PHYSICIANS AS ENTREPRENEURS : EVERYTHING DOCTORS NEED TO KNOW ABOUT ENTREPRENEURSHIP.

BY ATIF ZAFAR, MD.

According to conventional wisdom, doctors are lousy entrepreneurs and no better as businesspeople. This line of reasoning holds that they should just stick to caring for patients and leave the entrepreneurial and business part to others. Considering that a physician's training does not encourage entrepreneurial skills, this line of thinking is plausible to some extent, but not necessarily true.

Most importantly, in today's healthcare landscape and economy in general, these beliefs, no matter how justified, are no longer sustainable if physicians are to thrive. Rather, it’s important to focus on the fact that physicians do have the potential to make great entrepreneurs. Admittedly, only a small percentage of practicing physicians have entrepreneurial and innovation mindsets, but just a few would be enough to disrupt the system and add substantial value.

However, as physicians, we were never trained in anything other than being good physicians. The reality is that, to a great extent, we’re still stuck in the webs of the old system.

In the old system, physicians were taught to muscle it through medical school, push pass residency, get a "good job" and prudently work our way to retirement. Then we would gratefully take the pensions and like a fairy tale, we would "live happily ever after." Or better still, we could work till we drop, while still priding ourselves on being "good physicians."

Today, however, things have changed drastically. It’s no longer good enough

to just be "a good physician" as our sole

professional identify. However, because we are still partly stuck in webs of the past, being a physician and an entrepreneur is foreign to most of us.

Nonetheless, with the proper mindset, vision, and skills, we can break the

chains that the current medical system has shackled us with, and establish ourselves as competent physicians-entrepreneurs.

WHO IS A PHYSICIAN ENTREPRENEUR?

The definition of a physician-entrepreneur is broad and often results in misconceptions and myths. There is some sort of mysterious cloud of confusion surrounding what a physician

entrepreneur is, and what it entails. We’ll walk through the whole idea while dissecting its subcomponents.

Briefly, we can define entrepreneurship as the pursuit of opportunity with scarce,

uncontrolled resources. It’s widely defined as the entire process between designing, launching, and running a business while taking on a greater than normal financial risk. In the context of healthcare, entrepreneurship is not much different. The ultimate goal of all entrepreneurs, including physician entrepreneurs, is to create value by solving a problem through the deployment of innovation. Both physicians and entrepreneurs are inherently problem solvers: it’s definitely not a secret that there are enormous problems to solve in health care. With this definition, physician-entrepreneurs are health professionals who make conscious efforts to solve a problem in healthcare, while often taking on financial risk with possible options for reimbursement.

In the US, healthcare amounts to about 18% of the GDP and is rising with no signs of stopping.

Everyone who cares wants to cut down on healthcare spending - business owners, politicians, private individuals, everyone. We all want the best in health care, but nobody is willing to go bankrupt to get it. Unlike the trend in other science and technology industry, rather than decreasing, the cost of drug is rapidly increasing with time. I remember one of my last patients in clinic one day was a charming 82-year old gentleman who’d had a stroke a year earlier due to atrial fibrillation (an irregular heart rhythm). He was recovering.

At one point during our conversation he said something that has stuck with me ever since. He told me that he only had $25 in his wallet and, rather than spend it on the medication he needed (apixaban) he decided he’d use it to buy coffee at Starbucks for his wife when he went to meet her later that day at her nursing home, where she was recovering from a hip fracture. This was a man who knew full well the consequences of not taking his medication. Whenever I hear people talk about curbing healthcare spending, I think of this elderly man and his wife.

The problems in our present healthcare reality are enormous and to some extent, we can say physician-entrepreneurs are those health professionals that take a step out of the system in other to solve these problems. Don’t misunderstand me; "stepping out of the system" doesn’t necessarily mean the same thing as private practice, nor is it fundamentally about practice management. There are surely different roles for physician-entrepreneurs to fill, including those of small to medium sized business

owners, technopreneurs, and social

entrepreneurs. But employed physicians can still be physician-entrepreneurs.

In this capacity they’re better referred to as intrapreneurs, which entails an employed physician acting in an entrepreneurial role as freelancers, consultants or physician investors. Just like their colleagues in independent

practice, intrapreneurs have as much potential to be entrepreneurial. Learning programming, coding, and enlightening ourselves on artificial intelligence (AI) to integrate technology into medical practice is an attractive arena that has

certainly kept me interested. In most people’s opinion, this is the next big thing waiting to happen in healthcare. Amazon and other tech giants are currently in the brainstorming phase, but inevitably, this miracle in waiting is just a matter of time.

I heard the CEO of Google/Alphabet, Mr.

Sunder Pichai, explaining some of the

fascinating initiatives by these IT companies in the healthcare arena. One example is the fact that Google analyzes big data with a predictive model for readmission (admittedly, it’s funny

to hear about de-identification and data

privacy from companies like these, but

nevertheless). Similarly, the diabetic

retinopathy screening data of millions of

patients were being looked into to identify high risk of heart attack and stroke in patients. With these issues, timely intervention could spare patients serious disability. Admittedly this is a field in its infancy, but I believe the penetration of IT companies into healthcare is inevitable. Physicians need to familiarize themselves with coding, big data mining and artificial intelligence now, to ensure they’re poised to respond to these advancements as they happen.

Physician-entrepreneurs have a good

knowledge of the problems of the system, and can leverage this knowledge to create value for people in ways other than giving direct medical care. Every existing threat to medical practice

represents an important opportunity for

physician-entrepreneurs to create value by solving a problem. Every industrialized nation is continuously faced with the challenge of providing their population with adequate health services using often scarce resources. Innovation and physician entrepreneurship is the bridge that is gradually ameliorating this enormous problem.

PHYSICIAN-ENTREPRENEURS AS

ENTREPRENEURS

In this context, "physician entrepreneurs as entrepreneurs" refers to physician

entrepreneurs who are self-employed or under independent practice.

Physician entrepreneurship opens up self-employment opportunities for physicians, enabling them to use innovative approaches to pursue their personal dreams while improving

health outcomes. Like other entrepreneurs, a physician-entrepreneur is generally considered to be a proprietor of a business which offers services related to healthcare, being it direct care, research, administrative, educational, or consultative in nature. This means the physician is self-employed and is directly accountable to the client for whom they provide those services. These physicians may conduct private clinical practice, own a business or run an education or research consultancy. Thus, physician-entrepreneurs as entrepreneurs are unique innovators who make initiatives that lead to change or improvement of health systems. They independently participate in innovations in healthcare, which directly improve health outcomes, lead to better diagnosis and treatment options, as well as improve general efficiency and cost effectiveness within the healthcare system.

The fundamental characteristics of

entrepreneurship include using individual

creativity to develop new ideas, as well as the improvement of services and their delivery. It also includes creative design of new products or ways to use existing products. Physician-entrepreneurs as entrepreneurs combine this entrepreneurial characteristic with specialist skills and knowledge in healthcare to develop products and services which they market to external sources.

PHYSICIAN ENTREPRENEURS AS

INTRAPRENEURS

Unlike the independent entrepreneur we

discussed earlier, a physician intrapreneur is usually a salaried employee, currently working under a healthcare institution like a government run hospital. They design, promote, and deliver innovative health products or services within their employers’ institution, and within that organizational framework. The physician and the employer jointly bear the risks and share the benefits.

The type of innovations designed by

intrapreneurs are usually guided by the need to improve processes or develop valuable new products or services that are within the organizational bounds.

Globally, there’s increasing pressure on

healthcare systems as nations strive to meet the healthcare needs of their citizens efficiently and economically. We define both physician-entrepreneurs and intrapreneurs as effective tools within the system for bridging innovation gaps in healthcare.

TIPS FOR THE PHYSICIAN

ENTREPRENEUR

Like any other social entrepreneur, success doesn't come cheap for a physician-entrepreneur, but the following tips may certainly help.

YOU NEED TO HAVE A CAUSE AND A

CLEAR VISION

It’s one thing to start being a physician

entrepreneur but it's another thing to keep being one. The consistency and determination needed for success comes from a clear vision.

Lots of temptations may come along the way. You may have a conflict of interest with your employer or a big company might offer some huge chunk of money to buy you out. While this may be tempting, your whole vision as a physician-entrepreneur, the problems you set out to solve, and the values you wanted to create may all go down the drain if you fail to maintain you will, determination and a crystal clear vision.

YOU MUST BE WILLING TO TAKE RISKS AS A PHYSICIAN-ENTREPRENEUR

As physicians, we face different kinds of risks as part of our day-to-day medical practice. The ability to understand and efficiently manage risk is critical for success. Any physician-entrepreneur should learn to embrace risks as challenges, and devise creative ways to face them. The whole concept of entrepreneurship rests strongly on the willingness to take calculated risks. The question of whether the risk is worth taking or not is something you need to decide based on your comprehension of the situation.

ALWAYS LISTEN TO YOURSELF

While it’s important to take advice from others who have succeeded in similar endeavors, don’t be afraid of following your instincts.

Don’t worry about making a decision even if it’s not the most popular choice. As the saying goes, “go with your gut.”

BEING A PHYSICIAN-ENTREPRENEUR

NEEDS TIME AND METICULOUS PLANNING

If you've spent a chunk of your carrier just

being a "physician," making the switch might be a little daunting. You surely shouldn't expect to just set up and get going. Establishing yourself as a physician entrepreneur will take careful planning and years of hard work.

In terms of planning, you need to figure out the best time to start up, infrastructural requirements, your source of funds, what to call success, and how you’ll deal with the inevitable challenges. Meticulous planning and asking the right questions are important cornerstones to becoming a successful entrepreneur in any field, and it's no different in healthcare.

FINANCIAL EDUCATION IS IMPORTANT

If you want to go far as an entrepreneur,

financial expertise is indispensable. Depending on the structure and size of your “innovation," having good knowledge of financing could be critical to your success. You should be willing to

open yourself up to the world of financing, even though it’s completely different from your everyday medical practice.

FAILURE IS NOT THE END; IT’S THE BEST TEACHER

As you push to reach your entrepreneurial goals, you'll almost certainly fail, many more times than you’d like! But this is quite normal.

It happens everywhere: in sports, in arts, or in other scientific fields. This means you shouldn't be afraid of failure. Be prepared for it. When it eventually comes, if you’re prepared, you'll overcome it. If you were a little sloppy, then you should admit it and learn for next time. For what it's worth, it helps to see failure as a lesson rather than "failure." Insecurities like fear of failure can kill the entrepreneurial spirit.

EXPOSE YOURSELF TO PHYSICIAN AND

NON-PHYSICIAN ENTREPRENEURS

The positive influence you get by surrounding yourself with successful physician-entrepreneurs is contagious. Apart from the doses of motivation and encouragement you get, they may be skilled in areas that you may not be, and can offer valuable advice for your success. Surrounding yourself with successful peers challenges you to succeed. As a matter of fact, networking and connecting with other entrepreneurs is an excellent way to nurture your entrepreneurial skills.

YOU DON'T NEED TO BE A BUSINESS

EXPERT OR HAVE AN MBA TO BECOME A PHYSICIAN-ENTREPRENEUR

This is definitely not true. Sure, an MBA and expertise in business is an added advantage, but it’s not "can’t-do-without" kind of advantage. Since you need some sort of business understanding before stepping into the world of entrepreneurship, you can sign up

for a business coaching program or training courses. This is usually enough to give you a good foundation before stepping into the world of entrepreneurship. Besides learning

what you'll need to navigate the sometimes complex world of business and entrepreneurship, you already have all you need as a physician.

YOU DON'T NEED A LOT OF DISPOSABLE INCOME TO KICKSTART YOUR ENTREPRENEURIAL PLANS

Another widely believed myth. A lot of

physician-entrepreneurs start their businesses with very little capital. Though more money is probably better, how much capital you needdepends on what you’re trying to do.

Nonetheless, if you are new to the whole idea of physician entrepreneurship, try to start small. It might not be the next big thing in medical practice, but it might help save a life next door.

YOU DON'T HAVE TO QUIT YOUR

EVERYDAY MEDICAL PRACTICE TO BE A

SUCCESSFUL PHYSICIAN-ENTREPRENEUR

You don't have to quit your salaried day job to become a full time physician-entrepreneur in order to succeed. This is the whole origin of the term "intrapreneur." Most physician-

entrepreneurs start their ventures while

practicing clinical medicine - it's possibly even safer that way. These physician-entrepreneurs continue their everyday medical practice, and consider their entrepreneurial endeavors their "side gig." They sometimes even still continue, when their so-called "side-gig" becomes big enough to be the "main gig." You can absolutely keep wearing your clinical practice hat while growing and promoting your entrepreneurial endeavors.

WHY THE RISING NEED FOR PHYSICIAN-ENTREPRENEURS?

A disruption in health care is inevitable at this point. Better technology and the need for more efficient healthcare will be the major drivers, and entrepreneurship offers physicians a safety net while giving patients improved healthcare options for when this happens.

The threads of healthcare, technology, and business are becoming increasingly

interwoven. In today's world, the power of

technological innovation in healthcare is

greater than ever. Technology has enormously impacted the ways physicians diagnose and administer medical care, and the way they communicate with patients and each other.

The rapid infiltration of technology into

healthcare has created more opportunities for physicians to pursue career or professional interests outside the bounds of the traditional healthcare institution. Technological changes together with a wide range of challenges creates a rising demand for physician-entrepreneurs. The whole idea of physicians becoming entrepreneurs in healthcare is not entirely new, but it has gradually evolved over time. Modern physician-entrepreneurs have redefined what it means to be a physician, moving past entrepreneurship as just about private practice and more about entrepreneurial ventures way beyond the scope of normal clinical duties.

Recently, physician-entrepreneurs have

immersed themselves in medical innovation, positively changing how care is delivered to patients. Their participation is highly sought after in healthcare to help reshape the traditional business model. Physician-entrepreneurs are also increasingly participating in the development of new software and tech devices aimed at improving clinical outcomes for patients.

They’re energetically and passionately involved in creating solutions due to their frustrations with current healthcare inefficiencies. Some are getting involved because entrepreneurship offers them an opportunity to make a greater impact on patients than would be possible in a normal clinical setting.

A considerable number even get involved because of the intellectual stimulation that comes from innovation, while still others are motivated purely by possible financial gain.

Regardless of the motivations behind their involvement in entrepreneurship, a physician’s valuable insight into healthcare makes them more than suited for a wide range of important innovations in healthcare. The legacies of early physician-entrepreneurs are still with us today.

One notable example is cardiac surgeon Albert Starr. Dr. Starr was affected by rheumatic fever, an ailment that causes the narrowing of the heart valves with a marked predominance for mitral valve involvement The absence of a prosthetic mitral valve suitable for transplant during that period meant that most surgeons had to intentionally convert the more "unmanageable" mitral stenosis into mitral regurgitation, a more manageable condition.

Facing the threat of possible death as a result of this, Dr. Starr collaborated with Lowell Edwards, a retired engineer, to create a new mechanical valve for patients suffering from mitral stenosis. The pair eventually developed and marketed a simple mechanical device that could be well tolerated by patients suffering from the condition. The device soon gained popularity and many patients who used it could live for more than 30 years after having a valve replacement.

Dr. Starr’s story of innovation proves the value of physician involvement in entrepreneurial innovations. His clinical experience afforded him the important insights necessary to making the device reliable, and intuitive for users. Indeed, a study aimed at investigating the pattern of patent applications for medical devices showed that devices with significant

physician design involvement were much more effective and comfortable for patients. The study also found that medical startups founded by physicians were much more productive than those started by non-physicians.

Yet, despite these revelations, only few

medical institutions place emphasis on

entrepreneurial innovations. Most medical institutions have become outdated in this respect and provide students with little or no relevant education or opportunities to pursue

creativity or explore their ingenuity.