Five Things Every Clinician Should Know Before Joining a Healthcare Startup with Helen Tanner, PA-C, MPH (Solo Mini-Series, Part 1 of 2)
- 5 days ago
- 14 min read
Before You Sign: 5 Things Clinician Leaders Need to Know
In part one of this two-part solo mini-series, host and startup leader Helen Tanner walks through the five things every clinician leader should work through before signing an offer.
She explains why startup stage matters, why you need to understand who owns and governs the company, how to become equity literate, why your clinical credentials don't automatically translate in startup environments, and how to define the clinical versus administrative split before it defines your role.
For each of the five topics, Helen shares a practical next step, a question to ask during the interview process, or a resource to help you make a more informed decision. You will also find a free downloadable question guide linked in the show notes to help you evaluate startup opportunities with confidence.
Stay tuned as the part 2 of this episode, Helen explores the five things every clinician leader should expect once they're on the inside of a startup.
Must-Hear Insights and Key Moments
Revenue model dictates whether clinical or administrative work dominates depends less on the offer letter and more on how the company earns money.
Four equity numbers matter: Options granted, total shares, strike price, and valuation are the minimum data to demand before signing.
Stock options look like wealth but the denominator of total shares tells the real story.
The same title means radically different responsibilities at seed versus Series B, and misalignment burns clinicians fast.
Clinical versus administrative expectations shift constantly in startups; formal review dates protect against misalignment.
Many postings are written by non‑clinicians; red flags in scope and reporting lines can define your first six months.
Words of Wisdom: Standout Quotes from This Episode
“ The takeaway before you sign, you should be able to say in one sentence what stage this company is at and what that stage will ask of you. If you cannot, then you are likely not ready to sign.” - Helen Tanner
“So the takeaway, negotiate equity like it matters, because it does.” - Helen Tanner
“In the clinic, your value is obvious. In a startup, you have to state your value, or you may have to state your value in operational terms.” - Helen Tanner
“The early season is temporary. The point is to choose it and know it and walk in with open eyes.” - Helen Tanner
“This exists because it can be so exciting at the thought of joining and beginning in a startup, so much you forget to ask questions that deeply impact your work and life.” - Helen Tanner
Mentioned in the episode:
Follow The Early Hires
Follow Helen Tanner
Follow The Early Hires
Get The Early Hires Monthly Newsletter
Are you a clinician navigating startup life? Sign up at www.theearlyhires.com for monthly insights, updates and best practices for leading inside healthcare startups.
Blog Transcript:
Note: We use AI transcription so there may be some inaccuracies
Helen Tanner: Welcome back to The Early Hires. I'm your host, Helen Tanner, and this is a podcast for clinicians navigating startups. Today is a little different. Since launching this show, the questions that come in from this community and from my startup colleagues keep clustering around the same theme: how do I know if this offer is a good one?
What am I agreeing to? Am I protected? Should I do this? All related to joining a startup. I was the founding clinical leader at a startup. I joined very early stage and stayed through Series B. I was there on day one when the doors, quote, "opened." I built clinical teams, validated the care model, and sat in rooms where the business decisions got made.
I learned most of what I'm about to shar, by not knowing when it counted and not having experience or mentorship. So this is a two-part miniseries, 10 Things Every Clinician Leader Need to Know Before Signing or Joining a Startup. Today is part one, the five things to work through before you sign.
Next episode, part two, are the five things that matter once you start, once you're on the inside. The format's simple. For each one, I'm going to name the thing. Then I'm going to give you something to do about it, a next step, a question to ask, or a resource to use. I'm focusing this more on leadership and management roles.
While this can apply to practicing clinician roles, some of these questions may not be appropriate to ask in interviews if you're not applying for a more senior role. However, even if not in leadership, having this knowledge and insight is valuable to understand inner workings of startups and how your days might be shaped.
So let's get into it. Item number one, know the stage. Here is the thing to name first. Startup stage matters. Pre-seed and seed typically mean the company is still proving the idea works, seeing if they can get initial funding. Small team, very small team, typically 10, 20 people max. If you join here, you will do everything: see patients, build workflows, maybe pick the EMR, write the policies.
There's no clinical department. You really are the clinical department. Series A typically means the model has shown a pulse. It's showing validity. Investors are funding the growth. Now you're hiring, standardizing, and discovering that what worked for one clinic might not work as you continue to get a little bit bigger.
Series B and beyond starts to mean scale, more structure, more specialization, and honestly, more reorgs and job changes. Roles get split, layers get added, and the job you were hired for in month one may not exist in month 18 and will certainly look very different. Why does this matter before you sign?
Why do you need to know about this? Because the same title means completely different jobs at different stages. A medical director at a seed company is a builder role with sleeves rolled up, wearing many, many hats. Medical director at a Series C company is much more defined. It might be governance role, three layers from the front line.
Clinicians get burned when they sign up for one and expect the other. So here's what to do about it.
first, ask the company directly what stage are you? How much runway do you have in months? And what do the next 18 months look like?
Runway means how many months of cash the company has left at its current spending. If they can't answer that question or if it's really ambiguous, that can mean a couple of things. One, they may not feel comfortable sharing it with you based on the level of the role that you're applying for, but if you are a senior leader, they should be able to answer that in a fairly confident manner.
Next, do your own homework. Pull up the company's LinkedIn page. Look at the employee count over the last 12 months. Is it growing, flat, or shrinking? Look up their funding on Crunchbase or in press releases. Do some homework on the employees who've been there and see if they're still there or where they are now.
The takeaway before you sign, you should be able to say in one sentence what stage this company is at and what that stage will ask of you. If you cannot, then you are likely not ready to sign. Item number two, know the board and who owns the company. Know who controls the company. It's likely not the person interviewing you unless you are being interviewed very early on.
In clinical training, we learn org charts, attending, clinician, resident, student. We know who the medical director is, the chief medical officer. Startups run on a different chart, the ownership chart. Who sits on the board, whether the CEO still holds a majority stake or has been diluted below control, what the investors need to happen and by when It's hard to explain from the outside, but the board and the ownership structure shape everything you will experience as a clinical leader.
Whether quality gets funded, whether the company chases growth over what seems like safety at times, whether there's pressure to exit in three years or there's time and ability to build for 10. You'll feel those forces every day, every week, even if you never sit in on a board meeting. And to be fair, nobody hides this from you on purpose, or they shouldn't, but I think they assume that you will not ask because most clinicians do not.
But here's what you can do about it. Ask. In the interview process, who's on the board? Does the CEO still hold the controlling stake? What does the exit plan look like? These are fair questions. Founders ask them of investors constantly. A company that bristles when a senior clinical hire asks them is telling you how it treats its clinical leadership.
Learn the basics of how startup ownership works. There are companies like Carta, which I have no, stake or sponsorship in, but I know from personal experience, they're a good platform. And their platform, a lot of startups use to manage their equity. They publish free educational resources on cap tables, dilution, ownership.
So start reading. You don't need an MBA, especially now with the, accessibility of, AI at our fingertips, but you do need a couple evenings to really sit and go through and learn a little bit about equity. One more thing. Later this season, I am working on bringing a startup attorney onto the show to go deeper into exactly these questions, what to look for, what to ask, when to walk.
So today's just a primer of what's ahead. But the takeaway, you wouldn't join a clinic or a practice without knowing who runs it. Don't join a startup without knowing who owns it and who's controlling the decisions Number three, equity literacy. Equity, the golden ticket. This is the part of the offer that everyone gets excited about.
It's a startup. It's what it's about. It's gonna change my life, generational wealth. We're gonna sell, and I'm gonna, you know, change my life. Well, hold that thought a minute. The excitement's not wrong, the possibility is real, and people do sometimes win this lottery ticket, but before you spend that money in your head, let us dive into what you're actually being handed because here is the core truth: stock options are not money, they're a possibility of money.
They're wrapped in conditions, taxed in ways nobody explains very well at the beginning, and worth nothing at all in most outcomes. I'm gonna give a shout-out to one of my favorite podcasts of all times called How I Built This with Guy Raz If you want to hear some incredible founder stories about, quite frankly, the startups who make it through, it's not medically related per se, but those are the big names, the unicorns, the people who typically make it.
The stats are heavily against startups actually selling and these options coming to fruition. So again, it's important to understand equity because the language is the game when it comes to equity. Options give you the rights to buy shares later at a set price. That set price is the strike price. Vesting means you earn these options over time, usually over months, years. It can be set up different ways. The cliff means if you leave before you reach the cliff, you get nothing.
Dilution means every new funding round, it shrinks your percentage. And the exercise window means if you leave the company, you have a certain set time to pay real money to buy your share options or shares, or you lose them. Another thing to understand, and really important, is what fraction of the company that number of shares represents.
For example, 10,000 options out of one million shares is 1%. That's notable. 10,000 out of 100 million shares, well, that's a different story. Same number on the offer letter, but wildly different meaning. So here's what to do about it. Before you sign, consider asking for four numbers: the number of options you're being granted, the total shares outstanding, the strike price, and the most recent company valuation. Any company that will not give you those numbers is asking you to accept a compensation package without a full picture.
And this is not an abnormal ask. I asked. I didn't know all the terms or perhaps the right way to say it at the time, but I did ask and was told. Then get help reading it. There are a couple of resources, again, certainly with AI, some easy help. But a one-time review of your offer by a startup attorney can cost, depending on where you are, a couple hundred dollars, couple thousand dollars.
I highly suggest and consider if you have a complex offer, which many equity offers are, that you consider that. Clinicians spend a lot of money renewing certifications, CMEs. it may be very much worth the investment to understand your full equity offer. So the takeaway, negotiate equity like it matters, 'cause it does.
It's exciting, it does matter, and you're about to invest a lot of time and effort into building and helping something grow. So to have equity in a company is great. But consider it worth zero as when it comes to your comp package or your salary, I should say, because that money is not real money at this point.
Item four: your credential and your language. Your credential does not translate automatically in startup and business rooms. You have to translate it For example, an APP, a dentist, a pharmacist, physical therapist, a physician, they walk into a startup interview or early days in a startup assuming everybody in the room understands what their license allows them to do, what their training covers, what their experience is worth, and most likely the room does not really know.
Not because they're dismissive, but because they may have never worked with one of us, or even if they have, they may not fully understand our roles and our true capacity in the role we were hired for in this position. That gap can show up in a job description first. Many startup clinical job descriptions are written by people who've never hired a clinician.
I've seen postings that ask one license to do the work of three in five states part-time, perhaps having complete malpractice. Even with the best of intentions, it's complex. That's a knowledge gap and another reason they need you, but it becomes your problem the day you sign unless you ask. It also shows up in language.
In the clinic, your value is obvious. In a startup, you have to state your value, or you may have to state your value in operational terms. Not, "I provide excellent patient care." Instead, "I can design an intake workflow that cuts time to first visit," or, "I know which quality measures CMS actually pays on." So here are some things you can do about it.
Read the job description with a fine-tooth comb, I think most of us do this, but I even as far as reading it in detail, but I like to suggest even consider putting it, through AI from the perspective of the fine-tooth comb, reading from the other side. You know, asking for help reviewing for red flags or questions to ask in ambiguous sections.
Highlight some of those areas so that you can get clarity about those when you are, finalizing your offer or designing your, work plan as you sign on. Consider maybe asking who wrote it, and certainly ask who you report to at this stage and whether that person has hired or managed clinicians before.
And if you're an APP, certainly ask if they've worked with APPs before. This answer changes your experience and success in the first six months more than salary. So the takeaway, in a startup, you are your own translator. Fluency is your negotiating power. And item number five, understand the clinical versus administrative split.
I'll caveat this for patient care startups and health tech, and telehealth that are, you know, directly patient-facing. Before you sign, understand what the job actually is, clinical, administrative or the famous hybrid. Here is what I see in here sometimes.
Let's take a closer look at this. A startup offers a clinician a role described as a percentage, 60% clinical, 40% administrative, and the clinician hears the best version of that sentence. "I keep seeing patients, and I also get to build something." Great. Three days with patients, two days administrative. Then reality arrives, and it rarely matches the job description.
Sometimes the clinical side swallows everything. A provider resigns, a panel overflows, and you are the coverage plan. Sometimes it goes the other way. You're in meetings galore, clinical time is completely eaten month by month, and you realize you haven't seen a patient in nearly a quarter.
Now, one honest caveat, and it's a big one, if you are the first clinical hire or one of the first and earliest clinical hires, it can be very difficult to answer the question about proper split because there is no last person.
You're, you are the first people to do this. There's no calendar or schedule to show you. No one quite knows yet, including the founders. It's not necessarily a red flag, it's the nature of being first, but it does change what you're signing up for. So let me be plain. The 40-hour work week is not really a thing in startups, especially early.
You can set boundaries and have flexibility, but work overflows into all times. If you have listened to the guests who come on this show, you've heard them say it one after another. And look, most of us are used to working, after hours and work following us home, charts at night. We have done that our whole careers.
The difference is what the extra work is. It might be charts at night and also building a pitch deck for tomorrow morning because you're presenting to the chief medical officer of a hospital system at 9:00 with the CEO. Two different jobs sharing one evening. And if you're first or very early, ask about call specifically.
Who takes clinical call before there is a team? For a while, the honest answer may be all of you Also, and very important, ask what percentage of the company's revenue is expected to come from clinical services in your role. That number exists. It's on the pitch deck for the revenue for the overall clinical services and certainly how your role is portioned out to meet that number.
It will control your clinical versus administrative split more than anything written in your job description. If clinical services drive the revenue, your clinical time will be protected and demanded no matter what the offer says. If clinical revenue is a thin slice and the product is the business, then your clinical work is more of a cost line and the pull is toward the administrative work.
The financial model is the real job description, so ask about revenue percentages. So here's what to do. If the role already exists, ask for the schedule. What does a typical week actually look like for this role and the person doing it now or the person who just left? A company that can show you a real week has thought about it and has worked to build something that works for the company.
If you're first, early, ask a different question. What are the expectations for my first six months in hours and outputs? What you are testing is whether they have thought about it at all. Either way, ask the coverage question directly. When a provider calls out and the panel overflows, who covers?
If the answer is you, that's just important for you to know and weigh. Whatever you agree to, put a review date on it. " We revisit the clinical administrative balance at 90 days," for example, because none of this stays static in a startup. Teams get built, call gets shared, people get hired, the load redistributes over and over and over.
So the early season is temporary. The point is to choose it and know it and walk in with open eyes. So the takeaway again, know the expectations your role requires, clinical, administrative, hybrid, and the percentage of each role and time and revenue expectations. If it's not known because it's so early, make sure there's an understanding of reassessing every 90 days or so, whatever the time is, to prevent burnout or severe misbalance.
So that's part one, five things before you sign. Know the stage, know the board and ownership, get equity literate, translate your credential, and pin down the clinical versus administrative split. This conversation is important because it can be so exciting at the thought of joining and starting in a startup.
This conversation is important because it can be so exciting at the thought of joining and beginning in a startup, so much so you forget to ask questions that deeply impact your work and life.
It's about walking in with your eyes open, making you a better early hire, a better leader, and a better advocate for your team and patients inside these companies. That is the whole reason this show exists. The next episode, we'll go over what to expect in the first year of your startup role in startup life, title versus authority, the reorgs, protecting your license once you're inside, you name it.
If you want the checklist version of everything from today, I built a free guide, the questions to ask all in one place. The link is in the show notes and will be posted on The Early Hires website. I'm Helen Tanner. This is The Early Hires. If today helped you, please share this episode with a colleague.
I'll see you soon in part two.
