The start of medical school is an exciting point in every student’s path toward finally becoming a physician. While you should be spending the majority of your day learning and part of each day marveling in the uniqueness of human anatomy and physiology, it is important for us to remain aware of the barriers to care that exist within the systems we train, and eventually practice in. But now more than ever, being a medical student with a penchant for innovation and entrepreneurship can lead to opportunities to create real change and impact real patients.
As medical students with backgrounds in health care consulting and entrepreneurship, we kept notes on lessons learned as we trekked through the wards and the operating room during our clinical years in medical school. Our experience has been that there are few outlets for medical students to voice their professional opinions on health care systems and potential inefficiencies. While consulting for startups, we discovered that leaders in healthcare found our clinical experience, even as medical students, valuable to understanding their business models. As medical students, we have the distinct privilege to interact with providers and patients that very few business leaders have access to. These insights represent our organized wisdom and hope to serve as a helpful reference for future clinicians interesting in resolving health care issues through innovative endeavors.
1. Make sure to prioritize!
If you’re already in medical school, you likely know it’s pretty time consuming. That said, there are still many entrepreneurial opportunities in the periphery of medicine — but be wary of these. While these projects may seem like more fun, not taking your main task — to become a competent clinician, seriously, will not do you any favors in the task ahead. Furthermore, whether you’re a doctor, entrepreneur or school teacher, having the ability to pick a goal and focus on accomplishing it without getting sidetracked is essential to being successful. It is imperative to have mastery of clinical knowledge first in order to effectively create change as a physician-leader.
Once you take care of your main duties as a student, choose one or two interesting projects that you really want to invest time into and learn about long-term. These projects can be related to your surgical or medical specialty of interest or can be more health care systems focused. They can be clinically oriented or not, but focusing on a limited number of projects that you can pursue during your breaks will both give you some personal pride and satisfaction, as well as consistently keep your foot in the door with people in that specialty.
2. Use your breaks creatively.
While you don’t have a lot of time off in medical school, you at least have a very good idea of when that time off will happen. Use those structured breaks to expose yourself to people and ideas that you are interested in but may not see on a daily basis in the hospital. Just like shadowing a physician, you can often reach out to other organizations and see if you can spend time with someone on their team to get a sense of what they do and learn more about a certain subject.
This can be anything from a biomedical lab to a venture capital firm, so be creative and remember that people love students. If you are interested in innovation and start-ups in particular, there is an ever expanding world of incubators and accelerators that can expose you to a large number of people, companies and ideas in a relatively short period of time. Look up local meet-up events in your area at StartUpGrind or at the Society of Physician Entrepreneurs. Many medical schools and health systems have “innovation centers” that are often run by physicians who are entrepreneurs as well. Use your existing network to your advantage before branching to others.
3. Keep a list!
You will see areas for improvement every single day, and be tempted to dive right into creating solutions. Instead of getting frustrated by inefficiencies on the ward, type a brief note on your phone about your frustrations and give yourself time to think about it. It is likely that after some reflection, some ideas will seem better and more realistic than others, but they still need a lot of time investment in order for them to develop into something real.
If you keep an informal tracking document for your ideas, something that you can access easily such as a Google Doc, you can jot things down and then come back to the list when there is time. You can make this working document even better by adding references to journals, articles or other kinds of evidence in support of your ideas. You’ll be surprised to find that others, including many attendings, may have similar thoughts and interests. Having a central repository makes it easy to collect your thoughts and jog your memory at the right time.
4. Be respectful and curious, instead of frustrated!
If something you see seems inefficient or ineffective, ask your supervisors respectfully, to explain the logic behind their decisions and actions. You won’t always get a perfect answer, but more often than not, there is a very good reason to sacrifice efficiency, typically for patient safety and better outcomes. An opportune time to ask these questions is when reviewing the patient’s plan after rounds. First, try to understand yourself why the team is doing certain tasks for a patient and then reach out to the resident or attending for further clarification. You will find that they will be pleasantly surprised by your initiative to understand and will gladly take a minute or two to explain their rationale.
Having respect for those who came before you will allow you to learn from their experience and wisdom instead of writing them off. No one is happy with the status quo and obvious breakdowns in the health care system, but holding your instructors and other physicians responsible is like blaming front-line soldiers for a losing war strategy that was designed by generals they have never met.
Try not to get bogged down and become pessimistic about how health care is broken; rather see the health care system as evolving, and most importantly, see yourself as a potential catalyst for change. Successful healthcare startups are created around a problem that creates a real pain point for physicians, patients, and healthcare providers. After identifying systemic issues, it is important to learn more about them in order to truly understand the barriers to effective health care delivery. Stay positive and upbeat about the opportunities that exist to make things better, capitalizing on the scientific commitment to evidence-based practices and improvement.
5. Use your position as a student to your advantage.
The bottom line is that people love students. Use this to your advantage when seeking out new experiences and conversations with meaningful people. In our experience, people are far more receptive to giving up time to help in someone’s education, as opposed to helping someone’s business. That said, while you may have a great idea for a medical start-up or technology, use your time as a student to ask lots of questions and learn as much as you can, since the odds of you being able to start and run a company while in school are relatively low (though not impossible). Also, never be afraid to share your ideas with others due to the fear of rejection or having your concept stolen. In the grand scheme, three out of four startups fail regardless of how much investment and energy is put into them. Thus, it is important to bounce your ideas off as many people as possible in order to hone it and truly discover a problem that needs to be solved.
6. You can’t fix the plane while it’s in the air … sort of.
Health care is a beast and any single hospital is likely the most complex “business/organization” in a given city/region. On top of this, it performs an essential service that our modern society expects to be available 24 hours a day, seven days a week, and 365 days a year. This means that, unlike just about every other kind of organization, hospitals can not completely close down for any reason, so any improvements or changes have to be done on the fly. Just like you can’t stop a plane 30,000 feet up in the air to inspect the landing gear, you also can’t close a hospital with patients in beds and surgeries ongoing/scheduled in order to add a new wing or refurbish an old one.
In the past, major changes in a hospital/doctor’s office would come in the form of new equipment, new treatments (medications/procedures) and new staff (including entire “care team” composed of nurses, receptionists, technicians, etc.). All of these changes require substantial training and resource investment, and most importantly, take away time spent with patients. Then, once the changes are made, the system must now find its new “normal,” which takes time and introduces a lot of discomfort.
The “sort of” is based on the new role that software plays in the medical field. That said, there is one major exception to this general trend in that software and app-based technologies can be relatively seamlessly worked into current workflows without major disruption. This is the equivalent of upgrading a plane’s in-flight movie options wirelessly in mid-air, as this does not affect the central aspect of the plane.
Konstantin Karmazin, MD is currently a first-year medical intern at Mount Sinai Beth Israel completing a prelim year prior to starting training in neurology. His clinical focuses are on movement disorders, neuroendocrinology, and cognitive neurology. Outside of the hospital, he is passionate about the development of new technologies to make patient care better, cheaper, and more pleasant.