Disrupting healthcare job hunting, with Incredible Health’s Dr. Iman Abuzeid

0:00Scaling a business in the US can feel like a maze. Each state has its own payroll, benefits, and compliance rules, pulling your focus away from growth, which is why founders use Deal. Deal is the professional employer organization, or PEO, that gives you a dedicated HR expert, plus Fortune 500-level benefits for your team. The National Association of PEOs says businesses can grow twice as fast if they use one. So, if you're scaling, make it simple with Deal. Go to deel.com. slash MOS and get up to three months free. One of the patterns I've seen over and over and speaking with successful founders is this.

0:40They don't wait for HR problems to show up. They build solid systems early on so their company can grow without tripping over itself. JustWorks is one of those systems. JustWorks is the human resources platform that helps you scale without sacrificing your team's needs. It handles automated payroll, benefits, compliance, even international hiring, so you can scale your team without slowing your momentum. JustWorks secures your hiring systems so they don't cost you time, money, or people, which is how you scale with confidence. JustWorks for your people.

1:22Founders are very good at just going straight to execution. It's almost like a boat leaving a harbor. Like, you want to make sure you end up in the right place instead of ending up randomly in the middle of the ocean. Dr. Iman Abu Zayed's first startup fizzled out and left her stuck in the middle of that ocean. But the lessons she learned led her to an undeniable North Star in moving forward. That North Star? Listening to the pain points of her customers. We spoke with nurses and really heard the urgency in their voice. So it's almost like an emotional experience for them in terms of just the problems that they're tackling.

2:00Iman saw an opportunity to disrupt the way nurses get hired that would benefit everyone involved. That's why she co-founded Incredible Health, a marketplace for health care professionals. Incredible Health now boasts more than one million health care workers on the platform and has reached a valuation of nearly$1.7 billion. You got to have incredible talent at every position. It's like this huge push. There are fires burning when you're going home. Can you believe it? Such an idiot. And then you go back to, this is totally going to be amazing. There are so many easy ways. I have no idea what to do.

2:39Sorry, we made a mistake. But you have to time it right. Oops. Working out of a three-bedroom apartment. Stuff that just seems absolutely nut balls. Ten years later, we're like, well, that's just how you do it. We haven't made it just how you do it. This is Masters of Scale. I'm Jeff Berman, your host. This week on the show, we'll hear how Iman Abu Zayed's strategic approach to scale fueled the massive growth of incredible health. But first, we wanted to hear how she ended up getting bitten by the entrepreneurship bug after graduating from medical school. Iman, welcome to Masters of Scale. Thank you so much for having me.

3:24We're thrilled to have you. Like so many of the founders and leaders who have scaled companies in extraordinary ways, you're an immigrant. You didn't grow up here. Tell us a little bit about where you grew up. Sure. So I'm originally from Sudan. That's where my parents are from. I lived in Saudi Arabia and the Emirates and the UK. I immigrated to the U.S. when I was 24 years old. And I, you know, worked in management consulting in New York City and then moved to Philadelphia to do my MBA at Wharton and then moved to the San Francisco Bay Area to work in tech. The paths out of management consulting are many.

4:03There are varied paths. Going down an entrepreneurial path is not what a lot of management consultants do. It's taking on the risk yourself. It's having to give yourself the advice that you might be giving to others as a consultant. What inspired you to become an entrepreneur? I went to medical school in London, so I'm an MD by background. And if we just go back to even that time period, I was always interested in having a big impact. Don't get me wrong. Like working as a doctor is a wonderful career. and I recommend it to everyone. However, I really wanted to find a way to make an impact on a much larger scale.

4:36So after medical school, moved to New York, worked in management consulting. The benefit of that profession is that it just, A, I grew a lot of skills and B, just exposed me more to business. And then certainly the MBA at Wharton helped me do that even further. But for entrepreneurship, I genuinely believe, I think entrepreneurship is one of the, it's like the epitome of what you can do with your career in business. Like it's, I think it's amazing. It's like, imagine like a small group of people can transform an entire industry. Like it's magic. It's like the coolest thing. So I was always just trying to find ways to get there.

5:06What led you to move out to the Bay and how did you end up starting on an entrepreneurial journey? So I have a belief that the San Francisco Bay Area is still the world's capital of technology. If you want to start a company, especially a software company, it still is the best place. And that's for so many reasons, right? the capital, the talent, the ideas, you know, the network. Like it's just a really amazing place to start a company. So I knew I was finishing business school in 2013. Like there was only one plan, moved to the Bay Area and joined as a product manager at an early stage healthcare technology company.

5:44And that's really where I got exposed to software engineers and data scientists and designers and got to learn what it takes to actually build products that users love and how to grow them as well. And so after doing that for a couple of years, Left with a star software engineer that I was working with, Roan Portlock, who is a total whiz, went to MIT. He's a fantastic engineer as well. And we left to co-found a company. That's not the company you now have co-founded and you're running. What was that company? Yeah, so we actually started working on another idea. And we worked on it for about a year, which didn't actually work.

6:17It was actually an app that helped small and medium health care businesses like chiropractors, physical therapists, you know, so on, retain their clients. So it helped them, you know, engage with them between sessions and so on. And so it was live. There was revenue coming in, but we were really struggling with growing it. And so we made the decision after, gosh, a year of working on it to pivot to a different idea. And so just take us back, if you would. You and Rome are at a fairly early stage company. How does it come to be that you leave and start a company together? What catalyzed that decision to do that with each other?

6:50I'm a big fan of thinking through, well, what is your goal in five to 10 years and then work backwards from there? So I knew at age, you know, in my 20s, like, hey, I know I want to start a company. So what's the path to get there? You know, one path is get to the Bay Area. Another path is start, you know, you don't have enough skills. So like become a product manager first, you know. So all of that, that was like the ultimate goal at the end of the day. And then Rome, I encouraged him to join me on the journey. I don't think he has any regrets around joining me on this journey. Well, given where you are today, I have to imagine not.

7:21So, okay. So you all are working at this other company. You come up with this idea. Do you start working on it while you're there or do you all leave, burn the boats behind you and say, we're doing this and we're all in on this concept. We're going to go build a company. We left. So we were working on a company full time. Now, one of the things that happened around that time is joining a team called NFX. NFX is today, it's a seed and series A fund. At the time, it was a fund plus an accelerator. And so we joined their accelerator program. And that is actually where Rome and I just made the decision to pivot.

7:56And it was great to work with, you know, James Currier and Pete Flint and Gigi Weiss-Levy in terms of figuring out what to do next. And so they were awesome thought partners as well. Had you all raised money against the initial concept or were you bootstrapping it? Where were you in your process? Yeah, we were bootstrapping. We didn't raise, you know, meaningful capital until we started incredible health. What was the point at which, as you were in the NFX Accelerator, you and Rome looked at each other and just said, you know what, this really isn't working. There's a better idea. Take us through, like, was there an inflection point where that happened?

8:29What happened there? So essentially, we'd been working on this idea for a year. It was called Lift League, by the way. Fundamentally, we, you know, came to the conclusion that small business owners didn't necessarily prioritize or care as much about retaining customers as they did acquiring customers. And our product only helped with retention, not acquisition. And so based on that, we were like, hey, let's just cut bait and change the idea completely, which I came to understand is actually very common in Silicon Valley and in the Bay Area. There's so many companies today that were major pivots, like Twitter, like Slack.

9:05Those founders were working on completely different ideas. Yeah. So the decision to pivot when something isn't working is one thing. what to pivot to is a whole other matter. What was the idea for what is now Incredible Health? And what was that moment where you go, oh yeah, that's the thing that we need to go do? So one thing that we did at the time was really put together a much stronger ideation framework. And honestly, this is like probably advice I give to a lot of founders. I think founders are very good at just going straight to execution, but sometimes we've got to think through our ideas to make sure we end up in the right place.

9:40It's almost like a boat leaving a harbor. Like you want to make sure you end up in the right place instead of ending up randomly in the middle of the ocean. So what we did was, you know, part of this framework is when you have an idea, really think through the market size, think through the competition, and then think through your unique insights. Like what have you figured out that is 10x, at least 10x, you know, smarter, better, faster, cheaper, more compliant, whatever it is, than what's already out there. And then after that, if it's meeting those three criteria, market size, competition, and unique insight, then go really deep on the market research and the customer research.

10:15So we did that with a few ideas and ultimately decided to go with the incredible health idea to share a bit more about our thought process at the time. The healthcare industry is the biggest labor industry in the country by number of workers. So one in eight Americans works in healthcare. it's also an industry where we have tremendous huge labor shortages right like our demand for health care as a country keeps growing our population is aging it's putting more and more strain on the u.s health care system and we as a country have not done a great job of increasing the number of health care workers to meet that demand so we were very familiar with that huge you know supply demand imbalance as far as just like what else is out there you know it's primarily just job boards which is you know technology from 20 plus years ago which are very tough when there's big shortages, you know, because from an employer perspective, you know, you're posting a job and hoping all works out, which is really tough when there's huge shortages.

11:08And then similarly on the talent side or on the candidate side, you know, the healthcare workers were saying, I apply to 10 places. I usually don't even hear back. Right. So there was a few unique things that we did with Incredible Health that we believed it was at least 10x better than what's already out there. One was having employers apply to the talent instead of the other way around. So we really flipped, you know, flipped the script, flipped it around instead of waiting for healthcare workers to apply to employers, have the employers apply to the healthcare workers. We also worked on automating the matching and automating the screening because of where software was at that time.

11:40And still today, I mean, there's just, we have the ability to do that at scale. And so those are some of the initial insights. And so ultimately decided to pursue the idea based on that. Of course, we did a little bit of customer research too. We spoke with health system executives, we spoke with nurses and really heard the urgency in their voice. It was almost like an emotional experience for them in terms of just the problems that they're tackling with hiring in general. I imagine that part of the advantage of the pivot also was you went from pitching software to thousands upon thousands of prospective customers who were not all that practiced in evaluating new software systems and what have you.

12:17And all of a sudden you're pitching like Kaiser, you're pitching huge healthcare companies that have this massive need for talent and we have a talent shortage. So was part of it also that you saw that your sales channels and sales cycles would be cleaner and shorter? That was definitely one of our learnings. And selling in the enterprise world, you are working with a more sophisticated set of buyers. And that meant for us, we really had to have an amazing business case and ROI and all of that had to be put in place too. Yeah. So I'm curious as you were looking at the marketplace, well, obviously there's LinkedIn and obviously there's ZipRecruiter and other platforms.

12:57What did you see that you could do 10x better than the existing platforms for job applicants, for recruiting, etc., in healthcare specifically? First was the vertical focus on just healthcare. One of the complaints our customers have, like the health systems have, is that these horizontal marketplaces like LinkedIn and ZipRecruiter and so on are not necessarily customized for healthcare. The reason that matters is healthcare is a regulated industry. The healthcare workers have licenses and certifications and so on. All of that matters. So that was one piece. The second piece was just the employers applying to the talent instead of the other way around.

13:35So it's a completely different experience. Healthcare workers, they absolutely love it, right? They create a profile. They sit back and relax. They get interview requests. They get to decide which interviews they accept or decline. And, you know, we're often described by healthcare workers as this was the best job search experience of my entire career. We have thousands of five-star reviews across Google and Facebook and the App Store with them describing about what an amazing experience and what a delightful experience it's been. The other insight that we had was just around the automation of screening and of matching.

14:02And that's really what brings an enormous benefit to the employers in particular, as well as to the healthcare workers. For the employers, it's usually a very small team internally that's trying to hire a lot of roles. We started with nursing. We've now expanded to technicians and technologists. But at that time, it was, you know, one recruiter would be trying to fill 100 roles in nursing in a highly competitive market. And so they very much value the fact that the talent was pre-screened and pre-vetted and custom matched to their needs. Yeah. And one of the challenges of building a two-sided marketplace is it's like you can't open a nightclub and not have patrons there.

14:39It feels really weird to show up and be one of six people there. So when you were building this and you were getting at least some positive feedback on the demand side, right, on the employer side, how did you go about filling up the candidate pool quickly enough so that the employers were able to screen through these candidates at volume and be able to say, oh, no, these are the 10 we're desperate to talk to? Yeah, so we honestly use a lot of the classic tactics that other two-sided marketplaces in Silicon Valley use. So first and foremost, we made sure we were geographically constrained. So for example, in the first two years of this business, we were only in California.

15:18Like Incredible Health was only available in the Bay Area and the LA area. That's it for two years. And it wasn't until our third year that we started expanding to other states. The reason that mattered a lot is to build up the supply and demand at the same time in a constrained way. because we were limited on resources at the time as well. At the time, the team was like, you know, less than 10 people. I think we'd raised a$2 million seed round, but like that was it. We also wanted to make sure that our product and operations were good enough to drive success for both sides of our marketplace.

15:49And that was an enormous amount of product development and operational work that had to happen at the time. It was wonderful working with those early adopter health systems then because they were very engaged and understanding of what was happening. And they were, I consider them some of our development partners. Like they were influencing our product and our operations at the time, too. Will you tell us how you landed your first employer side partner and then how you engaged them to help evolve your product roadmap? Yeah. So, OK, we've now grown to over 1 ,500 hospitals. That's a lot of hospitals.

16:23It's a lot of hospitals in the U.S. And the largest, you know, we work with the largest health systems, including Ascension and Trinity and HCA. And we work with many community hospitals. We also work with many academic medical centers like in New York Presbyterian and NYU and Cedars-Sinai and many others like that. So if I rewind back to the early days, I think we got the very first health system through cold calling. Do you remember who it was? It was HCA. We didn't have a sales team at the time, so it was just me. And I would spend hours each day cold calling, cold emailing, and got a hold of someone.

16:57I still remember her name. Her name was Gloria. And what was Gloria's role at HCA? Gloria's a recruiter. God bless Gloria. Yeah, a very experienced recruiter. And so I sort of explained what we're up to. You know, at the time, we don't have a fancy deck and presentation. There's none of that. It's just a conversation. I explained to her what we're doing and what's different about it. And she said, you know, we are actually having a lot of challenges. And then she offered to introduce me to her boss. And so that's how the first one happened. And as you evolved the relationship with HCA and then Cedars and these other healthcare holding companies and hospitals, how did you engage them to understand what their needs were to inform the development of your product roadmap?

17:39So when it comes to enterprise, which are large, large customers, there's actually multiple groups that you have to engage with. So there's the end users. So the actual recruiters themselves were amazing in terms of just providing feedback in terms of their product experience because they care the most about the about the workflow within the product and as well as the experience that they're having with the candidates. So they were extremely helpful in just improving our actual core product experience. When it came to the executives and leaders, we were another group of important group of users.

18:11You know, with them, it was mostly around, they helped us really improve our reporting, our analytics, how to explain and the return on investment in the business case. So, you know, we just stayed in really close touch with both groups of users. We were probably in touch with our customers, you know, every single week. Like, honestly, look, seven years later, I'm still speaking with customers almost every day. I still listen to recordings of our team's call with the healthcare workers. And the number one value at Incredible Health company value we have is customer obsession. Like, do whatever you can to delight your users.

18:43And that's like firmly embedded in our culture and the way we do our work. And so that's a value that's required of every single team. This isn't just for the product team. This is for everyone. Operations, finance, everybody. More with Iman Abu Zayed on how a slow and steady approach to nationwide expansion paid off big for incredible health in just a minute.

19:19Real leaders don't back down when the stakes are high. They innovate, they push forward, and then they take the stage at the Masters of Scale Summit. Join us in San Francisco, October 7th to 9th, to hear from the CEO of the New York Times, scientists using cutting-edge technology to find cures, the leader of crypto powerhouse Coinbase, a retired four-star general, and many, many more. Apply now at mastersofscale.com slash apply25. That's mastersofscale.com slash apply25. If you're ready to take your startup from idea to impact, then AWS is your launchpad. From data storage to machine learning to secure app hosting, AWS gives you the tech trusted by the world's fastest scaling startups.

20:09And here's the best part. Join AWS Activate today and you could score up to$100 ,000 in AWS credits tailored to your stage and network. Go to aws.amazon.com slash activate and start building. Expanding your business in the U.S. can feel like a maze. Every state has its own payroll, benefits, and compliance rules, which can pull your focus away from growth. That's why founders use Deal. Deal is the professional employer organization, or PEO, that gives you a dedicated HR expert plus Fortune 500 level benefits for your team. The National Association of PEOs says businesses can grow twice as fast if they use one.

20:52So if you're scaling, make it simple with Deal. Go to deel.com slash mos and get up to three months free. Welcome back to Masters of Scale. You can find this conversation and more on our YouTube channel. I imagine as a founder and CEO, and I'm also imagining your investors, your early investors, saying, look, this is great. You're establishing product market fit. You're growing these geographically constrained ways so that we're making sure that we're serving both sides of the marketplace well. But hey, we're two years in and we're in two markets in California and it is a competitive marketplace and presumably the ZipRecruiters and others of the world are seeing what you're doing and would at least be contemplating whether they could compete with you in California and nationally.

21:45Were you worried about others jumping ahead of you in the broader national market or did you feel you had such a competitive advantage that you could take your time to really get it right in California before you expanded? Yeah, I mean, look, my perspective on competition is it's good to be aware of them, to study them and learn from them. I really don't think founders and CEOs should be obsessing or focusing very much on them. I think the obsession needs to be on the customers, not on the competition. So I want to drill into this for a second because I imagine if you'd waited five years to go beyond California, that would have been too long, right?

22:21Because others would have caught up and what have you. And I'm curious if you had investors or advisors who were encouraging you to scale fat, like, let's scale this thing. Let's go. Let's get out there and beat the market. How did that play out for you, and how did you know when it was time to go outside of California and go more national? I'll start by saying like, this is the benefit of having really high quality investors. I work with James Joaquin at Obvious Ventures, who's another OG, been doing the internet thing since the late 90s. He's a great guy. He and his wife, Zemmer, are phenomenal people.

22:54They're awesome. And then also I work with Jeff Jordan at Andreessen Horowitz. So Jeff Jordan was the CEO of OpenTable. So honestly, I had very good investors who know a ton about not just software and the internet, but also about marketplaces. With the benefit of their advice, right, we wanted to make sure that the marketplace was working well in two geographies, at least before we scale it further. So I never really got a ton of pressure from investors to expand rapidly until we got to stronger metrics. Once we got to the stronger metrics, then actually that actually triggered me to raise our Series A, which was another$15 million.

23:30And with that, we expanded to more states. It was actually our customers that were pushing us to expand beyond California more than our investors, especially with some of the bigger health systems we were working with. They were like, this is working great in California. Like, when are you coming to Texas and Nevada and, you know, et cetera. So we had to actually tell our customers, like, hold your horses. Like, we got to address a few things and then we'll support you. But it was a great way to grow because we were able to grow and expand to other states with our customers. You know the demand is there before you even show up there.

23:58The model for Incredible Health is interesting because only one side of this marketplace pays, if I understand it correctly. Is that right? That's right. How does the business model actually work? The business model is based on employers paying. We've achieved a days to hire of 20 days on average on the platform. We also drive really strong ROI for them, specifically around cost savings. So for every hospital we work with, we save them at least$5 million a year because by hiring permanent nurses faster from Incredible Health, they're able to reduce their temporary labor and overtime costs. that is why they pay for Incredible Health.