Victor Fuchs and Mark Cullen published an article in JAMA questioning the impact of health systems change on doctors and how the medical educational establishment should respond with curriculum reform that includes, among other things, health economics and population health. 

They further provide a short history of healthcare policy and structure and how it has evolved from an unregulated industry to one that has become increasingly corporatized. They note the rise in employed physicians and that :

Physicians might become less professional, but their professional role could increase as their entrepreneurial role decreases

It seems to me there is confusion about physician entrepreneurship, its definition and whether it represents a threat to professionalism. I’m not alone. Is a physician entrepreneur someone who starts and runs a business, or is it something more?

1. Entrepreneurship is the pursuit of opportunity with scarce, uncontrolled resources. The goal of all entrepreneurs, including physician entrepreneurs, is to create user defined value through the deployment of innovation using a VAST business model

2. Innovation has both a qualitative and quantitative component. It refers to doing something new or something old in a new way that creates user defined value that is a significant multiple of the competitive offering. Sick care sorely needs innovation that is not incremental or sustaining, but rather significantly adds at least 10x the present value to have an impact.

3. Physician entrepreneurship is not the same things as private practice nor is it fundamentally about practice management. The increasing rate of employed physicians should not be interpreted, as Prof. Fuchs implies, as decreasing entrepreneurial role of doctors and its consequent impact on medical professionalism. To the contrary, when done properly, it enhances medical professionalism.

4. There are many different goals and roles for physician entrepreneurs as small to medium sized business owners in private practice, technopreneurs, social entrepreneurs, intrapreneurs i.e.employed physicians acting like entrepreneurs, freelancers and consultants, and physician investors. Social entrepreneurship has a long history of physician involvement and business school courses in social entrepreneurship and impact investing are expanding. Here is a recent example of how one doctor is making a difference.  Here are the probems trying to create social impact apps to address the sick care needs of underserved populations

Roles can vary as well. Some physician entrepreneurs are problem seekers, others problem solvers. There are also story tellers, money finders, score keepers, social connectors, risk managers and business developers.

5. Employed physicians, whether academic or non-academic, have the potential to be no less entrepreneurial than their colleagues who are in independent practices. The numbers of employed physicians are increasing. As such, physician intrapreneurs, employed physicians trying to add value to their organizations as entrepreneurs, are becoming more and more important. Here is why it is so hard to be a successful intrapreneur, particularly when there is a toxic work environment or one that lacks a culture of innovation. Hiring physician intrapreneurs is one thing, Knowing what to do with them so they won’t leave is another.

6. While medical educational reform is necessary, expecting medical students to master health economics and population health is an unrealistic expectation. Medical schools need to be part of entrepreneurial universities with the goal of instilling an entrepreneurial mindset in all graduates, including health professionals. To that end, medical schools and their graduates schools should rethink how they teach and practice technology transfer and commercialization and how they give faculty innovators the tools, incentive and recognition for the scholarship of innovation they deserve.

7. Physician entrepreneurship enhances medical professionalism, it does not degrade it, as long its practitioners understand and resolve the conflicts between the ethics of medicine and the ethics of business. Violating the patient or public trust by self dealing or undisclosed conflicts of interest degrades any profession that has a fiduciary relationship with its customers or clients.

8. Physician entrepreneurs create value for patients in many ways other than seeing them face to face for an entire professional career. The upcoming generation of medical students and residents and scientists and engineers in graduate school understand that better than their school’s faculty and administrators and they have engaged in bottom up efforts to fill the gaps in their education and experiences.

9. Every threat to the existing practice of medicine, whether, as noted, it be acute care to chronic care, face to face care to digical care, or corporate care evolving into more patient centered care, represents an opportunity for physician entrepreneurs to help patients by adding value.

10. Every industrialized country is facing the issue of how to provide their citizens with health services with scarce resources. Innovation and entrepreneurship , fostered by rules that catalyze them, will be the solution. 

How you define entrepreneurship can limit your success. Contrary to popular mythology, entrepreneurship is not just about working for yourself or just creating a business.

Physician entrepreneurs whether as technopreneurs, medical practice entrepreneurs, intrapreneurs or international social entrepreneurs are making a difference. This non-profit group is trying to eliminate the stigma of mental illness in Nigeria.

All these physician entrepreneurs, regardless of the roles, holes and goals they are trying to fill, are facing the challenges of surviving and thriving during the COVID epidemic. Making biomedical and clinical entrepreneurship available to all, not just the lucky few, will take developing competencies through education and training, cash and communities.

Haven, once intended to tackle the high cost of health care in America, has folded. The joint venture between the CEOs of Amazon, Berkshire Hathaway and JPMorgan Chase informed employees Monday that it will shutter by the end of the month, Here is why non-sickcare entrepreneurs fail in sickcare. although I wouldn’t dismiss Amedzon as a failure.

The “golden age” of medical practice is being replaced by the “golden age” of physician entrepreneurship since there has been, arguably, no better time to be a doctor who sees the business of medicine as creating value on par with the practice of medicine as another way to help patients.