Thanks so much for joining me today, Tanasi.
Pleasure to be here. If you could give an introduction
as to what you do today and how did you get here?
Yeah, so I spend about 40 % of my time looking
at investments with Halo Health and Genesis Ventures
as a venture partner for Genesis Ventures, looking
at all of their health tech portfolio. and Halo
Health, I'm the chair of the board. Just as background,
Genesis Ventures is a generalist fund out of
Greece, investing globally in Greek founders
mostly, or at least companies willing to have
a presence in Greece. Recently listed by Sifted
as a top five most active investors in Europe.
And Halo Health is Canada's physician angel group.
and we have about 400 members who are actively
investing and we've invested in close to 50 companies
so far with five exits. What are some similarities
and differences you see in the European or the
Greek way of investing in startups versus the
Canadian way? The Canadian ecosystem is much
more mature compared to the Greek ecosystem.
About 10 years ago there was We're barely starting
to see an ecosystem with the first fund being
created at the time that the first private fund,
there was maybe one public fund that was created
in 2011, whereas venture capital has been in
Canada for decades. So being less mature means
smaller check sizes, smaller risk appetite, smaller
exits, everything's just smaller, but growing
fairly quickly. Fairly. We hit an upswing in
2021 and then like a lot of things in venture,
it's stalled a little bit since then. Was the
plan to always transition to venture from being
a physician? And if not, like, was there a moment
or what made you realize that, you know, maybe
I want to branch out and I want to branch out
into investing in startups, not something else?
So I still maintain a small clinical practice
and it was not the plan. No. I practiced more
than full -time for 11, 12 years. At the tail
end of that, I started working for a startup
called Dialogue, which ended up IPO -ing in 2001.
So I joined in early 2018. They went in their
seed stage and then the IPO three years later
and the big health tech boom. So there I got
to see a different way of doing things, much
more agile, much more innovative, different attitudes.
And that's how I got introduced to the world
of startups. So investing was something that
I was doing by myself in the public markets before
that. But startups was through working at Dialogue.
And as of 2020, I started looking into angel
investing. I got to really educate myself through
Halo Health. And then I started writing checks
as of 2021. Talk to me a bit more about the mindset
as a physician and as an investor in startups.
From my experience, med school teaches you to
be the anti entrepreneur, the anti VC. to minimize
risk at all costs. And even the way we think,
when a patient comes in, my thought process in
urgent care and a walk -in is always, is this
going to harm this patient? Is this going to
lead to a loss of life or limb in the next 24
hours? And then that timeline expands. Is this
something here that's going to cause morbidity
over the next six months? And then is this cancer?
So it's a very I don't want to use the word pessimist,
but it's a very risk mitigation approach to work
and to practice. Whereas venture is often about,
what is the upside here? How big can this be?
And we understand risks are inherent in venture
and we accept them. Whereas medicine, the type
of thinking is very different. So talk to me
about, how did you find, maybe through your work
in dialogue and then Halo Health and Genesis.
Like, what are your thoughts on the shift in
mindset between the two practices you do? I think
the closest parallel would be it's as if you're
dealing with very undifferentiated patients all
the time. So a startup, when you see a pitch
deck, you're not sure what the outcome is going
to be. There are plenty of risks and you just
have to price in and then minimize as many of
the risk as possible. The team, the market, the
product, the technical due diligence, how well
the team members know each other, not if they're
just qualified to be in that market. And you
just, you have to look for asymmetric bet. So
we're going to write a check for this much, but
if this goes well, how big could this be? Whereas
in medicine, you're still mitigating risks, if
we're talking about undifferentiated situations
and not routine cases that you would see in a
walk -in clinic or in any kind of settings. But
in medicine, there's no upside. You're just...
capping your downside. And then that's a completely
different way of doing things. You do not get
rewarded for taking risks. You get slapped on
the wrist for taking risks. In venture, if you
mitigate risks well enough, you can get rewarded
quite a bit. And it's also a numbers game. So
you do your 10 investments, six go to zero, not
a problem. you get your one or two, they give
you a hundred X, you're in the top 25%. In medicine,
six of your diagnoses are not right. You're looking
at some complications. Well, that's a difference.
So it's still making decisions on incomplete
information. It's still mitigating risk, but
the overall philosophy is very, very different.
What advice do you have for non -clinical investors
who want to invest in healthcare? So, if we're
talking about digital healthcare or medical device,
technology is good, and good technology is useful,
but hospitals, physicians, they don't pay for
good technology. They pay for a solution to the
problem. And you need to offer that solution
and you need to be able to integrate it into
the daily workflow as seamlessly as possible.
So unless you're willing to do that integration
from A to Z and minimize friction as much as
possible for everyone involved, whether that's
the... the physician or the clinician who's using
it, the patient, the administrative staff, your
good and impressive technology is not going to
get you anywhere. So this is the important thing
that I would look at as an investor looking into
digital health companies. You have two investment
opportunities. One is an amazing team. But with
a crappy product, you don't think fits the market.
You don't think maybe we'll get adoption in healthcare,
but the team is an amazing team. Team B is not
such a great team, but their product is something
that fits your thesis. It's an opportunity you've
identified and it's a really good product and
it solves the problem. Who do you pick? Can I
just ask a qualifying question? What do you mean
a good team? So a team that understands distribution
and product iteration, and a team that maybe
has some experience selling into healthcare,
and a team that has experience maybe building
software solutions adjacent to healthcare. All
right, all right. So I think it's an easy answer
for me, team, team all the way, team all the
way. And I've had some recent examples, recent
examples that remind me of that. So product is
one thing and then timing and why now entering
all of that is great. But if the team is not
agile enough, is not resilient enough, you're
not gonna get anywhere, even if you have the
best expert or the best product. How do you test
for that agility and resilience? It's an art,
right? There's no silver bullet here. You have
to, during your interactions, your multiple interactions
with them, you have to ask them some challenging
questions. You have to see how they respond.
You have to ask them questions about their past,
how they dealt with different challenges, especially
work -related challenges when it comes to this.
And then try to get a feel for how, if they're
more of a missionary or a mercenary type of person
where they're looking for. missionary being,
you know, I believe in this company and I will
do whatever it takes for just to see this materialized
and to see my product being used by my patients
or clinicians versus, oh, you know, the metrics
are good and hopefully we're gonna exit in X
amount of years for this valuation. So yeah,
it's a bit of an arts resilience is important.
having some kind of founder market fit and yeah,
and high IQ, obviously in high EQ. So the way
that they answer your questions when they get
challenged, that's gonna be a big deal. And what
are some common objective attributes you've seen
in your successful founders? Are there a certain
age? Do they come from a certain? area? Have
they had certain life experiences? Maybe they
used to play video games. I think that's talked
about quite a bit in the BC ecosystem. Or they
maybe failed a grade in school. Are there any
commonalities you've found? A chip on your shoulder
does help a little bit. Yeah, I have to say.
So being smart, having a bit of a chip. I was
wanting to stand out. I think one of the smartest
founders that I backed is as a middle child in
a family of doctors who kind of abandoned the
pre -med path and then decided to go into banking,
investment banking, which had to explain to her
family why it's great. And then once they realized
that it's great and she has a great salary, she's
like, oh, well, I want to do a startup. And she's
just raised an oversubscribed series A. So that
definitely helps. But I wish it was that easy
to tell you. Yeah, I think it's something I've
kind of recognized. I've taken the bet on, you
know, I have these theses in mind, and I don't
know if it's something I should continue doing.
It's largely to paint a story for my LPs and
my syndicate investors. I find if I tell them
I'm just going to invest in the best team, right?
I'm going to invest in the best founders building
in health care. That is my whole thesis. That
doesn't fly well, doesn't resonate. So I have
to kind of say, OK, I'm looking for inbox management
and AI diagnostics or, you know, the ambient
scribe plus, which is what is the additional
features here or the AI physician or, you know,
scheduling or whatever it is, RCM. I need these
theses or the the the the investors who invest
in us. They don't buy a vision. Do you kind of
find that being part of Halo Health and talking
to physicians like Is thesis -driven investment
the way? What are your thoughts on that? Yeah,
that's a great question. So there is the prepared
mind approach where you look into a market and
you build your own thesis and then you look for
companies specifically that solve the problems,
which is great. It has worked for big funds.
I think Accel was known for that. But at the
same time, try doing that exercise going back
in November of 2022 and saying, I'm looking for
this. And then in January, well, open AI is here,
right? So you would have to adjust quite a bit.
So it is a bit of, you know, it is a mix of things,
but I do like to have a basic a basic idea, a
basic investment thesis, but then really team
is the right team in a big -ish market. That's
the biggest driver as far as I'm concerned. And
then market is always, it's also hard to pinpoint
because the market can increase, the right product
can increase a market just by being so great
and having more people use it. When we were speaking
last year, we made a prediction that there will
be at least one AI scribe unicorn. There's been
multiple. And I got close into getting into one
of them, but I didn't have access to capital,
so I couldn't get in. But that would have been
a good investment if I did. What are some, so
to follow on that, what are some predictions
you are kind of seeing? at this point and I'll
kind of share mine after. So I think the AI scribe
plus is here already. So we're going to have
AI scribes that are just linked with AI agents.
And basically everything that the physician does
other than say this is the diagnosis and this
is the plan is going to be automated. So you
would see a physician would see a patient go
through the interview, come up with a diagnosis
and then plan and just say to the computer or
to his cell phone, this is the diagnosis, this
is the plan, organize a consultation with this
person, organize a consultation with that person
and I'll see you in three weeks. And then everything
after that, it's gonna get done. So the appointment
is gonna get automated, the medication is gonna
be sent to the patient. going to be direct messages
back to the physician if there is an adverse
reaction. There's going to be an AI agent that
calls you and tells you exactly where you need
to go, what you need to do in plain language
that you understand and gets a feel if you're
anxious or you're not anxious and is able to
troubleshoot some basic problems and then only
escalate to the physician if and only the AI
agent cannot do it. And then AI agents already
are quite quite good when you talk to them. It
is, they feel quite natural and then they're
able to deal with even you asking them relevant
questions or you interrupting the conversation.
So I think all of that, all of that is going
to get automated. So for, I think for the first
time we're going to have software that makes
your life easier and doesn't increase the amount
of things that you need to do. Obviously it's
not going to happen all at once and it's not
going to happen. It's not going to be evenly
distributed, but I think we're move forward there.
I completely agree. And do you think this will
be several point solutions like AI for prescription
generation and anything that happens after that,
AI for referrals, or do you kind of foresee one
company taking on everything that happens during
a physician visit and follow up? And then that
ties into patient inbound as well and AI agents
for, because this is a cycle. It's tough to know
what the market's going to do, but probably two
or three big players that end up consolidating
the smaller players. I think that that's how
I see it. I don't know if the big players are
going to start off as scribes or agent and move
into the other direction. Yeah. And does the
defensibility here lies in the tech or the distribution?
I would have to say distribution. You know, unless
one product is significantly better than the
other, but I think distribution is probably going
to be going to be where it's at. And what are
some hurdles you're seeing for something like
this, say like an AI automated AI agent that
does my referrals and prescriptions for me? Like,
why doesn't that exist right now? Is it a technical
problem? Is it a regulatory problem? Because
I don't need it. I'll happily pay for this. I
don't need to make money off this, right? Like
AI scribes, I don't make any money off them.
And that's, you know, in the past, I would have
said, if you're not generating revenue for me,
I'm not, I likely will not use your solution.
I've changed my mind on that. Because the pain
point with paperwork and referrals and referral
rejection and you know I get this because I'm
still in clinic once a day this referral was
rejected please send it to someone else and that's
literally 15 clicks and copy pasting five different
things and attaching the documents it's like
10 minutes of my time which should be one click
um sorry can we go back to the to the question
so the question is um what's what's the difficulty
Yeah, is it a technical problem at this point?
Because before you said that the defensibility
lies in the distribution, not in the tech. So
to follow on that, and I agree with that, is
this a technical problem currently, or is this
more of a regulatory problem about generating
prescriptions and the agent needing a license
maybe to prescribe certain medications? And what's
the path to that? I don't know if it's a false
dichotomy. I think it's a little bit of, so technically
the technology is almost there. So I know a startup
that does just integrate all of your software
in one. So you don't have to do 15 clicks, but
you're not able to talk to it, right? So technically
the technology is almost there, but there's a
lot of point solutions. So integrating all of
that into, you know, customizing that to what
you need, that's tough. So in terms of regulatory
hurdles, they're fairly big. And mostly it has
to do with different geographies and different
regulatory rules. And then there is how to integrate
workflow. So there's the clinical, that inertia,
the status quo that becomes, that's still a problem.
it's a combination of things, but I think you
have to, I think if you're able to prove to clinicians
that you're saving them time, you're providing
value that's 10x what they're doing right now,
it's not gonna be, that's gonna help a lot. But
I think if you have your champion, that's the
best way to go to market. You have one or two,
champions per institution, they're going to be
able to move things along. When do you think
we will see the first AI agent getting the license
to practice something in healthcare, be it counseling,
be it physical therapy, be it like prescribing
a medication or birth control? When do you think
that will happen? And you know, what's the path
to that? If I'm, if I'm a founder, and I'm like,
you know, I speak to Chad GPT or Gemini or an
AI agent. I'm like, this is really helpful. I
would love for this to be my counselor and be
reimbursed by insurance. And the barrier being
that it needs to be a registered healthcare AI
agent professional. Like, what is the path to
that? When do we see that? And am I thinking
of this the right way? Because my thinking is
you need that license to unlock revenue. I agree,
I agree. I don't know if it's easy to make that
prediction because there's the issue of liability
and a lot of healthcare delivery is personal
and people like the human touch. So I could see
it, let's say over the next five years being
authorized for re -prescriptions. or in a really
menial task. So I, or, you know, re -prescription
of an OCP or contraceptive, I could see it, maybe
treating something really, really simple, like
a benign, like a recurrent rash, for example,
like another eczema flare up. But I think for
the most parts, the lowest hanging fruit is administrative
tasks and administrative costs that have increased
quite a bit. in North America, and I'm guessing
other markets as well. So that one, I think it's
a safer bet. Now, yeah, getting a full license,
but that's a harder one. And there was also a
recent publication, I think in the New England,
where chatting with the therapist chatbot was
shown to be non -inferior, I think, too. compared
to chatting with a therapist. Even with that,
I don't think that's enough to change the status
quo in the near future. Like, and by near, I
mean in the 2020s. Yeah, I mean, I've been talking
to Gemini quite a bit. It always tells me I'm
smart and ask very interesting questions. Yeah.
And so I think that the motivational interviewing
techniques are built in in these chatbots, which
is very interesting. Um, and I had a conversation
with an AI agent, which was a networking thing
and it was very, it made me feel good. Um, I
don't know if it's good for me to be validated
that much, but it made me feel good because you
know, the constant validation also will reduce
your, your stress tolerance. Um, or when you
get a negative feedback, you won't be used to
it because your counselor or your best friend.
or this is something we're seeing, your partner
who is an AI agent, in some cases, is not providing
any constructive feedback. Is that something
you think about? And with the rise of AI agents,
how do you see the future of mental health? So
that's an interesting question, because we had
that discussion with the portfolio company at
Genesis. My honest opinion is that I don't see
them replacing a human therapist completely over,
at least over the next five years. I'm willing
to bet some money on that, let's say. But it
is - Why not? You still need that resistance.
You still need someone to go against, to push
against your assumptions, your schemas. your
defense, your ego defense mechanisms, you still
need that. And do you foresee like payers saying
you need that to get better? Like, do you foresee
like data coming out that patients love it? And
like, I love talking to Gemini, but it's not
helping my mental health, even though I love
it. Like, is that kind of you see that data coming
out at some point? You would need a study that
shows that outcomes over a long period of time
are comparable or better. And maybe AI is going
to go quickly, but there's a lot of nonverbal
communication that you cannot input into JAD
GPT, the latest version, or DeepSeq, or Perplexity,
or whatever you're using. So I don't see it over
the next five years. I do see a lot of some follow
-up communication that you may want to have with
your psychologist. That could be automated if
you have your CBT, a lot of your journaling could
be, you can get nudges to do your journaling
or do the exercises that you agreed upon during
your CBT session. I could see that being very
helpful, but not completely. I cannot see a full
AI agent doing psychotherapy. With that being
said, at least in developed countries. But then
if you're talking about the developing world,
I'm not sure how open the developing world would
be to having an AI agent as their psychotherapist.
Talk me through your diligence process. What
do you look for in startups that kind of come
in your inbox or are introduced to you? Nothing
new here. team for sure. Are they complementary?
Do they have enough experience or enough experience
in the specific market or in another market,
but they bring relevant skills to this market?
Have they known each other for a while? Have
they worked together because partner, founder
breakups are a very common cause of failure.
Then the market needs to be big enough, the timing,
there needs to be a good answer to why now. And
some traction or some kind of validation. If
we're talking about healthcare, there needs to
be some kind of validation, whether that's some
IP for a medical device or some beta testing
or some... at a minimum interviews with the stakeholders
where they got consistent feedback and now they're
ready to build. That's about it. I think that's
the initial screening. And then you have to go
into due diligence and really look at, are these,
is this team supporting their claims? What does
the competition look like? How are they differentiated
from the competition? and go from there. What
are you excited about in longevity medicine?
From what I see, there's this inherent belief
that we all have, including myself, that more
data is better, which goes against Western medicine
in a lot of ways, because we really focus on
pretest probability. Is this data useful? or
will it create more uncertainty? And you can
kind of see this in startups. There's a point
where you're doing diligence. You don't need
more data. You will not get more certainty because
the asset class is uncertain. It's a high -risk
asset class. Unfortunately, medicine is uncertain.
Healthcare is uncertain. And I don't think this
is something patients know or realize that we
can collect as much data as we want. Prognosis
and outcome prediction is inherently uncertain.
That's a probability. It's not deterministic.
We can never predict your future risk of something
as 100 % or 0%. And at some point, and I think
from a business perspective, it's great because
it creates a data flywheel. You order a test,
creates uncertainty. You need more testing, more
uncertainty, more testing. And this is this loop
where it just keeps going. And so it makes sense.
And I think it's a massive market opportunity.
But we'd love to get your thoughts. Yeah, longevity
is very trendy these days and longevity means
different things to different people. So anything
from I'm just getting blood tests or extra tests
more often to, well, here's why I'm using metformin
and rapamycin and then this new, I don't know,
NAD injection and stem cell injection. So it
means different things to different people at
this point. I'm very happy there's interest in
this segment. To answer your question, yes, so
traditional Western medicine and evidence -based
medicine stresses the fact that there is uncertainty
and that's great, but a couple of things here.
So if you have better data, then you can change
your pre -test and post -test probability. What
do I mean by better data? So full body MRIs may
give you some false positives, but they will
cover some edge cases. So they will cover the
pancreatic cancer. They will cover the glioblastoma
multiforme, like a rare brain tumor. And if you
have, you know, a full body MRI at age 50 and
it's completely clean, you have an idea that
your presence probability of having, if you go
do another test, another, let's say, abdominal
ultrasound in two years, the chances of having
pancreatic cancer have gone down quite a bit,
just based on the full body MRI. So I think with
technology advancing and technology becoming
more affordable, a lot of preventable deaths
will go down. And evidence -based medicine so
far has been very useful because we went from...
this is just what my opinion is, or this is what
this KOL does, or this is how we've always done
it, to okay, this is what the research shows,
and this is how we use best practices and the
best research to harmonize treatment and diagnosis,
which was absolutely necessary in the 90s and
up to now. But now with technology going... evolving
really fast and hopefully costs coming down,
we can have more useful data and cover edge cases
more easily. So the rare cancers, but also in
terms of prevention, we can catch cardiovascular
disease a little bit early or we can catch cancer.
We can catch hopefully some autoimmune, we can
prevent some autoimmune diseases from developing.
So I think that just having cheaper access to
diagnostics and wider access to diagnostics is
gonna help just avoid preventable deaths. Now,
is that gonna happen right away? No, is that
gonna be evenly distributed right away? No, but
that's where I think we are going because just
looking at the latest meta -analysis and just
trying to... base our clinical guidelines on
that, already you've lost, there's a lag, okay?
And your statistics are what they are, that they're
gonna cover most patients, but they're still
gonna be edge cases. So we're gonna have fewer
edge cases just by having more useful data. And
there are some examples already of a technology
really changing. the way diseases at least are
managed and hopefully in the future are prevented.
So CGM is already helping with a lot with diabetes
and you have a lot more data, but it's useful
data and people are able to titrate their medications
better and then to have more useful discussions
with their endocrinologist. So wearables are
going to give us increasingly more useful information.
So the Apple watch was just approved for diagnosed
sleep apnea. it's already been approved to diagnose
atrial fibrillation. And I've had two of my patients
get diagnosed themselves with their Apple watch.
And now I'm excited because sleep apnea affects
about 10 % of the population. And you go through
this usual questionnaire that's not very helpful
to try to figure out whether they have sleep
apnea or not. And the current standard of care
is that they just have to go to clinic, pick
up a machine, take their home, and then send
the machine back, then see a specialist and then
have treatment delivered to, or have access to
treatment. Now they can come directly to me and
then I can send to see the specialist. If they
wanna do some more testing, fine, but at least
it's picked up on time. If you had infinite funding
to build a startup in this space, how would you
begin? In the preventative medicine space, you
know, you could have molecular solutions where,
you know, just go directly at the mitochondrion
and then, you know, just reverse aging or stop
disease at the cellular level. I don't have any
insight. I don't have a lot of insight into that.
And I'm glad that people are looking into that.
But if we're talking about, you know, with what
we have now, it would be... Would you do like
a NECO style from Sweden, like which is like
a clinic or would you do like a function health
or something that's more, you know, telehealth?
They're converging. The two are converging because
function health, I think, just bought a full
body MRI a startup. So I think we are going in
that direction. And NECO health is using a lot
of money. So I think that's where we're going.
So which means regular blood tests and full body
scans. I don't know if I would do them every
year, but you could do maybe full body scans
every few years and then in between some liquid
biopsies that work better than what we have right
now because nothing works really well. from the
blood test that existed in the market. So I think
that's, yeah, that's very feasible in the next
few years until you have the next revolution
at the molecular level. Let's say I'm a physician,
you know, I graduated from high school, went
to undergrad for pre -med, did med school, did
residency, did fellowship, and I'm attending.
The only thing I know is medicine. I know nothing
else. And I have a problem in my workspace and
I'm thinking, you know, this is a solution that
could work. And then I come across A16Z and Sequoia
and I'm excited and I'm like, OK, this looks
promising. I want to build a startup. How should
I go about what are some mistakes I'm going to
make that I can avoid? And what are some mistakes
I'm just going to make anyways that are unavoidable?
What advice do you have for this physician? So
a lot of the physicians that I see are exactly
that and they tend to be academic physicians
and they want to build something based on their
research. And the most common mistake is just
trying to do everything themselves and trying
to recruit among either their students or some
undergrad or someone who doesn't have enough
expertise. there's a lot of not knowing what
you do not know. This is the most common problem
that I see and trying to keep all of the equity
to yourself and not understanding that this is
a completely different game. And your skills
have made you an expert in what you do, but building
a company going from, so I have good technology
or good research or maybe even good IP, going
from that to I have a successful company that
is a completely different game. And there's ego
that gets involved here, or there's just ignorance
of what we don't know, which is normal. We all
have blind spots. But the number one thing would
be to build a team around you, understand that
you don't have commercialization experience.
You will need someone to take care of technology,
even if you are the chief scientific officer.
You need people to build a commercially minded
team around you. So let's say that you get over
that. The other thing to understand is that someone
who worked at a big pharma company and has 20
years of experience is not necessarily the best
co -founder for you. You need someone who has
some technical skills or some commercialization
experience, but you need someone who understands
startups and the uncertainty of startups and
the resilience that's required. and to be able
to tolerate rejection, whether that's from investors
or from the initial customers where you're going
to have setbacks and you're starting on a new
adventure essentially and then you need the best
team and you need to realize that your previous
career has not prepared you for this. If your
kids came to you and said, dad, I want to be
an emergent medicine doctor, what would you tell
them? My kids too. So that would be in 16 years.
I would say just get a good idea of what it is.
just go shadow a few emergency physicians and
then, you know, talk to people who are early
in their career, talk to people who are late
in their career, get a feel for, you know, the
profession and then get a feel for, you know,
and see if you like it. But I would start the
real Question here is, is why? Okay. And I'm
trying to really get to the, what do you like
about it? What is it that drives you to do this?
What are your strengths? What are your weaknesses?
And then is this the only thing that will make
you happy? I think starting with knowing yourself
and strengths, weaknesses, ambitions. Interest,
once you get to know that, I think then you can
see that there's a lot of ways to be happy or
to have a successful career or whatever your
ambition is to make a lot of money or have a
big impact in society. And once you know yourself,
you have to identify at least a few solutions.
It cannot just be, I will be an emergency physician
or die. identify a few solutions, go try them
out. If you think emergency medicine is for you,
go for it. And just because you did it for 10
years or 12 years doesn't mean that you're married
to it for life. So that's how I would address
that. I would say no. That's been my answer for
a few. for a few years, but my wife tells me,
no, no, no, she has to walk me back from that.
So. Yeah, I think my 12 year old, she has an
interest in science and I can see, and even the
five year old that they're starting to kind of
pick on things and starting to go the medical
route. And I'm trying to kind of sway them away,
but we'll see if I win that battle. What brings
you more satisfaction? and joy investing in a
team that needs coaching or investing in a founding
team that you just your hands off? Do you think
the job is to help founders specifically coaching
with, you know, scaling and team building and
management of that sort, or is the job to just
pick the best founders and get out of the way
and maybe help them a little bit here and there,
but you're not involved that deeply? No, picking
the best founders and getting out of their way.
Like there's not, I don't care to maximize my
impact on within that team, picking the best
founders. It's a difficult decision anyway, just
sometimes just even finding the right team is
hard. And then let alone doing due diligence
and then negotiating and everything else that
goes with the deal. So no, picking the right
team. getting out of their way, that's absolutely
fine. Now, if I can help in any way, that's fine,
but I do not want to be involved in the day -to
-day. And it doesn't, you know, if you have a
lot of big portfolio, it's not really realistic
to say, oh, well, I'm going to help you with
this and that, or I'm going to be doing part
of the work. Mind you, over the last six months,
I have been helping a company, but, so maybe
that's colored by that, but. No, just it's so
delightful just getting those updates and things
are going up into the rights and then, you know,
this new opportunity that gets unlocked or there's
interest by this acquirer. That's venture is
hard enough as it is. So I prefer to have picked
a good team. If you had to pick out of investing
in medical device, versus digital health, what
would you pick? Oh, medical device is hard. So
definitely digital health. Medical device, you
have all the technical risk of building something,
going to regulatory, and then you have to build
distribution, which is very hard. Which do you
think is harder, FDA approval or distribution
and market adoption? I think distribution is
harder. I think distribution is harder. Interesting,
because we celebrate FDA approval so much, you
know, from it almost feels like the startup has
succeeded post -approval. They haven't, but I
think that that's what the, and maybe it's because
both things are so hard, we need to celebrate
our successes. The only thing that I'm going
to say here is, oh, you could just get acquired
as soon as you get your FDA approval, and That's,
I think that's a great path to exit. There are
not a lot of players that will acquire you. Okay,
that's been consolidated to four or five players
that do acquire a medical device. So you need
to probably have built some relationship with
one of them or a few of them from before you
get your FDA approval. But, you know, selling
after that, It's hard. Building your Salesforce,
going after KOLs, that takes a lot of capital,
a lot of energy, and there's a lot of challenges
there. And it takes a bit of different skillset
from the team, because your CTO is not as active,
the technical team is maybe improving the device
a little bit, but you need to hire a second team.
Whereas digital health, faster go -to -markets,
no defensibility, yes. You may or may not be
able to be as sticky as a medical device. But
generally, with AI, with a lot of the inefficiencies
in healthcare, I find it's a better investment.
And it definitely fits my background better.
Is it easier to teach entrepreneurship and business
to a healthcare expert or physician or to teach
healthcare to a business or entrepreneurship
expert? I think it's easier to have help on board,
to have healthcare expert or healthcare expertise
to have access to that when you're an entrepreneur.
Becoming an entrepreneur, there's a lot of...
personality traits that go with it that you medicine,
clinical medicine selects out for it and that
are actively discouraged. So I would prefer an
entrepreneur who has a great advisor and then
a few clinicians on his team, leading a team
as opposed to a physician by himself or I don't
know, maybe a physician who's well surrounded
could do it, but generally I would I would invest
more in an entrepreneur. OK. Last question, Tennessee.
If you could go back in time and talk to your
20 -year -old self, what would you tell him?
One thing is certain things are going to change
a lot. And you're not going to be able to predict
how they're going to change. So just stay flexible.
Just stay flexible. And success is just, you
know, or happiness going from failure to failure
without a loss of morale. Just stay flexible,
stay resilient, and you're gonna end up ahead
in the end. Thank you.