The balancing act of being both a clinician and entrepreneur

By Mehdi Razavi, M.D., a cardiac electrophysiologist at Baylor College of Medicine and director of clinical arrhythmia research and innovations at Texas Heart Institute. He is also co-founder and faculty advisor for Saranas, a Rice University-based startup delivering novel therapies for cardiac disease.

In the previous blogpost, I provided an overview of the mostly obvious but usually infrequent traits requisite for the successful physician entrepreneur.

Mehdi Razavi, M.D.

Now, I will show how you can balance clinical and entrepreneurial efforts. First, let’s dispense with the 800-pound gorilla lurking in the corner: Unless you are overwhelmed with a constant flurry of real game-changing ideas — and let me assure you are not regardless of any contrary conviction— the worst thing you can do is to abandon or significantly curtail your clinical practice.

If you became a physician for any reason other than improving your parents’ conditions you should stop reading now because this article isn’t written for you. The term “balance” makes clear enough that this is for those entrepreneurs who are determined to continue their clinical practice.

There is no lack of valid reasons each of which can be identified with a unique superlative:

We start with the most noble one. Ours is not a job. It’s a calling. The other extreme offers the most selfish one. Innovation’s pipeline starts in the clinic. The founder who is a poor innovator is as hamstrung as the surgeon with a poor understanding of anatomy. Or consider the epitome of “bread and butter” — that is to say practicality: Provision of a reliable paycheck.

Before impugning such ignoble drives, it would be advisable to recall that a steady paycheck will position you to approach risk from a position of strength and confidence instead of fear. Fear does to innovation what carbon dioxide is doing to the ice caps. It forces retreat, slowly at first and then with breathtaking efficiency. We end with the most obvious and overlooked: Why give up a skill so vital and complex that it demanded half your adult life to perfect?

‘Fear not. It can be done’

Now that I have hopefully convinced you not to give up your clinical practice, I will turn my attention to the challenge at hand. How can it be done? How, in a world where instant access has morphed from an amusing novelty to an aggravating necessary but woefully insufficient criterion for success — whatever that may be, can the physician entrepreneur not only survive, but thrive? By expending evermore time browbeating their “colleagues” in time killing exercises such as “peer to peers” many of us end up spending more time on the phone with physicians who represent insurance companies than the real ones who represent patients.

Fear not. It can be done. Some strategies are more obvious than others. Start by making more efficient use of your time. Make every minute count. Before objecting to the validity of this incendiary accusation ask yourself if you really were squeezing every last drop from the pulp of time would you be reading this post to begin with?

One of the things I enjoy about the entrepreneurial lifestyle is its uneven schedules. Its imposition on clinical work, though irregular, is more predictable than you think. Take advantage of this by stacking your more rigid clinical duties accordingly. In doing so you will provide yourself with blocks of uninterrupted time. Of course the trade-off is you will be getting home from the clinic later in the other days. Oh well, it makes for good sleep.

Other ways to find balance:

  1. Wake up an hour early or go to bed an hour late. This is not the time to take on the challenge of altering your circadian rhythms. My patients often kid me by saying I have horns until ten in the morning because I struggle mightily in the mornings. Instead of waking up at 5 a.m., I schedule evening team meetings and conference calls. This isn’t always the most efficient strategy as ours is a culture that awards the early bird. But once others become familiar with your routine they will adjust accordingly. The worms, after all, prefer to come to the surface at night.
  2. Stay focused. Instead of listening to a podcast about innovation and entrepreneurship on your drive back from work, turn off the radio and think about the problem you encountered earlier at work that continues to beg for a solution.
  3. Don’t forget “delegate” has eight letters, not four. Be meticulous and intimately involved when assembling your team. But once done trust your judgment and their aptitude. Get out of their way. It will increase their confidence in their work and yours in your judgment.
  4. Other strategies require a bit more of a nod from circumstance. If, like me, you have been blessed with the opportunity to work with students. then make the most it. A confession: I have learned more from my students than they have from me. Don’t be shy to engage and trust them. I promise they will reciprocate your confidence.
  5. Understand your limitations. Just as you demand others to respect your expertise you should offer them the same courtesy. If you think COGS are animals best hunted at night, you will offer nothing but badness to the dynamics of your team by chiming in after every other word comes.out.of your CEO’s mouth. What if you are the CEO? I believe you shouldn’t be.
  6. From you comes the revelation and proselytization. From others comes the implementation. Don’t get in their way. You will waste everyone’s time, most of all yours.
  7. Take an occasional break. You don’t need to be at every team meeting, especially after you have assembled your team. It’s about the team, not you.
  8. Don’t rush through clinic or cases in order to be present for the first study of the newest iteration of your paradigm-shifting, platform redefining technology. It’s insulting to the oath we took. And it’s plain wrong. I have never faced manifest or sensed concealed derision for having missed a meeting because I had been ablating an arrhythmia or examining a patient. Society may have hardened and become less forgiving in many ways. But not enough to have lost the respect afforded us when we are with our patients. At least not yet.
  9. Don’t get deeply involved in multiple startups. It’s very tempting and equally fruitless, void of any will be prized apples. Focus on raising money to send the older child to college while offering your grade schooler an encouraging pat on the head.

Finally, the most important admonition of all: Respect the inviolate nature of the Big Two from which you shall never withdraw the currency of time: Family and Exercise.

If your myopia is severe enough to convince you the time allotted to these two are expendable, then accept my assurance that reality will offer you painful, quick consequences, reinforcing the truism that sometimes when the stakes are at their highest, our judgments find a way to be at their lowest.

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