Ep27: How Physicians Can Get Into Innovation with Dr. Lance Black of TMCx & BioDesign – Potrero

Hills and Valleys is a podcast that uncovers stories from leaders in healthcare, tech, and everything in between. Straight from the heart of Silicon Valley, we give you a look at the good, the bad, and the future, one episode at a time. Brought to you by Potrero Medical.

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About Dr. Lance Black M.D.

Lance Black, MD, MBID is the Associate Director of the Texas Medical Center’s TMCx and Biodesign programs.

Dr. Black served previously as Medical Device Innovation Lead, and draws on his extensive military, medical, and engineering expertise to support the resident companies of TMCx in developing innovative healthcare technologies.

After earning his B.S. in Biological Engineering from Louisiana State University and his M.D. from LSU Health Sciences Center of New Orleans, Dr. Black served in the U.S. Air Force and deployed overseas twice: first as Chief of Medical Staff for Manas Transit Base in Kyrgyzstan, and then as a Squadron Flight Surgeon in Okinawa, Japan.

During his time in the armed forces, Dr. Black helped to create modular medical facilities for civilian use, and designed and implemented safety protocols for F-22 stealth fighter pilots and their crews.

Inspired from his work with Wounded Warrior amputees, Dr. Black utilized his background in Biological Engineering to focus on the design and development of medical devices. Following his exit from service, Dr. Black received his Masters of Biomedical Innovation & Development from Georgia Tech, including a year in their Masters of Industrial Design program.

Connect with Dr. Black on LinkedIn or Twitter @LanceMBlack

        Interviewer: Omar M. Khateeb, Director of Growth at Potrero Medical

      Interviewee: Dr. Lance Black 

Omar: Hi everyone. I’m Omar M. Khateeb, the Director of Growth here at Potrero Medical with another fantastic guest for Hills and Valley. Today, I’m joined by a fellow Texan. I’ve been connected with him for quite some time on LinkedIn. He’s somebody who comes from both the clinical world and the innovation world. He’s Dr. Lance Black Lance. Thank you so much for joining us. How are you doing today? 

Dr. Lance: Great Omar. Thanks for having me. 

Omar: Wonderful. I know that people heard your bio earlier in the intro, but could give us a little intro to who you are and the role that you serve today?

Dr. Lance: Sure. Right now, my title is Associate Director of TMC innovation. TMC stands for Texas Medical Center. As you mentioned, we’re in Houston, Texas where the world’s largest medical center, TMC, exists. We’re here to support startup companies by building density of digital device and therapeutic companies here in Houston.

Omar: That’s fantastic. It’s such a unique thing because most people don’t think of hospitals or even medical centers as hubs for innovation, especially for the medical technology and medical device world. So that’s something that’s very interesting. Of course I’m a little biased being from Texas, but TMC is one of the great medical centers in the world and it really is massive.

I mean, when you drive past it, a lot of people mistake that as downtown Houston, and I’m like, no, that that’s all medicine right there. Only in Texas, right? It’s bigger and better. 

I’m curious, what’s your story? Where did you grow up? What was life like where that was and how did you get into medicine?

Dr. Lance: Yeah. So I guess we’ll go back to Lafayette, Louisiana, where I’m from, which is Cajun country. I grew up a fan of science and math. I was one of those nerdy kids that caught into it and never left. I actually went into undergrad with the expectation that I was going to build the next Terminator robot?the Terminator for good.

It was going to take care of people, not terminate them. 

[Omar laughs]

And so, I went in with complete naivety and not understanding what it meant to be an engineer, a physician or anything for that matter. I just really enjoyed my time as an undergraduate. There was this one class that fundamentally galvanized what I wanted to do with my life.

And that was what’s traditionally called capstone and the engineering curriculum. In your final year, you solve a real world problem using all the engineering principles that you’ve learned over the previous years, then build and prototype a solution. I had the chance to meet a post-polio syndrome patient.

So this is a patient that was inflicted by polio earlier in his life, recovered and then later on developed symptoms that resulted from the initial infection. In his case, he was falling every couple of steps. His leg would just give out and he wouldn’t really know when it was going to give out, but occasionally it would just stop working and he would fall over. He went to his physician at the time and he said, what can I do with this leg? I want to be able to walk around and get out in and out of my car. His job was a land surveyor, so he had to do a lot of traveling and walking. The only option that he had at the time was a stiff leg brace, something that was going to keep his leg straight forward so that he can walk.

However now he’s walking with an awkward gait. It made him uncomfortable, hurt his back, and  was really difficult to put on and take off. So he came to us, this little student group, and he said, what can you do for me? So we took the idea of a seatbelt, where you can have full range of motion if you’re going slowly. And then as soon as there’s a high accelerative force, it locks you in place. We took that same idea and applied it to the knee. It allowed him to have a normal gait, and when it sensed an accelerated force that was beyond normal, it caught them and locked in place. That opportunity just culminated in my mind.

This is what I want to do for the rest of my life. I want to seek out healthcare problems and solve them with interesting engineering solutions. That’s what spurred me to go into medical school actually. That was my next step. I went to LSU in New Orleans where the Great Charity Hospital was. I spent a lot of time trying to figure out where I could do that best. What specialty or opportunity would I be able to really use my skills as an engineer? At the time I joined the military to help pay for med school more importantly, because I wanted to give back to my country and understand how I can bring healthcare into the service.

They needed primary care physicians more than anything else, so I went into primary care. As a family medicine physician, I trained at Eglin Air Force base in Florida. So that was my next stopover. I really enjoyed the training. I enjoyed getting to learn a little bit of everything from how to deliver a baby, to do general surgery, to taking care of patients on the floor. I loved that.

Then, I went to Langley Air Force base next, which was my first station. I was there for four years and at Langley I deployed several times overseas. I saw a different side of the world. I saw some really interesting things operationally and how the frontline encountered so many barriers and difficulties when it comes to taking care of their health. Not only are they healthy enough to go overseas, but how do we manage them if they do get hurt in battle. That really opened up my eyes on how I can apply engineering problems or process engineering into healthcare.

At the same time, I was growing frustrated with the technology I was using day in and day out. I don’t want to say I was burned out, but what I would say is I wasn’t getting excited about the next patient I was seeing. It was almost like it was just a repeat pattern. I had to see 25 patients a day, and I was being pushed to the next patient. No matter if I had five or 10 minutes to spend with them. I can already tell, this is not what’s going to work out for me in the long run. I tell people jokingly that being trained as an engineer kind of ruined me as a physician because I was seeking _____ problems. I wanted to be creative and submit new solutions, which is not what you’re paid to do in medicine. You’re paid to put into practice great research that has already been done and apply that in the real world setting. So you don’t really get paid to be creative. In fact, you don’t want to be too creative because you can risk patients. 

So when I completed my military commitment, four years later, I said, I’m going to go back to school. I’m going to give up clinical practice and try to create my own path where I can balance medicine and engineering. And that’s when I came across some programs out of Georgia tech. One in industrial design, which I did for a year. And then one in what’s called Biomedical Innovation Development, which is a Bench to Bedside engagement where you’re really learning how to concept forward and commercialize it. At the time I’d joined a private development firm that worked with innovative physicians, prototyping, and building interesting devices.

I did that for three years and now I’m here in Houston for the past four years where I have family. So it made a lot of sense for me to come here, but not only that, Houston was building something new and I was really excited about being part of that process, that next TMC innovation. 

It’s only been around for about six years so I kind of joined it at its very formative years, four years ago. You mentioned earlier that people don’t think of the health system as a place where innovation occurs, but it should be, right? That’s the proving ground. That’s an opportunity for us to validate those technologies, to really be in the grass roots with the patients, with the physicians doing the work and understand whether or not this technology has legs.

I think oftentimes, we as innovators stay within our four walls and come up with great ideas and really don’t give it the proof that’s needed in such a highly regulated field like medicine. 

So that’s a very long winded answer to your question of where I’m from and who I am, but it’s pretty vacillating when you think about where I’ve come from.

Omar: No, no, it’s not long at all. Look, that’s your story and it’s really fantastic. I think it’s funny because I actually went to medical school in Texas tech but I left about halfway through. I’ve been in touch with many of my friends who are now practicing. I was speaking to another one the other day and I think there’s a lot of young physicians (and older likewise) at various points in their careers where they’re trying to supplement their day jobs or also look for new areas to go into. 

It’s really overwhelming because one, you don’t really learn about these things in medical school or residency. So it’s almost a purely out of luck, like you happen to know the right person and you got exposure to it. Otherwise, I feel like there’s so much great talent and great minds out there that have not been exposed to other opportunities. That’s why I wanted to have you on, because I just know that so many physicians might listen to this and that this one interview will be that callous to say, I can be like Lance black. I think I’m going to do it. Whether they reach out to you or they just simply go and look at your LinkedIn and say, Wow, his early years is very much where I am now, I can actually explore this. I think it’s incredibly important. 

Dr. Lance: I have a bad reputation of talking people out of going to med school.

It’s not that I don’t respect and value the career that so many people have chosen to take. I do think we need great people to do that and to follow that calling. I think oftentimes, though, we get a little glamorized in knowing that we got accepted in med school. We have the potential to be a medical student, we have the potential to be a physician. Those things can be hard to see through and really understand. At the end of the day, what are you going to be doing? And is it something that you want to do for the next 20 to 25 years of your life? I stress this in my own life.

I really want to do something that I enjoy. I don’t want to do something where I’m looking forward to the day that I can retire or the day that I can do something that I really love and enjoy. I want to enjoy the present. I feel like I found that. It took a long time. I tell people it was almost like going through a divorce. Like you put so much time and sacrifice into health care and medicine, and by the time we get to the point where you feel like you made it, the last thought on your mind is okay, it’s time to leave, right? I’ve been told, “You’re crazy, what are you doing? Why would you get out of this? You just spent the last eight years of your life devoted to training for this moment, and now you’re ready to go.” 

It took me a few years. It wasn’t like an easy decision by any means. I still long for some of the days that I had as a practicing physician and do miss it, but it’s more about just trying to understand what motivates me as a person and what’s going to really bring the best out of me and challenge me and it wasn’t happening in clinical practice. Not that it can’t for some people that choose that career. I’m not the kind of person that says follow your dreams, I’m not like that. I was basically saying that I know what motivates me. I know what’s going to drive me and challenge me. And I think I found that through innovation, through working with entrepreneurs and being in this space. I’m very happy that I found it. Whether or not it’s a good fit for a lot of people is something that they have to determine for themselves. 

Omar: I’m right there with you. With a lot of the students that I mentor out of Stanford and Berkeley, I’ve talked a few out of going to medical school because unlike being an engineer or an entrepreneur, the moment you announce to family and friends that you want to be a doctor, everybody just gets behind it. There’s a dopamine rush and a lot of cognitive biases that’s pushing you in that direction. First of all, there are four years of medical school, then there’s training, which is three to 10 years, depending on what you do.

I have plenty of friends who went to law school, and I think they dedicate three years. But when they graduate, if they don’t want to practice a lot, it’s like, Oh yeah, I can go consult or I can be in business. There’s a variety of things. It’s not the same thing with medicine. It’s kind of like, I got the MD, so I have to find a way to practice medicine. I think either the AMA or Gallup surveyed physicians a few years ago and between 48% to 49% said that if they had to do it over again, tthey wouldn’t. I think that says something. While it’s a very noble calling, I think it’s really important that we make sure that people who go in there are not going in there purely just for money or for title or anything. It should be because they genuinely want to help.

A lot of times when you talk to people, they say they want to help. I was one of those people who wanted to help people, but when I was in med school, I realized that I could see myself doing other things and that was around innovation. That tipped me off as to deciding that I’m not going to do the patients or myself any favors if I stick to this. Again, like what you mentioned, you get out the other end and the next thing you’re thinking of is like, Oh, I can’t wait to start doing like this other thing later on in life. It just doesn’t make sense. 

Dr. Lance: Yeah. I think a lot of the frustration that physicians face are things that through enabling technologies we can help with. It’s the practice of medicine that people enjoy. It’s not the administrative burden, that paper pushing, or the lack of time you have to spend with your patients. Those things add up and certainly contribute to?if not completely cause?burnout. Those things can also be alleviated through enabling technologies.

I feel like part of what I do is helping physicians to do the practice that they signed up for. So instead of spending time doing things that are not meaningful to them, they’re able to get some of that time back in and apply it in a way that’s relevant to the clinical aspect they’re doing. I think it comes full circle a little bit. 

And you’re right, everybody has to make that decision for themselves and it’s tough. What I think is challenging to know is it takes a long time to get to the point where you actually understand what you’re going to be doing. It’s not something you can just go try out for six months and then make a decision. You have to put in at least seven years of time to even experience what your life is going to be like. And by the time you’ve done that, you’ve gotten so much sunk cost that you’re not going to want to go back because it doesn’t make sense financially and time-wise. 

You’re at a point in life where most people are in the middle of their career. They already have seven years experience working for a business. Most people have maybe even made several career advancements. The last thing you want to do is start over and just being maybe stupid enough to take that chance and do something different. 

I will say though, with all that being said, having an MD and that experience certainly has opened up doors for me to do what I want to do now. So, I don’t regret it. Would I do it over? No way! But it has served me well, so I don’t want to be overly pessimistic either.

Omar: I think there’s something to be said about that. You resisted one of the most common fallacies which is sunk cost. You’ve gotten so far down the rabbit hole and it’s like, Oh, I don’t want to leave all this time that I dedicated to that. But I think the bigger thing is that there’s an intuition in you that you wanted to follow this. I want to get to some of the great projects and innovations you’re doing at TMC, but just really quickly, especially for some of those visitors that are listening to this, what would you recommend just to get started as a physician?

A friend of mine is a great example of this. His name’s Scott. He was feeling a little bit burned out through clinical medicine and wanting to explore options because he has that entrepreneurial-like innovators itch. What’s the best place to start if you’re that physician? 

Dr. Lance: There are so many opportunities for physicians who are full-time in practice to work with startups. I think I would focus on building relationships with entrepreneurs by talking to those that are doing something that’s interesting to you in your field and serve as an advisor. At least it could be informally and casually, all the way to being a chief medical officer part-time. Certainly there are options there. But to get your toe into it, an informal advisor is something that I don’t want to say easy to do, but people are looking for positions and support them.

I think research is another great opportunity. I think a lot of physicians are involved. It’s an incredible research that has led to technologies that ultimately get sprung out into companies. There are those companies looking for additional clinical partners. I mean, that’s part of what I do day in and day out. I was looking for the right clinician who seeks out those kinds of opportunities. So, I think there’s a lot. I honestly didn’t know about the startup world until I got out of clinical medicine. 

As a clinician, we’re just so much buried in the weeds. I didn’t even have a LinkedIn profile, I don’t care to meet people. I just need to see the next patient, right? I’m not even understanding or thinking about all the things that are surrounding me. So, taking time to explore other industries is vital. if you’re feeling burnt out. I think some of the most brilliant physicians that are doing the best job have a side gig. Whether it be, I like to paint on the weekends or it’s I’m doing this great stuff as an adviser for this startup company. It’s something outside of the clinic that allows their brain to refocus and not being overly concentrated on just patient care.

And that’s healthy for anybody. 

Oamr: It’s part of the medical culture that we were trained in, which was the one thing that I love about medicine and the training. And there are a lot of bad things to say about it, but on the positive side is this theme around not only continuing education. When I was a young kid, my dad was a surgeon and I noticed that every doctor I talked to were really passionate about something else.

Their hobby was their work, but outside of that, some of them were really into history. My uncle who had passed on, he was a cardiac surgeon, but on the side he was really into sculpting. They knew everything about it inside and out. And I think it’s so important, not just for physicians, but every profession. I’ll be honest with you, I’m hard pressed to find another group of people outside of physicians, nurses, and other people who work in the hospital, who work harder and longer hours. It’s a very, very rough and difficult job. 

Dr. Lance: Right. It’s not one that’s easy to just say I’m going to do this part-time or I’m going to do it four days a week out of five. You’re oftentimes on call 24/7. Even if you’re not on call, you’re thinking about it or you’re clearing up some of your notes from the clinic. It’s long hours and it’s really tough to add any kind of extra work to that. That’s why I think having new creative outlets makes it more important.

I do think too, though, that we as type A personalities (wants to be perfectionists), we tend to overwork ourselves when in reality, there are opportunities for you to cut back and seek out other ways of being employed. As a physician, it doesn’t require 24/7 focus, you know? 

Omar: Absolutely. 

Dr. Lance: I think that’s a lie that we tell ourselves sometimes that I have to be working this much. 

Omar: Yeah, it really is. One physician who I interviewed, he was the Chief of Heart Failure and Therapies at Kansas University. His name is Dr. Andrew Sauer. He built that program from the ground to the top at a very young age. I think he started when he was 33 or 34, but he stepped back and handed the torch off to somebody. He writes a lot on LinkedIn about burnout and then refocusing on what’s important, which are his health and his family.

Medicine, especially residency, is very much like the military where there’s a lot of badge of honor in terms of how hard you’re working, the sleepless nights and everything. However, I think the over-glorification of that lifestyle leaks into your practice post-residency. It’s really important for physicians to hear people like you and like Dr. Sauer write about it and be vulnerable. You’re not going to lie on your deathbed and say, I wish I wrote a few more manuscripts to submit to New England Journal of Medicine. You’re going to think about the times that you should have just slowed down a little bit, spend more time with your family and for yourself. 

Dr. Lance: Absolutely. When you come out of residency, it’s not like it’s done, and you’re like, okay, I’m a clinician now. It takes some years to establish your clinical practice. It takes years to establish not just your acting in more your, your, your clinical stuff, right? How long do I interact with patients in this timeframe? How am I thinking about when they’re going to come back? There are some things you’re not necessarily taught in residency always, or at least not to the extent where you have enough volume underneath your belt.

You are in a constant learning state, I guess is the point, right? It doesn’t end in residency. Some people think after training, you’re going to go on practicing as a physician. There’s probably not going to be a time where you don’t feel like you’re under the gun and you’re trying to get caught up or you’re just to stay above the water. That’s why I think it’s the toughest, right? You feel like you’re always under pressure. When you’re in that mode, your brain is in defense mode. It’s like fight or flight. I’m just trying to survive. This is not about trying to find something else that’s been on my plate. This is just about trying to stay above water so I can just hold on to this job. 

So, it took me a little while to get to the point where I’m like, okay, that’s not what this is about. I don’t want to be in this fight or flight response. Now I took the extreme measure and just left clinical medicine, but I think there’s a point in time when you can say, I’m just going to stop working seven days a week, I’m going to work six days a week. That’s what I think physicians come to realize, but they’re not really mentored in that way. Before they come in and realize that on their own, it takes years to get to that point. I wish someone had told me, Hey, it’s gonna take you three or four years after residency just to get your feet underneath here, before you feel comfortable seeing 25 patients a day, and know how to move next. 

It’s like when you first started learning to drive a car, your hands are attended to, your eyes are focused, you don’t dare turn on the radio or take a drink of water because you’re so concerned with just learning how to drive. And then, six months later you’re driving with one hand on the wheel, you’re looking around, you’re drinking, and you’re doing whatever. It takes time, and that’s what I didn’t realize. It’s frustrating because you spend so much time getting to that point, but definitely here to encourage people that it’s not always that way. You should take the time, as soon as you feel comfortable to do so, to really explore other options. 

Omar: Absolutely. I think your advice earlier is really spot on, which is to simply start by checking on LinkedIn. I think exposure is a big thing, just having a conversation with somebody. The most important thing is that all the solutions to the problems that you think are out in the world are in your head, you just need the right things to turn that light bulb on that you didn’t know was there. 

To shift a little bit, I want to hear about some of the projects and innovation program that you guys have at TMC. What does that entail? 

Dr. Lance: TMC innovation is all about building density of healthcare startups in Houston.

It’s not this economic development play where we want Houston to be the next city to come to. It’s because we recognize this extraordinary, unique value that exists within the Texas Medical Center. We talk about being the world’s largest, but really when you break it down, it’s a collection of independent health systems that are all co-located. 

As you mentioned, people mistake it for Downtown Houston because it’s one building after another building. What you’re looking at are 21 hospitals within two square miles, multiple academic institutions, and research organizations, all dedicated to advancing healthcare, education, and research. There’s nothing like it on the planet and I can’t explain it to people enough. Imagine if you had five Mayo clinics and all was wrapped up into one geographical region. That’s what TMC is. We support over 10 million patient visits a year.It employs collectively 115,000 people. There’s a surgery done every two or three minutes, and a baby born every 20 minutes. The statistics are really on another level when it comes to healthcare delivery. There is no comparison. 

We recognized what we have in Houston and realized that this should be the place where entrepreneurs not only just start to grow their companies, but come to validate their technologies. That’s what TMC innovation really came into play. And that’s where, as a brainchild of our CEO at the time, Dr. Bobby Robbins, who came from Stanford recognized there’s some great stuff going on on the West coast and the East coast and there is no reason why that shouldn’t occur tenfold here in the Texas Medical Center. At that time we started a bio-design program, we started an accelerator called TMCX, we started to have coworking space called X plus, and we started a number of different programs and projects, including corporate partners on our campus that really created this magnet, if you will, to attract companies in the med device space particularly, as well as in digital health space. Now for in we also cater for the cancer therapeutic space, thanks to a grant that was given to us by secret which is a Texas based organization focused on research and cancer. 

What we do is we’re heavily focused on company formation, and on getting a company’s traction within the med center. What I mean by that is a meaningful agreement or an engagement between the startup and health system that’s going to advance the technology that much further. If it’s a clinical trial site, a joint development opportunity, or a pilot study, whatever you can imagine to validate the technology, we are seeking out those opportunities on behalf of our companies, and quite frankly, on behalf of the health systems as well. We know that they want to be innovative and we want to be able to serve that desire by bringing well-vetted technologies to the forefront. They get inundated with requests that they can’t filter through. So we do a lot of that filtering and say, “Hey, you should really pay attention to this company. This is what’s going to be the next best thing in five years. They have their stuff together, so think about doing something with them.” 

It starts with us working with our health systems, understanding their problems and understanding their areas of interest, and then bringing together startup companies that can serve and solve some of those problems. We’re trying to find that right now. A lot of what we do is like a dating service. Then once there’s that match, how do we accelerate those discussions to culminate into our relationship, whether it be clinical trial, et cetera. That’s what our team works very hard in doing. It’s not just finding the right stakeholders, but what does a startup need to have in place so that they are in a position to have the enterprise level conversation?

As I’m sure you know from working for Potrero, it’s one thing to convince a private clinic to adopt your technology, or even a small community hospital, because the stakeholders there are maybe easier to access. It’s a completely different thing to get a health system that employs 15,000 people to pay attention to a small company, right?

Omar: Absolutely! 

Dr. Lance: That’s what we specialize in. We specialize in helping startups get the attention they deserve in the enterprise health system market, because we have so many _____ to us that we serve happily. Folks like the Texas Children’s Hospital, the _____ College of Medicine, MD Anderson, Houston Methodist, or Memorial Hermann. I can go on and on and on, there’s so many ____. And the great part about it is that they’re collaborators, but they’re also competitors. Omar: They’re definitely competitors, especially cardiac surgeons, because I knew Cooley and _____ had long passed, but that rivalry is still there. I don’t care what anybody says. 

Dr. Lance: Exactly. And you know what? I wouldn’t have any other way because that competition breeds very interesting innovation opportunities. So, we play off of that and we totally respect and understand it. The reason they want to adopt technologies is to beat out their neighbor, right? So we’re okay with that. That’s how we advertise it. It’s not just this kumbaya health system that everybody thinks the same way. It’s a competitive marketplace. It’s a microcosm of what’s happening in the world. If you’re going to validate your technology, why not do it with an AMC (Academic Medical Center), right next door to a VA hospital, right next door to a private nonprofit.

Omar: Yeah, it’s all right there. It makes so much sense too not only because of the high patient volumes, the high procedural and therapy volumes, but also because Houston is an international hub. So you have a variety of different case presentations, and a lot of major surgeries are done there. My father actually had his open-heart there with Hazim Safi over Memorial Hermann. There are all these great opportunities there. 

I have a question and I don’t know if this is the right way to think about it. What it sounds like is that TMC acts like a Y Combinator. For those listening, Y Combinator is like the Harvard of incubators, they Airbnb Dropbox, five stars, they all came out of their Reddit. So you guys work with founders to essentially scale and get into place a system and a team to start doing that. But at the same time, it sounds like you also have a way to take founders who have a really good idea, maybe some patents and the minimally viable products, but also match make them with the right teams to start growing that and essentially provide an ecosystem. Is that correct? 

Dr. Lance: Through our bio-design program, we actually hire what we call fellows right now. Essentially they serve as entrepreneurs and residents. They come to us without even an idea where we’re betting on their potential. We’re betting on the fact that they have the right experience, they have the right passion and the grit to actually build a company. And then we form companies from scratch. Over the course of the year, they spend time identifying their needs. They take one of those needs, and then they solve it by developing a novel technology on their own and then they form a company.

So, we’re at the very beginning stages of things for sure through our biodesign program. I mean, through X or accelerator, you’re right. It’s more companies that have already demonstrated at some point the validity of their technology. Now they’re coming to us to partner further with clinical partners. It’s a little bit of a later stage. Generally those companies have either raised seed funding, or even as far as series a, so it’s a little bit more advanced than saying. We’re in the business of company formation and later stage company densification, I guess you could say.

Omar: This is more often than not regarding the kind of calls I usually get from physicians that I’m connected with on LinkedIn. I get a call from some physician who is more often than not usually surgeons. I think surgeons naturally have a tendency to tinker and think of new ways to do things, but there’s a variety of physicians who could do that. They call and say, “Hey, I’m always doing Google patent searches. I have this idea I’ve patented, but I don’t know what to do with it.” Could somebody like that come to you guys and say, “Hey, here are the patents I filed for. I own them, but I don’t know how to raise money, how to engineer or how to put a team together. Can you help me?” 

Dr. Lance: We do that all the time. We have physicians always asking us questions, just like you described and what we provide them is more or less a sounding board. And then we help direct them to not waste their time. We say, here’s the next step you should really think about doing. We have now, over the course of six years, companies and a network of professionals that we can also point them to. We say, You should start thinking about a patent and here is a law firm that works with startups and people just like you in the med device space.

So, we can provide them that next step and that next level to consider. We value very highly clinician input, a nurse, a physician or even a hospital administrator, because we also recognize that’s where our companies will have the opportunity to have access to their patients that they’re trying to help. So, we certainly open our doors really wide for anybody that has ideas in the clinical space. We want to be able to provide that level of support. Quite frankly, we’ve seen so much over the course of our applications for ads and over the course of our biodesign companies. We’ve seen thousands of companies. So chances are, there’s a proxy that we can point you to for you to think about by saying, this is how they’ve done it. Consider this, look at it this way. 

We do provide that service for our clinicians. We don’t have a formalized program, but what we do have is a community that often comes to us and tries to understand where are the next steps? What we see a lot of and what we want to avoid is a lot of wasted time, money, and effort on things that don’t really have a high potential for growth and for development into commercial infancy. That’s where we feel it’s our responsibility to help guide those young innovators or novel technologies from step one.

Omar: That’s fantastic. I’ll definitely leave it in the show notes, but I’m sure TMC has a website for a lot of physicians essentially to check out and get access to some materials and resources, right? 

Dr. Lance: Absolutely. tmc.edu/innovation has all information on our programs, our space, and the resources that are available to them. My contact information is on there and you can drop that in the notes as well. Please reach out to me directly, I’m happy to point you in the right direction and take it from there. 

Omar: Definitely. I don’t want to put you on the spot, but I have to ask this question. Are there any specific technologies, companies or projects that are a little more exciting than some of the others? What’s top of mind for you, if you don’t mind?

Dr. Lance: Sure. You know, this is a hard question. I don’t have favorites. 

[Both laugh]

Dr. Lance: Let me just preface it by saying this. I now get excited about founders that have recognized a nuance and a problem that nobody has seen before. I don’t get as excited about the technology. We can talk about how cool AI is, how cool blockchain is or what its capabilities are. Me and you can sit here and probably brainstorm some incredible ideas using those kinds of tools, VR, robotics and the list goes on and on because we’ve seen a lot. 

However, what we can’t do and where I think founders really have the upper hand is they have this experience that they see the world differently than everybody else does. They see congestive heart failure and the problems that we face and imagine that in a different way. And they come to you and they’re like, this is how I see the world. It’s almost now, by the way, to me, like they’re saying here’s the solution. As soon as I see their appreciation of what problem they’re solving, that’s when I like my ears perk up and I get excited about what they’re working on. I almost don’t care about the technology. Technology is the tool to solve that particular problem. 

With that being said, I’ll highlight a couple of companies that I think have just really uncovered the nuances of the need. One of them is called Luma Health. In fact, Luma is a company that we’re currently invested in through our venture fund, which is something else that we have to support companies. Adnan is the CEO, he’s a great guy. It’s a digital health tool to help guide patients through their character journey. You may have seen some of these platforms, but Luma  has a different take. It’s in a way that Adnan appreciates the patient journey. It’s making it much more personalized with the patient at the center. What are they going to experience when they walk into the hospital? And it’s not just clinically, like here’s the clinical information you need, because you were just told you have arthritis in your hip, but how to think about the financial future of that particular journey, how to think about its impact on your lifestyle or how you’re going to have to see physicians now regularly. How to think about the medication that you’re going to have to consider. What are your choices? It’s empowering the patient to be able to have control and oversight in their whole journey, which I really am excited about what Luma is doing. 

As a primary care physician, I think there is so much interesting technology, but it kind of falls into the fringe as a specialty care. This is only for a cardiothoracic surgeon on this one particular valve. That’s great and it’s technology we certainly need, but the crux of the care that’s being given is in primary care. And so I’ll give you another example. One that recognizes the utility of primary care in the mental health space. I think most people don’t realize that 90% of patients that are depressed or anxious are getting treated by their family practice physician not by a psychiatrist or a psychologist. There’s a stigma about going to those specialists. There’s also the trust factor that a lot of patients have with their primary care. There’s quite a few companies in this space where they’re empowering family practice physicians to feel better about treating those patients regardless of their severity. There’s a couple of companies in that space that I’m very proud that X has been able to support as well. One of them that’s just coming on board right now is called Eleos Health. I haven’t had a chance to work with them at length yet because they’re actually just joining TMCX. However, they use a voice analytics platform via telehealth . They can tell you right now how I’m feeling as I’m talking to you, based on my word speed, the nuance, the way that I’m using my words, and which words I choose to use in speaking with you. So you can imagine as a physician, if I’m talking to you via telehealth, and I know as you’re describing a certain part of your past it’s causing anxiety or fear or depression, then I know where to dig deeper and how to understand to help you.

Or if I get you a question that causes confusion or anxiety then I know I need to further clarify it. It’s so important that we become master communicators in healthcare. I think that’s where we drop the ball often. Part of it is not because of us, it’s because we have to hurry up to our next patient, but it’s so important for us to make sure that the patient understands clearly what the problem is and how to manage it. If they walk away confused, we’ve lost them. They’re not going to be compliant. They’re not going to come back and if they do, it’s going to be too late. Eleos is one of those interesting companies that’s making a big difference in mastering communication. I can keep going on and on if you want, because I have a lot more companies. 

Omaar: I was going to say that I want to have you back on the podcast. 

[Both laugh]

Omar: What I think is great is that, again going back to physicians, there’s this untapped resource there with all these great minds that have seen the same problem over and over and over again. And somebody has come up with some kind of solution to make something easier. It’s very daunting. Living in Silicon Valley, I see how anything is really possible, but if you don’t live here and don’t have any exposure to it, you really don’t know where to start.

A lot of times when physicians think about health tech, they think about these big companies, like Teladoc or Intuitive Surgical. Many times, there’s a lot of value in developing something that is as simple as improving compliance and communication via an app. That’s the thing that I wish they would teach more in medical school. It’d be great if they taught a simple elective of intro entrepreneurship or innovation, where you can develop a minimally viable product and then build on that so it grows. For Potrero Medical, our device is a great device. I’m biased obviously. On one side, it’s automating your urine output which is really rare, right? We give real-time intra-abdominal pressure and then it’s all going into our data science team and they’re building predictive algorithms.

But if you go back in time, that’s not what Potrero was. Here’s an interesting thing. They were two completely separate companies. Had those companies not been started where they focused on these niche problems, and then our founder, Dr. Dan Burnett, decided to combine them, it would have never existed. I think people underestimate the value of really simple ideas that solve a very niche problem, and scratch a very specific itch. Then those things end up growing and evolving to things that you could have never imagined in your wildest dreams. 

Dr. Lance: Yeah. I’ve had the experience of being in both worlds. Now looking back and thinking to myself, man, I had ideas all the time, constantly popping up. As physicians we’re taught to be highly self critical and say, well, I can’t validate if this idea actually will have any effects so you come to suppress it and you don’t do anything about it. You’re so focused on the fact that there’s no data to support whether or not that will work, and end up suppressing  the idea.

It’s those people that take the chance and say, I know this idea doesn’t have data to support it, or it seems like it’s over simplified, but I’m going to run with it and actually make a difference. That’s where I think a lot of these entrepreneurs breakthrough and it actually gets to a point to where it’s meaningful. When you look back, you’re like, well, now that’s an easy idea. I wish I would have thought of that, right?

Omar: Let’s be honest, in the early to late 2000s, we all at one point looked at our phone and said, man, wouldn’t it be so much easier just to order a taxi? Everybody thought about that! But somebody decided, yeah, let’s go ahead and just try it. And it evolved. I’m very happy to see more physicians like you. Aside from your role in innovation, you put out a lot of content and essentially put ideas out there in the world on LinkedIn for other people like physicians to see it.

A lot of times you just need that one catalyst to see something in a different way and say, I’m going to try, for example, just starting a simple blog and writing. Then you never know the opportunities and things that come your way. 

I think there’s a whole philosophy around ideation and ideas that I really appreciate. One of those things is that so many ideas just die in your head. And I think the first thing you should do is go talk about it with somebody, right? 

Dr. Lance: I think about innovators somewhat like prophets. They have this vision of the future that may not be shared by others. Oftentimes it’s everybody around you saying that’s a stupid idea or it’s unlikely somebody else already thought of that don’t even worry about it. But, take this year 2020 for example, where telehealth has just been blown up. The adoption is unbelievable as far as talking about scalability. Telehealth is not a brilliant idea. I mean, talking to your physician via video phone, that’s something I wasn’t sure it was considered in the 70’s when we started to even think about video phones as the future. 

What’s interesting is that people disregarded it until this year (2020). You have all of these founders that have been preaching telehealth for so long. They’ve been saying we need this, this is going to be what unlocks access problems that we’re facing today, much less in the future, which now with the pandemic, it’s even more blown out of proportion. It’s like prophets who are just preaching this future that they’re trying to get people to understand and to see it the same way. As physicians we depend so much on the reality of data and making sure that we’re very conservative. 

I told you earlier on that being an engineer kind of ruined me as a physician. Being a physician also ruins you as an entrepreneur. You’re taught to be risk averse, conservative, and take what’s available evidence-wise and use in practice. You’re not taught to be blue sky and say, let me think crazy ideas or let me try this out. You’re not taught that way and so you don’t have this divergent way of thinking. That’s where there’s a rub for physicians. As soon as they come up with an idea, they are taught to suppress it because it doesn’t have any way to validate it as opposed to entrepreneurs or physicians who have an entrepreneurial mindset where they’re taught to run with the crazy, right? They say, Hey, this has legs. Let’s go for it! 

And I don’t want to downplay something I think is really important, which is, it’s not all about the idea. 

Omar: Right. There’s a lot of execution and much timing luck, but it starts there. I think you’re so right about that Lance. One of my former classmates called me a couple of months ago and he had a really great idea and I kid you not the first thing he said was, “I was exploring this idea but you I was talking about it with a few of my friends and they don’t know if it’s worth pursuing it”. , I’m like, “well, what friends?” And then he’s like, “some of the other doctors in my practice”. I’m like, “the worst people to talk to, don’t talk to your peers!”. 

If you’re going to open a restaurant up you don’t talk to a bunch of people who’ve never opened a restaurant. I think just talking to the right people and having the right exposure is one of the positive effects of social media. So LinkedIn is one of them. MedTwitter is just amazing. It’s these high velocity conversations where you get this exposure. Just like with technology adoption, they’ve shown in so many studies that a big part of that is whoever that segment of people is going to adopt, them seeing other people like them doing it increases their chances of adoption and changing how they do things.

I think it’s the same with physicians. The more they start to see someone like you or other people in the medical community start to go purely in the innovation side or have one foot in clinical medicine, and the other foot in innovation, the better. There’s a variety of ways to do this.

There’s no one way to do it. It’s just like when people say, Oh, to be a real entrepreneur, you’ve got to quit your job and just launch. It’s not true. 

Here’s an interesting fact: a lot of people skipped out on the first two, or I think even three, but definitely the first two rounds of fundraising in Uber mainly because the founders were doing it as a side gig and no one thought they were taking it seriously.

Dr. Lance: Lesson learned. 

[Dr. Lance laughs] 

Omar: Yeah, exactly, lesson learned. I can’t remember what entrepreneurs were talking about it but they were friends with those founders. They said that had they invested that 20 grand in the first round, that 20 grand would have been worth like 50 or 60 million or actually more now. But they just didn’t take them seriously because they were doing it as a side gig.

Dr. Lance: It’s like Bitcoin man. 

Omar: Oh man, I was all hot on that. I came in late in Bitcoin, like 2016 or 2017, but when it  dipped I said, I’m holding. I’m going to forget about it. 

Dr. Lance: I came in right at the peak and then watched it fall. 

[Both laugh]

Omar: Crypto is great. It’s coming back, you know, it’s 2020.

Dr. Lance: Let’s make a little bit of a bounce back. I’m hopeful. I’m just not a heavy investor at this point. 

Omar: Yeah. I think the one thing that happened in 2020, especially in medicine, but really everywhere is that this is the first time in history where every single human being on planet earth, or let’s just say every person in America at the same time was rethinking everything because all the systems we live in including how we commute to work, communication, and health, are really designed by people who are for the most part dead right now. These systems were designed decades ago, but we’re still living in them, right? This notion that to run a company, you have to have an HQ, that got blown out of the water. And so I think that the other exciting thing is with healthcare, from 2020 we’ve seen so many things that are possible and I’m wondering how 2021 is going to look. 

What are some systems or some or traditional mindsets that were broken apart this year in healthcare and innovation? Is there anything that sticks out? 

Dr. Lance: When I was going through training, tele-health was ridiculous. Why would you not take the opportunity to do a good physical exam on a patient in person. Don’t do tele-health, it’s a waste of time. If it’s the last resort, you’ve got to do it. That mentality has been blown out of the water in 2020. Through enabling technology, we’re able to do not everything, but a lot of what we used to do in the clinic now remotely. We can do it cheaper, safer, and with better access to the patient. I don’t want to say I’m glad, but I think as a positive consequence out of 2020, if there’s anything, it’s the realization that some of this technology has been in place for years and actually just needs to be better utilized.

You take the time to adopt versus it being forced down our throats, so to speak. 

Omar: Yeah. Or just an afterthought where it’s like, yeah, we could do, but now it became a necessity, right? 

Dr. Lance: Yes. When you’re in the weeds of clinical practice, it’s hard not to come up with a thousand reasons not to adopt new technology. I completely understand that. I was in the transition between talking into a recorder to have a transcriptionist type up your notes for you, and then faxing those notes into the paper chart, and then going into an EMR. I was in that transition and if you weren’t adopting new technology, you were just frustrated every single day.

If you weren’t adopting voice dictation, like nuance or something like that, you were struggling and spending hours finishing your notes. People are still doing that, don’t get me wrong, but it’s an enabler. I think that’s where it’s hard for us to sometimes recognize that it’s going to take time to adopt. And it’s going to initially slow down your productivity, but just so that you can get an advantage from it. Later on, it’s going to improve your productivity, ultimately fold. So I think that’s what 2020 has shown a lot of clinical medicine. 

Omar: Oh, absolutely. Well, I really appreciate you getting on so late and it’s getting close to like six. As we wrap up, I want to ask you a few rapid fire questions. You can take as long as you want on these questions or as short as you want. I’ll just go to the next one. You ready? 

Dr. Lance: Sounds good. Let’s go!

Omar: Okay. So, here’s the first question to you. In your career, you’ve probably had a variety of mentors and people that you look to for advice. What was the most painful advice a mentor ever gave you that really helped you a lot? Who was it and what was that advice? 

Dr. Lance: Oh man, that’s tough Omar. It was painful. To have to admit this on television?

[Dr. Lance laughs]

Omar: You don’t have to, but it’ll probably be better. Not just painful. Painful, but it helped you. 

Dr. Lance: I had a mentor during medicine residency. His name was Dr. Persons. At the time, he was probably one of the most senior physicians in our clinic. He was probably 30 or 40 years my senior. I really looked up to him. I looked up to his experience. I kind of looked at him as somebody who validated whether or not I was doing things right. And he told me one time, he’s like “Lance, you have this tendency to want everybody to like you. And when the shit hits the fan and it comes time for things to go a certain way, you can’t rely on that. You have to rely on your clinical tenacity, your understanding of the situation and people need to respect that. If they’re just your friends, there’s a tendency to forget who’s in charge.”

I still struggle with that, by the way, Omar. I haven’t learned my lesson, I think. 

[Dr. Lance laughs]

It really kind of brought to light what’s important to me. How do I see my colleagues at work? How do I work with them? How do I become a better leader? One that is a servant leader, but at the same time is a leader that’s respected. Somebody can look up to me for advice or for leadership. That was probably one of the hardest things for me to hear from a mentor that I highly respected, but it was helpful. 

Omar: I’m so happy you shared that because I think there’s plenty of people who are listening to this who feel the same way. Especially these days, I think there’s a real big push to be very diplomatic about things, and be a little kinder and gentler, which I’m all for. But I think that’s such great advice because at the end of day you can’t make everyone happy. I think it’s a good reminder for all of us. 

Dr. Lance: Absolutely.

Omar: Okay, next question. What book do you feel that you most often gift or recommend? 

Dr. Lance: There are quite a few and it depends on who the person is. If it’s about business and understanding the entrepreneurial game and getting into that, I think there’s nothing better than Zero To One by Peter Thiel. That’s an incredible book. So there’s definitely that one. I’m trying to think of the other ones that I gift. This is going to sound super nerdy, but I’ve been getting into Quantum Gravity. 

Omar: That is the nerdiest thing I’ve heard all day, you’re right. 

[Dr. Lance laughs]

Dr. Lance: And there’s this amazing guy that’s like the poet of physics. That’s what they call them. He’s been writing some incredible books, one’s called The Order Of Time. His name is Carlos Ravelli and I’ve been telling everybody I know about it. I’m like, you’re not going to believe what this guy’s writing about time. It’s mind blowing! It puts things in such an interesting perspective for me. There’s so much going on around us and how we think about things really comes down to the way that your brain works and how we’ve evolved.

And so he takes time, for instance, and he talks about how it’s stretched and manipulated, and how it doesn’t exist at the quantum level. It’s a very interesting read and he writes a lot about physics. I look at him as somebody who’s taking a very technical topic and putting it in such a way that a lay person can understand it.

In Quantum Gravity, it can’t be much more technical than that, right? 

Omar: What’s the name of the book again?

Dr. Lance: One’s called The Order Of Time and he’s written volumes, but there’s two or three books that are really good. If you Amazon his name, you’ll find him. I just thought of another one called the 12 Brief Lessons Of Physics by him. I haven’t read it yet, but. 

Omar: I’m adding it right now to my list. 

Dr. Lance: Reality Is Not What It Seems, I think is the first one I read by him. And let me tell you, I couldn’t sleep at night because of some of the stuff that he was saying. He talks about black holes.

Omar: So if you were to recommend one for somebody to start with, it would be Reality Is Not What It Seems or Order Of Time? 

Dr. Lance: Reality Is Not What It Seems. 

Omar: Okay. Fantastic. I’m adding it. As you can tell, I have a habit of buying a lot of books.

Dr. Lance: I can see that. 

[Dr. Lance laughs]

Omar: I think physical books are a very underrated technology. They really are. So, here’s the last question for you. So we’re going to start 2021 soon, for the rest of 2021, imagine that outside of every medical practice, every hospital with all the physicians and nurses are going to see a billboard all across the country and that billboard is going to have one message on it.

What message would you put there? 

Dr. Lance: Man! Well, I think it goes back to the conversation that we’re having about physicians in general dampening great ideas because they’re reluctant to understand or take the risks. So I think it would be around “take the risk”. Today’s the day, don’t sit on what may be a great idea that honestly may change the way we practice medicine. Take that risk and be comfortable with it. It’s beaten into our minds not to be comfortable with risk and to squelch it at every possible turning point. But I think to be the next entrepreneur that’s going to make a difference, you’ve got to be comfortable with that risk. So that would be my message, to take the risks. 

Omar: Fantastic. I love that message. I couldn’t think of a better way to wrap things up. Hey, thank you so much for coming on the show. How can people find you and I’ll leave it in the note? 

Dr. Lance: Yeah, please email is the best way to communicate with me [email protected].

Of course on LinkedIn, I’m there. My Twitter  _____. Those are great ways to connect with me, but, please reach out. I’d love to have a call with anybody interested in what we do. 

Omar: Perfect. I’ll leave those in show notes. Hey, Lance, thank you so much for joining us and thank you all for listening. This has been another episode of Hills and Valleys, and we will see you next time. Bye for now.