Breaking into health innovation: tips and insights from a physician innovator [PODCAST]

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In this episode, we welcome Jay Shah, a cardiologist and health care executive, to discuss the future of health care. Jay shares his personal journey and insights on how to get started in health innovation, including tips on how to build a network, stay up-to-date with new technologies and trends, and find the time to pursue innovative projects. We also discuss the importance of collaboration and how physicians can work with other stakeholders in the health innovation ecosystem, such as entrepreneurs, investors, and other health care professionals. Whether you are a practicing physician or a medical student interested in innovation, join us for this inspiring conversation on how to make a difference in health care through innovation.

Jay Shah is a cardiologist and health care executive.

He shares his story and discusses his KevinMD article, “Only physicians can find the balance between tradition and active disruption.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today on the show we have Jay Shah. He’s a cardiologist and health care executive. His KevinMD article is titled “Only physicians can find the balance between tradition and active disruption.” Jay, welcome to the show.

Jay Shah: Thank you so much for having me, Kevin. I appreciate it.

Kevin Pho: So we’ll get to your article in a little bit, but first off, just briefly share your story and journey to where you are today.

Jay Shah: Yes, of course. Sure. I started, like probably a lot of physicians, growing up wanting to be a doctor for a lot of reasons. Then I did my medical school at the University of Missouri in Kansas City, so at a city general hospital, which was great. It was a great place to be a medical student, and I learned a ton. Then, by luck or chance or a combination of both, I ended up at Mass General for internal medicine residency, where, still, the best thing that happened there is that I met my wife. We did our cardiology fellowships at Washington University in St. Louis.

Then I did something quite different. I think a lot of my mentors thought I was kind of nuts. I went from those major, huge hospital organizations and started my own practice in Portland, Oregon, a solo practice within metropolitan Portland, and built that over seven years into a very large, very busy cardiology practice. Then, over the last three years, the last transition that I had in clinical medicine was that I moved down to Mayo Clinic. We had an opportunity, and I started the thoracic aortic disease program at Mayo Clinic in Arizona and built that into a national and international referral center.

Then, over the last 18 months, almost two years, I have transitioned from that role into the chief medical officer of a startup. So that’s been my last couple of years, and it’s been an amazing adventure and a great ride. That’s my story professionally. Of course, I have a family and two children, and that’s my joy and passion outside of work.

Kevin Pho: Now, some doctors, once they become an attending and get out to practice, kind of do that same thing for whatever, 30, 40 years, for the rest of their professional career. But you’ve pivoted a few times. You went from, of course, training at MGH and Washington University to private practice, to Mayo Clinic, and now your startup. So tell me the impetus behind these career pivots.

Jay Shah: I think if I had to boil it down to one thing, I would say it’s just a desire to try something new and a desire to learn. Repeatedly over the course of this last 20-year career journey, that’s always been the impetus for me. So, for example, going from Washington University, this thousand-bed hospital, a giant clinical, academic, and training program, to starting from one room, one MA, and two EKG machines, it’s just a huge difference.

The amount I learned in those first years of practice was incredibly valuable and incredibly interesting: not only being a clinician, being a doctor out of training for the first few years, when you learn the most for clinical acumen, but also learning how to set a practice up, how to run the business, how to hire people, how to manage staff, and how to do all those things that it really takes to run your own practice. And the same thing again going to Mayo Clinic and starting a program within a large organization, and again the same thing going 90 degrees and starting from scratch in the health tech, digital health industry as a chief medical officer.

So it’s always been that focus on where can I learn more, and what am I going to gain myself, for my own knowledge and my own education, with these pivots. That’s really what I think I initially thought about subconsciously but now actively think about: How are these changes going to help me learn and grow?

Kevin Pho: So talk about that transition from clinical medicine to now being a health care executive at a startup. How was that transition?

Jay Shah: It was interesting. I’d been practicing for over 10 years in full-time practice. I’d never done anything else. I didn’t prep, didn’t do much research; I was just a busy, busy clinician. And you’re going from that, which we are experts at, right? Most of your listeners are probably experts. You go in, you can knock it out, you see the patients, you do a great job for them, and you’re just rolling. You go from that to an environment where there are no patients, there’s no practice setup, there’s no real structure, into a startup world where you’re a novice. That is a significant shift. Then there’s realizing you have to go back to learning mode, realizing that things are not going to be as structured as you have had them for decades. For all of us in medicine, it’s always structured. Everything we’ve done in clinical medicine is structured. So that was a big shift.

The other big shift is not always being the expert in the room. You have your medical expertise, and that’s why companies in industry rely on you. That’s why they want you in the room, to bring your clinical expertise. You have that, but most of us have had to, or will have to, learn the business side: marketing, commercial, research, development, operations. You have to learn a lot of those aspects, which I loved and I love doing, which is why I wanted to do it. But you come into that world completely unaware, generally speaking. I would say most of us would. So it’s somewhat of a risk in that regard, which would scare some people. And it scared me, no doubt about that, but it also excited me. These were the things that I knew I would learn a lot about, and I wanted to. So that’s the major shift.

Kevin Pho: So you started a private practice, which certainly gave you that crash course in business training. Other than that, did you have any other formal business background before you jumped into this role at the health startup?

Jay Shah: No, not really. I’ve done some angel investing and some different types of investing, real estate, that kind of stuff, but nothing in the formal business sense. I never got an MBA, and I never went to do finance courses. But I think a lot of clinicians underestimate their acumen on the business side, especially those who are in the private practice world or who are in larger administrative roles in bigger organizations.

So, for example, within my private practice clinic, I built that cardiology department out. It did have an umbrella organization that had a lot of primary care and other specialties, and for five years I sat on the board and helped run the organization. That doesn’t come with an MBA, but that is tremendous experience: managing people, understanding business, understanding budgets. We’ve had to do that, and I think a lot of us underestimate and downplay that type of experience.

I think that even the traditional types of leadership that we have in clinical medicine, leading trainees, fellows, and residents, mean you’re managing people. You’re managing teams. You have that experience. We’ve had all of that experience, and I think it’s crucial that we don’t forget that, especially if you’re looking to transition. Those are incredibly rich and valuable experiences that can be parlayed into a business environment.

Kevin Pho: All right, let’s talk about your KevinMD article, titled “Only physicians can find the balance between tradition and active disruption.” Now, tell us, how did this article come together?

Jay Shah: As I’ve been doing this role as chief medical officer in the startup world, in the business world, for the last 18 months to two years, one thing I’ve noticed is that there’s a clear lack of physician voice, provider voice, in this world. I’m sitting with VCs and going to these large health care innovation conferences, and the number of practicing physicians, nurses, and providers who actually see patients is less than 5 percent of the audience. So there’s all this talk, noise, people, companies, efforts, and money going into trying to disrupt health care and trying to make it better in certain ways, or a lot of ways, make it more efficient, make it more, whatever the goal is. But the physician voice is largely absent.

What happens when I sit there in the audience, or when I’m participating in panels, is that it’s clear to me that the people trying to make a difference, trying to make improvements in innovative companies and businesses, really oftentimes have no voice from someone who actually does the work of clinical medicine. So, again, there’s incredible value in practicing medicine and bringing that to bear in the efforts of innovation.

Just as an example, within my own company, I’m the only physician voice right now. So a lot of times what happens is people will come up with an idea, or a change to the product, or an idea about where the product should go. Then, generally, with interaction with them, we totally shift. We go from one idea and shift it to something entirely different, based on our clinical expertise and our knowledge of what would actually work in practice, what wouldn’t work, where there are too many hurdles to really try something, versus where there’s a real opportunity for improvement. I think that was the genesis for that article: really wanting to let other physicians know, to empower themselves, that their experience and their knowledge are tremendously needed in this space.

Kevin Pho: Now, what do you think are some of the root causes why there are so few practicing physicians in the health tech startup space?

Jay Shah: Well, we alluded to some of them. I think it’s scary a lot of times. Going from clinical practice to this world is a complete 90-degree turn, and generally, depending on your specialty, your income will go down. There’s a lot more risk involved, right? You’re taking compensation in the form of equity a lot of times rather than cash compensation. Startups fail. So there’s a risk involved that doesn’t generally exist after we’ve done all our training and been in practice, and you have a great practice that’s successful, or you’re in a good place. That’s a fairly comfortable place to sit. It may not be as exciting, perhaps, or maybe some people do find it engaging for a long period of time, but I think that there’s a safety in that. So that’s one hurdle.

The other hurdle is what you mentioned before, and I found this when I was looking to try to transition into this field: Oftentimes the companies that were looking for medical people were looking for people with experience in a business sense. So how does a clinician who’s done full-time clinical work tell a company, “Well, look, I have skills that would apply, but I haven’t actually done something on my CV to represent that”? They don’t necessarily buy it when I say, “Well, medical experience comes with a lot of business acumen and training and management of people.” They don’t really quite understand that. They understand it from the framework of more traditional businesses.

So if you’re coming from a strategic company like a Medtronic, that gives you a lot of cachet, so to speak, even though you’re not a practicing clinician, over someone who’s applying as a practicing clinician who says, “I’ve never done this before, but look at all this other experience I have.” So there’s a hurdle to clear. You’ve got to get your foot in the door in some respect. Once you get your foot in the door, then the door is open, because then all of a sudden you’re a practicing clinician with some business experience. But it’s getting that foot in the door that, at least in my experience, was a little bit harder.

Kevin Pho: So what are some of the solutions going forward? Because physicians who continue to see patients are themselves already overwhelmed. Physician burnout rates are at 60 percent. In the primary care world, you spend a day seeing patients, you go home, you’re charting at night, and there’s no bandwidth left for anything else, correct? So for those physicians who may be interested in diversifying their professional life, so they could be part-time clinical and part-time with health innovation, what do you see as some of those solutions going forward?

Jay Shah: The first is being willing to get off the hamster wheel a little bit, or at least slow down. Like you said, I was in practice where I was going from 5:30 a.m. to 6 or 7 p.m. daily, five days a week, weekends, call, all the things you just said. That doesn’t give you time or energy to explore other things. So it’s actively making the choice that says, “I’m going to take half a day, a day. I’m going to take every afternoon or a few hours a week, and I’m going to do this other work, and I’m not going to do clinical practice. I’m going to shut down Epic, I’m going to turn off the computer, and I’m going to go look at something else.” I think that’s an active choice. That’s something that’s in our hands.

Then I think it’s a matter of dipping your toes in the water to see what works. We have a built-in advantage in that most of us can generally modify our schedule, still practice, but modify our schedule and reduce that time so that we have time to look at other things and try other things. You still have your safety net. You still have your income from your clinical practice, but you can do some consulting work. Maybe you do some advisory board work. There are plenty of opportunities there, just a couple of hours a month. It doesn’t make much money; that’s not the point. The point is to just try and learn about these other aspects.

What happened for me is I tried a few consulting roles, and I did that for six months, 12 months. Now, all of a sudden, you have some experience as a consultant in the business world, and you’re starting to listen to those conversations and understand the lingo and the talk and the emphasis and what people are thinking about. So then, if it comes time to say, “Look, I want to try something new, try something totally different,” and you find an opportunity that you want, you’re going to have some experience. You have some idea of what you’re getting into, and you’ve still done this with the safety of the clinical practice.

Then the last thing is that, generally, and this happened for me, most companies other than large, strategic, big companies are not going to want to pay a physician salary up front, full-time. I think that’s great, actually. It seems like a downside, but it’s not, because what you generally can negotiate is a part-time role. So you say, “I’m going to keep practicing three days a week. You’re going to get my time two days a week for this amount of money,” or whatever compensation they’re going to offer. So for six, nine, 12 months, you can try it out. Try before you buy. You can just sit there, go through the meetings, and learn about the product, learn about the team, and learn about the company. If it’s not right for you, “OK, I’m out. I’m going to go back to clinical practice. I’ve tried it, and I didn’t want to do that.” Or you say, “Look, I want to jump. This is a great opportunity. I like this team. I like what they’re doing. I feel comfortable now. It’s been nine months. I feel comfortable with this.” That’s how I think we get to the point where we can really make that transition in a comfortable way.

I think the last part is not ever feeling like you are leaving clinical medicine forever. I think a lot of people feel that way. It’s like, “If I jump, if I do this, I’m wasting my career. I’m wasting all this time that I put into clinical medicine.” That’s not true. In fact, you’re using all that knowledge and that experience that you’ve gained for this much better, or different, or more exciting opportunity that’s going to engage your brain in a different way and, hopefully, make you more passionate about what you’re doing. I think those are the things to remember, and that’s how I would advise people if they want to make that transition.

Kevin Pho: Now, let’s say you’re a physician who decided to make that transition, cut back or adjusted their hours, and wants to go looking for some of these opportunities in the health innovation space. What’s the next step for that?

Jay Shah: First of all, use your network. You’d be surprised at how broad our networks are after doing all this training and work that we’ve done, and generally people have gone through different institutions. If you are at all active on LinkedIn, which is generally the platform for most of this, the business and social media platform, make your profile, make it robust, and go start searching your LinkedIn network. You’d be shocked at who you could probably get in contact with.

This was my experience. I did a tremendous amount of informational interviewing, and I really would just connect with physicians in all these different roles. A lot of times they were just cold calls. I would just email those physicians and say, “Look, I’m a doctor too. I’d be curious how you got into this role, and I’d be curious about what this role actually means.” Like, what does the chief medical officer for JPMorgan do? I have no idea. So I’m going to email this guy, and they respond 95 percent of the time. They’re physicians. They’ve done this before at some point in their career. They’ll say, “Oh, OK, sure. I’ll give you 15 minutes of time and talk on the phone.” It was easy. It was so easy to get in contact with other physicians. They were willing to give their time and energy to give you perspective. It was extremely easy. So in that way, you can really use your network to learn more.

Then, as I said, you can look at the opportunities on LinkedIn. There’s a tremendous number of sites that are for consulting or advisory-type roles that are very small, part-time, or even hourly. You can just dip your toe and explore the whole space, explore your specialty and the companies that are around in that space, around your specialty, because those are going to be the more likely ones to give you opportunities. That’s how I would start.

Kevin Pho: We’re talking to Jay Shah. He’s a cardiologist and health care executive. His KevinMD article is titled “Only physicians can find the balance between tradition and active disruption.” Jay, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Jay Shah: Well, the main thing I would say to anyone is just to never stop learning: never stop looking to learn, never stop looking to grow. I think that’s become more mainstream, having this growth mindset. I think for physicians and clinicians, that means maybe looking outside of your comfort zone and looking outside of the lanes that we’re just staying in.

The second thing I would say is never underestimate the amount of experience and education that we have, as it relates to trying something new. What we have through our training and through our work is a tremendous wealth of knowledge, and we should never undersell that or underestimate how valuable that is. I think we do that a little too often. So those would be the two things I would recommend.

Kevin Pho: Jay, thank you so much for sharing your time and expertise. Thanks again for being on the show.

Jay Shah: Thank you very much, Kevin. I appreciate your time.

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