The Wrong Unicorns
Over the past several years, I’ve had a front-row seat to healthcare innovation—advising startups, working with founders, and watching companies try to transform care delivery. After a while, a sort of pattern emerges: we keep following the same ineffectual playbook.
Venture capitalists are obsessed with unicorns — companies that reach billion-dollar valuations. Who can blame them? After all, big exits are the name of the game. Founder stories, mission and vision statements, grandiose conferences, and proclamations of tech-fueled disruption are means to an end.
Yet attempts to revolutionize healthcare remain…underwhelming.
Sure, there have been some notable exits — Amazon buying One Medical, Doximity going public, Teladoc vastly overpaying for Livongo. Investment and enthusiasm ebb and flow with hype cycles and broader market forces. Clinical impact and systemic change remain elusive.
Why?
Could it be that meaningful healthcare disruption (assuming that is the goal) won’t follow the typical Silicon Valley playbook? Are solutions too often (under)informed by the biases of outsiders disconnected from the true needs of the system? Is leadership too often packed with the same retreads from payors and health systems — destined to repeat the same mistakes?
Maybe healthcare innovation hasn’t progressed much because it’s playing the wrong game with the same ineffective players.
What if healthcare’s rarest and most underappreciated asset isn’t money, tech, or C-suite paper champions—it’s high EQ leaders who understand medical practice and business strategy?
We’re all familiar with the pattern. Offering solutions looking for a problem. Refusing to see the big picture or play the long game. Thinking healthcare can be SaaS’ed — the human element replaced by technology. Ignoring the importance of frontline experience. Devaluing the real operators who do it day in and day out. Faking it, but never quite making it.
Healthcare innovation doesn’t lack grand ideas. But the current approach hasn’t yielded meaningful results. Maybe we’re focused on the wrong things. Could it be that the real unicorns are experienced physician leaders capable of bridging the gap between the clinical, business, and innovation worlds?
Not just advisors or figureheads, these individuals are essential parts of the leadership circle. They aren’t just doctors—they’re proven operators, strategists, and connectors. They speak the language of clinicians and the language of business, aligning incentives in ways others can’t. They understand the realities of care delivery while also knowing how to scale, execute, and drive change.
Unicorn physician innovators aren’t “nice haves,” they’re “must haves.”
DOA: Hire a career payor/hospital exec, attach a “value-based care” label to your company/solution, and watch it get dragged down by the same inertia that’s sunk every previous attempt.
Built to last: Design physician-led, innovative models that align economic incentives with real-world medicine and embrace the long, methodical game.
Healthcare innovation is at a crossroads. Forward-thinking companies will prioritize physician-driven leadership as they look toward their next phase of growth. They’ll understand that growth-mindset doctors are the secret sauce to sustainable change (and financial success).
Many companies don’t realize this truth until it’s too late. They cave to investor pressure, recycling the same failed strategies — scale at all costs, clinical and business models be damned! — and hoping for a different outcome. They overlook the unicorns standing right in front of them: proven healthcare operators who have successfully “executed” for years.
As it stands, healthcare innovation continues to flail about, scratching its collective head and wondering why the needle barely quivers. Meanwhile, winners will recognize, invest in, and empower the rare leaders who bridge worlds and see the bigger picture.
Think I’m wrong? Ask yourself which direction healthcare is heading and who’s been steering the ship. Think about why the system has largely shrugged off would be disruptors. Be honest about how, in healthcare, the typical investor approach has failed. Admit that physician marginalization created many of the problems we face.
Call it self-serving if you want, but experience matters. Those of us who have worked on both sides — delivering care and thinking strategically — aren’t just “nice haves.” We’re “must haves.”
Physician leaders aren’t just the key to success—they’re the difference between building something real and repeating the same cycle of failure. Smart builders won’t just find these unicorns—they’ll recognize their value and build with them.
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
Amazon hired Atul Gawande, maybe the walking example of who you're writing about. Can we just admit there's no attractive profit margin in healthcare and get on with it?
Amen! Ben