11/30/2022
This article is Part 3 of a series on physician entrepreneurs. In our first article we touched on how the mindset for physicians and entrepreneurs are very different. Last week, I discussed why physicians leading innovation is very important and yet often under-appreciated by investors, vendors and even fellow physicians.
Physicians are and can be a powerful force in healthcare entrepreneurship. However, can they do it alone or do they need business partners? My answer is a resounding YES!
To understand my perspective, let’s review the challenges presented to physician entrepreneurs from a business growth and financial perspective. I believe too many physician entrepreneurs fail to see our blind spots when it comes to driving the margin for financial success. Physician are mission focused, however, with no margin we can not achieve our mission.
On the flip side, it is equally all too common for business people to discount physicians interested in running businesses. I have been told by many investors that they do not invest in physician led companies. “Doctors are poor businessman is the common mantra.” Business minds and clinical minds can learn a great deal from each other. While I this assessment is true for all physicians, we have to recognize their is some truth in this perception of our business colleagues.
My impression is the difficulty for physician entrepreneurs is not the business side per se but more about a difference in skills around leadership training, team building and the “big” vision that one needs to scale a business. We can these areas as blind spots that come from our siloes in healthcare.
Leadership training
Lack of leadership training is a huge problem in American medicine. Most physicians become leaders because they are by default physicians. Physician who gain hospital leadership are typically those who publish the most, are the most productive or seek ways to balance clinical workloads. Physicians are trained to be problem solvers and this serves most well as they work to fix problems within their silo. Where I see most physicians fail is in trying to use the same skills for past success and apply these to larger issues and problems. Unfortunately, most physicians see early success when lead like a physician. In clinical care physicians are the team leader by default, see patients, write orders and direct staff to carry out their orders. Physicians are rarely challenged by those who report to them and most become pretty upset if challenged by their direct reports, patients or fellow physicians. Medicine is by nature a top down leadership model and very hierarchical. Titles and roles are well defined and well delineated. The idea of “chain of command” is still prevalent in healthcare.
Physician are typically not trained at all in leadership. Without leadership training in team building, culture building, change management we physicians also struggle to see how we could be more successful by surrounding ourselves with smart people with different strengths.
Physician entrepreneurs typically feel the need to get an MBA, learn marketing and “do it all.” This character is natural to physicians who are eager to continually learn and thrive by our independent thinking. It’s not a flaw in physicians but is a flaw in how we are trained and the physician vs entrepreneur mindset.
A one or two year MBA program for physicians adds great training for physician leaders. However, like medical school, this education can’t match the experience of a strong business partner. Physicians , with or without an MBA, will be far better off by hiring or partnering with a successful business minded entrepreneur to lead their innovation. Business expertise is paramount to developing forecast models, managing expenses, overseeing balance sheets and ensuring margin can help drive mission. As physicians we understand the value of experience, we should think the same about our business partners.
Team Building
Physician entrepreneurs need to think about how to best build their team. Team building is not natural to the physician entrepreneur. Physicians often create physician only partnerships, practices and boards. The idea of team to most of us physicians goes back to our clinical training. Team is the physician lead and having those who report to us , completing the orders we direct. We rarely have peer to peer teams or delegate decision making to others on our team.
To build a successful team as an entrepreneur, you need a team that will align strengths with strengths. You will want diverse experience and expertise. Clinical, technology, financial, marketing and legal expertise are key components to any healthcare business you are starting. You want to find people smarter, more experienced and more skilled than you to be your partners. You don’t want to hire individuals that think, act, walk and talk like you. You want to trust your team to make great decisions without your micro-management or feeling they are just carrying out orders.
The leadership team you assemble will develop the culture of your organization. The culture will dictate your success or failure and with a poor one you will fail fast. If physicians bring their top down, hierarchical approach to their company, no question it will fail fast. The ideal leadership team will see each other as peers and and feel comfortable challenging you, your ideas and your company strategy. Dialogue not direction, oversight not micro-management, healthy conflict and not a “yes” culture are keys to building your team.
Successful physician entrepreneurs recognize the team and how it works collectively and collaboratively is by far the most important. Personally, this leadership team culture if far more important than titles and whether the physician or business partner is the CEO. Together, a great leadership team will work seamlessly without needing to check organizational charts. What’s most important for physician entrepreneurs is to have a strong business minded partner that can work in synergy as a dyad. Shared mission, vision and cultural alignment is far more important than titles or organizational charts.
Big Vision
As a physician entrepreneur, the vision to scaling a business is not in the wheelhouse of most entrepreneurs especially anyone who has not done this in the past. Growing your practice by a few thousand patients or having 30 offices in your town is not in any way similar to scaling a business regionally, nationally or internationally. If you are first time physician entrepreneur, I can almost guarantee you, despite your strongest rebuttal, that this is not a skill set you possess.
A great read and even better title from Marshall Goldsmith’s book “what got you here, won’t get you there” is something to keep saying over and over. If you have a great idea, one that’s working well and you want to expand, I would strongly encourage you to find a partner who has done this successfully. This business partner is not anyone but rather someone who shares your vision, is adept leader and understands the true building blocks needed to rapidly help your business grow. My advice, don’t find someone who has run a big business, rather, find someone who has truly built a business. Managing is not the same as building or growing and you need to find a “roll up their sleeves” partner.
One way to think about scaling is to think of your business as a “flywheel.” A business partner that can help you build a flywheel is key to scaling. The flywheel is something that once put in motion almost moves on its own and in a highly repeatable and seamless fashion. Flywheels don’t have one offs or rotate in various directions than can only go fast or slow or not at all. My personal feeling is a strong business lead can add wind to the flywheel in the form of fundraising, operational excellence and oversight to manage expenses.
In summary, as a physician entrepreneur you need to have a very strong team around you. A team that can fill in the gaps that you were never taught in medical school or in running your practice. This team will need your help in setting the mission, vision and building a culture of success. Embrace a dyadic model or team based approach to building out your innovation into a business. The strongest leaders place the strongest folks around them to ensure together they have superpowers for success.
Note: Welcome to the third newsletter of “What the doctor sees”.. this newsletter is based on the opinion and experience of this physician and is intended to foster dialogue, discussion and debate. The opinions expressed here are not medical advice and sometimes will have references but for the most part will come from experience. Please add your experiences and perspectives to the discussion whether they agree or differ. We can make healthcare better together and through sharing of great ideas.
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For more on dyads — check out this link. https://www.huronlearninglab.com/hardwired-results/hardwired-results-17/how-to-create-an-effective-dyad-model
For a great book — https://www.amazon.com/What-Got-Here-Wont-There/dp/1401301304For