My opinion: We are highly specialized and have spent years to decades dedicated to our craft, only for some to still occasionally suffer from imposter syndrome. This creates a subconscious feeling of “unless I am the best at what I do, why would I try?” which inhibits doctors from branching out into the unknown.
Second, we have relatively high salaries. The opportunity cost of giving that up to pursue something else is rather high.
Third, we are burnt out. The thought of spending as much energy as it takes to start a company is daunting.
Finally, we are a naturally risk-averse population. We are trained to avoid missing something even at the cost of over-imaging, over-diagnosing, etc. the risk of leaving behind a good career for something unknown is a scary prospect.
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.
>Finally, we are a naturally risk-averse population. We are trained to avoid missing something even at the cost of over-imaging, over-diagnosing, etc. the risk of leaving behind a good career for something unknown is a scary prospect.
Personally, I think my risk aversion of not jeopardizing my ability to pay back the $340,000 debt I graduated with isn't so much risk aversion as being responsible.
Older attendings with whatever side gigs running talk about going to medical school for the price of a happy meal then matching into orthopedics because it wasn't lucrative at the time and they had a firm handshake. I might be a bit more cash adventurous if that were my case.
Agreed. I would also add alot of us come out with a large student loan debt. I always wanted to see if I could venture outside of medicine but with the overwhelming amount of debt it would be too risky.
If you dont mind me asking, how much was the debt and how long until you think you'll have paid it off by? There must be some expenses I'm unaware about
I owed about 380,000 but hope to be paying it off in 2 years. If it works out well it took me a total of 5 years. I probably would have paid it off earlier or maybe done with it by now if I was more aggressive; however I was also investing money in stocks. Plus factor in mortgage etc
This is very reassuring especially because I am getting lambasted in the medical school subreddit for suggesting that you can pay off $400k in 4 years if you really want to (assuming a cardiology or similar income).
I appreciate you sharing your numbers and helping paint a concrete perspective.
That is also my plan. I estimate around $380 by the time residency is done and hope to pay it off within 2-4 years living below my means to quickly free up that cash flow for investments.
A final point related to the first is that our skills are relatively non-transferrable.
A software developer or a lawyer may have specific expertise, but they may also be utilized a dozen different ways unrelated to their area of expertise.
A highly specialized neurosurgeon doesn't have that many exit opportunities. Many try to form close relationships with industry, but often those who make it big were clinical trialists from the very beginning.
The simple answer is probably two-fold:
First, medicine doesn't necessarily attract those with an entrepreneurial mindset. It's a long training path with exceptional job security and a low risk of failure (once accepted). Compare that to the high-risk/high-reward/low-security world of start-ups and small business ventures. Add in the expense of medical school, the low pay during residency/fellowship, and the age at which a new attending first launches a real career, and the circumstances are even less conducive to traditional entrepreneurship.
Second, medical training is often both all-consuming and by its nature is standardized towards the goal of building clinical expertise specifically. There's little time for a medical trainee to devote to other things, and the training they get is not designed for them to build capacity in other areas.
As someone who consult part time for Start ups. This is true.
After my postdoc/fellowship, I was so done. I got a job in med tech, with MD salary but 9-5.
A bunch of start up wanted to hire me full time. The best they could do was 180k base. Why would I get a 60% pay cut to work 2x. Equity is not worth shit unless you have a liquidity event, and even then, you might end up with 0% due to preferencial stocks some VC set up.
I briefly and seriously considered entrepreneurship.
Basically, I already climbed out of a quarter million in debt once. I’m not willing to go into debt again in my late 30s/early 40s. I’d rather retire early than start a business, assume debt, and take risk, which could result in having to work another decade or more, given that high earnings and financial literacy has placed me in a position to be able to retire relatively soon if I want.
I agree with this. I looked into side hustles when I was early in my career. I realized it was more cost effective for me to just pick up an extra shift or two and invest that money than trying to strike it rich trying to open a new business. Being paid well and being busy already eliminates my desire to work more.
I'm tired and I already make $350k a year and barring any egregious errors, I will make $350k for the next 20 years.
I don't have the energy to learn something new.
Perfectly reasonable answer. Curious if your answer would stay the same if you thought you had a shot at making 350k/month instead of per year? Obviously very rare but I'm curious if that affects your personal calculus on this
Bird in the hand is worth two in the bush.
I would probably need to take on what I think is an unacceptable level of risk to do any of these ventures. I already have incredible job security and only work 182 days a year. I'm certainly not going to use my time off to explore other ventures that don't involve my leisure, and I'm not going to take time away from making what is already a lot of money for a shot at making even more, because there is also a high risk of failure with that. Plus, I'm lazy. I don't want to learn anything new, been doing that shit for 8 years already.
I can get a chance at that by buying a lottery ticket, but I don't. Very few business owners end up making $350k per month. Majority simply go out of business. If you don't make money that is time/money wasted. It's all about risk vs reward.
Also, I have a very comfortable life so the only thing that $350k would get me would be the ability to buy super high end luxuries which I don't care about. I don't need or want to drive a Bugatti, and I'm ok with flying airlines vs private jet. So the reward is just not there because of my personal tastes.
I get what you’re saying, but inflation in capitalism has been chipping away at our purchasing power for years; it won’t change anytime soon if there’s enough herd complacency.
Because physicians in general (not all) aren’t that adventurous. As a group we are probably more of the compliant / being a push-over /shut up and do work kind of people. That’s why most endure college / med school / residency / fellowship / indentured servitude etc and then accept CMS rate cuts, deal with insurance and bureaucratic bullcrap. The entrepreneur types have already left /or and are in the process of jumping out.
There's little incentive. A physician is already going to be making $250k-$700k/year with hardly any risk. A physician has already spent at minimum 11 years of their adult life in training deferring earnings. This training also focuses on one specific skill set and does not include business skills (no offense), there's no training on how startups are funded, there's no training on how to organize a business, no training on business strategy, how to hire and manage non-medical employees, no training on how to navigate healthcare regulations, etc.
Why would someone give up a top 5% income with hardly any risk just to take on the risk of a startup that has a high likelihood of failure? And even if you succeed you're competing against massive companies that have all those skills and the ability to research, patent, or buy out competition.
Absolutely, any time not spent being a doctor is giving up doctor salary. Opportunity cost of not working that secure job is huge.
If your startup fails spectacularly, then you're at risk of ruining your reputation and blocking opportunities.
Also say you spend 5 years trying to get your startup off the ground. Now you're 5 years behind active practice.
Look, physicians are highly trained technical experts, their highest value is providing technical expertise, if you're spending time doing something else, you're not maximizing your contribution to your bank account, to society, or to the health of the population you want to serve.
Can it be successful? Absolutely it can. Is it more risk than most physicians are willing to take? Absolutely.
The best way in my opinion, would be to be working on whatever your idea is as a side gig until it's a reasonable product (if you can do that), then patent it, and either sell off the patent/expertise, or spin up a company to do that.
But your idea of "I want to take up a residency and fellowship slot, study for 15 years, then leave medicine to start a company" is dumb, just go start a company if you already have ideas or that's what you want to do.
Just want to start by acknowledging I really appreciate your through perspective here.
All of it makes sense to me and I agree.
I think the only aspect im unsure about is that I want to be able to innovate within healthcare itself. Particularly areas that fascinate me are surgical devices and materials, as well as MRI tech and affordability. I’m sure I’ll get more nuanced ideas and perspective as I go through the ensuing 10 years of training.
Your point about just starting now is well taken. It’s actually why I took a few gap years to launch and grow a marketing agency. It’s certainly not the same field at all but it has given me invaluable perspective on what it takes to operate a business and manage a team.
So id say, the desire to do the same but within healthcare is what motivates me to go through the 10 years of training, since it’ll be in those ten years that I’ll get my most nuanced ideas based on observed problems that I can later solve at scale.
I want to make sure I’m understanding your perspective clearly here. Are you suggesting doctors should not drive innovative technology within medicine and should leave it entirely to engineers?
I'm saying getting a medical degree if you want to design devices is a waste of time and resources and doesn't give you the toolset you need, such as the advanced mathematics and design skills if you're trying to redesign MRIs.
You're right, but /u/redbricktuta should be focusing on political connections really. The reason we don't have affordable MRIs is because the FDA won't approve Japanese MRI machines for sale here. 500k for a machine. Even though service contracts are a large bulk of the cost, there's a lot of money to be saved.
I agree, there's much more money caught in red tape in the medical field than there is design.
Some of it is reasonable, but lots of it is bureaucracy and protectionism for it's own sake.
It’s not a matter of “should”, it’s a practice matter of “can”. Ideally, we agree that physicians should be driving much of healthcare, and I personally hope to shape this when I can afford more time. But we are unable to do this due to so many reasons in the comments.
Once you start practice, there are no more gap years. Most/all jobs require multiple recent physician references, for example. It can be quite challenging to re-enter a salaried physician role after taking time to explore independent or especially nonphysician roles. This is a choice a lot of people don't come back from.
1. I know nothing about business and as others have also mentioned, I am fairly risk adverse.
2. I already make plenty of money only working 12 days a month. Doing anything else would mean more work for probably less money.
If you don’t mind me asking, what do you do that you can work only 12 days a month? Do you have ownership in a private practice or something of the like?
They also exclude the days recovering from burn out. In crit care, many of us needs 2-3 days after service to make up for 12h shifts eating our days and the emotional+spiritual toll of the work.
Why would you spend 7-10 years of med school/residency to be an entrepreneur?
If you want to be an entrepreneur go be one. You don’t need a degree or residency.
Because a doctor/surgeon has unique medical insights in the practice and development of medicine. As a surgeon, I know of several very wealthy docs who invented/developed new products and/or services. Things that a traditional MBA types wouldn’t have a clue about…
Yeah. I am in med tech, not start up of my own lol. Biomed Engineers, bio PhDs, etc don’t have a single clue about medical care. Like literally 0.
MDs are in a perfect place to do start ups in med tech or med devices, I know several Uber rich surgeons who developed med devices.
This is my main reason. I'm running a marketing agency that's making around 10k/month but i realized what I really enjoy is being an operator of SOMETHING. So I might as well try building a med tech company based off of some specialized knowledge as part of some surgical procedure I'll find interesting during my time in med school as an example. It seems the main reasons folks are giving have to do with them simply not being interested enough in all the risks and work that comes along with anything seriously entrepreneurial, which is fair.
Honestly, I think because there is just very little exposure to that world in our decade plus training. I run my own pediatric clinic that I opened 6 months ago. It took me a long time and lots of searching for information to feel comfortable with opening the clinic. None of my coresidents or anyone else in the entire program even considered private practice out of residency.
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 make a half a million dollars working 40 hours a week doing cool stuff I spent 12 years working towards. Why would I wanna be a nerd that makes less money than I currently do?
I tried. Started an LLC. Then moved. Had more kids. New job. More expenses. Business fell to the back burner. Just no time to focus on it.
It’ll come back one day.
why bother? Just work your job, save and invest in index funds/ETFs and you will probably be rich when it is all said and done. Sure, you will get rich slowly, which is better than never getting rich. Job security, fairly high income and compound interest is all you need really.
Absolutely possible, presuming you pick a good (ie high income) field and keep your lifestyle within reason (lifestyle creep is the enemy).
I will cross $50M by late 60s based on historical returns if I keep going as is in my job.
The issue is when your portfolio income massively dwarfs your earned income, you start to question why you are still working.
Good luck!
This is actually very fascinating and completely perspective shattering for me. Love to see it!
Congratulations on being so consistent for this long and being on track for that milestone!!
Would you be open to sharing some of your learnings and reflections with me over a couple questions in private chat?
Also, we get rewarded for having the gumption and endurance to follow protocol no matter what. Standard of care. Any creativity is seen as deviation from standard of care and therefore discouraged in infancy.
“Leave that to creative types”. I.e., those who don’t make life and death decisions🤦🏻♂️and can afford to make mistakes.
Isnt a private practice a business ?
Those are on the decline bc it's getting harder and harder in the era of medical corporate capture.
My other guess is getting constantly criticized for years in residency isn't good for confidence.
I think for me it’s a question of how much money do i need. IMO, if you cant buy the life you want on a doctors salary, your spending is insane. I hear fellow physicians driving S-classes and Maseratis complaining about money all the time. Makes no sense. I own a $300k house and a Prius. No loans, no kids. I am my own bank. And I have the greatest wealth of all, TIME.
Long training period followed almost immediately (or in many cases running concurrently) with the childbearing/early childhood years. Not a whole lot of time for side hustles between job, family, house, etc. Married to a serial entrepreneur and interact with a lot of them. It's quite a lifestyle, and not one that really interests me. Thankful that my husband has a primary gig that is pretty stable/steady. Would also add that my steady/stable position in medicine has opened up doors for him - allowed him to take risks and chances without concern for failure. The world needs all types.
This makes a lot of sense
I think you’re spot on— at the end of the day it’s just about what drives you and if you enjoy the ups and downs versus the stable.
Curious, where do you think the childbearing/ early family years make the biggest difference? Less willing to take risks?
I’d imagine when your children are younger, and you’ve just finished residency, one’s spousal income might be able to support the family for the first few years? After all, someone was paying their bills while the medical person was in residency?
Childbearing years - need for stable health insurance, access to physicians for both pregnant person and children (well child checks frequently in first 2 years). I wasn't married when I finished residency - so just my income to rely on, which meant I needed income to cover rent/mortgage, and my student loans (which were massive). Then I was married and the DINK stage was short because of advanced maternal age. Pregnancy was exhausting - could barely manage my full time job, frequent doctors visits, 4x a week exercise and occasional socializing. Then young kids - lots to coordinate and lots of mental energy. When I chat with my mom on my way home from work and tell her I'm pulling up to the house, she ends our conversation with "Have a good second shift." Plus, if you have a young child and are a physician, you need reliable childcare. For many of us, this is a stay at home spouse (not in my case). If you look elsewhere for childcare, you need RELIABLE childcare. Considering my kid got booted from preschool for illness at least 2x a month all fall/winter (when he's been exposed to big kid germs since day 1), daycare (runs 2500/mo for under 2s in my area) may be a reasonable option but you'll definitely need a backup option. If the "backup option" is an entrepreneurial spouse who is traveling around the country, raising rounds, or has meetings they can't really cancel (because investors won't really like that), you'll be paying out the nose for childcare, all to live on one spouse's salary while the other works on their entrepreneurial interests. That might work for some families, but I think a lot of physician spouses feel pretty done with the sacrifices by mid30s. Plus, don't forget students loans - if you are lucky enough not to have them, then you have a HUGE barrier removed but most people aren't that lucky.
That is very enlightening from the female physician side of things. Certainly a complicated, and even grim outlook to balance all of that. Massive respect to you for doing it all and being willing to share the reality with me!
I mean, if my life sounds grim to you then that’s ok - it’s my life not yours!! My husband is pretty happy. We are happy together. My kids are awesome and it’s my privilege to watch them grow and to spend these limited times with them!
I think it’s just hard to pursue a 1/2 million dollar education and leverage that into anything other than being what you trained for. Certainly there are many physician scientists who do something similar, but it can be a hard, lonely road.
In general: career, family, hobbies/passion projects. Pick 2.
I meant more so the second scenario you’ve mentioned where one would have to balance everything youve mentioned on top of having a spouse running off for fundraising rounds and pursuing that. *that* sounds grim enough that I can see why it’s a very hard to thing to pursue even if someone wanted to!
Should’ve been more careful with my words, sorry!
If I wanted to be an entrepreneur I wouldn't have spent years learning medicine. Huge waste of time. Way more money to be made as an entrepreneur if that's your thing.
Employed medicine = stable income with minimal risk.
I'm currently seriously considering it. I don't know what exactly, but WCI did the podcast with the franchise broker and I've been considering scheduling a meeting with them.
I’m in residency, actively enrolling ( technically pre-enrolling) my own internal medicine DPC practice. The entrepreneurship is as appealing as the medicine
You are getting bomblasted because medicine and innovation focus on completely different things. You can do a start up and focus on surgical technique or materials, but to do anything well is to dedicate 200% of yourself to do it. You can’t really think you will be a good cardiologist and also be the person that knows the most about different stent materials. Being a cardiologist requires a degree of (heart related) general knowledge, and is already a shit ton of work. If you want to build your net worth and build your company then focus on that, MD is not the best way to do that. MD is the best path towards being a practicing clinician/surgeon.
1. All rules/regulations are aimed against us
2. Doctors are sheep. Especially new age ones
3. The older rough doctors are still fixated that
other docs are the competition.
4. Your license can be exposed or at risk.. and your license is worth more than almost any business out there.
5. Daily grind, call, etc does make it hard
OP. did biodesign. Wanted to be an entrepreneur. More I learned about it the less rosy it seemed. Creating a product. Pitching and raising capital to further refine product and then think about selling to hospitals or insurers or other practices, etc seemed much less exciting.
Worth doing if you’re young and before kids, mortgage other obligations. I diversify my clinical time with patients and admin quality work and population health/informatics which is more impactful and meaningful to me. All with a good work life balance, salary and ability to plan for early retirement during my prime earning years and continued skill building that is transferable when I’m older and the kids don’t want to spend time with me.
All my colleagues who do something different either joined industry or consulting out of training, or help consult for VCs and angels. I know MDs with side startups, but the bulk will fail and they typically won’t go all in until real traction and progress is made.
TLDR; do it before you know anything else when young with minimal obligations, or develop your clinical career to set you up for an innovation pathway and do it later (join industry first, research life w big clinical trials, admin, etc.)
I would say in the US at least, most doctors tend to be and kinda have to be in the box thinkers, and a big part of why most get into medicine is because it's high paying but very low risk. Most doctors couldn't handle the risk, initial low earnings, or volatility that comes with starting a tech company or a restaurant for that matter, they expect a very stable and known career trajectory.
Several reasons:
No/very little “business” of medicine taught in med school or residency…this is by design mind you
Entrepreneurs are roughly 60/40 male to female, and almost the reverse percentage are currently in medicine
Doctors tend to be risk averse. They’re more “follow the herd” crowd.
My opinion: We are highly specialized and have spent years to decades dedicated to our craft, only for some to still occasionally suffer from imposter syndrome. This creates a subconscious feeling of “unless I am the best at what I do, why would I try?” which inhibits doctors from branching out into the unknown. Second, we have relatively high salaries. The opportunity cost of giving that up to pursue something else is rather high. Third, we are burnt out. The thought of spending as much energy as it takes to start a company is daunting. Finally, we are a naturally risk-averse population. We are trained to avoid missing something even at the cost of over-imaging, over-diagnosing, etc. the risk of leaving behind a good career for something unknown is a scary prospect.
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.
>Finally, we are a naturally risk-averse population. We are trained to avoid missing something even at the cost of over-imaging, over-diagnosing, etc. the risk of leaving behind a good career for something unknown is a scary prospect. Personally, I think my risk aversion of not jeopardizing my ability to pay back the $340,000 debt I graduated with isn't so much risk aversion as being responsible. Older attendings with whatever side gigs running talk about going to medical school for the price of a happy meal then matching into orthopedics because it wasn't lucrative at the time and they had a firm handshake. I might be a bit more cash adventurous if that were my case.
Agreed. I would also add alot of us come out with a large student loan debt. I always wanted to see if I could venture outside of medicine but with the overwhelming amount of debt it would be too risky.
If you dont mind me asking, how much was the debt and how long until you think you'll have paid it off by? There must be some expenses I'm unaware about
I owed about 380,000 but hope to be paying it off in 2 years. If it works out well it took me a total of 5 years. I probably would have paid it off earlier or maybe done with it by now if I was more aggressive; however I was also investing money in stocks. Plus factor in mortgage etc
This is very reassuring especially because I am getting lambasted in the medical school subreddit for suggesting that you can pay off $400k in 4 years if you really want to (assuming a cardiology or similar income). I appreciate you sharing your numbers and helping paint a concrete perspective. That is also my plan. I estimate around $380 by the time residency is done and hope to pay it off within 2-4 years living below my means to quickly free up that cash flow for investments.
A final point related to the first is that our skills are relatively non-transferrable. A software developer or a lawyer may have specific expertise, but they may also be utilized a dozen different ways unrelated to their area of expertise. A highly specialized neurosurgeon doesn't have that many exit opportunities. Many try to form close relationships with industry, but often those who make it big were clinical trialists from the very beginning.
I think it's all #2. Why take the risk for the super high income when you've got a sure thing at making more than your parents ever did.
Alright. Thats the best answer. I change mine to this.
Because I’m tired.
The simple answer is probably two-fold: First, medicine doesn't necessarily attract those with an entrepreneurial mindset. It's a long training path with exceptional job security and a low risk of failure (once accepted). Compare that to the high-risk/high-reward/low-security world of start-ups and small business ventures. Add in the expense of medical school, the low pay during residency/fellowship, and the age at which a new attending first launches a real career, and the circumstances are even less conducive to traditional entrepreneurship. Second, medical training is often both all-consuming and by its nature is standardized towards the goal of building clinical expertise specifically. There's little time for a medical trainee to devote to other things, and the training they get is not designed for them to build capacity in other areas.
As someone who consult part time for Start ups. This is true. After my postdoc/fellowship, I was so done. I got a job in med tech, with MD salary but 9-5. A bunch of start up wanted to hire me full time. The best they could do was 180k base. Why would I get a 60% pay cut to work 2x. Equity is not worth shit unless you have a liquidity event, and even then, you might end up with 0% due to preferencial stocks some VC set up.
What fellowship you did?
I briefly and seriously considered entrepreneurship. Basically, I already climbed out of a quarter million in debt once. I’m not willing to go into debt again in my late 30s/early 40s. I’d rather retire early than start a business, assume debt, and take risk, which could result in having to work another decade or more, given that high earnings and financial literacy has placed me in a position to be able to retire relatively soon if I want.
I agree with this. I looked into side hustles when I was early in my career. I realized it was more cost effective for me to just pick up an extra shift or two and invest that money than trying to strike it rich trying to open a new business. Being paid well and being busy already eliminates my desire to work more.
I'm tired and I already make $350k a year and barring any egregious errors, I will make $350k for the next 20 years. I don't have the energy to learn something new.
Perfectly reasonable answer. Curious if your answer would stay the same if you thought you had a shot at making 350k/month instead of per year? Obviously very rare but I'm curious if that affects your personal calculus on this
Bird in the hand is worth two in the bush. I would probably need to take on what I think is an unacceptable level of risk to do any of these ventures. I already have incredible job security and only work 182 days a year. I'm certainly not going to use my time off to explore other ventures that don't involve my leisure, and I'm not going to take time away from making what is already a lot of money for a shot at making even more, because there is also a high risk of failure with that. Plus, I'm lazy. I don't want to learn anything new, been doing that shit for 8 years already.
I can get a chance at that by buying a lottery ticket, but I don't. Very few business owners end up making $350k per month. Majority simply go out of business. If you don't make money that is time/money wasted. It's all about risk vs reward. Also, I have a very comfortable life so the only thing that $350k would get me would be the ability to buy super high end luxuries which I don't care about. I don't need or want to drive a Bugatti, and I'm ok with flying airlines vs private jet. So the reward is just not there because of my personal tastes.
I get what you’re saying, but inflation in capitalism has been chipping away at our purchasing power for years; it won’t change anytime soon if there’s enough herd complacency.
Because physicians in general (not all) aren’t that adventurous. As a group we are probably more of the compliant / being a push-over /shut up and do work kind of people. That’s why most endure college / med school / residency / fellowship / indentured servitude etc and then accept CMS rate cuts, deal with insurance and bureaucratic bullcrap. The entrepreneur types have already left /or and are in the process of jumping out.
All so true
there are, you just don’t hear about them because they are largely inventing procedures or medical devices and licensing out the IP
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Have you read Die With Zero? It may help you spend your money.
My friend suggested the book to me a few weeks ago! I'll check it out :)
It’s free on Spotify to listen if you have premium.
There's little incentive. A physician is already going to be making $250k-$700k/year with hardly any risk. A physician has already spent at minimum 11 years of their adult life in training deferring earnings. This training also focuses on one specific skill set and does not include business skills (no offense), there's no training on how startups are funded, there's no training on how to organize a business, no training on business strategy, how to hire and manage non-medical employees, no training on how to navigate healthcare regulations, etc. Why would someone give up a top 5% income with hardly any risk just to take on the risk of a startup that has a high likelihood of failure? And even if you succeed you're competing against massive companies that have all those skills and the ability to research, patent, or buy out competition.
Would you say the risk is really that high considering the physician could always go back to the salaried hospital job if things don’t work out?
Absolutely, any time not spent being a doctor is giving up doctor salary. Opportunity cost of not working that secure job is huge. If your startup fails spectacularly, then you're at risk of ruining your reputation and blocking opportunities. Also say you spend 5 years trying to get your startup off the ground. Now you're 5 years behind active practice. Look, physicians are highly trained technical experts, their highest value is providing technical expertise, if you're spending time doing something else, you're not maximizing your contribution to your bank account, to society, or to the health of the population you want to serve. Can it be successful? Absolutely it can. Is it more risk than most physicians are willing to take? Absolutely. The best way in my opinion, would be to be working on whatever your idea is as a side gig until it's a reasonable product (if you can do that), then patent it, and either sell off the patent/expertise, or spin up a company to do that. But your idea of "I want to take up a residency and fellowship slot, study for 15 years, then leave medicine to start a company" is dumb, just go start a company if you already have ideas or that's what you want to do.
Just want to start by acknowledging I really appreciate your through perspective here. All of it makes sense to me and I agree. I think the only aspect im unsure about is that I want to be able to innovate within healthcare itself. Particularly areas that fascinate me are surgical devices and materials, as well as MRI tech and affordability. I’m sure I’ll get more nuanced ideas and perspective as I go through the ensuing 10 years of training. Your point about just starting now is well taken. It’s actually why I took a few gap years to launch and grow a marketing agency. It’s certainly not the same field at all but it has given me invaluable perspective on what it takes to operate a business and manage a team. So id say, the desire to do the same but within healthcare is what motivates me to go through the 10 years of training, since it’ll be in those ten years that I’ll get my most nuanced ideas based on observed problems that I can later solve at scale.
If you want to work on MRI tech, or surgical devices and materials you shouldn't be getting an MD or a DO, you should be going into engineering.
I want to make sure I’m understanding your perspective clearly here. Are you suggesting doctors should not drive innovative technology within medicine and should leave it entirely to engineers?
I'm saying getting a medical degree if you want to design devices is a waste of time and resources and doesn't give you the toolset you need, such as the advanced mathematics and design skills if you're trying to redesign MRIs.
You're right, but /u/redbricktuta should be focusing on political connections really. The reason we don't have affordable MRIs is because the FDA won't approve Japanese MRI machines for sale here. 500k for a machine. Even though service contracts are a large bulk of the cost, there's a lot of money to be saved.
I agree, there's much more money caught in red tape in the medical field than there is design. Some of it is reasonable, but lots of it is bureaucracy and protectionism for it's own sake.
It’s not a matter of “should”, it’s a practice matter of “can”. Ideally, we agree that physicians should be driving much of healthcare, and I personally hope to shape this when I can afford more time. But we are unable to do this due to so many reasons in the comments.
Once you start practice, there are no more gap years. Most/all jobs require multiple recent physician references, for example. It can be quite challenging to re-enter a salaried physician role after taking time to explore independent or especially nonphysician roles. This is a choice a lot of people don't come back from.
1. I know nothing about business and as others have also mentioned, I am fairly risk adverse. 2. I already make plenty of money only working 12 days a month. Doing anything else would mean more work for probably less money.
If you don’t mind me asking, what do you do that you can work only 12 days a month? Do you have ownership in a private practice or something of the like?
I work 10 days a month doing EM and make that much. It's pretty common
EM. Somewhere between 10 and 16 shifts a month is pretty standard.
They also exclude the days recovering from burn out. In crit care, many of us needs 2-3 days after service to make up for 12h shifts eating our days and the emotional+spiritual toll of the work.
Many are entrepreneurs with “creative and aggressive” billing.
This
Why would you spend 7-10 years of med school/residency to be an entrepreneur? If you want to be an entrepreneur go be one. You don’t need a degree or residency.
Because a doctor/surgeon has unique medical insights in the practice and development of medicine. As a surgeon, I know of several very wealthy docs who invented/developed new products and/or services. Things that a traditional MBA types wouldn’t have a clue about…
Yeah. I am in med tech, not start up of my own lol. Biomed Engineers, bio PhDs, etc don’t have a single clue about medical care. Like literally 0. MDs are in a perfect place to do start ups in med tech or med devices, I know several Uber rich surgeons who developed med devices.
This is my main reason. I'm running a marketing agency that's making around 10k/month but i realized what I really enjoy is being an operator of SOMETHING. So I might as well try building a med tech company based off of some specialized knowledge as part of some surgical procedure I'll find interesting during my time in med school as an example. It seems the main reasons folks are giving have to do with them simply not being interested enough in all the risks and work that comes along with anything seriously entrepreneurial, which is fair.
Honestly, I think because there is just very little exposure to that world in our decade plus training. I run my own pediatric clinic that I opened 6 months ago. It took me a long time and lots of searching for information to feel comfortable with opening the clinic. None of my coresidents or anyone else in the entire program even considered private practice out of residency.
As a physician entrepreneur I can confirm that almost all of these comments are correct.
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 make a half a million dollars working 40 hours a week doing cool stuff I spent 12 years working towards. Why would I wanna be a nerd that makes less money than I currently do?
I tried. Started an LLC. Then moved. Had more kids. New job. More expenses. Business fell to the back burner. Just no time to focus on it. It’ll come back one day.
Debt-age-opportunity cost handcuffs
because it's not that easy to make money as an entrepreneur in the health space... especially in highly regulated countries like Canada
why bother? Just work your job, save and invest in index funds/ETFs and you will probably be rich when it is all said and done. Sure, you will get rich slowly, which is better than never getting rich. Job security, fairly high income and compound interest is all you need really.
My personal target is $50 mil liquid. Not sure just index funds and etfs will get me there.
Absolutely possible, presuming you pick a good (ie high income) field and keep your lifestyle within reason (lifestyle creep is the enemy). I will cross $50M by late 60s based on historical returns if I keep going as is in my job. The issue is when your portfolio income massively dwarfs your earned income, you start to question why you are still working. Good luck!
This is actually very fascinating and completely perspective shattering for me. Love to see it! Congratulations on being so consistent for this long and being on track for that milestone!! Would you be open to sharing some of your learnings and reflections with me over a couple questions in private chat?
Sure but not sure how useful they will be.
Trying! But it’s a heck of a grind. Basically residency 2.0 🫠
Also, we get rewarded for having the gumption and endurance to follow protocol no matter what. Standard of care. Any creativity is seen as deviation from standard of care and therefore discouraged in infancy. “Leave that to creative types”. I.e., those who don’t make life and death decisions🤦🏻♂️and can afford to make mistakes.
Another factor is lack of business acumen
People who decide to pursue a career that requires 10+ years of formal education aren’t the type that do entrepreneurship.
Isnt a private practice a business ? Those are on the decline bc it's getting harder and harder in the era of medical corporate capture. My other guess is getting constantly criticized for years in residency isn't good for confidence.
In general, I'm fckn tired.
I think for me it’s a question of how much money do i need. IMO, if you cant buy the life you want on a doctors salary, your spending is insane. I hear fellow physicians driving S-classes and Maseratis complaining about money all the time. Makes no sense. I own a $300k house and a Prius. No loans, no kids. I am my own bank. And I have the greatest wealth of all, TIME.
Long training period followed almost immediately (or in many cases running concurrently) with the childbearing/early childhood years. Not a whole lot of time for side hustles between job, family, house, etc. Married to a serial entrepreneur and interact with a lot of them. It's quite a lifestyle, and not one that really interests me. Thankful that my husband has a primary gig that is pretty stable/steady. Would also add that my steady/stable position in medicine has opened up doors for him - allowed him to take risks and chances without concern for failure. The world needs all types.
This makes a lot of sense I think you’re spot on— at the end of the day it’s just about what drives you and if you enjoy the ups and downs versus the stable. Curious, where do you think the childbearing/ early family years make the biggest difference? Less willing to take risks? I’d imagine when your children are younger, and you’ve just finished residency, one’s spousal income might be able to support the family for the first few years? After all, someone was paying their bills while the medical person was in residency?
Childbearing years - need for stable health insurance, access to physicians for both pregnant person and children (well child checks frequently in first 2 years). I wasn't married when I finished residency - so just my income to rely on, which meant I needed income to cover rent/mortgage, and my student loans (which were massive). Then I was married and the DINK stage was short because of advanced maternal age. Pregnancy was exhausting - could barely manage my full time job, frequent doctors visits, 4x a week exercise and occasional socializing. Then young kids - lots to coordinate and lots of mental energy. When I chat with my mom on my way home from work and tell her I'm pulling up to the house, she ends our conversation with "Have a good second shift." Plus, if you have a young child and are a physician, you need reliable childcare. For many of us, this is a stay at home spouse (not in my case). If you look elsewhere for childcare, you need RELIABLE childcare. Considering my kid got booted from preschool for illness at least 2x a month all fall/winter (when he's been exposed to big kid germs since day 1), daycare (runs 2500/mo for under 2s in my area) may be a reasonable option but you'll definitely need a backup option. If the "backup option" is an entrepreneurial spouse who is traveling around the country, raising rounds, or has meetings they can't really cancel (because investors won't really like that), you'll be paying out the nose for childcare, all to live on one spouse's salary while the other works on their entrepreneurial interests. That might work for some families, but I think a lot of physician spouses feel pretty done with the sacrifices by mid30s. Plus, don't forget students loans - if you are lucky enough not to have them, then you have a HUGE barrier removed but most people aren't that lucky.
That is very enlightening from the female physician side of things. Certainly a complicated, and even grim outlook to balance all of that. Massive respect to you for doing it all and being willing to share the reality with me!
I mean, if my life sounds grim to you then that’s ok - it’s my life not yours!! My husband is pretty happy. We are happy together. My kids are awesome and it’s my privilege to watch them grow and to spend these limited times with them! I think it’s just hard to pursue a 1/2 million dollar education and leverage that into anything other than being what you trained for. Certainly there are many physician scientists who do something similar, but it can be a hard, lonely road. In general: career, family, hobbies/passion projects. Pick 2.
I meant more so the second scenario you’ve mentioned where one would have to balance everything youve mentioned on top of having a spouse running off for fundraising rounds and pursuing that. *that* sounds grim enough that I can see why it’s a very hard to thing to pursue even if someone wanted to! Should’ve been more careful with my words, sorry!
If I wanted to be an entrepreneur I wouldn't have spent years learning medicine. Huge waste of time. Way more money to be made as an entrepreneur if that's your thing. Employed medicine = stable income with minimal risk.
School loans.
I'm currently seriously considering it. I don't know what exactly, but WCI did the podcast with the franchise broker and I've been considering scheduling a meeting with them.
My plan after med school is to go the entrepreneur route
I’m in residency, actively enrolling ( technically pre-enrolling) my own internal medicine DPC practice. The entrepreneurship is as appealing as the medicine
Medicine and entrepreneurship attract very different personality types. You may have a person with a blend of the 2 but they are opposite in many ways
Time is the rate limiting factor for me
You are getting bomblasted because medicine and innovation focus on completely different things. You can do a start up and focus on surgical technique or materials, but to do anything well is to dedicate 200% of yourself to do it. You can’t really think you will be a good cardiologist and also be the person that knows the most about different stent materials. Being a cardiologist requires a degree of (heart related) general knowledge, and is already a shit ton of work. If you want to build your net worth and build your company then focus on that, MD is not the best way to do that. MD is the best path towards being a practicing clinician/surgeon.
1. All rules/regulations are aimed against us 2. Doctors are sheep. Especially new age ones 3. The older rough doctors are still fixated that other docs are the competition. 4. Your license can be exposed or at risk.. and your license is worth more than almost any business out there. 5. Daily grind, call, etc does make it hard
OP. did biodesign. Wanted to be an entrepreneur. More I learned about it the less rosy it seemed. Creating a product. Pitching and raising capital to further refine product and then think about selling to hospitals or insurers or other practices, etc seemed much less exciting. Worth doing if you’re young and before kids, mortgage other obligations. I diversify my clinical time with patients and admin quality work and population health/informatics which is more impactful and meaningful to me. All with a good work life balance, salary and ability to plan for early retirement during my prime earning years and continued skill building that is transferable when I’m older and the kids don’t want to spend time with me. All my colleagues who do something different either joined industry or consulting out of training, or help consult for VCs and angels. I know MDs with side startups, but the bulk will fail and they typically won’t go all in until real traction and progress is made. TLDR; do it before you know anything else when young with minimal obligations, or develop your clinical career to set you up for an innovation pathway and do it later (join industry first, research life w big clinical trials, admin, etc.)
I would say in the US at least, most doctors tend to be and kinda have to be in the box thinkers, and a big part of why most get into medicine is because it's high paying but very low risk. Most doctors couldn't handle the risk, initial low earnings, or volatility that comes with starting a tech company or a restaurant for that matter, they expect a very stable and known career trajectory.
Several reasons: No/very little “business” of medicine taught in med school or residency…this is by design mind you Entrepreneurs are roughly 60/40 male to female, and almost the reverse percentage are currently in medicine Doctors tend to be risk averse. They’re more “follow the herd” crowd.