STARTING A COMPANY: THE PHYSICIAN ENTREPRENEUR

Anesthesiologists spend thousands of hours in operating rooms, surrounded by other people’s inventions. We may think, “Why can’t I start a company to invent something like the pulse oximeter (i.e. Dr. Bill New, Stanford anesthesiologist-engineer), the laryngeal mask airway (i.e. Dr. Archie Brain of England), or even the Bair Hugger? Heck, I use a hair dryer every morning. Why didn’t I realize how useful hot air could be in warming surgical patients?”

In a recent Stanford Anesthesia Grand Rounds lecture, anesthesiologist-entrepreneur Jeffery Bleich, MD discussed this very topic. How does a physician go about converting his idea into a medical technology company? Dr. Bleich is a unique individual, a board-certified anesthesiologist and pain medicine specialist who completed Stanford Business School’s Sloan Fellowship and founded not one but two Silicon Valley medical companies. These are some highlights from Dr. Bleich’s lecture:

  1. Anesthesiologists can be ideally suited for starting companies, because our specialty interfaces with all aspects of medicine, from neonates to geriatrics, from cardiac and brain surgery to ambulatory procedures such as orthopedics, ENT, and plastics. Anesthesiologists have ample time to contemplate new ideas as they take part in surgical and medical interventions, and we have the ability to create flexible schedules to explore entrepreneurial ventures.
  2. Dr. Bleich recommends a 20-year plan as an approach to starting a medical business. Where you want to be in 20 years dictates what decisions you will make regarding your future 10 years from now, 5 years from now, and most importantly, today.
  3. Think of a Problem that needs a better solution. Then the most important ingredients in your plan are Team > Market > Idea. One might think that the Idea is the key to starting a company, but Dr. Bleich stressed that an excellent Team comes first. If one assembles an excellent Team to approach a big Market, the Idea will develop out of Team and Market.
  4. Find a Mentor. A seasoned role model who has started a company prior to you will be your greatest asset in guiding you through the process. For a modest percentage of ownership in the venture, recruit a Mentor. In the Stanford geographical area, Silicon Valley is a rich resource of such individuals.
  5. “Kill ‘em Quick.” This phrase refers to the concept of killing bad ideas quickly. Try to criticize and defeat each new idea you have. If you are capable of killing the idea in short order, this is preferable to investing years of time and quantities of dollars only to find the idea is not viable. If you can’t kill the idea quickly, go with it.
  6. Expertise + Passion = Magic. Passion is necessary and contagious. If you have Passion for the Idea and the Expertise to back it up, your likelihood for success grows.
  7. Deliver. This requires sweat and effort. Dr. Bleich reports that starting a company becomes a 7-day a week project that infringes on family time, traditional work time, and free time. He stresses that intellectual honesty and execution are needed to keep the company on path. The need to “make a difference” in the world can be an overriding theme that keeps the work on track.
  8. Funding. From 2004-2009, Dr. Bleich was the Founder and CEO of Baxano, Inc, a company that developed both a minimally invasive procedure and instruments to approach lumbar stenosis surgery. In the company’s infancy, Dr. Bleich was the sole owner of Baxano, Inc. During the ensuing years, Baxano raised $70 million in venture capital money to support the company. Eventually the company merged with a public company in an acquisition.
  9. A cautionary tale: Dr. Bleich described venture capital (VC) funding as an “extremely financially risky path,” particularly in the medical technology industry today. However, he added, if you can obtain this type of financial capital, it does provide a sort of “rocket fuel” that can enable a company to attempt to grow a business very quickly. Unfortunately, it also requires giving up control of the company’s major financial decisions to the Venture investors.
  10. Dr. Bleich has since founded a second company, Pulson, Inc., where he again serves as President and CEO. This time around he’s been able to avoid VC funding, partly because Pulson, as a software company focused on consumer health, requires less overhead than did Baxano, a medical device company developing minimally invasive surgical tools. Forgoing the “rocket fuel” the venture capitalists offer means the new company has grown more slowly than a typical VC funded enterprise, but bootstrapping the company in this manner has allowed control of the company to remain with the founders, which so far appears to have been worth the tradeoff.
  11. Dr. Bleich described the current financing climate for medical device companies as a “wasteland.” It’s his personal opinion that the federal government, appropriately concerned with out of control inflation in medical care costs, has recognized that proprietary new medical devices are typically very expensive compared to generic devices, yet more often than not they are at best only marginally better than old technology. In order to shut down expensive new proprietary products from hitting the market, the government has three ”levers” that it can pull to suppress medical device innovation:  a) it can make it more difficult to get products approved or cleared through the Food and Drug Administration (FDA);  b) it can make it more difficult for new products to gain reimbursement through Centers for Medicare & Medicaid (CMS);  and c) it can (and did) add punitive new taxes that specifically target medical devices. These factors have combined to increase the risk and cost of bringing new medical technologies to market, while decreasing the value of the few that actually make it, causing many of the finest investors across the medical technology industry to leave for greener pastures.
  12. Dr. Bleich encouraged would-be entrepreneurs to not be discouraged by the lack of interest in medical technology investing as we used to know it. In fact, he described a silver lining in these dark clouds, and provided examples of newly emerging areas in healthcare innovation that are bursting with future promise. He suggested that some of the best new territories for medical innovation include the individual and converged categories of: a) wireless technology, b) genomics, and c) Big Data.
  13. What about the value of a physician going to business school and gaining a business degree? Dr. Bleich graduated from Stanford Business School, one of the world’s elite business schools. Was it worth it? Dr. Bleich admits it helped him approach the business world with more confidence. The degree itself didn’t help him find a job that was of particular interest to him, because an MD with one year of business school is very unlikely to be able to qualify for a high level business position. After interviewing with a couple of large medical technology companies, he soon realized the only way he would be able to find a job in the business world that gave him the level of responsibility he was looking for was to create the company himself. Not surprisingly, when he founded his own company, Baxano, as the only employee, he hired himself as CEO.
  14. With MD salaries as high as or higher than most mid-level business jobs, and with the income potential of MD’s still relatively high, Dr. Bleich stressed that the motivation to go into business and start a company should not be money. “If your major motivation is simply to make a fortune, your odds would be better rolling the dice at a craps table in Las Vegas than starting a medical company,” he said. “It’s a gamble either way. You should become an entrepreneur because you know in your heart that you cannot go to the grave without trying to make the world a better place with your business idea.”

I thank Dr. Jeffery Bleich for his expertise, candid remarks, and advice.

The American Dream is alive and well in the 21st Century, and if you have the heart and soul of an entrepreneur, I hope you summon your intellect and your courage, and start a company that changes the world we live and work in.

Introducing …,  THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a legal mystery. Publication date September 9, 2014 by Pegasus Books.

The first four chapters are available for free at Amazon. Read them and you’ll be hooked! To reach the Amazon webpage, click on the book image below:

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Stanford professor Dr. Nico Antone leaves the wife he hates and the job he loves to return to Hibbing, Minnesota where he spent his childhood. He believes his son’s best chance to get accepted into a prestigious college is to graduate at the top of his class in this remote Midwestern town. His son becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who grew up in Hibbing. An operating room death rocks their world, and Dr. Antone’s family and his relationship to Mr. Dylan are forever changed.

Equal parts legal thriller and medical thriller, The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps, and courtroom confrontation, and concludes in a final twist that will leave readers questioning what is of value in the world we live in.

REVIEWS:

5.0 out of 5 stars The Doctor and Mr Dylan, March 3, 2015
By
prabha venugopal (chicago, il USA) – See all my reviews
Verified Purchase(What’s this?)
Gripping from the beginning to the end. Very well written, bringing to the forefront all the human emotions seen in an operating room spill over into real life. I cannot wait for Dr. Novak to wrote another book! As another physician in the same profession, my admiration for his book knows no limits.

Bang-Up Debut Novel, November 16, 2014

By Norm Goldman “Publisher & Editor of Bookpleasures”

This part legal and medical thriller is structured with a mixed bag of situations involving relationships, jealousy, evil, lies, courtroom drama, operating room mishaps as well as moments that engender conflicting and unexpected outcomes. Noteworthy is that as the suspense builds readers will become eager to uncover the truth involving a mishap concerning Nico and a surgical procedure that has unanticipated ramifications.

This is a bang-up debut from a writer who understands timing and is able to deliver hairpin turns, particularly involving the courtroom drama,that you would expect from a book of this genre.

TwinCities.com PIONEER PRESS Entertainment

by Mary Ann Grossman, Entertainment Editor, St. Paul Pioneer Press mgrossman@pioneerpress.com, January 4, 2015

“The Doctor & Mr. Dylan” by Rick Novak (Pegasus Books, $17.50)

Dr. Nico Antone doesn’t hide the fact he hates his wife, but he says he didn’t kill her during an operation. The authorities think otherwise and his trial is the riveting suspense in this novel that is part medical thriller, part legal thriller, part exploration of family relationships.

Nico is an anesthesiologist (as is the author) who leaves his wife, their plush life in California and his job at Stanford to move to his hometown of Hibbing so their son, Johnny, has a better chance of getting into a prestigious college. Johnny hates the idea of moving to a small, cold town, but he’s popular from the first day in school. Nico doesn’t do so well. He’s envied by Bobby, an anesthetist who’s jealous of the better-educated Nico. But it’s hard to take Bobby seriously, since he thinks he’s the young Bob Dylan and lives in the house where Bobby Zimmerman grew up. To complicate matters, Nico is attracted to the mother of the young woman his son is dating. When the two teens get in trouble, Nico’s furious, rich wife comes to Minnesota and needs an emergency operation that puts her on Nico’s operating table.

Novak grew up in Hibbing, where he worked in the iron ore mines and played on the U.S. Junior Men’s Curling championship teams of 1974 and ’75. After graduating from Carleton College, he earned a medical degree at the University of Chicago and spent 30-plus years at Stanford Hospital, where he was an associate professor of anesthesia and Deputy Chief of the Anesthesia Department. His courtroom scenes are based on his experiences as an expert witness.

The Physician’s Late-Night Reading List

Two Pritzker alums pen captivating tales

By Brooke E. O’Neill, University of Chicago Pritzker School of Medicine, editir, Medicine on the Midway Magazine

For most physicians, writing — patient notes, case histories, perhaps journal articles — is part of the job. But for anesthesiologist-novelist Rick Novak, MD’80, and neurosurgeon-memoirist Moris Senegor, MD’82, it’s a second career that consumes early morning hours long before they step into the OR.

Fans of John Grisham will find a kindred spirit in Novak, whose fast-paced medical thriller, The Doctor & Mr. Dylan (Pegasus Books, 2014), transports readers to rural Northern Minnesota, where an accomplished physician and a deranged anesthetist who thinks he’s rock legend Bob Dylan see their worlds collide in the most unexpected ways.

Delivering real-life twists and turns — and a love letter to the Bay Area — is Senegor’s Dogmeat: A Memoir of Love and Neurosurgery in San Francisco (Xlibris, 2014), a coming-of-age tale chronicling the author’s away rotation with renowned neurosurgeon Charles Wilson, MD, at the University of California, San Francisco. Brutally honest, it spares no details of a time Senegor, who also served as a resident under the University of Chicago’s famed neurosurgery chair Sean Mullan, MD, describes as “one of the biggest failures of my life.”

One a vividly imagined nail-biter, the other an intimate peek into the surgical suite, both books deliver an ample dose of intensity and drama.

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The Doctor and Mr. Dylan (Pegasus Books, 2014) by Rick Novak, MD’80

“I thought it was a novel way of killing someone,” said Rick Novak, deputy chief of anesthesiology at Stanford University, describing the imagined hospital death that was the genesis of his dark thriller The Doctor & Mr. Dylan. A huge Bob Dylan fan — the rock icon was born in Novak’s hometown of Hibbing, Minnesota, where the story takes place — he then dreamed up a possible culprit: a psychotic anesthetist who thinks he’s Dylan.

From there, the words flowed. “I would write whenever I was with my laptop and had a free moment: in mornings, in evenings, in gaps between cases,” said Novak, who also blogs about anesthesia topics. “I don’t sleep much.”

After finishing the manuscript — one year to write, another to edit — came the challenge of finding a publisher. “In anesthesia, I’m an expert,” Novak said. “In the literary world, I’m an unknown.” After 207 responses of “no, thanks” or no answer at all, he landed an agent. Two months later, she informed him that Pegasus Books had bought his debut novel.

“I started crying,” Novak admits. “I have a third grader and at the time the big word the class was learning was ‘perseverance.’ That was it exactly.”

Dr. Joseph Andresen, Editor, Santa Clara County Medical Association Medical Bulletin, from the January/February 2015 issue:

BOOK REVIEW “THE DOCTOR AND MR. DYLAN”

This past month, Dr. Rick Novak handed me a hardbound copy of his debut novel The Doctor and Mr. Dylan. Rick and I go way back. It was my first week of residency at Stanford when we first met. A newcomer to the operating room, all the smells and sounds were foreign to me despite my previous three years in the hospital as an internal medicine resident. Rick, a soft spoken Minnesotan at heart, in his second year of residency, took me under his wing and guided me through those first few bewildering months, sharing his experience and wisdom freely.

Fast-forward 30 years later. Dr. Rick Novak, a novel and mystery author? This was new to me as I sat down and opened the first page of The Doctor and Mr. Dylan. I have to admit that I didn’t know what to expect. Few books highlight a physician/anesthesiologist as a protagonist, and few books feature a SCCMA member as a physician/author. However, a medical-mystery theme novel wasn’t at the top of my must read list. With my 50-hour workweek, living and breathing medicine, imagining more emotional stress and drama was the furthest thing from my mind. However, three days later, as I turned the last page, and read the last few words. “life is a series of choices. I stuck my forefinger into the crook of the steering wheel, spun it hard to the left and …” This completed my 72-hour journey of and free moments I had, completely immersed in this story of life’s disappointments, human imperfections, and simple joys.

Rick, I can’t wait for your next book. Bravo!

Hibbingite writes twisted medical tale

HIBBING — Readers who are looking for a whodunit that will keep them up all night are in for a treat.

Hibbing native Rick Novak recently released his first book “The Doctor and Mr. Dylan,” a fiction set in Hibbing that merges anesthesia complications, a tumultuous marriage and the legend of Bob Dylan.

“The dialogue is sometimes funny, and there are lots of plot twists,” he said.

Novak said the book will not only entertain readers, but teach them about anesthesiology, Dylanology, the stressful race for elite college admission, and life on the Iron Range.

“The book is very conversational and streamlined,” he said. “I try to write as one would tell a story out loud.”

Novak said “The Doctor and Mr. Dylan” took him three years to perfect. He is currently working on his second book.

5.0 out of 5 stars I Sense We Have Another F.Scott Fitzgerald Emerging on the Literary Scene, December 1, 2014
By
Deann Brady (Sunnyvale, CA USA) – See all my reviews
(REAL NAME)
I found Rick Novak’s first novel, “The Doctor and Mr. Dylan,” a most exciting combination of biting sarcasm, mystery and daily activity spun with fresh new phrases that made me turn my ear back to listen to the literary cadence of his words again and again even though, on the other hand, I was anxious to turn the pages to see what would happen next. His brilliant handling of scenes is reminiscent of The Great Gatsby by F. Scott Fitzgerald. A compelling read!Deany Brady, author of “An Appalachian Childhood”

By

allan mishra

This review is from: The Doctor and Mr. Dylan (Kindle Edition)

Just finished Dr. Novak’s delightful novel. I sincerely enjoyed his honest take about the pressures and values that exist within California’s Silicon Valley. He also brought the North Country of Minnesota to life with memorable characters and a twisting, addictive plot. Buried beneath the fun and funny story is a deeper message about how to best care for your kids, your relationships and yourself. Very well written and highly recommended.

Learn more about Rick Novak’s fiction writing at rick novak.com by clicking on the picture below:

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