By CAROLYN BRADNER- JASIK, MD

Six months ago, I made the decision to join a digital health startup, after directing the inpatient EHR roll-out at the University of California San Francisco (UCSF) Benioff Children’s Hospital. This may not seem that surprising: there is a lot of discussion lately of the growing dissatisfaction among doctors with the healthcare system, and “digital dropouts” leaving medicine to work in tech.

The difference is that I am neither 28 nor right out of residency. I’m a 40-year-old healthcare executive who is squarely mid-career, and I did not make the change for the usual reasons: the lure of money, job dissatisfaction, etc. I loved my job at UCSF, and in fact, I continue to see patients there. So why did I leave a promising academic career for a riskier role at a startup? Because we need more seasoned clinicians at the front lines of digital health to get us to scale. Our institutions have made huge financial investments, and now it’s time for us to make a more personal commitment.

Every week, I receive an email from a colleague asking me to meet with a young physician who’s considering a career in tech, right out of training. We would not have digital therapeutics or a national physician network without innovators who left medicine early in their career to pursue a big idea. But this is not enough to induce mainstream adoption of digital health: we also need to hear the voices of physicians who have been in practice for a while or have held operational roles within large health systems.

…institutions have made huge financial investments, and now it’s time for us to make a more personal commitment.

I left my role at UCSF because I was disappointed as companies with great ideas were passed over. I often sat through pitches thinking, This is terrific, but we will never buy this because …

• The technology is great, but it doesn’t solve any pain point that we currently have.
• The product does not integrate well with our clinical workflows, including our EHR.
• The startup has an A+ solution to our problem, but our EHR has a C+ solution that we already paid for and can implement with little cost.
• The technology budget has already been (over)spent on our EHR. Asking for additional resources is a heavy lift.
• Our staff have tech fatigue from large, complex EHR rollouts. The bandwidth to train and implement another tech solution is not there.

Rock Health recently reported that digital health received $4.3 billion in funding this year.  But at the same time, 75% of this went to early-stage Series A and B rounds for innovations that may not stick. To take us to the next phase, we need more cross-pollination of perspectives, among both startups and enterprise organizations alike. The seeds of this type of collaboration have already been planted, with innovation centers popping up at healthcare institutions, and startups hiring clinicians earlier.

So why don’t more seasoned, executive physicians leave their posts to disrupt care? Most can be found on advisory boards or as innovation champions within their organization. But occasional input will not move the needle.  Deep investment in product design and implementation is necessary, as healthcare innovation is equal parts technology and workflows. As Rebecca Coelius described it on The Health Care Blog, you “need to know what’s inside the box to think outside it.” Knowledge of clinical processes, including billing, compliance, and operations, is imperative for any startup that wants to intersect with health systems.

To design a product that consumers love and healthcare organizations want to recommend, you need all hands on deck.

At Mango Health, we understand what it will take to embed a consumer-facing mobile solution within a complex enterprise health system. Starting with medication adherence, our product empowers consumers to better manage chronic conditions,  particularly if the app is connected with their care team. To design a product that consumers love and healthcare organizations want to recommend, you need all hands on deck. Our CEO, Jason Oberfest, understands that longevity in digital health requires a team with the full package: tech, design, business expertise, as well as senior-level in-house clinical experience. My role is to help build a product that patients can use every day, and the healthcare industry wants to buy.

The transition has not been easy.  I left behind a secure position, salary, and potential for high impact at a leading organization. But working at Mango Health also gives me insider understanding of how innovation is funded, the opportunity to learn from industry-leading designers and developers, and a fresh perspective on selling to enterprise health systems. Immersing myself as a new type of stakeholder in the industry enriches my skill set, no matter what the future holds for my career.

If you are ready for a new challenge, consider exploring a position at a startup to lend your voice and experience to shape digital health’s future. There are many options that may not even require you to permanently separate: you can go on a sabbatical, take on a dual appointment, or consult for an extended period. You may find, like I did, that advising an early stage startup is the best part of your week!

Carolyn is a board-certified clinical informatics physician with a background in technology operations and research. She holds a dual position as VP of Medical Outcomes at Mango Health and is an Associate Professor at the University of California, San Francisco.  She has 15 years of research experience and recently transitioned to industry to focus on mobile health applications.