The best investment I ever made didn’t start with a pitch deck. It started with a nurse spending two hours on a task that should have taken ten minutes.
I was rounding as a hospitalist, and I noticed, again, the amount of time clinical staff spent on manual equipment checks, compliance logs, and inventory reconciliation. It was the kind of operational friction that becomes invisible when you see it every day. You stop questioning it. You assume someone in administration knows about it and has decided the current process is good enough. Nobody had decided that. It was just how things were done.
Months later, when a physician in my network introduced me to a startup building a technology solution for exactly that problem, I didn’t need a market research report. I didn’t need a consultant to validate the clinical need. I had lived inside the pain point for years. I knew it was real because I watched it consume hours of clinical staff time every week, hours that could have been spent on patient care.
That investment became one of the strongest in my portfolio. And it taught me a principle I now apply to every deal: the highest-conviction health care investments don’t originate in boardrooms. They originate at the bedside.
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The 3 a.m. thesis
There’s a specific type of insight that only physicians have, and it comes from working inside the health care system at hours when nobody from the business side is watching.
At 3 a.m., when you’re managing a crashing patient, you’re not thinking about market size. You’re thinking about what’s working and what isn’t. The EHR interface that adds clicks when you need speed. The communication gap between the ICU and the floor. The device that should integrate with your monitoring system but doesn’t. The medication that works clinically but takes 45 minutes to get through pharmacy because the ordering workflow was designed by someone who never placed an emergent order.
Every one of those frustrations is a potential investment thesis. Not a vague observation that health care is broken, but a specific, granular, workflow-level insight about where the system fails and what a solution would need to look like to actually get adopted.
The difference between a physician’s insight and a consultant’s insight is specificity. A consultant can tell you that hospital workflow inefficiencies cost the U.S. health care system billions annually. A physician can tell you that the specific bottleneck happens at shift change when the outgoing nurse has to reconcile a crash cart log that nobody trusts because it’s paper-based, and the incoming nurse has to redo the check because there’s no digital verification system. That level of granularity is where real products get built, and it only exists inside the heads of people who do the work.
Three patterns I’ve learned to recognize
After seven years of investing alongside a network of over 200 physicians, I’ve noticed that the strongest deals share a common origin story. They don’t start with a technology looking for a problem. They start with a clinical observation that someone refused to ignore.
The first pattern is the workaround signal. When you notice that clinical staff have built an informal system to compensate for a gap in their tools, a shared spreadsheet to track something the EHR doesn’t handle, a group text thread to communicate information that should flow through the system automatically, a manual log that everyone fills out but nobody trusts, that workaround is a product waiting to be built. The fact that people have gone to the trouble of creating a workaround means the pain is real and the existing tools are insufficient. I’ve funded companies that started as productized versions of workarounds physicians had been using for years.
The second pattern is the repeated complaint. Not the occasional grumble, but the frustration you hear from multiple clinicians across multiple institutions about the same problem. When a cardiologist in Baltimore and a hospitalist in Kansas City and a nurse manager in Houston independently describe the same workflow bottleneck, that’s market validation from the most informed user base in the world. No focus group produces signal that clean. When I hear the same complaint from three or more clinicians in our network, unprompted, in separate conversations, I start looking for companies solving that problem.
The third pattern is the near-miss. When a patient safety event almost happens because of a systems failure, equipment not where it should be, information not reaching the right person in time, a protocol gap that nobody noticed until it nearly caused harm, that near-miss identifies a problem with clinical urgency. Products that prevent near-misses don’t need a sophisticated sales pitch. They sell on patient safety, which is the one value proposition that every stakeholder in health care, physicians, administrators, insurers, and patients, agrees on.
Why boardroom-originated deals fail more often
The alternative is what I call boardroom origination: a non-clinical team identifies a market opportunity through research, builds a product based on consultant interviews, and tries to sell it into the clinical environment.
This approach isn’t inherently wrong. But the failure rate is higher when the founding insight doesn’t come from someone who has experienced the problem directly. The most common failure mode is building a product that solves the problem as described in a report rather than as experienced in practice. The report says hospitals struggle with inventory management. The reality is that hospitals have a dozen different inventory challenges, and the specific one painful enough to drive a purchasing decision varies by department, institution size, and payer mix. A physician who has lived inside that complexity knows which problem keeps the CNO up at night, because they’ve had the conversation in the hallway at 6 a.m.
What this means for you
If you’re a practicing physician, you’re generating investment-grade market intelligence every day without realizing it. The frustrations you experience, the workflow gaps, the technology failures, the communication breakdowns, are not just complaints. They’re data points that the health care investment industry needs and almost entirely lacks.
You don’t have to act on every one of them. But start paying attention to them differently. The next time you build a workaround for a tool that doesn’t work, ask yourself: Is someone building a solution for this? The next time a colleague at another institution describes the same frustration you’ve been living with, ask: Is this a pattern? The next time a near-miss happens because of a systems gap, ask: Who’s funding the fix?
The answers to those questions are where the best health care investments begin. Not in a boardroom. At the bedside. Where you already are.
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.
