Why medical schools discourage entrepreneurs

As a medical student looking to explore entrepreneurship, I quickly came across Shiv Gaglani’s October 2013 article in Entrepreneur, entitled “Why Medical Schools are Pumping Out Entrepreneurs,” in which he the highlights similarities and differences he sees between medical students and entrepreneurs. I was struck by his proposed differences — he does not share his take on their origins, so I have come to delineate my own view.

Medical students are not by nature risk averse, obedient, individual-driven, and lacking imagination. Rather, these traits are fostered by nurture: they are acquired, the product of modern undergraduate medical education. Incoming medical students are faced with several obstacles and unfavorable incentives to engage in an entrepreneurial mindset and activity early in their medical education, if not before:

1. Disincentive: conservative, traditional learning pathways. To be considered as serious candidates for admission to top medical schools, applicants must “check off” a variety of formational activities and experiences during their undergraduate years to include in their medical school applications. This pre-med “checklist” mentality gradually diminishes one’s capacity for imagination leading up to medical school enrollment. Then, in the first two years of the average medical school curriculum, students are primarily learning through memorization rather than through experiential discovery, further solidifying this sense that medical training is a path to conform to with restricted room for creativity or invention. Medical students are eventually encouraged to think individually during their clinical years, but by this time one’s dopamine-reward circuit and the School’s clinical grade expectations are best fulfilled by the regurgitation of memorized medical knowledge rather than by creativity or ingenuity.

2. Obstacle: time. It comes as no surprise that medical students are constantly studying or spending 80 hours per week in the hospital. There is seemingly an infinite amount of medical knowledge to be learned in the classroom and on the wards, and we sacrifice sleep, exercise, and relationships to consume as much as we can from the fire hose. But what would every entrepreneur, successful or not, say is crucial to developing an entrepreneurial mindset and skillset? Time. Time to succeed, and certainly time to fail (and often). In medical school curricula, there is no dedicated time for us to get our “hands wet” in entrepreneurial activity.

3. Disincentive: money. The enormous amount of debt that most medical students incur during medical school, added to the heavy pre-existing debt from undergraduate education for many, discourages risk tolerance. We feel compelled to power through medical school to begin to earn that reliable income promised to us to pay down our debts: that delayed cash flow is at the forefront of most students’ minds. And, largely, medical school faculty and administration draw their incentives from number of manuscripts published, grants, set salaries, and other health system politics that discourage involvement in, and incentives for, programmatic or institutional entrepreneurial activities.

The obstacles and disincentives found in modern medical education prove difficult for entrepreneurial medical students to overcome. I’ve met several with entrepreneurial mindsets, including Mr. Gaglani of Osmosis and Alex Ryu of LifeGuard Games, and know there are many more out there: must they take time off from their medical training, leaving the very environments that could benefit most from their creative thinking and tenacious activity?

Modern medical education, and its future physicians and current patients, suffers when they do. We must move alleviate the aforementioned obstacles and disincentives and incorporate into the medical curriculum exposure to and training in entrepreneurship principles to better equip the physicians of tomorrow to tackle the pervasive problems within health care today.

Jonathan O’Donnell is a medical student and can be reached on Twitter @jonodoc.

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  • Dr. Drake Ramoray

    I agree that medicine training does not cultivate a sense of entrepreneurship. I also know that you probably didn’t pick the title. I think a more appropriate title would be “HOW medical schools discourage entrepreneurs”. Perhaps a minor point, but use of the word “why” suggests that it is something that is intentionally done. Like, why do medical schools push for Patient Centered Medical Homes when there is little data that they work and much emerging data that they don’t. The same institutions that push for evidence based medicine, are pushing a healthcare model that has little evidence that it will work and will probably make primary care doctors obsolete.

    I don’t feel that one of the goals of medical school is to produce entrepreneurship not that they have some intent to discourage it. You can certainly make the case that they should, but given the time constraints in training and the current push for decreasing the length of training, I don’t see entrepreneurship being a formal part of medical education anytime soon.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I am a bit ambivalent about this. I’m not sure why medical school should teach or train people for entrepreneurship. I don’t even know how you do that formally…
    Perhaps encouraging independent thinking can help, but before that becomes possible, the fundamentals must be somehow mastered, and the fundamentals in medicine are pretty extensive, and they should be so, considering that the first day after graduation you are empowered to cut people or order them to ingest chemicals of all types.
    I’m pretty sure though that entrepreneurship is not served by encouraging students to get an MBA, which should probably be a certificate program in community colleges, not an academic endeavor (with my sincere apologies to half of America).
    Debt on the other hand is a huge problem, and not just for medical students, because indebtedness is the best way to keep people from questioning the powers to be, which could explain why new physicians are reluctant to strike out on their own, preferring salaried safety.

    • Jonodoc

      Thank you for sharing your thoughts and adding to the discussion. I’d like to highlight how you encourage independent thinking (currently scarce in undergraduate medical education) and that entrepreneurship is something that does not require an MBA.

      I do not dispute that mastering the fundamentals of medicine is crucial to the future of the medical student. I would suggest that, concurrent with this mastery, one should learn how to think openly, creatively, and independently. However, this is not my experience in undergraduate medical education – it is mostly memorization and quickly moving from one subject or clinic to the next. As digital health technologies improve, particularly technologies like IBM’s Watson, the need for medical students to learn all of this information diminishes, and may eventually disappear. This opens the door for the medical education process to focus on finding creative solutions to pathological and health care delivery problems. Medical students are some of the brightest, most ambitious, most pleasantly-naive people – just the right mix to cause some creative destruction, if only medical schools were open to it.

  • Brailleyard

    @jonodoc:disqus I absolutely appreciate the article as both a fellow medical student (3rd year) and potential entrepreneur who has often butted heads with administration during attempts to set up incubators etc. on our medical campus. It actually got the point that I decided that I would take some TIME off to pursue an MBA with hopes ensuring my ability to influence my future hospital system. That leads me to my second point aimed @MargalitGurArie:disqus , (below) what may be achieved by an MBA is the same thing that one gets through multiple failures – agility. I completely get what you’re saying about medical fundamentals – they are indeed numerous, but shouldn’t entrepreneurial activity be valued as much as research? During the first summer of medical school (post-1st year) our institution requires students to conduct academic research ( as that is what will hopefully strengthen your residency application) regardless of whether-or-not you actually plan to conduct research as a graduate. That glorious time could be filled with stints at IDEO (stanford) or the Mayo Clinic Center for Innovation, Duke Institute for Health Innovation, etc.

    Sadly – I feel that medical school often leaves too little time / offers too little support for students to even discover these opportunities.
    I welcome your thoughts.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      Maybe I’m misunderstanding something here. As far as I know, medicine is a profession, and when someone goes to medical school, my assumption is that the person intends to eventually become a physician and practice the profession, as in taking care of patients.
      For a minority, who chooses to stay in academia, research may become a full time occupation, and this is true for all professions and all university departments, but research is something that a professional physician will need to at the very least read, evaluate and apply in daily practice, hence it may be helpful (or rather imperative) to understand how it’s done.

      Incubators for creating a business that is in some way related to medicine, by serving doctors or patients or systems or what have you, does not strike me as an objective of medical schools. However, noting your interests, I am thinking that maybe there should be a separate track (a Masters or PhD) in medicine that does not graduate “doctors”, has different admission criteria, different curriculum, and is in addition to the already insufficient capacity of medical schools.

      • Jonodoc

        Interesting points, @MargalitGurArie:disqus. It should always be the primary purpose of a medical school to educate students to become physicians and to take care of patients. I hope this is always the case. However, the creation of a separate track (Masters, PhD, MBA, etc) removes the student from the clinical environment, from the very patient care, the very “customer,” that he needs to encounter to grow in his clinical knowledge and in his understanding of health care problems. The issue today is that there is a great divide between those who truly understand what is wrong with health care (physicians, nurses, other clinical providers) and those who have the tools to solve the problems (business leaders, engineers, computer scientists). Tomorrow’s health care would benefit from health care providers (including physicians) who can blend both of those groups.

        Incubators are not an objective of medical school. But they could be. As health systems find it harder and harder to remain a part of University systems, these incubators could serve as a natural bridge to bring the multidisciplinary University talent together with the health care profession. There is a tremendous digital revolution taking place in health care and I just hope that we can equip tomorrow’s physicians to be leaders in it, not pawns.

    • Jonodoc

      Thank you @Brailleyard:disqus! I’m sorry you’ve had such difficulty working with your administration. You are not alone! I hope that you find the support and encouragement you need and deserve in the MBA program.

      You also raise an issue that I have been thinking about for some time: is there a fundamental difference between the activity of entrepreneurship and the activity of research? Yes, entrepreneurs needs to commercialize their product in order to remain viable, but researchers also need to pull in those grant dollars. The only difference I see is that researchers require money BEFORE they begin a project while entrepreneurs hope to earn money AFTER they put their work in. But the day-to-day activity – identifying a problem, generating hypotheses, running experiments (testing with customers), overcoming failure, pivoting, networking – are practically identical. Why wouldn’t struggling health enterprises and academic centers want to setup outlets to encourage their creative minds to generate ground-breaking ideas/products and earn their institution money? Unfortunately in health care, MDs are trained without fostering innovation or creativity.

      I, too, feel that medical school lacks the time and support to discover creative opportunities. And I agree that a stint at IDEO or Mayo or Duke (the DIHI is still finding its way) should be valued as much as a research experience. Those constraints of lack of time + support loom large but can be overcome by the motivated medical student. Please keep the discussion strong in your mind and in your social circle!

  • Jonodoc

    Very good point, drma. Additional business learning, whether for personal or professional reasons, would benefit doctors. The question is where should it be placed and in what form? I do not doubt its importance and that we can fit it in somewhere.

    I think you raise also raise the broader interesting question of what should be included in a modern undergraduate medical education. Must we really memorize all that we do in the pre-clinical years? How are our thinking processes changed during our stint in medical school? The days are receding when doctors are the sole and authoritative source of care for their patients; more and more, patients are assuming greater responsibility for their care with the technological revolution we are just beginning. So shouldn’t doctors be positioned and equipped to be leaders in this transition? It’s our jobs on the line.

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