One of my favorite things about being an entrepreneur is the people I’m privileged to meet and spend time with. This week I met a fellow Montana physician, Alistair MacDonald, who has started his own company. He’s created a product that automatically decreases the volume on music playing in the operating room if a patient’s vital signs are tanking. It seems like an important idea to me. He made some great points during our conversation. The OR is filled with hard surfaces that echo, making it loud and hard to hear. You can’t read lips because faces are covered with a surgical mask. Loud conversations contribute to noise pollution. Hearing important tones and alarms in an emergency is harder than it should be.
Enter a device that interfaces directly between the anesthesiologist’s vital signs monitor and any kind of audio system you want to use. Now, when vitals are outside safe parameters, the music is automatically muted, letting everyone focus on addressing a potentially critical situation. Cool tech, right?
With an invention like that, you might imagine that Alistair is saving lives in his sleep, and taking checks from his mailbox on his way to early retirement. Not even close. Enter the world of being a physician entrepreneur. As we got to talking I realized that there were major similarities to his experience and mine running my own startup. Doctors are interesting people. Part of my job at our company, Fluent, has been developing a deeper understanding of exactly what makes physicians unique, and what motivates us. I can’t believe that my story, or Alistair’s, is all that unique, and I’d like to walk you thorough a few of the key issues I’ve identified in this space over the last four years. My hope is that others can learn from this information, in the best case scenario avoiding some of the pitfalls that Alistair and I have run into. Physicians have great ideas for how to make medicine better and safer. So, what exactly keeps us from innovating health care successfully?
First, we are not natural business people. This is related to a number of factors, not the least of which is the typical personality profile of a physician. Empathy, compassion, and humility are at the top of the list of traits that make a good doctor. An entrepreneur’s list starts differently, with not being afraid to take risks ranking highest. They also understand that failure is part of the game. Not exactly what I learned in medical school. We are trained to be risk averse. And, how about sales and promotion? Being great at these is essential to successful entrepreneurs. Most physicians hate the idea of being a salesman. At the end of the day, we just want to help people. Alistair and I both talked about having had thoughts of giving away our intellectual property at one time or another. We have a burning need to get our ideas out into the world. Good thing neither of us acted on that. No matter who you are, you need to have a passion to see your business succeed to make it as a startup. I believe in being altruistic, but you can’t give everything away and still call it a business.
Alistair and I have both been bootstrapping our companies to date. The more I talk to founders who are not physicians, I get the idea that they would have taken on capital long before now if they were in our shoes. I’ve made excuses to avoid considering outside funding. Not rational excuses, but it was the reality of my thinking. We could do a lot with capital. I’m a busy physician with a family that I love. I’ve done my best for my company in the time I’ve been able to give. That said, there are things that are simply not possible with a small team on a shoestring budget. Top that off with limited hours available to do the work. How much sales and marketing can you really do? Even worse, these are not my team’s best strengths. Our strengths are creative problem solving and innovation. We are determined perfectionists. Alistair and I have probably pushed ourselves further into the technical weeds than a normal person would consider. He’s overseen every last detail of making his product just right. I’ve done the same. I actually taught myself to write computer code so we could get our platform off the ground. Taking the hard road to get there makes perfect sense to anyone who has gone through medical school and residency. It’s what we do.
Another problem for Alistair and I is that we didn’t start with a business plan. We started with a need to scratch our own itch. It may be that it’s the hardest possible itch to cure, but we took it on anyway. A smart business person begins by asking what people actually want to buy. They ask, “what are the implications of going into business with this product or service, versus another one?”. Then they do market research, write a business plan, pick the right partners, do their due diligence, etc. We didn’t do any of that. We just started building. My company created a product that never existed before, electronic medical record (EMR) automation software. We made it because we needed it to exist. It had to be done. We can consistently save doctors 40-60 minutes every day. That’s a tremendous value proposition. At 10 percent adoption it’s $2.3 billion per year. And that’s just in the U.S. on one EMR. Even so, it’s been hard to take to market. My company is now four years old, thousands of dollars of my own money put into it, endless sweat equity, and so far our only revenue is from consulting services. Hospital systems are not out shopping for cutting-edge software and technology. They’re struggling to pay the bills and meet mandatory requirements. They are also risk averse, just like we are as physicians. Something new and novel doesn’t fit well in that kind of a model. The good news is that people do love our product and we have some amazing testimonials. I love our product. Unfortunately, it’s been painfully slow to overcome the obstacles necessary to get it into the hands of the people who need it most.
Aside from my arguments above, maybe one of the worst things haunting physician entrepreneurs is that we simply aren’t hungry enough. Let’s face it; we’re certainly not poor. We’ve spent a career in school and in practice. It was challenging to get here. Do I actually want to risk trying something completely outside my comfort zone full-time? Don’t think I haven’t considered it, but I will admit to being scared. That was never part of my plan. Physician for life, that was the idea. Then there’s the fact that most of us still love medicine. I know I do. What happens to all of that if I jump in completely to a new life in the business world, a world I know relatively little about?
So what does a creative, compassionate, perfectionist, busy, physician, family man, who hates sales and loves medicine do with his startup? “Embrace it with passionate optimism,” is the only viable answer I can come up with. The question becomes, “Are our lives better for it?” In my case, even with all the challenges, it is a resounding yes from deep in my soul. So, I’ll stay on the ride as long as that’s true.
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