I think one of the reasons tech startups haven't made a bigger dent in healthcare / biotech is bc they overweight startup hustle and underweight experience and domain expertise. Better to walk towards the right target than run really fast to the wrong one, and in fields like healthcare you can't pivot as quickly once you realize you're going in the wrong direction

Basically all successful biotech CEOs are old, former big pharma execs or academics -- two fields not known for their hustle. And they can grow big, fast: look at CEOs of Juno, avexis, kite; those companies were bought for $9-12B cash just 5ish years post series a

The biggest health tech companies are Cerner and Epic. They were founded in the 1970s I think. Have avoided disruption bc they know the system. Many other successful health tech companies are founded by dyed in the wool industry veterans or doctors with a good understanding of the field who work 9-5

Plus Atul probably has some hustle. He became a best selling author while being a surgeon and prof at Harvard. Takes initiative to decide to write books and actually pull off getting them sold. He sure knows how to build an audience -- probably has a bigger audience than any health tech startup CEO

I agree with all of what you are saying but I just don't buy that this is the guy. A prof, surgeon and 'successful author' is just not the right mix for this.

I would say: ex-surgeon Hospital administrator of a progressive hospital. Ex-director of technology and services for a healthcare provider or insurer. Head of a prestigious applied research centre.

'Prof' and 'author' are intellectual, non-leadership, non-outcome, non-operational, non-managerial positions. He's imminently qualified to be the spokesperson and possibly 'Chief Medical Officer', but not CEO.

Does he even have a history of doing in-depth research on the operational and cost challenges of running a healthcare system?

The 'innovation' required here will not be medical - it will be political, operational ... fighting incumbent structures.

Someone with a kind-of relevant background who is also an ex-physician. There are many of those.

I'm still perplexed.

Amazon was hugely successful with AWS because it was an outgrowth of their business. They bought their way into groceries.

They will use their deep distribution and warehousing advantage to move into delivery. All of that makes sense.

But taking on incumbent, politicized structures? With armies of lobbyists to legislate their control of systems?

I think this guy is going to get eaten by the entrenched powers that be.

Though I wish him well and applaud Bezos for going after this.

Wallmart already has some opticians in their stores - I really wish they would move into pharmacies, then maybe 'family doctor locations' and then commoditizing common things and operations.

I actually think Wallmart is in many ways so much better positioned than Amazon to make their way into healthcare by grabbing the low hanging fruit and using their massive pricing power and physical installed base.

I completely agree with you philosophically, and your idea that Walmart might be better positioned than amazon makes sense to me. Owning providers (versus paying health systems massive prices for access to providers) seems to be an emerging theme.

I've spoken to / heard talks from several ex-MD hospital admins of large health systems, informatics heads at massive university health systems, and leaders of large providers, and from hearing them I just have no confidence that they have the will to enact change. They are benefiting from the current system and to do something radical to fix the system would go against everything they'd learned in their careers, and probably burn many professional bridges (they'd be fighting their former colleagues)

I'd point to Rushika Fernandopoulle at Iora health as an example of a physician with no ops experience who has excelled in fighting incumbent structures. If Atul has that phenotype, I'd take that over hospital admin experience any day. But of course thats just my perspective and I understand picking Atul is a big risk

"I just have no confidence that they have the will to enact change. They are benefiting from the current system and to do something radical to fix the system would go against everything they'd learned in their careers"

I hear you - but I also believe there are a number of them who imminently grasp the dysfunction and would like to do something about it. This is kind of out of my discipline but my Uncle was on the board of governors of a Hospital and he and the board watched as crazy stuff happened and definitely wanted to do something.

I worked in mobile at a once very succesfull handset manufacturer ... I watched the iPhone be borne and eat our lunch. As the execs failed, paradoxically, some of them knew what was happening and just could not get the system they were inside to change ... but a lot of us, were we to be in different systems, I think could be successful at it.

Anyhow. I wish him the best ...

I agree and to refine a bit, I think it depends on the type of business.

The Internet was wide open 10-15 years ago. Today, not so much.

A CEO of anything in healthcare, especially something like this, had better have a lot of domain expertise.