Family Physician and Executive Leader, Dr. Neil Patel on The Cheat Code to Innovation Is Starting Over
- Apr 8
- 41 min read
From Underserved Care to Startup Leadership: Why Gap-Closing Translates Across Both Worlds
In this episode, Helen sits down with Dr. Neil Patel, a family physician with more than 20 years of clinical practice and over 15 years as an early clinical leader in healthcare startups. Neil was part of the founding team at Iora Health and later served as Chief Health Officer at Patina Health, carrying lessons across multiple stages of company building, including growth, scale, and closure.
Neil reflects on how his early career in underserved and FQHC settings shaped the way he approaches innovation. He explains why clinicians drawn to community health are often the same people pulled toward startups — not because the environments are similar, but because both require identifying gaps and building solutions where infrastructure is incomplete.
The conversation explores why humility is a core leadership skill, why starting from a blank slate is often the real cheat code to innovation, and how listening like a clinician translates directly into leading teams, products, and organizations. Neil also shares how serving freelancers at Iora expanded his definition of “underserved,” why access to care is one of the most overlooked areas for innovation, and why founding teams work better when responsibility for outcomes is shared.
This episode goes deep on closing gaps rather than chasing solutions — and why meaningful innovation happens when leaders stay humble enough to let patients, teams, and data lead the work.
For clinicians navigating startup life, this conversation offers grounded perspective from someone who has lived multiple chapters — and chosen to start over.
Must-Hear Insights and Key Moments
Chasing gaps matters more than chasing solutions.
Experience can become a liability in early-stage startups.
Humility is a core leadership skill, not a personality trait.
Listening is the work — in the exam room and the boardroom.
Underserved is defined by unmet needs, not demographics.
Access to care is easy to innovate on when you measure it.
Starting from a blank slate fuels better innovation.
Founding teams work best when accountability is shared.
Clinical training translates to startup leadership when applied intentionally.
Community and trusted peers are essential in ambiguous roles.
Neil closed Patina Health in September and is now listening to gaps before his next move
He deliberately taps into prior teams to solve new problems by calling trusted colleagues
Everyone on a founding team should be responsible for presenting outcomes to the board
Words of Wisdom: Standout Quotes from This Episode
"The person in the room who has done it before is a liability. I am likely to repeat the same mistakes. Our strength is keeping an open mind. That is the cheat code to innovation, starting over." - Dr. Neil Patel
"When you are not feeling well, you are underserved. The missing link is listening and empathy. Serving seniors taught me how underserved we all are as we age." - Dr. Neil Patel
"You have to be humble to be in a startup. Otherwise, how will you listen and draw feedback from your team, patients, users, and outcomes? We are chasing a gap, not a solution." - Dr. Neil Patel
"If I listen to my team and patients in an environment where everything is new, we will do innovative stuff. There is no opposite of innovation in a true startup." - Dr. Neil Patel
"Having humility is key when you are an early hire. But it took me about a year to realize none of us have done this before." - Helen Tanner
"I have been drawn to areas of medicine where there is a gap that needs to be closed. That is what a startup is trying to do." - Helen Tanner
"When ops and HR are introduced depends on the company stage. I was not prepared for that coming from large systems." - Helen Tanner
"As clinicians we are taught complex problem solving cross collaboratively but we do not think about it like that. Those skills translate into business success." - Helen Tanner
Mentioned in the episode:
About Dr. Patel
Dr. Neil Patel is a family physician with more than 20 years of clinical practice and over 15 years as an early clinical leader in healthcare startups. He was part of the founding team at Iora Health, an early innovator in primary care, and later served as Chief Health Officer at Patina Health, a geriatric care startup focused on reimagining aging through virtual and home-based care.
Before Iora, Neil helped start the Atlantic City Special Care Center, serving complex patients from the Local 54 hotel workers union with the AtlantiCare health system. The center was featured by Atul Gawande in The Hot Spotters as an early proof point that patient activation through continuous healing relationships could deliver tremendous value and bend the cost curve.
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Blog Transcript:
Note: We use AI transcription so there may be some inaccuracies
Helen Tanner: All right. So one of the things that I've learned while working in healthcare startups is how rare it is to find clinicians who stay in the work long enough to see multiple chapters, early experimentation, scale success, and as sometimes closure. Dr. Neil Patel is one of those clinicians. Neil is a family physician who spent more than 20 years in clinical practice while also serving as an early clinical leader inside healthcare startups.
For over 15 years, his career spans underserved in community health, founding era, primary care innovation, and senior clinical leadership roles. Working alongside founders and executive teams to design and scale new models. He was part of the founding team at Iora Health and later helped build Patina Health as chief health officer, carrying forward lessons about care, delivery, leadership, and risk across different stages and outcomes.
What makes Neil's perspective very valuable and what I enjoy talking to him about is the depth and range of his experience grounded in years of patient care, underserved care, and, I'm really grateful to have him here today. Hi, Neil. Hi.
Neil Patel: Thank you. You're so kind.
Helen Tanner: I'm very excited to talk with you.
And I just wanted to start off by asking when did you first realize your career might extend beyond traditional clinical practice?
Neil Patel: That's a good question. You know, in a way my sort of career realized before I did, and what I mean is that it was more of a gradual, transition as really.
Feeling led by my work and the patients, what I found I needed to learn and become more competent in as my practice evolved. So really it was gradual over the course of, a bunch of my early experiences where I found myself interested in things that previously hadn't interested me or been an area of study, including, what I thought my patients needed.
So an example would be, Spanish or maybe even sort of marketing or how to read a p and l. Mm-hmm. These are all sort of some of the more startup skills that you might be thinking about. Um, that came to me gradually because they had to learn them.
Helen Tanner: Yeah, absolutely. Okay. I'm gonna turn off, you wanna turn off the camera?
Neil Patel: Yeah.
Helen Tanner: Okay. Okay.
Neil Patel: Oh, yeah.
Helen Tanner: So,
Neil Patel: uh, you go, we can go keep on too. Whatever you like, honestly, but
Helen Tanner: No, let's turn it off. Let's turn off. That's fine.
Neil Patel: Yeah. Cool.
Helen Tanner: Okay. I'm turning off my,
Neil Patel: oh, you're an H now. All right. Let's see. There we go. Okay.
Helen Tanner: So what was your first exposure to a more non-traditional, uh, innovative care model or, or the startup space?
Neil Patel: Um, you know, I think there was a lot that I saw that was innovative, um, and lot that I experienced gradually over time, even when, um, I was too new to realize it, right? So, um, my early medical school training and even some experiences I had probably as a, as a kid were innovative. But, um, you know, my first job as an attending after my training was a practice in Atlantic City that was a startup in every way.
So, um, that was probably where I first found myself, um, really deeply as a clinician in the world of. Innovation, um, even when it's daily practice, how do we begin our day? How do we conduct our visits? How do we document our care? When something is brand new and you're not, you don't have the advantage or the burden of prior habits, um, it's sort of very easy to innovate, uh, especially when you're deeply patient centered as I think most clinicians ought to be in inspired to be.
Helen Tanner: Yeah. And I know you shared that you spent very meaningful time early in your career in underserved and community health settings, and that's a very different environment from venture-backed startups. What drew you to the underserved and community health early on?
Neil Patel: You know, I think, uh, at a young age I was really had a deep sort of, um, respect and gratitude for the privilege I had, right.
Um, growing up in New Jersey and. Being, you know, really good at school and taking tests and things like that, I thought, well, you know, I should use this to help people. As simple as that. Yeah. Um, and you know,
before you really dig in, it's, and you survey the people around you, your eye is drawn to the underserved. Right. However that's defined. Um, or folks who are really local to you. But, you know, being in more urban environments, I think, um, you have to, you have the ability to choose which community you wanna really serve.
So, um, I was drawn to that population. I spent my primary care clinic in training was in South Boston, and I'll always be deeply grateful to that community and the South Boston Community Health Center. Um, that was a place that was both innovative. It made your first question harder to answer or earlier question about innovation.
Um, even as it was the, you know, pillar. Neighborhood, FQHC on Broadway. Um, we were thinking a lot about community-oriented primary care. We were thinking about patient-centered communication, um, and a lot of really innovative concepts. Um, but that was just the fabric that I was trained under.
Helen Tanner: Yeah, absolutely.
I know Boston is, has an outstanding reputation and certainly is kind of created the best practice for FQHC work, so that's an incredible start. And did you, after that time period, then you were in Atlantic City, you know, when did you join Iora Health? You know, what, what was your journey there?
Neil Patel: Yeah, well, you know, um, I'll tell you the longer version.
So one of the really, um, experiences I'm most grateful for at the Boston University Family Medicine training was the opportunity to travel and work abroad. So I spent. Um, several months in Lutu Africa. I spent some time in Akil, Ecuador. Um, and, you know, I was really training in family medicine at that time mm-hmm.
For the breadth of my training. Um, I had a deep respect for primary care and one of my, my sort of preceptor as a first year was incredible primary care doc. Um, but that wasn't really my goal. My goal was to work abroad and have the broadest tool set. Um, and that was an interest that was honed by these, you know, really two incredible experiences prior to that.
It spent some time in India, so I was really interested in the underserved and it struck me that, um, the most underserved people are don, right?
Helen Tanner: Mm-hmm.
Neil Patel: Um, and I, I think it's worth bringing up. 'cause as I found myself in the Atlantic City practice, I realized that one of the things that drew me so.
Powerfully towards working in underserved areas, in rural clinics and places with fewer resources is that you were left with the patient and their strength and wisdom, their families. You were left with your relationship with those people and some simple tools, um, medical tools and knowledge. And in a startup space, it a lot has peeled away.
And it reminded me of the sort of patient focused creativity that I was exhilarated by working in places where we had just fewer resources, especially coming from training in Boston and medical school in Newark. These were places with incredible hospitals and incredible teams and sort of everything you could imagine for a medicine available, you know, in one roof.
And a startup is sort of. Similar, it's, you know, it's unroofed. Mm-hmm. And, and maybe just a, you know, a single room in a hut somewhere. Um, so some of those same passions were reignited, but also I think some of the same maybe skills you need to succeed in either environment overlap.
Closing Gaps, Not Chasing Solutions
Helen Tanner: Yeah. I loved our conversation the other week, uh, and we had so much in common about our interest and especially our work in FQHC and working with the underserved and I, you mentioned, um, we were talking about this a little bit, like, I wonder how did you know we started off working with underserved FQHC, how did we get to the startup space?
Which in some ways is just so incredibly different, right? And in many ways on the business side, certainly. But I was thinking further and along the lines of what you were saying is, I know for me, it seems like I've been drawn. To areas of medicine where there's a gap that needs to be closed, you know, or there's some kind of unmet need.
And essentially that's what a startup is trying to do, right? Is create something to meet an unmet need. It's just in a very different lens. And I have been really thinking about that since we, we last spoke. Um, I don't know what, what you think about that, but I, because it can seem so opposite, but, but really the people working in one can, it can translate to the other very clearly,
Neil Patel: you know?
Um, that's a really interesting idea. And I, I think as I think about it, the community that really taught me that lesson was the Freelancers Union. So shout out to the Freelancers. Oh, interesting.
Helen Tanner: And
Neil Patel: New York City. We opened a clinic with them, um, in the first year at Iora. And it was an amazing space, built on amazing ideas with this amazing community of, um.
Independent workers, right? Sort of united to create the infrastructure. A mutual, you know, that they needed to, uh, live their best lives and do their best work, right? Um, it was not an underserved community, as I had more narrowly defined it prior to that, right? Mm-hmm. So I was working in FQHC, I was really doing that so I could go work, you know, on a hill somewhere, right?
Um, and so, you know, later on, a few years later in my career, um, when I was serving that community, um, kind of going into it, I thought, well, you know, this might not be for me, but, um, you know, we're building something bigger here at Iora, right? Um, but what I learned right away, I never had that thought. After our first day, we were busy, and I realized that when you're not feeling well, uh, you're underserved, right?
Mm-hmm. There's this really, it was just my concern was erased, um, when I realized that particularly if you're not feeling well and you know, it's been a while, maybe you're not sleeping well and it's just not clear how to get help. Right. Um, uh, you don't feel better. The, you know, the, the missing link where people are underserved, where things like listening, um, you know, empathy, certainly from the healthcare space, and many people don't have empathy outside of their healthcare either.
Right. I saw that, uh, across my career. You know, um, one of my senior residents, uh, Liz Rudiger, I remember her saying, um, you know, the clinic was in South Boston and Southview was the one place you could come for. Like, someone who would be like, kind and listen to you. Mm-hmm.
Helen Tanner: Right?
Neil Patel: Like reliably. Now a lot of people had that at home or they had that, you know, within themselves, but, um, a lot of folks didn't.
Right. And frankly, when I was, you know, particularly in Lales, Suzu, man, what a amazing time I had there. The two people were. You know, they were kind, they were empathetic. Um, I had great relationships and I'm not sure that their lives were any worse than anyone else's lives, right? Mm-hmm. Um, uh, and from a medical perspective, they fit my definition of underserved in a sort of very specific way.
So the freelancers fit my definition in a new way and expanded my definition. Um, that happened again to me when I started serving seniors. Um, you know, geriatrics is a, a passion that I found sort of as an old man. Um, mm-hmm. And wow. Um, how underserved are we all as we age in a very different way, right?
People, you know, to the point where folks are not even things seen. Um, and there's so much we can do if we wanna close that gap, right? Mm-hmm. So people like you and I maybe are on a quest to close gaps or we're drawn towards the gaps. Um, and, and there's, there's really gaps everywhere. Um, kind of wish I could start over and be like a, I.
A radiologist and be a a pathologist and like, where, where do the, where do I find the gaps in like these fields, you know? Yeah. So, but I'll tell you, uh, the FQHC thing, um, I've heard this from other folks who've been in the unfortunate position to have to sort of recruit and hire into like, you know, practices, particularly startups.
Um, a lot of the FQHC crowd is, are drawn to, you know, startups who believe they're really trying to solve a big problem, right? Yes.
Helen Tanner: Mm-hmm.
Neil Patel: They're drawn to a gap and it feels awful as the like, hiring manager. And I'm like, oh man, I wanna, like, I don't wanna hire like this, this person and take 'em away from their, like clinic and all their patients and, you know, in like six months you'll sit in a clinic that might be empty for a little while, like, we don't know, you know?
Mm-hmm. It didn't seem like good use of resources, but, uh, um, so there's a, there's definitely a crowd of folks who are, I think maybe gap closers and they, they end up in different places, huh?
Helen Tanner: Yeah. Yeah, I remember, um, when I was recruited and I was working at the FQHC before I was recruited into, um, the startup.
And I remember the CEO sitting me down and, and explaining to me about the role. And, and I, I just said, no, you know, I, I can't leave, I can't leave my patients. I'm so, you know, there was just so many reasons for me to say no. And, you know, he kept working, kept twisting. And then of course it got to the point where, well, how could I not say yes to this?
This is an epic chance to help close a gap from, from a very early stage, from the earliest stage. So I just had, it just took a minute to reframe, you know, because in my mind what I'd be leaving, uh, to go to, and it, and it wasn't just another job, it was an opportunity to, to strategically build. Um, so, so yeah.
That's a really, that's really interesting. Um, you know, pathway. And I'm curious, did you do your time abroad after, or, or, you know, during, when you were at your practice at Atlantic City and is that what brought you then to your next phase or
Neil Patel: that No, the, the chronology would be, uh, um, the opposite probably.
Okay. So, um, you know, I think as a, in second grade I went to India and that was wild. Right At that young age. Mm-hmm. Just like expanded my, you know, it's all about expansion, right. So it expanded my definition of what was like, normal in the world and my life and, you know, who I was as a really, you know, that, you know, as a, as a kid.
And then, I don't know, lemme think after that then I think I spent time, you know, I spent some time in medical school abroad. I had those two experiences in residency that I had mentioned.
Helen Tanner: Yeah.
Neil Patel: You know why KI was at, uh, that's like the. Sort of big government, um, Aternity Hospital and you know, I had wonderful, um, OB team and experiences in Boston, but it was a lower volume, you know, so I was like, lemme go out there and like, really, you know, work on this.
And that was a wild experience. So, you know, I think, uh, I think the more you like chase gaps and find yourself in different places, the more some of these like early experiences where you have a chance to play with different, you know, ways of reasoning and ways of sort of solving problems really come in handy.
Um, and you know, that's, that's sort of a principle I think, uh, I sort of stumbled upon, but I try to pass on. So, you know, once in a while I'll be asked to speak at sort of a family practice management like block for a residency. And, you know, um, one thing I encourage the, the residents to think about is.
That, you know, if they think about their most frustrating clinical experiences, you know, like close your eyes, um, imagine, you know, you're in the exam room in your primary care clinic and something that's like, you know, sad or frustrating or again, sort of a negative sort of experience happened the last two weeks.
Um, and then think about all like sort of the stakeholders and you have the patient and maybe their family's there. You've got sort of all the external factors. You've got all these like sort of administrative barriers often, and those are sometimes we attribute to different people. But if you pull back and look at that sort of group of folks, um, you know, look at yourself like, you know, we've got more job security, then most of the folks in the story we've got generally like a livable wage or way better, um, you know, uh, we should be solving the problem, right?
Who's gonna solve it? Like, the patient is already usually doing their best to solve their own problems. Like, that's, that's usually the baseline if you start there. Um, and you know, you think about this, you know, somebody in a suit in. The administrative sort of stratum and you know, like we have, we have a lot of power that they might not have.
Mm-hmm. As, as the doctor, right. So I try to sort of, uh, I don't know if it's like, um, inspiring or not, or maybe it just makes people feel like some kinda shame for not doing better. Um, but I wanna, I want people to experience that, like, do better if it's a problem, right?
Helen Tanner: Yeah.
Neil Patel: If, if you see something that like isn't working, like find a way to do better, right?
Um, and don't limit yourself to like, just your practice and the kidney or whatever it is that you're thinking about with that patient. Uh, think about access, right? That's a, you know, access to care is so important and like so easy to innovate on, right? You can try so many different things. Try to improve your patient's access and experience of access.
Um, but a lot of people don't think about it. They sort of outsource that to other people and maybe complain, but yeah, don't, don't do much better than that. So, you know, that's not entirely the case. Obviously. There's like, you know, all sorts of. Folks working hard on access. But, uh, I think, uh, maybe that's a stereotype for physicians that has some truth in particular.
I won't call out other, other, but as physicians, we certainly like don't think about access and the science of access really, especially if you're a science nerd already and there's a whole like eng industrial engineering kind of like science to like thinking about access and measuring it and stuff like that.
So add that to like creatinine in your panel and, and measure it, right?
The Cheat Code to Innovation Is Starting Over
Helen Tanner: Yeah. And I think it also gets when you, when you're in the grinds each and every day and you've been doing the same thing for weeks and months and years, sometimes it can be hard to step back and look at some of those other factors and, and force yourself to innovate and think of things in a different way.
And maybe something happens that instigates you to do that. Um, or us, I mean the general you. Um, but yeah, it is. It can be challenging to step out and make sure that you're looking at the big picture. And then what can we do to be a problem solver? Is, do you feel like your transition into kind of the more quote, traditional startup space came from this thinking of you knew you wanted to innovate and you knew you wanted be a part of that innovative community that wasn't just kind of grinding on the same thing every day?
Neil Patel: I don't know. Yeah, maybe. But you know, I think like the cheat code to innovation is just start fresh, right? Mm-hmm. So I don't think I'm a particularly innovative guy, like in my personal life. Like, I know I don't like paint, you know, amazing things or, you know, my, my like, my closest like sort of art hobby is, uh, photography, which is like a very creative endeavor.
But
Helen Tanner: yeah,
Neil Patel: but it gives you a sense of like, I'm not, you know, just writing science fiction novels. Like, you know, I'm not a in guy, but if you put me in an environment where, um. Everything is new and everything is fresh then. And if I listen, if I listen to my team and I listen to my patients like we're gonna do innovative stuff, um, there's just no other way, right?
There's, there's no opposite of innovation in, in an environment that's truly a startup. So, um, you know, uh, I'm giving shout out, shout out to Rashika, uh, Fernando Poule. 'cause he, he basically understood that, um, he's, he's a few years older than me. Then I met him. He was like, we're gonna start a practice in Atlantic City and it's gonna be a blank slate.
And if we have a chance of doing better than, you know, the giants whose shoulders we stand on, it's gonna be because we started over. You know? And I think about that a lot. You know, I, uh, you know, I'm a family doc. I've been doing a lot of geriatrics. Um, really, I really care about my patients. I'm really kind and I learned a lot.
Like I have a lot of medical knowledge and all that kind of stuff, but I'm not any kinder than your average. Clinician out there, and not even, I'm like below average, knowledgeable probably. But like, um, so what's, what's the difference? Like, why am I gonna somehow have better outcomes than the next guy?
It's because I had a chance to start over. Right. And build something from scratch around a community. And, you know, really even part of what I, the knowledge I carry in the practice, I sort of try to follow and lead through is one of like, you know, listening, um, really listen to your patients, listen to your team, listen to your instincts, like, and be willing to try new things.
Right. And if you do that, then improvement is just like, uh, happens on its own, right? Yeah. Um, whereas in an environment where if I'd been, if I'd stayed at the FQHC and had a wonderful, like, career in South Yeah. I don't know. I wasn't the, the practice improvement guy. I was like, I was just doing my job, you know?
Helen Tanner: Mm-hmm.
Neil Patel: As a resident. And so I don't, I may not have like realized how easy it was, but it did tap into something I experienced in abroad, right. It like made me, something reminded me of that connection and, you know, that, um, but in a startup, you have that to the nth degree. So you can think about your, you know, true startup.
You can think about like, what gap do you wanna close out there in the world, and how do you think about closing it? And you think about operations, you think about, you know, growth, and you think about values, you know, uh, what are the core values of the, of the company? You get to start all that fresh, right?
So there's like all sorts of opportunity to come up upon something better, even if you're not that brilliant, right? You're trying new things. You gotta find something better.
Humility, Listening, and the Person Who Has Done It Before
Helen Tanner: as, yeah. And as a physician entering into new companies, you know, that you are building, uh, what. Skills do you feel like you already had that would contribute to your success there?
And what skills were you kind of hit with a fire hose that you needed to learn really quickly?
Neil Patel: Yeah, that's a tough question. You know, um, when we train in like psychiatry, we talk about like insight. Mm-hmm. Like, I don't know if I have that level of insight that you're asking, but I'll tell you the skills that I recognize, um, and aspire to, you know, in my, especially in like tough, tough moments, uh, you know, and maybe, maybe more like sort of values.
Um, and I think one of the, you know, the, the most important one would be humility. Um, I think, you know, right adjacent to humility are sort of related values, like maybe like non-judgment and listening, you know, like. Listening is a humble act. It's hard to listen when you're ambitious. Yeah. Unless, unless you realize like, oh, I need to, I need to listen in order to get my goal.
Right. Um, uh, you know, I would do this, like I feel a little bit guilty about it, but it was almost had like a trick question I would offer during interviews. And maybe I shouldn't divulge my secret, but, uh, you know, I describe a case, um, I try to make it a case I'd seen, like, you know, recently myself. So I knew some of the details and I'd share, you know, just a high level of what I remember and like ask like, you know, what, what do you think?
You know, um, and you know, there's certain candidates would ask more questions at that point and others would begin to sort of describe what they thought and what they might wanna do. And I was listening for that. Right. Um, 'cause they didn't know about the, enough about the case to. You know, maybe I get a good clinical idea from them, but, you know, I was open to it, but that wasn't the point.
Right. And I was looking for people who were just more curious, they couldn't help it, you know? Mm-hmm. Um, so, you know, curiosity is a hops given a jump from the humility. So I, I think that's something that we all ought to cultivate if we want to be better as, um, you know, team members in a startup or maybe even as clinicians or in our personal lives as like, sort of try to cultivate humility and listening.
Um, certainly works in a clinical setting.
Helen Tanner: Yeah. I think when you're an early hire, you're, you know, you're one of the early on the founding team or, or close to it, having humility is key, but it can be hard because you were brought in for your expertise. In a certain area. So obviously you, in your case, in my, in my case and our different examples, clinical, but in the early stages, there's also so many other skills that we need.
And that in particular is we need to be careful about that with the humility piece. 'cause I know sometimes for me, I felt like I had to come in with a sense of, you know, confidence I can do this, um, you know, I can make these decisions. But really it took me really about a year to relax, to truly realize none of us have done this before.
You know, all of us were brought in for specific skills, but really none of us have done this before. And I've, and I, and it's okay to not have it figured out. It's okay to not. Know all the answers, and the only way we're gonna get really through this and successful as a team is if we are humble, lean on each other and really know and listen to your point to what we're each bringing to the table versus No, I know best.
No, I know best. No, I know best. And I, I don't know. I, I found that, and I watched that be challenging at times because it can be a hard thing to do when there's only, you know, one of each of you filling the role and everybody's kind of looking for you on your certain area.
Neil Patel: Yeah, it's really hard. There's so many reasons, right?
Like what you described, sort of humility may feel at odds with how you feel. Like you ought to think of yourself to build your, maintain your confidence, or present yourself to others, right? Um, but like anything that's hard gets easier with practice, right? Mm-hmm. Repetition and maybe practice often implies like rituals of practice, you know what I mean?
So, um. The person in the room who's done it before is a liability. So I discovered a practice early on without it, it sort of guess it became a ritual or repeated when, often when we'd opened a new practice, I'd be the only one in the room who had done it before, you know? And so I'd say, Hey, listen, like I'm, I'm a liability because I'm likely to repeat the same mistakes in the past.
So you can, you know, um, it's my job to keep an open mind, but all of us, like, who have an open mind, like that's our strength otherwise. Mm-hmm. Otherwise, why make a startup? Right? That's the, that's the cheat code to innovation's starting over. So if everyone knows what they're doing, you're not starting over.
You know what I mean? Um, but you know, there's other ways I think to perhaps practice and humility without just reaching into your soul to become a more humble person, you know? Um, for instance, uh, you know, agile and the whole. Body of, you know, ritual and like operations around agile development is sort of a, a formal practiced, ritualized way of being humble and listening and saying to yourselves as a team, developing a new product.
Um, we don't know exactly where we need to go in order to meet this outcome, but can we try something and can we see if it gets us any closer and then build on it, right? And how will we know if we're closer? We have to listen. We have to listen to our users, we have to listen to feedback. Even in our own sort of meetings.
As developers, we have to. Be giving each other feedback all the time. That's, you know, and so some of this feedback is your formal retro, it's a meeting that happens, like it's on the calendar, it happens every week. There's different ways of listening to each other. Uh, listening to your users becomes like a lot of data analytics, which is really a cool thing that's happening or happen maybe in the last like 20 years in healthcare technology is that, um, the data analytics side of technology has sort of, um, really gotten the attention from brilliant people that it needed, right?
Um, so for so many years, like EMRs weren't necessarily trying to figure out how to understand a population or draw attention to people who needed more attention, but sort of, I'm seeing so many incredible things, um, where the tools we use, the technology we use like helps us to know who we ought to be thinking about, which is like, you know, that's humble, right?
Mm-hmm. Like, you know, why rely on like the schedule of the day for. How I spend most of my time, right? Like, who made that schedule? And like, they probably thought it was important, you know, six months ago when they made the appointment, you know, but like, who needs help today? And why? You have to be really humble to like, not just sort of follow your schedule.
And if the, the cheat code is don't have a schedule 'cause we just started the practice and now we got some patients, how are we gonna, like how are we gonna get 'em all in, right?
Helen Tanner: Mm-hmm.
Neil Patel: Let's try different things. 'cause we don't have, you know, we don't have operations already or outside schedulers or what have you.
Especially in some of the more, you know, health tech startups can really think about the patients user interface and solve a problem. So, so maybe that's, maybe that's like the insight is that, you know, you have to be humble to be in a startup. Otherwise, um, how are you gonna, you know, listen and draw the feedback you need from your team or from the patients, from the users, from the outcomes, right?
Listening to the data to sort of guide you. Um. Uh, otherwise you're depending on being like sort of, you know, the idea so compelling that it just sort of takes over, right? Like you knew what you needed, you knew the solution like before you started. If you're that brilliant or lucky, then perhaps humility will hurt you.
But most of us, you know, we're chasing a gap, not a solution, right? We see a gap in a patient or a group or a problem that needs to be solved and then we go and listen, right? And then we let the solutions develop from there. I think that's sort of maybe my opinion on how a lot of tough problems are gonna be solved by startups.
Building HR and Operations at the Right Time
Helen Tanner: Yeah. And you mentioned, you alluded to the fact that, you know, you don't have all the departments and that a lot of us are used to and organized health systems. You mentioned, you know, you may not have a full. Ops team built out. You know, you may have an ops person or you, you may have a clinical person, you may, you know, you'll have the CEO,
Neil Patel: but shout out, shout out to the head of ops everywhere.
Helen Tanner: Shout out to the head of ops everywhere. Um, yes, as my husband being an ops person in a startup, but, um, but yes, so shout out to ops. And this is one thing that was really surprising to me, and now of course, being in this space, it seems it's the norm, but apparently HR is kinda a bad word. Um, at least it, it has been in a lot of the startups I've been around lately.
Is that you, there's almost, there's no HR and I at certain point. At certain point there will be. There must be. And there's people doing HR functions, but I mean, has that been your experience?
Neil Patel: That HR is a bad word. No. Uh, I, I, I get the, the general, uh, conventional wisdom. I can appreciate where people are coming from, but that's not been my experience.
Um, but I've had like the, I mean, great luck of working with some, like really incredible HR business partners, um,
Helen Tanner: early on in startups, like from founding days.
Neil Patel: Uh, you know, um,
Helen Tanner: I guess that's what I mean. I love, no, I have many colleagues and friends in hr, but as far as having a formal HR department in the early days of a startup, yeah,
Neil Patel: yeah, I'd say so.
You know, here's why. One of the reasons why, you know, we started Iora was because the HR function for a big hospital system was tuned for a big hospital system. And so our practice was a partnership between local 54, um, in Atlantic City hotel workers and the local health system, Atlantic Care. And Atlantic Care is amazing.
Local 54 is amazing, but the, um, HR infrastructure for. The health system was tuned for that purpose. And we needed to move fast. We needed to like hire people. You know, early on we had this role, a community health worker role. We called a health coach, um mm-hmm. And it was really a community health worker, um, is the best way to describe it.
And I, I thought we'd have like a, you know, one in five, you know, trying our best, trying to hire the best people with like a, a big talent pool in Atlantic City. 'cause you got this rich community. There's no shortage of like smart, passionate people in Atlantic City. So, you know, we could choose and it was tough because, um, it's a new role, right?
Um, to us to, to the patients, to the person we were hiring from like different backgrounds. Um, but we wanted that to be okay, right? Um, that hey, like let's try this out. And if like, sort of some of the skills that it takes that we're all trying to figure out together to really create these deep healing relationships with your panel of patients.
Like if that. Isn't the, isn't what you are like uniquely good at, then it shouldn't be a big deal. Right? You shouldn't have to like, you know, hound people for showing up late and write 'em up three times or whatever. Right. And some of the things that I, you know, make sense in a hospital floor, like hospital floor, like, there's like real clear like criteria and you need to like, follow it.
And we're, we got a scaled operation here, right? So at Iora, one of the reasons we just went that route and said, Hey, why don't we do this crazy thing and start a company is 'cause we wanted to be in control of that. We didn't wanna like, um, just turn a blind eye to it or like, we didn't have a disrespect for hr.
We, it was more like we need HR to be part of the full stack and the clean slate. And so, um, you know, my friend Nicola was our first HR team by herself at Iora, and she was a social worker who had worked in like
Helen Tanner: Oh interesting
Neil Patel: practice operations for a long time.
Helen Tanner: Mm-hmm.
Neil Patel: She just. And, but we, we had to do all the functions, right?
We had to like, you know, there were all the amazing things that HR thinks about, had to get, you know, thought about in due time at least. And so, and then, you know, over time, like perhaps as you scale, there's sort of different skills you have to add or capabilities. You don't wanna add HR capabilities too early, right?
So, so that's where we're all a liability, right? So it's easy. Maybe I wasn't, I didn't give an example of like what I truly mean when I say like, I'm a liability at a, at a, a health or a health tech or a geriatric or a value-based care tech startup. Like, you know, maybe you think I can help you and I, maybe I can, but I'm also, you know, I could first do no harm, right?
In the HR world, you can think of it. Or even like you think about your general counsel or you think about your, your highly experienced operator. All of us wanna sort of start building the infrastructure that we think we'll need. And start. Right? And we don't even help ourselves, right? So we, we start to sort of, um, recreate the rituals that we found helpful before, but if you're really solving a problem that's new and the solution might be different, then all those things actually could sort of help you from finding like the, the right solution, right?
Um, so maybe that's the barrier to innovation. And so, you know, um, so all of us have to be really humble, but I'd say a lot of hr, um, and operations and like that kind of rigor has to happen at the right time. 'cause if you have a lot of rigor, when you need flexibility, you may not be able to find the solution, right?
Um, so I think that's like sort of a, sort of a classic sort of, um, area that people in maybe business and management think a lot, think about a lot. Um, it's like, how do you marry, you know, um. The right operations with the right sort of flexibility to let really creative people be creative, um, and let the customer, the patient, the data, the outcomes lead you.
Um, you know, one of the outcomes I've been chasing is, uh, this thing called MLR, right? Mm-hmm. So we're measuring the medical loss ratio, basically, how much does the care of a patient cost against whatever fund was available from maybe they paid a premium or their employer paid, or the government paid.
And, you know, how do you listen to the MLR, right? Like, so you, you know, you're staring at this data point. You try to measure it, you try to like, think about it, and you have to be open to how the care is gonna go, and you do the things you think are right, but you have to be open to like, truly new solutions if we're gonna help patients to reduce their MLR something that patients don't even know about, right?
Helen Tanner: Mm-hmm.
Neil Patel: Um, and so what happens when you listen to the patient, especially in aging, patient says, well, I don't know anything about MLR, but I'll tell you, um. They might say, I wanna live at home and I wanna make sure I take care of my dogs. And, um, you know, I like to drive, um, real simple, right? So in geriatrics, what I learned from incredible geriatricians who, you know, gave me advice and trained me is, you know, you just listen to what the patient's values and preferences are.
Um, make that your outcome and follow it. And you know what, I found that in value-based care, particularly with senior populations, when you do that, that, that number, that's just math coming from a spreadsheet somewhere that you don't really get to look at, um, sort of works itself out, right? People. Mm-hmm.
People wanna be healthy, they want to be making good decisions. Sometimes they need things that are really expensive, sometimes they don't, but they generally will find a way to be as healthy as they can. And ultimately, healthcare cost is just the cost of poor health, right? So. You know, and maybe it all comes together.
And I really, you know, what I love about being a physician in startups is that I don't have to close myself to the wisdom of the patient at the most intimate level one-on-one in order to, um, open myself to the wisdom that might come from, you know, scrum meetings or the wisdom that hopefully is coming from the boardroom of the most senior leaders trying to make decisions that impact everybody.
Um, physicians we have this unique, for me, feels unique is ability to go from all parts and all levels of the organization, um, but still have that ear open to individual patients and their individual needs.
Helen Tanner: Yeah, very much so. And in thinking of the audience, clinicians navigating startups at various stages, I do think it is important.
Those functions certainly important, needed. And when they're introduced depends on the stage of the company, where the company growth is and at what level and depth that they are introduced and, and grown to. And I, I think that was something that I know I was not prepared for and didn't understand, even though I was joining a founding team.
And I step back and think about, well, obviously these are all brand new roles. Were not gonna have every single department. But I had not worked outside of either a large academic health system, nonprofit, FQHC to where all those functions had been in play for, for many years. I wouldn't, didn't even know to think about that.
They wouldn't have already been formed. Um. And so that was quite a shock for me. And I do think, and then it made sense and then certainly you build out and, and that's, that's an exciting thing that you are able to innovate and build out at the right time for those functions. And so I do think people joining startups and who haven't done it before, that is a normal thing to be perhaps surprised about, but it's an expectation to come across as the, it's normal.
It's normal to, to watch that growth too. So I hope that makes sense.
Neil Patel: Yeah. I think it's nice when there's a community, we talked about this, uh, earlier, you and I, about, um, it's nice to have a community of folks who are living through and working and enjoying startups. 'cause you realize a lot of what's truly maybe crazy is also normal.
Helen Tanner: Yes, yes. Absolutely. Well, well put,
Neil Patel: I'd say that, you know, but as you think about as a founding team, so, you know, team is something that I. I really crave, I like working on teams. Um, and when you have a team of specialists, you know, like a founding team, um, I think again, there's a, it's a little bit harder now to be open to new things and innovate.
So, you know, I, I mentioned Nicola earlier. She wasn't, you know, only hired in to do the HR functions. She was a integral member of the founding team involved with everything. Like,
Helen Tanner: yes.
Neil Patel: It was nothing. She wasn't involved with, um, uh, all of us. Right?
Helen Tanner: Right.
Neil Patel: I think there's this, you know, if you're gonna start a new endeavor and you're gonna go through the, um, give up so much to do it, and also like take on the risk or whatever it is that you know, it better be worth it.
So you want to be thoughtful about your founding team. You wanna be generalists, um, you wanna push each other to do every job. You know, is it sort of a business urban legend or maybe it's true that a. Southwest would have their executives do baggage claim, you know, and it was like to make the airline better, um, that experience was valuable, even though having an executive run the baggage claim would require like two other baggage handlers to make sure they didn't screw it up.
Mm-hmm. You know, but, but maybe the, you know, the what the sharing of perspectives has made it all worth it. Um, but it's easier if you just, everyone's handling the bags and everyone's CFO, right?
Helen Tanner: Yeah.
Neil Patel: Um, and, you know, I had an early experience with a cup in Santa Ana, California called Latino Health Access.
Helen Tanner: Mm-hmm.
Neil Patel: Manica Rapa was sort of their leader. And one thing that they had put sort of the, a bunch of like lean and Toyota production method, um, rituals in place, and each quarter their sort of, you know, top level company meeting, their board meeting was run by a different team or four teams, and each team.
Every member of the company, right? So it's everyone's responsibility once a year to speak to the financial, uh, metrics and performance, to think about the clinical outcomes and think about the growth outcomes, right? Um, and they taught, they were really in the position having seen a lot of success in their own community with their own sort of community leading them and their proda facilitating that leadership.
They were in a position to teach others. And so one of the things they taught was, run your practice this way. Um, don't make it the job of somebody to understand and report on the performance in a job of somebody else to deliver that performance or deliver one of the key jobs to be done, um, to find that performance.
And man, uh, it must've been working. It was a really incredible group of people out there. Again, maybe that's another ritual that, um, we ought to think about.
Helen Tanner: Yeah, you
Neil Patel: wanna be humble. It takes practice. It's hard. So one way to be humble is to make it everyone's responsibility to report on the outcomes. Um, so, and, and why is that a cheat code?
Is because it's much harder to do it the other way. So it's much harder for me to give up my power. I'm, I'm the, you know, co-founder. I'm in the C-suite. I get to talk to the board, I get to make hiring and firing decisions like ultimately like deny people's PTO. And so for me to give up the power and do my team so they can lead me, um, one way to do it is to literally say, well, one of those responsibilities is to communicate to the board.
So I'm not gonna hoard that, um, influence, right? 'cause there's not enough to be humble about it. I don't particularly enjoy board meetings. They're fine.
Helen Tanner: Yeah.
Neil Patel: But sometimes they're, they're rough and they're, they're supposed to be, they sort of a function. Right. But the meeting itself isn't always like a, a catwalk.
Depending on your board, you're a better board will. Make that a meeting you have to think hard about, right? Mm-hmm. Or certainly a later stage board. Um, but my team, especially my clinical team, they don't wanna be in that meeting. They're grateful. I try to, you know, I've struggled to like, sort of, I'm trying to help get, help people to understand the outcome so they can show me how to improve them.
And a lot of times people are like, I don't wanna worry about that. Like, I'm so glad you take care of that and communicate to the board about all that stuff because like, I, I don't, I don't really wanna think about, it's like, no, I need you to understand. 'cause I don't know, like, you know, I need your wisdom on these numbers.
You know what I mean?
Helen Tanner: Yeah. The shared metrics.
Neil Patel: Yeah. That, that's much harder. Why not just have them present the metrics? Um, so yes. You know, maybe I need to think about, um, Santa Ana a little bit more.
Everyone Should Present to the Board
Helen Tanner: So. Okay. Um, you have been through your earlier experiences and you with Iora Health, you're with Patina.
What. Are you doing? What is, what are you doing now? You know, what are your, what's next for Neil?
Neil Patel: Uh, well, um, I'm busy chilling, but, but I'll tell you, you know, it's, it's great. So maybe what I'm learning, hey, uh, maybe what I'm realizing through this conversation is, uh, that, that blank slate sort of Chico that I found so valuable.
Um, you know, I'm, I've found myself in a position with a blank slate. So right now I'm, um, you know, we, we had a wonderful practice, um, and company called Patina that we closed shop at the end of September. So it's been a few months where I've been really, you know, having wonderful conversations, talking to people about opportunities out there like far and wide.
Um, I've been really struck by how much we all have in common and how our experiences as I'm talking to folks about, maybe it's a, you know, a real concrete opportunity, but more often it's, it's just sort of networking. Everyone's solving their own problem. They understand it so deeply, right? Because they're, they're really in it if they're solving a problem.
But as we, as we talk, we realize how, how much our experiences have in common, how much we have to instruct each other. So it's sort of like a chance to team up with as many people as I can, sort of in, in a one phone call at a time. Um, and in doing that, really listen to sort of where, where the gaps are that I can go chase down and, and help close.
So it's been a real, it's a real, been a real privilege to have some time. I spent a lot of time with my family. Um, I was snowshoeing this morning.
Helen Tanner: Yes, I
Neil Patel: was telling you earlier, I was, uh, digging out some ice in my patio. What time for that?
Helen Tanner: I need to get out and do that too. Oh my gosh. thank, thankfully it's finally warming up.
So maybe, maybe that'll help. Um, well this is really, I just enjoyed this so much. I really appreciate your time. I, I have a couple last questions for you. Um, when, what was the single most resource that the single most helpful resource, I'm gonna scratch that. I'm gonna repeat that question. What was the single most helpful resource for you as you were joining a startup or navigating through a startup and why?
Neil Patel: Hmm. Single most, you know, um, I don't know, but the first thing that pops in my mind actually is I was able to and began to really deliberately tap into my prior teams to solve my new problems. And I found that really helpful. So, you know, if I was facing an operational question, if know. I might call, right?
I might call Diane or I might call Adrian and take their opinion. 'cause I respected their experience and, but I really respected their instincts and I understood their instincts and how they might apply to my problem. Right? Um, and so I, I really, you know, others will follow suit. So I have a lot of chance to help people in my life.
So I think tapping into really deliberately to, you know, make one call to somebody who you trust, who might have thought about this for every like, real tough problem you're facing. And then, you know, hopefully you have enough time in a startup. Like it's interesting. You have to prioritize these kinds of conversations if they're gonna make the most forward progress.
And so if you can make time for that in a startup environment and you ritualize that, then um, it's been great. And, you know, as a side benefit, I get sort of the, maybe the more like sort of social support and the empathy that I might need.
Helen Tanner: Mm-hmm.
Neil Patel: I'm somebody, somebody who shares my fashion.
Helen Tanner: Yes. And when we think about clinician and startup integration, how has being a clinician shaped the way you operate in startups?
And then vice versa. How do you think startup work has shaped the way you think as a clinician now?
Neil Patel: Oh boy, that's a, that's a really question. Um, how did being a clinician, you know, I found, like operating in a, I found that operating in a leadership environment really. Came second nature to me. If I behave the way I have learned to behave with my patients, yeah, with my patients, I'm there to listen.
I start with a history before I think about objective data or move to a physical, I think about how I can build a relationship before I give any sort of advice. I think about,
I think really deliberately about the advice I give. Um, and that didn't necessarily inform how I behaved with my own team. Right. Um, felt like a different environment. But what I found is that if I sort of just carried those principles through and talking to my CEO, uh, or talking to someone who reports into me, um, start with listening and really just try to like.
Um, behave how I would in an exam room, not think of them as my patient necessarily, but just behave the same way. Mm-hmm. Um, my conversations went better. I learned more. Um, and, you know, I found it much harder to escalate. So, man, you can talk to my friend Jack Stoddard and like we've, we've yelled at each other a little bit more than we're proud to say.
Um, and you know, that escalation when you're like, if I just say this a little bit louder mm-hmm. Maybe it'll get through, um, you know, then you laugh about it later. But, um, you know, that, that's, that's behavior I wouldn't dream of doing with a patient, right. Um, if I find myself getting upset with a patient, I have to take a deep breath, right?
And I have to think, huh, why am I feeling upset? Like, what is, what is, you know, sometimes, you know, like what my colleagues in the behavioral health side have taught me is this sort of, people will make you feel how they feel, right? So if I'm feeling this way. Um, what does that inform me about my patient and man, you know, that's how we should be treating each other all the time, right?
So for clinicians, maybe that comes more naturally. So perhaps we, we have that advantage if we in the, in a more sometimes really tough tense environment, right? In a startup when pressures are high, um, perhaps we can tap into that advantage of we that we have when we sit across the room from a patient and the practice we've had, right?
We've had a chance to practice that really difficult skill over and over again so we can use it when we're talking to our, our business colleagues.
Helen Tanner: I resonate with that so much, and I think that is so well said and such good insight and one that maybe a lot of clinicians wouldn't think to break it down like that.
I mean, even I've seen, um. Uh, just with the, just with, um, AI and health tech and a lot of those, the industries hiring clinicians and, and clinicians being interested to move into, you know, non-traditional roles. Right. And I have seen a couple of people who are really making a splash to really help guide clinicians who are interested, interested in coming into these spaces.
And they have broken down the language and how we operate as clinicians that could be translated into being valuable for these, you know, product development or user experience type roles when you're getting these questions, like, how have you solved complex issues and worked cross collabor, you know, uh, cross collaboratively with multiple departments and ultimately some of their examples of kind of these coach type, um.
Leaders are saying, well, you are a clinician, you are taught, you are presented a co a lot of times a complex problem. And you have to break down what, what are your steps? What are you gonna, what are you gonna order? You know, what are your next steps in this? What teams are you gonna talk to about what you need to do?
Well, I need to, you know, get the lab tech. I need to talk to radiology, I need to talk to the family, uh, I need to talk obviously to the patient and get the plan together. And then, so step by step by step, you break that down and you are doing complex problem solving cross collaboratively, but we just don't necessarily think about it like that 'cause it's a traditional way that we are working in medicine.
And so I really love that you broke that down that way, um, because I'm seeing that more and more, those skills being able to be translated into also business success and working with our business colleagues. So I love that.
Neil Patel: Thank you.
Helen Tanner: Very good. Well, Neil, thank you so very much for your time today.
It was a fantastic conversation and I look forward to chatting with you further.
Neil Patel: Wonderful. Thank you so much.
