An Alternative Journey to Physician Entrepreneurship

Published - Written by Mario Ramirez, MD, MPP

My Journey

After reading through the other posts on the Physician Innovation Network, I think there are some common themes that stand out.  Most notably, many of those working in the innovation space today had an early sense in their career that they wanted to pursue something different—something nontraditional.  My background has some similarities in that regard.  While I didn’t come from a business or finance background, I started down a path that combined clinical medicine with international affairs and national defense when I was in medical school.  After finishing my emergency medicine residency, I left academia to join the Air Force which was an incredibly pivotal experience in my life.  After a combat tour through Afghanistan, I was fortunate to continue serving as a White House appointee on global affairs and emerging infectious diseases at the U.S. Department of Health and Human Services. When I left public service to return to civilian medicine, I had a better sense that trying to create innovative solutions to really hard problems was an important professional interest I had developed.  While I loved the day to day act of caring for patients, I also shared the frustrations of the status quo and the feeling that we needed to fundamentally change our approach to certain health problems if we were going to make true progress.

As an ER physician, the opioid crisis happens to be one of those really hard problems that touches my life on a daily basis—having seen its effects first hand in both the veteran and civilian communities, I knew it was something that I wanted to work on.  So, when I went back to a full clinical practice, I decided to leverage the flexibility of an ER work schedule to also accept a part time position as the Chief Medical Officer for a startup company named AffirmHealth that had built a software solution for physicians and patients to safely manage their opioid prescriptions.  While balancing a clinical practice and working at a start-up is labor intensive, it’s been very personally rewarding to see the company grow successfully while improving patient safety.  My role as the CMO at Affirm has been to provide insight into the clinician workflow and decision making so that the products we build have true clinical utility.  In addition to my work at AffirmHealth, I also now work as the Chief Medical Development Officer at Briovation, a health innovation fund in Nashville that invests in startup health companies each year and hosts an annual health innovation festival named Health:Further.  In my position at Brio, I have the chance to provide clinical due diligence on potential investments, many of them digital health innovations, as well as shape our content at Health:Further each year. 


An Interest in Digital Health

In my opinion, we are approaching an inflection point in American healthcare.  It’s difficult to foresee a future where we can continue spending as much as we do on healthcare without realizing better health outcomes in this country.  When we look at the issue on a global scale, however, the opposite is true—achieving the most basic of global health standards would still require significantly more investment than the world makes now.   I’m hopeful that the digital heath revolution is one way we can overcome these disparities.  Never before have we had access to more information with so much opportunity to extract data at a relatively fractional cost.  Similarly, digital health offers an opportunity, whether through telemedicine or clinical decision support, to extend data driven healthcare into new communities that have not traditionally had solid access to good care.  As physicians, I think that any tool that allows us to achieve those goals should excite us.


Opportunities and Challenges in Digital Health

Any clinician who has worked with an electronic health record would likely have mixed feelings about the experience.  In a way, EHRs are the perfect example of the good and bad that go along with digital health.  On the good side, they can present data in a more efficient and searchable manner that improves patient safety—having gone through training just as records were switching from handwritten to electronic format, it actually seems crazy that we used to practice by writing illegible notes to each other on paper.  The problem with EHRs, however, is that they have fundamentally changed how we practice medicine.  There is an incredibly steep learning curve that goes along with learning new systems that seem to be implemented every few years, and most negatively, they have anchored the physician to their computer which can have a significant impact on the doctor-patient relationship.  We now spend more time with our computers than we do with our patients which runs counter to why so many of us entered medicine in the first place. 

Unfortunately, digital health as a whole is no different.  For all of the benefit that goes along with “big data,” resource management, and clinical support, we frequently have to trade the personal side of these interactions.  In a way, our patients become electronic records instead of living, breathing human beings. When we see them on our computer screens, we trade the ease of these electronic interactions for the sometimes difficult but personal touch that is the art of medicine.  I think the greatest challenge for digital health is finding a way to make medicine human again.  If we can achieve that, then we’ll have fully realized the value in the digital health revolution.


Advice for Others Interested in Health Innovation and Entrepreneurship

Whenever I think about this, I always end up back at a point not far from where I started.  For all sorts of reasons, practicing medicine today can be very frustrating.  The problems around burnout and job satisfaction are real.  But for all of its imperfections, it’s still an incredible opportunity that we have as physicians to enter the very private lives of our patients and try to make them feel better.  There are few other professions that afford such an opportunity on a daily basis. 

My advice to others thinking of entering this space is to approach it from that perspective.  Don’t do it for the financial reward or any other reason—statistically speaking, it’s much more likely that a new venture will fail than be successful.  But if you invest your energy in developing new solutions that leverage your clinical experience to truly improve the care we deliver, then the work becomes less about the hours and the effort, and more rewarding both personally and professionally.