Category Archives: Healthcare

Trends in Medical School Innovation and Entrepreneurship Education

Trends in Medical School Innovation and Entrepreneurship Education

GUEST POST from Arlen Meyers, M.D.

Biomedical and health entrepreneurship continues to expand around the world. Driven by global pressures to optimize the allocation of scarce resources, life science bioentrepreneurs are creating innovative products, platforms, service and systems that deliver more value. As a result, the demand for biomedical and health professional entrepreneurial talent has increased and biomedical and health innovation and entrepreneurship education and training (BEET) programs are growing to fill the gap.

Authors of a 2019 analysis of 171 allopathic medical schools conducted an exhaustive search of the published literature and websites of existing medical school innovation and entrepreneurship (MS I&E) programs, with an emphasis on answering the following three questions:

1. How are I&E programs organized and integrated with the medical school curriculum?
2. What are the core competencies of the I&E program?
3. How are the core competencies measured/evaluated?

Twenty-eight I&E-oriented medical education programs were identified from 26 schools; all of the programs integrated faculty leadership with backgrounds in medicine, engineering, and/or business/entrepreneurship. Of the programs, 57% (16/28) had been launched within the past four years and 75% (21/28) based program enrollment on a selective application process. Nearly all (27/28) incorporated lecture series and/or hands-on modules as a teaching technique. The most prevalent metric was completion of a capstone project (22/28; 79%). At least 15.2% (26/171) of American and Canadian allopathic medical schools include the option for students to participate in an I&E curriculum-based program.

In a few short years, educational offerings in MS I&E have accelerated, in part due to the impact of the COVID pandemic. Trends include:

  1. Sharing lessons learned teaching medical students innovation and entrepreneurship
  2. Experimenting with various program business models
  3. Creating medical student entrepreneurs
  4. Rethinking MS I&E
  5. Designing a curriculum map and defining learning objectives, entrustable professional activities and knowledge,skills, abilities and competencies
  6. Mentoring and guiding medical students
  7. Offering non-clinical-career options
  8. Providing exit ramps
  9. Rethinking how we select medical students
  10. Resetting the future of academic medical center work
  11. Using principles of medical education reform and what we should be teaching in MedEd 2030
  12. Training MS I&E faculty
  13. Encouraging interprofessional and transdisciplinary entrepreneurship programs
  14. Integrating premed, medical student and postgraduate programs
  15. Encouraging life-long learning

We should teach innovation, entrepreneurship and the business of medicine in medical schools, not MD/MBA programs. MBE programs are a better option for those interested in getting an idea to a patient.

Here are the many reasons why physician entrepreneurship is important and why we are likely to see more of the international design, development and deployment of MS I&E programs in both allopathic and osteopathic schools as well as other health professional schools, including nursing, pharmacy and public health schools. Ultimately, as a result, patients and sickcare systems will be the beneficiaries and doctors will be better and happier.

Image credit: Pixabay

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How COVID-19 Has Exposed Us

How COVID-19 Has Exposed Us

GUEST POST from Greg Satell

The moon landing in 1969 was, in many ways, the high point of the American century. Since then, we’ve been beset by scandals like Watergate, Iran-Contra and two presidential impeachments, mired in never-ending wars that we don’t win, while increasingly encumbered by rising debts and income inequality amid falling productivity growth. Incomes have stagnated while education and healthcare costs have soared.

Yet in an essay written back in February, just before the Covid-19 crisis, Ross Douthat wrote that these apparent woes are actually signs of success. In effect, he argued that we lack major technological breakthroughs because we become so technologically advanced, and we lack economic progress because we’ve become so prosperous.

Even then, it was a strange and somewhat maddening position to take. Why would Douthat, an intelligent and insightful man, write such things? Because he so wanted to believe them that he went in search for facts to support them. Many of us have been doing the same. Yet the Covid-19 crisis has unmasked us and it’s time to start facing up to the truth.

A Failed Market Revolution

In 1954, the eminent economist Paul Samuelson, came across an obscure dissertation written by a French graduate student named Louis Bachelier around the turn of the century. The paper, which anticipated Einstein’s later breakthrough on Brownian motion, declared somewhat innocently that “the mathematical expectation of the speculator is zero.”

Samuelson’s discovery launched a revolution in mathematical finance models based on on Bachelier’s assumption, including the Efficient Market Hypothesis, portfolio theory, the Capital Asset Pricing Model (CAPM) and the Black-Scholes model. The underlying assumption was that markets were rational, and risk could be quantified and managed effectively.

The flaws in these models should have been obvious even at the time and some, including the mathematician Benoit Mandelbrot, pointed out that markets were far more volatile than the financial engineering models predicted. Nevertheless, policymakers chose to ignore the warnings and put their faith in the “magic of the market.”

Probably the biggest failure of market fundamentalism is that, as economist Thomas Philippon points out in his book The Great Reversal, over the past 40 years markets in the United States have become significantly weaker. In a similar vein, a study published in Harvard Business Review that examined 893 industries found that two thirds had become more concentrated.

The truth is that we’ve chosen weaker markets and less competition, which has led to less dynamism and innovation. That’s no accident.

Digital Disruption

In Regional Advantage, AnnaLee Saxenian describes how Silicon Valley replaced Boston’s “Technology Highway” as the center of the digital universe. While Boston was corporate and hierarchical, Silicon Valley was freewheeling and networked. The Silicon Valley ethos was very much the counterculture.

So, it was no accident that when Steve Jobs flew to New York to recruit John Sculley, who was at the time President of Pepsi, to lead Apple he asked him,”Do you want to sell sugar water for the rest of your life, or do you want to come with me and change the world?” The implication being that selling computers was a higher calling than selling soft drinks.

That was nearly 40 years ago and while the Covid-19 crisis has certainly highlighted some benefits of digital technology, such as cheap and effective teleconferencing, it’s also become clear that the digital revolution has largely been a disappointment. Productivity growth, except for a relatively brief period in the late nineties and early aughts, has been depressed since the 1970s.

Compare the iPhone to the breakthroughs of the mid-twentieth century, such as Bell Lab’s transistor, Boeing’s 707 and IBM’s 360 and it becomes clear that while digital technology has done much to disrupt industries, it’s done relatively little to create significant new value, at least in comparison to earlier technologies.

The Uncertain Promise of Globalization

The aftermath of the fall of the Berlin Wall was a time of great optimism. With the Cold War over, books like Francis Fukayama’s The End of History predicted a capitalist, democratic utopia in which free markets would conquer the world making everyone more prosperous. Those that refused to reform would be unable to compete.

While there were genuine achievements, especially in lifting up the world’s poorest, it’s hard to see how globalization has made us significantly better off. In fact, rather than the triumph of freedom, we’ve seen a global rise in populist authoritarian movements, the polar opposite of what intellectuals like Fukayama predicted.

In the United States, the situation has become especially dire. Social mobility and life expectancy in the white working class are declining, while anxiety and depression are rising to epidemic levels. While wages have stagnated, the cost of healthcare and education has soared, squeezing the middle class. Income inequality is at its highest level in 50 years.

So, while it’s true that there have been real benefits from globalization, such as curbing inflation, we’ve done little to mitigate the costs to the average citizen. That didn’t just happen but was the result of choices that we made.

We Need to Choose Resilience and Grand Challenges Over Output and Disruption

The Covid-19 crisis has unmasked us. We thought that markets, technology and globalization would save us, that we could just set up some sensible rules of the road and everything would run on autopilot. That’s clearly untrue. We took short-term profits while ignoring long-term costs, loaded up on debt and hoped for the best.

The current crisis has followed the same pattern. We simply failed to prepare for known risks because it seemed expedient not to. George Bush warned about the possibility of a pandemic as did his Health and Human Services Secretary. Jay Leno mocked them. The Obama administration set up a step-by-step playbook and it was ignored. The long list of failures goes on.

Yet we don’t have to be victims of our failed choices. We can learn to make better ones. After the 1918 Spanish Flu pandemic, we embarked on a 70-year productivity boom. Out of the ashes of World War II, we built a new era of peace and prosperity that was unprecedented in world history. We can do so again. We have that power.

New technologies, under development as we speak, will likely give us the power to cure cancer, create clean energy, save the environment and colonize space. We can rebuild the middle class, usher in a new era of peace and prosperity, increase life expectancy while improving quality of life. These are all things we may be able to achieve in the next decade or two.

Yet those possibilities are merely potential that we can succeed or fail to actualize. We can, as we did after World War II, choose to invest in the future and tackle grand challenges. We can build new infrastructure, spawn new industries and create an educated workforce. Or we can, as we did after the end of the Cold War, choose disruption over construction.

What’s clear is that nothing is inevitable. The digital revolution didn’t have to be a dud. The Great Recession didn’t have to happen. The Covid-19 Pandemic could have been, at the very least, greatly mitigated. We are responsible for the choices we make. Now is the time to shoot for the moon (and Mars), not to grade ourselves on a curve.

— Article courtesy of the Digital Tonto blog
— Image credit: Pixabay

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Why We Need Digital Health Package Inserts

Why We Need Digital Health Package Inserts

GUEST POST from Arlen Meyers, M.D.

The Food and Drug Administration announced new rules for nutrition labels that can go on the front of food packages to indicate that they are “healthy.”

According to one source, a package insert is a document included in the package of a medication that provides information about that drug and its use. For prescription medications, the insert is technical, and provides information for medical professionals about how to prescribe the drug. Package inserts for prescription drugs often include a separate document called a “patient package insert” with information written in plain language intended for the end-user — the person who will take the drug or give the drug to another person, for example a minor. Inserts for over-the-counter medications are also written plainly.

In the US the document is called “prescribing information” or the “package insert” (PI) and layperson’s document is called the patient package insert (PPI). In Europe the technical document is called the “summary of product characteristics” (SmPC) and the document for end-users is called the “patient information leaflet” (PIL) or “package leaflet”.

Given the confusion about 1) which digital health product to prescribe for any given patient, 2) the fact that many products are actually consumer products designated to provide information and education, not diagnosis or treatment, and 3) most are not clinically validated or cost-effective, perhaps it’s time to require package inserts for the prescriber and the patients.

Prescription digital therapeutics is also being added to the therapeutic armementarium and is raising several questions about safety, effectiveness, cost-effectiveness, ROI, reimbursement and regulatory requirements, including whether package inserts should be required, how they should be made available to patients, and what they should include.

What is in a package insert is described and required by the FDA and includes:

  • Clinical pharmacology – tells how the medicine works in the body, how it is absorbed and eliminated, and what its effects are likely to be at various concentrations. May also contain results of various clinical trials (studies) and/or explanations of the medication’s effect on various populations (e.g. children, women, etc.).
  • Indications and usage – uses (indications) for which the drug has been FDA-approved (e.g. migraines, seizures, high blood pressure). Physicians legally can and often do prescribe medicines for purposes not listed in this section (so-called “off-label uses”).
  • Contraindications – lists situations in which the medication should not be used, for example in patients with other medical conditions such as kidney problems or allergies
  • Warnings – covers possible serious side effects that may occur
  • Precautions – explains how to use the medication safely including physical impairments and drug interactions; for example “Do not drink alcohol while taking this medication” or “Do not take this medication if you are currently taking MAOI inhibitors
  • Adverse reactions – lists all side effects observed in all studies of the drug (as opposed to just the dangerous side effects which are separately listed in “Warnings” section)
  • Drug abuse and dependence – provides information regarding whether prolonged use of the medication can cause physical dependence (only included if applicable)
  • Overdosage – gives the results of an overdose and provides recommended action in such cases
  • Dosage and administration – gives recommended dosage(s); may list more than one for different conditions or different patients (e.g., lower dosages for children)
  • How supplied – explains in detail the physical characteristics of the medication including color, shape, markings, etc., and storage information (e.g., “Store between 68 and 78°F “)

Of course, there would need to be some modifications, like:

  1. Safety and efficacy
  2. Cybersecurity risks
  3. Data security
  4. Data , privacy, ownership and transfer rights
  5. Side effects
  6. Designation as a consumer product or a diagnostic or therapeutic device
  7. Generic substitution possibilities
  8. Adverse app reactions
  9. App-app interactions
  10. Compatibility with other drugs or devices

One thing that will not be in the insert will be what all this costs to you or someone else who has to pay for it.

Research shows that “Safety of apps is an emerging public health issue. The available evidence shows that apps pose clinical risks to consumers. Involvement of consumers, regulators, and healthcare professionals in development and testing can improve quality. Additionally, mandatory reporting of safety concerns is needed to improve outcomes.”

It is short-sighted, however, to let DTC medical apps slip under the regulatory radar. As described in a recent article for Nature, they could turn out to have costs which insurers or taxpayers might ultimately be responsible for.

But, the FDA is not the only agency with regulatory power. How about the Federal Trade Commission? Almost every promotion these days claims “AI-powered” What should be the truth in advertising standards to make that claim? Should there be something like a nutrition label ?

Medical student and resident education in clinical informatics, including artificial intelligence, is a good start. Here are some potential curricular and extracurricular learning opportunities for artificial intelligence in medicine.

At this point you are probably thinking, “We have enough regulations and we love our APPs. So what if they don’t make us any better.”

Go shove your insert.

Next, you’ll be telling us it has to have all that cotton in the bottle too.

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Land Mines of Intrapreneurship

Land Mines of Intrapreneurship

GUEST POST from Arlen Meyers, M.D.

Entrepreneurship is the pursuit of opportunity under VUCA (volatile, uncertain, complex and ambiguous) conditions with the goal of creating user/stakeholder defined value through the deployment of innovation using a VAST business model.

Intrapreneurs are employees trying to act like entrepreneurs within their organizations or non-profits. Here is the textbook of physician intrapreneurship.

Here is how to get your ideas noticed:

If you are trying to develop and deploy an AI solution in your sickcare organization, have you answered these questions?

Here are some reasons why your initiative will fail.

Do you have a VAST edupreneur business model?

Studies show that around 60 to 80% of new products fail. The same is probably true for programs and new educational offerings. It is difficult to determine the exact number of unreported cases, because who would like to talk about his innovation flops? The odds are against you.

So, what are the landmines to detect and avoid?

  1. You did not do your homework because you where unwilling, unable to do so ,or ,you do not have an entrepreneurial mindset and think because you already have 2 people who said they were interested that you could forge ahead.
  2. You did not have an exit strategy.
  3. You did not read the field manual.
  4. You don’t have the right sponsor with staying power.
  5. You tried to bite off more than your stakeholders are willing or able to chew.
  6. You are a bad rebel and chalk it up to “being authentic.”
  7. You do not have the right clinical champions on board.
  8. You have empty seats on the bus or the wrong people sitting in them.
  9. You are making these rookie intrapreneur mindset mistakes.
  10. You are not addressing the dysfunction of teams.
  11. You are not aligned with your organization’s strategy or vision.
  12. You are working in the wrong place with a toxic or fixed culture or for the wrong person.
  13. You don’t have an innovation strategy
  14. You don’t get sales and marketing
  15. You didn’t ask and answer these four questions before you started
  16.  If you’ve got a major change on the horizon, here’s how to avoid three of the most common saboteurs of company transformation. First, understand that significant change will be harder than you think it will be to achieve. Next, be realistic about your organization’s capacity to implement changes. Finally, make sure your organization understands how and why the transformation is important to you.
  17. You have not learned how to win at Survivor  1) Don’t expect friendship. Invest in relationships outside your company to meet your emotional needs; 2) Manage sideways. Your reputation with your peers becomes an important factor as you’re being considered for senior ranks; and 3) Hone your political skills.

If you get too far ahead of your troops, it is hard to tell the difference between you and the enemy. De-risk yourself. Be careful out there.

Image credit: Pixabay

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Should you be a physician entrepreneur?

Should you be a physician entrepreneur?

GUEST POST from Arlen Meyers, M.D.

Not every doctor is cut out to be a physician entrepreneur. Are you?

It seems to me there is confusion about physician entrepreneurship, its definition and whether it represents a threat to professionalism. I’m not alone. Is a physician entrepreneur someone who starts and runs a business, or is it something more?

Entrepreneurship is the pursuit of opportunity under variable, uncertain, complex and ambiguous conditions. The goal of all entrepreneurs, including physician entrepreneurs, is to create user defined value through the deployment of innovation using a VAST business model to accomplish, in the case of medical professionals, the quintuple aim or, if applicable, shareholder value.

Here are three things to know about physician entrepreneurship.

Because of the many changes in the art and practice of medicine, many doctors have decided to get involved in non-clinical side gigs or, in some instances, leave medicine entirely. Here is a guide to non-clinical careers.

Doctors are practicing the art of entrepreneurship for many reasons:

  1. It helps patients
  2. It’s fun and challenging
  3. It gives them the ability to exercise creativity
  4. It creates alignment and engagement with organization
  5. The profit motive
  6. It creates meaning
  7. It satisfies psychic needs
  8. It provides another sources of external vaidation
  9. It’s a way to get outside of your comfort zone
  10. It allows you to take more risk
  11. The sick care business model is broken and they want to be part of the big fix after feeling ignored and disempowered
  12. They have to to surthrive

Whether you are a pre-med, a medical student, a resident, a fellow or a practicing clinician thinking about beginning the entrepreneurial journey, you should take some time to identify your persona.

You career strategy starts with answering:

  1. Where are you now?
  2. Where do you want to go?
  3. How do you want to get there?

Begin by matching yourself with one of the four core entrepreneurial personas as defined by their willingness and ability to practice entrepreneurship successfully.

The Convinced and Confident know entrepreneurship should be part of their career pathway. In fact, many of them have had entrepreneurial life experiences prior to medical school.

The Curious but Clueless don’t know what they don’t know but are willing to learn more. Many have never held a job in their life. Some might be willing, but unable to develop an entrepreneurial mindset. . Others discover their innerpreneur, and move on.

The I Couldn’t Care Less are unwilling and unable to give it a try. Their attitude is , “I went to medical school to take care of patients, not take care of business”. What they don’t realize is that if you don’t take care of business, you have no business taking care of patients.

The Conflicted have yet to discover their “innerpreneur”, but are conflicted about whether to step outside of their comfort zones and cut the chord.

Your persona will help lead you to the next steps:

  1. The Convinced and Confident: Continue to improve your knowledge, skills, abilities and competencies and learn from your experience.
  2. The Curious but Clueless: Start with education, building your networks and finding mentors
  3. The I Couldn’t Care Less: Pass on entrepreneurship until or unless you change your mind. Here are the many reasons why you should not be a physician entrepreneur.
  4. The Conflicted: Start with the 6Rs of physician career transitioning, beginning with reflection.

Where you are in the thought process will depend on who you are.

Moving from unawareness to awareness to intention to decision to action might show you someone in the mirror you would have never recognized in the past. Or, you might be looking at the same old person.

Image credit: Pixabay

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Challenges of Artificial Intelligence Adoption, Dissemination and Implementation

Challenges of Artificial Intelligence Adoption, Dissemination and Implementation

GUEST POST from Arlen Meyers, M.D.

Dissemination and Implementation Science (DIS) is a growing research field that seeks to inform how evidence-based interventions can be successfully adopted, implemented, and maintained in health care delivery and community settings.

Here is what you should know about dissemination and implementation.

Sickcare artificial intelligence products and services have a unique set of barriers to dissemination and implementation.

Every sickcare AI entrepreneur will eventually be faced with the task of finding customers willing and able to buy and integrate the product into their facility. But, every potential customer or segment is not the same.

There are differences in:

  1. The governance structure
  2. The process for vetting and choosing a particular vendor or solution
  3. The makeup of the buying group and decision makers
  4. The process customers use to disseminate and implement the solution
  5. Whether or not they are willing to work with vendors on pilots
  6. The terms and conditions of contracts
  7. The business model of the organization when it comes to working with early-stage companies
  8. How stakeholders are educated and trained
  9. When and how which end users and stakeholders have input in the decision
  10. The length of the sales cycle
  11. The complexity of the decision-making process
  12. Whether the product is a point solution or platform
  13. Whether the product can be used throughout all parts of just a few of the sickcare delivery network
  14. A transactional approach v a partnership and future development one
  15. The service after the sale arrangement

Here is what Sales Navigator won’t tell you.

Here is why ColdLinking does not work.

When it comes to AI product marketing and sales, when you have seen one successful integration, you have seen one process to make it happen and the success of the dissemination and implentation that creates the promised results will vary from one place to the next.

Do your homework. One size does not fit all.

Image credit: Pixabay

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What will it take to create a national medical records system?

What will it take to create a national medical records system?

GUEST POST from Arlen Meyers, M.D.

Almost every person that has experienced the US sickcare system has been frustrated by the lack of data interoperability. We are all paying the costs, now pegged at $4.1T. About $1T of the tab is waste.

Here is the case for data interoperability.

Larry Ellison, the CEO of Oracle, is the latest person who says he wants his company to fix that.

Like those that preceded him, he will face:

  1. Stakeholders that don’t play nice with each other
  2. An enormous cost
  3. Trying to create a VAST business model
  4. Inconsistent technical standards
  5. Competition
  6. The lack of a national patient unique identifier system
  7. Privacy and confidentiality issues
  8. A highly regulated system for patients sharing their data
  9. End user resistance to dissemination and implementation
  10. Cybersecurity
  11. Connecting the kaleidoscope of the disparate elements of the US sickcare system of systems, like the VA, safety net hospitals, rural hospitals, academic centers and DOD facilities
  12. Combining financial data with clinical data
  13. Combining research data with clinical care data
  14. Varying levels of data maturity in the system
  15. Accessing data that is created outside of traditional medical service facilities
  16. The growth of retail sickcare and sicktech companies
  17. Harnessing data from the internet of medical things
  18. Integrating artificial intelligence to not only achieve the quintuple aim, but also create shareholder value that will conflict with one another
  19. Winning the “cloud wars”
  20. The lack of trust and growing sickcare technoskepticism
  21. The Cerner VA implentation FUBAR halo effects.
  22. Changing the EMR “SHIT” -single most hated information technology- to a whole product solution
  23. Accessing unstructured data on social media sites
  24. Governance of the enterprise
  25. Regulatory oversight of software as a medical device and digital therapeutics
  26. Low levels of sickcare professional and patient data literacy
  27. Barriers to international data sharing in a era of pandemics and required rapid response
  28. Fax facts
  29. Push back from patients who want to be paid for their data
  30. Decentralized clinical trial data issues
  31. DEI
  32. Leaderpreneurship skills
  33. UI/UX Will he eliminate passwords?

Wouldn’t it be nice if Sickcare USA, Inc. could provide you with the same experience as your bank ATM system?

Is Larry really the smartest person or just in the wrong room?

Image Credit: Pixabay

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17 Reasons Not to Be a Physician Entrepreneur

17 Reasons Not to Be a Physician Entrepreneur

GUEST POST from Arlen Meyers, M.D.

Judging by the headlines on their LinkedIn profile and their presence on social media, more and more MD/DOs are innovators, coaches, entrepreneurs and non-clinical consultants. Many are starting or working with biomedical and clinical startups, including a group of medical school graduates, who don’t do a residency or starting their own company.. But:

  • They are not trained to do so
  • Entrepreneurship in the US has been in a downward spiral in the US for the past 40 years.
  • Most startups will fail
  • Most startups don’t have money to pay people
  • There is an innovation bubble.
  • Job security is low
  • You have to deal with people who have entrepreneurial psychopathologies are simply untrustworthy.
  • Students loan burdens are rising
  • Many are not in it for the long run
  • There are unrealistic expectations on both the consultant/employee and employer side.
  • Most MD/MBA programs should be terminated
  • Innovation theater is pervasive.

What is physician entrepreneurship? Entrepreneurship is the pursuit of opportunity under volatile, uncertain, complex and ambibuous conditions (VUCA).. The goal of physician entrepreneurs, is to create user defined value through the deployment of innovation using a VAST business model to accomplish the quintuple aim. There are many ways to do that other than creating a company.

Here are some reasons why you should think twice about being a physician entrepreneur:

  1. You are not ready to innovate
  2. You do not have the courage to innovate
  3. You do not have the mindset to innovate
  4. You think that your clinical mindset and your medical degree and training is enough to succeed
  5. You are not in a financial position to take the risk
  6. You are doing it to get away from someone of some job instead of towards something that is a better fit
  7. You do not have a career transition strategy
  8. You or your family are not willing to pay the price of successive failure
  9. You are unwilling to come down off the mountain
  10. It’s not personal
  11. You are not ready to quit your day job
  12. If you decide to create a company, or work for one, making money for the company is not that important to you.
  13. You don’t have the knowledge, skills, abilities and competencies to add value to a business
  14. You don’t have entrepreneurial DNA
  15. You don’t have a big enough network or know how to manage it as part of building your personal brand
  16. You don’t know how to sell things
  17. You are a problem solver, not a problem seeker.

Think twice about telling someone to take your white coat and shove it. You will save yourself and lots of other people heartburn and other people’s time, effort and money.

Image Credit: Pixabay

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Future of Global Physician Entrepreneurship

Future of Global Physician Entrepreneurship

GUEST POST from Arlen Meyers, M.D.

What’s your definition of entrepreneurship? Here’s the conventional one.

Mine is that physician entrepreneurship is the physician pursuit of opportunity under volatile, uncertain ,complex and ambiguous (VUCA) conditions with the goal of creating user defined value through the deployment of innovation using a VAST business model.

There are many myths about entrepreneurs. Here are some about physician entrepreneurs.

The life science innovation roadmap is risky, expensive and time consuming. To be successful, bioentrepreneurs whether healthcare professionals, scientists, engineers, investors or service providers, need to work as a team with their organizations to overcome the multiple hurdles taking their ideas to the market and patients. The process is neither linear nor predictable and outcomes are never guaranteed. In addition, because of global macroeconomic conditions, investors are unwilling to gamble on unproven technologies in a more hostile regulatory and legal environment. Consequently, commercializing bioscience discoveries is becoming more and more difficult. However, innovators still thrive. Where are some of these exciting business opportunities for bioentrepreneurs?

An initial understanding of the changes happening in international systems is the first step in identifying potential market opportunities. Here are but a few:

  1. Major and continual healthcare policy reforms
  2. Migration away from fee for service payment
  3. Consumerization, commoditization, internationalization, customization and digitization of care.
  4. Changing from a sick care system to a preventive and wellness system
  5. Defined benefit to defined contribution health insurance coverage
  6. Rightsizing the healthcare workforce
  7. Do it yourself medicine (DIY)
  8. Mobile and digical (physical and digital) care delivery models
  9. The growth of employed physicians
  10. Innovation management systems and increasing attention to health entrepreneurship.
  11. Increasing demand for high touch care
  12. Increasing discontinuity of cares changing quickly. All of these changes present biomedical and healthcare entrepreneurs opportunities to create new products, services, models and platforms. Patients are taking more control of funding and contributing to basic and clinical research using the internet and social media continues to play a bigger and bigger role in healthcare marketing and delivery.
  13. Demographic and economic changes and social mobility
  14. Closing the digital divide
  15. The impact of the 4th industrial revolution

Take opportunities in AIntrepreneurship, for example, in India, China, MENA and Africa

The drivers of physician international entrepreneurship include:

  1. Fear: Doctors are afraid they will suffer the professional, personal and economic consequences if they don’t adapt to change
  2. Greed: Physician incomes are threatened by innovation and new business models
  3. Necessity: Most doctors in industrialized countries have a relatively high standard of living. They did not bother themselves with innovation or entrepreneurship because they didn’t have to.
  4. The innovation imperative: The pace of change has accelerated and markets and employers are demanding more with less
  5. Generational demands: Medical students and residents are questioning their career decisions and demanding that schools provide them with the innovation and entrepreneurship education and training knowledge, skills and attitudes they need to thrive after graduation and throughout their careers
  6. The shifting doctor-patient relationship: Technology and DIY medicine is disintermediating doctors and fundamentally altering the doctor-patient relationship
  7. Resources: The internet, local ecosystems, acclerators and access to early stage capital has made it easier to start a business or develop an idea. People are connecting to the global economy.
  8. Portfolio careers: The sick care gig economy is growing and the future of work is changing. Fewer are committing to one lifetime career or job, including clinical medicine
  9. Opportunities: With change, comes opportunities and those few doctors with an entrepreneurial mindset are actively pursuing them. The opportunities in health entrepreneurship are sizable and physician entrepreneurs are increasing well positioned to capitalize on them.
  10. Culture: The culture of medicine is changing and encouraging creativity and innovation
  11. Politics: Access to quality care at an affordable price is in high demand as middle classes grow in developing countries. Not providing it leads to social upheaval and political instability.
  12. Budget deficits: The demand for care is almost infinite. However, the supply is limited. Consequently, policy makers and markets are looking for ways to improve outcomes at a lower cost through the deployment of innovation.
  13. Youth unemployment: Restless unemployed, educated citizens are demanding jobs and ways to use their talents.
  14. Economic development: Innovation and entrepreneurship is fuel that that feeds the engines of economic development in emerging economies. like Africa.
  15. Globalization: People, money and technology go where they are treated best, regardless of location.

The future of physician entrepreneurship is measured by progress in four domains: educationpracticeresearch and impact. Unfortunately, each part of the physician innovation value chain is highly resistant to change and subject to multiple barriers to dissemination and implementation. We have made progress in all, but, the results are unevenly distributed.

The future of international physician entrepreneurship will be punctuated by:

  • The coherence of disparate technologies from diverse industries other than sickcare
  • Increasing transdisciplinary and international dependencies and collaboration
  • Educational reform in health professional, public health, bioengineering and computer science programs
  • Significant regulatory, legal, economic, ethical and societal issues
  • Generational, social and demographic variations in dissemination and implementation
  • An evolving global IT cybernervous system and interoperability
  • More difficult trust, privacy and security barriers
  • A high touch backlash against high tech
  • The rise of patient sickcare entrepreneurship
  • A slow migration to healthcare from sickcare

That said, this is the golden age of physician entrepreneurship, as reflected by the record number of applicants to US medical schools, the number of doctors pursuing non-clinical careers or side gigs, the ever increasing number of biomedical and clinical ecosystems, inclusion of digital health, business of medicine and entrepreneurship education and training in medical and graduate schools and the results and impact of entrepreneurs during the COVID pandemic.

Physician medical practice entrepreneurs, technopreneurs, intrapreneurs, social entrepreneurs, philanthropreneurs, edupreneurs and others are changing the world and the movement is spreading rapidly. Fortunately, despite efforts to the contrary, there is no vaccine to stop it.

Image credit: Unsplash

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We need MD/MBEs not MD/MBAs

We need MD/MBEs not MD/MBAs

GUEST POST from Arlen Meyers, M.D.

The number of MD/MBAs graduating from medical schools continues to expand with about 5% of the roughly 20,000 US medical student graduates having dual degrees. While in past times the idea was to get the knowledge, skills, abilities and competencies to manage health services organizations, many are now doing it on the way to digital health startup land.

Most all of the 38 osteopathic schools offer dual degree programs as well.

However, MBA programs are dwindling and the ones that are still around are rethinking their value proposition and restructuring their curriculum.

For example, business schools are racing to add concentrations in science, technology, engineering and math to their M.B.A. programs as they try to broaden their appeal to prospective students overseas who want to work in the U.S.

Several schools, including Northwestern’s Kellogg School of Management and North Carolina’s Kenan-Flagler Business School, have unveiled STEM-designated master’s in business degrees in recent months. The University of California Berkeley’s Haas School of Business recently reclassified its entire M.B.A. program as STEM.

But, BMETALS is the new STEM.

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.

  1. We don’t know how much value the graduates contribute to the sick care system.
  2. The programs are usually not domain specific. Some think that’s a good thing, encouraging exposure to how other industries have solved generic problems. Others feel sick-care is so unique that the lessons are not applicable.
  3. Medical students are already up their waists in debt, most of which is taxpayer subsidized. Should additional debt be added to their student loans?
  4. Few of the programs address the needs of physician entrepreneurs.
  5. There are many substitutes for physician entrepreneurs around the world and US schools are no longer the mecca.
  6. Content has become generic and offered for free on the Internet.
  7. Connections are easy to make using social media.
  8. The MBA is losing credibility, given the large number of places that offer them, particularly those below the first-tier schools.
  9. Employers can see through the credentials.
  10. Costs continue to escalate and the programs do not accommodate the specific needs of busy clinician students.
  11. We need a thorough conversation about the policy wisdom of encouraging dual degrees, potentially side tracking graduates into non clinical roles when there is a global demand for clinicians.
  12. We need to track outcomes and roles of graduates to determine whether the dual degree adds value to the communities they are designed to serve and whether they are cost-effective in an era of skyrocketing student debt.

In addition, there is a difference between having knowledge, skills, abilities and competencies in the business of medicine, health systems science, health service organization management, leadership and leaderpreneurship and entrepreneurship/intrapreneurship. There is a confusing array of dual degree programs leaving students scratching their heads and, in many instances, wasting their time and money.

Also, more medical students are jumping ship to pursue non-clinical careers. While the numbers may a small portion of the roughly 20,000 first year US medical students, the trend is evident.

Instead, we should consider re-shuffling the deck and offer a new combined MBE (Masters in Bioinnovation and Entrepreneurship) degree or dual MD/MBE or PhD/MBE program.

According to Prof. Varda Liberman, the new Provost of Reichman University and Head of the MBA in Healthcare Innovation, “Healthcare systems are going through enormous changes worldwide and with the COVID-19, these changes were accelerated. There is an immediate need for a complete redesign that will necessitate innovative multidisciplinary solutions, leveraging technology, science, information systems, and national policy. Our MBA program in Healthcare Innovation, offered by Reichman University, in collaboration with Israel’s largest hospital, the Sheba Medical Center, Tel Hashomer, is designed to prepare the future leaders of the healthcare industry to develop solutions that will enable the needed redesign. The program brings together all the unique advantages of Israeli innovation, to provide our students with the tools and skills necessary to understand the complexity of the healthcare industry today. The program brings together all the key players of the ecosystem – those coming from the healthcare system, engineering, entrepreneurship, AI, law, biomedicine, pharmacology, high tech, investment, management, and public policy”.

Here’s how it would work:

  1. A four-year program combining two years in medical school and two years in an MBE program, patterned similar to Professional Science Masters Programs.
  2. The medical school curriculum would be separate and distinct from that offered to medical students interested in practicing medicine. Among other topics, we would teach sales.
  3. Clinical rotations should start on day one, intended to instill an entrepreneurial mindset and emphasize being a problem seeker, not a problem solver at this stage
  4. Interdisciplinary education with experiential learning in project teams that includes business, science, engineering, law and other health professionals.
  5. Experiential learning and a mandatory internship with local, national or international company in biopharma, medtech or digital health.
  6. A new tuition and funding structure, possibly run by private equity or medical technology companies who sponsor applicants. The present medical education business model won’t work if it depends on short term revenue by putting butts in the seats.
  7. Project teams would be offered proof of concept funding and iCorps team support
  8. Domain experts would work with project teams
  9. Each student would be assigned an entrepreneur mentor throughout the program
  10. Social biomedical entrepreneurship and ethics would be core streams throughout training. Those interested in creating non-profits or going into public service might be candidates for tuition deferral or waiver.

Another alternative is to make medical school 3 years instead of 4 and offer a one year track in biomedical and clinical entrepreneurship.

The good news for educators is that you don’t need to start from scratch. Karolinska beat you to the punch.

The purpose of the degree program is to provide students with the knowledge, skills and abilities they need to lead global biomedical innovation. Here’s what the curriculum would include:

  1. Building Biotechnology: Introduction to biomedical entrepreneurship
  2. Regulatory Affairs and Reimbursement
  3. Life Science Intellectual Property
  4. International (Bio) Business
  5. Biotech law and ethics
  6. Internship
  7. International trip
  8. Device and digital health entrepreneurship
  9. Leading high performance teams
  10. Bioentrepreneurial finance
  11. Drug discovery and development
  12. Care delivery entrepreneurship
  13. Social entrepreneurship
  14. Electives in other aspects of entrepreneurship

The David Eccles School of Business at the University of Utah is taking its top 10 ranked program for entrepreneurship to new heights with a master’s degree designed for serious entrepreneurs.

The degree is called the Master of Business Creation (MBC), and it’s the first of its kind.

Applicants must be full-time entrepreneurs who want to create, launch and scale a new business, who want more than the 9-to-5 job, who have the drive to overcome the impossible, who want to build their knowledge while doing, and who are willing to put in the hours to make it happen.

We don’t need more physician administrators. We need more physician innovators and entrepreneurs who can lead us out of our sick care mess and close global health outcome disparities. While I believe the optimal career track involves a reasonable time practicing clinical medicine, students are thinking otherwise. For those that do, they need a new path to creating the future and medical and business educators need to create educational products that meet their needs.

Image credit: Pixabay

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