Why Doctors Win at Healthcare Entrepreneurship - Curology

今天的嘉宾做了一件事，表面上看挺简单的，实际上却特别难。

Today's guest builds something that sounds really simple at first glance but is genuinely hard.

他让皮肤科诊疗变得触手可及。

He made dermatology accessible.

在远程医疗还没火起来、消费者直连医疗还根本没人提的时候，他就已经在新墨西哥的沙漠里，看着病人开车两小时以上，就为了看个痤疮，结果发现开的药根本买不起。

Before telemedicine was trendy or very well known, before direct to consumer health was even a thing, He was in the Desert Of New Mexico watching patients drive over two hours for an acne consultation only to find out the medication they were prescribed was not affordable.

他当时已经是认证皮肤科医生了，但没选择开个普通诊所，而是和他哥哥、妈妈还有个朋友一起，创办了后来的Curology。

He was already a board certified dermatologist, but instead of building a regular practice, our guest teamed up with his brother and his mother and a friend to launch what would become Curology.

Curology成了第一家把远程医疗、个性化配药、直接面向消费者的服务全整合进一个订阅模式的公司，已经服务了五百多万患者。

Curology became the first company to combine telehealth, custom compounding, direct to consumer, care, all into a single subscription and has created over 5,000,000 patients.

现在，他进入了人生的新阶段，担任董事会主席、作家，也是最坚定呼吁让医生走进董事会的人之一，Dr. David Lortscher。

Now in his newest chapter, our guest is an executive chair, author, and one of the strongest voices advocating for more physicians in boardrooms, Doctor.

大卫·洛尔特舍尔。

David Lortscher.

大卫，今天能请到你真是太好了。

David, it's really good to have you today.

非常感谢。

Thanks so much.

很高兴能来。

Awesome to be here.

大卫，我们想先请你简单介绍一下自己。

David, we'd love to start off with just a little bit about you.

跟我们说说你是谁，以及你是怎么走到今天的。

Tell us who you are and how you got to where you are today.

是的。

Yeah.

我2012年完成了皮肤科住院医师培训。

So I I finished dermatology residency back in 2012.

正如你提到的，我第一份工作是在新墨西哥州做的。

And as you mentioned, I took my first job practicing out in New Mexico.

那时候，iPhone已经推出五年了，人人都在搞远程医疗公司。

And at that time, this was, like, five years after the iPhone had come out, and everybody was starting their own telehealth company.

而这个领域里最大的机会就在皮肤科。

And the the biggest space for this was dermatology.

在皮肤科里面，焦点全在痤疮上。

And seemingly within dermatology, it was all about acne.

对吧？

Right?

因为痤疮特别适合远程诊疗。

Because acne is perfect for telehealth.

诊断痤疮根本不需要碰触患者的皮肤。

You don't have to touch someone's skin to diagnose it.

也不用做活检或者任何手术。

You don't need to do any biopsies or procedures.

所以挺有意思的是，2013年，我独立行医大概半年后，就自己创办了一家远程皮肤科公司。

And, so it was funny that, you know, in 2013, like, about six months after I started practicing on my own, I ended up starting my own teledermatology company.

原因就是，像你刚才说的，我看到太多患者要开两小时车来找我看病，于是一直在搜罗现有的解决方案。

And the reason for that is, like, you know, as you said, I saw all these patients driving two hours to see me and was constantly scouring the existing options.

我该怎么让你更容易看上病呢？

Like, how can I help you be seen more easily?

你知道，我那时候排队等看病的人排了六个月。

You know, I had I had a six month waiting list.

我很快发现，当时那十来家做皮肤科远程医疗的公司，没一家真正解决了患者的问题。

And what I what I quickly learned is that none of the 10 or so telehealth for dermatology options seemed to solve the problem for patients.

所以我干脆也加入进来，和几个合伙人一起创办了自己的公司，就像你提到的那样。

And so what I did is I sort of threw my hat in the ring, started my own company, with a couple of cofounders, as you mentioned.

我当了十年Curology的首席执行官。

And I spent ten years as CEO of Curology.

那段经历特别有意思。

It was extraordinarily fun.

我们差点破产，但也经历过年收入两亿美元的时刻。

We we got to, you know, experience almost going broke.

就像你说的，我们服务了五百万名患者，一路上学到了很多。

We got to experience getting to 200,000,000 of revenue, and as you said, treating 5,000,000 patients and learning a lot along the way.

十年后，我卸任了CEO，公司聘用了新的CEO来接手。

And after ten years, I stepped back as CEO, and we hired another CEO to to take care of the company.

我转任执行主席，这比当CEO轻松多了。

And I stepped back to the position of executive chair, which is a lot, lot easier than being CEO.

过去几年，我花了不少时间跟很多创业的同事和朋友交流，其中有不少是医生。

So in the last couple of years, I've taken the time to talk to a lot of my colleagues and friends who've started their own companies, including a lot of doctors who have.

随着深入了解，我惊讶地发现，真正投身创业的医生很少，但那些这么做的，往往都特别成功。

And as I started learning more about that, was really surprised to see how few doctors go into entrepreneurship, but of the ones who do, how successful they are.

所以，我才写了你提到的那本书，叫《为什么医生更容易成功》。

And so so that's why I wrote the book you're mentioning called Why Doctors Win.

最近几年，我一直帮助其他医生进入创业和初创领域。

And, and so so really the last couple of years, I've been helping other physicians get into entrepreneurship and startups.

这是一段

It's a

非常有意思的旅程，大卫。

really interesting journey, David.

我觉得很多听播客的人会对这个角度特别感兴趣——不仅是一位医生创业者，还深入理解了这背后真正意味着什么。

I think a lot of folks listening to podcasts are gonna be really interested by that angle of, not only being a physician founder, but having the experience of really diving deep into what that actually means.

我们 definitely 会花很多时间来聊聊这个话题。

And definitely wanna dedicate a lot of time during our talk to to discuss that.

我也想稍微谈一谈 Curology，还有你在创办这家公司过程中可能遇到的一些困难。

I did wanna talk a little bit about Curology too, you know, and some of the, maybe difficulties that that you, might have faced, like, going through that that process of building the company.

你提到过，差不多是 iPhone 刚出来的时候，就开始做远程医疗了。

You mentioned, like, telehealth, around when the iPhone was was coming out.

我知道，尤其是涉及处方药的时候，大家最关心的就是执照问题。

I know, you know, one of the things we think about with, especially, with any kind of prescriptions is is is, like, licensing.

尤其是做远程医疗这类业务，你一开始在新墨西哥州，但想扩展到其他地区时，有没有遇到过获取其他州执照的困难？

And so especially when you're doing, like, this telehealth type work, were you, were you facing, like, any any issues early on where, you know, you're you're based in New Mexico, but when you're trying to scale throughout, like, getting licensure in other places and and scaling in that way was difficult?

是的。

Yeah.

我们早期确实面临很多挑战，执照问题就是其中之一。

I mean, we we had a lot of challenges early on, and licensure was certainly one of them.

你知道，要给任何州的患者看病，医生或相关从业者必须持有该州的执业执照。

We you know, as as you know, to to treat patients in any given state, the physicians or the practitioners at your practice need to be licensed in the patient state.

很多远程医疗初创公司都是通过签约全国各地的临床医生来解决这个问题。

And the way a lot of telehealth startups approach that is to contract with clinicians across the country.

但我们的方式有点不一样。

Our approach was a little bit different.

早在早期招募皮肤科医生的时候，我们就要求他们接受三个月的培训，因为我们设计的系统必须极致高效，才能给患者提供极低的价格。

Basically, even when we bring on when we brought on a dermatologist in the early days of psychology, we would require they go through three months of training because what we built was basically designed to be as efficient as possible for patients so could charge a really, really low price.

这意味着，医生平时接诊一次能赚一两百美元，我们却只付他们五美元。

And that meant that instead of paying doctors, like, the $100 or $200 they're used to for doing a console, we were paying them $5 per console.

但要保证高质量，他们就得花三个月时间把所有快捷键都背下来。

But to do that and reach a high level of quality, they would need to, they would need to spend three months memorizing all of these different keyboard shortcuts.

比如，要是有患者得了某种罕见的蛋白粉诱发的痤疮，他们只要敲三下键盘，就能立刻给出专业解释。

So for example, like if a patient came in with like an obscure type of protein powder induced acne, that they would be able to type three keystrokes and then immediately give an explanation to the patient.

患者们特别喜欢这种体验。

And the patients loved it.

但问题是，培训人太难了，根本不可能随便找五十个医生来培训一下就上岗。

But the difficulty of that was that because it was so hard to train people, it wasn't easy to just find 50 doctors and train them.

所以我们做的就是，我自己申请了全部五十个州的执业执照，成了第一个为所有患者看病的医生。

So what we did is I got myself licensed in all 50 states, and I was that first doctor to treat all the patients.

说实话，我跟当地邮局那些帮我做指纹采集、公证文件的人简直成了朋友，寄这些材料的过程简直是一场噩梦。

Was literally, So I think, I became best friends with the people at the local post Atlantic's doing my fingerprints and, like, notarizing all these documents, and it was a nightmare sending all that stuff in.

但创业初期，这种事你必须得扛下来，才能让生意走上正轨。

But just one of those things you have to early on to help your business succeed.

对。

Right.

这很合理。

That makes sense.

我从你的书里注意到，你特别强调要把每次问诊的成本压到最低，这样你的医生才能接尽可能多的病人，让诊疗费远低于现实中看医生的价钱。

I think one of the things that you really focus on from your book in in your book was that how you wanted to make the visit as cheap as possible so that the physicians that were working with you are able to see as many patients as possible so that the visit fee is, you know, a fraction of what it would be to go see a doctor in the real world.

不过我觉得，你还有一个特别的做法，也让Curology与众不同——你们不只是做远程诊疗，还自己研发复合药物，这部分也是重要的收入来源。

But I think one way you also supplemented that and one thing that made Curology a little bit unique was that you not only did the telehealth component, but you also create your own compound medication, and that was where some of the revenue came from as well.

我也很想听听这方面的细节，因为你之前根本没做过药。

I'd love to hear a little bit more about that as well because you didn't have any experience making drugs.

你从来没经历过FDA的审批流程，不过我知道你这次其实也不需要。

You had never, you know, gone through the f d FDA approval process, which I know you didn't have to for this either.

但我很好奇，你是怎么搞定这些的？

But I'm curious, how did you navigate that?

你当时是怎么决定不只做远程诊疗的？

How did you decide that not just gonna do telehealth?

我们不只是提供诊疗服务。

We're not just gonna provide care.

我们还要自己研发患者用来治疗痤疮的药物，而且要有效、便宜。

We're also going to create the medications our patients will use to treat their acne and to treat in an effective manner, in a cheap manner?

是的。

Yeah.

我们当时的思路是，如果能把每次咨询的成本降到五美元，只要其他环节都做得好，就有可能服务几十万患者。

The way we decided was that I figured if we can really get the cost per consult down to $5, then if we can execute everything else well, we might have hundreds of thousands of patients.

如果真是这样，我们就能解决另一个我注意到的大问题了——不仅看皮肤科医生难、等得久，而且患者看完病去药房拿药，还得打电话回我们办公室说：‘我这回自付部分要一百美元。’

And if that's true, we could potentially solve the other big problem that I noticed, not just that it was difficult and took a long time to see a dermatologist, was the fact that when patients came in to see me, they'd go to the pharmacy and call our office saying, I have like $100 worth of co pays.

作为医生，我知道这些药都是三十年前就发明出来的。

And I knew as a doctor that all of those medicines were invented like three decades ago.

它们的专利早就过期了。

They were no longer patented.

所以这些药根本没必要卖这么贵，成本应该只有几美分才对。

So there was no reason that these medicines shouldn't cost pennies.

只要我们能拿到足够的患者量，就能自己生产这些药。

And so if we could get the volume, we could be able to make the medicines ourselves.

于是我们就这么做了。

And so that's what we did.

我觉得我们能拿到足够多的患者，是因为我们把问诊做得又高效又便宜。

I figured we would be able to get the volume because we made the consult so efficient and cheap.

然后我们就得自己建一个配药房。

And then we had to build our own compounding pharmacy.

所以现在，我们有一家五万平方英尺的配药房，规模大得惊人，专门生产个性化配方。

And so today, we have a 50,000 square foot compounding pharmacy, which is, you know, absolutely monstrous and making personalized formulas.

我们大概有六十种不同的配方组合，具体数字你别当真，但基本上能应对任何一种可能的痤疮类型。

We have about 60, don't quote me on the exact number, different permutations and combinations that can basically fit any single type of acne you could possibly have.

早期真的特别难，因为所有配药的难题都由我一个人来解决。

And in the early days, it was it was really difficult because I took the responsibility on myself to figure out how do you make these compounds.

之前从来没人做过这种事。

Like, no one had else ever done it before.

那时候，如果有人去配药房找皮肤病用药，通常是因为得了罕见病，比如皮肤T细胞淋巴瘤，需要定制一些特别的药。

When you went to a compounding pharmacy for dermatology back then, it was because you had a rare condition, maybe like cutaneous T cell lymphoma, and they needed to make something weird for you.

那些药膏总是特别粗糙，根本不像能涂在脸上的东西。

And these preparations always came out like really gritty and didn't feel like something you would put on your face.

所以我一直在想，怎么才能确保我们混合的这些成分不会互相抵消效果？

So I was like, how can we figure out how to make sure all the ingredients that we compound together don't inactivate each other?

又怎么才能让药膏的质地让人用起来舒服、有质感？

And how can we make sure it's cosmetically appealing?

那时候我就在办公室、公寓，甚至车库里，摆满这些活性成分，拼命摸索这一切。

And so so that was basically me with all these active ingredients in my office or in my apartment or in my garage trying to figure all that stuff out.

所以，那也是整个过程中非常重要的一部分。

So that was that was, like, another big side of the equation.

我记得你在书里提到过，你当时在大学校园附近做了很多临床试验，找人试用并收集反馈，我觉得这种做法特别创新，也很独特。

I recall you also saying in in your book mentioning how you were sort of running many clinical trials just a near a college campus, getting people to try it and sort of get their feedback because I thought it really innovative and a unique way to approach it.

是的。

Yeah.

其实那会儿我跟大学生合作，是为另一个创业点子做准备，但最后没做起来。

And and that was actually when I was working with people from a college campus, that was actually for a different startup idea I had that I didn't end up launching.

不过我在书里采访了Abridge、Doximity、UpToDate这些成功医疗创业公司的创始人，发现他们都有一个共同点：在早期都花大力气去问一个问题——人们真的会为此买单吗？

But one of the commonalities I did see in my book, and this is where I interviewed the founders of Abridge and Doximity and UpToDate and all these successful health care startups, is that their founders really did go to great lengths early on to make sure to ask the question, like, will people buy this?

这个产品真能解决用户的实际需求吗？

Will this actually solve a consumer need?

很多创业者，包括不少医生出身的创业者，往往忽略了这一点，因为他们太容易陷入‘我发明了一个超酷的医疗设备’或者‘我找到了一个超棒的分子’这种思维里。

And that's one of the things that a lot of founders, including a lot of physician founders, fail to do because it's so easy to say, oh, I have this really cool medical device that I've invented, or I have this really cool molecule or whatever it is.

但创业可不是那种‘你只要做出来，别人自然就会来’的事。

But it's typically not in startups as though if you build it, they will come.

无论是面向患者、企业还是医院，真正触达消费者都特别特别难。

It really, really is difficult to reach consumers whether your customer is, like, a patient or a business or a hospital.

所以你真的得走出去，跟人多聊聊。

And so, yeah, you really have to get out there and talk to people.

对。

Yeah.

大卫，光是听你刚才说的这些，我就觉得你已经充分展现了那种商业头脑，深入到运营的细节里，去解决各种实际问题。

David, you know, just just based on what you you've shared, you've you've, I feel like, demonstrated a lot of that, like, business sense or, like, really going down into, like, the nitty gritty of the of the operations and figuring out, like, solutions to these problems.

我想再多了解一点你的背景，特别是非临床方面的经历。听起来你刚结束临床培训、开始行医不久，就迅速搭起了Curology的雏形，还一路摸索出远程医疗、药物配制这些复杂流程——这些在别的地方根本没人这么干。

I I do wanna kinda dive in in into your background a little bit more maybe on the nonclinical side because it sounds like very shortly after you practice or finished, clinical training and started practicing, you were able to put together what was the early stage of Curology and and go through these processes of figuring out the, how do you do telehealth and and then how do you compound and, like, all these pretty complex processes that maybe weren't done, in in many other places.

而这些，临床培训里是完全不会教的。

And, obviously, we don't really get that training clinically.

所以我很好奇，在创办Curology之前，你是不是一直就带着创业和创新的思维？这会不会是你自然而然把临床经验跟商业想法结合起来的过程？

So I'm curious, like, maybe in your in your past before before Curology, were you always kind of, like, innovation entrepreneurial, in in nature and, like, this is kind of just the natural progression of, like, finding a way that you can integrate your clinical career into it?

我觉得，即使我不算特别有创业精神，我也一直很好奇。

I would say even if I wasn't necessarily entrepreneurial, I was always very curious.

为什么这件事要这么做？

Like, why does something work this way?

为什么就不能做得更好？

Why can't it be better?

所以呢，这后来变得特别关键，因为你得不断追问，挖到第五层才行。

And and so, you know, like, that ended up being critical because, you know, you have to sort of ask five levels deep.

为什么非得这样？

Like, why is it this way?

为什么不能换种方式？

Why is it this way?

为什么就不能换个做法？

Why can't it be another way?

我觉得，正是这种思维方式让我能找出那些具体问题的解决方案。

And and that's that's sort of what allowed me to, I think, to figure out those specific problems.

在商业方面，我一直在琢磨怎么运营公司，幸运的是，我从小一起长大的一个好朋友给了我很多帮助，后来他成了我公司的联合创始人。

And then on the business side, trying to figure out, like, how to run a business, I I fortunately had a lot of help from one of my best friends that I grew up with who ended up becoming a cofounder of my company.

那时候，他在高盛工作。

And at the time, he was he worked at Goldman Sachs.

他刚从哈佛商学院毕业。

He had been to Harvard Business School.

所以他非常懂商业这一块。

And so he knew the business side of things.

他知道怎么帮我思考：这个路演会不会吸引投资人？

He knew how to help me think through, like, will this pitch be attractive to investors?

做市场推广的时候，有哪些关键点需要考虑？

Like, what sort of things you need to think about when you're marketing to customers?

怎么判断营销效果到底好不好？

Like, how do you calculate whether your marketing is effective?

诸如此类的问题。

And all those sorts of things.

我创业初期能有这样一位导师指导，真的很幸运，很多人可没这份运气。

So I was lucky to have that mentorship as I started my business, which a lot of people don't have.

而这也正是我最终决定写这本书的主要原因。

And that is actually the main reason I ended up writing this book.

如果你是一名医生，正琢磨着：我发明了这个东西，或者有了个想法，要不要试着把它落地应用？

Because if you are a physician trying to figure out, hey, I invented this thing or I have this idea, should I try to bring it into practice?

大多数人并没有遇到那种愿意认真听你讲，还愿意给你坦诚反馈的导师。

Most don't have that mentorship as someone who's, like, really willing to listen and then importantly give them, like, super transparent feedback.

所以，这本书其实就是我把当初创业时特别想拥有的那些信息，全都整理了出来。

And so, you know, basically, this is, like, all of the information I wish I had back when I was thinking about starting the company.

是的。

Yeah.

这很合理。

That makes sense.

你已经分享了不少非常关键的经验。

You've already shared some really key lessons you learned.

找一个能弥补你短板的合作伙伴，尽早测试人们是否真的对你的产品或想法感兴趣。

Having a good partner that sort of complements your skill set, testing whether people actually are interested in your product, your idea early on.

不过更具体地说，你提到过去几年你一直在写这本书，深入钻研创业，帮助其他创始人。

But I guess to go more into that, you said you spent the past few years really you writing your book, going deep entrepreneurship, helping support other founders.

所以想问问，是什么让你觉得，是时候卸下Curology首席执行官的职务，转而投入这些新事业，而不是继续留任呢？

I guess, to transition to that topic, what made you realize it was the right time to step down as CEO of Curology and dive into these other endeavors instead of staying on?

很多CEO都不愿意放手自己公司的控制权。

I mean, a lot of CEOs out there don't wanna give up control of their company.

毕竟公司是他们一手创建的。

They built it.

他们希望亲眼看着它走到最后。

They we want to see it to the very end.

那是什么让你意识到，现在卸任，对公司和你自己来说，都是正确的决定？

What made you realize is the right time and the right decision for your company and for yourself?

是的。

Yeah.

其实，初创公司的终点很难说清楚。

I mean, the very end of a startup is actually hard to define.

对吧？

Right?

真的很难界定。

Hard to define.

就算上市了，你还是在经营一个小型企业。

Because if you IPO, you're still running the company's small business.

对吧？

Right?

如果被其他公司收购了，至少希望你的这个‘孩子’还能在新公司里继续活下去。

And if you get acquired by another company, it's like, hopefully, your baby is still gonna be alive within that startup.

所以对我来说，关键在于我是不是还在成长？

And so for me, it was more of a matter of am I still learning?

我是不是还觉得有意思？

Am I still having fun?

还有，我是不是可以被替代？

And am I replaceable?

我觉得在前五到七年里，公司根本离不开那个作为CEO、主导核心创新的人。

I think for the first, like, five to six to seven years, there was no way that the company could have done without the person who did the the primary innovation as CEO.

对吧？

Right?

而且，当你创办一家初创公司时，情况可不只是那么简单。

And and because when you have a startup, it's not just, okay.

我有个好点子，于是创办了一家公司。

I had a good idea, and I started a company.

在产品开发和头几年，乃至接下来的几年里，你会遇到各种各样的问题。你每天都在解决新问题，感觉就像每天都在重新创业一样。

It's like there's so many problems that come up as you're building the product and in the first few years and in the next few years that you're actually solving new problems every day and, like, sort of, like, recofounding the company every day.

但一旦你找到了产品市场契合点，实现了稳定增长——我们也确实做到了——情况就不一样了。

But once you've found product market fit, once you're having reliable growth, which we did achieve, then things are different.

那时候的情况就变成了：好吧，现在的问题是怎么从一年一百名员工，增长到两三年后的两百名员工。

Then things are like, Okay, now it's a question of, Okay, you're going from 100 employees one year to 200 employees a year or two later.

这时候，问题就开始转向了，比如怎么让公司保持高效运作？

And the questions start being more about, like, how do you keep the company productive?

怎么管理庞大的团队？

How do you manage large groups of people?

怎么分配资金？

How do you allocate capital?

这些事都挺有意思，也有挑战性，值得去做，但就是不是我感兴趣的。

And all of those things are interesting, challenging, worthwhile endeavors, but just aren't my interest.

我真正感兴趣的是解决医学领域里的核心问题，然后搭建系统来让它们变得更好。

My interest is, like, solving, like, core problems in medicine and then, like, building systems to to to make them better.

一旦我们把这套核心系统建起来了，对我来说就没什么吸引力了。

And so once once we sort of had that core system built, it became less interesting to me.

我哥哥，他也是我的联合创始人，也有同样的感受。

And, and my brother, who was also my cofounder, felt the same way.

他当时是首席技术官。

So he was the CTO.

大概十年后，我们俩都意识到，得找个人来接替我们，那种真正喜欢管大团队、搞大系统的人。

And what we both decided about ten years in is, like, we need to find someone else to replace us who's, like, enjoys managing these large teams and, like, this this this large system.

所以我们就决定退到幕后。

And that's how we decided to step back.

这真的很有趣。

It's really interesting.

你提到你和你弟弟一起工作，这一点让我挺有感触的。

And, you know, you mentioned working for your brother.

我刚听说你的故事时就在想，你和你弟弟、还有你妈妈，一起创办了这家公司，关系这么紧密。

This is something I I thought of when I was first hearing about your story is you worked very closely with your with your brother and and your mother in in starting the company.

我很好奇，你们之间的合作是什么样的？

And, I'm I'm curious what what that dynamic was like.

你们之前就有很好的工作默契吗？过渡起来顺利吗？

Was that, you know, a strong working relationship you already had, and it was a easy transition?

和家人一起工作，有没有遇到过特别难处理的时候？

Was working with family difficult in certain ways?

或者说是的。

Or yeah.

再多讲一点当时的背景情况。

Just just a little bit more background on how that was.

其实我们已经五年没联系了。

Well, we haven't spoken to each other in five year.

我开玩笑的。

I'm just joking.

所以是的。

So yeah.

把我吓坏了。

Have Scared

我。

me.

其实特别棒。

It it was actually wonderful.

你懂的。

You know?

我和我弟弟运气很好，性格特别特别相似。

We're we're lucky, my brother and I, that our personalities are very, very, very similar.

我们喜欢开玩笑，但工作上特别专注。

We like to joke around, but we're very, very focused on work.

我们做事效率很高。

We're very efficient.

我们更愿意直接去做，而不是光说不练。

So we'd much rather do something than talk about doing something.

虽然我们也有过分歧，但过不了多久，比如一小时后，就又一起出去喝酒了，一直都是朋友。

And, so although we had disagreements, you know, we were we were always friends, like, an hour later going out to get a drink together.

所以那真的特别美好。

So it it was it was actually really wonderful.

我觉得，如果你能遇到这样一个人——你们彼此非常了解、彼此信任，那就一定要珍惜这种关系。

And I think it's a it's it's something that you should really embrace if you can find it, the ability to to start some something with somebody you know really well because you trust each other.

你能知道两个人能不能合得来。

You know whether you're gonna work well together.

所以那真的特别好。

And so so it it was great.

而且我妈妈的性格跟我们俩很不一样，但特别适合我们——她真的很关心我们扩张时的每一个细节，确保服务质量始终如一。

And and our mom was a was a really good compliment to us and that she has a different personality than we do, but is the really like, you know, I I want to be involved in the in the as we're scaling, the details of making sure the quality stays high.

我妈妈也是皮肤科医生，所以她帮忙扩展了皮肤科团队。

So she was helping she my mom is a dermatologist as well, and so she was helping scale the dermatology team.

比如每招一个新的皮肤科医生或护士助理，我们怎么确保他们能充分赋能，给患者提供最好的护理，同时快速熟悉我们的体系，保持高标准。

Like, as we hire the next dermatologist and nurse practitioners, how do we make sure that they're empowered to care for patients as well as they possibly can and how they're learning our system and we're keeping quality high and stuff like that.

说真的，再理想不过了。

So it was actually I couldn't have asked for a better setup.

是的。

Yeah.

听上去真不错。

That's good to hear.

太棒了。

That's awesome.

我觉得每个人都有很明确的分工，你们合作得特别默契，公司内部的角色划分也非常清晰。

I feel it seems like everyone had their, like, kinda clear role of one, you guys worked really well together, but then very clear roles within that within the company itself.

另外，我想聊点别的，就是你最近在做的那些事，比如跟医生创业者和医生创办的公司相关的讨论。

Another thing that that, you know, kind of pivoting to the the work you've been doing more recently with talking about physician entrepreneurs and and companies, that that are started by physicians.

我现在还在读医学生，视角可能不一样，但就算只是看现在这局面——AI编程助手这些新东西层出不穷，感觉越来越多的医生都在尝试自己搞点事业。

Being still in medical school right now, I think I I have a different perspective, but even just seeing what the scene is now with with these, you know, like, AI coding agents and everything, it seems like so many physicians now are trying to build their own thing.

我们正进入一个新时代，越来越多有临床背景的人，要么想转行，要么留在医疗圈里，把临床经验跟运营或技术结合起来，不管是加入现有公司，还是自己创业。

And we're in entering this era where, there's just more people that are that have a clinical background that are either trying to pivot out of it or stay in it and, like, then combine their clinical skills with some kind of operational tech, experience, whether that would be working at a company that exists, or before.

我很好奇，在你写这本书的这段时间里，从你创办Curology到现在，你看到医生创业者这个群体发生了哪些变化？

I'm curious in your in your time that you've been you that you in your time you've been working on the book that you you you've published, how have you seen this transformation in physician entrepreneurs, maybe from the time when you built Curology to to now?

我觉得尤其是过去一年，医生开始自己创业的情况明显多了起来。

I think, the last year particularly has seen a boom in physicians being able to start their own thing.

我觉得最主要的原因是，现在你一边干着本职工作，一边起步做点别的，变得容易多了。

And I think the biggest reason is that it's a lot easier to start something while you still have your core job right now.

现在要开发一套端到端的软件技术，比两年前容易多了。

It's a lot easier to build sort of an end to end technology, at least software wise, than it would have been even two years ago.

我觉得这是个特别好的变化。

And so I think that's a wonderful change.

我写书时采访了十家公司的创始人，比如UpToDate、Abridged、Vis这些，很多人都是先试探着进了创业圈。

And when I look at the 10 different companies where I interviewed the founders for the book, these UpToDate, Abridged, Vis, all these people, many of them sort of dipped their toes into the startup world first.

其中有几位自己动手开发过应用。

A couple of them built their own apps.

对吧？

Right?

比如Doximity的联合创始人内特·格罗斯，他在培训初期就自己做了应用。

For example, Nate Gross, the cofounder of Doximity, he built his own apps early on in training.

Abridged的创始人希夫也是同样的情况。

Same thing same thing with Shiv, the founder of of Abridged.

但这主要是因为他们本身有编程背景。

But but that's because they had their own coding background.

他们当时多少能自己开发一些应用。

They were able to build apps on their own to some extent.

我说的是，他们俩都不觉得自己是顶尖工程师，但确实有技术底子。

And I mean and and neither would claim they're they're a great engineer, but they they had the background.

但现在你不用有这种背景也能做到。

But now you can do that without that background.

这其实是进入创业领域特别好的方式——自己动手做个应用，亲身体会一下：第一，就算有 Cloud Code 这样的工具，做出来一个体验好的东西有多难；第二，等你真做出个体验不错的东西，又有多难让人愿意用。

And that is a wonderful way to get into entrepreneurship, right, like starting to build your own app because you can see for yourself building something, a, how hard it is to build even with tools like Cloud Code, something that feels great, and b, once you build something that feels great, how hard it is to get someone to use it.

所以你要是真下功夫，自己做个应用，差不多就能获得相当于斯坦福商学院的实战教育了。

So, you know, it's like you you really can give yourself honestly like the equivalent of a Stanford Business School education by trying to build an app if you if you really work at it.

就算最后没成功，你也能学到很多东西。

And even if you fail, you'll learn a ton.

我觉得这真的特别好，希望这种趋势能一直持续下去。

So I think I think it's great, you know, and hopefully the trend continues.

对。

Yeah.

看到越来越多的临床医生主动学习如何开发自己的应用，真的让人很振奋。

It's really exciting to see more and more clinicians sort of take the initiative to learn about how to build their own applications.

即使他们不打算创业或商业化，至少他们在弥合技术与临床之间的鸿沟，这一点特别值得赞赏。

Even if they don't start their own company or try to commercialize, at the end of the day, at least they're bridge bridging the gap between the technical and clinical skills, which is really cool to see.

我注意到你们采访的那十家公司，大多数的创始人或负责人都是临床医生，主要是医生，但通常他们都有一个合作伙伴。

I think one of the key things I noticed about the companies you for example, you interviewed 10 companies, most of them had a CEO or a leader who was founder, who was a clinician, a physician for the most part, but they also typically had a partner.

比如内特·格罗斯在Doximity里就和杰夫搭档。

For example, Nate Gross had Jeff in Doximity.

对于想创业的医生来说，不管是做远程医疗、类似Doximity的产品，还是诊所运营团队，他们该怎么去寻找合适的联合创始人，或者判断自己是否该单干？

How do you think about or how should a physician who is looking to start a company, whether it's telehealth or something like Doximity or even a clinic clinical practice group or anything, how should they think about finding the right cofounder or right fit or even going at it themselves?

因为过去你非得有个CTO不可。

Because I think back in the day, you had to have a CTO.

那时候你得找人写代码，因为你自己不懂技术，但现在就像你说的，自己写应用越来越容易了，至少能做出一个最小可用版本。

You had to have someone who could build the code because you didn't have the expertise, but it's getting easier and easier, like you said, to code your own apps and at least, you know, have a MVP or v one up.

那今天，一个人该怎样思考这个问题呢？

How would how should someone think about it today?

我觉得在找联合创始人，以及决定是自己创业等方面，有两个重要的经验教训。

I think two big lessons on in terms of, like, finding a cofounder, deciding whether it'd be, like, run your own company, etcetera.

其中一个反复出现的模式是，你其实不一定需要一个商业方面的联合创始人。

One is that the pattern I saw over and over and again is that you don't necessarily need a business cofounder.

对吧？

Right?

对我来说，那种说法并不成立，比如‘我是医生，或者拥有医学博士学位，我发明了这项技术，但我不知道如何经营公司’。

It's not it's not to me, it it it's not true to say, well, you know, I'm a doctor or I'm an MD PhD, and I've invented this thing, but I don't know how to run a business.

所以，我得找个人来帮我打理这家公司。

Therefore, I need to find someone to help me run this business.

我觉得你真正该做的是，承认自己不懂商业，然后花大量时间去学习。

I think you you what you do need to do is recognize that you don't understand business and then spend a shit ton of time learning about it.

你得有这种谦逊的心态，承认自己不懂商业，这真的很重要。

You need to have that humility that you don't understand business, and that's really important.

我觉得这也是决定一个人是成功还是失败的关键因素。

And I think that's a big thing of what divides people who succeed and who fail.

但我觉得确实没必要专门雇一个全职的商业人才。

But I think it's very, very true that you do not need to go hire a full a full time business person.

事实上，这么做可能还适得其反。

And in fact, I think it can be a little bit counterproductive.

第二点是，对于医生来说，最合适的联合创始人还是搞技术的人，前提是你在创办一家科技公司。

The second thing is I think the the most complementary cofounder to a physician still is a is a software person, assuming you're founding a tech company.

就算你自己随便写点代码，也很难达到能规模化、真正起量的水平。

You know, even if you even if you cloud code something, like, it is not going to be to the quality to scale and, you know, like, gain traction.

这种模式我们已经反复看到了。

And it's just the it's just the pattern we've seen again and again.

就连像BizAI这样的AI公司也是如此。

And this is true even with, you know, AI companies like BizAI.

对吧？

Right?

这就像Chris Monsey和他那位技术合伙人在我搭的桥上合作的情况。

This was, like, Chris Monsey and his and his, like, tech cofounder in my bridge.

这就像Shiv和他的技术合伙人一样。

This was, like, Shiv and his tech cofounder.

你懂的？

And, like you know?

所以我觉得，既然你是这个点子的创始人，不管有没有商业背景，都该当公司的CEO。

So so I think I think being being the person who created the idea suggests that no matter what your business background, you should probably be CEO of the company.

对吧？

Right?

因为就像我说的，你得天天为公司想出新点子，公司才能活下去。

Because like I said, you're gonna continue needing to come up with new ideas every day for the company to survive.

所以你需要那个最初点燃灵感的人，持续保持这种创造力，而且你对产品领域的理解，肯定比任何外人更深。

So you need that sort of, like, creativity of the of the same person at the of the Spark, and probably you understand the product space better than anyone else who would bring in.

因此，我的看法是，有想法的医生创始人，就应该当CEO。

So I think I think, you know, my inclination is for the physician founder who has the idea to become the CEO.

这几乎总是会变成全职工作，但一开始并不一定非得全职。

Almost always that ends up becoming full time, but it doesn't need to be full time at the beginning.

有很多例子，人都是慢慢融入进来的。

There's lots of examples of people who sort of, like, ease their way in.

而且，有个联合创始人真的特别有帮助。

And then, you know, having a cofounder is really powerful.

如果你进入制药领域，发明了一个新分子想推向市场，那你的联合创始人最好有监管或业务拓展的背景，这样才能搞清楚怎么把药商业化。

If you're going into the, you know, let's say, the pharma space and you've invented a new molecule that you want to take to commercialize, it probably really helps for your co founder to have regulatory or business development background to figure out how to commercialize a drug.

如果你做人工智能，有个很棒的临床应用场景，哪怕你自己能用云代码搭个基础版本，有个懂软件的联合创始人还是特别关键。

If you're going into the AI space and you have this really good clinical application of AI, even if you can cloud code a basic version, it really helps to have a software cofounder.

但一般来说，最适合当CEO的，还是那个最初提出想法的人。

But but usually, the best CEO will be the person who came up with the idea.

在医疗领域，往往就是医生本人。

And in in medicine, oftentimes, that's the physician.

这说得通。

That makes sense.

医生确实有那些得天独厚的优势，这些优势不该被浪费，而应该好好利用起来，推动公司发展。

And the physician, I feel like has those, like, unfair advantages that they need to be unfair, fair advantages that they should be leveraging to to really drive the company.

我觉得最容易被忽略的一点，是临床经验对产品方向的驱动作用。

I think the one that is very easy to assume is the clinical grounding that drives the product.

所以，如果你是专科医生，就能用你的临床经验判断出真正需要什么。

And so, you know, if you're a specialist, you're able to use your clinical knowledge to decide what actually you need.

但我很好奇，作为医生，还有哪些优势是你独有的，却常常被人忽视的？

But I'm curious, what are what do you feel like are other things that are, by being a physician, uniquely position yourself to be to be that head that maybe people don't necessarily always think about?

我觉得这可以分成两个阶段。

So I think, you know, it comes in two phases.

首先是创意阶段，然后是执行阶段。

First is in the idea phase, then is the execution phase.

在创意阶段，医生特别擅长发现问题，也能找到真正的解决方案。

So in the idea, physicians are really well spotted, really well positioned to, like, spot the problems, right, and figure out the solutions.

你想想看，著名投资人马克·塞斯特说过，你没真正生活在某个行业里，就不可能真正理解它。

And, you know, if you if you look back at, like, what the famous investor Mark Sester said is, like, you never really understand an industry until you've lived in it.

这正是医生所擅长的。

And that's what physicians do.

我们身处医疗体系之中。

We live inside of health care.

所以能从内部看到它的运作方式。

And so we see it from our own side.

我们自己也是病人，因此也能从患者的角度来看待它。

We're also patients, so we see it from the patient's side.

这就让我们能意识到，这确实是个大问题，和那些外部的人——比如顾问或者投行人士——觉得医疗系统里有商机不一样。

And so that enables us to see this is actually a really big problem in a way that's different from like, okay, I'm a consultant, or I'm an investment banker, and I think I see some opportunity in the health care system.

医生对这个问题的看法，往往更准确。

The physician's view of that will likely be more accurate.

而他们另一个优势，在于执行层面。

And then the other advantage they have is on the execution side.

一旦你发现了问题并找到了解决方案，就要开始创办公司了。

So once you do spot that problem and the solution, you're founding the company.

就拿我的公司Curology来说，执行的关键就在于如何设计流程，让医生用起来特别高效，同时让患者感受到这是他们经历过最有洞察力的诊疗。

So for my company, Curology, the execution became how do I design these workflows to make them so, so efficient for clinicians but also so, so high quality for the patients where they feel like this is the most insightful consult I've ever gotten.

在我看来，除了皮肤科医生，没人能真正把这件事做得特别好。

And there's no way for someone other than a dermatologist in my mind to do that super well.

再举个执行层面的例子，大多数公司都是B2B模式，对吧？

And then another example in the execution phase is most companies are B2B, right?

你卖的对象是医院的首席医疗官或者首席信息官。

So you're selling to the chief medical officer or the chief information officer of a hospital.

而这些职位的人，很多时候本身就是医生，对吧？

And oftentimes, these are physicians, right?

所以当你带着初创公司去医院推销时，第一个销售员几乎总是CEO本人。

And so when you're walking in selling to a hospital, and if you're a startup, the first salesperson is almost always going be the CEO.

如果这位CEO的名字后面带着MD头衔，你在向这些人推销时就会有明显的优势。

If that person has an MD behind his or her name, you're going to have a really big advantage in selling to those people.

我在采访的很多公司里都确实看到过这种情况。

And I've definitely seen that example in a lot of these companies that I interviewed.

这其实是一种双重优势：一方面你知道怎么跟他们沟通，另一方面，他们的身份本身就能带来天然的信任感。

It's it's just selling selling because, like, you know how to speak to them, but also selling because, like, they're gonna automatically have the credibility.

医院的CEO或CFO可能没有医学学位，但他们依然能理解，知道你有这个背景，就会信任你，愿意听你的商业提案，也会默认医疗方面的问题已经有人把关了。

And then the hospital CEO or the hospital CFO, they might not have an MD behind their name, but they'll still understand and give you the credibility that because you do have that behind your name, they're gonna listen to, like, the business pitch, and they're gonna sort of give you credit that the medical side has handled.

所以我觉得这就是为什么很多由医生创办的企业能成功卖出去产品。

So I think that's why we see a lot of these businesses that a physician founder succeed in selling.

这说得通。

That that makes sense.

我觉得有临床背景，像你所说的，有MD头衔，哪怕还没见面，就能建立起信任感——无论是见CMO、CIO，还是任何一家医疗系统里可能购买医疗科技产品的人。

I think having a clinical background, having sort of MD behind your name, like you said, just provides credibility even before you even meet the person, before you meet the CMO, c CMI, whoever you meet with the health system or any sort of anyone will be buying a health tech product.

完全没错。

Totally.

确实如此。

Yeah.

我们平时根本不会收到医生发来的垃圾邮件。

So we're not used to getting junk mail from, like, medical doctors.

对吧？

Right?

如果我收到一封来自医生的邮件，第一反应就是，这肯定不是垃圾邮件。

It's like it's like if I get if I get an email from someone MD, it's like, you know, I don't I I assume it's not spam is my first assumption.

你懂的。

You know?

所以没错。

So yeah.

希望如此。

Hopefully.

我觉得，直到最近，甚至在某些情况下到现在，医疗行业对走非传统道路还是存在某种偏见。

I guess but when you think about it, I think up until very recently, at some point till in certain cases till today, there's almost a stigma against, you know, taking a nontraditional route in health care.

比如，去医学院的人，99%都会按部就班地去住院医师培训，除非你上的是斯坦福这类学校。

For example, like, if you go to medical school, 99% of the people in your class, unless you go to Stanford or somewhere, will be doing residency, follow a traditional path.

在医学院里，如果你说不想做住院医，或者中途退出，甚至做完住院医后不直接当主治医生，而是想创业或加入初创公司，这条路往往很难走，因为学校既不提供指导，有时还会被人看不起。

In within medical school itself, you know, if you say you you don't want a new residency or if you want, you know, if you wanna leave residency halfway through or even after finishing instead of going to attending SHIP to start your own company or join a start up, it's sometimes very difficult to navigate because there's no clear path or there's no support provided in your school or it's even looked down upon by certain people.

对于正在考虑创业或走非传统道路的人——不管是医学生、住院医，还是主治医生——你有什么建议？

What advice would you have to people who are, you know, thinking about pursuing entrepreneurship or going to, you know, a nontraditional route, whether they're in medical school, residency, attending, etcetera?

那你会怎么鼓励他们，哪怕只是利用业余时间去试试看，探索一下自己的可能性呢？

And how would you sort of encourage them to at least pursue their ideas even if it's just part time or exploring, you know, what their options are?

是的。

Yeah.

我喜欢这个说法，因为它正好点出了我写这本书的核心原因。

I mean, I like that because that that really gets to the core issue of why I wrote my book.

对吧？

Right?

我跟医生们解释的时候，通常会分成书里的四个部分。

And the the way that I explain this to physicians is basically like the four parts of my book.

对吧？

Right?

首先，我会讲讲离开临床工作是什么感觉——刚开始肯定特别迷茫。

So first is I tell the story of what is it like to leave clinical practice for a start It's going to feel confusing.

那些非创业的同事，也会觉得你莫名其妙。

The non entrepreneurial physicians who are your colleagues are going to be confused.

我还讲了自己打电话给皮肤病理学进修项目的主任，告诉他我不去了的事。

And I told the story of me having to call my fellowship director at the dermatopathology fellowship I was about to attend that I wasn't coming.

对吧？

Right?

所以，你得准备好面对很多这样的对话。

And so, you know, you're gonna have to have a lot of those conversations.

这就是第一部分。

So that's part one.

离开临床实践，会是什么感觉？

What's it like to leave clinical practice?

没人能理解，但其实这没关系。

And it's like, no one's gonna understand, but but the answer is that's fine.

对吧？

Right?

第二个问题是，你正在创办或加入的初创公司——不管是作为员工还是高管——它有没有成功的潜力？

The second question is, like, is the startup that you're founding or joining, if you're joining as an employee or an executive, is the startup positioned for success?

因为这才是真正关键的事情。

Because that's the thing that really, really matters.

对吧？

Right?

那些你离开的医生们怎么想，其实根本不重要。

It doesn't matter what you what the physicians who you leave behind think.

重要的是你加入或创办的那家初创公司能不能成功。

It matters whether the startup you join or the one you found succeeds.

所以第二部分，就是要建立一套方法论。

And so that's why the part two is building the framework.

如果你是医生，你本来就具备判断一家初创公司能否成功的全部知识，只是缺少一套系统的分析框架。

So if you are a physician, you have all of the knowledge to be able to figure out whether a startup's going to succeed, but you don't have the mental framework for how to research that.

我教的正是这个。

So that's what I try to teach there.

第三部分，你需要学会怎么落地执行。

And then part three is you need to learn how to execute.