“What would you do with a billion dollars and an appetite for innovating healthcare?”
This question was posed by Dr. Benjamin Schwartz, orthopedic surgeon and prolific opinion writer on LinkedIn on topics of healthcare technology, innovation and delivery reform. He recently began writing a blog found at dembones.substack. For the billion-dollar question, here’s the lead off:
The concept for a physician and community-owned hospital might be impactful at a local level, but is this really the best way to spend that kind of money in an effort to influence the trajectory of US healthcare nationally? What effect would this have on widespread burnout, practice buyouts and the ongoing exodus of physicians and other providers from medicine?
Our argument is that for landmark and sweeping changes for the healthcare profession and for healthcare in general, creation of a massive, enabled community of physicians and healthcare providers would have a far greater impact. The key word here is “enabled”, as will be explained. The complete opposite of divide and conquer would be the goal, instead achieving a unite and prosper outcome.
How? By merging the interests, needs and talents of physicians and healthcare providers within an inclusive community. This community is then enabled through an ecosystem focused on education as well as meaningful involvement within healthcare innovation, wealth building opportunities and the business of medicine. The two main drivers of this ecosystem, tied to strength in numbers, would be the collective knowledge and the powerful funding potential of the community. Properly channeled into healthcare related opportunities, this is where meaningful impact and change could occur.
With the right mix of impactful solutions tied to effective marketing and grassroots growth, could a community be grown to 10,000, 100,000 or even 1 million? With a billion dollars, there’s no question in our mind that the high end of that range could be achieved, but what’s even more exciting is a realistic potential to accomplish this with grassroots growth alone, simply because our profession has been waiting for this type of solution for decades, and the need has never been greater.
Determining whether widespread interest in joining this community would exist depends upon understanding the problem, defining the opportunity and identifying whether similar solutions or competitors exist.
THE PROBLEM
Simply put, a lot of pain exists for physicians and healthcare providers. Steady declines in reimbursement, autonomy and job satisfaction coupled with surging levels of burnout, bureaucracy and practice buy-outs have resulted in epidemic levels of physicians leaving the profession, either through retirement or job transition. This number was estimated at 117,000 MDs in 2021 alone. Burnout is reported as high as 60% in some subspecialties.
These problems didn’t develop overnight. So how did this happen? Core to answering that question is the fact that physicians are poorly organized. Divide and conquer strategies have always worked well against us. Our professional societies provide value, but an unintended consequence is that they lead to division by virtue of serving subspecialty interests alone. They fail to support the personal needs that extend beyond the doors of the medical practice. These needs include financial education, wealth-building strategies, innovation support, coaching and work-life balancing.
In an environment of decreasing payment rates and job satisfaction, financial success away from the office would empower healthcare providers to say “no” to a bad contract, a poor work environment or an offer to be bought out. The percentage of physicians in private or independent practices has shrunk to an alarming 25% nationally, with private equity firms being an active buyer in recent years.
THE OPPORTUNITY
If physicians and healthcare providers could be aggregated on a platform designed solely to empower that community, the impact on the individual and the medical profession would be significant. This concept moves well beyond the existing angel investment clubs and discussion groups to create a vibrant ecosystem offering meaningful involvement within healthcare innovation, wealth building opportunities and the business of medicine.
COMPETITIVE LANDSCAPE
There are a handful of communities or entities that have more than 1 MILLION physicians and/or healthcare providers on their platform. These include LinkedIn, Doximity, Sermo and StudentDoctor.net. No company or entity has successfully aggregated healthcare providers with a well-defined mission to provide multifaceted access and opportunities, particularly as it relates to wealth-building strategies and direct involvement within the business of medicine.
LinkedIn is a professional social media platform with over 740 million members and over 2 million groups. They don’t provide data such as how many physicians are members, but this likely includes a large majority of U.S. physicians. Many physicians join LinkedIn and then say “Now what?”. Valuable communication takes place on LinkedIn, but beyond talk and relationship building, there are no tools or roadmaps leading to tangible results.
Doximity: According to Doximity’s website, as of September 2021, the company had over 1.8 million verified members, which includes approximately 80% of all U.S. physicians and 45% of all nurse practitioners and physician assistants. Many physicians wonder how they became a “verified member”. But the question is, who really benefits the most out of this provider aggregation? Utility provided to the member network includes the Doximity Dialer, telemedicine services and curated educational content, but isn’t it the underlying truth that Doximity is winning far more than the individual through revenue streams tied to advertising and database licensing?
Sermo is a large physician network with 1.3 million verified global members where paid surveys represent the core business. These paid surveys link various entities within the healthcare space with the Sermo member network for crowd sourcing of professional opinions. Beyond making a few dollars to answer surveys, the individual receives very little additional benefit through this massive physician network.
Studentdoctor.net is a large forum-based community supporting students and healthcare providers in the earlier stages of their training and practice. While there may be some educational content on topics of finance, this is not a primary focus of this community.
In summary, these massive physician communities offer limited value as it relates to access and opportunities within healthcare innovation, wealth-building or “business of medicine” opportunities. While physician-directed educational content on topics of personal finance is available somewhat piecemeal on the internet, there is a void when it comes to tools that allow a medical community to act in a coordinated fashion. The Society of Physician Entrepreneurs (SoPE) has made excellent progress organizing and educating physicians, and has impacted thousands. Through our own efforts, as well as a partnership with SoPE, Merge Medical intends to provide broad educational content with a focus on action and measurable outputs. To quote Herbert Spencer, Nobel Prize winner 1902, “The great aim of education is not knowledge but action.”
There are many smaller medical communities that are organized around themes of entrepreneurship, angel investing, private market investing, innovation, coaching and wellness. These entities provide real value, but they struggle to move the needle nationally due to scale. Currently, no fabric of unity exists serving to tie these various entities together. It is this open lane where Merge Medical plans to participate.
MERGE MEDICAL: PRODUCT AND SOLUTION
Merge Medical is the embodiment of the concepts described above. At the risk of being redundant, Merge Medical is a grassroots community of physicians and healthcare providers where the interests, needs and talents of the group are merged within an educational and output-focused ecosystem delivering meaningful involvement within healthcare innovation, wealth building opportunities and the business of medicine.
The two main drivers of this ecosystem, tied to strength in numbers, are the collective knowledge and the powerful funding potential of the community. Properly channeled into healthcare related opportunities, this is where meaningful impact and change can occur. It’s time to stop divide and conquer and replace this with unite and prosper.
Merge Medical is the answer to Dr. Schwartz’s billion-dollar question. Structured as a non-profit, the goal is to grow a massive, enabled medical community where the individual benefits more than the entity. This is not the case with the companies described above. Rather than competing, Merge Medical wants to partner with any individual, community or company that is pro-physician or pro-healthcare provider. These entities are targets for Merge Medical collaboration.
KEY PRODUCT FEATURES
STRUCTURAL COMPONENTS
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WEBSITE
Our goal is to create both a learning platform and an ecosystem delivering roadmaps and action items allowing individual involvement within the business of medicine. This will mean different things to different people due to the varied interests, needs and talents of our member network. Our website can be found at mergemedical.org and will offer a deep well of content that is searchable by “Insight Topics”, contributor name or simply by word search. If a healthcare provider enters the site planning to spend ten minutes, yet gets lost for an hour intrigued by the body of content, we will have accomplished our goal.
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FORUM
After an initial onboarding process, the website offers bidirectional navigation and seamless passage into our forum,. The forum is a place where collective opinion can bring value, and ideas are vetted. Member polls can be used to gauge interest in particular ideas, companies or initiatives.
We have the ability to create password protected sections of the forum. One example of this is that Merge Medical is working with The ENT Forum and other efforts by leaders in the ENT space to create a clinically integrated network (CIN). As some of these discussions are more private in nature, this section of the forum can be gated with a password. Another example is the Merge Venture Club. Through partner DSScorp (DeFi Solutions and Services), members will be able to explore the creation of venture portfolios using the DAO LLC legal structure. This will be outlined with clarity in future blogs.
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PODCAST
Our podcast series will create a bridge between our community and healthcare-related startups and growth stage companies. As per our disclaimer, Merge Medical and the podcast hosts are providing this content for informational purposes only, and are not broker dealers or registered investment advisors. We are not providing investment advice. We will bring awareness to interesting projects and companies and then leave further discussion of the clinical and/or investable merits of these companies up to free discussion within the forum.
We have two forms of the podcast, “10 in 10″ and “Deep Dive”. From the startup founder perspective, the concept of the 10 in 10 Podcast is this: “What if you had ten minutes of undivided time with a legendary investor; what are the 10 most important things that you would want this person to learn about your company?” We see this as a quick hitting introduction to companies with a compelling story. If the viewer/listener wants to learn more, the Deep Dive Podcast is the longer uncut version.
AREAS OF INTEREST AND IMPACT
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HEALTHCARE INNOVATION
As discussed, Sermo is a company with more than 1.3 million physicians in their network where the core business activity is paid crowdsourcing of answers to industry questions. The “brain trust” represented by that 1.3 million physicians benefits industry clients, but not the physicians themselves. On the other end of the spectrum, venture capital firms involved in the healthcare space rely on a very small number of medical consultants to evaluate opportunities and assist in deal vetting. Why is it that so many healthcare related start-ups have little to no input from medical providers who are actually in the trenches, and represent potential users of the solution or product? This problem (and the associated Merge Medical opportunity) is highlighted in the LinkedIn post shown here:
It’s truly staggering how many medical ventures are conceived and built (many never get there) without involvement of medical professionals or clinicians. Is there a problem with match-making or access? This highlights the potential to build a “brain trust” through community where healthcare-related opportunities and deals can be vetted. This is done by the same medical professionals who ultimately are asked to use new technology or services. Beyond vetting, this same community can invest together and also provide a source for advisors within the healthcare innovation space.
But what about a physician with the proverbial “idea on a napkin”. Through partners such as Vita Group, Merge Medical can provide the bridge between a clinician and partners providing solutions along the path from idea to market. We are sharing numerous blogs from Vita Group with titles such as: “Crafting an Effective Business Plan: A Step-By-Step Guide”, “Filing a Patent in 5 Steps”, “Top 10 Questions to Ask When Choosing a Research and Development Company (Part 1)”, “Top 3 Hardest Steps for Inventors in the Development Process”, “Top 3 Marketing Strategy Tips”, “Top 5: What Makes a Great Medical Device Idea?” and “When Should You File for a Patent?”
In summary, Merge Medical creates an ecosystem through which physicians and medical professionals can interface, and become more involved within healthcare innovation. This includes education and awareness provided by our blogs, podcasts and other content. This also includes partner support, idea and deal vetting through the forum, match-making for startup advisor services and investing through venture portfolio creation.
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IDENTIFYING “BEST-OF-BREED” PRACTICE SOLUTIONS
Through our forum and our podcast series, it is our goal to identify and spotlight companies that have created novel solutions for the various problems that we face while trying to run profitable, efficient, value-based and patient-centered practices. It’s simply impossible to go it alone and have knowledge of everything available on the market. It’s even harder to vet these solutions one by one. This is where the value of community and our forum come into full light. The ability to introduce companies, discuss their clinical value, receive input from current users and poll the community is invaluable.
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IDENTIFYING ALTERNATIVE ASSET AND PASSIVE INCOME OPPORTUNITIES
This topic will be covered in greater depth in subsequent blogs and podcasts.
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PHYSICIAN EQUITY OPPORTUNITIES
Within the circle of Merge Medical co-creators, we have talked quite a bit about PE (Private Equity) and replacing the word “Private” with “Physician” for a whole new meaning of PE. While providing capital for business expansion or bringing efficiencies to an inefficient business seems positive, the problem with private equity’ s involvement in medicine can be two-fold.
First, is that an incoming management team may not understand the specific business as well as the providers, and not having taken the Hippocratic Oath, they are not held to the same ethical standards. Profit driven motives within this environment have led to a tremendous spike in provider burnout and pre-mature retirement or job transitions. It takes a decade to create most physicians, especially those providing skilled surgical and procedural services. In a post-PE world with provider shortages, there are no quick solutions that provide acceptable quality measures.
The second issue is the time frame within which most PE firms are working. Healthcare and its delivery has many problems, but suffice it to say that the patients are not going away. After the potential ill-effects of a PE business relationship are gone, and the PE firm has sold to the next buyer, a business sits, potentially far less healthy than it began. These are generalizations that may not hold true in all instances. We welcome discussion on this topic in our forum.
So where there is a problem with large opportunity, solutions will often arise. If Merge Medical can grow a community well into the thousands, can we not begin to fund sound projects with a keen eye on the future using the concept of “Physician Equity”? We can create business structures where profitability is important, but ethics and the longer-term heath of the profession are respected. Examples include lending, medical real estate, practice buy-outs and staying private initiatives such as a Clinically Integrated Network (CIN). These are topics (and action items) that we envision flourishing as our community grows. We will likely attract and attach partners that can assist within this area of community activity.
KICKING THE WHOLE THING OFF
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CO-CREATOR
What we are building has been underway for more than 9 months. As the need for a unified medical community has been here for decades, taking a few extra months to ensure that the proper pieces are in place has made sense. We are now preparing to get loud and start telling the Merge Medical story. Merge Medical is brought to you by twelve co-creators. Many of our co-creators have established communities of their own. Beginning with these individuals and entities, we are going to demonstrate that Merge Medical doesn’t want to be viewed as a competitor, but instead as a fabric of unity for any individual, community or company that is pro-physician or pro-healthcare professional. Co-marketing provides mutual benefit.
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AMBASSADORS
As we begin telling our story, we expect to find physicians and healthcare providers who feel a connection with our mission. We have created a way for a limited number of individuals to become involved through ambassador status. These individuals will have a voice and be positioned at the growth center of the Merge Medical community. Being involved behind the scenes, ambassadors will have 12 involvement categories from which to choose. Each ambassador will be recognized on the Merge Medical website and forum by name and with an ambassador number. Twitter has its blue check. Imagine being Facebook #12. Ambassadors will also receive free membership in the Merge DAO Venture Club.
We want to foster two-way communication to help gauge overall sentiment of the community and help guide our efforts in product refinement and member growth.
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GRASSROOTS GROWTH
We firmly believe that Merge Medical provides a long awaited solution to a massive growing problem. Our solution includes what we build directly and is fueled by a willingness to partner with other communities and entities that share our mission. This foundation and a strong mission, supported by 12 co-creators and a growing list of ambassadors, give us a very real chance to grow in a grassroots, or even viral, fashion through word of mouth, email and social media campaigns.
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PAID MARKETING
We hope that our grassroots efforts will bring awareness to numerous additional sponsors and partners. This will fuel our paid marketing campaigns optimized to grow our membership. Do we need a billion dollars. I don’t think so.
LET’S GO !!!!!!
Co-authored by:
Dr. Jeff Cole
Dr. John Jefferies
Dr. Jeff Brown