

Ask HN: Don't want to be a doctor - What should I do with my MD? - jasonz

About me:
I am entering my fourth year of medical school.  I have come to realize that I do not want to continue on with my medical education to become a practicing physician.  Upon graduation in May, I will be looking for new career opportunities.  Currently, I have been working on a couple projects in the radiology department related to computer programming (and have been loving it).  My two favorite sites are HN and techcrunch.  I am open/excited to try out new options.  Speaking generally, I believe I would be happy working for a company/startup with even a remote connection to the healthcare industry (so I can leverage my knowledge base).  Ideally, I would be a part of a smart team focused on rapidly iterating solutions to problems.<p>Questions (because HN has the best advice):<p>What other career paths are available to MDs?<p>Do you know of any companies that need MDs?<p>Do you have any experience working with MDs?<p>Do you have any other advice for me?
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rdl
For a couple years, I've worked for a company founded by an MD ~20 years ago,
doing PACS (Radiology IT system; basically how X-Rays and CTs and MRIs get
distributed within a hospital, viewed by doctors, archived, and sent between
sites; my particular client is the US military in
Iraq/Afghanistan/Kuwait/etc.). The founder is an MD (Ortho), but I don't think
he's ever practiced medicine. I would probably say he's a better businessman
than 99% of the MDs I've met, but probably would have been a worse doctor.

Generally, the perception of MDs in business, especially outside medical
startups, is that they're horrible. First, they're usually convinced they're
the smartest in the room, and even if they may be, that they're also the most
knowledgeable about any given domain -- even if they have no idea about it.
They often end up involved in mediocre small businesses, taken advantage of in
scams, etc., due to being rich and bad at business.

They're also super-expensive; education and debt. The best are probably
military doctors who leave after their first tour, but even then, they're
mid/late 30s.

Within medicine, having an MD as the medical interface of your company (could
be CEO, could be bizdev, could just be a chief medical officer) is essential.
One of the factors limiting medical IT startups is that they're really just IT
startups with some additional hassle, but the pool of suitable MDs willing to
work in a startup is low.

I think there are a lot of great opportunities in medicine: the
PACS/Telemedicine field is open (especially for consumer-facing systems, or
for SaaS); various forms of automation (pharmacy, EHR/EMR, lab, etc.) exist,
but generally have been developed by large companies and aren't as well
engineered as one would like, or as innovative -- the long product cycle,
conservative buyers, and FDA regulations slow this, but the effect is greater
than this can explain. Probably the best opportunity for disruptive innovation
is direct, consumer-facing health, especially in less or unregulated areas.
Scott Adams (Dilbert)'s idea of passively monitoring one's daily life, then
when you get sick, go back and look at the previous N months of data archive
and identify causes or lifestyle issues; then do statistical analysis across
people, is one idea. Providing better realtime advice and decision support
about things with health impact (diet, exercise, various drugs, ...).

I guess the most relevant question is about you -- aside from liking
HN/TechCrunch, and being an MD, are you someone who wants to code? Work on
hardware? Business? Do you like quick/simple projects, well-funded low risk
big projects, or true startups? Are you location-specific at all?

If it were me, if I didn't have 100% answers, I would probably try to intern
or contract/consult with a variety of companies or projects, just to get a
feel for how they work. Founding a startup is a 5-10 year project, so spending
a year figuring out exactly what kind of startup, or if you want to do a
startup at all, is probably worthwhile.

My next project is actually an IT infrastructure thing, which has healthcare
and defense as primary markets.

~~~
jasonz
Thank you for the response - I very much appreciate the advice.

To answer some questions: I definitely want to be involved in the coding and
technical aspects of a company. If I had to pick it would be a startup over
the lower risk/higher stability of an established business. I would choose
software over hardware due to the length of the development/approval cycle and
the fact that I very much enjoy the creative process of coding. I'm flexible
about location.

I agree that there are a ton of great opportunities in medicine. For the past
18 months I have been on clinical rotations and have quickly realized how
poorly the current model of healthcare functions. Far too much time is wasted
on tasks that distract from providing better patient care. These pain-points
and inefficiencies could be easily addressed with simple software solutions. I
truly believe that the talent on HN could change the way medicine is
practiced. We could decrease the number of deaths due to mistakes (estimated
~100,000/year) and increase doctor/patient satisfaction.

I find the current enterprise software used in the hospital to be the most
frustrating. The modern patient is a data-generating machine, yet we still use
outdated programs to manage these patients. It's not customized to the
clinical situation. It's ugly. It's unintuitive and difficult to use.

I'm interested in improving healthcare from a tech perspective. Providing
better analysis and visualization of data. Creating a collection of tools that
make everyone's job in the hospital easier. From my perspective there are a
bunch of situations where the solution is an adaptation/translation of an
established technology from outside the hospital.

3 examples - (I have a huge list):

1\. a twitter/yammer/googlewave-like application that would be patient-centric
and keep the whole healthcare team up to date on the management of the patient
(a new member to the team could easily be brought up to speed on a patient)

2\. a panic status board application for the inpatient consult service (once I
call the consult I have absolutely no idea where they are in the proces -
sometimes for days)

3\. a stackoverflow/wiki on location-specific hospital logistics and
information (I can never remember all the details of ordering a rare
test/procedure - plus it would accelerate the learning curve for the new
residents/staff each year)

ps - as for your assessment of doctor's egos, you're definitely correct (you
should see what happens when you put 20 or 30 in a room together).

~~~
rdl
Your 3 examples are great, but they often end up being huge amounts of
consulting -- you need to integrate with the quirks of how the specific
practice works, and whatever hardware and existing systems they have already.
A lot of this is related to insurance as well.

I think huge conglomerates like Kaiser, which provide insurance and care
through a single network, could go a long way to improving healthcare IT. At
some point, they become big enough to actually become a device manufacturer,
software developer, etc., or at least to allow a single product to take over
their entire practice. It would almost make sense to have an IT-focused
medical hedge fund which develops a great IT system, then goes around and buys
practices in strategic markets to convert to the IT system; sort of like the
medical borg.

Mobile interfaces to existing EMRs would be interesting -- either within a
hospital, or for consults outside. Being able to quickly check and see where
someone is in the process would be great. The problem is this either requires
huge amounts of customization to work with existing workflow, or adjusting
workflow. Radiology with PACS is really the only case where workflow has been
totally changed by IT, and that was mainly to allow perhaps the laziest
specialists of all to work from home or the beach.

------
earle
Jasonz: I have a startup in the medical field I'd like to talk to you about.
How do I contact you directly?

EDIT: I should add, I was the co-founding CTO of Hotjobs.com, amongst other
things -- this isn't some mickey mouse thing.

~~~
jasonz
hn.jasonz (at) gmail - would love to talk

------
HappyCamperz
Get a job for a company that sells alternative/homeopathic/naturopathic
therapies / remedies.

It lends creedence to the placebo effect :)

seriously.

~~~
rdl
I think it would be difficult morally for a doctor to do that. "Do no harm",
and all.

The most soulless way for an unethical MD to make money is probably to work
with insurance companies to deny coverage, or work with lawyers to either
award or defend cases, in cases where the medical science and financial
interest don't align.

------
newobj
How about <http://www.myca.com> ?

~~~
jasonz
very interesting - thanks

