How to Break into Health Tech

Following last week’s tactical career post, A Networking Email that Works, here is a method to crack into the Health Tech/Service Innovation startup world. I assume this would work in other start-up heavy fields, but cannot confirm. 

The startup world can be daunting, especially for those used to larger organizations and/or academia.  The risks are greater, the rewards are supposed to be greater as well, but the truth is, if you really, really want to change health care, start ups seem to be the best place to do it.  One strong word of advice on risk– the best way to deal with career risk is cash.  I highly recommend you have at least 6 months of full living expenses (you budget, don’t you?!?) before joining a high risk company.  Otherwise every ebb and flow will send you careening in unhealthy ways.  You read into every meeting to see if your family is going to starve, and that makes it hard to change the world. Ok, if I haven’t shaken you yet…

Cracking into the world of startups is a networking game.  As an academic physician (the role most likely to ask for advice in this scenario) you are both too expensive and know almost nothing useful to a startup.  That said, we clearly need doctors in digital health.  If you are not a doctor, the odds are that you know more and cost a little less, but the same patterns hold true.  

There are tons of digital health companies created and dying every day. Any database is out of date and so you need to create it in real time.  Fortunately, the journey is helpful.  

Step 1: Check out the portfolio page of high quality health care Venture Capitalists (VCs).  

VCs examples that I like from past positive experience are:

• Flare Capital

• .406 Ventures

• Oak HC/FT

• Venrock

There are others, feel free to go wild, this is just a starting point.

Now, look through EVERY COMPANY on the Healthcare Portfolio page.  Pay attention to the ones that seem interesting to you and discard the rest.  I am a deeply intuitive decision maker, so I just go with my first instinct.  You do you. 

Step 2: Check out the Portfolio Company websites.  

You are looking for 3 things in priority order to pull you further:

1. Company Mission including population served

2. Leadership team background

3. Open Roles page

The goal here is to find a company that speaks to you enough to reach out in Step 5.  Don't worry if there isn't an opening, reach out if you like the company as you never know what will happen. In a subsequent post we can go into how to evaluate a start up you’d consider joining (hint: think like an investor).

Step 3: Find out the other funders of companies you like.

Sometimes this information is on the company site, sometimes it is on Pitchbook or Crunchbase.  This lets you build a database, see who knows whom, and find the few companies or investors on which to target.

Step 4: Repeat until you have 5-10 companies you like, or run out of time or energy. 

Step 5: Reach out through your network

This one can be a bit tricky, but send A Networking Email that Works to anyone in your network that might get you closer to a company on your list.  LinkedIn is helpful.  If you don’t have anyone, send a cold email to the leadership team, what do you have to lose?  Alternatively, track down a VC (hint, the board members of the company who work for VC funds are usually the lead VC for that deal).  Remember you are going for an informational interview— to learn more about the company— not a job offer, so play it cool.  

Good luck!  Again, this took me 50-70 conversations before finding the right match for me, so be patient, polite and persistent.

A Networking Email That Works

On the heels of the generalist series there has been some inbound requests from friends and colleagues for career advice.  The next few entries will outline a networking approach to gain entry and credibility when entering a new field.  First, here's the skeleton of the e-mail template that I’ve used to get in conversations with truly wonderful people that have had a profound impact on my career. 

 

Dear PERSON OF INTEREST,

WARM INTRODUCTION NAME suggested we should meet because of REASON YOU ARE GREAT.  I am QUICK BACKGROUND and looking to advance in DESIRED FIELD.  Would you be willing to spend 30 minutes with me to share your story: what you do and how you got there?

Thank you so much for considering,

YOUR NAME HERE

 

That’s it, works almost all the time.  Now let’s break it down part by part to understand what is included and what is intentionally excluded.

 

Warm introduction: 

This one is a challenge starting out but gets easier over time.  A warm introduction, a reference from someone else in your mutual network, is crucial to get this person’s attention and ensure your legitimacy.  Additionally, this applies very mild social pressure so that they do not ignore you.  No one wants a colleague to follow up with “why didn’t you respond to so and so!?” and remember, the utilization and expansion of a network grows its value.

What if you don’t know anyone?  With LinkedIn and other social media, it is easier than ever to understand who you know and who they know. If you are persistent and pleasant, these conversations can start almost anywhere and chain you to almost anyone you’d like to meet.  A word of caution, never fake an introduction if you don’t have one.  It is dishonest, unethical, and easily disproved.  Expect the recipient to check with the referrer before responding. 

 

Reason you are great:

A quick summary of your understanding of their expertise.  Flattery never hurts, especially powerful people.  Examples include: “your success in health tech.”  The important part of this sentence is that it is about their greatness, NOT YOUR NEEDS.  By being self-centered you give your recipient a guilt-free excuse to not do something nice for you.

 

Quick background/Desired Field:

Self-explanatory, keep it brief.  “I am a medical student looking to get into entrepreneurship SO THAT I can improve care in this country.”  This establishes your value and interest without spending too long on yourself. Do not inquire about specific roles, jobs, internships, etc. for reasons that will become clear in a moment. 

 

Your Story:

This is the hook of this email.  Most messages contain requests for favors which, other than being rude, fail two basic tests of action: First, there may be no makeable deal.  If you ask for a job and there is no job, then the answer is at best an apologetic “no” and the close of communication. Second, you’ve failed to appeal to the recipient’s self-interest in your request. However, due to the Ben Franklin Effect you still want to ask for something, and this is where the story idea comes through.  One of the best pieces of advice that I ever received was to listen to everyone’s life story, decide which ones appeal to you most, and then spend as much time with those people as possible.  It is an ingenuous, genuine method of learning about others and one’s self. Furthermore, everyone loves to share their version of their story!  They are rarely asked (or not often enough!).  You appeal to your recipient’s desire to teach, share and contribute which is a very powerful force.  Additionally, you will begin to see patterns of action and sequences of events and the incredible role of capitalizing on luck that plays into success.  By limiting it to 30 min you are minimizing the burden.

Now, what happens if they agree?  Easy—schedule whatever time they give you. Early, late, weekends, whatever.  Again, this is about them, not you, so make it work however you can.  Someone once asked me for a favor and then complained that the availability I offered them THE NEXT DAY was “too early in the morning for them” (7am local time!!).  Needless to say, that was not a productive relationship.  Also, block at least a 30 minute post call buffer in case it runs long (which is always good), for you to write a thank you email, consolidate your notes, and predictably, send the emails to the next set of individuals in the chain recommended by your recipient.

 

So now that you have the meeting scheduled, what are the possible outcomes?  Best case scenario- you find a mutual match, you get along well, the story is thrilling and a wonderful relationship begins.  This is extremely rare, but don’t worry, you only need one or a few of these relationships in your whole career.  Rarely, there is no magic, you don’t get along and the call ends in a dead end. Oh well, thank you note away! The most likely outcome is that your new colleague will suggest 1-5 people to whom you should speak next.  When I started this journey I was lucky enough to get 10 recommendations (!!) from an early meeting which changed the course of my career.  If they offer contact information, great, if not don’t ask.  Don’t make them do work, you can figure out an email address or LinkedIn profile.  Do ask if you can use their name as WARM INTRODUCTION.  And on and on you go! 

You may need 5 conversations, you may need 75 (I did), but persist in this method and you will develop lifelong, mutually productive relationships with mentors and colleagues. Good luck!

Career Path for the Generalist, Part 3: The Integrator

I hope you’ve enjoyed the first two parts of the Generalist Career Path!  I’ve gotten great feedback which motivates me to continue writing. A word about part 3: read the links. It is worth getting familiar with the concepts as I attempt to create my own unified theory. I’ve also revised Part 2: Interpreter if you’d like to quickly re-read. 

If the Commando gets shit done across specialty domains, while the Interpreter builds empathetic relationships across specialists within domains, then the Integrator evolves from the previous phases to create lasting value by… integrating across domains. Maybe this is what you have secretly thought you should be doing: designing solutions: organizations, technology, services and products that combine specialties to create something new from the composite parts.  Perhaps you’ve even been frustrated by specialist bosses (twos) who cannot see what you can see.  Remember, your value is not the depth of your skill but rather the breadth of your skill.  As such, you are uniquely positioned to see what others cannot, similar to the concept of Chance III.  

Charlie Munger, perhaps the most successful generalist, put it best:

“each discipline entwines with, and in the process strengthens, every other. From each discipline the thoughtful person draws significant mental models, the key ideas that combine to produce a cohesive understanding. Those who cultivate this broad view are well on their way to achieving worldly wisdom.” --Investing: The Last Liberal Art by Robert Hagstrom

And that is the role of the Integrator–to lead organizations with wisdom to solve really, really hard problems.  As your organization grows and succeeds, the problems you face will traverse the Cynefin framework into complexity and chaos.  Setting up payroll is complicated, but it is a solved problem requiring one or two functions.  Similarly for getting everyone laptops, launching  an email client or ordering furniture.  As your organization grows, it slows, in part because you run out of obvious, comfortable, single functional problems. 

To solve this coordination challenge, bureaucracy starts to emerge in the form of project plans, timelines and the dreaded “accountable person” to ensure work across functions and this naturally ends in failure.  Why?  Simply– complex work requires cross-functional nuance, which is not the same thing as merely combining single functions in a meeting.  Furthermore, the choice “accountable individual” exposes your organization to both the Sartre problem and Conway’s Law in that the solution space is predetermined by the choice of designee.  Software teams tend to solve problems with software, compliance teams with policies, and operators with procedures.  Whichever specialist you choose will terminally bias the outcome.  What the organization requires is someone who understands what everybody does to combine them in novel ways to solve novel problems: the Integrator!

A successful Integrator requires legitimate power by virtue of a senior leadership position because the greatest challenges will be your specialist peer leaders who are looking for control over their resources, certainty and predictability (and often fallaciously desiring full utilization) that is inconsistent with creation and novel problem-solving.  Empathy is important here but so is urgency, you have to bring your peers along in a Goldilocks fashion, which is a challenge I continue to struggle with as a leader.

If you can pull it off, it is amazing what your organization can accomplish.  Work is clear as it is made visible, work in progress drops and with it all the fires start to go out.  No more draining weekly update meetings with no time to do the work. Incredibly rare evening and weekend emergency meetings.  Work gets done faster as you do less of it at once because teams work together instead of in a never ending arms race against one another.  The sense of calm, controlled progress is intoxicating and sounds too good to be true.  However, once you’ve been on the other side you cannot imagine going back. 

And this is about as far as I’ve gotten in 40 years so it is as far as I can take you now.  Perhaps I will write future parts as I learn them. 

-- Special thanks to Marie Castelli for sharing the HBR Integrator article!

Career Path for the Generalist, Part 2: The Interpreter

Well, it looks like Part 1: Commando really resonated with folks as I got tremendous positive feedback and requests for the next part! I do this to be as helpful as possible in making sense of our world, so the feedback keeps me going. Back in:

Step 2: Interpreter
At some point if you are a successful enough commando operation, resources start pouring in. (Yes I am going to sidestep all of the rigors of sales and fundraising, that's for another time). Adults arrive with defined skills. Policies and procedures get written and for a few brief moments of relief, it looks like everything is going to be OK. And then, suddenly, the dreaded "silos" emerge. There are so many people in marketing that they all talk to each other and no one in Product. Or your Clinical team has plenty of time to commiserate and decide that Operations is incompetent. Us vs. Them creeps in and trust shatters. Progress grinds to a halt. Accountability disperses. Project counts tick upwards, status meetings abound and nothing gets done.

First, it's probably time for tools like Scrum and OKRs if you haven't already been using it, but really, it is a moment for you to grow up into an Interpreter. It is probably already happening if you pay close enough attention. Some job titles may come your way-- Product manager, project manager, special projects, chief of staff, cross-functional anything, etc. People from other teams come to you to get things done, regardless of your seniority. They ask for advice, or complain about a third function's unreasonable behavior. You realize you enjoy making things make sense, but unfortunately it isn't your "real work." Well, it should be--this is your moment to evolve past your Commando phase and become an Interpreter.

The key to Interpreter is to shift your focus from what you do to getting the organization to do. That's right, the very thing you pride yourself on, that the organization values you for-- getting stuff done--is exactly what you must transition away from. Or at least recruit into.  

The reason for this is complexity. Where once you could spread across multiple functions, as success pours in you dig deeper into complexity. Mistakes you couldn't even see before now become all you talk about. It is time for your company to grow up and you have to help it. Your instinct will be to keep doing, dive in and become a specialist. You know, "learn to love the work." You won't, so don't.

You are set up as an Interpreter because as a Commando, you both know WHAT everyone is doing (and why) and just enough of HOW they are doing it to become dangerous. As an Interpreter, that knowledge converts from adequate substitution to a basis for an empathetic relationship. That empathy is the basis for the cross-functional work your organization needs.  However, to best listen to others fully, you must suppress your own opinions.  The very thing that powered your speed as a commando will now hinder you endlessly as an Interpreter.

Instead, leverage what people already want you to do-- start connecting the dots, the concepts, the people across the organization. When Engineering says they will only work on one thing at a time and Sales loses their mind, help them build empathy for one another. Be the bridge. You can see both sides, so help everyone else see all the sides, together.

What does this look like? Bringing together people that usually don’t talk and not letting them out until they see eye to eye. It means resolving disputes not by picking sides, but by seeing a new way through. Empathy, patience, trust building are all crucial in this phase and that is what makes the jump so challenging. It is a near 180, a complete reconstruction of your work persona from the commando phase.

This works just as well outside the organization as inside of it.  Great generalist interpreters can represent their organization externally in sales, marketing and fundraising roles.  The ability to encapsulate an entire organization and make it digestible for an outside customer, investor, acquirer or regulator audience is absolutely crucial to the success of an organization. 

If you can convene others across domains, internally and externally, you might just be ready to move on to Stage 3: Integrator.

Career Path for the Generalist, Part 1: The Commando

During Family Medicine Clerkship at Tulane, Dr. Pam Wiseman shared some pithy wisdom which altered my career progression forever:

Generalism is a disease. It can be treated, but not cured.

In a world of increasing complexity and pressure to specialize in all industries, there remain plenty of us that simply cannot pick one thing to focus on for our lives.  While everyone else races to the depths of a field-- learning everything and mastering their slice of the universe, we instead gaze at the whole landscape with wonder and start making sense of it all.  We appear to be dilettantes, easily bored, unable to focus, get serious or commit.  Secretly, we all wish we could love anything as much as our specialized peers.  Many of us have repeatedly tried and failed, so we feel that we are somehow broken. Nothing could be further from the truth.

If this strikes a chord, congratulations you are a generalist.  You are the type of person that would rather do something different every day if you could find a way to make a living doing it.  You have trouble deciding between fields of work or study because you love a little bit of everything (or you hate a little bit of everything). If you are a physician, you cannot fathom the idea that you would do the same thing all day long and get better at just that thing.  You try and fail to describe yourself as a collection of a few specialists.  For instance, I was once called "a doctor pretending to be an engineer who wishes he had an MBA."

The world today is set up for specialists-- clear career paths, mastery of one discipline, fitting nicely into the larger machine, marching deeper into detail.  And yet as complexity in society grows, the ability to jump branches to find novel solutions is more valuable than ever.  This notion that we need generalists to guide us forward has appeared in science fiction, later backed up by research (like all the best ideas).  So if you are a generalist, phew, you are going to be OK.  But it isn't going to be easy...

As a self-diagnosed generalist, I too have experienced the exquisite pain of always being beaten out by specialists.  Whether in medicine, technology or entrepreneurship, I've continually yielded my role to those that can focus to develop expertise on a focused topic.  So what are you to do if you are a generalist?  The way I see it there is a career path for us too, but the leaps between roles are massive, fraught with peril and rare.  See, I told you it won't be easy!

The generalist career path goes from Commando->Interpreter>Integrator.  In this post we will cover the Commando.

1.  Commando:  We've all heard the admonition: Jack of All Trades, Master of None.  This bogeyman is used to warn young generalists away from our nature toward the path of specialists.  It is a curse that we are destined to live if we are not careful.  However, it turns out that there is a time and place when you desperately need Jacks of All Trades and those are in resource-constrained environments.

For example, in medicine, we see this in rural health, global health, and humanitarian disasters.  Physicians who can do everything- deliver babies, trauma surgery, appendectomies, treat hypertension, depression- are the first ones into a disaster.  And we are in awe of them.  Similarly, in start-up environments, there just isn't enough work (or money) to have people dedicated to sales, marketing, product, building furniture, IT or compliance so you need people that can (or simply will) do all of them.

Toughness, grit, creativity in just-good-enough problem solving all while demonstrating the possible are all the hallmarks of the commando phase and they feel great.  And doing is the essence of the Commando role.  It is a blast-- you are always in way over your head, learning new things, never feeling comfortable and busy as hell.  We attempt to outrun our mistakes rather than avoid them.

And while you are having fun, part of you is always wondering when the adults are going to show up.  You are at first relieved when they do-- someone to help make sense of the mess that's been created with “Discipline” and “Experience.”  Shortly thereafter, however, you begin to feel a combination of boredom and uselessness.  Those same front-line docs don't have the same impact in a multi-specialty hospital. Start-up people flame out in large corporate cultures.

If you attempt to continue operating as a commando, you will soon either leave the situation because "things aren't the way they used to be" (boredom) or be asked to leave to make way for specialists (outcompeted).  Your next move will be to find another place to be a commando, hoping that the commando phase lasts a little longer, but secretly knowing the same pattern will play out again. The truly insidious part is that the more successful of a commando you are, the faster the commando phase will end! So what else can you do? You can move on to Step 2: Interpreter.

36 years of condensed wisdom

Greetings all,
Nearly a year since I last clocked in.  Oh well, here I am.  I recently had the pleasure of turning 36 and have been thinking those thoughts one tends to think when you hit the middle 30s around one's birthday.  It has actually been a phenomenal year on all counts, and I'd like to share my current guiding approach to life. At this point I am coming to realize the tale of mastering one's self as put forth by almost every version of hero literature out there (video games being my drug of choice) that Survivor had it right with one half of their twin masterpieces in Burning Heart:

Deep in our soul
A quiet ember
Know it's you against you
It's the paradox
That drives us on

So how to win against yourself?  I have it down to three steps:
S

1. Lower your expectations 
2. Learn to rest
3. Keep going

That's it! Good luck

For those of you want to hear more...

Lower your expectations

Credit to Leron Finger for introducing this one to me many years ago in a Saturday in the Ochsner Pediatric ICU.  Even better, listen to Vienna by Billy Joel, it captures the concept perfectly.

Learn to rest

Saw this one on r/getmotivated and it hit me hard.  So much of my ethic has been driven by the internal belief that I am lazy.  Therefore resting was not due to normal human factors, but rather due to my laziness.  You know what happens when you don't rest?  You quit.  And then you fail Step 3, and that is the whole game.

Keep going

This is the advice that matters the most. Nothing else comes close. Advice as old as time, and yet it always needs to be repeated. Ben Horowitz calls it the Struggle. Duncan Reece kindly reminded me back in January 2015 that we needed to stay in the game until we can go back on offense.  Michael Keaton did a great Ray Kroc ripping off a proto-Tony Robbins in the Founder.  Hell, Dory from Finding Nemo had it right.  

So remember- lower your expectations and learn to rest so that you can keep going.  Because that is only chance you have to do something worthwhile. 

The Trouble with AI: No Single Wringable Neck

Pretty exciting news in that as of June 2017 I am now certified in 3 things: Open Water Scuba Diving, Internal Medicine and Scrum Agile Product Ownership.  (The first was the most fun.)

Anyhow, one of the concepts brought up in Scrum Agile is the idea that the Product owner is the single wringable neck.  The one person on the team that the customer/management/anybody can blame when everything goes wrong.  Sounds like a fun job, right?

So why do you need this? Because, something always goes wrong. (and thankfully for that!)

What exactly does this have to do with AI?  As a doctor in technology I am constantly bombarded with really exciting applications of artificial intelligence that are going to make me irrelevant.  These are usually put forward by very well intentioned, highly intelligent and well-funded individuals that haven't the faintest idea of what a primary doctor actually does (shame on us).  In general I have adapted a wait and see attitude, although there have been some promising breakthroughs in using AI to accomplish what needs machines the most-- the dreaded paperwork of medicine.

Even outside of healthcare we see robots that can climb stairs, robots that can fold clothing, and most obviously, self-driving cars.  And we hear the same story-- once these get good enough, they are going to take over.

And in some sense, I agree.  However, the individuals working on these technologies are product people: scientists, engineers, product managers, designers, etc. They are all motivated to make the best/coolest thing possible.  And that is exactly what they are doing.

But this approach alone will fail.

What exactly is the quality threshold where we will trust AI/robots/computer driven cars?  We will likely see long stretches of accident free days like we never have before.  But perfection today is no guarantee of perfection tomorrow.  Somewhere, at some point during this utopia of perfect driving, one of these cars will kill someone.  Or it won't, but we won't be able to shake the idea that it could happen.  They already have far fewer accidents than humans.  But they lack something humans have. A wringable neck.

If you get hit by another driver, we have an elaborate series of mechanisms to punish that person and make you whole (ish) again.  We have someone to blame and a way to blame them.

How do we hold the robots accountable?

I propose that this is the hurdle we must overcome in order to expand robots, AI and other autonomous devices in our lives.  It is a legal one, a regulatory one, a cultural one, not a technical one.  No amount of perfection will rid us of the human desire for retribution when harmed.  So to all of the makers out there-- please keep improving the quality, but know that you must offer a neck a some point if you want others to adopt your technology.