It’s just as important to invent the technology as it is to get buy-in from the patient – this latter part requires clinical expertise with a lot of empathy.
Targeting the Right Audience
Over the past 2 decades of practicing medicine, I have identified so many different patient pockets. There are groups of patients who all behave the same, buy into the same market hype, follow the same lifestyle, or will make sudden lifestyle changes on a dime.
As a healthcare startup if you’re doing market research and you can only see 2-3 patient categories you’ll end up spending a ton of money on the wrong patient base.
The right audience will benefit the most from the right intervention. Adoption in this group is sometimes all it takes to create the adoption wave.
You then need buy-in from the physicians and the medical community. If the patients want it then chances are the physicians will follow suit.
So now you have this incredible patient device or software or tool – how do you inject it into the life of the patient?
When you go to the transmission guy he’ll tell you that you need a rebuild. You can probably drive the car a few more thousand miles but by then the rebuild might cost more. Your choice. Take it or leave it.
There is something really pure about going to a good mechanic, you have the option to take their advice or step aside for the next willing, paying customer.
It’s not the same in healthcare. Patients are pulled into so many different directions because health is emotional and not the science that it should be. You need a clinician – a seasoned one – who can properly introduce and sell the patient on this intervention.
Not your marketing guy, not your product manager, and definitely not your sales team are going to accomplish that.
Physician Leader Engagement
So you have a great product but you don’t have a physician whom you can bring along to believe in your product. This is yet another common problem in healthcare startups where the product is good but you haven’t had a physician engaged in the company long enough to peddle it.
What you’ve created likely is complex – at least in some ways. A physician leader has to spend many months with your team and your product to understand your flow and grock what you are hoping to achieve.
You wouldn’t bring on a CFO just for their name and yet many healthcare startups bring on MDs because of their pedigree – often too late and too disengaged to matter.
Healthcare Startup Culture
I have consulted for enough healthcare startups to know that the product and results are valued above all.
The exact thing that is wrong with this concept is what is wrong with healthcare now. We obsess over blood pressure numbers but can’t make heads or tails of it. It is high in John who lives to 90 and it is just a touch high in Jane who gets a stroke at 50.
If you aren’t pressure-testing your results on real patients and aren’t involving an experienced clinician with holes in their boots you’re just inventing the car that can go 1,000,000 mph with nowhere to actually go that speed.
A healthcare startup physician who has been with the product long enough can not only lead but figure out ways to test the efficacy of engagement with the product. Something that market testing just won’t deliver as effectively.
Whenever I was brought into a project on a different team in the company it was already too late. A lot had to be trashed and we had to rebuild from scratch. This is frustrating for everyone.
The Hidden Talent
The healthcare startup doctor who is excited to work in a healthcare startup doesn’t have the boots-on-the-ground experience you’d like. While the doctors who have the experience aren’t willing to work in a healthcare startup.
The natural progression of a physician’s career should be going from clinician to teacher to advisor. Convincing the right physician that they will make a far bigger impact in healthcare by supporting a healthcare startup is the key.
You’re a sell-out if you go working for health tech. This is a tough letter to wear on your chest and you’ll have to justify it to colleagues and friends constantly. Unless there is a clinical side to the work where outcomes can be measured, even in the most archaic of ways.
Forget the Pedigree
“We have Dr. Smith who is the head cardiologist at John Hopkins and went to MIT undergrad and is married to a cardiothoracic surgeon who went to Harvard.” … crickets.
Doctors aren’t impressed by pedigree. Patients aren’t impressed by pedigree. Only big businesses, executives, and medical groups care.
The doctor who will add the most important clinical factor to your healthcare startup likely won’t be that pedigreed MD. Why bother. They can ride the rainbow to the pot of gold on the back of their medical school alone.
Interview the doctors based on their passion in that particular field. Ask them questions to see how they learn new things and understand complex problems. Then spend the next year teaching them what they need to know to communicate with your engineering nerds.
Communicating with Nerds
Doctors are nerds no matter how cool they act with their Teslas or BMWs. Engineers are nerds – well, they’re nerds. And yet these 2 groups aren’t at all alike.
Doctors have been beaten down to go through the motion and don’t think critically any longer. Engineers are constantly using their critical thinking skills and rarely can just enjoy being on autopilot.
Doctors are burnt out from lack of autonomy and because they rarely see results from their hard work. They need to realize that the more effort they put in the more they’ll witness in results.
Bringing a doctor along and helping them understand the logistics of data science and the tedious process of training models seems burdensome. But there is always 1 engineer who is the perfect person for this job.
To accomplish that you just have to pull on the heartstring of the doctor. Our empathy organ is massive and easily manipulated because we want desperately to make a difference.
Part-time or Full-time
Bring your first physician leader on as a trial – as a healthcare consultant. Let them interact with the teams after they sign their NDA. Let them test the potential of the product and get some feedback from them.
Physicians are accustomed to working as contractors getting their 1099 pay. This is a great way for the healthcare startup to test out this physician lead.
Don’t forget that your physician lead or clinical lead will need to do some independent research. Let them know you’ll reimburse them for this time.
US Physician? Resident? NP? PA?
Experience with patients and in different clinical settings trumps a lot of these other factors. For example, it doesn’t matter if you’re a DO or MD – as long as the experience is there.
A solid NP or PA can be an incredible tool but you’ll have to vet their experience. These clinicians sometimes get stuck doing task-based work without enough critical thinking.
Residents can be okay if they are very knowledgeable and really interested in your healthcare startup niche. Otherwise, I think the lack of clinical experience may not be enough.
Needless to say, the US healthcare system is a beast of its own. If you don’t know how to talk to patients in fluid English it’s going to be tough.
How Much to Pay
In the beginning, a physician leader who works only a handful of hours a week should get at least $150/hr. That sounds like a lot but you’re asking them to work somewhere else as well and your work likely will take far more brainpower.
I have consulted for some healthcare startups for free the first few months because when I think there is long-term potential for something meaningful I don’t care about the money.
Maybe you’ll find someone who is equally passionate about the product and patient population and is willing to cut their pay if there is a potential for more hours and income in the future.
For someone who will be your full-time chief medical officer or physician lead, you’re looking at around $150k a year. My experience with healthcare startups is that they move so fast and there is so much to do, I doubt any physician leader will put in less than full-time.
A physician could be enticed by getting their name on some research papers or getting a CMO to put on their resume on LinkedIn. Or because the work is something they are really passionate about.