VOLUME 3, ISSUE 1: Entrepreneurship in Retina

Feature

Entrepreneurship in Retina: Where to Start

A roundtable of experts in entrepreneurship share their insights on the opportunities and challenges of launching a career outside the clinic.

Moderated by Namrata Saroj, OD
With Darius M. Moshfeghi, MD; Rishi P. Singh, MD; and Charles C. Wykoff, MD, PhD

Chatter and cross-cutting advice can confuse young retina specialists who are considering expanding their professional contributions to areas outside the clinic. Whether one is considering entrepreneurship or an expanded role at an institution, understanding the experiences of others who recently went down the same path is helpful.

I asked Darius M. Moshfeghi, MD; Rishi P. Singh, MD; and Charles C. Wykoff, MD, PhD, to sit down for an extended discussion about how they got to where they are, what roadblocks they encountered, and what they would tell those whose ambitions tell them to fly higher.

—Namrata Saroj, OD

Namrata Saroj, OD: All three of you are involved in different aspects of entrepreneurship in retina. Is there a single entry point for those seeking to expand their professional scope?

Darius M. Moshfeghi, MD: Creating your own path is important. This way, you can prioritize what you think is important rather than collaborating with a company that will ask you to prioritize what they need. For me, starting various companies has worked.

Charles C. Wykoff, MD, PhD: I agree that creating your own path is key. But, if you want to “do more” but don’t yet have your own idea, become a yes person and get engaged with others’ ideas and passions while remaining open to your own ideas. Regardless of where you are, mentors are important; experienced people can guide your vague idea toward something actionable and ultimately tangible. My mentors have been invaluable in guiding me and my thought processes in the space of drug and device development, something I have a passion for.

Rishi P. Singh, MD: My concepts of what I’ve wanted have changed as my career advanced. Helping design studies, contributing to scientific advisory boards, and educating ophthalmologists and optometrists has been a passion for a long time. As I grow as a physician, other opportunities have presented themselves.

Dr. Saroj: What shape do those opportunities take?

Dr. Singh: I’ve transitioned to focus on the larger healthcare landscape in a hospital system rather than only in ophthalmology. I am fortunate to have been in a physician-led organization at the Cleveland Clinic for 12 years. That means I can focus on areas such as improving OR efficiency for the ophthalmology department, and then move on to fields outside of my specialty such as facial plastics, ENT, and other surgical specialties. I’m now on the Board of Governors for the hospital system, which is the body that reviews the clinical, financial, and academic performance of each of our institutes.

Dr. Saroj: Does your experience as a clinician inform your role on the Board of Governors and vice versa?

Dr. Singh: I found that the frustrations and struggles of medicine—issues like patient access and streamlining and insurance problems—are not limited to ophthalmology. By being in the clinic and the OR, I can identify problems in the hospital system. By working in leadership for the hospital, I can help implement solutions. Seeing how adjustments can be found and generalized to other fields has been very helpful to me.

BRINGING AN IDEA TO FRUITION

Dr. Saroj: What factors must young entrepreneurs consider?

Dr. Wykoff: As far as I have experienced them, there are at least four pillars to entrepreneurship: ideas, mentors, work, and time. They all sound simple, but each carries unique dimensions.

Dr. Saroj: Are some pillars more important than others? Are any of them underestimated by young retina specialists looking to step outside the normal industry collaboration framework?

Dr. Wykoff: Ideas are the most important—without them, you have nothing. Mentors are a close second, as they’ll guide you through idea development, such as helping you develop preclinical data for a fledgling idea or identify future partners for collaboration.

I think people tend to accurately estimate the work it will take to bring an idea to life. But we nearly always underestimate the amount of time involved. Among the projects I am foundationally involved with, I have yet to see any of them progress all the way from concept to market in the decade-plus that I have been doing this. I would have given up long ago on multiple projects if mentors and friends like Dr. Moshfeghi, Netan Choudhry, MD; and Philip J. Rosenfeld, MD, PhD, weren’t there to encourage me to persevere through hurdles and roadblocks.

Dr. Moshfeghi: The four-pillar scheme Dr. Wykoff proposed is good, and I would propose that we add two pillars: finding the right partners and raising funds. One of my mentors, Mark S. Blumenkranz, MD, MMS, gave me a piece of advice on this: “Do the right thing for the right reason with the right people, and the money will follow.” I think that is true for both raising funds and pursuing entrepreneurship.

Dr. Singh: That’s entirely right. It’s not about the money. It’s about the passion and engagement in the role. For those who want to approach retina from an entrepreneurial standpoint, I cannot stress this enough. Some people get really excited by the chance to work the speaker circuit, to make a significant amount of money serving as the moderator for a dinner lecture. But there’s an opportunity cost that needs to be considered. If you’re on the road for a weekend—in a different city, not spending time with your family, not working on your passions and dedicating time to your entrepreneurial endeavors—then you’re going to miss out on opportunity.

MENTORSHIP

Dr. Saroj: You all had mentors who guided you toward success. But you’re also at the point in your careers where you’ll be the mentor for a young entrepreneur. What is your approach to selecting whom you will mentor and who is not the right fit?

Dr. Wykoff: When I was starting out, Dr. Moshfeghi gave me a piece of advice that has lingered in my thoughts: “Answer every email; return every phone call.” When someone wants an ear to share their idea with or comes looking for advice, I try to always take the time to listen. I enjoy hearing others’ insights—it can be really motivating. Plus, I’ve made a good number of mistakes along the way and like the concept of hopefully helping others over those hurdles.

Dr. Moshfeghi: In general, I’ll take a meeting with anyone who wants to meet with me. A lot of people flame out at the first meeting. They just want to meet and say hello, or they want an introduction to someone else. But if a person I meet with consistently follows up and shows consistent progress and isn’t asking you to do the work for them, then I feel it’s worth it to invest time and energy into their success.

I often tell young entrepreneurs that they need to help the people that they’re seeking help from. If you provide some assistance to the person whose mentorship you’re seeking, they’re likely to repay the favor. Sometimes it’s something simple like helping draft a paper; other times it’s something far more complex.

Dr. Wykoff: You can read someone, or at least someone’s dedication, pretty quickly. If you collaborate with them on a project and they are detail-oriented and put the time in, I tend to gravitate toward them. If they’re sloppy or lazy or inefficient, then I move away.

Time is finite and the opportunities many. The more productive collaborators and projects take precedence. It’s natural selection.

Dr. Singh: I always remind future entrepreneurs in the field that they need to be seen to be taken seriously. And by that I mean that they need to attend meetings, that they need to write papers, that they need to interact with people in the field. I wrote my first paper when I was an undergraduate student, so by the time I got to the stage when I needed mentorship, I had already interacted with some of the people who might potentially take an interest in me. When I brought up a question or asked for guidance, they listened and responded.

Dr. Saroj: Working on the industry side, I often engage with mentees who are under the wing of leaders in the field. I tend to continue with such collaborations only if the mentees show initiative. Have any of you come across counterintuitive themes in mentorship?

Dr. Singh: There are two counterintuitive themes that jump out to me.

It’s worth noting that there are good mentors and un-ideal mentors. Good mentors are people you look toward for guidance and information, and un-ideal mentors are people you look at and say, “I don’t want to be like this person at all.” Sometimes the good mentors can become un-ideal as you peel back their layers and find their deeper convictions. Finding a un-ideal mentor, in a way, can be good for development. It can help you hone your focus on what you actually want to do.

A piece of advice that might surprise some people looking for mentors: Look outside of your field for guidance. People who are adjacent to what you ultimately want to do—for example, a nonophthalmic MD or a medical entrepreneur—may have a fresh perspective on the field, a different attitude entirely. Their experiences are ones that people in this field may not have the chance to encounter.

ENRICHING PROFESSIONAL DEVELOPMENT

Dr. Saroj: How has entrepreneurship enriched your experience in retina?

Dr. Wykoff: My experiences have certainly enriched my entrepreneurship. But, in some ways, entrepreneurship creates problems. With each concept pursued, other ideas become visible, and the opportunities expand beyond available bandwidth.

Dr. Saroj: And that’s a problem?

Dr. Wykoff: In a way, yes. You have an idea and then a plan, and that leads to implementation and follow-through. On this road of planning and innovating, your network expands, and then you have more ideas because you’ve made new connections. It forces you to prioritize, because unfortunately we can’t do everything at once.

A phrase I use with my kids applies equally well to this situation: “You can do anything you want in life, you just can’t do them all at the same time.” Seeing short-term, medium-term, and long-term goals in your field of view at once is difficult, but it’s necessary as your experience expands your possibilities.

Dr. Singh: My experiences in this field have led to a more tested emotional intelligence. There are right things and wrong things to say in certain times of conflict; you can throw gasoline on a fire if you want to, or you can mediate a discussion and come out with a constructive outcome.

Take, for example, a situation in which one person wants to do something that everyone else on the team thinks is a bad idea. You can tell that person that their idea is stupid, or you can work to build insight in the group that the proposed course of action is not right at that time. The latter option builds bridges, and the former option burns them.

Dr. Moshfeghi: Creating a business venture gives you the opportunity to dictate the terms of your legacy. As an entrepreneur enters the field and spends time with other people in the space, you’ll inevitably start partnering with other projects. Some of them are fun; others you’ll slowly step away from. But for your own project—for the one you built—you’ll find that it gives you renewed energy.

For me, that project is Pr3vent. It drives multiple aspects of my life. Pr3vent is developing artificial intelligence to screen every newborn infant for features associated with vision-threatening disease. This is an unmet need: Approximately 5% of babies have referral-warranted disease, and screening each patient with unautomated methods won’t work.

Dr. Saroj: You mentioned collaborating with other people in the entrepreneurial space. Can you expand on that?

Dr. Moshfeghi: When you connect with other companies, you meet a diverse group of people who have similar motivations and have faced similar challenges. You’ve had your cash crunch. You’ve been halted by government barriers. You have failures. The people you meet are just like you, and they’ll encourage you when you hit those roadblocks.

With Pr3vent, we have just completed the Stanford accelerator, which is called StartX. When you collaborate with something like StartX, you start meeting people working in other areas of innovation. I’ve met inventors who are designing water-sparing showerheads that sense body movement, and I’ve met innovators who are creating technology to track cattle. It really runs the gamut. You start getting mentorship from people who are adjacent to what you’re doing, and it’s a real boost.

I love the burst of energy I get when I meet with government regulators or when I’m fundraising or when I’m brainstorming. I take that energy and bring it back to my clinic. It keeps me fresh.

Dr. Saroj: It’s easy to think that time spent with entrepreneurial commitments comes at the expense of clinical time. But Dr. Moshfeghi has indicated that they complement each other. Has that been your experience, Dr. Singh?

Dr. Singh: You have to be in the trenches in order to see the issues with patients to understand what your initiatives should be. I don’t think you need to be in clinic four days a week, though. I’m in clinic twice a week and in the OR once a week. The other two days are spent on administrative responsibilities. The upshot is that you must cut your clinical workload in order to pursue other ventures.

Dr. Moshfeghi: The most valuable commodity is time. Years ago, I wanted to add more clinics to my workload and find more surgical time. My brother Andrew Moshfeghi, MD, MBA, told me that I was wasting my time, and that I should try to contract my schedule so I could find more time for entrepreneurial ventures that I have a passion for. It was the best advice I ever received.

Dr. Wykoff: I think setting aside a block of time in which nothing is scheduled is very important. I think of this as white space. It’s a time dedicated to sitting somewhere with a blank piece of paper, so to speak, so I can hash out my ideas and think of how to move them forward. No conference calls. No distractions. Just time to prioritize my goals and brainstorm.

ADVICE TO YOUNG ENTREPRENEURS

Dr. Saroj: What are one or two things that young entrepreneurs can do to get the ball rolling on their extra-clinical careers?

Dr. Moshfeghi: You need to work on your pitch. If you can’t get an investor to support your idea, go back to your pitch and rehearse it until you nail it down.

There was one particular investor whom I spoke with often. Each time I pitched him, he would tell me to leave. But there was one time when I wasn’t pitching him—I was just explaining my idea—and he asked me if he could invest. I had finally nailed it.

Dr. Singh: I have two pieces of advice. First figure out what your purpose is; research, education, and business development are examples. Second, remember that you can’t force progress. Opportunities will come with time. Keep your work effort up, keep your passion high, and eventually it will happen.

Dr. Wykoff: I often encounter people who want to do something meaningful, but they don’t quite know what shape it will take. For those people, I advise being a yes person. When people come to you with ideas for projects, an invitation to an advisory board, or the chance to develop new guidelines for something like an ASRS protocol for managing a particular disease, say yes.

Everyone thinks that they’re overloaded and too busy, and they’re probably right. But, if you want to explore entrepreneurial opportunities in retina, it helps to get exposure to how others think and how projects develop from inspiration to completion. You’ll meet potential mentors and be exposed to the challenges of concept development. Jump in!