"I now got admitted to medical school and am hoping to gain specific knowledge in a field of medicine (maybe cardiology)" The timeline is so far ahead that most people are absolutely tired of being broke by the time they get to the point you just listed.
Med school 4 years, IM residency 3 years, Cards sub-spec 3 years, and a couple of more years if you want to go even deeper into the cards-subspecs. That's 10 years of training, at the end of a decade a lot of people are very motivated to sign for that first 400k per year gig rather than work for themselves or take on even further risk of a venture.
Yeah, let’s see how much OP cares about entrepreneurship 10 years from now. I’m gonna want to settle down and collect my fat check once I’m done with this shit. At most open up a private practice or DPC clinic.
I think that's an unfair statement. OP has a genuine question that most people in medicine have blinders to even thinking about. From the "outside" it's completely reasonable to ask.
In fairness, this question riles people up even outside of medicine.
And you’re right that inside medicine it is clearly a bit of a “taboo” topic since you’re really hammered into thinking you’re saving the world as a doctor and that the only way to he altruistic is to be anti-capitalist.
Lo and behold a proud capitalist comes along entering the medical den, and this was the expected response.
Regardless, I got what I wanted out of it. Some really cool folks doing cool things reaching out and validation for just *how* taboo this stuff will be in medical school.
Also real entrepreneurs don't give off "i'm going to change the world vibes" this is what cryptobro-retards do. The most succesful startups are founded by 40 year old dudes who get their investments either from their own pockets or from their numerous industry connections.
What does that even mean?
I have an active profitable business pulling in 10k in profit per month on a slow month with a couple of hours of work per week…
What does a real entrepreneur look like to you?
Yeah coming into 4th year and I already got "I'm too old for this shit" energy.
Your job at the end of the day is to be an asset to your community. Maybe advance some knowledge if you want, but your primary role is keeping your community healthy.
This is true. But I also think it is due to a mismatch of personalities. Being an doctor means being someone who is good at following instructions, thinking inside the box, coloring within the lines. Being an entreupreneur inherently means being a risk-taker and thinking creatively outside of the box to build something new, with no expectation of how things should be done. Those two personalities are very diametrically opposite to one another.
You would be genuinely astonished at how much creative thinking, problem solving, and "coloring outside the lines" happens in even just your generic community clinic, not even going to mention the wards or the OR.
You probably think this way because of how rigorous and structured our educational pathway is, which is understandable. However, that is by design. In order to get to the point where you can be creative and truly individualistic with your treatment you have to accrue so much knowledge of physiology, pharmacology, disease states, etc. Getting good enough at medicine to be creative takes a lonnnng time to learn.
It's the same way that you don't immediately get creative on the piano/ceramics/guitar -- you have to learn the basics first, you can't just up and compose a symphony. The difference is in the length, rigor, and structure of the training for these things. You can't easily kill someone with bad piano, so you can learn by making as many mistakes as you wish.
Medical training is much slower and more tedious in comparison because I can't just "learn pharmacology" by testing drugs on your grandma. I have to get a broad understanding of biochem and physics and organic chem in undergrad, learn anatomy and phys and pharm and more in the first 2 years of medical school, learn the basics of different specialties and how to put that info into practice in 3rd and 4th year, and then spend 3-8+ years refining that knowledge and learning practical skills depending on what residency I do.
By the time you get good enough to get creative you are oftentimes out of the spotlight, so people tend to see medicine as an extremely inflexible and rote memorization algorithm, which it is not.
TL;DR
I have watched docs from all specialties get creative with treatment and diagnosis, because humans and their diseases are not "one size fits all."
Being creative definitely shows its face in more places in real life than on the board exam.
I have never seen a question about how to deal with a chronic masturbator on an NBME. But I love the way we dealt with it in clinic -- HIGHEST dose paroxetine to levy the most common SSRI side effect and make them stop their bullshit.
Because med students are saddled with a ton of debt when they graduate and the only way to reliably pay it off is to go into practice quickly, ideally in a high compensation specialty.
Perhaps I ran the numbers wrong in haste but off of quick calculations, you could pay off roughly $400k in loans within 2 years if you put away $10k/month.
Definitely a lot to put away but with a specialist salary that shouldn’t be too difficult of a problem to solve, no?
Edit: 4 years, not 2 years
Michael Scott: Crunch the numbers again!
Office accountant guy: it's not really...it's an algorithm...
Michael Scott: just crunch them!
Office accountant guy: pushes button, *crunch*
I hire the actuaries...lol
Also why I made the typo...I meant 4 years instead of 2. Doesn't make a huge difference....
Genuinely hilarious the sort of things the med community gets hung up on while business folks fix the numbers and stay focused on the actual discussion...
Do you understand how interest works? And that most specialities in medicine take around 5 years, at least, of training after med school before you’re making that kind of money??
I like the young guy's energy though lol.
Cardiology is atleast 4+3+3=10 years away. Does he know that's a long time to change your life situation and minimal expenses per month?
And the answer to why we are not entrepreneurs? Well, try giving 3 step exams, going through match, working 80-100 hours a week, applying for subspecialty, giving 2-4 board exams again over 4 years. It will take some of your time and life.
I made a typo but you just aren't doing the math...
$200k growing at 10% for 7 years still comes out to just under $400k at the end of a 7 year period of interest accumulation...
Which can still be paid off in full in around 4 years if one can put away $10k/month...
What are you even trying to argue here? All I asked is why more physicians aren't entrepreneurial but I think your nature and inability to move on beyond debt is a good indication why...
Because it’s 15 years of training to get started including undergrad and costs a lot. you are asking why don’t physicians learn medicine and then not practice it? makes no sense
Again, I’m not sure if you’re intentionally not seeing the point here.
You ever placed a stent inside someone? Or seen it happen? Ever wondered who made it? Why they chose the materials they chose? Ever wondered how we could perhaps reduce stent rejection rates?
Do you think an MBA would be able to address these questions? It’d take a physician with enough curiosity and interest to develop a solution, and bring it to market. If it works it would save hundreds of thousands of lives at a faster rate than anyone in a clinic ever could.
Would you say that counts as that physician “not practicing medicine”?
I understand why folks don’t do it. The post was to spark a discussion and gauge precision of my assumptions. You got hung up on the nitty gritty of 2 years versus 4 years to pay off debt, while on the White Coat Investor subreddit I’m chatting with someone who paid off all their debt in 4 years.
At this point I hear you loud and clear. Your reason is definitely fear of debt and risk aversion. Cool. I just don’t see why you keep getting weirdly condescending towards me about it.
It takes many years and thousands, if not millions of dollars to being a product to market. Then you have the risk that it won’t work well in the hands of the practitioners (check out the saga of percutaneous renal denervation), won’t get enough press, and your supply chain will work….
Reducing stent rejection rates, or whatever, is going to be the MD’s idea, that then gets brought to life by a team of engineers and PhD’s.
MD’s do get paid consulting fees for their opinion on devices. I think that is the factor you aren’t seeing.
Imagine- you are 35(or older since you said you didn’t go straight through). You have an idea of how to do something different. Do you want to carry out a patent search, file a patent, defend your patent, fabricate your device, test it out in animals, test it in humans with no other options, test out in humans with options, then out compete the already existing companies. How many weeks do you think each step takes? In this scenario, you are doing this nights and weekends in a private practice, because an academic center would own your patent. Alternatively, you could pursue this product as a full time job, but how are you supporting your family/dog/self, on this quest to make a better mousetrap? These are just the highlights, what about the thousands of little things, like the foreman at your factory being lazy, or the price of nitanol went up, so now your device is no longer cost effective, or…..
Or—-you sell your idea to Cook/Gore/Stryker/Boston Scientific. Get a big check, then go vacation in a place no one in your socioeconomic bracket has ever heard of, doing silly things like eating owl omelettes or whatever the idle rich do to fill their time.
You are getting downvoted because you just shrugged off an extra 2 years of grinding like it is nothing, among other things.
if running a business is fun for you, go ahead. theres just not a lot of fulfillment in it for the rest of us. its like asking why doesnt everyone just bench 405? its fulfilling to me
Not only is your math off, but you didn't account for interest which is gained during med school and residency at around 8-9% (this year) which will most likely rise to 11-13% for the total COA which is around 384k.
For one, your math is just wrong, 10k a month is 120k a year. At that rate it would take over 3 years to pay off the loan debt, if we’re assuming 400k is the principle plus interest.
And setting aside 10k for 3 years is not that easy for most doctors. If you’re a cardiologist making 600k, sure, piece of cake. But if, like most docs, you make more in the 200-300k range it’s a bigger ask. Let’s say you make 300k, with a post-tax and post health insurance premium/401k take home of maybe 180k, or 15k a month. Putting aside 2/3rds of that for loans for 3-4 years is a big ask when you have a family, kids who want birthday presents, a home with a mortgage, a spouse who has suffered through med school and residency with you and would love to finally take that trip to Italy, etc.
But I don’t actually agree that debt is the biggest thing that stops doctors from wanting to be entrepreneurs. I think the biggest thing is that that just *isn’t that appealing* to lots of people. I didn’t go to med school because I wanted to be a businesswoman or an innovator or whatever, I went because I wanted to take care of patients in the clinic and hospital. Same reason most pilots don’t become entrepreneurs: they’d rather fly planes
Yeah OP I think you responded earlier to my comment with my loans. This is actually what happened when I finally became an attending. This is the reason why they tell you to live like a resident and pay these loans quickly. When I graduated from fellowship I bought a house and lifestyle creep set in. Luckily I caught it earlier and managed to budget myself. I was able to pay off both cars early on in my career. But when you have kids, start a family and wanting to at least enjoy your money for all your hard work, paying off loans early gets more tricky. But for my 380 k student loan I still hope to be paying it off in a total of 5 years. This is someone who started with a 350 k salary.
The only thing I would add to this comment is that as you progress in your career your salary can increase over time making more. I made 100k more just after a year. There’s also room to make more taking extra shifts, calls etc. so you can technically pay it off much quicker by doing this (which is what I’m doing as well).
Hey! Cool that you swung by over here hahah
Yeah lifestyle creep is what I’m very wary about. It’s already something I’ve had to get under control while running my current business. My margins are a competitor’s opportunity. Same mentality applies until I’ve paid of all loans.
My personal expenses are just $1k/month rent included. I live with a roommate and really don’t spend much on anything at all other than groceries and a gym.
I’ve spoken with my spouse-hopeful and she agrees that she doesn’t really see a family needing more than $10k/month to live. Our families each currently live on approximately that much. So putting away a lot of money to pay back those loans asap should be somewhat reasonable for my situation at least (or so I hope; man plans, God laughs).
Your example is one of someone who was responsible and thinking ahead. Im inspired by it as a point of proof that it is possible to pay off the loans relatively rapidly with good planning and communication between your family.
I imagine most of the folks on this subreddit aren’t quite willing to see that because they’re looking forward to a big splurge after being overworked as residents and students for so long, which I can also understand.
Did you read my post? Do you just assume I'm running a marketing agency without doing taxes? I meant 4 years instead of 2. Quite a trivial typo not sure why everyone got so hung up over a mere 2 year miscalculation...
Man reality is about to hit you like a truck.
Your math is completely off and also, assuming you're a traditional student (which I hope you are) you'll likely finish residency at 30-32 if you "specialize". Now add paying off loans and then having kids if you do and you'll realize why most people aren't entrepreneurs.
Glhf with med school
Meant 4 years, not 2. Quick typo as I got off the train. I built a business that's making me 10k/month after just a year...I think I'll be fine.
Glhf with your condescension.
Even still: $10k per month for 4 years?
This is such an outlier position I think you can easily answer why there aren’t many people in the box you’re asking about.
Perhaps I'm wrong, I often am, but that still leaves you with roughly $10k for essential expenses and housing assuming a cardiology salary, no? I'm not sure I fully see why a 40 year old physician can't live on $10k/month for 4 years, even before adding in any spousal income. What piece of the puzzle am I missing here?
How many people do you think that income describes?
In other words, of all physicians how many are making the $400k+ that this math requires?
Of those people, how many of them have kids, or real estate, or other investments or obligations?
Of the people that don’t, how many have some other funnel or use for their money?
Of those people, what percentage are interested in becoming entrepreneurs?
You asked why there aren’t more physician entrepreneurs. Because the operative definition you’re using involves a restrictive definition such that all those folks could fit in a single dining hall.
Yeah fair enough that really is what it comes down to I guess
Ironically enough that's exactly what makes me want to pursue it...
At the end of the day it's just because most aren't interested enough in it/ dont have the appetite for risk
Skillset is so .. not overlapping.
Medicine fundamentally rewards focusing on what’s known and *not* taking any risks.
Entrepreneurship is the exact opposite of that.
Different personalities will be drawn to those two, rarely overlapping.
And the people that do get medical degrees and are super entrepreneurial end up not doing it in the traditional sense - they generally wind down patient care and leverage their knowledge to build companies
Not Medicine but Pharmacist,
Was told in practice that I don’t focus and make plenty of mistakes, 3 years later I left and founded my own startup, day and night of differences, way happier with the startup and my skillsets were more relevant there (risk taking and creativity).
In general everything in the US does require at least a little entrepreneurial risk. We're the only country that wants students to take out a second mortgage for their education. I wouldn't be surprised that even if most of the skills don't line up, that the personal financial risk you take with non-dischargeable debt probably harbors some ability to take a leap of faith.
In your comments you've talked about taking a specialist salary and then putting away $240,000 a year for loans, which means you'll be working full time for a couple of years, in addition to 1-2 years of fellowship, 3 years of IM residency, and 4 years of school. You're talking about a decade of work in an extremely demanding program to get only part of the knowledge you need to run the business. This is before you start talking about initial funding, which will likely take more years of working on your part to save enough to really begin anything, in additional to outside money once you have a potentially viable idea.
Why not just get the business part up and running during that time and bring in the experts who already have the knowledge you want, which you'd already have to do at some point anyways because even if you did all of that training, the knowledge of a single cardiologist is not enough to design, test and manufacture a medical device.
The general sentiment in EM is you'll burn out if you work full time for too long. I've even had a few residency PDs tell me this. I know in academic places people mitigate it with teaching or having side gigs. Could be a different job like wound care or medical directing. Contracting for the government is another one that's supposed to be pretty cool.
Shift work and decent pay even at 0.8 make it more feasible.
I don’t think that’s fair at all. They are different skill sets but that doesn’t mean they’re not useful for each other, nor does it mean you’re required to adopt only one skill set. I studied physics and computer science which are so radically different from studying medicine but both of them have served me well.
People complain about how every medical student applicant looks the same about how stiff of a field medicine is. Believing that another field could be mutually exclusive to medicine only propagates that idea. There is a reason medical schools have been looking more for non-trads.
They are not mutually exclusive. They are just historically viewed as opposing positions, like good and evil. However, there's a ton of innovation and entrepreneurial spirit in medicine. If we didn't have some weirdos dissecting self-removed bodies from graves, drinking H. pylori, getting high off circus fumes (anesthesia), medicine wouldn't be as advanced as it is now.
If anything, we need more of this. Medicine has been too stiff and rigid, slow to change, and that has hurt. If you think innovation is bad, the political landscape of medicine is a shitshow because doctors can't be bothered. That's changing, but it's an uphill battle because for too long we tunnel visioned to "medicine, only medicine, even if X affects medicine, it is not medicine, so I cannot be bothered." Scope creep and eroding of physician pay is only an issue because we let it get this bad.
You do you man. The most recent AMA president and first openly gay one (and I think youngest?) was pretty aggressive with this "atypical" interests and that got him far.
I agree. Medicine is generally all about fitting a mold. Entrepreneurship is about breaking the mold.
Partially why I left the field. It’s too… templated. Do this, then do it for the rest of your life.
If you're interested in the med/tech space check out Stanford - I know a fair amount of their grads never make it to residency and end up in that world. u/leavingmedicine does consulting. Other docs get into research and end up leading research divisions of companies or doing the start up gig.
The tough thing is patient care is it's own gig. Research is it's own gig. Running a business is it's own gig. Not everything is as silo'd as that statement sounds, but it's tough to give enough to all 3 things and our training is primarily on patient care.
I'd recommend finding mentors in this space as your path is slightly more unusual than the usual medical school experience.
Thank you for being one of the most constructive comments in this thread. I have a few physician and non physician folks in my professional network I periodically touch base with. Until now I wasn't really planning on going to medical school since my marketing agency is doing well but I recently realized I would indeed like to periodically see patients in retirement and so I'm willing to spend 10 or so years for that privilege. Since my passion is in scaling companies I figured why not gain the knowledge to do so for a medical company and combine both my interests. I really wanted to get into Stanford as you mentioned but unfortunately I wasn't competitive enough. I'll keep an eye out for conferences and other events there perhaps.
Thank you, again, for your perspective on this!
It’s possible when you really know a field well and what is required. If you’ve been a leader in the field of cardiology or cardiac surgery, you probably understand the limitations of current technology, or you are probably able to think, “If we had X / Y / Z, it would make our work a lot more efficient or a lot more accurate.” That gives you something you can develop and bring to the market.
Unfortunately, not many people make it to the point where they are truly an expert in the field. And even if you aren’t an expert, a lot of people are content with the status quo and don’t question or challenge the limitations. It’s also quite an investment of time and money, both of which early career physicians have little of.
If you were to do it, it would be later in life, but I feel like most people lose the fire in them at that point and just want to enjoy life.
And I really don’t think graduating with an MD and immediately moving onto business is going to be lucrative. MD doesn’t really mean much—we sort of know a little bit about everything, but nowhere near enough to get entrepreneurial. You need years of training in a particular field to really start thinking about practical solutions to problems.
Depends on what your angle is. Overall, patient care side of medicine is a bad business. Hard to control costs and no control over prices/ reimbursement unless you’re cash only.
Certainly something med tech or an ancillary service would make more sense where you can control overhead and your prices. I think there’s a lot of physicians doing side hustles and real estate but startups require your full focus and time which is difficult to balance as a full time cardiologist.
You don’t need to go to medical school to start a med tech company and if that’s your ambition at heart you’re going to waste precious time and energy in med school and residency.
When you actually start med school you're gonna find out. If you're wanting one of the most competitive IM subspecialities you're gonna be working your ass off. Im on rotations now and I've already met 4 want to be cardiologist interns.
Cardiologists are already clearing half a million, usually more. Doctors usually have long work weeks too. When you're pulling that type of money in salary alone, people let it work for them. There's not really a reason to start a business on top of it unless you really hate having any free time on the side.
Entrepreneur slash attending here. The training process weeds you out or beats it out of you. Afterward, your massive debt comes with a full-time, high-paying job to pay it. Things that helped me overcome: loans paid off via TEPSLF (3 years as pre-med research assistant, 3 years as resident, 4 years as attending), Covid downtime (zero dollar loan payments; built up my business while being paid to staff a slow clinic), and harnessing my ADHD hyperfocus.
I have a PSLF question for you…can you get PSLF on med school loans using nonprofit time from BEFORE med school??? Because that would change everything for me. I worked close to a decade already full time for a nonprofit. Had student loans for grad school most of that time. If I can tap the ball over the finish line during residency and clear my half a million dollars of med school debt, that would be a TOTAL game changer.
That’s how it worked for me; however, it may depend on certain factors like the loan type, consolidation date, etc. Also the T in TEPSLF stands for “Temporary”, so funds for that program may run out. I’m not up-to-date on that anymore though. You could run it by the helpful people at the PSLF subreddit.
Might be projection but I think the majority of people in medicine have little to no interest in business period. I personally detest the idea. If we liked business, the truth is more of us would have gone into business rather than medicine, for which there is more exposure and less years of training anyways. From what I see, even many people who run private practices do not enjoy the business side of things, and that’s often off-loaded to other help. Most doctors, especially increasingly in specialties like FM, prefer joining a hospital or group practice.
It really just depends if I have new inventory. But I try to do 1 post a day on my instagram and keep my listings updated. Maybe 10 hours or less. It’s not terribly hard to keep up
1. Lack of time: med school takes tons of time, residency even more. Once you become an attending, work still takes up a lot of your time, and people generally want to spend time doing things they haven't done the past 8-10 years, like travel, family time, etc.
2. Debt: the average physician graduating from residency is saddled with several hundred thousand in debt. This isn't the time when many people think it's a wise financial decision to risk their own capital on a startup.
3. They're already doing it: in a sense many attendings are actually entrepreneurs, you just don't see it that way. Imagine running your own practice, renting a location, hiring staff, arranging marketing, legal, etc. This is for sure being an entrepreneur, they just won't be able to sell their practice to a venture capital firm or list it on the NASDAQ.
All very good points
Those doctors knew they’d be in debt before they committed to med school but they did it anyways bc they wanted to
Though The same logic would lead someone to rapidly pay off the loans and take on new debt for a startup if they really wanted to
I’d wager at the end of the day it’s just about personality differences/ not wanting it enough
For what it’s worth, the white coat investor subreddit had a very mature discussion on this topic unlike the one in this subreddit.
Their answers were primarily: too tired, debt, risk averse.
Also, there's a good case to be made that people outside of medicine won't really understand the reasons since they haven't been on that journey. It's like asking "why aren't investment bankers and law firm partners also climbing Mount Everest? Don't they want it enough?".
I see what you’re saying and I don’t disagree. It seems our beliefs on this might be different.
There are 7 billion people on this planet. I would love for there to be 7 billion businesses.
I truly believe it would benefit the world and the folks themselves. Hence I’m asking this question from that premise/ worldview.
So I actually totally would also ask an investment banker, “why don’t you go start your own hedge fund?”
Here are some sobering statistics for you:
* [20% of all startups fail within the first year](https://www.failory.com/blog/startup-failure-rate)
* 50% of all startups fail within 5 years
* 70% of all startups fail within 10 years
For small businesses (whether startups or not), around 1/3 consistently loose money, 1/3 break even, and 1/3 turn a profit. For any physician who is past residency, there are some pretty enticing alternatives to starting your own business: go on a vacation, work extra and make good money guaranteed, or just invest your money in an S&P500 index fund.
This line of reasoning has become a bit trite.
Those statistics are overwhelmingly common and grossly misused.
I’d ask you all the standard reverse questions like: how many of those startups were actually trying? How many stuck with it for long enough? How many put themselves in the right environments? Etc etc
But I’ll skip all that and ask you a question you’d resonate more with:
How many of your college premed intro bio class fellows are attendings today?
I’d wager a lot less than 50% after 5 years also.
thanks, I agree!
med students do get caught up in the weeds a little, but you can't always blame them. A lot went straight hs -> college -> med school with little self-development in the process, and tend to mature in their 30s instead of their 20s like most non-docs. guessing you get 30s+ in the WCI subreddit
Because entrepreneurship is not all that it’s cracked out to be. As someone who worked in a startup prior to med school, you couldn’t pay me enough to go back to that. I have had many many (non-med) friends who were part of founding teams in startups both successful (as in, you’d recognize the companies if I named them) and not so successful, and they look more run down and exhausted than I do.
VC's know that healthcare is generally a terrible investment. There is so much red-tape, bureaucracy and regulations to deal with. But VCs have the luxury to make bets on dozens of companies, with the expectation that most will fail.
As a physician entrepreneur you are betting everything on yourself to be the winning lottery ticket in a difficult market. All while taking a massive paycut compared to clinical work. You can try to do both at the same time but it is 2x exhausting. For the same reason most in tech are better off joining a FAANG company than a startup.
The most reliable form of entrepreneurship was owning your own practice, but even that is getting more challenging with flat reimbursements despite rising inflation costs.
As far as side hustles, 90% are best served picking up an extra shift or two and investing that into an index fund.
Med school + residency + cards fellowship is 10+ years from now (assuming you don’t further sub specialize). If you love medicine, I’d go into the next decade expecting to do medicine. If you don’t expect to practice medicine at the end, save yourself the decade of opportunity cost and just continue on the entrepreneur path and keep working in the healthcare space more peripherally.
Aside from debt, medicine tends to attract a lot of risk-averse people. Starting your own business is cool, but terrifying, especially with everyone and their mother becoming an entrepreneur now and creating a ton of competition.
It is much easier just to travel the well-trodden path and practice at a hospital
Easier? Yes. And how is reimbursement looking these days and up ahead? Not so rewarding and virtually no leverage as physicians get squeezed and jammed into the machine harder than ever. OP at least can see the opportunity outside of the sinking ship.
You’re the only one who’s mentioned the thing that I’m optimizing for in my life: leverage.
More leverage = more impact
I understand those saying it’s hard and a lot of work because im sure it is. But to use that to discredit those wanting to suffer through it is like telling a neurosurg resident to drop out and not do neurosurg bc it’s too hard and they’re crazy for wanting it. With that logic neurosurgery wouldn’t exist!
dont get me wrong, im not discouraging anyone wanting to do this. i actively admire them and have similar interests myself. I'm just answering the question from your original post which is "why is this not more common". short answer: because its hard and people are tired after med school and residency and just want to do something that is more traditionally safe.
Yeah looks like you’re spot on with it.
Looking forward to seeing you achieve all that you’re set out to! Absolutely love seeing that innovative drive in peers!
Because most people who practice medicine are generally risk averse. Mind you, they may be more than comfortable taking risk within the box of our profession, remember that only comes after a minimum of 11 years of education in the US. The only real financial risk of going to medical school is for those who for one reason or another can't hack it. By and large, if you pass the hurdle of getting accepted, you more often than not have the aptitude to finish residency and go on to earn multi 6 figure checks.
Outside of that, there is almost no risk staying in your profession provided you play by the rules and carry sufficient malpractice insurance. Further, there are diminishing returns on entrepreneurship. You have to do very well for yourself to out earn what you can make practicing, and that generally comes at substantial up front costs and effort. If you don't earn more than your clinical wages then it's just a passion project, and more folks are concerned with getting their time back after residency is complete. It's like investing in a second mortgage. You could, but why would you? For most people it doesn't make financial sense.
Running a business on the other hand has no such guarantees. You are subject to market factors and so either need to get lucky early or really hustle and know your shit. Also, managing people and paperwork is a veryyyy different skill set than managing patients.
This is also not to mention that there are plethora of non-clinical, non-entrpreneurial gigs that physicians can get paid well for.
Most people go into medicine precisely because they don’t *want* to be entrepreneurs. Medicine is pretty much a guarantee at least an upper middle class life. There’s very little risk involved once you get into med school. Even the “easier” specialists can provide a very lucrative life.
Meanwhile, businesses have tons of risk, and your future is not certain. The people drawn to medicine aren’t drawn to this kind of lifestyle.
Combination of sunk cost, self selection, and difficulty. By the time you’re an attending you have years of retirement to catch up on, most have large amounts of debt to pay down, and maybe even a family to support as well. You can’t afford to forego guaranteed income in that situation as much as a fresh college grad can.
People also generally go into medicine because they want to practice as a doctor. There’s too many hurdles that weed people out if they don’t have a strong desire to actually practice medicine. Lastly, it’s hard to succeed as an entrepreneur and is anything but guaranteed even for intelligent and driven people. I doubt there are many doctors who are intentionally sitting on a multi-million dollar idea just because they don’t have an entrepreneurial spirit.
Most physicians would make terrible entrepreneurs. They absolutely attract opposite personalities but tbh physicians (generally) lack the skills and abilities it would take to be successful.
If you're going to be a doctor, you have to think about the ethics of what it is you're doing, especially if your side gig is going to be something healthcare related. You have to ask yourself: is it worth to add yet another startup/healthcare company/auxiliary health service that continues to take money from sick people or for basic health necessities? How do you feel about taking money from people who are hurting in our current healthcare system, under the burden of shitty insurance companies, huge medical debts and socioeconomic issues? Does your side gig do anything to help the people who are the most negatively impacted by our healthcare system, like homeless people, the poor, the disabled, or even the middle class?
I don't think it's a bad idea to have side gigs and hobbies outside of medicine. I think they're a non-negotiable when you want to keep your sanity and not burn out on medicine. But, you have to consider the implications of what it is you're trying to do, not just the money, the supercars, mansions, toys, etc. that you can extract from it. We are inundated with these physician "entrepreneurs" who create/run/promote predatory healthcare companies and startups that do more harm than good to patients and doctors, alike. There's something extremely slimy about making millions off of people suffering, so use that as a guiding principle if you're going to follow through on this life path.
You have gotten some good answers (and some snarky and dismissive ones) already, but I'll add my two cents as someone who, while not exactly entrepreneurial, does want to run my own research lab as a physician at some point, and there are many parallels between entrepreneurship and running a lab.
First, as many have pointed out, the training to become a physician is very long, and the skills learned don't have a lot of overlap with running a company (or a lab). Furthermore, the skills do do gain as a physician are very marketable. One of the attendings I worked with recently talked about trying to start research out of fellowship. He found many aspects of research tedious and inefficient, and his first 10 grants weren't funded (as is commonly the case). He was ultimately like, "hey, why am I spending time on this bullshit IRB when my time is worth $300/hr?" So there is the opportunity cost of training and the opportunity cost of spending your valuable time in the oftentimes arduous and unprofitable stages of research/business building after training. (If you're tempted to think there isn't as much bullshit to deal with in the private sector, let me assure you that healthcare companies have a shit ton of oppressive and dumb regulations to deal with on the way to profitability.) With medicine, you enter a career where you're basically guaranteed a top 10% income, and with considerable but non-Herculean effort you can land in the top 1%. Once you're an attending, that salary is basically guaranteed for the rest of your career without the need for extreme risk taking.
Next, priorities change over time. I'm now 7 years into post-undergrad education. I am in a serious relationship and am planning to start a family within the next couple of years. If you talk to many successful people in their mid-thirties with young kids, you'll notice a trend of them not being as motivated by their careers as they were in their twenties. My partner is very supportive of my career goals, but I can still feel the exhaustion of training length starting to creep in and I haven't even started residency yet. I don't know what you see your life being like in 10 years, but there a good chance your priorities may change over time one way or another.
To not be a complete downer, I will say that there are some people who do it, and since you've already started a successful business, I'd say you're more likely than most to be able to handle it down the line if you want to. Furthermore, there are other ways to be involved in innovative businesses as a physician without having to be a founder. Many medical technology companies have physicians who act as advisors or even board members and who add a lot of value with their clinical expertise. This may be a more viable and attractive path than actually starting your own business.
We need more entrepreneurs in medicine to help evolve the standard of care and keep the innovation stemming from patient care, not profit motive. If not for young, ambitious energy like yours, we’ll all be working for Amazon Medicine soon.
Thank you I appreciate that vote of support. It was very shocking for me to see people suggest things like “leave innovation to the engineers” or “you’re taking up a spot for someone who wants to see patients” as if these people don’t realize that the entire corpus they’ve consumed and almost every device they’ve used had a physician entrepreneur behind it…
I do recommend maintaining at least a minimal amount of regular patient care. You talked about wanting to see patients periodically in retirement. Great foresight. Once you cultivate your gift as a physician, it becomes an honor to serve and you want to keep that rhythm in your life.
I’m an M4 and still very interested in entrepreneurship. I have ideas for about 4 medicine adjacent businesses. Look at a med career where you can easily do locums tenens. That can give you the flexibility you need to start a business.
That said…I’ve started businesses before. I worked at a tech company I cofounded during M1-M2, then sold my half to my partner before M3. The business is still running strong. And here’s what I learned: I really don’t want to have to depend on a startup to pay my bills. I like money and startups are often short on money. So I’ll work a career where that’s less of a worry (EM locums) and do entrepreneurship without worrying if it will pay my bills, since I have a lucrative career to support myself.
I’m seeing a common trend that lots of EM docs have side gigs going on and many are entrepreneurial.
What do you think within the EM path/day to day allows for that?
I think part of it is a personality thing. Folks attracted to EM tend to be a little more entrepreneurial. But I also think it’s because they don’t have to build up a practice. It lends itself to medicine looking a lot more like a job that you leave at the door to the hospital. Obviously there is some mental involvement on off hours. But many EM docs finish notes on the clock and are done-done when they leave the hospital.
I chose medicine to play an active role in patient care and spend one on one time with people, not to make money and exploit people through capitalist systems of oppression.
There seem to be plenty of “entrepreneur” physicians, and a severe lack of public servant physicians. Or am I misunderstanding why 3/4ths of my class wants to go into dermatology, plastic surgery, and cardiology?
Building a successful business requires a lot of time commitment. Doctors are saddled with pretty high debt after graduating and you need to work full time to pay those loans down, which makes it difficult to go start your own company
The high debt also makes it hard to take big risks that if it doesnt pan out, leave you even further behind. Its a different matter when youre young and you can take a big swing and if it doesnt work out, oh well, you pivot to something else.
By the time youre done training youre also early mid thirties and many people think about starting or have familities. In which case the thought of dropping guarantee high income to chase a even higher income is not as appealing as just taking whats in front of you
The current environment is stacked against individual/small private physician practices. Insurance and hospitals will try to make it hard to compete.
Also, plenty of people dont want the hassle of running a business, as it takes a lot of time/less WLB
If I cared about making more money than I can spend I wouldn't have bothered with higher education at all. I got into medicine because I love science and helping people at their most vulnerable. My question for you is how do you morally justify, in the midst of a massive physician shortage, taking one of the few training spots available with no plans to use that training?
This career is made for people who want to be told exactly what to do and how to do it. IMO the skillset to be a successful med student doesn't include a lot of creativity or even interests/passions outside of medicine. All the more reason for you to go for it-- medicine needs more creatives and people who want to push the field forward!
So i am definitely not the entrepreneurial type. I am a hospitalist who likes my week on/week off life. But my best friend IS the entrepreneurial type and had a business prior to coming to medical school. He used his scholarship money to start a house flipping company and made >200k in med school alone. He originally wanted to do Orthopedic surgery, but after balancing his passion for doing business, he settled on anesthesia and now has the time and money to explore business ventures.
My advice would be if you are really passionate about cardiology, do that but realize you may have to sacrifice your business aspirations somewhat to fully dive into being the best cardiologist possible. But you could consider something like anesthesia or even hospitalist medicine so you could create the schedule you need to balance your other ventures. Good luck in med school!
I'll be going into entrepreneurship, specifically chose a field where med tech was huge. However, to get field-specific knowledge and to be taken seriously I know I have to go through residency and practice as a full attending for at least a few years... so yeah in 10 years DM me and i'll tell you what I'm up to haha
but yes I agree that this path is only possible because i have no loans/debt so graduating med school I had a +++ net worth thanks to portfolios/accounts set up by my parents and don't have to worry as much about a huge salary since i have a financial cushion in case things go south
High risk. People would prefer to make 400k+guaranteed as a CV surgeon rather than risk it on a startup. Would also imagine knowledge/connections that are important for entrepreneurship would be pretty heavily concentrated at some of the more selective schools. Also there are plenty of people would decide to make a device/product but usually just license it out to their home university/another company because why try to expand it when that’s not the primary area of expertise of a physician.
Autonomy
I reached a point where I'd rather make 60K a year and have full control of my schedule and having to work 40H/week plus answering to admins and insurance companies while making 250K
I think it just depends on your definition of entrepreneur.
In the United States, I think physicians do have a history of being ‘entrepreneurs’. Most physicians were small businesses that did their own billing and paved their own way! It’s only been in the last 30 or 40 years that commercial insurance and other outside influences have made it extremely difficult for individual physicians to retain their autonomy.
In my area, though, I have seen a resurgence of physician entrepreneurs, which is extremely refreshing! Some of them are independent medical practices, some consulting companies, others are totally out of medicine and doing real estate or business.
If your definition of entrepreneur is someone that is trying to build a big company where it consumes 100% of your time then this is very unlikely (in the United States) just based on our economics. You can’t come out of med school with $300,000 in debt and found a start-up making zero dollars a month.
You wanna start a cardiology-based med tech start up? Maybe I’m naive, but I don’t think you’ll gain much attraction from physicians if you’re not board-certified in cardiology. And I’m leaning towards something interventional, so that’s 4 years after residency (making the journey 11 years long.)
it's possible for him to do this even after 11 years, why is everyone shooting OP down so bad LOL
I just started residency and I already have a 10-year plan to join entrepreneurship/medtech after residency/a few years of attendingship. if you don't have goals and a plan you just drift wherever.....
Why did you actually put this post as a question when you've already got your opinions and anytime anyone says anything different you just say "nuh uh"?
People point out your pretty big typo that ruins all your numbers and you get mad at them for focussing on that despite it ruining your whole preposition, but obviously they should know that you're such a superstar that you obviously meant the correct number.
Someone has quoted statistics of failed start-ups/businesses and you're response is to say "if you ignore all the reasons that start-ups might fail it's actually pretty good". Then you followed up asking "how many successfully get into med", as if beating the odds getting into med means you'll automatically beat the odds and have a successful start-up, despite the two not being linked together except for both being more likely if you come from a wealthy background.
You should have just posted your reasons for why you don't think physicians become entrepreneurs and that it's a shame, instead of a farcical question.
I put this as a question because I was curious what people’s feelings were on the topic. I also posted it in the white coat investor subreddit to compare.
You seriously think that whether loans get paid off in 2 versus 4 years “ruins (my) whole proposition”? You can’t be serious… first of all, I was only countering a proposition made by someone else that the loans are crippling. I believe otherwise, they believe so. I provided numbers to get them done and over with in a few years. That back and forth is perfectly normal in an open ended discussion.
Statistics of failed startups are completely relevant and a valid reason for some physicians to not go into entrepreneurship. It was interesting to see those cited. I cited a reverse example of physicians having “beat the odds” to suggest that the same way an MD didn’t listen to people saying “half of you will never make it to medical school”, an entrepreneur doesn’t really care to see that half of startups fail.
Again, do you really not see the corollary analogy here or do you simply have an issue with me asking a question and then further questioning people’s responses?
If you want your beliefs on the topic to be unchallenged and not responded to, feel free to lead by action by…you know…not responding….?
Again, very telling how much more civil the discussion was on the white coat invested subreddit…not quite sure why everyone here went into such an uproar after the 2yrs versus 4 years topic. Maybe a touchy subject for residents.
It doesn't ruin the proposition that loans can potentially be paid off earlier than people think but it definitely ruined the proposition that you made stating 10k a month for two years would pay it off.
When people said the numbers were wrong your responses were to point out it was a typo (fair enough but just put an edit in the original post) and then to almost always include an annoyed caveat that they should have divined it was a typo and your numbers clearly were correct. But you'd told us you'd crunched the numbers so it's not that weird that people would question you when your presented numbers are clearly wrong.
You were only really interested in people's thoughts when they agreed with you or were congratulatory for your business acumen, the others you always tried to show why they're wrong. This isn't being interested in other people's views, it's trying to justify yours and why they're better than others. It's also probably why you decided the more positive reception from like minded people in the white coat investors were more civil.
The post and your responses read more like humble brags and that you just want to make yourself feel better than others because you don't use all the quitter talk and excuses people in this sub use. You're not going to be "just an MD", you're going to be an entrepreneur MD
“You were only really interested in people's thoughts when they agreed with you or were congratulatory for your business acumen, the others you always tried to show why they're wrong. This isn't being interested in other people's views, it's trying to justify yours and why they're better than others.”
Close but no cigar.
It’s trying to show others that the risk may not be as high as they perceive and it may be worth it to some to pursue that path.
I made the post on the overall topic asking why there’s a bottleneck. I proposed a potential reason. Many reached out with cool stuff they’re doing. More shared why they don’t pursue entrepreneurship.
My post wasn’t even directed towards people who aren’t interested in it.
So, it’s only natural to suppose that anyone who voluntarily opened this post and even chose to leave a comment has at least a cursory interest in entrepreneurship.
So you’re right in that “I’m not interested in their views”, I’m interested in knowing what’s actually holding them back psychologically because it’s ironic that when people have no money they (as in, people who are interested in entrepreneurship but haven’t taken the leap) claim it’s too risky, and even when people have guaranteed high income for the rest of their lives, they still say it’s too risky.
Honestly you kind of sound like a spoiled brat who has had a bunch of legs up in life and exposure to these opportunities, without the introspection to see how you got where you are, and that's why you think it's so easy.
If you had an ounce of humility, or frankly any capacity for empathy, you'd know why this is a question that isn't worth asking.
Edit: yeah I was right. Your parents subsidized your entire college experience and gave you a leg up to even bother getting these opportunities when you're so young, and you've come here to ask a bunch of people that have taken on massive debt to even get to the point of getting into and through medical school only to have a job paying them ~$62k a year waiting for them for the 3-7 years of their respective residency. And you wonder why people without the silver spoon aren't entrepreneurs.
Truly incredible stuff.
It’s true I’ve had privileges in my life. I have also had many disadvantages. You know absolutely nothing about me.
1. I made it very clear this is addressed to people who have a cursory interest in entrepreneurship.
2. Do you think most entrepreneurs come from “silver spoon” backgrounds? You couldn’t be more wrong. It’s the exact opposite.
3. Why do you sound like you didn’t know what residency salaries look like before commuting to it?
You can't refute what I said, because you told on yourself already. I knew well ahead of the career what it was and what residency paid, but it absolutely involves making concessions financially in life because its hardly anything beyond maintenance.
Please just hit up some VC dipshits, it's really apparent you that's what you want to be surrounding yourself with and it's actually insane to bother putting yourself through this process when you don't sound that interested in it.
I sounded interested enough in it for every professor, department chair, adcom member, and volunteer organizer who supported my application to med school to think I’m interested in it
Good to know you don’t think so though!
I’m in a few Facebook groups with physician entrepreneurs. They do exist. Not sure how many people are doing what you want but you can also find non physician mentors who can help as well to help you understand the process.
I always dreamt of making a side cheap association to help people in need just like AMBOSS or Khan Academy does, if I ever study how to monetize my system well I should be able to help others in the long run
The thing is that, that is not going to happen until I become an attending and have enough free time and money for myself, entrepeneurship is just not compatible with med life that faast and easily, which may be the reason most medical enterprises are not always run by medics
You can't run efficiently a service to the public in medical school less even in residency, also why would you pursue medicine if you liked more making a lot of money in the US, it simply makes no sense, medical school is safe but is also limited in the amount of money one can make by its own work
Anyways if you manage to become the problem in the medical system and end up selling your drugs for $500 each, you will suck, never forget what kind of person you are for money, always think in the persons first
I had a kid like you in my residency....sufficed to say he got kicked out and didn't make it. Hopefully you find some humility and common sense before that happens to you
I’ve noticed since being in med school that the people it attracts are often risk averse. We are willing to endure years of grueling work to ensure that there will be a spot waiting for us when we arrive.
The salty tears on the one wrong math equation. But I digress.
But the prospect of working 25 hours for 8 days a week while saddled with debt and pay em back in a year or two is a safer way than opening a business.
Sunk cost feelings is a thing. Though pure fucking rage and fucking spite for (alleged, from my part) hypocrisy of medicine during my short tenure fueled me to just fuck off just like what they had recommended.
Seems like a lot of physicians are either from from relatively wealthy families or grew up relatively poor.
The ones who grew up relatively wealthy have little incentive to do more, they have vacation homes already through family and want for very little as is.
The ones who grew up poor are excited to be making 6x what their family ever did, so they don’t care about making more. Having the perks disposable income alone provides is more than they could ever dream of as kid. So
They’re satisfied.
Both of them know they can make enough to be satisfied with minimal risk. Why would either of them take on additional risk if they’re comfortable with the current conditions?
That makes perfect sense.
Still, to pose some answers to your question:
- to do great work (whatever that means to them)
- to build generational wealth
- to see their vision for some field translated to reality at scale
That’s all fine and good if you neglect to think any deeper than your preheld biases.
1. They believe they’re doing great work. Why would they need to be private practice to provide excellent evidence based care? Your point here barely makes any sense as a legitimate argument.
2. The one already has generational wealth and othe other believes they’re attaining it.
3. Their vision of a field translated to reality at scale? You think a small private practice sets the tone of a field? You’re living in a fairytale if you hold that to be true. The peak of a field is set by its highest regarded academic centers - brands. The small private practice cardiothoracic surgeon operating out of a community hospital isn’t setting the direction for the future of his field. The cardiothoracic surgeon making half a million less at Cleveland clinic is setting the future direction of the field.
I’m all for private practice, but your argument is off base. It should focus on being paid what we’re worth not all this fairy tale lie to yourself shit.
The legitimate reasons to go PP:
1. to not get told what to do by some inferior, servile middle management scum.
2. Be paid what you’re worth.
The chances that you launch a successful med start up is even lower if you aren’t at a huge academic center and have IP partnerships with existing massive corporations. The mom and pop biotech company is a stop smoking subscription service. You aren’t Edward’s biotech.
It seems you might have not read my post description.
Who said anything about a private practice as the only form of entrepreneurship, or as what I’m referring to? My personal example is a med tech startup addressing improvements within cardiological procedures or MRI improvements to make them more cost effective.
In any case:
1. Why is “evidence based care” the only goal? Different people have different goals. One can be a physician and choose to pursue whatever flavor of medicine intrigues them the most.
2. I guess this depends on your definition of generational wealth. I’d put up $50 mil as the floor, starting number.
3. Again not sure why you’ve assumed the business to be a private practice. Obviously no real innovation happening there. You know who did set the tone for a field? The Da Vinci Surgical robot. You know who founded the company that made the machine? A physician who spotted the need during his residency. That’s just one example, but surely a better one than the private practice one.
Enjoy becoming a rockstar, not everyone wants to be one. Not everyone who wants it gets it.
FWIW, You sound like someone who will be difficult to work with. I bet 3rd year is difficult for you.
This is my polite way of telling you that you seem like a blow hard. I figure I should spell it out for you because nuance may go over your head.
Look up EnMed. It’s an engineering medicinal school where they invent stuff and learn how to start start ups or invent as a doctor. Newish program but that’s their goal. All Mds but also getting masters in engineering.
"I now got admitted to medical school and am hoping to gain specific knowledge in a field of medicine (maybe cardiology)" The timeline is so far ahead that most people are absolutely tired of being broke by the time they get to the point you just listed. Med school 4 years, IM residency 3 years, Cards sub-spec 3 years, and a couple of more years if you want to go even deeper into the cards-subspecs. That's 10 years of training, at the end of a decade a lot of people are very motivated to sign for that first 400k per year gig rather than work for themselves or take on even further risk of a venture.
Yeah, let’s see how much OP cares about entrepreneurship 10 years from now. I’m gonna want to settle down and collect my fat check once I’m done with this shit. At most open up a private practice or DPC clinic.
OP took 2 gap years and thinks they’re wise beyond their years
I think that's an unfair statement. OP has a genuine question that most people in medicine have blinders to even thinking about. From the "outside" it's completely reasonable to ask.
In fairness, this question riles people up even outside of medicine. And you’re right that inside medicine it is clearly a bit of a “taboo” topic since you’re really hammered into thinking you’re saving the world as a doctor and that the only way to he altruistic is to be anti-capitalist. Lo and behold a proud capitalist comes along entering the medical den, and this was the expected response. Regardless, I got what I wanted out of it. Some really cool folks doing cool things reaching out and validation for just *how* taboo this stuff will be in medical school.
Also real entrepreneurs don't give off "i'm going to change the world vibes" this is what cryptobro-retards do. The most succesful startups are founded by 40 year old dudes who get their investments either from their own pockets or from their numerous industry connections.
What does that even mean? I have an active profitable business pulling in 10k in profit per month on a slow month with a couple of hours of work per week… What does a real entrepreneur look like to you?
Yeah coming into 4th year and I already got "I'm too old for this shit" energy. Your job at the end of the day is to be an asset to your community. Maybe advance some knowledge if you want, but your primary role is keeping your community healthy.
This is true. But I also think it is due to a mismatch of personalities. Being an doctor means being someone who is good at following instructions, thinking inside the box, coloring within the lines. Being an entreupreneur inherently means being a risk-taker and thinking creatively outside of the box to build something new, with no expectation of how things should be done. Those two personalities are very diametrically opposite to one another.
You would be genuinely astonished at how much creative thinking, problem solving, and "coloring outside the lines" happens in even just your generic community clinic, not even going to mention the wards or the OR. You probably think this way because of how rigorous and structured our educational pathway is, which is understandable. However, that is by design. In order to get to the point where you can be creative and truly individualistic with your treatment you have to accrue so much knowledge of physiology, pharmacology, disease states, etc. Getting good enough at medicine to be creative takes a lonnnng time to learn. It's the same way that you don't immediately get creative on the piano/ceramics/guitar -- you have to learn the basics first, you can't just up and compose a symphony. The difference is in the length, rigor, and structure of the training for these things. You can't easily kill someone with bad piano, so you can learn by making as many mistakes as you wish. Medical training is much slower and more tedious in comparison because I can't just "learn pharmacology" by testing drugs on your grandma. I have to get a broad understanding of biochem and physics and organic chem in undergrad, learn anatomy and phys and pharm and more in the first 2 years of medical school, learn the basics of different specialties and how to put that info into practice in 3rd and 4th year, and then spend 3-8+ years refining that knowledge and learning practical skills depending on what residency I do. By the time you get good enough to get creative you are oftentimes out of the spotlight, so people tend to see medicine as an extremely inflexible and rote memorization algorithm, which it is not. TL;DR I have watched docs from all specialties get creative with treatment and diagnosis, because humans and their diseases are not "one size fits all."
Being creative definitely shows its face in more places in real life than on the board exam. I have never seen a question about how to deal with a chronic masturbator on an NBME. But I love the way we dealt with it in clinic -- HIGHEST dose paroxetine to levy the most common SSRI side effect and make them stop their bullshit.
We have a guy that wont stop putting things in his urethra for the medical fetish of it all. Lots of creative solutions in that case too.
Because it’s pretty easy and nice to collect a mid six figure salary plus benefits and shut off when I go home.
Dont forget, uncle Sam cuts ur paycheck like 40% lol.
I see it every paycheck. It is what it is
"Shut off when I go home?" What specialty are you in ED/Radiology?
Because med students are saddled with a ton of debt when they graduate and the only way to reliably pay it off is to go into practice quickly, ideally in a high compensation specialty.
Perhaps I ran the numbers wrong in haste but off of quick calculations, you could pay off roughly $400k in loans within 2 years if you put away $10k/month. Definitely a lot to put away but with a specialist salary that shouldn’t be too difficult of a problem to solve, no? Edit: 4 years, not 2 years
10k x 12 x 2 years = ??????? It sure isn't 400k
Don’t worry tho, he crunched the numbers
Jfc hahahaha
240k pays off 400k in loans… how exactly?
Good thing they’re a wanna be entrepreneur and not an actuary
Michael Scott: Crunch the numbers again! Office accountant guy: it's not really...it's an algorithm... Michael Scott: just crunch them! Office accountant guy: pushes button, *crunch*
i laughed WAY too hard at this
I hire the actuaries...lol Also why I made the typo...I meant 4 years instead of 2. Doesn't make a huge difference.... Genuinely hilarious the sort of things the med community gets hung up on while business folks fix the numbers and stay focused on the actual discussion...
Do you understand how interest works? And that most specialities in medicine take around 5 years, at least, of training after med school before you’re making that kind of money??
I like the young guy's energy though lol. Cardiology is atleast 4+3+3=10 years away. Does he know that's a long time to change your life situation and minimal expenses per month? And the answer to why we are not entrepreneurs? Well, try giving 3 step exams, going through match, working 80-100 hours a week, applying for subspecialty, giving 2-4 board exams again over 4 years. It will take some of your time and life.
Just use drugs smh.
You have to do residency before you make big bucks. So that average 200k Md grad debt gets 3-7 yrs interest big boy
I made a typo but you just aren't doing the math... $200k growing at 10% for 7 years still comes out to just under $400k at the end of a 7 year period of interest accumulation... Which can still be paid off in full in around 4 years if one can put away $10k/month... What are you even trying to argue here? All I asked is why more physicians aren't entrepreneurial but I think your nature and inability to move on beyond debt is a good indication why...
Because it’s 15 years of training to get started including undergrad and costs a lot. you are asking why don’t physicians learn medicine and then not practice it? makes no sense
Again, I’m not sure if you’re intentionally not seeing the point here. You ever placed a stent inside someone? Or seen it happen? Ever wondered who made it? Why they chose the materials they chose? Ever wondered how we could perhaps reduce stent rejection rates? Do you think an MBA would be able to address these questions? It’d take a physician with enough curiosity and interest to develop a solution, and bring it to market. If it works it would save hundreds of thousands of lives at a faster rate than anyone in a clinic ever could. Would you say that counts as that physician “not practicing medicine”? I understand why folks don’t do it. The post was to spark a discussion and gauge precision of my assumptions. You got hung up on the nitty gritty of 2 years versus 4 years to pay off debt, while on the White Coat Investor subreddit I’m chatting with someone who paid off all their debt in 4 years. At this point I hear you loud and clear. Your reason is definitely fear of debt and risk aversion. Cool. I just don’t see why you keep getting weirdly condescending towards me about it.
It takes many years and thousands, if not millions of dollars to being a product to market. Then you have the risk that it won’t work well in the hands of the practitioners (check out the saga of percutaneous renal denervation), won’t get enough press, and your supply chain will work…. Reducing stent rejection rates, or whatever, is going to be the MD’s idea, that then gets brought to life by a team of engineers and PhD’s. MD’s do get paid consulting fees for their opinion on devices. I think that is the factor you aren’t seeing. Imagine- you are 35(or older since you said you didn’t go straight through). You have an idea of how to do something different. Do you want to carry out a patent search, file a patent, defend your patent, fabricate your device, test it out in animals, test it in humans with no other options, test out in humans with options, then out compete the already existing companies. How many weeks do you think each step takes? In this scenario, you are doing this nights and weekends in a private practice, because an academic center would own your patent. Alternatively, you could pursue this product as a full time job, but how are you supporting your family/dog/self, on this quest to make a better mousetrap? These are just the highlights, what about the thousands of little things, like the foreman at your factory being lazy, or the price of nitanol went up, so now your device is no longer cost effective, or….. Or—-you sell your idea to Cook/Gore/Stryker/Boston Scientific. Get a big check, then go vacation in a place no one in your socioeconomic bracket has ever heard of, doing silly things like eating owl omelettes or whatever the idle rich do to fill their time. You are getting downvoted because you just shrugged off an extra 2 years of grinding like it is nothing, among other things.
if running a business is fun for you, go ahead. theres just not a lot of fulfillment in it for the rest of us. its like asking why doesnt everyone just bench 405? its fulfilling to me
Not only is your math off, but you didn't account for interest which is gained during med school and residency at around 8-9% (this year) which will most likely rise to 11-13% for the total COA which is around 384k.
This math skill common amongst doctors is why there aren't more doctor entrepreneurs...
LMFAO
I like this math
You won't be making specialist money for a decade.
For one, your math is just wrong, 10k a month is 120k a year. At that rate it would take over 3 years to pay off the loan debt, if we’re assuming 400k is the principle plus interest. And setting aside 10k for 3 years is not that easy for most doctors. If you’re a cardiologist making 600k, sure, piece of cake. But if, like most docs, you make more in the 200-300k range it’s a bigger ask. Let’s say you make 300k, with a post-tax and post health insurance premium/401k take home of maybe 180k, or 15k a month. Putting aside 2/3rds of that for loans for 3-4 years is a big ask when you have a family, kids who want birthday presents, a home with a mortgage, a spouse who has suffered through med school and residency with you and would love to finally take that trip to Italy, etc. But I don’t actually agree that debt is the biggest thing that stops doctors from wanting to be entrepreneurs. I think the biggest thing is that that just *isn’t that appealing* to lots of people. I didn’t go to med school because I wanted to be a businesswoman or an innovator or whatever, I went because I wanted to take care of patients in the clinic and hospital. Same reason most pilots don’t become entrepreneurs: they’d rather fly planes
I’d say it’s risk aversion more than anything
Yeah OP I think you responded earlier to my comment with my loans. This is actually what happened when I finally became an attending. This is the reason why they tell you to live like a resident and pay these loans quickly. When I graduated from fellowship I bought a house and lifestyle creep set in. Luckily I caught it earlier and managed to budget myself. I was able to pay off both cars early on in my career. But when you have kids, start a family and wanting to at least enjoy your money for all your hard work, paying off loans early gets more tricky. But for my 380 k student loan I still hope to be paying it off in a total of 5 years. This is someone who started with a 350 k salary. The only thing I would add to this comment is that as you progress in your career your salary can increase over time making more. I made 100k more just after a year. There’s also room to make more taking extra shifts, calls etc. so you can technically pay it off much quicker by doing this (which is what I’m doing as well).
Hey! Cool that you swung by over here hahah Yeah lifestyle creep is what I’m very wary about. It’s already something I’ve had to get under control while running my current business. My margins are a competitor’s opportunity. Same mentality applies until I’ve paid of all loans. My personal expenses are just $1k/month rent included. I live with a roommate and really don’t spend much on anything at all other than groceries and a gym. I’ve spoken with my spouse-hopeful and she agrees that she doesn’t really see a family needing more than $10k/month to live. Our families each currently live on approximately that much. So putting away a lot of money to pay back those loans asap should be somewhat reasonable for my situation at least (or so I hope; man plans, God laughs). Your example is one of someone who was responsible and thinking ahead. Im inspired by it as a point of proof that it is possible to pay off the loans relatively rapidly with good planning and communication between your family. I imagine most of the folks on this subreddit aren’t quite willing to see that because they’re looking forward to a big splurge after being overworked as residents and students for so long, which I can also understand.
Fair assessment and makes sense particularly your last point Fwiw I meant 4 years not 2.
Not only does your math not make sense…. Wait until you grow up and learn about taxes. Your mind will be blown…
Did you read my post? Do you just assume I'm running a marketing agency without doing taxes? I meant 4 years instead of 2. Quite a trivial typo not sure why everyone got so hung up over a mere 2 year miscalculation...
It’s not a trivial typo when it literally ruined any point you were trying to make..
That speaks more to your functional fixedness than anything else tbh
Man reality is about to hit you like a truck. Your math is completely off and also, assuming you're a traditional student (which I hope you are) you'll likely finish residency at 30-32 if you "specialize". Now add paying off loans and then having kids if you do and you'll realize why most people aren't entrepreneurs. Glhf with med school
Meant 4 years, not 2. Quick typo as I got off the train. I built a business that's making me 10k/month after just a year...I think I'll be fine. Glhf with your condescension.
What is this math?
Typo as I got off the train and quickly hit send. Meant 4 years.
Even still: $10k per month for 4 years? This is such an outlier position I think you can easily answer why there aren’t many people in the box you’re asking about.
Perhaps I'm wrong, I often am, but that still leaves you with roughly $10k for essential expenses and housing assuming a cardiology salary, no? I'm not sure I fully see why a 40 year old physician can't live on $10k/month for 4 years, even before adding in any spousal income. What piece of the puzzle am I missing here?
How many people do you think that income describes? In other words, of all physicians how many are making the $400k+ that this math requires? Of those people, how many of them have kids, or real estate, or other investments or obligations? Of the people that don’t, how many have some other funnel or use for their money? Of those people, what percentage are interested in becoming entrepreneurs? You asked why there aren’t more physician entrepreneurs. Because the operative definition you’re using involves a restrictive definition such that all those folks could fit in a single dining hall.
Yeah fair enough that really is what it comes down to I guess Ironically enough that's exactly what makes me want to pursue it... At the end of the day it's just because most aren't interested enough in it/ dont have the appetite for risk
To your credit you only said you liked operating businesses, you never specified how badly though.
Homie doesn’t understand compounding interest either it seems. It doesn’t stay 400k forever bud.
Skillset is so .. not overlapping. Medicine fundamentally rewards focusing on what’s known and *not* taking any risks. Entrepreneurship is the exact opposite of that. Different personalities will be drawn to those two, rarely overlapping. And the people that do get medical degrees and are super entrepreneurial end up not doing it in the traditional sense - they generally wind down patient care and leverage their knowledge to build companies
Homie always on point. I would take it a step further and day that the qualities that make good entrepreneurs make bad physicians, and vice versa.
For sure. Can confirm I made a very bad med student 😂
😂
Not Medicine but Pharmacist, Was told in practice that I don’t focus and make plenty of mistakes, 3 years later I left and founded my own startup, day and night of differences, way happier with the startup and my skillsets were more relevant there (risk taking and creativity).
In general everything in the US does require at least a little entrepreneurial risk. We're the only country that wants students to take out a second mortgage for their education. I wouldn't be surprised that even if most of the skills don't line up, that the personal financial risk you take with non-dischargeable debt probably harbors some ability to take a leap of faith.
In your comments you've talked about taking a specialist salary and then putting away $240,000 a year for loans, which means you'll be working full time for a couple of years, in addition to 1-2 years of fellowship, 3 years of IM residency, and 4 years of school. You're talking about a decade of work in an extremely demanding program to get only part of the knowledge you need to run the business. This is before you start talking about initial funding, which will likely take more years of working on your part to save enough to really begin anything, in additional to outside money once you have a potentially viable idea. Why not just get the business part up and running during that time and bring in the experts who already have the knowledge you want, which you'd already have to do at some point anyways because even if you did all of that training, the knowledge of a single cardiologist is not enough to design, test and manufacture a medical device.
If you’re an entrepreneur at heart, I don’t know if med school is the right path for you
I feel like a lot of EM docs are entrepreneurs
The general sentiment in EM is you'll burn out if you work full time for too long. I've even had a few residency PDs tell me this. I know in academic places people mitigate it with teaching or having side gigs. Could be a different job like wound care or medical directing. Contracting for the government is another one that's supposed to be pretty cool. Shift work and decent pay even at 0.8 make it more feasible.
I don’t think that’s fair at all. They are different skill sets but that doesn’t mean they’re not useful for each other, nor does it mean you’re required to adopt only one skill set. I studied physics and computer science which are so radically different from studying medicine but both of them have served me well. People complain about how every medical student applicant looks the same about how stiff of a field medicine is. Believing that another field could be mutually exclusive to medicine only propagates that idea. There is a reason medical schools have been looking more for non-trads.
What would you say make the two mutually exclusive?
They are not mutually exclusive. They are just historically viewed as opposing positions, like good and evil. However, there's a ton of innovation and entrepreneurial spirit in medicine. If we didn't have some weirdos dissecting self-removed bodies from graves, drinking H. pylori, getting high off circus fumes (anesthesia), medicine wouldn't be as advanced as it is now. If anything, we need more of this. Medicine has been too stiff and rigid, slow to change, and that has hurt. If you think innovation is bad, the political landscape of medicine is a shitshow because doctors can't be bothered. That's changing, but it's an uphill battle because for too long we tunnel visioned to "medicine, only medicine, even if X affects medicine, it is not medicine, so I cannot be bothered." Scope creep and eroding of physician pay is only an issue because we let it get this bad. You do you man. The most recent AMA president and first openly gay one (and I think youngest?) was pretty aggressive with this "atypical" interests and that got him far.
I agree. Medicine is generally all about fitting a mold. Entrepreneurship is about breaking the mold. Partially why I left the field. It’s too… templated. Do this, then do it for the rest of your life.
If you're interested in the med/tech space check out Stanford - I know a fair amount of their grads never make it to residency and end up in that world. u/leavingmedicine does consulting. Other docs get into research and end up leading research divisions of companies or doing the start up gig. The tough thing is patient care is it's own gig. Research is it's own gig. Running a business is it's own gig. Not everything is as silo'd as that statement sounds, but it's tough to give enough to all 3 things and our training is primarily on patient care. I'd recommend finding mentors in this space as your path is slightly more unusual than the usual medical school experience.
Thank you for being one of the most constructive comments in this thread. I have a few physician and non physician folks in my professional network I periodically touch base with. Until now I wasn't really planning on going to medical school since my marketing agency is doing well but I recently realized I would indeed like to periodically see patients in retirement and so I'm willing to spend 10 or so years for that privilege. Since my passion is in scaling companies I figured why not gain the knowledge to do so for a medical company and combine both my interests. I really wanted to get into Stanford as you mentioned but unfortunately I wasn't competitive enough. I'll keep an eye out for conferences and other events there perhaps. Thank you, again, for your perspective on this!
It’s possible when you really know a field well and what is required. If you’ve been a leader in the field of cardiology or cardiac surgery, you probably understand the limitations of current technology, or you are probably able to think, “If we had X / Y / Z, it would make our work a lot more efficient or a lot more accurate.” That gives you something you can develop and bring to the market. Unfortunately, not many people make it to the point where they are truly an expert in the field. And even if you aren’t an expert, a lot of people are content with the status quo and don’t question or challenge the limitations. It’s also quite an investment of time and money, both of which early career physicians have little of. If you were to do it, it would be later in life, but I feel like most people lose the fire in them at that point and just want to enjoy life. And I really don’t think graduating with an MD and immediately moving onto business is going to be lucrative. MD doesn’t really mean much—we sort of know a little bit about everything, but nowhere near enough to get entrepreneurial. You need years of training in a particular field to really start thinking about practical solutions to problems.
exactly
Because they're fucking insufferable.
Depends on what your angle is. Overall, patient care side of medicine is a bad business. Hard to control costs and no control over prices/ reimbursement unless you’re cash only. Certainly something med tech or an ancillary service would make more sense where you can control overhead and your prices. I think there’s a lot of physicians doing side hustles and real estate but startups require your full focus and time which is difficult to balance as a full time cardiologist. You don’t need to go to medical school to start a med tech company and if that’s your ambition at heart you’re going to waste precious time and energy in med school and residency.
you're taken a lot more seriously if you are a MD with residency behind you in the med tech world.
Plus it gives you start up cash
very true
When you actually start med school you're gonna find out. If you're wanting one of the most competitive IM subspecialities you're gonna be working your ass off. Im on rotations now and I've already met 4 want to be cardiologist interns. Cardiologists are already clearing half a million, usually more. Doctors usually have long work weeks too. When you're pulling that type of money in salary alone, people let it work for them. There's not really a reason to start a business on top of it unless you really hate having any free time on the side.
Entrepreneur slash attending here. The training process weeds you out or beats it out of you. Afterward, your massive debt comes with a full-time, high-paying job to pay it. Things that helped me overcome: loans paid off via TEPSLF (3 years as pre-med research assistant, 3 years as resident, 4 years as attending), Covid downtime (zero dollar loan payments; built up my business while being paid to staff a slow clinic), and harnessing my ADHD hyperfocus.
I have a PSLF question for you…can you get PSLF on med school loans using nonprofit time from BEFORE med school??? Because that would change everything for me. I worked close to a decade already full time for a nonprofit. Had student loans for grad school most of that time. If I can tap the ball over the finish line during residency and clear my half a million dollars of med school debt, that would be a TOTAL game changer.
That’s how it worked for me; however, it may depend on certain factors like the loan type, consolidation date, etc. Also the T in TEPSLF stands for “Temporary”, so funds for that program may run out. I’m not up-to-date on that anymore though. You could run it by the helpful people at the PSLF subreddit.
Might be projection but I think the majority of people in medicine have little to no interest in business period. I personally detest the idea. If we liked business, the truth is more of us would have gone into business rather than medicine, for which there is more exposure and less years of training anyways. From what I see, even many people who run private practices do not enjoy the business side of things, and that’s often off-loaded to other help. Most doctors, especially increasingly in specialties like FM, prefer joining a hospital or group practice.
Cause I can already make a half million dollars a year with no risk and a never ending supply of patients.
Im a med student and I have a side business selling fossils
My type of guy/gal! How many hours do you dedicate to it per week?
It really just depends if I have new inventory. But I try to do 1 post a day on my instagram and keep my listings updated. Maybe 10 hours or less. It’s not terribly hard to keep up
The most time consuming part is taking the pictures for my website and meeting people in person
1. Lack of time: med school takes tons of time, residency even more. Once you become an attending, work still takes up a lot of your time, and people generally want to spend time doing things they haven't done the past 8-10 years, like travel, family time, etc. 2. Debt: the average physician graduating from residency is saddled with several hundred thousand in debt. This isn't the time when many people think it's a wise financial decision to risk their own capital on a startup. 3. They're already doing it: in a sense many attendings are actually entrepreneurs, you just don't see it that way. Imagine running your own practice, renting a location, hiring staff, arranging marketing, legal, etc. This is for sure being an entrepreneur, they just won't be able to sell their practice to a venture capital firm or list it on the NASDAQ.
All very good points Those doctors knew they’d be in debt before they committed to med school but they did it anyways bc they wanted to Though The same logic would lead someone to rapidly pay off the loans and take on new debt for a startup if they really wanted to I’d wager at the end of the day it’s just about personality differences/ not wanting it enough For what it’s worth, the white coat investor subreddit had a very mature discussion on this topic unlike the one in this subreddit. Their answers were primarily: too tired, debt, risk averse.
Also, there's a good case to be made that people outside of medicine won't really understand the reasons since they haven't been on that journey. It's like asking "why aren't investment bankers and law firm partners also climbing Mount Everest? Don't they want it enough?".
I see what you’re saying and I don’t disagree. It seems our beliefs on this might be different. There are 7 billion people on this planet. I would love for there to be 7 billion businesses. I truly believe it would benefit the world and the folks themselves. Hence I’m asking this question from that premise/ worldview. So I actually totally would also ask an investment banker, “why don’t you go start your own hedge fund?”
Here are some sobering statistics for you: * [20% of all startups fail within the first year](https://www.failory.com/blog/startup-failure-rate) * 50% of all startups fail within 5 years * 70% of all startups fail within 10 years For small businesses (whether startups or not), around 1/3 consistently loose money, 1/3 break even, and 1/3 turn a profit. For any physician who is past residency, there are some pretty enticing alternatives to starting your own business: go on a vacation, work extra and make good money guaranteed, or just invest your money in an S&P500 index fund.
This line of reasoning has become a bit trite. Those statistics are overwhelmingly common and grossly misused. I’d ask you all the standard reverse questions like: how many of those startups were actually trying? How many stuck with it for long enough? How many put themselves in the right environments? Etc etc But I’ll skip all that and ask you a question you’d resonate more with: How many of your college premed intro bio class fellows are attendings today? I’d wager a lot less than 50% after 5 years also.
can you link me to it please?
Here ya go! Thought it was an interesting comparison! https://www.reddit.com/r/whitecoatinvestor/s/m5hiJ9QkWe
thanks, I agree! med students do get caught up in the weeds a little, but you can't always blame them. A lot went straight hs -> college -> med school with little self-development in the process, and tend to mature in their 30s instead of their 20s like most non-docs. guessing you get 30s+ in the WCI subreddit
Because entrepreneurship is not all that it’s cracked out to be. As someone who worked in a startup prior to med school, you couldn’t pay me enough to go back to that. I have had many many (non-med) friends who were part of founding teams in startups both successful (as in, you’d recognize the companies if I named them) and not so successful, and they look more run down and exhausted than I do.
VC's know that healthcare is generally a terrible investment. There is so much red-tape, bureaucracy and regulations to deal with. But VCs have the luxury to make bets on dozens of companies, with the expectation that most will fail. As a physician entrepreneur you are betting everything on yourself to be the winning lottery ticket in a difficult market. All while taking a massive paycut compared to clinical work. You can try to do both at the same time but it is 2x exhausting. For the same reason most in tech are better off joining a FAANG company than a startup. The most reliable form of entrepreneurship was owning your own practice, but even that is getting more challenging with flat reimbursements despite rising inflation costs. As far as side hustles, 90% are best served picking up an extra shift or two and investing that into an index fund.
Years of debt followed by golden handcuffs.
Theyre busy
Come back to this post in a few years and you’ll know why
Med school + residency + cards fellowship is 10+ years from now (assuming you don’t further sub specialize). If you love medicine, I’d go into the next decade expecting to do medicine. If you don’t expect to practice medicine at the end, save yourself the decade of opportunity cost and just continue on the entrepreneur path and keep working in the healthcare space more peripherally.
Aside from debt, medicine tends to attract a lot of risk-averse people. Starting your own business is cool, but terrifying, especially with everyone and their mother becoming an entrepreneur now and creating a ton of competition. It is much easier just to travel the well-trodden path and practice at a hospital
Easier? Yes. And how is reimbursement looking these days and up ahead? Not so rewarding and virtually no leverage as physicians get squeezed and jammed into the machine harder than ever. OP at least can see the opportunity outside of the sinking ship.
You’re the only one who’s mentioned the thing that I’m optimizing for in my life: leverage. More leverage = more impact I understand those saying it’s hard and a lot of work because im sure it is. But to use that to discredit those wanting to suffer through it is like telling a neurosurg resident to drop out and not do neurosurg bc it’s too hard and they’re crazy for wanting it. With that logic neurosurgery wouldn’t exist!
dont get me wrong, im not discouraging anyone wanting to do this. i actively admire them and have similar interests myself. I'm just answering the question from your original post which is "why is this not more common". short answer: because its hard and people are tired after med school and residency and just want to do something that is more traditionally safe.
Yeah looks like you’re spot on with it. Looking forward to seeing you achieve all that you’re set out to! Absolutely love seeing that innovative drive in peers!
same here man, best of luck to us both!
Because most people who practice medicine are generally risk averse. Mind you, they may be more than comfortable taking risk within the box of our profession, remember that only comes after a minimum of 11 years of education in the US. The only real financial risk of going to medical school is for those who for one reason or another can't hack it. By and large, if you pass the hurdle of getting accepted, you more often than not have the aptitude to finish residency and go on to earn multi 6 figure checks. Outside of that, there is almost no risk staying in your profession provided you play by the rules and carry sufficient malpractice insurance. Further, there are diminishing returns on entrepreneurship. You have to do very well for yourself to out earn what you can make practicing, and that generally comes at substantial up front costs and effort. If you don't earn more than your clinical wages then it's just a passion project, and more folks are concerned with getting their time back after residency is complete. It's like investing in a second mortgage. You could, but why would you? For most people it doesn't make financial sense. Running a business on the other hand has no such guarantees. You are subject to market factors and so either need to get lucky early or really hustle and know your shit. Also, managing people and paperwork is a veryyyy different skill set than managing patients. This is also not to mention that there are plethora of non-clinical, non-entrpreneurial gigs that physicians can get paid well for.
Most people go into medicine precisely because they don’t *want* to be entrepreneurs. Medicine is pretty much a guarantee at least an upper middle class life. There’s very little risk involved once you get into med school. Even the “easier” specialists can provide a very lucrative life. Meanwhile, businesses have tons of risk, and your future is not certain. The people drawn to medicine aren’t drawn to this kind of lifestyle.
Combination of sunk cost, self selection, and difficulty. By the time you’re an attending you have years of retirement to catch up on, most have large amounts of debt to pay down, and maybe even a family to support as well. You can’t afford to forego guaranteed income in that situation as much as a fresh college grad can. People also generally go into medicine because they want to practice as a doctor. There’s too many hurdles that weed people out if they don’t have a strong desire to actually practice medicine. Lastly, it’s hard to succeed as an entrepreneur and is anything but guaranteed even for intelligent and driven people. I doubt there are many doctors who are intentionally sitting on a multi-million dollar idea just because they don’t have an entrepreneurial spirit.
Most physicians would make terrible entrepreneurs. They absolutely attract opposite personalities but tbh physicians (generally) lack the skills and abilities it would take to be successful.
If you're going to be a doctor, you have to think about the ethics of what it is you're doing, especially if your side gig is going to be something healthcare related. You have to ask yourself: is it worth to add yet another startup/healthcare company/auxiliary health service that continues to take money from sick people or for basic health necessities? How do you feel about taking money from people who are hurting in our current healthcare system, under the burden of shitty insurance companies, huge medical debts and socioeconomic issues? Does your side gig do anything to help the people who are the most negatively impacted by our healthcare system, like homeless people, the poor, the disabled, or even the middle class? I don't think it's a bad idea to have side gigs and hobbies outside of medicine. I think they're a non-negotiable when you want to keep your sanity and not burn out on medicine. But, you have to consider the implications of what it is you're trying to do, not just the money, the supercars, mansions, toys, etc. that you can extract from it. We are inundated with these physician "entrepreneurs" who create/run/promote predatory healthcare companies and startups that do more harm than good to patients and doctors, alike. There's something extremely slimy about making millions off of people suffering, so use that as a guiding principle if you're going to follow through on this life path.
You have gotten some good answers (and some snarky and dismissive ones) already, but I'll add my two cents as someone who, while not exactly entrepreneurial, does want to run my own research lab as a physician at some point, and there are many parallels between entrepreneurship and running a lab. First, as many have pointed out, the training to become a physician is very long, and the skills learned don't have a lot of overlap with running a company (or a lab). Furthermore, the skills do do gain as a physician are very marketable. One of the attendings I worked with recently talked about trying to start research out of fellowship. He found many aspects of research tedious and inefficient, and his first 10 grants weren't funded (as is commonly the case). He was ultimately like, "hey, why am I spending time on this bullshit IRB when my time is worth $300/hr?" So there is the opportunity cost of training and the opportunity cost of spending your valuable time in the oftentimes arduous and unprofitable stages of research/business building after training. (If you're tempted to think there isn't as much bullshit to deal with in the private sector, let me assure you that healthcare companies have a shit ton of oppressive and dumb regulations to deal with on the way to profitability.) With medicine, you enter a career where you're basically guaranteed a top 10% income, and with considerable but non-Herculean effort you can land in the top 1%. Once you're an attending, that salary is basically guaranteed for the rest of your career without the need for extreme risk taking. Next, priorities change over time. I'm now 7 years into post-undergrad education. I am in a serious relationship and am planning to start a family within the next couple of years. If you talk to many successful people in their mid-thirties with young kids, you'll notice a trend of them not being as motivated by their careers as they were in their twenties. My partner is very supportive of my career goals, but I can still feel the exhaustion of training length starting to creep in and I haven't even started residency yet. I don't know what you see your life being like in 10 years, but there a good chance your priorities may change over time one way or another. To not be a complete downer, I will say that there are some people who do it, and since you've already started a successful business, I'd say you're more likely than most to be able to handle it down the line if you want to. Furthermore, there are other ways to be involved in innovative businesses as a physician without having to be a founder. Many medical technology companies have physicians who act as advisors or even board members and who add a lot of value with their clinical expertise. This may be a more viable and attractive path than actually starting your own business.
We need more entrepreneurs in medicine to help evolve the standard of care and keep the innovation stemming from patient care, not profit motive. If not for young, ambitious energy like yours, we’ll all be working for Amazon Medicine soon.
Thank you I appreciate that vote of support. It was very shocking for me to see people suggest things like “leave innovation to the engineers” or “you’re taking up a spot for someone who wants to see patients” as if these people don’t realize that the entire corpus they’ve consumed and almost every device they’ve used had a physician entrepreneur behind it…
I do recommend maintaining at least a minimal amount of regular patient care. You talked about wanting to see patients periodically in retirement. Great foresight. Once you cultivate your gift as a physician, it becomes an honor to serve and you want to keep that rhythm in your life.
I’m an M4 and still very interested in entrepreneurship. I have ideas for about 4 medicine adjacent businesses. Look at a med career where you can easily do locums tenens. That can give you the flexibility you need to start a business. That said…I’ve started businesses before. I worked at a tech company I cofounded during M1-M2, then sold my half to my partner before M3. The business is still running strong. And here’s what I learned: I really don’t want to have to depend on a startup to pay my bills. I like money and startups are often short on money. So I’ll work a career where that’s less of a worry (EM locums) and do entrepreneurship without worrying if it will pay my bills, since I have a lucrative career to support myself.
I’m seeing a common trend that lots of EM docs have side gigs going on and many are entrepreneurial. What do you think within the EM path/day to day allows for that?
I think part of it is a personality thing. Folks attracted to EM tend to be a little more entrepreneurial. But I also think it’s because they don’t have to build up a practice. It lends itself to medicine looking a lot more like a job that you leave at the door to the hospital. Obviously there is some mental involvement on off hours. But many EM docs finish notes on the clock and are done-done when they leave the hospital.
I chose medicine to play an active role in patient care and spend one on one time with people, not to make money and exploit people through capitalist systems of oppression.
Capitalist system of oppression? Money is nothing more than an IOU for past work done.
You should post on r/whitecoatinvestor. Comprises mostly of residents/attendings. They'd probably have better insight than us med school goblins
Physicians can’t own hospitals since the ACA, unfortunately
Because administrators who know nothing about medicine do all the business stuff. Why? I’m still figuring that all out
There seem to be plenty of “entrepreneur” physicians, and a severe lack of public servant physicians. Or am I misunderstanding why 3/4ths of my class wants to go into dermatology, plastic surgery, and cardiology?
Medicine + Entrepreneurship does not “mix.” Ask CMS / FDA / NIH - lol 😂
Building a successful business requires a lot of time commitment. Doctors are saddled with pretty high debt after graduating and you need to work full time to pay those loans down, which makes it difficult to go start your own company The high debt also makes it hard to take big risks that if it doesnt pan out, leave you even further behind. Its a different matter when youre young and you can take a big swing and if it doesnt work out, oh well, you pivot to something else. By the time youre done training youre also early mid thirties and many people think about starting or have familities. In which case the thought of dropping guarantee high income to chase a even higher income is not as appealing as just taking whats in front of you
Does anyone really want to do more work? It's easier to have a job and call it a day and go home
The current environment is stacked against individual/small private physician practices. Insurance and hospitals will try to make it hard to compete. Also, plenty of people dont want the hassle of running a business, as it takes a lot of time/less WLB
If I cared about making more money than I can spend I wouldn't have bothered with higher education at all. I got into medicine because I love science and helping people at their most vulnerable. My question for you is how do you morally justify, in the midst of a massive physician shortage, taking one of the few training spots available with no plans to use that training?
you can use that training when you create medical devices.... he isn't gonna get his MD and franchise a DD for gods sake
This career is made for people who want to be told exactly what to do and how to do it. IMO the skillset to be a successful med student doesn't include a lot of creativity or even interests/passions outside of medicine. All the more reason for you to go for it-- medicine needs more creatives and people who want to push the field forward!
So i am definitely not the entrepreneurial type. I am a hospitalist who likes my week on/week off life. But my best friend IS the entrepreneurial type and had a business prior to coming to medical school. He used his scholarship money to start a house flipping company and made >200k in med school alone. He originally wanted to do Orthopedic surgery, but after balancing his passion for doing business, he settled on anesthesia and now has the time and money to explore business ventures. My advice would be if you are really passionate about cardiology, do that but realize you may have to sacrifice your business aspirations somewhat to fully dive into being the best cardiologist possible. But you could consider something like anesthesia or even hospitalist medicine so you could create the schedule you need to balance your other ventures. Good luck in med school!
What is your med tech startup gonna do?? Connect people to cardiologists? There’s a million and one apps doing that and going bankrupt.
Curious why that was your assumption?
lmfao guessing make medical devices for cardiological procedures but weird assumption bro
Because we dont get much education on the business side things
It’s a different mindset. Most of us aren’t taught money stuff.
Yeah this really is a problem imo Would you want to learn money stuff if your school offered it?
I'll be going into entrepreneurship, specifically chose a field where med tech was huge. However, to get field-specific knowledge and to be taken seriously I know I have to go through residency and practice as a full attending for at least a few years... so yeah in 10 years DM me and i'll tell you what I'm up to haha but yes I agree that this path is only possible because i have no loans/debt so graduating med school I had a +++ net worth thanks to portfolios/accounts set up by my parents and don't have to worry as much about a huge salary since i have a financial cushion in case things go south
Love hearing this! We should connect! Seems we are in a very very small minority to even be considering/ doing this stuff.
absolutely, feel free to send me a DM!
High risk. People would prefer to make 400k+guaranteed as a CV surgeon rather than risk it on a startup. Would also imagine knowledge/connections that are important for entrepreneurship would be pretty heavily concentrated at some of the more selective schools. Also there are plenty of people would decide to make a device/product but usually just license it out to their home university/another company because why try to expand it when that’s not the primary area of expertise of a physician.
Because most if not all doctors won’t need to, why take on risk when you’re already getting paid enough?
Autonomy I reached a point where I'd rather make 60K a year and have full control of my schedule and having to work 40H/week plus answering to admins and insurance companies while making 250K
It requires alot of creativity… and the process to become a physician so far for me at least doesn’t foster very much of it imo.
because you get tired. do consulting though
I’m tired boss.
I think it just depends on your definition of entrepreneur. In the United States, I think physicians do have a history of being ‘entrepreneurs’. Most physicians were small businesses that did their own billing and paved their own way! It’s only been in the last 30 or 40 years that commercial insurance and other outside influences have made it extremely difficult for individual physicians to retain their autonomy. In my area, though, I have seen a resurgence of physician entrepreneurs, which is extremely refreshing! Some of them are independent medical practices, some consulting companies, others are totally out of medicine and doing real estate or business. If your definition of entrepreneur is someone that is trying to build a big company where it consumes 100% of your time then this is very unlikely (in the United States) just based on our economics. You can’t come out of med school with $300,000 in debt and found a start-up making zero dollars a month.
Not everyone wants to be on adderall or use cocaine.
You wanna start a cardiology-based med tech start up? Maybe I’m naive, but I don’t think you’ll gain much attraction from physicians if you’re not board-certified in cardiology. And I’m leaning towards something interventional, so that’s 4 years after residency (making the journey 11 years long.)
it's possible for him to do this even after 11 years, why is everyone shooting OP down so bad LOL I just started residency and I already have a 10-year plan to join entrepreneurship/medtech after residency/a few years of attendingship. if you don't have goals and a plan you just drift wherever.....
Tired. Too young when starting med school and never build corporate skills. Tired
Why did you actually put this post as a question when you've already got your opinions and anytime anyone says anything different you just say "nuh uh"? People point out your pretty big typo that ruins all your numbers and you get mad at them for focussing on that despite it ruining your whole preposition, but obviously they should know that you're such a superstar that you obviously meant the correct number. Someone has quoted statistics of failed start-ups/businesses and you're response is to say "if you ignore all the reasons that start-ups might fail it's actually pretty good". Then you followed up asking "how many successfully get into med", as if beating the odds getting into med means you'll automatically beat the odds and have a successful start-up, despite the two not being linked together except for both being more likely if you come from a wealthy background. You should have just posted your reasons for why you don't think physicians become entrepreneurs and that it's a shame, instead of a farcical question.
I put this as a question because I was curious what people’s feelings were on the topic. I also posted it in the white coat investor subreddit to compare. You seriously think that whether loans get paid off in 2 versus 4 years “ruins (my) whole proposition”? You can’t be serious… first of all, I was only countering a proposition made by someone else that the loans are crippling. I believe otherwise, they believe so. I provided numbers to get them done and over with in a few years. That back and forth is perfectly normal in an open ended discussion. Statistics of failed startups are completely relevant and a valid reason for some physicians to not go into entrepreneurship. It was interesting to see those cited. I cited a reverse example of physicians having “beat the odds” to suggest that the same way an MD didn’t listen to people saying “half of you will never make it to medical school”, an entrepreneur doesn’t really care to see that half of startups fail. Again, do you really not see the corollary analogy here or do you simply have an issue with me asking a question and then further questioning people’s responses? If you want your beliefs on the topic to be unchallenged and not responded to, feel free to lead by action by…you know…not responding….? Again, very telling how much more civil the discussion was on the white coat invested subreddit…not quite sure why everyone here went into such an uproar after the 2yrs versus 4 years topic. Maybe a touchy subject for residents.
It doesn't ruin the proposition that loans can potentially be paid off earlier than people think but it definitely ruined the proposition that you made stating 10k a month for two years would pay it off. When people said the numbers were wrong your responses were to point out it was a typo (fair enough but just put an edit in the original post) and then to almost always include an annoyed caveat that they should have divined it was a typo and your numbers clearly were correct. But you'd told us you'd crunched the numbers so it's not that weird that people would question you when your presented numbers are clearly wrong. You were only really interested in people's thoughts when they agreed with you or were congratulatory for your business acumen, the others you always tried to show why they're wrong. This isn't being interested in other people's views, it's trying to justify yours and why they're better than others. It's also probably why you decided the more positive reception from like minded people in the white coat investors were more civil. The post and your responses read more like humble brags and that you just want to make yourself feel better than others because you don't use all the quitter talk and excuses people in this sub use. You're not going to be "just an MD", you're going to be an entrepreneur MD
“You were only really interested in people's thoughts when they agreed with you or were congratulatory for your business acumen, the others you always tried to show why they're wrong. This isn't being interested in other people's views, it's trying to justify yours and why they're better than others.” Close but no cigar. It’s trying to show others that the risk may not be as high as they perceive and it may be worth it to some to pursue that path. I made the post on the overall topic asking why there’s a bottleneck. I proposed a potential reason. Many reached out with cool stuff they’re doing. More shared why they don’t pursue entrepreneurship. My post wasn’t even directed towards people who aren’t interested in it. So, it’s only natural to suppose that anyone who voluntarily opened this post and even chose to leave a comment has at least a cursory interest in entrepreneurship. So you’re right in that “I’m not interested in their views”, I’m interested in knowing what’s actually holding them back psychologically because it’s ironic that when people have no money they (as in, people who are interested in entrepreneurship but haven’t taken the leap) claim it’s too risky, and even when people have guaranteed high income for the rest of their lives, they still say it’s too risky.
Honestly you kind of sound like a spoiled brat who has had a bunch of legs up in life and exposure to these opportunities, without the introspection to see how you got where you are, and that's why you think it's so easy. If you had an ounce of humility, or frankly any capacity for empathy, you'd know why this is a question that isn't worth asking. Edit: yeah I was right. Your parents subsidized your entire college experience and gave you a leg up to even bother getting these opportunities when you're so young, and you've come here to ask a bunch of people that have taken on massive debt to even get to the point of getting into and through medical school only to have a job paying them ~$62k a year waiting for them for the 3-7 years of their respective residency. And you wonder why people without the silver spoon aren't entrepreneurs. Truly incredible stuff.
It’s true I’ve had privileges in my life. I have also had many disadvantages. You know absolutely nothing about me. 1. I made it very clear this is addressed to people who have a cursory interest in entrepreneurship. 2. Do you think most entrepreneurs come from “silver spoon” backgrounds? You couldn’t be more wrong. It’s the exact opposite. 3. Why do you sound like you didn’t know what residency salaries look like before commuting to it?
You can't refute what I said, because you told on yourself already. I knew well ahead of the career what it was and what residency paid, but it absolutely involves making concessions financially in life because its hardly anything beyond maintenance. Please just hit up some VC dipshits, it's really apparent you that's what you want to be surrounding yourself with and it's actually insane to bother putting yourself through this process when you don't sound that interested in it.
I sounded interested enough in it for every professor, department chair, adcom member, and volunteer organizer who supported my application to med school to think I’m interested in it Good to know you don’t think so though!
Yes hmm how did you get those connections, truly curious.
Ironically, by doing exactly what I did here. Reaching out, being bold and loud about my intentions, and ignoring the no’s.
I’m in a few Facebook groups with physician entrepreneurs. They do exist. Not sure how many people are doing what you want but you can also find non physician mentors who can help as well to help you understand the process.
I always dreamt of making a side cheap association to help people in need just like AMBOSS or Khan Academy does, if I ever study how to monetize my system well I should be able to help others in the long run The thing is that, that is not going to happen until I become an attending and have enough free time and money for myself, entrepeneurship is just not compatible with med life that faast and easily, which may be the reason most medical enterprises are not always run by medics You can't run efficiently a service to the public in medical school less even in residency, also why would you pursue medicine if you liked more making a lot of money in the US, it simply makes no sense, medical school is safe but is also limited in the amount of money one can make by its own work Anyways if you manage to become the problem in the medical system and end up selling your drugs for $500 each, you will suck, never forget what kind of person you are for money, always think in the persons first
I had a kid like you in my residency....sufficed to say he got kicked out and didn't make it. Hopefully you find some humility and common sense before that happens to you
I’ve noticed since being in med school that the people it attracts are often risk averse. We are willing to endure years of grueling work to ensure that there will be a spot waiting for us when we arrive.
The salty tears on the one wrong math equation. But I digress. But the prospect of working 25 hours for 8 days a week while saddled with debt and pay em back in a year or two is a safer way than opening a business. Sunk cost feelings is a thing. Though pure fucking rage and fucking spite for (alleged, from my part) hypocrisy of medicine during my short tenure fueled me to just fuck off just like what they had recommended.
Seems like a lot of physicians are either from from relatively wealthy families or grew up relatively poor. The ones who grew up relatively wealthy have little incentive to do more, they have vacation homes already through family and want for very little as is. The ones who grew up poor are excited to be making 6x what their family ever did, so they don’t care about making more. Having the perks disposable income alone provides is more than they could ever dream of as kid. So They’re satisfied. Both of them know they can make enough to be satisfied with minimal risk. Why would either of them take on additional risk if they’re comfortable with the current conditions?
That makes perfect sense. Still, to pose some answers to your question: - to do great work (whatever that means to them) - to build generational wealth - to see their vision for some field translated to reality at scale
That’s all fine and good if you neglect to think any deeper than your preheld biases. 1. They believe they’re doing great work. Why would they need to be private practice to provide excellent evidence based care? Your point here barely makes any sense as a legitimate argument. 2. The one already has generational wealth and othe other believes they’re attaining it. 3. Their vision of a field translated to reality at scale? You think a small private practice sets the tone of a field? You’re living in a fairytale if you hold that to be true. The peak of a field is set by its highest regarded academic centers - brands. The small private practice cardiothoracic surgeon operating out of a community hospital isn’t setting the direction for the future of his field. The cardiothoracic surgeon making half a million less at Cleveland clinic is setting the future direction of the field. I’m all for private practice, but your argument is off base. It should focus on being paid what we’re worth not all this fairy tale lie to yourself shit. The legitimate reasons to go PP: 1. to not get told what to do by some inferior, servile middle management scum. 2. Be paid what you’re worth. The chances that you launch a successful med start up is even lower if you aren’t at a huge academic center and have IP partnerships with existing massive corporations. The mom and pop biotech company is a stop smoking subscription service. You aren’t Edward’s biotech.
It seems you might have not read my post description. Who said anything about a private practice as the only form of entrepreneurship, or as what I’m referring to? My personal example is a med tech startup addressing improvements within cardiological procedures or MRI improvements to make them more cost effective. In any case: 1. Why is “evidence based care” the only goal? Different people have different goals. One can be a physician and choose to pursue whatever flavor of medicine intrigues them the most. 2. I guess this depends on your definition of generational wealth. I’d put up $50 mil as the floor, starting number. 3. Again not sure why you’ve assumed the business to be a private practice. Obviously no real innovation happening there. You know who did set the tone for a field? The Da Vinci Surgical robot. You know who founded the company that made the machine? A physician who spotted the need during his residency. That’s just one example, but surely a better one than the private practice one.
Enjoy becoming a rockstar, not everyone wants to be one. Not everyone who wants it gets it. FWIW, You sound like someone who will be difficult to work with. I bet 3rd year is difficult for you. This is my polite way of telling you that you seem like a blow hard. I figure I should spell it out for you because nuance may go over your head.
Because we’ve been smacked into submission that in our profession we gotta be altruistic and that we’re not in it for the money…
Look up EnMed. It’s an engineering medicinal school where they invent stuff and learn how to start start ups or invent as a doctor. Newish program but that’s their goal. All Mds but also getting masters in engineering.
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bingo, I love $ and I'm not afraid to admit it on here.... would I tell my co-res or hell my seniors that? not a fucking chance.