How political fear was pitted against technical needs

There wasn’t a single person in the federal government who said, ‘My job is the seamless implementation of the Affordable Care Act.’ 

So far, this is the best article I’ve read about why was botched so badly.

“They were running the biggest start-up in the world, and they didn’t have anyone who had run a start-up, or even run a business,” said David Cutler, a Harvard professor and health adviser to Obama’s 2008 campaign, who was not the individual who provided the memo to The Washington Post but confirmed he was the author. “It’s very hard to think of a situation where the people best at getting legislation passed are best at implementing it. They are a different set of skills.” How political fear was pitted against technical needs

I just turned off voicemail on my phone. You have to call AT&T to make that happen. I feel much better living in the 21st Century. And I also feel better saving all that collective time from those leaving voicemails and me listening to voicemails. So much waste…saved!

Why aren’t there more physician entrepreneurs?

As we’re talking to more and more people about Sherpaa, so many people are asking “Why hasn’t someone come up with this idea before?" 

My response is:

  • A health innovation like Sherpaa has to be founded by a physician and an insurance expert
  • The founders have to deeply understand the issues around starting a business, raising capital, designing a beautiful product, hiring the right developers, the right team, the right operations to power the backend of the company, etc.
  • The founders have to execute on the promise in a way that truly resonates with users
  • The business has to be financially sustainable

That being said, it takes a specific set of skills to conceive of a business, fund the business, and execute on it in a way that makes the business successful over time.

There are ~600,000 practicing physicians in the United States. Of these, ~450,000 are specialists and ~150,000 are generalists. Once you become a doctor, your life is set if you follow the straight and narrow. There is a defined professional trajectory making decent money on day one that rises every day you stick to the straight and narrow. It’s a very conservative and comfortable situation and one that the vast majority stick with forever. Upon completing residencies and fellowships, doctors have spent likely 10 years of their life in medical school and residency and are just simply ready to settle down and start making some money. They want to start having a family as they enter their 30’s and they’re in debt a few hundred thousand from medical school. Taking the salaried job, after slaving away for 80 hours a week for the last 10 years is just way, way too enticing. And more and more doctors are being hired by healthcare systems for comfy, cushy, lifestyle jobs. Striking out on your own as an entrepreneur is risky, especially when you’re so deep in debt.

The vast majority of physicians are specialists like cardiologists, neurologists, cardiothoracic surgeons, etc. For the last 10 years their brain has been trained to think in silos. But being an entrepreneur and the leader of a company, you need to be a systems thinker. If you think in silos, your business is over. Companies have a ton of working parts. So if you’re a specialist, you’re probably going to think "If all you have is a hammer, the whole world looks like a nail.” So you’re going to probably try and create a business that impacts your specialty. It would be rare for a neurosurgeon to create a health company that affects the general population. So that means, out of the roughly 600,000 practicing physicians, the 150,000 generalists will be the pool that creates health companies that impact the general population.

Physicians are also notoriously inexperienced business people. I remember in medical school, we’d get a special lecture a year on the business of medicine or the legal side of medicine or personal finances. In fact, the last business class I ever took was in 10th grade. I’ve had to teach myself the fundamentals of business. Essentially, I received my MBA from books I’ve read and experience in my previous two companies. 

Also, physicians aren’t so much team players. They’re paid for their own personal opinions, the buck stops with them individually, and they are legally responsible for their own actions. Giving up decision-making control to someone else isn’t in their DNA. But being an entrepreneur requires being a team player, giving up control, and managing people. It’s a skill we have to learn. 

So health companies that affect the general population will very likely come from the 150,000 generalists.

Now what fraction of 150,000 generalists will actually then deny the comfortable straight and narrow, have the creativity for a realistic innovative idea, have the skills to then raise money, build and manage the team, have the skills to build the product or service that people absolutely love, and execute a financially sustainable business over time? 

That 600,000 is quickly whittled down to, I’d wager, way under 100. And the fact that realistic health innovation is so damn few and far between supports this theory.

Of course, there are so many assumptions in this theory, but I’d still generally stand by them.

Sherpaa’s killer feature

Some doctors email. But their main priority and financial incentive is seeing patients in their office because that’s how they get paid. One of our investors recently said he invested because of one simple realization: “you can email a doctor.”

Of course that’s important. However, that’s only part of our killer feature.

Sherpaa’s killer feature is that you can email with our doctors who’s sole responsibility is to email with you and solve problems over email.

We’ve hired doctors and told them their only job is to solve medical problems over email. And we’ve found that 70% of medical problems are solved this way without referring you to see a doctor in person. That’s the killer feature— hired, undistracted doctors who communicate efficiently and effectively like we all do nowadays.