An Interview With Uday Kumar, MD
“Fail early, fail often”: Insights to becoming an innovator

It is important to think of how to be more innovative and how to move from inspiration to perspiration in your practice, your hospital, or your medical system.

CardioSource WorldNews: Interventions spoke with Uday Kumar, MD—cardiologist and a cardio-electrophysiologist, and the founder, president and CEO of Element Science Inc. and the founder or iRhythm technologies—on some of the key features of an innovator in the health care industry.

CSI: Interventions: You’ve gone from being an electrophysiologist to actually creating a product and marketing it. A lot of cardiologists are very creative, but how do you innovate yourself? Get to that point in which you get a product out there?

Uday Kumar, MD: It’s a good question. I think the first thing that is really important for physicians—and I have a lot of fellows in my teaching coming to me with these questions, particularly a lot of young fellows—is to think, ‘How do I do both?’ We have to be good at one thing, and so the first determine if you are primarily a physician who takes care of patients or are you primarily someone who likes being an entrepreneur? Because to be good at either is 150% effort. So, for me, even though I am fully on board in everything, at some point, I stopped practicing, because it’s not possible to do both really well.

In terms of innovation, if you’re a physician and you see issues in your clinical practice, it’s not about, ‘Well, I have the best way to solve it,’ because the solution is typically a widget and an idea you came up with; that’s great and a good starting point to exhibit that you’re interested in it. What Then you should take a step back.

A lot of what we do at Stanford biodesign where I was a fellow, and where I still teach, is ask if your widget is solving something that’s your problem, your hospital’s problem, or an important problem everywhere? So you have to take some time and not fall in love with what you’re developing, and to try to understand if there is something of value there that, with good development, good investment, and good clinical data, would really change or be meaningful to clinical practice. This takes coming to scientific sessions and conferences, speaking to colleagues who might be able to say, “Yeah, that’s a great thing. I have that problem all the time, too.”

The hard part is that it’s hard not to fall in love with your ideas. It’s difficult to take a step back and be rational about it. But, if you can, and you then go through these steps to understand that this is a real problem that’s not solvable by what’s out there and what you have is better, I think the next step then is to figure out, “What next?” How do you really go about doing and making something realizable if you have a full-time day job? That’s where the challenge is.

If you’re in an academic setting or you’re in a community hospital, or you have friends, you need to start trying to figure out who’s in your network of people who might be able to develop the idea that you have. Again, obviously if you’re in an academic institution, first make sure it’s disclosed to your University and understand your role. Also, I think there’s another fallacy that being an innovator makes you a billionaire. Rare. Extremely rare.

Moreover, you’re doing this because you think there’s a better way to help your patients. If you have that mindset and you think there’s a real problem, then you’ll be more open to think, ‘Hey, I have a full-time day job. I love seeing patients, I love treating them, but I think this is really important.’ Find other people who can be as passionate, but maybe more on the engineering and development side—incubators, affiliated schools and the University, your network, your cousin who’s a technologist in the California because maybe he knows somebody where you are. There’s also geography. Different parts of the country do things well but differently. You may have to say, ‘I have intellectual property on this idea, but there’s this guy over 3,000 miles away who might be more likely to develop it.’ But it is all predicated on doing what you do best: focusing on patients.

Now, if you’re of the mindset that you love taking care of patients but really believe in your idea and have talked to a lot of people, they may also believe in it. If you really want to make a go of it, are you willing to take a step back? And, again, in medicine, oftentimes after going through residencies and fellowships and getting your first job, and at that point life, spouses, and partners, and children, and all the other important things in life, that’s a big change. You also have to look inward and ask if you are comfortable not having a job without a steady income? Or to be doing something that helps society every day even though it is a risk for you? Some people can do that. For me, I knew I wanted to get into device development since medical school, and I pursued a path to end up where I am now. But I think for people in mid-career it’s a really really important life decision because the vast majority of innovative ideas fail.

That’s good or bad because, in failure, you can learn things that you can apply to the next project. We often say, ‘Fail early fail often.’ But it’s hard when you have a mortgage, private school for your children, and all the rest. You must also talk to your practice partners or your chief or whomever, asking, ‘How can I do this? How can I carve out time to figure out what the right pathway forward is?’ The good thing is that more and more people are thinking of innovation, so maybe there might be opportunities, but it comes at some economic cost. And you have to be ready to accept that because that’s a tradeoff to you pursuing your dreams.

Everyone in medicine is so busy today, it’s hard to carve out time to think.

Exactly. That’s the first step. Think about what’s next and then determine is there a real path there? That’s just the beginning. The reality is that, if you really want to get products to patients, it costs money and typically not insignificant sums. It’s great when physicians are part of a leading team because investors think, ‘Wow, here’s the inventor. Here’s the person who knows the need. That’s great that they’re going to be devoting to it full time.’ But that’s extremely rare. Most of the time, it’ll be a physician or someone who’s in the basic science lab who lends their name from a scientific and clinical standpoint. But, operationally, there’s a team of people who’ve done this before or who can really take an idea forward; that’s probably the more likely model of innovation for most physicians. For example, I’m partnering with a team as an advisor, as a clinical sounding board, as kind of someone who was there from the beginning—but that’s once in a while when I’m needed, when we do an animal lab, or something. Your day job is still your day job. For a few, physicians, they’ll make the leap and try it. But, again, I think it’s really important to align your expectations with where things may go or may not. Be fully prepared to dive back into medicine and prepare that path in case being a full-time innovator doesn’t work out.

Obviously you have a passion for this and you need this excitement to succeed. That’s what you should be looking for correct? Whereas if you’re a year into this and you’re going, “I’ve lost my passion, I’ve lost my excitement,” it is time to rethink.

Yes. I always recommend is people give themselves a timeframe. So when I started iRhythm, after I finished the BioDesign fellowship, I gave myself 6-12 months to determine if this is an idea, even though I’m really passionate about it, that other people are passionate for enough to give me money.

Or maybe they aren’t sure and express the risks. You want to know this ahead of time. But the typical thing for most innovators is that they don’t want to hear that; they want to continue to drink the Kool-Aid. The good thing is if you hear a kind of tempered enthusiasm, and then you look at the risk in front of you can determine that though it isn’t something you have done before, you could do it. Or it is something like, ‘Well I’ve never coded in my life and I don’t have it. Maybe this is not the right boot.’ At least you get data, just like good physicians, to make a decision. So give a reasonable time frame that’s acceptable to you, your partners, your family, and yourself, and hold to it because you will think, ‘Well, I’m so close and I think I’m there.’ That always happens. Enthusiasm has to start, but then you have to make sure that the enthusiasm is shared by others.

Another issue is that the macro-economic and health care environments continue to change. So you might have a great idea whose time has not come yet; it might be, for example, that we’re in a fee-for-service click-charge environment in which decisions, unfortunately, still get made by how something generates revenue. If you have a very value-driven device, it might be important to set the stage, but know that its place may be really valuable in a few years. These are things you need to take into account. And, again, I think if you lay out all the cards, you can figure this out. You can determine what’s reasonable and find people who are professional investors. Then you get can there because it makes sense. But give yourself a time frame and budget, and get data that goes beyond what you yourself think.

Uday Kumar, MD, is the Director of Strategy, Stanford Biodesign Program at Stanford University and the Founder, President, and CEO of Element Science, Inc. and co-founder of iRhtyhm Technologies.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Electrophysiology, Health Care Sector, Technology

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