Your ultimate guide to hiring doctors into digital health
Great chief medical officers are the real unicorns
One of the most challenging hires any digital health company can make is a chief medical officer (CMO). Founders tell me that finding the right person for the role can truly be a ‘make or break’ moment for their business. CMOs are the true unicorns.
In light of that, I’ve been spending the past month digging into this topic. I’ve been asking questions to founders, recruiters and other experts about the optimal background of a CMO, and how they can work with other teams within the organization. And of course, I talked to plenty of CMOs (note: for the sake of clarity, I’m not talking about chief marketing officers).
Here’s a summary of what I learned:
Not all CMO jobs are the same
So let’s break it down. There are lots of different flavors of CMOs. Some are driving product development and might have a background in tech. Others are more focused on clinical operations or sales.
Some CMOs report to the CEO; others to the chief product officer, COO or head of sales. There’s a wide variety out there. Some CMOs will tell you it’s extremely important to define the reporting structure. Others say it doesn’t matter as long as they have the ear of all of the key opinion leaders. Overall, the preference of most of the CMOs I talked to is to report to the CEO.
According to Accolade’s CMO Dr. Shantanu Nundy, these are the four major types of CMO roles he tends to see in digital health:
CMO Clinical Operations
I’ve been told the rarest type is a clinical leader who can also drive product development. And that presents a problem in digital health because a lot of start-ups want to hire them, so there’s a big competition for talent.
Some notable examples of ‘CMO Product’ in our industry: Dr. Connie Chen at Lyra runs product. Likewise, Accolade’s Dr. Nundy spends most of his time on product and strategy - and he reports to the head of product. Livongo’s longtime CMO and president Dr. Jenny Schneider is another product powerhouse.
‘CMO Sales’ is more common. But if the product is regulated, exec search firm Bowdoin Group founder Dave Melville says it’s highly unlikely or advisable that you’d see clinicians embedded into sales.
You might be wondering about the last of the four - ‘CMO Optics.’ These folks, according to Nundy, are often trotted out to conferences or to give presentations to make the organization look good. They typically have amazing credentials and aren’t usually as involved in the day-to-day operations.
Of course, you’ll also find examples where clinicians sit entirely separately from the business team. That’s very common within telemedicine companies. Sometimes, at these start-ups, the medical care will be outsourced to a third-party firm that contracts with providers.
You might also find CMOs who are involved with a mix of all of the above! But most will lean to spending more time with one team or another.
Mixing the two cultures: Tech & medicine
Once a founder has honed in on a hire, a lot of work needs to be done internally to figure out how to integrate the tech and clinical teams. The two cultures are often like oil and water.
Some of the most experienced founders I talked to, like Naomi Allen at Brightline Health, have spent hours contemplating how to do this well - and even wrote an internal white paper on the topic. This can be especially challenging when the CMO comes straight from academia.
“When you hire from academic medicine, you’ll often find doctors who know a lot about their specialty area but are risk averse,” Dr. Dena Bravata, a health-technology advisor to many start-ups, explained to me recently. “So imagine you have a digital platform trying to do something that hasn’t been done before, oftentimes you’ll find that these folks get very uncomfortable and adopt a dogmatic, hierarchical approach.”
Dr. Bravata said she’ll sometimes see engineers present an idea to the clinical team for how to tackle a problem. The CMO will respond quickly that it can’t be done because of “the rules of medicine.” That tends to cause a lot of tension within an organization. Sometimes the CMO is correct that the approach might be harmful to patients or is legally precarious, but they miss an opportunity to explain their thinking in simple terms. In other cases, by shutting the project down, they might miss an opportunity to find a creative middle-ground.
Moreover, it can be challenging for a CMO who has trained for many years to move into digital health and feel like a novice when it comes to technology or business. So Dr. Bravata recommends hiring MDs with a willingness to learn, or those who have some kind of industry background. Dr. Davis Liu from telemedicine start-up Lemonaid said it’s important that doctors moving into health-tech have a “curiosity/growth” mindset and be open to healthy levels of conflict with other teams (it should be “task-related” versus personal, he stresses).
Likewise - and this is critical - the engineers and product leads should show enthusiasm for learning about medicine. The organization needs to ensure that the physicians feel that the engineers have their back and won’t circumvent them.
“For many CMOs, their license is on the line,” said Dr. Bravata. “It’s critical that there’s genuine respect for expertise on both sides.”
Where should founders recruit CMOs?
As always, the answer is “it depends.” What kind of CMO is the founder looking to hire?
That said, here are some real stories from the field:
Dr. Bravata said she’s seen some start-ups do well by hiring ambitious, tech-savvy doctors with about 3 to 4 years of clinical training.
Dr. Carolyn Jasik at Omada Health often hires “safety net” doctors, meaning those who have experience working in environments with limited resources.
Naomi Allen from Brightline Health, who previously worked at Livongo, has seen some companies recruit emergency room doctors because they’re great at triaging and thinking quickly.
Jon Brilliant, a serial digital health entrepreneur, tweeted to me this week that he’s had success bringing on doctors who are interested in entrepreneurship or have even started companies previously to scratch their own itch. Hiring out of academia can be trickier, he told me, because of challenges translating clinical knowledge into a product that supports the business model.
It may make sense to recruit from health plans or pharma if the job requires interfacing with those stakeholders, although there might be some cultural challenges. These sorts of companies can be bureaucratic.
Another successful strategy for some involves recruiting from other digital health companies. According to Melville, these entrepreneurial docs who have succeeded at other companies are “rockstars” and founders should do what it takes to hire them.
I don’t want to overly knock on academics. Hiring from Duke or Stanford, and other storied institutions, can work well sometimes. It just requires more of a learning curve. These folks are often great at being thought leaders, as well as kicking off clinical research, suggests Melville. But they may be new to management, so Melville recommends also bringing on a role like SVP of Clinical Development.
Ideally, everyone agrees, the search needs to go a lot further than what looks good on paper.
There’s lots of approaches here that can work.
Most CMOs agree that an open dialog is key. At Omada Health, Dr. Carolyn Jasik works extremely closely with the head of product Mike Tadlock. The two used to commute together every morning pre-Covid. During the pandemic, they’ve started checking in daily while walking their dogs.
Omada’s Jasik has spent a lot of time thinking about how to incorporate clinical expertise into the organization. Before she came on board, the company had tried out a “clinical innovation” person who liaised with product. That’s very common in digital health and it’s the approach currently adopted by other companies like Ginger.
Then, Omada tried out hiring clinicians to lend out to certain teams like operations, sales and product. That’s another popular approach that can work well.
As Omada expanded its scope and grew, Dr. Jasik flipped the model. Now, she has a clinical subject matter expert per product type (diabetes, hypertension, musculoskeletal and so on). That person runs the clinical operations and they are the primary liaison on product. That doesn’t mean going to every product meeting, but they are required to give a final sign off.
To practice or not to practice?
It’s a very personal choice for any CMO whether to continue seeing patients after taking a full-time role in digital health. But at some companies - like Omada Health - there’s an option to do so that’s discussed ahead of time. Many of Omada’s clinicians choose to dedicate about a half day a week to practicing medicine. But there needs to be some flexibility, suggests Dr. Jasik. If there’s a huge deadline up ahead, it might not be the best time to pull about 20 hours of clinic time that week.
When I polled more than 100 clinicians working in digital health on Twitter, about a third said that their companies supported them if they chose to carve out time to see patients. 16% said they didn’t feel supported at all; and another third said “it’s complicated.”
One consideration for those that choose to practice is that some companies may get “dinged” from an equity or compensation standpoint, Dr. Chitra Akileswaran shared with me in response to the poll. So that’s something to bear in mind.
Several doctors responded to the poll to say that they get a lot out of practicing. It helps remind them what’s important - their patients - and they bring those lessons back to their company.
What level of clinical training is necessary to go into digital health?
The million dollar question...
The top CMOs in digital health get asked these questions a lot: “Is it worth completing residency? If so, how long should I practice medicine? When’s the right time to make the move to industry?”
For those interested, I shared a tweet on the topic and got dozens of responses. It’s worth reading through them. Most folks - but not everyone - agreed that it’s important for medical students interested in digital health to finish residency. As one hospitalist, Dr. Joy Bhosai, put it on Twitter: “med school may give you an MD but it doesn’t make you a DR.” It also helps to have clinical training to be able to speak with other clinical leaders, health systems, plans and brokers and be taken seriously, suggests Dr. Akileswaran.
I did also hear from some respondents, however, that there’s ethical considerations taking a spot from someone who wants to practice medicine. So if you are in medical school and would prefer to be in sales or product, versus clinical, they suggest doing that sooner rather than later.
Ultimately, what the industry needs to be thinking about next - as USC’s Dr. Leslie Saxon pointed out to me on Twitter - is new training modules for physicians to learn virtual care. That’ll set up a next generation of doctors for telemedicine, but it’s also vital education for those looking to make a move into digital health.
So that’s a wrap on CMOs. As always, I am keen to hear from you. Drop me a line if you agree/disagree @chrissyfarr on Twitter. I’ll keep sharing information on the topic as I hear it!
COOL JOBS ALERT!
We asked our network for openings and scoured the web. Here’s seven to get you started on your search.
This is a regular section of the newsletter, so shoot me cool jobs to @chrissyfarr on Twitter.
Want to work with seniors? Cyft is hiring a full stack/backend engineer. As Leonard D’Avolio, the company’s founder told me, the mission of Cyst is to help serious illness care providers thrive in value-based contracts. What’s D’Avolio looking for? “If using data to serve people and their families at their hour of greatest need appeals, we may be a good fit.”
Live and breathe digital health? Rock Health, the fund and research group, is on the hunt for a senior engagement manager to join the consulting practice. This is an ideal role for someone who’s looking to develop trusted relationships across the health care market.
Looking to make a dent in the behavioral health crisis? Ginger is looking to expand its marketing team. Christine Hsu Evans, the company’s chief marketing officer, told me that a few more roles will be open in the coming days. Bonus: New hires will report to rockstar female leaders.
Want to transform health care from within? UCSF’s Center for Digital Health Innovation is looking for a senior product designer to guide patient experience. A big part of the role involves meeting with patients and doctors to hear their pain points; as well as improving the experience around the electronic health record.
Keen to help patients with eating disorder recovery? Equip Health is looking for a VP of Product to manage the team with a “lead by example” approach. The right person for the role is high empathy and has experience in consumer-facing teams/health care. CEO Kristina Saffran says the new hire will report to her and be part of the leadership team.
Into computer vision? Scanwell Health is looking for a lead who can help build the software, but ideally has some medical device experience. As Aaron Rowe, principal scientist told me, it’s a great place to work on diagnostic tests for disease like malaria and flu. Those interested should email email@example.com.
Passionate about at-home fertility services? Legacy CEO Khaled Kteily is looking for a chief of staff to be his right-hand person. Kteily says culture is everything at his company, so every full-time employee gets an executive coach.
My personal highlights of the week
Medical experts in my network are growing increasingly concerned that in 2021, we could see an acceleration of unnecessary spine, knee and joint replacement surgeries. I had the opportunity to moderate a panel on the topic with PeerWell CEO Manish Shah and Contigo Health’s CMO Dr. Jonathan Slotkin. Watch the whole thing here.
It was a blast to interview one of my career heroes Jane Metcalfe at a virtual event for JPM. Jane is one of the creators of Wired Magazine and former president of TCHO Chocolates. Now, she runs an online magazine about the future of the human body called NEO.LIFE. We talk about anything and everything, including Jane’s experiences as a female exec running a media company in the 1990s. You can catch the full interview here.