Innovation My most valuable learning experience: Starting a business Alexander Jay Ryu, MD, Syracuse, NY
Alexander is a preliminary medicine resident at State University of New York Upstate Medical University and a recent graduate of Harvard Medical School. While in medical school, he cofounded Wizdy Games, a company developing mobile games that teach children to manage various health conditions, and PreMed Insiders, an advisory service for those considering or applying to medical school. (Surgery 2017;161:885-6.) From the State University of New York, Syracuse, NY TO BECOME A BETTER DOCTOR, consider starting a business. Alternatively, consider collaborating (as an advisor, consultant, or part-time employee) with a company other than your employer. Although this may not be feasible for everyone, it is strongly worth considering. This sentiment was born out of my experience starting 2 companies during a yearlong sabbatical between my second and third years of medical school. The insights and experience I gained have helped me in countless and, at times, surprising ways, from helping to improve my thinking about innovation in health care to strengthening my ability to connect with patients and other hospital professionals. Although my experience is still limited and trends are shifting, the contemporary culture of medicine too often has a negative view of forays into or collaborations with business, driven by an “us and them” mentality. The requirements and curricula that students and trainees face also tend not to facilitate entrepreneurial pursuits. This scenario leads us to overlook critical opportunities to serve patients better through means as straightforward as communicating more clearly or providing a more welcoming environment to more complex avenues, such as the development of new biotechnology or mechanisms, for providing care. It is my hope that educational systems and students can address this possibility by taking steps that facilitate intersector collaboration and Accepted for publication August 2, 2016. Reprint requests: Alexander Jay Ryu, MD, SUNY Upstate Medical University, 750 E Adams St, Room 1816, Syracuse 13201, NY. E-mail:
[email protected]. 0039-6060/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2016.08.034
innovation, which I define as the creation of superior products, services, companies, or initiatives. These steps include rethinking the mentality of medicine versus business, allocating institutional resources to support innovation, and individually pursuing opportunities to learn through business. To address prevailing cultural trends in medicine, we must first become aware of them and their potential limitations. Often, these cultural trends start as early as one’s undergraduate education. Having attended a university that housed an undergraduate business school in addition to a liberal arts school, this distinction between the business and premedical student stereotype was particularly clear. As the archetypes went, business students were sophisticated, eloquent “schmoozers” if you will, focused on securing high-paying Wall Street jobs, while the premedical students were compulsive and studious and a bit more focused on caring about altruistic issues. These dichotomies, however, are overblown and warrant further examination. Despite the somewhat negative connotation, is schmoozing not the art of cultivating relationships and putting relative strangers at ease while getting to know them and their strengths? Albeit with a different context and substance, there are certainly shared elements with the process of developing patient relationships that is encouraged in medical school. From my own experience starting a company, then later working in a hospital, I have found that the many meetings, cold calls, and networking sessions I had pursued to grow my company enabled me to relate better to patients and collaborate more effectively with colleagues. While the average premedical student may not be as SURGERY 885
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focused on income as the average business undergraduate, is it any coincidence that often the most competitive residency programs are also those that may lead to the highest paying jobs? In medical school, these false divisions persist both in the informal culture and in the curriculum. For example, the curriculum of my ivory-tower medical school highlighted multiple cases of the shortcomings of industry, such as pharmaceutical corporate wrongdoing in the face of negative data (eg, the Vioxx debacle) or numerous studies extolling abuse of conflict of interest. One major drawback of this focus was emphasis placed on studying the negative scenarios but ignoring the numerous positive, ethical, and successful collaborations with many well-meaning industry-medical professionals truly devoted to improving health care. Fortunately, anyone can take steps to develop a more balanced understanding of the interactions of medicine with industry, and as a result, grow as a physician. While the demands of premedical and medical education, though important, are often onerous, time spent interacting or working with those from other backgrounds will pay dividends in the long run. In addition, understanding the processes that underlie generating innovative ideas, vetting them, building a team, and securing resources---as exemplified by industry---can help nearly anyone in medicine work more effectively. Premedical requirements could even be revised to reflect the importance of this interaction, not by requiring more multiple-choice questions about psychology or communication, but by assigning greater value to varied undergraduate experiences that equip one to understand the broader ecosystem of health care delivery. Medical schools as the primary educational institution for future physicians can also allocate resources to developing more innovative physicians. Ultimately, this approach, in itself “innovative,” can help to better serve patients and assist medical schools in attracting and educating individuals who will have the most innovative impact. If medical schools desire to prioritize teaching students to innovate, a greater focus on real-world experience is warranted. While offering lectures or courses on entrepreneurship and the business of health care delivery certainly represents educational progress, starting and working with companies is more pragmatic and practical than academic experience and should be learned as such. Just as medical schools often provide stipends for summer research employment with relatively few strings attached, perhaps there should be similar opportunities for funding to pursue internships elsewhere in health care, at a pharmaceutical,
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medical device, or health care services company. Specific to entrepreneurship, rather than providing a course on the topic, a stronger commitment would be to provide fellowships for students who wish to start their own business. These fellowships could be funded by medical schools, business schools, or in collaboration with other organizations, such as industry or philanthropic organizations, interested in advancing health care. I was fortunate to attend an institution that offered a generously funded competition for the development of business plans in health care innovation, but such medical school–sponsored opportunities are rare and should be available more broadly. Speaking from my own experience and that of a limited group of my peers who have pursued similar ends, starting a business generally is not feasible alongside medical school coursework. While one might argue that this is not within the traditional academic “business model,” it is clear that a student who becomes successful outside of academic practice is still a potentially very important asset for any educational institution. For students and trainees interested in medical innovation, the best advice I can offer is to focus on expanding your perspective and your experience in the business world. Cultivate relationships with those who work in adjacent areas of health care and try to ascertain what strengths they have that you lack. Challenge yourself to examine the opposing opinion with respect to interactions with business, especially when discussions are most polarized. Continually try to understand how and why the health care system operates as it does and realize that you will not find all the answers to this through your premedical or medical curriculum, no matter how well you master the material. Force yourself to occasionally take intelligent risks in whatever ways make sense to you. Throughout our undergraduate education and continuing into medical school, we are all conditioned to expect academic success, but the ability to “learn” how to fail and then reorient is at the heart of all novel pursuits. To gain experience, try setting up a business of your own, no matter how small. For students or trainees, starting something as simple as a tutoring business will yield insights beyond what any classroom content can offer. Alternatively, consider volunteering some of your time or pursuing an internship at a local health care business. Importantly, fear not what any supervisors or colleagues might think of your nontraditional pursuit. If you end up loving it, you will be glad you did it. If not, it is still an experience that can benefit you and your patients in the future.