GUEST POST from Arlen Meyers

In their classic book on negotiation and persuasion, Fisher and Ury outline the steps to get to yes.

They suggest the following approach:

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

 In his new book, Nobel Peace Prize winner Muhammad Yunus shares his vision for a kinder, gentler planet. It starts with recognizing what he describes as the inherent cruelty of capitalism, the need to value the abilities of every human being and understanding that saving the environment must be a collective effort.

Now, Pope Francis has thrown his Papal tiara into the ring.

To create and spread the harvest of global wealth creation, Yunus emphasizes going back to our entrepreneurial roots, making low interest loans to those most in need (microfinance) and creating social enterprises that are a balance between selfishness (making money for ourselves) and selflessness (helping others create wealth for themselves and, in so doing, changing the human condition). While corporate social responsibility is the latest fad, most companies don’t take it far enough. Giving fish, or Todd’s shoes, isn’t the same as teaching people how to fish or start their own shoe business. The goal of the latter, as in almost ever social enterprise, is to demonstrate measurable scaleable impact.

Such thinking highlights the conflict between the ethics and purpose of medicine and the ethics and purpose of business. In systems, like in the US, where medicine is a business, the contrast in even starker.

However, as noted in a recent article , the dual purpose playbook requires focusing on four key management practices for an organization to do well and do good at the same time:

1. setting and monitoring dual goals
2. structuring the organization to support both goals
3. hiring and socializing employees to embrace them
4. practicing dual minded leadership

Here are some ideas that might help us reach some of the UN’s sustainable development goals:

1. Include social entrepreneurship as part of biomedical entrepreneurship education programs and emphasize the relationships between social determinants, like education, and health.
2. Teach biomedical entrepreneurs more about accounting, finance and business law
3. Include and achieve learning objectives in international entrepreneurship in the curriculum.
4. Judge startup ventures by their triple bottom line impact. The TBL is an accounting framework that incorporates three dimensions of performance: social, environmental and financial. This differs from traditional reporting frameworks as it includes ecological (or environmental) and social measures that can be difficult to assign appropriate means of measurement. The TBL dimensions are also commonly called the three Ps: people, planet and profits, or, the 3 Ps.
5. Provide microfinance loans to patient entrepreneurs
6. Use more patient funded business models
7. Tap into the desire to do well by doing good
8. Include discussions about creating non-profit v for profit business entities
9. Create a sub-ecosystem focusing on using biomedical, clinical and digital health innovation as a social enterprise in accelerators, scalerators, venture conferences, pitch competitions and courses.

10. Showcase and celebrate biomedical and clinical social entrepreneurs

11. Create products and services that address the social determinants of health and ways to reduce their inequities that contributes to disparate health outcomes. Breakfast and a bedroom has more impact than data. The biggest bang for the buck comes from helping educate at risk populations, like students who are first generation, marginalized or excluded girls, those in the lower socioeconomic classes, self identified minorities and others, like the disabled and recently released prisoners.

12. Incorporate social enterprise into medical systems science education.

Here is the mission driven business model canvas:

Here are some differences between the mission driven and the elusive medical business model canvas

Here are the top five differences between not for profit and for profit hospitals.

Many questions have arisen regarding hospitals’ status as tax-exempt organizations.

Conscious capitalism is the rational alternative approach, dedicated to advancing humanity, while using tried and proven business principles. The idea has four principles guiding and underlying every business:

1. Higher purpose. Business can and should be done with a higher purpose in mind, not just with a view to maximizing profits. A compelling sense of purpose creates an extraordinary degree of engagement for all stakeholders and catalyzes tremendous organizational energy.
2. Stakeholder orientation. Recognizing the interdependent nature of life and the human foundations and business, a business needs to create value with and for its various stakeholders (customers, employees, vendors, investors, communities, etc.). Like the life forms in an ecosystem, healthy stakeholders lead to a healthy business system.
3. Conscious leadership. Conscious leaders understand and embrace the higher purpose of business and focus on creating value for and harmonizing the human interests of the business stakeholders. They recognize the integral role of culture and purposefully cultivate a conscious culture.
4. Conscious culture. This is the ethos – the values, principles, practices – underlying the social fabric of a business, which permeates the atmosphere of a business and connects the stakeholders to each other and to the purpose, people and processes that comprise the company.

Medicine in the US is a business. However, it is also a social enterprise, joining many othercompanies and industries practicing social entrepreneurship. Compassionate capitalism is another way to do well by doing good.

Bioentrepreneurship is a means towards an end-creating user or beneficiary defined value through the deployment of innovation. Whether that end is selfless or selfish or combination of both is your decision. What you decide will impact the future of our planet and the people who inhabit it. It will also put a smile on the faces of your stockholders and employees.

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GUEST POST from Arlen Meyers

Around this time of year you will start to see prognostications and articles about sick care future directions and trends and how you can take advantage of them. Here’s my list.

One that almost everyone agrees on is the global aging population and the dropping fertility rates.

For example, Japan has one of the world’s fastest-growing elderly populations and a tight labor market. The combination of these factors is driving innovation and spawning startups in the elder care space. And like the Walkman and e-mail displaying cellphones-the resulting devices may go global over the next few years. Of the 92 Japanese startups seeking to be valued at $1 billion or more, 25 are focused on health care. Most of the backing doesn’t come from venture capitalists, but from large companies looking for growth businesses. For example, Tatsuya Takahashi got support from Sharp and Canon when he co-founded Z-Works in 2015, seeking to improve patient monitoring after he missed being present when his grandmother and father died. Two years later he formed a partnership with a unit of insurance company Sompo Holdings to put his gear into more than 100 nursing homes in Japan. At a nursing home outside Tokyo, whose residents average 86 years old, 48 rooms have been equipped with four devices that monitor the occupants and stream data to the nurses’ station using software designed by Z-Works.

Here’s a story about the growing numbers of those in the sandwich generation and the costs involved to both when kids move back home after graduation.

A 2014 study by the Pew Research Center found that 52% of the US residents in their 60s are financially supporting either a parent or an adult child, up from 45% in 2005. Things are not that much different in other countries.

Entrepreneurs in almost every industry are noticing and trying to ride the silver tsunami all the way to the bank. Look for;

1. High tech solutions, using gerontechnologies. Alexa, where did I leave my keys? When is my next doctor’s appointment? Maybe you can get a deal on Black Friday on a robot for your loved one.
2. High touch solutions, creating alternative living arrangements from tiny homes in your back yard, to over 55 communities to smart cities
3. Intergenerational anti-loneliness and social isolation solutions
4. Investment funds targeted to solving the problems of the aging population
5. The rise of aging not-for-profits
6. Finding ways to improve the caregiver experience
7. Rethinking sick care jobs, such as community care workers
8. Social media and the entertainment industry, along with their advertisers, used to ignore anyone who was not between the ages of 18-24. That has changed as we see more and more “older” actors and models and aging themes reflected in movies, plays and literature.
9. The financial services industry continues to scramble to capture more and more of people worried about outliving their savings, including seniors and their kids taking care of them.
10. Sick care IT and digital health entrepreneurs are creating ways to help older patients share their information with family members and other care givers.
11. Senior travel and hospitality offerings
12. Senior dating apps

There is always opportunity when edge technologies and trends collide. Best Buy will try to capitalize on where loneliness, DIY medicine, remote sensing and remote patient monitoring, telemedicine, aging at home and consumer medical electronics meet. However, using these products will , for the 20-25% of those in rural towns with out broadband access, require closing the sick care digital divide.

Of course, politicians are pandering to papa, too.

But when you look deep within, from a human perspective, the business of aging too often falls short of delivering solutions that meet fundamental societal needs. Aging has been good for business, but can we honestly say that business has been good for aging?

It used to be that if you wanted to take the social pulse of the nation, you would watch sit-coms. Now you have to stream and binge on Netflix watching the Kominsky Method.

So what is the future? You tell me. In the future, the top jobs are robot engineer and elder caregiver.

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GUEST POST from Arlen Meyers

The economists tell us that labor productivity is a measure of the amount of goods and services that the average worker produces in an hour of work. The level of productivity is the single most important determinant of a country’s standard of living, with faster productivity growth leading to an increasingly better standard of living. Given recent stagnation in wages, however, some are re-examining the link. It turns out if you make more things or produce more services, you don’t necessarily make more money.

As noted in a recent WSJ article, perhaps we are experiencing a kind of Solow Paradox 2.0, with the digital age more around us than ever except in the productivity statistics. There are several reasons for this lag. First of all, we’re in the early deployment years of major recent innovations, including cloud computing, IoT, big data and analytics, robotics, and AI and machine learning. Notes McKinsey: “The challenge of adoption in the current digital wave may be even harder because of the broad range of uses of digital that not only help improve current processes but fundamentally transform business models and operations.”

While leading edge companies are already leveraging these advances, most are still in the learning stages. The most sophisticated companies have been pulling far ahead of everyone else in deploying these advanced technologies. According to McKinsey, “Europe overall operates at only 12 percent of digital potential, and the United States at 18 percent, with large sectors lagging in both. While the ICT, media, financial services, and professional services sectors are rapidly digitizing, other sectors such as education, health care, and construction are not.”

Given all the changes and demands on the sick care system, many experts are suggesting ways to increase sick care worker productivity. If you are a clinician, the measure now is straight forward i.e. the number of relative value units you can generate and how much revenue and reimbursement that translates to for you or your employer. Some are trying to move the goals posts or change how we keep score, but, for now, most doctors are being measured and compensated by how many points they put on the board. One of these days, though, CFOs are gong to have to figure out what to do with all those doctor cash cows.

On the other hand, some doctors think we should abandon measures of doctor productivity.

Healthcare is a key component of the US economy, but healthcare spending increases consistently outstrip GDP growth. Improving productivity in healthcare delivery could change this dynamic without harming patient care.

Charles Duhigg has written about what makes people productive in his book, Smarter, Faster, Better. For those of you who just read the conclusions sections of scientific and medical journal articles, here are the takeaways as they could potentially apply to sick care workers:

1. Make people feel like they are owners, not renters. Expand their locus of control, constantly reminding them about how the work they do is about something they care about. Remind yourself and co-workers that you are building a cathedral, not just laying stones. Suppose doctors and other employees were owners instead of cogs?

2. Many say you should choose a stretch goal and break it down into SMART (specific,measurable,achievable,realistic,timeline) objectives. When it comes to innovation, though, some think DUMB goals make more sense than SMART goals. Taking it one step further, HARD goals are better motivators:

Question #1: Animated. “Think about where you want your career to be, and describe to me exactly what you’re doing (what kind of work you’re doing, who you’re working with, what your days look like, etc.) one year, three years, and five years from now.”

Question #2: Heartfelt. “Describe at least three reasons why you want this goal (note: the reasons can be intrinsic, personal, and/or extrinsic).”

Question #3: Difficult. “What are the three to five most important skills you’ll need to develop to achieve this goal? How will you develop those skills?”

Question #4: Required. “What do you need to have accomplished by the end of the next six months to keep on track toward achieving this goal? What about by the end of the next 90 days? The next 30 days? What’s one thing you can accomplish today?”

3. Start with the end in mind, create a retrograde pathway, and focus. Ask, “what next and by when?”

4. Envision multiple futures and open yourself to multiple options

5. Make teams more effective by focusing on the how (give everyone a chance to speak and are safe) instead of the who.

6. Push decision making to the person closest to the problem. Rule makers , managers, bureaucrats and many physician executives have a very hard time with this one.

7. Innovation is mostly about doing old things in new ways. To connect the dots and harvest institutional history, become an “innovation broker”. Innovation brokers don’t just build network pipes and pumps, but instead accelerate the flow of information and fix the pipes that are clogged.

8. Customers buy emotionally and justify rationally. Inventors and innovators should do the same. The user defined value of an idea or invention is often more aptly measured by how it makes you feel, not what you think about it.

9. The productivity curve maxes out at some mean level of stress. Something that is boring or a task that is overwhelming does not drive productivity. In fact, excessive stress, change fatigue and administrivia crush productivity. Some seem to think that the way to make doctors more productive is to make them conform to rules and mandates telling them how to be more productive.

10. Just because you have realized a creative breakthrough does not mean it will create user defined value. Be open to the fact that your baby might, in fact, be ugly. Statistically, most are.

11. Get rid of the SHIT in your life. Mitigate technofatigue.

12. Use these AI tools to streamline your day

13. Do a better job of coding

14. Minimize no shows

15. Use the OKR system to measure your results.

Here are six more keys to improving physician workflow.

Of course a much easier way is to make doctors wear performance-monitoring wearables.

Virtual and face to face mentors help too.

Sick care labor economists debate whether productivity is increasing or decreasing and whether it is contributing to an increased standard of living. If you want one answer, ask your neighbor, the pediatrician. Or, maybe we should just all learn from Leicester City to solve the Solow paradocs.

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GUEST POST from Arlen Meyers

One of the best ways to reduce your tax burden and save for the future is to maximize contributions to your Individual Retirment Account (IRA) early and often, create the proper asset mix and periodically doing an asset allocation rebalance at the right time.

Similarly, the future of most companies, organizations and universities depends on their ability to put innovation in the bank as part of 3 horizon planning. Just like individual accounts, it requires structure, a process, people (leaders, champions, teams), strategy,execution,discipline, creativity ,imagination and the tools to measure results.

Harvard Professor Gary Pisano claims that the reason companies often fail in their attempts to become innovative again or to keep their innovative capacity is due to three factors. One is strategy. For a larger company with an existing business, you need an explicit strategy around how you allocate resources to the new versus the old.

The second is getting the right systems in place. Very different kinds of innovation and problem-solving processes go on when you’re trying to do something transformative versus routine innovation.

The third element of that DNA is their culture. There’s got to be the right kind of culture and has the courage to innovate.

Here are the six steps in the innovation life cycle:

Identifying a Problem to Solve. Successful innovation programs are not only great at generating solutions, they excel at identifying problems. Identifying problems requires that organizations take these four steps to prepare for problem solving: gather & organize existing information, reframe and ask why, set expectations, and identify what success looks like.

Identifying a Process that Works For You. Should I use design thinking or six sigma methodology? Having a process for sharing, identifying and selecting great ideas is what makes innovation a repeatable (even predictable) practice. Get an overview of the different options available to you and figure out which one works best for both your organization, but also for this unique innovation initiative.

Engaging Others in the Process. Employee engagement, open innovation – the future of innovative thinking requires that you reach out to the collective intelligence surrounding you. But how do you get people to share their ideas? How do you keep them coming back to build on the ideas of others? What sorts of incentives motivate creative participation? Every innovation push needs to include a communications plan.

Empowering Groups of People to Build Ideas into Projects. When it comes to turning great ideas into great projects, it’s important to build teams of people that will help steward it through to completion. They need to refine ideas, do research, find collaborators, and more.

Evaluate and Prioritize. Your organization has lots of great ideas, but you only want to move forward with the best ones, the ones most in line with your organizational goals. How do you funnel ideas through a process that helps you evaluate and identify the ideas that will deliver the highest ROI?

Idea Implementation. The best programs have been anticipating this step from the beginning. You’ll need to have buy-in, organizational allies, and creativity in marshalling resources. This is the most important step, of course, in your innovation program.

Every financial planning and retirement site has a calculator to tell you whether you will have enough to retire. But, few firms have done an organizational Innovation Readiness Assessment (IRA) to see if they are on the right track.

Giffford Pinchot, who originated the term “intrapreneur”, has suggested that you rate your organization in several domains to see whether your innovation future looks bright or bleek:

1. Transmission of vision and strategic intent
2. Tolerance for risk, failure and mistakes
3. Support for intrapreneurs
4. Managers who support innovation
5. Empowered cross functional teams
6. Decision making by the doers
7. Discretionary time to innovate
8. Attention on the new, not the now
9. Self- selection
10. No early hand offs to managers
11. Internal boundary crossing
12. Strong organizational culture of support
13. Focus on customers
14. Choice of internal suppliers
15. Measurement of innovation
16. Transparency and truth
17. Good treatment of people
18. Ethical and professional
19. Swinging for singles, not home runs
20. Robust external open networks

If you ask a sample of people to rate these in your company on a scale of 1-10, don’t be surprised if the average equals somewhere between 2-4. Few organizations, you see, are truly innovative or have a truly innovative culture. Most don’t even think about how to bridge the now with the new, let alone measure it.

Do a cultural audit. Organizational innovation competencies must include:

• Leadership
• Vision
• Strategy and execution
• Alignment and engagement
• Tactics
• Structure, policy and procedure
• Tools and incentives
• Teams
• Champions
• Innovation learning system and knowledge management

Here are some examples of questionnaires you can use to identify innovation opportunities for improvement:

1. INSEAD and Logica model
2. Innovation Excellence Co-Founder Braden Kelley’s Free Innovation Audit (fill out online or use the downloadable Excel spreadsheet)

There are also ways to measure individual/intrapreneur innovation mindset and readiness

Initiator

Ambidextrous individuals take the initiative and are alert to opportunities beyond the confines of their own jobs.

Cooperator

Ambidextrous individuals are cooperative and seek out opportunities to combine their efforts with others.

Broker

Ambidextrous individuals are brokers, always looking to build internal linkages.

Multitasker

Ambidextrous individuals are multitaskers who are comfortable wearing more than one hat.

Theoretically, then, organizational ambidexterity happens when organizations and individuals are ready, willing and able to innovate. For one author, that means the leadership of your organization needs to focus on three core competencies:

1. Start by being a problem seeker, not a problem solver
2. Lead innovators, don’t manage innovation
3. Look for precedents and why they succeeded or failed

The good news is that now you have something to measure and pursue the many opportunities for improvement. Your business depends on your innovation nest egg as much as your personal retirement. Start now and you’ll have a much happier business future.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

Most sick care technology companies, at some stage of their development, decide whether to hire a Chief Medical Officer (CMO), either part time or full time. However, given that the job description involves a combination of clinical and business domain expertise, there is a shortage of qualified applicants and a war for talent, much like there is for sick care data scientists.

The roles and responsibilities of hospital CMOs are different from biomedical and clinical company CMOs. However, the job descriptions of both are undergoing rapid change.

Since there is no technology CMO school (Sorry, doc, but that MBA won’t get you there), most get OJT with the attendant inefficiencies, role conflicts, waste and dysfunctions. How, then, should we rethink physician entrepreneurship education and training for those interested in a technology CMO career pathway?

1. Start with a needs assessment. Clinical and domain expertise is the price of entry. Beyond that, we need to talk to industry, investors and the various innovation ecosystems to define the needed skills, knowledge, abilities and competencies the market wants.
2. Use the needs assessment to create learning objectives. Those will most likely involve understanding how to translate data into value, dissemination and implementation science,project management, strategic thinking, leaderpreneurship,product management, emarketing, clinical trial design and execution, and and using social media to create stakeholder engagement.
3. Use the learning objectives to design the curriculum that would include not just education and training, but mentors, networks, experiential learning and international knowledge exchange as well.
4. Create rubrics to measure competency metrics.
5. Require each participant to create a personal and professional career development plan
6. Begin introducing medical students, residents and fellows to aspects of the curriculum early in their training
7. Create a network of technology CMOs to encourage sharing best practices and life long learning
8. Develop scholarships, fellowships and other funding models in cooperation with medtech/biopharma/digital health/care delivery companies
9. Introduce potential CMOs to internship opportunities. The good news is that you won’t have to wear white pants and a short white coat. However, on some nights, you might have to sleep in house at the co-working space.
10. Medical specialty societies and associations should offer continuing education for technology CMOs
11. Most universities are not entrepreneurial, nimble or responsive enough to offer this kind of thing. It should be done at the bottom-up community level and most of the faculty should be practicing CMOs
12. The process should be a hybrid model, with a combination of face to face and online experiences.

Filling the CMO manpower gap will take years given the length of the pipeline and the limited supply of doctors with an entrepreneurial mindset. That said, things are changing as more and more medical students choose to forgo practicing clinical medicine for something else.

Once you have the knowledge, skills, abilities and competencies to do the job that needs to be done, then you have to find one. That will take mentors, networks, career coaching and peer to peer support. Here are some tips:

1. When you go to meeting and conferences, don’t ignore the vendors or just take their free T-shirts. Do informational interviews to learn more about what they do, whether and how they involved medical consultants and who to contact for more information.
2. Talk to opinion leaders or those who are already in CMO or advisory positions
3. Relentlessly network, particularly building robust networks outside of your field of interest.
4. Build your personal brand directly and on social media
5. Refine your soft skills-communication, collaboration, creativity and complex problem solving
6. Join side gig dating services, like the AMA Physician Innovation Network (you don’t need to be a member), the Society of Physician Entrepreneurs or other jobs boards
7. Find a place in your local biocluster
8. Create a personal and professional career development plan
9. Live in the right place , since tech hubs and jobs are concentrating in fewer and fewer places
10. Think big but start small
11. Think twice about not doing a residency. It’s called “physician entrepreneur” for a reason.
12. No, you don’t need to “grab an MBA“. Instead, we need MBEs.
13. Determine whether the company needs you to be a CMO or something else, like an advisor
14. If part of your compensation is equity, find out whether you are working for a C corp or an LLC and determine the right kind of equity award.

Once you land a job, then the first 90 days are critical to setting the stage for a successful career trajectory. As noted in a recent HBR blog, the biggest challenge leaders face during these periods is staying focused on the right things. You are drinking from the proverbial fire hose while trying to get settled and figure out how to start to have an impact. It’s easy to take on too much or to waste your precious time. So, it helps to have a set of questions to guide you. Here are the five most important ones to ask…and keep on asking on a regular basis.

The sooner, we start, though, the better , at least theoretically, the company success outcomes and that’s good for patients.

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GUEST POST from Arlen Meyers

Entrepreneurship education programs are expanding rapidly and recent polls indicate that 20-25% of B school applicants are interested in starting their own business. Many applicants, including medical school and graduate school applicants already have, but feel they lack the business skills to start and scale their companies. Consequently, there are more Masters in Entrepreneurship programs sprouting up around the world. In addition, bioentrepreneurship education and training programs (BEET) are not far behind and things are changing rapidly:

There are several drivers of international bioentrepreneurship education programs:

1. The biologic revolution and emerging technologies
2. Student demand for education and training that will give them a competitive advantage in the job market where there are shrinking academic research career opportunities
3. The desire to create biomedical new ventures
4. Expanding innovation ecosystems at academic medical centers
5. An understanding of the importance of coherence and how cross-campus, interdisciplinary collaboration facilitates innovation
6. The innovation imperative to stay competitive
7. Digital health creating new products, markets and jobs
8. The need to re-invent sick care and address global health disparities
9. The changing financial, regulatory, legal and intellectual property landscape
10. Faculty innovation champions eager to get their ideas to patients
11. The lack of bioentrepreneurship educational offerings at academic medical centers
12. Higher education, sick care and government resistance to change
13. Philanthropreneurs funding change and demanding a different model.

Since most of these programs are in their early stages, to a large extent, best practices are still in development and many are experiments. Based on our experience, here are some general categories of best practices we should be measuring and sharing:

1. Pedagogy. What are the best ways to teach biomedical innovation and entrepreneurship (BMIE)?
2. Technology. Which educational technologies have the most impact and which do not?
3. Markets. Which students are most attracted to BMIE progams and how do we target them?
4. Prerequisites. How do we define prerequisites, if any, for BMIE, and how do we provide students with them?
5. Early education. How do we integrate k-20 innovation, creativity and entrepreneurship education and training?
6. Defining KSAs. What knowledge, skills, abilities and competencies should graduates have after completing the programs? What should be the learning objectives of these programs that drive curriculum design? What are the market driven soft skills in demand? How about social and international entrepreneurship?
7. Outcome metrics. How should we define outcomes to measure the success of programs both in the short term and the long term? Can entrepreneurship be learned or should those who are interested just go to the school of hard knocks?
8. What is the value added from the programs.?How have the programs contributed user defined value, regional economic development value and enhanced US global competitiveness?
9. Faculty development. How do we recruit, develop, reward and promote BMIE faculty?
10. Knowledge sharing. What are the best ways to share best practices , minimize redundancy and overlap and collaborate with other disciplines and campuses?
11. Innovation. What are recent innovations in BMIE education and training? What should be on the research agenda and where are funding sources to do it?
12. Credibility and recognition. How do we make BMIE a separate academic domain? Should it be or are success factors more domain specific, like engineering, biomedicine, aerospace or energy?
13. Ecosystem integration What are the most successful ways to ingrate these education programs into regional innovation ecosystems?
14. Market demand. What is the market demand for graduates and do graduates have a competitive advantage over those without formal education and training?
15. Business models. How to we create VAST business models for BMIE programs?

1. Validity Regardless or which elements of your model you choose, they have to be valid. In other words, the dogs have to eat the food. When the dog won’t eat the food, you’ll have to change your approach and try again.

2. Automaticity At the very start of planning your venture, you should think about how you are going to work on your business, not in it. Reducing hands on time to manage operations will give you more time to lead the company and create strategies for growth and give you more personal time to enjoy the fruits of your success. Outsourcing, automating or using technologies to ramp up operations, sourcing and distribution is a key part of scaling, and something that investors want to see…which brings us to the next piece.

3. Scalability Your business model is primarily a way to create a business machine that can produce an infinite number of products. Think of it as a device that takes in customers and creates profits out the other end and can do so at quicker and quicker speeds.

4. Time and Traction Finally, your model need to create as much profit as quickly as possible with a growing customer base that is loyal to your brand.

In my view, we are training too many MD/MBAs that don’t add value to the system and that many programs should be terminated or restructured. At the University of Colorado, we intend to offer a Masters in Bioentrepreneurship (MBE), building on our experience offering a certificate program in bioentrepreneurship as a joint program between a business school and an academic medical center graduate school. As a result, we hope to contribute some answers and share experiences about our efforts to provide BMIE education to business, science, engineering, law, arts and humanities and health professional students who are interested in the pursuit of biomedical and clinical opportunities with the goal of creating user defined value through the deployment of innovation.

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GUEST POST from Arlen Meyers

Physician entrepreneurship has changed from a curiosity to becoming mainstream in 5 short years. Defined as physicians pursuing opportunity with scarce resources and conditions of uncertainty with the goal of creating user define value through the deployment of biomedical and clinical innovation, we are starting to see some trends and fault lines forming.

1. The phenomenon affects all physician demographics including the young and the restless (in training or in practice less than 5 years) , the desperados (in the prime of their professional careers (6-40 years in practice) and the old and the grumpy (arbitrarily over 65) but looking to rewire, not retire, pursuing encore careers. 

2.International bioentrepreneurship education programs are evolving and offering various levels of training and platforms. MD/MBA programs , while still being offered, are being displaced by more specific, sick care relevant, market driven offerings that teach moreclinically relevant, market driven knowledge, skills and attitudes. They are growing because almost every health system in the world is challenged with getting better outcomes for less cost. More medical schools are offering education in innovation, entrepreneurship and design thinking.

3. More medical students are electing to forgo residencies to work with industry or create their own companies. While ultimately a personal decision, some think it is an encouraging sign while others question the wisdom of that pathway. After all, it’s called physician entrepreneur for a reason. The market for physician entrepreneurs, either as advisors, founders or employees, particularly in digital health companies, is starting to plateau. Part of the reason is that while the number of startups is increasing, fewer become scale ups that hire people.

4. Digital health is getting most of the attention. Unfortunately, it has yet to demonstrate it can deliver most of the value.

5. Academic medical centers have searched and replaced “research” with “innovation” in their marketing literature and branding communications. Listen to this for some stories about how they are doing.

6. Sickcare employment has dropped for the first time in 10 years. Reading the tea leaves is always hazardous to your health, but some feel the era of “rightsizing” has started as we wean ourselves from inefficient, wasteful, costly medical and business practices. In addition, with the migration of care to non-hospital settings, integrated delivery systems are shedding unprofitable parts and that translates into fewer employed physicians.

7. Consolidation of hospitals and insurance companies are making it harder to innovate and creating hostilities between the administrators,third party intermediaries and the grunts in the trenches. Mergers and acquisitions have moved from horizontal to vertical.

8. Physician employment is plateauing, but significant intrapreneurial barriers persist. 

9. People are finally beginning to abandon the notion that doctors are lousy business people. Even doctors are starting to believe the contrary about themselves.

10. The names of the players and the dramatis personae have changed. The word police have been active.

11. Value based care is driving the necessity for advanced information technologies, like artificial intelligence, do help determine quality and costs and improve productivity

12. Immigration policy is interfering with entrepreneurship

13. International medical graduates who are US citizens are seeing physician entrepreneurship as a viable alternative career pathway, particularly that 50% who do not match into a US residency

14. COI rules are interfering with physician-industry collaboration and new product development

15. Sick care data scientists are in sort supply unless you live on the US coasts

16. Women make up more than 50% of medical school students. However, fewer woman than men stay in the clinical workforce, mostly to take care of family members or find a non-clinical job after burning out.

17. Sources of early seed stage money have changed, altering the all aspects of biomedical and clinical startups.

18. Accelerators and incubators continue to evolve as part of their inevitable life cycles

19. AI, robotics, cloud storage, blockchain and mobile devices are having a bigger impact on digital health design, development and launch

20. Many digital health products and services are encountering significant resistance crossing the chasm to widespread adoption.

21. Regulatory and reimbursement rules are shaping the future of new products and services.

22. Burnout continues to claim more and more victims who looking for alternative non-clinical career possibilities

23. Community based innovation networks and ecosystems continue to grow and evolve

24. Medical schools continue to ignore the importance of entrepreneurship and digital health and data science education and training

25. Graduate bioscience and medical school education is in desperate need of reform

26. Outsiders, Google, Apple and Microsoft and the three amigos-Berkshire,JP Morgan and Amedzon- are trying to change the game and then scale it to others.

27. The fourth industrial revolution is changing the future of sick care work.

28. Patient entrepreneurs want a seat at the value creation table.

29. Interprofessional entrepreneurship is growing

Physician entrepreneurship continues to evolve before our eyes. If things go according to plan, physician entrepreneurs will be more and more involved in the innovation supply chain at earlier stages helping others innovate our way out of the sick care mess. If things don’t go that way, we’ll just have lots more people with lots more letters after their names sitting in the corner office of the Innovation Center. Smart medicine has already attracted a lot of smart money. Let’s see if it attracts the smart doctors and students.

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