Q: Should I Leave Medical School For a Startup?

SKMurphy startup advice column: a reader asks how to decide whether to leave medical school to pursue a startup idea.

Q: Should I Leave Medical School For a Startup?

“When you are in the middle of a story it isn’t a story at all, but only a confusion; a dark roaring, a blindness, a wreckage of shattered glass and splintered wood; like a house in a whirlwind, or else a boat crushed by icebergs or swept over the rapids, and all aboard powerless to stop it. It’s only afterwards that it becomes anything like a story at all.  When you are telling it, to yourself or to someone else.”
Margaret Atwood in “Alias Grace

The following is based on a series of actual emails and conversations with an individual reassessing if they were on the right path in their life. I have changed some details and omitted others to preserve their privacy.

Should I Leave Medical School For a Startup?Q: I have started medical school but all through my first semester I have been more interested in mobile health applications. I have been frustrated by school’s focus on rote memorization of things that won’t matter in practice or that a computer already knows better than any human. I feel very stifled in school and have not felt I am exercising my creative side. I have not found a group of innovative and energetic people with whom I can share my passion for invention and large scale change

As far as I can tell, most of the entrepreneurs doing healthcare startups are not physicians–although they often hire Chief Medical Officers  later.  I love patient care and the idea of helping people, I have made the effort to get this far, but the trajectory for a career as a practicing clinical physician no longer seems bright or exciting. So I am re-evaluating my options and feel like I am on the verge of a major life decision.

I could continue and assume my pain is temporary. I would be able to use a medical degree as leverage down the road or I could change course and pursue my passion for a tech startup. I am not a coder but I have an idea for a product that I have built some rough wireframes for.  I have sketched out a  six month plan for development of both the technology and the business.

Any other words of wisdom for someone in my shoes?

SKMurphy Take: Startups Are Easy to Romantacize

Since you are in Medical School and have not yet blown up a few startups, it’s easier to romanticize entrepreneurship.

Graduating from Medical School and becoming a doctor is a lifetime asset that will enable you to help people in ways few others can. It will authorize you to speak with an authority that non-physician entrepreneurs will lack. All of the problems in health care will not get solved in the next decade: if you decide to persevere and become a doctor, there will be plenty left to address. They may be transformed, but there will be many opportunities to combine clinical expertise with entrepreneurial problem-solving and technology insight.

You can become an entrepreneur at any age–and many successful companies are started by entrepreneurs who are over 40. If you leave medical school now, it’s unlikely you could be re-admitted three years from now after a foray into startups.

Entrepreneurship offers a distinct set of challenges from many of the accomplishments you needed for admittance to medical school. You may be underestimating the challenge, assuming that because you have done well in school, that will translate into building a successful startup. I was told this story by an Indian entrepreneur who had graduated from IIT: he had been contacted by a former classmate who told him, “I don’t understand it. You were near the bottom of our class, and I was near the top but my company failed, and yours is doing quite well.” It’s much more complex than it looks.

You have been given an opportunity that many aspire to, but few are granted. I worry that you are contemplating throwing it away in favor of an idealized view of how difficult it is to build a sustainable company. I would seek out other physician entrepreneurs and see how to chart a path that builds on what you have already accomplished. They may offer you perspectives that are pertinent to your dilemma.

Q: Some Clarifications and Additional Questions

One of the key reasons I am contemplating leaving med school is because I just can’t get interested in the material. I am not an academic type, I don’t like schooling in general, and I am uncomfortable being part of a large institution. I like to think outside the box and have been more successful in my creative pursuits and managerial positions. My path to medical school was non-traditional and until now I have not taken out loans but that will change next semester, at which point I think I will have to be fully committed. I worry that I am on the wrong track.

No one else in my extended family has been an entrepreneur but I have held a several sales and service jobs that required independent work on my part to satisfy a customer.

Have you talked with others in this situation? How did they decide?

Do you know other people who dropped out of medical school and founded a tech startup?

If I chose not to return to school next semester, what are the next logical steps?

SKMurphy: Have Multiple Backup Plans

Candidly, I was more prepared to convince you to stay in school, but as we discussed your history and the fact that you were facing a breakpoint with the loans, leaving school now seems like a viable option. I believe you are fully capable of graduating from medical school and becoming an effective and caring physician. As we talked, I developed the sense that you had decided to leave and were trying to find a way to explain it to your wife and family.

Institutions and bureaucracy are a fact of life. Succeeding in a healthcare-related startup will require you to work with different kinds of organizations–or at least understand how they work. Clinics, hospitals, insurance companies, regulatory agencies, research institutions, grant agencies, and various aspects of the legal profession, including the courts, will likely intersect with your path to launching and achieving a sustainable business. If your startup is successful and starts to scale, it will develop its own process and procedures.

Although we have supported several physicians and other healthcare professionals such as nurses, physical therapists, and medical researchers as clients, I have yet to talk with anyone who left medical school and was successful as an entrepreneur. I do know two individuals whose physician fathers strongly encouraged them to go to medical school. They now have their own companies that operate in medical-related fields. But both realized that becoming a doctor was not their calling.

I would encourage you to have serious conversations with family members and friends whose opinion you value and clarify your value and next steps.

If you decide to leave medical school, develop a high level plan for exploring different entrepreneurial options: have at least three product ideas you are interested in pursuing. Put another way, don’t leave for one “great idea” as this risks locking you down so that you cannot make adjustments. Have a plan for several ideas you can explore.

If you decide to pursue an entrepreneurial path, have a stopping rule for “getting a real job” if it does not work out. You can always try again later, but don’t make “I’ve exhausted all of my savings and my wife’s patience” your stopping rule. I have seen people fail to do this, and it does not end well.

ADD/ADHD is not uncommon among entrepreneurs. Managed properly, this usually means you need to work closely with one or more people who have “attention surplus disorder,” it can improve your peripheral vision, maintain a wide situational awareness, encourage you to explore adjacent opportunities, tinker with and improve your business model, and get unstuck if the path you are on is not viable.

But you need to make long-term predictable commitments to your wife, family, customers, business partners, and employees, so be careful of acting on too many good ideas (it’s OK to curate them, but you need to strike a balance between exploration and execution).

I wish you every success.

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