I graduated residency with over 100 peer-reviewed publications, an EB-1A visa for extraordinary ability in medicine, and zero understanding of how health care capital works.
Nobody taught me what a term sheet was. Nobody explained how venture capital flowed into the companies building the devices, drugs, and software I used on patients every day. Nobody mentioned that the same analytical rigor I applied to systematic reviews, defining a question, evaluating evidence, synthesizing findings, identifying limitations, was exactly the skill set that health care investors were missing and desperately needed.
I figured all of this out on my own, over years, by trial and error. It didn’t have to take that long.
The gap is well documented, but the conversation is stuck
Studies show that medical students and residents answer fewer than 55 percent of basic financial literacy questions correctly. Only 19 percent achieve what researchers define as financial proficiency. And 89 percent say they believe they should receive financial training during medical school. The data is clear: Physicians graduate with an average of $200,000 in debt and almost no formal education in how money works.
But here’s where the conversation gets stuck. When medical educators talk about financial literacy for physicians, they mean personal finance, budgeting, loan repayment, retirement accounts, disability insurance. That’s important. I’m not dismissing it. But it’s incomplete. It addresses one narrow dimension of financial knowledge while ignoring the much larger opportunity that physician training uniquely positions you for.
Nobody is teaching physicians that they could be health care founders. Nobody is teaching them that they could be health care investors. And nobody is explaining that the clinical skills they’ve spent a decade building, evidence appraisal, pattern recognition, workflow knowledge, regulatory navigation, give them a structural advantage in both of those roles that almost no other professional has.
The founder gap
Physicians have historically been behind some of the most transformative innovations in medicine. But today, the vast majority of health care startups are founded by people who have never treated a patient. They build products based on market research rather than lived clinical experience. The result: Billions invested in solutions that fail at the point of care because nobody who works inside the clinical workflow was involved in designing them.
As of 2016, only 13 medical schools offered any form of entrepreneurship programming. Mayo Clinic recently launched one of the first Innovation Tracks embedded in an internal medicine residency, covering needs assessment, product design, regulatory environment, and startup methodology. It’s excellent. And it’s almost entirely alone. A recent study found the majority of IM residents had never received formal education in innovation or entrepreneurship, yet universally agreed it was important to being a well-rounded physician.
The investor-allocator gap
This is the gap I fell into, and the one I think is even more consequential. Health care is a $5.3 trillion industry. It represents 18 percent of GDP and is projected to exceed $8 trillion within a decade. In 2024 alone, over $23 billion in venture capital and $115 billion in private equity flowed into health care companies, totaling nearly $140 billion in private capital allocated to shaping the future of how medicine is practiced, delivered, and paid for.
Physicians participate in almost none of this.
The people allocating this capital are primarily financial professionals with MBAs and backgrounds in banking, consulting, or technology. Many of them are brilliant at financial modeling. Very few of them have ever managed a crashing patient, navigated a prior authorization, or explained to a nurse why a new piece of technology is worth changing a workflow that already functions.
After transitioning from clinical practice to health care venture capital, I’ve made over 20 investments across digital health, biotech, devices, and therapeutics, working alongside a network of more than 200 physicians. The single most consistent finding in my experience is that physician judgment about clinical adoption, whether a product will actually be used at the bedside, is the most valuable input in health care investing, and it is the input most consistently absent from the rooms where investment decisions are made.
Residency doesn’t need to turn physicians into fund managers. But it should expose them to how private capital flows into health care and where their clinical expertise fits into that process. A physician who understands the difference between a 510(k) and a PMA pathway, who can evaluate a startup’s reimbursement thesis, who can assess whether a product will be adopted in clinical practice, that physician can serve as a clinical advisor, a venture scout, a limited partner, or a company board member. All of these roles create massive value. None of them are taught.
What the missing rotation could look like
I’m not proposing another year of training. A single elective or longitudinal seminar could cover how health care companies are funded, from angel investment through growth equity. It could show residents how evaluating a clinical trial and evaluating a health care startup require remarkably similar skills. It could expose them to physician-founders who built companies out of clinical problems encountered during training. And it could introduce clinical advisory and physician-led diligence, explaining how a physician’s assessment of clinical utility is worth more to a venture fund than a hundred hours of market research.
The content isn’t hard to build. The challenge is the assumption that a physician’s role in health care ends at the patient encounter.
Why this matters more than we think
Over $140 billion in private capital is being deployed every year into the health care industry. That capital determines which drugs get developed, which devices reach the operating room, which digital health platforms get adopted by health systems, and which innovations die on the vine. The people making those decisions are overwhelmingly not physicians.
Health care is one of the largest sectors in the global economy. Physicians understand it more deeply than any other professional group. They see the problems firsthand. They can evaluate solutions with a rigor that no MBA program teaches. They have earned, through a decade of training, hundreds of thousands of dollars in debt, and years of patient care, an expertise that is extraordinarily valuable outside the exam room.
But we don’t tell them that. We train them to diagnose, treat, and publish. We don’t train them to build, fund, or lead. And until we do, the people with the deepest understanding of health care will continue to sit on the sidelines while others decide how the industry’s resources are allocated.
That should bother every physician. And it’s a gap we have both the talent and the opportunity to close.
Harsha Moole is an internal medicine-trained physician-scientist with more than 100 peer-reviewed publications, including work featured in the New England Journal of Medicine. After years of clinical practice and gastroenterology outcomes research, he made an unconventional transition from the bedside to the boardroom by founding PhysicianEstate, a health care-focused venture capital firm.
Over the past seven years, Dr. Moole has made 22 early-stage health care investments across digital health, medical devices, biotech, and therapeutics. He has also built a network of more than 200 physicians from institutions such as Johns Hopkins and Stanford who help source opportunities and provide clinical diligence before capital is deployed. His core thesis is that physician-scientists with firsthand clinical experience are uniquely positioned to identify health care investments that generalist investors often miss.
His research background is reflected in his publication record on Google Scholar, and he shares professional updates on LinkedIn.
