A Doctor's Guide to Startups
On Pivots, Uncertainties, Moving Fast, and Circling Back + Thoughts on Founder Mode
Presented by Commons Clinic
Routine and reproducibility are critical to a surgeon’s success. Creating repeatable processes ensures order and fosters predictable outcomes. Medicine relies on completing tasks and mental checklists in an orderly fashion: entering orders, following up on tests, answering pages, replying to messages, responding to consults, and dictating notes. The work is never done. If you don’t stay on top of it, it can consume you. So, I like order.
Startups are about uncertainty—the only constant is change. Accepting this reality can be difficult when coming from the usually orderly world of medicine. During my time as a mentor, advisor, and investor, I’ve come to terms with the sometimes fickle nature of healthcare startups. In fact, I kind of enjoy it now—it keeps things fresh, interesting, and engaging. Getting to that point took some time, and finding parallels between the startup world and the medical field helped.
Here’s how I learned to embrace the chaos.
From the EIC
Working with healthcare startups is an excellent way to fight burnout. Lots of docs love to innovate and have a passion for improving patient care. Leveraging clinical experience to do so provides a sense of fulfillment. Unfortunately, such opportunities seem hard to come by on the frontlines. To fill the void, more clinicians are turning to health tech startups—a boon for companies in need of medical expertise. How do you ensure that a chocolate-and-peanut-butter opportunity doesn’t turn into oil and water?
Startups are all about risk and uncertainty, while medicine craves protocol and structure. As physicians, we are taught early on to balance the pros and cons of an intervention and take steps to mitigate complications. Risk aversion protects patients from unnecessary harm, but it can also stifle innovation. Twenty years ago, sending a joint replacement patient home the day of surgery with only aspirin to prevent blood clots would have been considered an unacceptable risk. Now, it’s commonplace. The ability to responsibly walk the line between risk and innovation makes physicians invaluable to startups.
One of the most effective ways to help startups achieve this balance is to join a clinical advisory board (CAB). My first such role was with Buoy Health, and I currently serve on the CAB for TailorCare. Leveraging my experience as an orthopedic surgeon and practicing physician to guide product development, clinical pathways, and provide insight into the doctor-patient relationship is incredibly rewarding. Better yet, they’ve taught me invaluable lessons about the inner workings of a startup. There’s no one way to find such roles. My advice: put yourself out there, share your thoughts on topics or companies of interest on social media, and build your network!
Living with uncertainty means getting comfortable with “the pivot.” My first health tech investment and advisory role was with Kitchry, a meal plan app and virtual nutritionist service for patients with dietary restrictions. Five years later, the company is now called Healent and is gaining traction as an AI-driven clinical intelligence service for pain management. There were multiple pivots in between.
While it may not be as dramatic, docs pivot all the time. Good surgeons enter the OR with a Plan B. If a patient’s cancer isn’t responding to first-line treatment, an alternative chemotherapeutic regimen is tried. Thoughtfully but decisively responding to evolving conditions is something we often do as doctors. Because they tend to be more orderly, we don’t necessarily think of these changes as pivots—but they are.
In medicine, we expect consults to be completed in a timely fashion. We rely on each other to circle back quickly and communicate clearly. Startups often don’t work this way. Meetings may be postponed or canceled abruptly. Emails may go unanswered indefinitely. Ghosting is as common as actually circling back. Coming from the professional rigor of healthcare, such inconsistency may be off-putting. As I’ve learned, these perceived slights usually aren’t personal or intentional. Startup priorities are constantly shifting. Putting out fires and shuffling tasks is a fact of life.
We do the same in healthcare (ask any resident what it means to “run the list”). Prioritization is necessary—we categorize tasks as “emergent,” “urgent,” and “routine.” That said, disrespectful behavior shouldn’t be tolerated, and everyone’s time and effort should be valued. Communication is key, and a quick note goes a long way.
My current role with Commons Clinic evolved from periodic check-ins with CEO Nick Aubin. We first connected over a mutual interest in bringing real value to musculoskeletal (MSK) care. No agenda or ulterior motives—just two guys riffing. (Frankly, I think agenda-free meetings lead to deeper relationships over time.) He’s busy. I’m busy. Every so often, we’d ping each other to share something interesting. One of my pings spurred the launch of this newsletter and my current position as senior clinical fellow.
Finally, a critical component of working with startups is finding work-life balance or, ideally, work-life harmony. Startup involvement can be extremely rewarding. It’s an opportunity to leverage clinical experience in a way that feels impactful. While the uncertainties of the startup world can be jarring initially, they aren’t all that different from what we experience in frontline healthcare. Dipping your toes in by investing, mentoring, and advising can help smooth the transition. Fractional roles evolve organically as relationships deepen. In the end, our world and their world aren’t so different.
Bridging the Startup-Healthcare Gap
Leverage clinical expertise to navigate uncertainty and risk responsibly.
View company pivots as a necessary response to evolving conditions.
Use brief check-ins to keep lines of communication open.
Appreciate the subtle similarities between frontline care and fast-moving startups.
Start by investing, mentoring, and advising and go from there!
On Founder Mode
Last week, Y Combinator co-founder Paul Graham published an article on his blog titled “Founder Mode.” The post immediately went viral, in part because Graham is a muse for startup founders and partly because the post plainly expressed how many of them feel.
I’ve never started a company, but there are some similarities between surgeons and founders. Both are tasked with running high-performing teams in stressful, high-stakes environments. Like running a startup, operating requires a balance between paying attention to detail and micromanaging to the point of distraction. Ultimately, founders and surgeons must take ownership of decisions and outcomes.
I wrote a few weeks ago about “Surgeon Mode.” In my mind, there is no one right way to succeed in high-stress environments that require people skills—whether founding a company or performing a surgery. Some surgeons blare music and encourage conversation. In other ORs, the only sound is the steady beeping of the anesthesia machine. Both approaches can work.
The best surgeons I’ve known (and those I’ve learned the most from) foster an environment of accountability, lead by example, and encourage open communication. They create clear expectations with the North Star of achieving excellence. They are tough but fair—demanding but respectful. They expect as much of themselves as they do of those around them. In short, they build great teams, and great people naturally gravitate toward them. That’s a mode we can all get behind.
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
