Out in the health care business world, people often ask questions about the challenges of running a business and being a practicing anesthesiologist. I’m the CEO and co-founder of ePreop, Inc., and an anesthesiologist at St. Jude Medical Center in Fullerton. Here are a few answers to the questions I’m most often asked. I hope they’ll be of help to anyone interested in the process, or anyone considering embarking on a similar endeavor.
How do you move from an idea to an actual business?
As a group, physicians are conservative by nature, and this can make it difficult to take the leap of investing the time and money required to start a business. I fall into the camp of ideas are easy; implementing ideas takes hard work and commitment. I saw a problem around getting patients ready for surgery and the huge costs associated with unnecessary preoperative testing.
My original idea in 2008 was to generate accurate protocols within the electronic health record (EHR) at the point of care, such as personalized patient instructions and protocols for preoperative testing. I brought in a programmer who believed in the vision, and we worked together to get the integration live.
We started by working with GoogleHealth, which at that time had a personal health record with a published application programming interface (API). We quickly proved that it was possible to pull in data from an EHR and generate clinical guidelines. I then took this working proof of concept to hospitals and managed care groups, which is how we got our first contracts.
The most important next step was to bring in the right people to help. Surrounding yourself with smart people that you know, trust, and enjoy being around is probably the most valuable decision any businessperson can make.
The first person I brought on board was Manoj Kulkarni, MD, who had been a resident with me at the University of California, Irvine. He became the co-founder of ePreop. We were both excited about having a positive impact on health care, and we still take real pride in what the platform does. We also spend time discussing and debating topics unrelated to medicine. This helps maintain a little balance and also helps you look at things from different perspectives. I’m certainly focused (some say obsessed) with regard to ePreop, as I am sure is the case with most entrepreneurs and their companies. Finding that balance is something I’m still working on.
How does a new company find funding?
Manoj and I funded the company in the beginning, and then raised some angel investment over the first five or so years. We were fortunate to obtain some good contracts that allowed us to keep building out the software. When the company needed more money, we continued to step up individually. This strategy was adequate for a while, but would not work for the long term.
We wanted to grow faster and build the team out in more directions, so we brought in some private equity funding. This was an eye-opening experience, but over a year later, I can say it was one of the smartest things we did. We’re no longer constantly worrying about funding and about the personal financial risk to our families and angel investors. Now we have seasoned executives working with and advising the company. We have plenty of capital to grow, and I’ve been able to focus more on building the products.
What are the greatest challenges?
I would break the challenges down into two areas: those related to business and those focused around family and personal life. For both, time is the greatest asset and the hardest thing to find.
On the family front, I have an incredibly supportive wife and great kids. I am constantly working on finding time and being present and available for them. Both business and medicine result in sacrifices around time spent with family. One positive aspect of practicing anesthesia is that, when the operating room day is over and you’re not on call, you’re able to leave work behind. Owning a business is a different experience. It’s never completed like a surgical case. Of course, on the days in anesthesia when things don’t go well, that’s much more difficult to deal with than the tough days around the business.
Speaking from the perspective of business challenges, I never imagined the regulatory and integration barriers would be so difficult. The sales cycle is ridiculously long, even after facilities understand they need the service. After the executives and clinical team get on board, you still need to get the IT department to prioritize and sign off as well.
And of course, don’t forget the monumental problem of getting EHR corporations to agree to integrate with your platform. This EHR integration piece has been a major challenge. Though the platform can stand alone, over the last seven years we’ve managed to integrate and/or partner with nearly every major EHR platform on the market, including Epic. This has removed a major hurdle and helped launch ePreop into the next stage.
How can you run a business and practice anesthesia?
As I mentioned above, one of the biggest challenges has been balancing my time as an anesthesiologist and as the CEO of a growing company. My anesthesia group (Allied Anesthesia) is forward thinking and always supportive, which has really helped.
There are pluses and minuses. I do work more hours now as I run the business, but the hours are different. There’s great stress around taking call, caring for sick patients, and being responsible for people’s lives, which makes the hours spent as an anesthesiologist more taxing. I don’t think I appreciated this fact as much when I practiced full time. Transitioning toward business has shed an objective light on how much our specialty really does for patient care. It makes me proud to be an anesthesiologist.
That being said, I feel fairly certain that our specialty is going to take a major financial hit in the next few years, based on what I am seeing from hospital executives and other anesthesia groups. Some groups in the Midwest are supervising at 10:1 ratios. The demographics and costs are going to push other regions into the same model. Anesthesia groups must own the entire screening process, increase the hospital’s case mix index, decrease length of stay, and reduce readmissions. They must also master value-based payments and Qualified Clinical Data Registry (QCDR) reporting. Those that do will be in a much better position to justify stipends and survive.
As a CEO, I’m always thinking about product development, sales, support, growth, financials, and more. Our platform has expanded to include enhanced recovery pathways and allow QCDR reporting. Running a business has taught me things that I never would have anticipated, and I’m grateful for having the opportunity to learn. It is exciting to run a business and see it grow.
I don’t know if I’ll be able to keep on practicing anesthesiology in the long run—over the past year or so, my clinical practice has dwindled and I have focused on the business. If I continue to take an extended leave, I might need to retrain clinically at some point. But as a physician, I get great satisfaction from knowing that my business goal is to improve surgical outcomes and have a positive impact on the health of far more patients than I could ever personally treat.