Physician Founders Outperform 3x: Curology's David Lortscher on Why Doctors Win

0:00Good morning, Tim.

0:00David Lortscher: Good morning. It's starting to feel a little cooler. Starting to go outside a little more. And I took my kids fishing this weekend to a local pond. Oh, nice. What did you fish for? Bass? Yeah, we got a little rock bass. Seeing my daughter catch her first fish, like, totally unassisted was an awesome thing. Amazing. The tug is the drug. It's like, definitely got a little adrenaline and seeing that fish flop around was, yeah, it was pretty awesome. When they come, when they surface and they just attack the bait or the fly, whatever you use, and it's pretty amazing. Yeah. It's almost trout season here, so they'll be stocking the streams pretty soon.

0:38David Lortscher: It's pretty exciting. Shenandoah. Make it happen. Yeah. Gotta love it. Should we do it? Let's do it. All right.

0:49Welcome back to Health Tech Remedy. This is the show where leaders in health technology break down the stories behind today's most innovative health companies, and we speak with those leaders shaping the future of care. I'm Trevor Royce. I'm a radiation oncologist and researcher, and I'm joined by my co-host, Tim Showalter. Morning, everyone. Today, we're doing something a little bit different.

1:07David Lortscher: We're going to talk with David Lorcher, the dermatologist and founder of Curology. But the center of gravity for this episode is actually his new book, Why Doctors Win, The Doctor's Guide to Creating or Joining a High Impact Startup, which I had the pleasure of enjoying during my spring break trip this year. Yeah, I mean, obviously, we're biased as physicians, but the kind of core concepts and themes here appeal to us as entrepreneurs and people in health technology with physician backgrounds and clinically active. obviously relevant to the show talks about the book and you read it so you can speak to this kind of more directly but you know what are the the key attributes or characteristics of physicians that may bring them specific advantages in this world of health technology healthcare startups and these entrepreneurial pursuits and healthcare broadly not just as advisors or medical validators or evaluators but actually as like core founders executives product thinkers operators the actual meat and bones of these people?

2:08How do they contribute uniquely to this environment?

2:10David Lortscher: Yeah, I mean, this book provides a lot of how-to perspective on choosing business ideas that will work and deciding which teams to join. I also think it's a good challenge for physicians. I mean, implicit in the title of the book is that a clinical perspective is really important to the success of any company trying to make an impact in healthcare. And of course, doctors may understand the problem deeply. But really, in order to make an impact, you've got to take an active role on some side of health technology or whatever your chosen path is, and really add to your clinical insights to become a part of the operating or strategic team.

2:54David Lortscher: And I think that's what makes David's perspective interesting. He really, in the Curology story in particular, I think, which is a good example for how physicians can make a positive impact in the space, he really had to redesign the overall care model. So it wasn't just about, you know, hanging up a shingle in the virtual world, but really going deeper to change the dermatology experience. Yeah, totally. And I think, you know, a key part of this is that clinical expertise alone, and this is something that we've chatted about, does not make someone intrinsically a good startup founder. You know, doctors could understand the problem deeply, but they still have to learn the market, the buyer, the business model, the regulatory path, the implementation burdens, and the speed that it takes to build a company.

3:37Just being a clinical expert, obviously, does not perfectly translate to being a founder. And there's so many stories of overconfident physicians becoming entrepreneurs that have not panned out. However, to your point, having the intrinsic qualities that made you a successful professional as a physician, having the drive, the wherewithal to self-teach and figure out a very complicated clinical landscape, obviously, those key principles and attributes of success translate and can translate very well to an entrepreneurial world. And then I think really where that differentiator comes is obviously the truly deep understanding of the clinical experience, the doctors who are often the customers, or the patients and their experience who are the other most common customer in health technology.

4:21Understanding deeply what those entities are dealing with truly obviously makes you have a better appreciation and guide as a product.

4:30David Lortscher: I love that. I think that's kind of core to what I took away from the book, which was that doctors and other clinicians should not necessarily view startups as something outside of the profession of medicine, but really as a way to extend impact. But in order to do it, it's like you've got to learn a new skill set. It's a new set of procedures. The field is evolving so much. And doctors can create them or join them or advise them, sometimes lead them. But to do that well and to have it be an extension of their medical careers, they need to translate clinical judgment into real business insights and operational competencies.

5:11David Lortscher: and that means knowing when to be precise and iterate on the problem and when to move fast. And I think it's really exciting to hear how he had a few ideas he thought about before Curology and ultimately how he landed on solving a set of problems that he took on. Yeah, totally. I think the Curology story is a great application of these concepts, obviously told through David's story and will be a good illustration of this entrepreneurial journey from the physician perspective and how they can uniquely contribute and ultimately have a successful business. So it'll be a really fun interview. Yeah, excited to hop in.

5:48David Lortscher: So listeners, stay tuned for our conversation with Dr. David Borscher. Let's do it. Thanks, Tim.

5:58David Lortscher: David, welcome to Health Tech Remedy. It's great to have you here. Thanks so much, guys. Great to be here. So you are a board-certified dermatologist, the founder of Curology, and now the author of Why Doctors Win, The Doctor's Guide to Creating or Joining a High-Impact Startup. And Curology is one of the most interesting examples of a physician-founded company that started with a specific access problem and you did it like right after your training, which is pretty remarkable that you sort of got on it right away. So we really want to talk to you about both stories, both the Curology side, as well as this great book that you've provided, The Field.

6:34David Lortscher: So really looking forward to hearing sort of bits of information throughout your life. So David, let's start with your own origin story. You know, we'd love to hear a little bit about your background and kind of how you came to be doing what you do. As I understand, you were practicing dermatology in New Mexico before starting Curology. We'd love to hear a little bit about how you got there, what you were seeing in clinic that made you feel the dermatology system wasn't working and take it from there. Yeah, so this was back in 2012. And it was that year that smartphone penetration in the U.S. had just passed about 50%.

7:04And so it was clear to me, and I think a lot of other people, like the way patients receive care was going to change over the next few years by a lot, right? And so one of the ways that was going to change is telehealth. And, you know, in New Mexico, I had many of my patients driving two hours to see me. You know, it's just one of those places where you do not have many physicians. And as I was looking for solutions to help these patients be seen without coming into the office, for a lot of the things, there was no reason they needed to drive two hours each way. I began to look into telehealth solutions.

7:33And so that was really the impetus for me to start thinking about a company in space. And what was the core problem in accessing dermatologists, the cost, perplexity of prescriptions, the consumer experience, all of the above, you know, and how was telehealth able to address some of that? Yeah, I mean, so it's two things. So one is just the remoteness of many people from medical specialists, which is obviously still a problem in the country. And then it was the cost as well. So as I was speaking to my patients, trying to help them find a telehealth solution so they could see me more easily, there were already about 10 to 12 dermatology telehealth services on the market.

8:12But as I was looking through them, none of them actually seemed to solve the full problem in my eyes. And the way that most of them worked at the time was that if you're a patient, you go online to see a dermatologist through one of these startup portals, and you pay$60, and a dermatologist will see you asynchronously, and then get back to you, prescribe medications, and then follow up with you as needed. And for many patients, that worked well. But for most of my patients, what I saw is that$60 to see a doctor was actually a pretty ridiculous cost. And they're used to having insurance cover everything.

8:45And of course, back then, insurance wasn't covering telehealth at all. And so the way that the business model worked for a lot of these telehealth companies is that they would pay the dermatologist 30 out of the$60, then the telehealth company would take home the other 30. and the sort of counterintuitive insight that we had was that$30, although it may not seem like much to pay a doctor for a consult, for this case was actually way too much. Like if you were able to design a process where you could see a patient in less than five minutes and yet make it a delightful experience, you'd be able to finally make this affordable for patients.

9:15And so you'd be solving both the problem of like how difficult it is to get to a dermatologist physically, but then also like making sure it's affordable for patients as well. Yeah. And I guess just to round this out a little bit in terms of Some of the unique features of dermatology, I mean, it's a very visual specialty and the acuity is such that maybe it lends itself well to telehealth. Is that sort of part of this contributing as well? Yeah, big time. Because you, yeah, as you're saying, you don't need to listen to a patient's heart. If you're a dermatologist, you know, you don't need to perform any procedures on them for the most part.

9:45So yes, it's especially with acne and many other things where you don't need to necessarily feel a patient's skin or do a biopsy. It lends itself very well to telehealth.

9:52David Lortscher: I'll just say as the father of teenage kids who like deal deal with this acne thing I think that obviously one one of the things that I would look for for the virtual care model it seems like you've solved it for this as well is just meeting people where they are on the scheduling side and not having to wait like months to get into a dermatology appointment I think we've all had that experience where like the dermatologist will see you but they'll see you in four months to there's a real like time to access problem. and having to miss school or take off work to do it is just where I see a huge opportunity.

10:26David Lortscher: Yep. Yep. Absolutely. Well, I want to get into a little bit about the actual nitty gritty of the Curology sort of care stack a little bit. I know that there's a lot of elements that are complicated, right? There's figuring out what are like personalized prescription formulas that are going to be there, like actually what's delivered, the teledermatology side. I think you dealt with compounding and what's the business model for subscription, you know, and how those get fulfilled. And then, of course, there's the standard business stuff like consumer branding, things like that. Tell me about the learning process for that.

11:01David Lortscher: Like what were things like when you started and how did they evolve over time? Yeah. So our business model stayed the same basically from day zero. So the business model that we pursued was a little odd and that a patient would pay us$20 every month and that would cover their medical care. And then it would also cover these compounded medications you're mentioning. And so part of the innovation back then was being able to see the consultations extraordinarily efficiently. And then we believe that if we were able to lower the price by seeing the consultations so efficiently, we'd have enough volume that we could make our own medications in-house.

11:33And so that's what we did. And by compounding our own medications and doing that very efficiently, we were able to get them the whole care package for$20 a month. And so the original focus was on acne. And these patients, many of whom were in their 20s or late teens, found this just to be an incredible value proposition. Because as you mentioned, you know, it's not just getting them the care on time, but it's also getting them the medication and then making sure that it's affordable as well. So yeah, that was the whole package. And when we launched, that was the exact business model and it stayed the same ever since.

12:05David Lortscher: That's remarkable. But I think there's also a story of all the extra work and creativity you had to apply to deliver that. So as I understand it, you basically did more than digitize the office visit. As you said before, there are other companies that had invented this, like, you know, had delivered this real-time patient-doctor visit built around a classic clinic schedule. but you really had to reinvent the workflow overall. So provider review, digital image review, personalized treatment and shipment. How did you decide in working with your care team what parts of the traditional dermatology experience to keep and which parts to rebuild or did you just remake the whole thing basically?

12:46Yeah, I mean, this is the part where being a physician, I think gave us a big advantage in deciding this new sort of care paradigm that we built for our company. and basically the part that I saw that we didn't want to keep was having part-time dermatologists see patients for us. I believe that we would never get to a really high level of care and a high level of efficiency if we had part-time dermatologists. So from the very beginning, the plan was we need to have doctors who not just know how to treat acne and be a dermatologist, but how to do that very efficiently on this specific platform.

13:21So, you know, from the beginning, I built these 300 different keyboard shortcuts where you take a dot and then three letters. And for every single like long tail use case where maybe some weird protein powder is causing someone's acne, I could just type like four keystrokes and the patient would get this concise but clear explanation of how to make their acne get better. And so by doing a little more work up front and by forcing every new dermatologist who came on to come on full time and then do that additional work to be able to learn how to do this efficiently, we were able to really, really decrease the cost for

13:54David Lortscher: consult while keeping the quality really high. Yeah, that's like an individual doctor can do a lot more, which affects your goal for the price, which is great. And obviously, a lot of these are operational advances. You're really getting into the weeds of the overall operation. be it, you know, the provider aspects, I'm sure the compounding pharmacy, logistics of fulfilling things, customer service queries, regulatory considerations. Which of these operational areas that you had to solve for were a lot harder than expected? Yeah, I mean, the thing that I still have nightmares about is trying to figure out how to compound the creams on our own.

14:31And I did not expect that to be difficult, right? Because as a dermatologist, I had ordered compounded creams for my patients with certain types of psoriasis or like certain types of cutaneous lymphoma. And it seemed easy. I just called the compounding pharmacy, they go pick it up and it may be expensive, but it wasn't that difficult to do. And I was very surprised when I realized like, hold on, this is not gonna work. We're gonna have to sort of reinvent it. And the main reason is that when I was doing initial research and I would call in like a combination acne cream to a compounding pharmacy, this is nothing they'd gotten a prescription for before, right?

15:01People didn't do these compounding creams. And so when I got it back, it was sort of weird, it was gritty, it would liquefy and it was not something that anyone with any self-respect would put on their face. And so I sort of was sitting there in my apartment in the kitchen for months and months on end, trying to figure out how to make these compounded formulations better. And so I had to learn way more than I thought I'd have to learn, like how to make different emulsions, whether it's an oil and water emulsion or water and oil emulsion and how to get the active ingredients micronized to be the right size to like suspend in the in the emulsion and and then you know also figuring out how do we make sure that these are not inactivating each other so working with like finding these analytical labs to like test them over time to make sure the ingredients aren't degrading and so you know that was a part of the business that i didn't really expect to go as deep on but it was probably like 52 percent of my time for like the first for the first 12 months at least That is really, really interesting.

15:58I'm curious, you know, now that time has gone by and I assume the company has changed and workflows have changed, how much of that is still a challenge for you all? Or is that a lot of that pretty much solved? Yeah, I mean, I think it's now it's a strength for us because we know how to like when we want to innovate with a new formulation or like move to a new use case, we know how to do it much faster than anybody else. And with the result that like works much better for the patient. So, you know, we have dozens and dozens of different permutations and combinations of formulations that we make.

16:30And so we can start somebody on a really gentle formulation and then as our skin gets used to it, we can, you know, start to give them something stronger. And so, you know, we really like honed that into a big talent for the organization. So our doctors know how to prescribe it. Our nurse practitioners know how to use it very wisely. And then our compounding pharmacy knows how to make it efficiently, but then also to build new creams as the doctors create demand for it. Very cool. Very interesting. Is that a big focus currently of Curology done today? It is. Yeah. I mean, we have a 50 ,000 square foot compounding pharmacy in Pittsburgh and it's, you know, it's a big core of our operations.

17:04Amazing. And I guess related to that, going back to something that you touched on earlier, you know, one thing that I hear a lot from angel investors or early stage investors, period, is like, I have the scar tissue to show for it, and I no longer invest in physician founders. What I'm hearing from your perspective is actually you found that to be quite a strength for you based on your lived experience as a dermatologist and like some of the science that it sounds like you really had to apply to solve some of these problems. Can you reflect a little bit on that? Yeah. When we came into market and there were 10 other competitors doing almost the exact same thing, right?

17:37Telehealth for dermatology, most of which had a focus on acne, just like we did. Almost none of those were founded by doctors. They were better funded than we were. They were started by people with much more business experience than we had. Right? I had zero. My brother had essentially zero and he was our co-founder and CTO. And the reason we ended up out competing all of those startups is because we did have that medical insight. So we knew how to provide good care while still questioning the way in which that care is provided. And I don't think with a doctor on the team, you could have done that.

18:05And so by the same token, we wouldn't have survived with a great tech person on the team. Right. So I think like just like having like a great CTO is a superpower as a founder, having a great physician, if you're a health care startup, is also a superpower. But you certainly wouldn't want it to be just one or the other.

18:22David Lortscher: Yeah, I'm curious, what did you, you mentioned you didn't have a business background before, although I know from reading your book that you were definitely very interested in starting businesses. But I'm curious, what were the hardest things for you to learn personally as CEO? I mean, the thing that I messed up the biggest early on was marketing. And I think it's so easy as a physician or anyone who's not a marketer to undervalue how important it is to tell the story well, both to investors and to customers. And so at the beginning, I really thought I was doing as good a job as I could to market this.

18:57It's like, let's go get opinions from everyone. Let's ask a bunch of friends. Let's A-B test things. but I did not put anywhere near enough the resources early on into getting a brand whose message resonated with consumers early on. I didn't know what a great marketer looked like, and so I didn't end up getting help from those people. And once I finally did, that helped change

19:19David Lortscher: the company's trajectory a lot. That's interesting. As you went through that process and learned about the marketing aspects and the storytelling, obviously your identity is evolving, right? Because you're like CEO, you're also a physician, you know, you wear a lot of hats. And I'm curious if there are things that you felt like you had to intentionally set aside or unlearn about being a doctor in order to be a great entrepreneur, or if you feel like it all connects together. I mean, I think the biggest thing is just as a doctor, you often feel like you're the expert, right? You're like, you have your team of assistants and nurses and you're educating the patient.

19:55And I think as soon as you start into a startup in any role, you want to let go of that idea that you're the expert. It's like, what can I learn? Who can I bring in to learn it from? And so I think that was the main thing you have to set aside. And like a lot of the most successful physician founders have really stepped into startups as a student with that sort of mindset.

20:12David Lortscher: Yeah, I just want to emphasize that that's what I've learned in my own experience as well. Like it's you, doctors are lifelong learners, right? We have to stay up on the current evidence, but also are used to being the experts in the room. And I think that's so spot on. Like, you know your area deeply, but you have to have a learning mindset and be open to new changes. That makes a lot of sense. This is probably a good moment to kind of shift focus more specifically or directly to the book. and I understand you wrote a book, David. Can you tell us a little bit about it? That I did. I mean, it was the funnest thing I've ever done.

20:47So what I realized was that as I stepped back and looked at the most successful healthcare companies, 51 % of the most valuable healthcare companies have a physician founder. And that was sort of mind blowing to me because Trevor, I had heard the same things to you of investors saying, oh, it's like, I don't really trust a physician entrepreneur, right? Doctors don't get entrepreneurship. And so I asked myself, if that's the case, you know, why is the single most valuable healthcare company of the last four decades, which is Intuitive Surgical, founded by a physician? Why is the second most valuable healthcare company, which is Gilead, founded by a physician?

21:18Why is the fourth most valuable? And all the way down to the point where 51 % of all of those top companies have a physician founder. And I looked at the healthcare startups overall, and it's only 17, 1-7 % of startups have a physician founder. So when you look at the rate of performance, physician-founded startups outperform by 3x. And that was sort of mind-blowing to me because it just went against the narrative of what I had always heard. And so what I started to do is reach out to some of my founder friends, especially in healthcare and especially physicians, and ask them, like, what has your experience been?

21:51Like, what have different people brought to the team and how have you succeeded as founders? And then I ended up formally interviewing 10 of these physician-founded startups and telling their story in my book. And the goal really is to tell younger physicians or people who might be interested in joining a startup or starting starting a company, what it's like to leave clinical practice for a startup. How do you tell if an idea is good, whether it's like your own idea or whether you're trying to join another startup? And then I walk them through these different 10 case studies. So companies like Viz, I know Tim, which you're well acquainted with, companies like Abridge, both physician-founded companies, all the way to biotech companies like Spark, medical practice companies like ChenMed, and tell those stories and find the common threads between them.

22:32And so really, the book I wrote is meant to be a guidebook for how physicians can get involved in startups in a way that sets the companies and themselves up for success.

22:41David Lortscher: And David, congratulations on writing a great book. I read it during spring break and it was really enjoyable, great stories. And I think a lot of important lessons for physicians who may be interested in getting involved in startups. And I'm just curious if you could share for the listeners a little bit of a perspective on how you evaluate ideas for companies and sort of how someone with a clinical background might approach evaluating a new problem or a new challenge. Yeah. I mean, the lens that I encourage people to look through an idea is one that was invented by Ben Horowitz, where he says, you need to have a transformational product, right?

23:23Like it needs to be a great idea. It needs to truly solve a big problem for someone. But then you also need to have a path to winning the market. And that latter criterion is something that I think a lot of doctors miss. You know, we sort of get this syndrome of believing if I build it, they will come. Right. And so what doctors might may do is like create like a gadget or a device or have some sort of software product that they believe is really great. But if you don't have a really clear way to how are you going to get customers, whether that is patients or whether that's hospitals, whatever your customer is, having that strategy is key to a startup idea being good.

23:58And so, you know, I take people through a couple examples in the book of like, you know, how did I evaluate the startup idea that became my company? And then how did I also evaluate a startup idea I had that I decided wouldn't in fact be a good idea? And I use that same thought process for all of the 10 physician founded companies that I interviewed and highlighted. And so really it's that idea of You need to have a truly transformational product, something that is clearly better solving a real problem than the next best option. And then you need to have a clear path to winning the market. Because if you're a startup and you're a number two, many or most of those number two players just don't survive.

24:35David Lortscher: That's a big lesson. Gotta win the market. There's this framework that I've been exposed to in the past from executive coaching about playing to win. And it underpins a lot of that idea, which is that you really, when you're taking on a problem, you want to have a strategy that will get you to win in the game that you're playing. And I think your framework really provides physicians a reference point for that. Yeah. And I think it's interesting to look at some examples because, you know, a lot of a lot of the path to winning the market comes from your insight as a physician. So like if you look back at the early days of Abridge, like they were one of the earlier companies to AI scribing, but not the earliest.

25:16Right. Like at some point they came out with this really huge lead. And when you look back to why they were able to do that, is that Shiv, Abridge's CEO, who is a physician, he's a cardiologist, he did not take like this sort of traditional path of like, let's start working on software to be an AI scribe. He had this view that doctors are going to be really hesitant to adopt a new technology unless it's almost perfect. So what Abridge did first is launch a patient-facing app that just helped transcribe doctor conversations. And so meanwhile, while all these other companies are trying to build this AI scribe, what Abridge did is build a patient-facing app.

25:51When patients had a much lower threshold for using something, they're like, this is free, this sounds great, I can bring it to my doctor's appointments, and then I'm going to get a great summary at the end. And so by using this counterintuitive insight that he knew that doctors wouldn't actually use something unless it was perfect, they actually took the way that appeared longer, but it actually gave them their route to winning the market, which was a better product because they were able to get all this data, all this audio data, and all this experience before the other companies were. That's a really powerful example.

26:20I like that a lot. I guess I'm going back to the product idea from a unique strength of physicians and those that are thinking about their own startup. How can that doctor that say, oh, this is a good idea, truly connect the dots to separate these problems in their daily life as a physician that are just annoying versus those that, aha, this is a venture scale company, this is a venture scale idea. Can you reflect a little bit on that based on the things you saw in your book? Yeah, I mean, I would say that the most critical thing is your own research process at the beginning once you have the idea.

26:57And it's a little abstract to say how do you research a good idea. So what I do in the second part of the book is take people in depth through my own research process. And I give an example of an idea that I believed was good, but after I researched it enough, I changed my mind and I said, I don't think this will be a big startup. And, you know, so the idea I had was if you combine these different antioxidants and supplements and take them as an Asian person who can't metabolize alcohol, this will help nudge the enzyme that metabolizes acetaldehyde into functioning correctly. and all of a sudden you won't be sort of the outcast who can't go out for a drink with your friend.

27:35You'll be able to metabolize alcohol. And a lot of my friends who were Asian were like, holy shit, this sounds like an awesome idea. I would totally buy this. But the process I went through was to see not just is this a good product. And I walked people through that in the book, how do you do sort of a really cheap study or inexpensively find out whether the product was good. But then I had to research how do we win the market, right? And what I learned in that phase is that in order to win the market with a supplement product, you have to have something that is really, really special and probably has a distribution advantage.

28:09Because all of these ingredients that exist, we can't patent, right? These are different supplements. These are different antioxidants that have already been on the market. There are these big, big, huge conglomerates with all these vitamins that have great placements in 7-Eleven that if our stuff works, they're just going to be able to repackage it with their own label and we're not going to win. So even though when I tested this out with my friends who had this problem, they were like, this is amazing. By doing the research process, I realized there was no way to win the market here. So I elected not to go with that idea.

28:38David Lortscher: That's a great example. I'm curious about extending that directly into healthcare delivery. I think there can be situations where a physician purely understands the clinical need, what's the problem for the patient, what's the frustration for the physicians, but there can be all these really important issues related to reimbursement incentives and workflow adoption and implementation, things like that. How do you think, how do you recommend physicians approach translating some sort of a clinical signal or clinical idea into a real business model and sort of considering all those complicated considerations?

29:15David Lortscher: Yeah. I mean, I think the perfect recipe for doing that is just the history of the company Viz and Viz.ai. And, you know, so when, when Viz launched, they were not among even the first 10 or first 20 companies trying to do AI for radiology. But a few years later, they emerged as the clear leader in the space. And the reason they had that success is because their physician founder, Chris Monsi, he took his go-to-market knowledge and did something much different than all the competitors did. So let me tell you what he did. So, you know, the competitors in the AI for radiology space, they're like, okay, we need a really great ML engineer from Stanford, whatever it is.

29:54We need a really great radiologist. We need a bunch of data. And we're going to build the best possible AI for radiology. The problem is 20 different companies were doing that and none of them, and especially at the time, like back in 2016, were able to get significantly enough better than a physician that is worthwhile for anyone to use them. So what Viz did is it said, we're going to make our business model and our go-to-market plan our strength. And so instead of saying, we're just going to build the most powerful AI, they built it in to the workflow of a patient presenting to the ER with a potential huge stroke, like a large vessel occlusion stroke.

30:28And they said, as soon as a patient goes through the CT scanner to look for a stroke, the Viz algorithm is going to start trying to detect it. And if the Viz algorithm detects a likely stroke, it will automatically, through the app, like notify the neuroradiologist on call so he can read the scan and verify whether this is actually true. It'll automatically notify the neurosurgeon on call or the interventional radiologist. It'll automatically notify the ER team. And right, because every minute counts when you have a big stroke like this. And so Viz, even though their model was not necessarily any more accurate, right?

31:00They have the same 95 % accuracy everybody else did. They built this super valuable clinical workflow that solved a real problem. And what they ended up seeing is that patients who came into the ER with an LBO stroke, instead of taking an average of like two to four hours to be in the OR and having the stroke relieved, they were in the OR in 30 to 60 minutes. So they were literally saving lives and saving brain cells because of the go-to-market strategy that they implemented. And that really came from not just the founder's experience as a doctor, but the fact that he was in hospitals talking to doctors, building from his own experience, building from their experience, and really just solving the whole problem.

31:38David Lortscher: Yeah, and David, David, thanks for plugging Viz. Chris is my boss, actually, at Viz.ai, and he's got a fantastic story. And, you know, that still shows up in the time is brain and patients first focus for the company. And I think it's really about solving the problem, which is getting patients access to treatment faster rather than just finding the stroke. You know, so it's about all the downstream stuff, which is great. We're obviously in this moment in healthcare AI and it's extremely dynamic right now. And I'm sure there are a lot of physician founders out there who are thinking about how they can make an impact within healthcare AI and yet it's moving really fast.

32:15David Lortscher: It's a dynamic space. Where do you feel like physicians are most needed in this next wave of innovation? I think the place where it's easiest to slot a physician in is as a founder at a great high potential healthcare startup that doesn't already have a physician founder. Right. And I think that like as like if you're if you're like a really sharp Stanford engineering grad and you have this idea, you can make life so much easier on yourself by hiring a physician to help you with a go to market with all the medical details. And it's really not possible to get that level of medical insight without a physician founder on the team.

32:49And like, you know, I use the example of my own company where all these other telehealth for dermatology startups, they had physician advisors, right? They were more prominent dermatologists on their team than I was, but they failed to completely rework the work, rework the workflow because it wasn't there. It wasn't their passion project. It wasn't a full time job. They weren't completely dedicated to it. And so, you know, having someone who is a physician helping you like question those assumptions is great. And so the question for doctors is like, how do you find those startups? Right. Right.

33:18And so you need to get yourself out into the world to find the people that you can help as either the first physician hire or a physician founder. And like a lot of the people I've seen do it, you know, I list all the examples in my book of how each of these physicians got into the startup world. For two of them, it was by getting an MBA. You know, like that's not the most common route, but some people do it. For two of them, it was working at a health tech incubator. Right. So, you know, at Stanford or at Pitt, they have these health tech incubators and they need doctors to help mentor people with their startup ideas.

33:43For some people, it was blogging or speaking and getting your name out there, like saying what you think is wrong with health care. For other people, it was like just getting their hands dirty and building an app. And obviously, that's much easier today than it ever has been. So there's lots of ways to get yourself involved and to start learning, not just like in depth in your own field, but building that like T-shaped expertise. Like you have the vertical line of the T's, the depth of the expertise, like the horizontal line, the more you can get breadth of expertise as well by seeing different companies, by learning a little bit about business, by learning a little bit about marketing, other areas of medicine.

34:17That's sort of what creates these serendipitous opportunities to join a great company.

34:22David Lortscher: I love that. And like for the T shape, there's part of the T that goes deep, right? So you got to like, you're describing build, operate, deeply advise, get really embedded in the workflow and really get entrenched in solving the problem. And I think to have a meaningful impact, you need to get a little bit deeper than just taking periodic advisory meetings with startups. It's really about like rolling up your sleeves, founding your own thing, getting involved, you know, really in areas where you can make a true impact on the overall company and ultimately on healthcare. Yeah. I mean, the most you could learn, like you said, going deep of like, if any doctor can afford to take a year off and just like take an unpaid position at a great startup like Viz or Abridge or whatever it is, I mean, the amount you will learn is just going to be incredible.

35:04Yeah, so true. One last question for you before we kind of move to wrap. And it's been really, I really enjoyed this conversation and the wheels have been kind of been turning. You know, things are moving so fast in technology now. And that's true in health technology. Your book came out, I think, in October of last year. I'm curious, is there, what was the chapter that you wish you had written in there or almost written or some story that you wanted? Now, having reflected on this and gone through the book, was there something that, oh, for my next book, I want to tell this story. Is there something that rings true that this fast-moving world of AI and startups that would be your next story to tell?

35:40I think that a chapter that's missing is on the positive impact that all of these startups have had on patients. And, you know, it really is insane just how much more access to health people have today compared to even five years ago, but especially 20 years ago. And then looking forward for the next 10 to 20 years, I mean, this is going to be an absolute positive revolution for patients in the healthcare space in terms of like finding conditions earlier, treating them more effectively. I think, you know, treating them more cost effectively as well so more people can access it. So I think really, really just the stories of the impact on the patients is one that I think I want to tell again soon.

36:21Fantastic. Thanks so much, David. It's been a terrific conversation. David Lortcher, founder of Curology and a new book out, Why Doctors Win. Last I checked, it had five stars on Amazon and Goodreads. So for your physician listeners out there, you should give it a shot.

36:34David Lortscher: Thanks, guys. Listeners, go out and read the book. It's great.