Reflections and learnings from a medical school student turned founder

Last year, I left UCSF after my preclinical years to build my own startup, Shimmer (I wrote about making this decision here for those curious).

The journey to entrepreneurship from med school isn’t very common, and for me, much of it was serendipitous and unplanned. This year, I found many people reaching out to ask for help deciding between the two careers and about my experience.

I wanted to consolidate my reflections and learnings in case it could be helpful to others interested in these careers. Some of these thoughts may seem controversial, but I’m very open to chatting about them, they’re still formulating.

One note before getting started: I’m coming from the perspective of my own company, Shimmer, a consumer wellness service which at this moment is pre-series A. Different stages and business models yield very different experiences.

I’ve found pro/con charting a great way to think through the differences between the two, so I start first with that. Afterwards, I’ll discuss some deeper reflections I’ve had along the way.

Pros and cons — early-stage startups & medical school

Pro/con comparison between early-stage startups and medical school

Startup pros

• Mission: You get to create your own vision and work on a problem that means so much to you. At Shimmer, we crafted a vision of helping millions of people access more affordable and responsive mental health support — this continues to inspire and shape our work every day.
• Fast paced, exciting environment: At least in consumer products (different industries have different velocities) you get to move quickly and get things done fast. Products iterate quickly and nimbly. In research, it took many months to get feedback on my papers. At Shimmer, we run 2-week experiments and are constantly analyzing new data.
• Creative influence: Ownership and creative direction in what you work on, opportunities to develop intuition for bigger picture issues.
• Decision-making power: Freedom to make your own decisions and learn from your mistakes directly. No one is there to approve or regulate your actions on the day-to-day.
• Exploration into different roles: You get to see how the whole business comes together and wear a variety of different hats. I’ve gotten to work across HR, product, care improvement, curriculum development, legal, operations, website development, marketing, and strategy.
• Community: Being a founder unlocks a unique community of individuals you get to vibe with. Startups can be very hard. When you meet another founder, there’s a shared sense of camaraderie and connection. I’ve been grateful to have made passionate, talented, and supportive friends along the journey.

Medical school pros

• Authentic, caring, & intellectual culture: Medical students are some of the kindest friends I’ve made. They have a genuine passion to serve others and are fun to have unique, intellectual discussions with. The people have to be one of my favorite things about the medical path. It can still be found in startups (at Shimmer, we’ve built a culture of deeply empathetic and caring individuals), but there is a much wider array of cultures that exist dependent on a variety of factors (mission, industry, etc.).
• Independence: You’re responsible for your own success. Publications, test scores, awards, and recommendations are all your own to seek out.
• Treat and care for patients: As a physician, you directly influence the health and wellness of individual patients. These interactions can be very meaningful and fulfilling.
• Expertise: Medical school is competitive and thus there are few physicians in comparison to other professions. You develop valuable and scarce expertise.
• Certainty and stability of future outlook: Decisions and future career plans are well laid out (especially in comparison to startups). As a doctor you’re almost guaranteed a solid income your entire life as well.
• Clear path to success: The things you need to do to succeed are clearly laid out for you and the path to achieving them is also generally straightforward.

Startup cons

• Hard to win: It’s incredibly difficult to become a successful startup, 99% of them fail. While in medicine your success metrics are very much in your control, even an experienced founder may fail due to forces outside of their control. It can be frustrating and demotivating sometimes when you don’t know whether your company will live up to the beautiful vision you’ve idealized.
• Uncertainty in career/company direction: It is hard to know where your future career will end up and what exit opportunities are available if things fail. Especially in an early stage company, you have limited access to information to make optimal decisions. Deciding things like when to collect more data, when to execute, and what direction to iterate may feel anxiety-inducing without proper information.
• Master of none: At least in early stage, you develop many skills but are often not great at any of them. One caveat is that from a market perspective, you become an expert in a specific niche problem area.
• Dependent on other people: Raising capital from investors, team dynamics, and customers are all things you are dependent on to achieve success. You must learn to work with other people to achieve success; these variables may introduce many challenges. At Shimmer, it was my first time managing a team and interfacing with so many different parties with different incentives. This is a stark contrast to medicine where success in studying and conducting research were very individual pursuits.
• Limited intellectual freedom: You spend the majority of your time obsessing over a narrow, specific problem and going super deep into it. You don’t get to think outside of that specific problem very much. Though the mental health peer support space is fascinating to me and has much depth, I often miss exposure to things like AI, crypto, and the life sciences that I had the freedom to dip my toes into while a medical student.
• Large amounts of stress and responsibility: Being responsible for the future of other people’s careers and the satisfaction and health of numerous members/customers can be extremely burdensome and stressful. You are oftentimes the reason why things aren’t getting done fast or well enough.

Med school cons

I focus on more detailed descriptions of some of the cons here since I think the pros are well-known and emphasized often.

• Hierarchical structures: Much of my knowledge of this is communicated through my medical student friends and peers since I haven’t done clinical rotations. Medical students are at the bottom of the hierarchy and are sometimes treated disrespectfully. However, the culture is changing and it is highly dependent on the team you work with. Despite this, it’s still a frequent and pervasive, especially in surgery.
• Long hours leading to burnout & a lack of preventive mental health/wellness resources: I’m particularly passionate about mental health issues, which may color my opinion here. Physicians have double the suicide rate of the general population. There is a TON of burnout in medical student & physician populations. Sad news about medical school students taking their own lives has not been a rare event. Most schools (even UCSF) fail to provide proactive mental health and well-being interventions as part of their education. A staff member once mentioned to me after the recent death of a medical student that the first thing that they were told was to “not mention that medical education was a part of the cause of these deaths.” Medical student work incredibly long hours, without pay (in fact they PAY to be there), and are given meager amounts of support to do so. This should not be the norm.
• Menial, repetitive work & limited scope: During rotations as a medical student, you are an apprentice. This means you’re often observing or doing extremely simple tasks (get this item from this location, or document this encounter in this way) that may not be as intellectually engaging. Your time is often considered the least valuable resource by other team members (one could argue this makes sense in the context of patient treatment).
• Hoops: An incredibly large number of tasks are expected to be completed purely for the purposes of limiting access to the profession. Two good examples: 1) Board exams — these have been shown to have no correlation to clinical performance, but are used to determine which residency students get into. 2) Publication count — students pump out as many publications (oftentimes at a low quality) as possible; in competitive specialties, some students have as many as 40 publications created in just 1–2 years of full-time research. Both of these are examples of hoops or barriers created to constrain doctor supply and have little correlation to clinical performance.
• Limited scale: Doctors become highly specialized operators, oftentimes going through similar workflows every day once they begin work. Your capacity is limited to the number of patients you can touch. No systems level thinking is explicitly a part of the role (though it can be learned and applied if one desires).
• Prestige-seeking: This is one of my least favorite parts of the culture. Your value is tied to which school you came from or what residency you went to, rather than how good of a doctor you truly are. Incentives are not aligned — better doctors are not rewarded more financially or socially, rather, those that work at “top-tier” institutions or have lots of publications are thought of as so.
• $$$: Medical school is incredibly expensive. Though there is a clear path to a steady and rewarding income afterwards, other jobs may provide more immediate rewards with much better WLB (see this projection calculator by James Diao).

Deeper reflections

It’s hard to be an amazing founder and an amazing clinician at the same time

This is the reality of the immense amount of effort, knowledge, and dedication that is required to do both of these roles well.

Ultimately, if your dream is to build companies, dedicating 7 years of your life to medicine is not going to make you as good of a company builder as if you spent 7 years working in startups. Likewise, spending 7 years of your life in startups would not translate as efficiently as working 7 years in medicine.

Having a perspective in both is still very useful for a variety of reasons, namely 1) discovering unique insights, 2) exploring your personal values and interests, & 3) being able cross-communicate between the two fields. However, successful 50/50 splits are rare and difficult, and even 80/20 splits can be hard in such demanding roles.

Different success metrics lead to different cultures

In academic medicine, the success metrics are: 1) number of publications we can create 2) quality of letters of recommendations and 3) scores on standardized tests. These have little correlations with the skill or value of a doctor, but rather demonstrate competency in your ability.

Similar vanity metrics exist in the startup world (number of employees, startup awards they’ve received, which investors you have, team pedigree). However, to raise a Series A, your success metrics are ultimately whether or not your company is doing well and creating value.

These two very different frameworks in competitive environments influence cultures greatly. In medicine you may see competition on an individual level, while in startups you’re often dealing with the complexities of working in a team to effectively achieve your goals.

Students need to have more transparent information about what being a medical student is like, and what career options are out there for them.

At the end of the day, I think both paths have enormous potential for helping improve people’s health and wellness. My hope is that we give more clarity to these paths, especially within medical school. It saddens me how little information is provided for medical students to explore opportunities outside of being a full-time clinician.

This article written by my friend Sherman provides a look into some of this struggle.

This has been one of the motivations for communities like MD++, where we support over 1400 medical students in discovering and pursuing their unique path through fireside chats, networking meetups, and informational panels.

Another great resource is this podcast, “Physicians Off the Beaten Path,” that interviews physicians who have pursued unique careers outside of full-time practice.

Open to chatting and exchanging thoughts—reach me at jonxwang@alumni.stanford.edu. I’m planning on working on a “breaking into entrepreneurship as a med student” article sometime soon, stay tuned!