Why medics must become innovators and entrepreneurs

Dear Colleagues,

If you’re here to learn how to make money, you’re in the wrong lecture hall. I’m just an ordinary Infectious Diseases  physician. I earn a couple of lacs monthly, which is nothing to boast about. So, if you want to learn how to make money, I could refer you to my industrialist friends who own private jets and Rolls-Royces.

 

But let’s get serious now. 

 

What is entrepreneurship? Is it the same as financial investment? 

Absolutely not.

 

Entrepreneurship is creating something new—a technology, a device, a new service, or an innovative business model—that addresses a specific need or solves a particular challenge. Entrepreneurs are driven by the desire to bring their ideas to life and willing to embrace significant risks, including investing time, money, and effort, without any guaranteed returns. For instance, consider a group of biomedical engineers developing a new rapid point-of-care diagnostic test for urinary tract infections (UTIs). Despite their expertise and dedication, there’s no certainty that they will succeed. They may invest years and significant financial resources into this endeavour, fully aware that the success rate in med-tech entrepreneurship is only about 20-30 per cent. This statistic underscores the harsh reality that 70-80 per cent of entrepreneurial ventures in this field fail, highlighting the inherent risks involved in entrepreneurship.

 

On the other hand, investment involves putting your money into existing businesses or financial instruments like stocks, bonds, or other assets to generate financial returns. Investors carefully assess the risks and potential rewards before committing their funds. They conduct due diligence and often diversify their portfolios to spread risk across multiple entities. This diversification strategy helps mitigate losses, ensuring that even if one investment fails, others may succeed. The main objective of investment is financial gain, and the failure rate for investments is generally around 20 per cent. This means that in 80 per cent of cases, investors achieve their desired financial returns.

 

The primary difference between entrepreneurship and investment is in their goals and outcomes. Entrepreneurship is about building something new, with financial gain being a potential, but not guaranteed, outcome—a by-product of the entrepreneurial journey. In contrast, investment focuses on achieving financial returns, with a significantly higher likelihood of success. While 80 per cent of investments may meet their financial goals, only about 20 per cent of entrepreneurial ventures reach their intended objectives, underscoring the substantial risks and challenges entrepreneurs face.

 

Is starting a clinic or hospital entrepreneurship?

Now, you might wonder, if a doctor starts a clinic or even a hospital, is that entrepreneurship? The answer is yes, but it’s a specific type of entrepreneurship that primarily focuses on service delivery rather than innovation.

 

Entrepreneurship, at its core, involves creating something new that addresses a need or solves a particular challenge. When a doctor starts a clinic or hospital, they are indeed engaging in a form of entrepreneurship because they are establishing a new service offering. This involves taking on risks, managing resources, and aiming to fulfil a need in the healthcare market, which aligns with the broader definition of entrepreneurship.

 

However, it’s important to distinguish this from the type of entrepreneurship that drives significant innovation. Traditional medical practice—like starting a clinic or hospital—is typically more about providing established healthcare services rather than innovating or disrupting the field with new technologies, business models, or treatment methods. The main focus is generally on patient care, adhering to established medical practices, and ensuring the clinic or hospital runs efficiently.

 

This kind of entrepreneurship is crucial because it meets the immediate healthcare needs of the community and contributes to the economy by creating jobs and improving access to healthcare. But it’s often more about maintaining and enhancing existing systems than creating entirely new ones.

 

Yes, starting a clinic or hospital is a form of entrepreneurship because it involves setting up a new business venture in the healthcare sector. But, it is generally considered a more traditional form of entrepreneurship focused on service provision based on the existing models, rather than on innovation and developing new solutions to existing problems in the healthcare industry.

 

When we talk about inspiring entrepreneurship in the medical community, we are often referring to encouraging doctors to move beyond these traditional forms and into areas where they can innovate, create new technologies, or develop novel approaches that can fundamentally change the way healthcare is delivered.

Personal journey: From AMR to innovative entrepreneurship

I am a clinician, an academic, a researcher and a policymaker of some sort. Why am I talking about innovative entrepreneurship? 

 

That’s because of my involvement in the field of AMR (Antimicrobial Resistance). Over the last twenty years, during my involvement in the field of AMR, my perspective on approaching complex challenges changed. I have been very active in the field of AMR, creating the Chennai declaration and engaging in political activism to convince stakeholders. Yes, with collective efforts, we witnessed some success. 

 

Let me explain why my perspective has significantly changed over the years. My journey in Antimicrobial Resistance (AMR) has been long and complex. I’ve worked at various levels, from national to international policy, and served as a jury member for the Longitude Prize—a prestigious award encouraging innovation in rapid point-of-care diagnostics for AMR. When I first started working on AMR policy, I was optimistic about the big impact we could make. I believed in policy changes, stewardship programmes, and regulations. However, over time, I realised that the global AMR action plan, while initially promising, was not as successful as we had hoped. I used to describe it as a complete failure, but with more experience, I now diplomatically refer to it as a “partial success.”

 

I was one of the 20 member jury members for the prize. But at that time, I didn’t take innovation seriously. Over the next ten years, I felt the AMR policy implementation process was really slow and partial. At the same time, I witnessed fantastic development in innovation. We assessed more than 250 innovative technologies. The commitment and technology these teams developed were inspirational and groundbreaking. That’s when I realised the power of innovation. The risk innovative entrepreneurs undertake is to make a positive change in the world.

 

The distinction between complex and simple challenges became clear to me. AMR is a complex challenge, influenced by a multitude of socio-economic and political factors. This complexity has hindered the success of AMR policies, highlighting the need for a more nuanced approach. During my time with the Longitude Prize, I witnessed the evolution of start-ups and scientists who rose to the challenge of creating rapid point-of-care diagnostic tools. Despite the long odds, these innovators persevered, leading to significant advancements in technology. This experience deepened my appreciation for innovation. I realised that while policy is essential, it is innovation that truly drives change.

This shift in my perspective led me to become more involved in entrepreneurship. I founded a consulting service, Quorum Veda, to support Indian start-ups in the med-tech field. I aim to help them refine their ideas, face enormous challenges, and bring about the change desperately needed in the medical field. My interaction with innovative entrepreneurs has given me valuable experience in identifying challenges, building teams, managing resources, and navigating the risks of success and failure. This experience is invaluable and a solid foundation for more significant roles in policy-making.

 

The unknown: COVID-19 and the need for preparedness

As ID physicians, we are often unprepared for unpredictable global pandemics such as COVID-19. The emergence of such unknown outbreak entities has highlighted the critical need for preparedness and adaptability within our community. During the COVID-19 pandemic, it became painfully evident that our existing methods and knowledge were insufficient. For example, we were caught off guard by the airborne versus droplet transmission debate, which was based on outdated research from the 1960s. This underscores the importance of innovation in our field to better combat infectious diseases and handle future crises effectively. We must expect the unknown and be ready to innovate rapidly in response.

 

The lack of innovation in the medical community

The medical community, particularly in India, has been slow to embrace innovation. Doctors are trained to follow guidelines and mitigate risks rather than think creatively or take risks. This mindset has stifled innovation, turning doctors into consumers rather than innovators. We rely on technology and ideas developed by engineers but rarely contribute to developing new devices or technologies ourselves. This must change. The current medical curriculum is designed to make us followers rather than leaders or innovators. We need to revamp this curriculum to encourage doctors to become innovators and leaders. We have the ideas; we need the tools and support to refine them and develop them into technologies.

 

Solutions: Fostering innovation and entrepreneurship

First and foremost, we need to convince the medical community of the necessity of embarking on the journey of innovation and entrepreneurship. This change in perspective is crucial and must be addressed with urgency. To achieve this, we need to leverage medical society conferences, journals, and media to spread this message and facilitate this shift in thinking.

As Steve Jobs once said, “Innovation distinguishes between a leader and a follower.” This quote underscores the importance of innovation as the driving force behind leadership and progress. By embracing innovation and entrepreneurship, medics can move from merely following established guidelines or models to leading the charge in developing new solutions and advancing the field.

 

Once we establish this mindset, the next steps involve creating a conducive environment for fostering innovation at the grassroots level.

To create a meaningful change, we need to start at the medical student level. Every medical school should have incubation centres that foster a start-up ecosystem. These centres should operate through a collaborative effort between engineers, who can transform ideas into devices; medical professionals, who generate these ideas; and administrators, who can help raise funds and support start-ups. We already have successful examples, such as CCAMP in Bangalore and Venture Centre in Pune, which serve as models.

 

However, entrepreneurship must be treated as something other than a part-time endeavour. Engineering students, for instance, often participate in start-ups while working on their PhDs, developing innovations during their academic training. In contrast, medical students are typically focused on passing their postgraduate entrance exams and pursuing further medical education, leaving little room for entrepreneurial activities. We should consider introducing a combined 5-year DM/PhD programme in medical innovation and entrepreneurship to bridge this gap. If a student’s entrepreneurial venture succeeds, that’s fantastic. If it doesn’t, they still earn a DM or PhD, which will significantly enhance their clinical or administrative careers.

Imagine all medical schools nationwide having incubation centres in collaboration with engineering teams. We have examples like SCT Trivandrum, which has developed promising technologies, and IISc Bangalore, which is now starting a medical school. IIT Chennai is also planning to start a medical school and already has an impressive incubation centre. If all medical schools, their students, teachers, and even private practitioners became part of the start-up ecosystem, we could ignite a revolution—both economic and technological. Currently, doctors are primarily consumers of technology and ideas developed by engineers. This needs to change. The current curriculum teaches us to follow guidelines and mitigate risks, but it does not encourage us to think creatively, innovate, or lead. We need a curriculum that empowers doctors to be innovators and leaders, refining their ideas into viable technologies.

 

The role of senior doctors in start-ups

Senior medics should take on advisory roles in start-ups. While these positions may not have immediate financial rewards, they often offer advisory stakes, which could be valuable if the startup succeeds. The success rate for start-ups is around 20-30 per cent, but as physicians, we already have an income from our clinical practice, allowing us to take calculated risks in the entrepreneurial space. It’s true that start-ups may not pay you immediately—many of them struggle to get off the ground, relying on limited funding from sources like DBP or ICMR, and may not even secure angel investors. However, by taking part in these ventures, we can contribute to groundbreaking innovations that will benefit the medical field in the long run.

Converting doctors into innovators and entrepreneurs is not an easy task. It requires a tectonic shift—a revolution—in the way we think. But this change must begin somewhere. If I, a senior physician, academic, policymaker, and researcher, can work with innovative entrepreneurs, then so can others. When I speak about AMR, the world listens because I have contributed to the field and witnessed the devastating effects of AMR on patients daily. However, I cannot speak on igniting a change in the medical community to embrace entrepreneurship and innovation unless I, too, become an entrepreneur, at least in a symbolic way. I started my consulting service to support Indian start-ups in the med-tech field, help them refine their ideas, and help them face the enormous challenges ahead.

A call to action: Working together to create change

We all need to work together and become involved in start-ups in various capacities. Whether as advisors, collaborators, or innovators, our collective efforts can make a difference. Together, we can create a revolution in the medical field—one that empowers doctors to not only follow but lead, innovate, and transform the future of healthcare.

(This article is a transcript of a lecture delivered at a medical conference)