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A Residency Is Not a Startup


Physician entrepreneurs evolve in stages, just like clinicians. While there are some similarities between residencies and startups, there are distinct differences.

Physician entrepreneurs evolve in stages, just like clinicians. While there are some similarities, I believe there are distinct differences.

1. The culture, ethics, and ethos of business is different from that of medicine. For physicians to be entrepreneurs, they need to reconcile the two.

2. The risk profiles of doctors are different from the risk profiles of entrepreneurs. While there are differences in how various specialists practice and rely on experience and clinical judgement instead of tests, entrepreneurs are risk managers who, in many instances, are willing to roll the dice on high-risk, high-return endeavors.

3. Residents, by definition, practice under controlled circumstances under the supervision of experienced attendings who are charged with granting them graduated levels of responsibility. Entrepreneurs make unsupervised mistakes from Day 1.

4. The buck does not stop with residents. It stops with attendings. Most entrepreneurs have no one to take the fall for their mistakes but themselves.

5. While medicine is supposed to be a team sport, it frequently is not and most residents can get away with minimal team participation.

6. Most residents do not have an entrepreneurial mindset, and in fact, are chastised if they fall outside the lines. Medical education demands conformity. Clinical creatives are punished.

7. Great entrepreneurs have great networks. Most clinicians bowl alone or have limited networks outside of medicine.

8. Most entrepreneurs are problem seekers. Most doctors are problem solvers.

9. Entrepreneurs keep score differently than medical trainees. For most medical students, residents, and fellows, the idea is to check off as many boxes as you can to get to the next career goal or milestone. Even when given the option to participate in an entrepreneurial venture, the objective for medical students is to strengthen their CV to get a competitive residency like dermatology, orthopedics, or interventional cardiology, not add patient defined value.

10. Although it is most valuable, clinical judgement is not rewarded in medicine. Learning from mistakes is the lore of entrepreneurship in most startup blogs and newsletters.

Residents who are interested in transitioning or participating in entrepreneurial ventures will face another learning curve. What got them to where they are won't get them to where they want to go in business. There are no business boards. There are no home study courses. There are no in-service exams nor, in most instances, are there attendings watching over them.

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