Consider Startup Inequality When Choosing a Medical School or Residency

Income inequality is getting worse. So is entrepreneurship inequality. In a new report, a few communities and ecosystems are getting bigger and the rest are floundering. That concentration of startup activity is unusual, economists say. During the economic recovery of the early 1990s, 125 counties combined to generate half the total new business establishments in the country. In this recovery, just 20 counties have generated half the growth. I'll bet you can name many of them. The impact is pervasive and affects politics, socioeconomic advancement, and regional and national competitiveness.

At the same time, physician entrepreneurship and biomedical and clinical innovation are front and center in the war against sick-care dysfunction and cost. Undergraduates, medical students, and residents want to join their practicing foxhole buddies on the front lines. But, as entrepreneurship inequality is a reality, with wide geographic dispersity and differences, what should undergraduates look for when choosing a medical school or medical students when choosing a residency that will provide them with what they need to pursue biomedical and clinical opportunities? Most residents will live and practice where they train, so the decision has long-term impact.

Medical schools do not teach the business of medicine or entrepreneurship and are unlikely to in any meaningful way in the foreseeable future. Consequently, it is up to students and residents to take things into their own hands and avail themselves of other educational resources, networks, mentors, and experiential learning opportunities. Here are some ways to do it.

If you are applying to medical school next year or looking for a residency this fall, look for these things:

1. Bioentrepreneurship education programs that are convenient, affordable, and fit into the workflow of medical students and their curriculum.

2. Programs that train the trainers by educating and training basic science and clinical faculty, e.g. iCorps grant programs.

3. Using education models that are familiar, like Innovation Grand Rounds, Company Clinicopathologic Conferences, and “see one, do one, teach one” strategies, emphasizing experiential learning under the supervision of “innovation attendings.”

4. Emphasis on the similarities between the clinical mindset and the entrepreneurial mindset.

5. Integrating and including students, residents, and faculty into local innovation ecosystems.

6. Student exposure to sponsors, champions, and mentors.

7. Opportunities for physician and trainee entrepreneurs to showcase their work or practice presenting it and, thereby, practice their communication and emotional intelligence skills. For example, I recently attended a session where four science grad students and four business school students presented their ideas to each other as a way to improve their presentation skills and learn to speak to an audience not familiar with their terms and lingo.

8. Money, such as a seed stage fund, to reward medical students for their entrepreneurial efforts.

9. Engagement of those with interest to help them create a personal and professional development plan that includes, hopefully, completing a residency and some reasonable exposure to clinical practice.

10. Places that celebrate student and resident accomplishments and showcase them to other medical student entrepreneurs around the world. They have created Medical Student and Faculty Bioentrepreneur of the Year Awards, with a prize to support their entrepreneurial ventures, and include entrepreneurial activities as part of promotion and tenure evaluations.

Undergraduates and medical students, more and more, have backgrounds not just in STEM, but in computer science, business, and finance as well. Many are former startup entrepreneurs or have worked for startups. For them and many others, medicine is not an end in itself, but a means towards a much bigger end i.e. leveraging their convergent skills to create a bigger impact and more meaningful change. Given the disparities in entrepreneurial opportunities, however, some will have a harder time than others and will have to move on to succeed, to the detriment of their communities. We can't afford an entrepreneurial brain drain any more than we can tolerate medical practice disparities that don't add value.

Given the disparity between supply and demand, most undergrads will go to medical school where they are accepted and can afford and medical school graduates will accept residencies that primarily satisfy their clinical training objectives. For those that have a choice, though, i.e the high-value physician entrepreneurial targets, academic medical centers, integrated health systems and group practices will need to do a lot more work to be competitive for the best of the rest.