Getting Started as a Physician Entrepreneur

Five years after starting a private practice, Colorado-based obesity medicine specialist Carolynn Francavilla, MD, was at risk of going under.

The pandemic hit, and her patients couldn’t come to the clinic. At the same time, her husband started a career transition and her business partner left the practice, making her the sole proprietor. Francavilla had to find new ways to support her family, her employees, and her patients — fast.

She connected with fellow business owners and looked for ways to become more resourceful. First, she and her husband bought a camper and rented it out as a vacation stay. The money supplemented his job transition.

Soon after, she built an online course for treating obesity and prescribing obesity medications. Then, she started a consulting business, helping doctors expand into obesity medicine. Her entrepreneurial approach soon spilled over into her practice as she found new ways to add value and optimize.

Until 2020, Francavilla saw owning a business, making payroll, and marketing as the price of practicing medicine on her own terms. But as her business ventures increased, that changed.

“Now I identify as an entrepreneur,” she told Medscape Medical News. And there’s an entire cottage industry of bloggers and consultants ready to back the doctors who want to be entrepreneurs, too.

Whether it’s investing, franchising, launching a new healthcare product, or a nonclinical venture like real estate — experts agree that doctors are well suited to leverage their clinical expertise or capital and make the leap into business. Once they conquer the fear of getting started, entrepreneurship can offer the financial security and protection from burnout that many seek.

Already Prepared

It’s a widely held myth that doctors make lousy business people. In reality, “[physicians] already have the skills that could make them good at business,” Francavilla said. For one, they’re natural problem solvers, which is a fundamental part of starting and running a business, she added.

Their clinical expertise also sets physicians up to see opportunities others might not. On the frontlines of healthcare, doctors see a problem or unmet need over and over again. Not only do they know the solution — but they also understand the environment where it will be used. They know how to integrate it.

“My opinion has always been that when you have a technical CEO, they can be excellent in entrepreneurship because they understand their end user,” said healthcare sales consultant Lisa Miller, who helps clients like physicians commercialize life science products.

“It’s a dream for an entrepreneur to see a problem, understand the fix and the end user. That is a perfect scenario,” Miller said.

But you don’t have to develop, scale, and sell a medical solution to become a physician entrepreneur. That’s just one of many avenues.

Managing a private practice already makes you a physician entrepreneur — though the number of doctors taking this approach is steadily decreasing. Franchising or investing — both in clinical and nonclinical spaces — makes you an entrepreneur. Leveraging your technical expertise to consult for other doctors or medical businesses is also entrepreneurship.

The key is to notice repeated problems you have the potential to fix. “It’s a mindset switch,” according to Arlen Meyers, MD, MBA, president and CEO of the Society for Physician Entrepreneurs. Become empathetic to your end user, get inside their head, and decide what they need, he said.

“When I get someone asking me the same question over and over again, that’s a possible business,” Francavilla said. When her friends kept asking about the camper she stayed in on vacation, she took that as a sign to buy one and rent it out. When doctors were continually asking her how to prescribe obesity medicine, she saw an opportunity to build and sell a course.

Similarly, John Shufeldt, MD, JD, a venture capitalist and emergency medicine specialist, saw a need for better access to medical care in the 90s, so he started a system of urgent care chains called NextCare. In 2010, he noticed that many patients didn’t need a physical exam to be treated, so he developed a telehealth company called MeMD that he sold to Walmart in 2021.

Shufeldt told Medscape Medical News that if you find a problem that’s pervasive, expensive to solve, and persistent, partnering with the right people to solve that problem can create a business.

The good news is every doctor is gritty enough for entrepreneurship — otherwise, they wouldn’t have made it through training, Shufeldt said. And grit is one of the key attributes his firm looks for when investing in entrepreneurs.

The Inertia of Fear

If doctors are so well positioned to make the entrepreneurial move, why don’t more do it?

Experts agree that it often comes down to fear. Fear about finances, about time and sacrifices, and failure.

Some physicians “are afraid because they are wearing golden handcuffs, and they don’t want to give up a comfortable lifestyle,” said Meyers. The move to entrepreneurship — whether launching a new product or passively investing — will demand time, financial resources, and a little courage.

Other doctors, like many people, fear the unknown. Accustomed to being experts, physicians can be deterred by their lack of business acumen, complicated regulatory requirements, or limited knowledge of a non-clinical industry.

“Physicians are really highly trained, and we tend to think we have to be that highly trained to be good at anything,” Francavilla said. “But business isn’t that complicated.”

What you don’t know, someone else does, she said. Ask a peer, build a team, or hire a lawyer or accountant. In business, it’s not on you to know everything, Francavilla added.

Shufeldt said that fear of failure can also be a huge hurdle for physicians, in particular. They’ve spent their lives getting the best grades and doing everything right. That kind of perfectionism can make entrepreneurship feel insurmountable.

Unlike many of his colleagues, Shufeldt said he grew up failing at school, sports, and at a lot of things. And that ended up being his “secret sauce.”

“I never had this fear of looking stupid. I never had the fear of failing because I always fail,” Shufeldt, who has seen 18 businesses through to 13 exits, told Medscape Medical News. Once you get out of your head about failure, every problem becomes an opportunity, he said. “Then it’s game on.”

A Hedge Against Burnout

There’s no question that entrepreneurship is challenging. Finding the time, resources, and the right idea is tricky. There are always unexpected hurdles and doing it all on top of maintaining your career as a physician can be overwhelming.

But Shufeldt, Francavilla, and Meyers agree that it can save or sustain a medical career.

“For me, this was always a hedge against burnout,” Shufeldt said. Even today, he still gets excited to go into the emergency department, but that’s because he doesn’t have to go every day.

It’s a way for doctors to supplement what they are already doing so they don’t have to see 30 patients a day, Meyers added. And it adds some much-needed variety and reprieve from clinical work.

“I love patients, but I put a lot of energy into the patients I see,” Francavilla said. “I find it hard to provide that level of care 40 hours a week.” Instead, she prefers the mix of consulting, patient care, educational, and nonclinical tasks that now fill her schedule. That’s the benefit of entrepreneurship. You get to decide “where you enjoy spending your time,” she said.

Donavyn Coffey is a Kentucky-based journalist reporting on healthcare, the environment, and anything that affects the way we eat. She has a master’s degree from NYU’s Arthur L. Carter Journalism Institute, New York, and a master’s in molecular nutrition from Aarhus University in Aarhus, Denmark. You can see more of her work in Wired, Teen Vogue, Scientific American, and elsewhere.