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    6.3.1 The Startup Ecosystem

    Startups are hard and entrepreneurs don’t get the luxury of long runways. Networking (a.k.a. hustling) is the dark art that is required for any startup, and is even more important in healthcare. The list below notes a few stereotype personalities that an upcoming health entrepreneur may encounter. At the risk of being judgmental, it provides some mental rules-of-thumb to keep entrepreneurship interactions more productive.

    Fake Mentors

    There are plenty of self-proclaimed mentors fishing around to be an advisor to a nascent startup. They end up consuming precious equity and not doing much except making unfruitful introductions. Amassing a huge collection of startups to “advise,” fake mentors hope for at least one of their advisees making a notable exit.

    Typically, fake mentors in healthcare are physicians looking to diversify beyond the usual clinical persona. Otherwise they tend to be senior executives from big corporations or researchers from academia. Lawyers tend to oblige too, because a lot of their value-add is in doing boilerplate legal work like company incorporation or patent filing (most offer to defer their professional fees until a funding milestone occurs). Even though an offer of guidance may feel flattering, try to pick mentors as carefully as your employees.

    Aimless Networking Junkies

    They are not entrepreneurs, but enjoy pretending to be one. You will find them floating around at most networking events. The boisterous ones stand out by consistently asking sensationalistic questions during the Q&A sessions of an event. For example, in 2014, that meant bringing up the topic of Google Glass, or worse, wearing one while mentioning it. Sometimes they start local meetup groups that attract other junkies as an audience. Either way, stay away from them if you can, as they are largely a waste of an entrepreneur’s time.

    Incubator Gators

    This appears to be the fastest growing category, especially in relation to health. Existing tech incubators/accelerators like YCombinator.com and Techstars.com have started indulging in health-focused startups. A pack of health-tech-specific incubators have dropped anchor in the last five years, led by RockHealth.com, HealthboxAccelerator.com, BluePrintHealth.org, and StartupHealth.com. Traditional hospitals systems, pharma companies, insurers, and state-funded organizations have also jumped in solo or with industry partnerships to force their entry into the innovation realm in this way. For example, New York’s DigitalHealthAccelerator.com and Stanford’s StartX.com/med. A CHCF report found more than 90 dedicated health incubators in late 2014. [1]

    It’s advisable to approach only those incubators that have good portfolio companies and take fair equity (should be single-digit in most cases). Think twice before signing up with a program that invests cash and then takes some of it back as tuition or rent. Realize that going with a purebred tech incubator means that you won’t get the clinical network that comes with a health-focused one. On the other hand, most incubators started by health organizations will have minimal knowledge about creating engaging digital experiences or scaling solutions to millions of end users.

    The idealist entrepreneur might argue that great ideas thrive anywhere, but my personal recommendation for health startups would be to favor San Francisco, New York, and Boston as locations (in that order). Talented team members and influential investors tend to be clustered together in these locations, making it easier for the entrepreneur to execute. Add San Diego to the end of the list if your product has a significant medical device context.

    Event Managers

    Trends come and go, but people in this category are the ones that always finish laughing all the way to the bank. These are ex-networking junkies who have developed an ability to spot the next industry buzzword that can be turned into a conference. Perhaps this is why new technology topics are often long on events and short on substance.

    As an healthcare entrepreneur, you should strive to know the Event Manager types. More importantly, let them know your specialty and startup focus. One day you will need to land a speaker opportunity that builds your startup’s brand at one of these events.

    Evangelists

    These are the people who genuinely care about a topic, be it a technology or some aspect of entrepreneurship. Usually they are ex-entrepreneurs holding weird titles like “Developer Evangelist,” and displaying no direct affiliation with healthcare. They never explicitly market themselves but still build popularity through great blog posts and thoughtful speeches. Their LinkedIn profile or online resume often feels unkempt and haphazard, as if they don’t want to be taken too seriously.

    Evangelists are nothing but good news for entrepreneurs. A word of caution though, about a peculiar sub-category of One-Hit-Wonder Evangelists. These are ex-entrepreneurs with one or more good exits in the past that have forever eliminated their need to hold a paid job. They always evangelize something (anything) in order to keep feeling relevant in the domain. They can do damage to startups because of their constrained thinking.

    Other conventions and personalities

    The stereotyped bigotry of authoritative clinical experts (a.k.a. “The God Complex”) is often dramatized in stories and anecdotes. Unfortunately, with the rise of technology as a disruptive force, that same stereotype is often reflected in the personality of tech legends who tend to dismiss anything and anyone that is already entrenched in healthcare. For example, famous venture capitalist Vinod Khosla often concludes in his speeches that true disruption can only come from those who are outsiders to an industry. He is entitled to his opinion, but making generalized rules for innovation seems like an inherently contradictory act. Technology entrepreneurship has laid out baselines for disruptive entrepreneurship but perhaps health will teach us how to gracefully evolve the art further. Beware of hyperbolic legends who can distort reality and send you chasing mirages.


    [1] CHCF. Survival of the Fittest: Health Care Accelerators Evolve Toward Specialization. Accessed April 25, 2016.