In this episode, we discuss physician entrepreneurship and how most physicians are primed to become entrepreneurs.
Learn more about physician entrepreneurship.
“Practicing Physicians, we’ve already learned how to take so many sources of data, often conflicting and confusing, and put that together in a cohesive picture. That’s literally what we do, right? So in some ways, I think physicians are primed to be entrepreneurs.” -Van Krishnamoorthy MD
In today’s episode, Coach Gabriella Dennery MD interviews doctor and entrepreneur Dr. Van Krishnamoorthy. They discuss his journey as a physician, and what led him into multiple startups. Dr. Krishnamoorthy was a practicing radiologist and is currently the CEO of TNT- Tactile Navigation Tools. TNT is creating tools to help those with vision impairments: FeelTNT. Dr. Krishnamoorthy explains why he believes that physicians are primed to be entrepreneurs. He goes over the production process of an idea and explains how the funding process for a startup works. If you have been thinking about starting your own business, this episode is for you. And if you aren’t interested in starting a business but are just interested in hearing an inspiring story, you are in the right place!
Podcast Produced by Amanda Taran
Please enjoy the full transcript below
Van Krishnamoorthy: Practicing Physicians, we’ve already learned how to take so many sources of data, often conflicting and confusing, and put that together in a cohesive picture. That’s literally what we do, right? When we practice. In some ways, I think physicians are primed to be entrepreneurs.
Gabriella: Hello, my name is Gabriella Dennery, MD, life coach at DocWorking and Welcome to DocWorking: The Whole Physician Podcast. Today, I’m here with my wonderful guest, Dr. Van Krishnamoorthy, who’s going to talk about his ventures in entrepreneurship and startups, and he’s involved in so many different things, and how all that connects at this day with his current mission-vision. And so, Dr. Van Krishnamoorthy, Welcome to DocWorking: The Whole Physician Podcast.
Van Krishnamoorthy: Thank you. I’m happy to be here.
Gabriella: I’m glad you’re here. We had such a wonderful conversation a couple months ago, and you brought up so many wonderful points and so, I’m going to start by asking you–, tell us a little bit about your journey in medicine?
Van Krishnamoorthy: Sure, yeah. So, I started in Academic Radiology at Yale, and then was recruited over at the Columbia in New York City. That’s kind of what started me on my journey on my many different pursuits. When I was at Columbia, I got involved in hospital quality work, at New York Presbyterian, which has a bunch of campuses, and that was something I really enjoyed. But to advance in that area, I probably would have had to go back and get a second degree, which wasn’t something I wanted to do. My second degree, beyond the MD, typically people have MPHs, or MBAs, or some other additional degree to help them progress in that area of the hospital administration. I thought maybe Big Pharma would be a better place because I was doing an advanced imaging at Columbia, so it was an easy transition over into oncology and other liver diseases and drug development. I did that for a little bit.
All along that process, what I found myself doing was always trying to figure out how to innovate, how to come up with new solutions, and quickly try to test them. Big organizations are wonderful. They do really amazing things that require a lot of resources. However, they’re also very hierarchical and slow because of that– that’s when I realized that the happier kind of small environment in the startup world. In New York, my wife, and I invested in real estate, so that gave me some flexibility to bring in income to the real estate and pursue other things I wanted to do. That’s when I started getting involved in different startups. And during that journey I also realized that I have a rare eye disease. That’s what really pivoted me to leverage all of the things I’ve been doing in that process and that journey towards helping in disabilities and creating tools for people with vision impairments.
Gabriella: Because it’s such a heck of a journey and how you’ve combined all these interests and what you’ve learned along the way through all your interests. So, before we get to TNT, which we’re going to talk about shortly. Your current passion of helping people with visual impairments through some pretty innovative stuff, I think there might be some steps in between that we need to talk about a little bit. Because you mentioned when we first met that you had six startups, not necessarily all at the same time, but that you went to different interests before you got to TNT. So, I’m wondering if you could talk about that journey a little bit.
Van Krishnamoorthy: Sure. In radiology, one of the things that I didn’t know when I first started radiology, but became more obvious over time is that a lot of different industries, a lot of areas use imaging. Obviously, our brain sees it because when we see with our eyes and we navigate the world, we just do it so naturally, we don’t really think about it. But the types of research that’s happening in radiology with artificial intelligence actually translates quite easily into other areas. In radiology, the AI work is to essentially create programs and tools that do some of the things that I would have done or I used to do as radiologist. For example, if there’s a CT scan, or an x-ray, or some other imaging test, the software would be able to pick out abnormal areas and come up with a diagnosis, and that kind of research actually translated quite well into the startup work that I started doing.
There’s a company called Enlitic, which basically is creating AI that does what radiologists do. Not to replace radiologists, but because we all have gotten so busy as physicians that we need systems that focuses on to the right tests and the most critical tests. I worked in abdominal imaging. So, someone with a liver transplant came in to the emergency room and liver transplant patients have lots of abnormal labs, very complex picture, and they usually get some kind of imaging. If you have a bunch of those scans when you show for your workday as a radiologist, you want to be able to immediately go to the ones that have an abnormal finding or an abnormal diagnosis. And those kinds of efficiency improvements are what a lot of the AI work is really focused on and it’ll make us better as physicians and radiologists, and the whole team can get to the right treatment more quickly.
That kind of imaging AI work translated well into lots of areas. So, if you go into my time in Big Pharma, a lot of oncology trials, a lot of generally medical trials involve imaging of some kind. A lot of that is actually– part of what makes drug development slow is the systems, the ways we collect that data. The imaging from where it was collected, we check if it’s good quality, we analyze it for the important information, all of that is very human labor driven. And so sometimes you’ll have someone who had a scan as part of a trial and that scan quality is actually terrible.
But you don’t realize that until six months later, when you’re analyzing all the images, whereas if we had some kind of algorithm that would look for quality issues then you could have had that trial participant go back and get their scan again, whereas if six months later is too late, because so much has changed while they’re on the medicine that they’re testing. That’s in drug development and then as you’d mentioned with TNT provisional impairment creating tools that help people who can’t see well or at all, that involves a lot of AI work as well to really create algorithms that will translate what we would see normally, but give that information through auditory or touch. So, I guess the running theme along that is the use of imaging and creating algorithms to analyze that imaging in automated ways.
Gabriella: Mm-hmm. So, in other words to enhance your work as opposed to well– we don’t want to scare anybody–
Van Krishnamoorthy: Right.
Gabriella: [crosstalk] placing physicians and their values to help them get to information more efficiently and more accurately, do you think?
Van Krishnamoorthy: That’s the idea, so even if the accuracy– in some areas for example, if you look at a head CT for someone who’s coming in with symptoms of a stroke and talking a little out of my area, because I was an abdominal radiologist, but if it’s stroke, it’s all about getting that treatment as quickly as possible. You want to try to minimize what kind of deficits they have longer term. People come in with symptoms that look like the stroke quite often and they’ll be a whole list of CT scans that need to be read. But even if the accuracy of an algorithm to pick up, let’s say, blood, hemorrhage in this head CT, which would mean you can’t give them that medication to treat the stroke. Even if it’s not as good as a radiologist, if it can flag that scan as suspicious, that still lets the radiologist in the emergency room look at that scan first. It turns out that that kind of example, AI algorithms, what we’re finding is they’re as good as radiologists because the ability to find something like blood stands out really clearly. It’s an easy example for it to train algorithms.
The other part of that is in developing these algorithms, the good ones, like what Enlitic was doing and is continuing to doing is they use radiologists like me to actually label data. What algorithm that’s actually learning from experts as opposed to and lot of AI was initially built for medical imaging, the algorithm would try to figure out what’s wrong based on a report, so a text report of what the findings were. But that didn’t work very well. The accuracy is really quite poor. But when you have experts actually labeling images saying there’s blood here or there’s something abnormal here and this is what we call it, then the algorithms get a lot better. So, some cases the algorithms are as good as the radiologists, and other cases are not like a chest x-ray. Chest x-rays are really hard because there’s so many things in one image. Algorithms aren’t particularly very good about interpreting chest x-rays.
Gabriella: I’m going to move to a slightly different part of the conversation because you mentioned how one of the themes, I think throughout your work is AI, and technology, and the use of technology in algorithms in improving patient care. You also mentioned that you’ve been in these environments where you said, we’re big, and slow, and bureaucratic, and that you preferred something a little small. So, those are kind of the two themes I’m picking up so far right now in terms of your journey as an entrepreneur and in startups and you’re also in real estate. Do you think there are other unifying themes that help you with TNT at this point or that inform your work with TNT at this point? We’ll get into TNT in a minute.
Van Krishnamoorthy: Sure. I think one of the things which is indirectly enables me to pursue things I’m interested in is having source of income outside of what I would generate through the work I’m doing. The real estate generated income is one of those ways. As physicians when we’re practicing our income is high enough that we can actually invest in areas that bring income back to us and one of the easy or obvious ways is to do real estate. When rental income comes in and you’re able to pay your bills through that then it lets you have the freedom to pursue other areas that otherwise you wouldn’t be able to, because by the time we get through medical school and residency and fellowship, we usually have a family and there’s a lot of bills, a lot of things that you have to address. I think that’s one of the things I’ve found a way to at least fund myself in a way to go after some of these passions, which I wouldn’t be able to do otherwise if I didn’t have that source of income.
Gabriella: That’s a good point to have the multiple sources of income to give you that freedom as you said to pursue other interests and you’ve had quite a few. What I’ve liked about our initial conversation when we first met is that you weren’t afraid of letting something go if something you didn’t like or it didn’t float your boat anymore that you said, “Hey, it’s time to move on.” What was that about for you in terms of being able to let go of something to move on to something else?
Van Krishnamoorthy: Sure. I think one of the things that I realized is that there isn’t necessarily a right answer for everybody. For me I think I probably have some subclinical ADHD. [laughs] When we’re both growing up, there wasn’t even really a diagnosis or if it were there was nothing you could do about it. It wasn’t bad enough that it prevented me obviously from doing well in school and so on. But where it manifests is, if I get really excited and would put really intense effort and time into something, and then when the personal satisfaction and progress starts to level off or hits a roadblock that definitely does affect me I think more than if I didn’t have that sort of what I’m calling subclinical ADHD, not a psychiatrist. I probably shouldn’t diagnose myself.
Gabriella: Let’s call that a dreamer and whatnot.
Van Krishnamoorthy: Yeah, a dreamer. The other part of that too is there’s so many parts of our lives that can be improved. That’s another thing that I find myself is I’m always in just the things that I do every day, I find that there’s ways we can improve things, make them more efficient, more enjoyable. I think it’s a combination of those things like working really intensely and then seeing if the output is enough for me, and then also noticing other areas that might be places I can have an impact, and then trying to balance those, and I think balancing those is probably the hardest part because it’s where’s that line between “giving up versus realizing where you can have the most impact.” The line is always moving. [laughs]
Gabriella: And definitely, as you mentioned other variables in life. There’s families, children, there’s all sorts of other considerations, and so, yes, the line will always move which is kind of a good thing. It’s a natural part of life and that you have the ability and the flexibility to adapt. At the same time, I think as I’m listening to you, I’m seeing this journey of you know what– my overall vision is to improve people’s lives. Would that be an accurate assessment for you?
Van Krishnamoorthy: Yes, that’d be a great way to put it. A lot of us in medicine, even when we were young, we had this innate desire to do good and to help those around us. That’s what took me to medicine in the first place and I think that’s continued throughout. I’m always trying to see where I can have the most positive impact and keep myself interested in the process.
Gabriella: Yes, you have to be passionate about what you do. That’s for sure. Tell us about TNT. What does TNT stand for and how did you get there?
Van Krishnamoorthy: Sure. TNT is Tactile Navigation Tools. I did not create it. It was another physician at NYU who also has a rare eye disease and his symptoms manifested much earlier and so that drove him to try to improve his own standard of living and his ability to pursue things that interested him. That took him all the way to where he is at NYU now and JR Rizzo is his name. He developed a few things. One was an improved version of the walking cane. So, your viewers have probably seen somebody who is severely or completely blind and is swinging a white cane in front of them and that cane kind of acts as a tactile way of them identifying what’s in their path. That basic technology hasn’t changed in hundred years. There’s been minor improvements but essentially it hasn’t changed. So, what JR did is he created a much better version of the cane, which is you could think of it like pushing a lawn mower or pushing a vacuum cleaner. It has wings and wheels on it, so it gives you much more precise accurate information of the environment that the person is walking in. It lets them avoid falls, it lets them detect things in their way, and then indirectly actually flags that person to everybody around them more easily than the cane would, so people will get out of the way as that person is using the device.
He did that. He tested in a small clinical study. So that’s one product. The other product he has been developing, that’s where the AI comes in, where he’s got a backpack with a bunch of sensors on it and the sensors collect things like video, audio, ultrasound, different types of data, and that is fed into the AI platform, which as we train it, it learns different things like, it’s excellent at detecting stoplights and telling you it’s red, green, yellow, telling the person if there’s a walk sign versus the stop sign, because in New York City only a small tiny percentage of intersections have those audible intersections where it tells you wait or walk. So, most intersections are actually quite dangerous for anyone with a visual impairment. We train it to detect different things around the environment and communicate that to the person who’s wearing the backpack.
So, those two devices that he had been working on and is classic research or academic, create these amazing tools and produce amazing data, and then the next step is, how do you get it out to the world, and so, that’s where he brought me on to commercialize. That’s where I leverage some of what I’ve learned in Big Pharma and some of those startups that I was part of. So with the cane, we started taking pre-orders to prove that there’s a market for the cane. That’s one of the first things investors want to know is someone willing to pay for it, and they’ll pay for it before it’s even ready to ship. That’s a great sign. So, now we’re in the process of finding a manufacturer so we can ship those pre-orders and the second product will take more time since it’s a lot more complex product. So, we’re still in the development phase of trying to turn it into a product that people can buy and use.
Gabriella: I think what was fascinating to me as you were showing me the device and we’ll let people know, they can find the information about that on feeltnt.com, and you can see this wonderful tool called DragonFly, which also as you mentioned on the website, and as we talked about before, it helps the person pushing it as you said, it’s kind of pushed like a lawnmower so straightforward and there are wings on the side to help detect what’s going on and to give someone a little bit of burst.
But it also helps decrease any kind of joint pain or discomfort in the shoulder, in the arms, in the wrist as they don’t have to swing it back and forth. This is really a new way of conceiving of such a simple tool. As you said, a tool that’s been around for over a hundred years without any particular changes. For physicians out there who are listening and who would be interested in finding out more about this and interested perhaps in getting their patients access to this tool, how does that work?
Van Krishnamoorthy: Right now, for DragonFly, what we’re doing is the pre-order page is still live. So, that’s one way that an actual family member, or a physician, or someone who cares for a person with visual impairment, or someone who still has some vision can order it themselves. Groups of individuals can go to our page and do the pre-order. But really the scaled part of it once we ship out those first pre-orders, and what we’ve done is built out relationships with various vision centers and non-profits like Helen Keller, and they already have many locations and relationships where they serve thousands or tens of thousands of patients every year. So, we’re going to work through them to get the cane out. We don’t want it to be difficult for someone to find the cane. We would rather get it out there in the world through these channels that are trusted by various patients already.
Then the other kind of one group that I think is probably the most underserved is the pediatric population. For the obvious reasons, it’s more vulnerable population. They’re usually living under the care of parents. I think that segment where, for example, as we’re able to really keep a baby alive at younger and younger birth ages that is leading to more deficits. So, auditory, visual, or other impairments, and so that segment often has multiple impairments, not just one. So, it’s not just vision or not just auditory, it can often be both as well as cognition. So, those patients I think really the best way we can serve them is through these clinics and services that are targeted towards that segment, and it’s more complex whenever you have family members as well as the patient.
But the great thing about the pediatric population is that, kids just explore the world. So just anecdotally, we had DragonFly and we had some kids with multiple impairments try out DragonFly and either they went from being really timid with exploring the world around them to just running and pushing it around and figuring out where the next step was or if there’s some big obstacle in the way. Because kids aren’t afraid. They’ll explore whereas we adults, we look at something we’re like, “Oh, there’s ten obstacles in my way. Let me try to go around it,” whereas kids will just go through it. The DragonFly really kind of enables that. I mean that’s anecdotal at this point, but that’s a segment that we’re really excited about helping.
Gabriella: That’s excellent. So, I’m hearing medicine to using those skills in different arenas. Are you still in practice at this point?
Van Krishnamoorthy: I’m not. When I first left to pharma, a lot of pharma companies actually– the big pharma companies who require physicians to be full time and they consider it a conflict of interest to practice which makes sense. Because if you’re providing care at a site and then that site is also part of a trial, then in a sense, there’s a conflict of interest there, and so that can make the data a little bit more questionable. So, a lot of companies will say, “Okay, you can be part of the company, but you have to either stop or limit your clinical care.” So, since then I haven’t been doing radiology. So that’s been one sort of taking me in that direction. Then as far as administrative medicine that once I’ve decided I want to pursue an additional degree, I haven’t really gone into that area. In the startup world, it’s less of a pedigree and more of what you actually do with your skills.
Gabriella: So, you don’t need an MBA to start anything out. You could just go and trial and error your way through it which is probably the best teacher.
Van Krishnamoorthy: It puts kind of a fire under you, because when you make the transition from you know, it’s a joke. We would say, the golden handcuff of a physician salary, it’s high enough that it locks you in some ways to where you are and makes you more risk averse. But so, once you give up that golden handcuffs and you’re surviving off of other sources of income or investors who believe in you, and you’re paying yourself in part through those investors then you really have that fire under you to try to succeed and try to keep innovating and pivoting because you don’t have that handcuff anymore. Survival is a lot more dependent on what you do and what choices you make. So yeah, I think that is a great way to learn.
We as physicians we’re a little bit, I’m drinking my own Kool-Aid I guess, but by becoming practicing physicians, we’ve already learned how to take so many sources of data often conflicting and confusing, and putting that together in a cohesive picture, that’s literally what we do when we practice. In some ways I think physicians are primed to be entrepreneurs because they already are able to do that. When you want to create something, there are so many things that you have to factor and many of which you haven’t even realized exists until you start doing it. We’re just naturally good at that. We’ve spent over a decade [laughs] to learn how to do that. I actually think we’re just a great source of entrepreneurs.
Gabriella: And so combining skills that you have honed in over the years even as a doctor as you said, the basic skills being able to have conflicting information together in a cohesive picture, and then moving that forward into different endeavors, different interests, and you still have that passion of impacting lives. So, it’s still medical practice perhaps in a different way, perhaps seeing it in maybe a less conventional way, but you’re doing that and DragonFly is such an exciting development. I’m in love with it.
The minute you talked about it, it’s like, “Wow, this is so amazing,” and to really look at giving access to the world in ways that perhaps weren’t thought of before combining all the skills that you have acquired over the years and accumulated over the years and having the real estate to support you throughout this process. Perhaps, do you think that having a separate source of income, a passion to guide you, the skill set of a physician–, the intangible skill set of the physician combining those three, I think make for a good entrepreneur?
Van Krishnamoorthy: I believe so. It worked so far for me. I still need that one big exit to have that hat that says I had an acquisition or an IPO, but I’ll get there. [laughs]
Gabriella: I think you will. [laughs] Persistence is key definitely. The backpack will be out. When do you think that that’s going to start?
Van Krishnamoorthy: That’s a good question. I think what we realized or I should say my vision on this is, and the word ‘vision’ always makes me smile, because I’m doing vision work, but anyway, it’s a little bit of a pun for us, is to get DragonFly out and have sales grow, and I think that’ll enable us to raise a venture capital round. Angel investors are amazing. They get you started, but you need something with more stability, and that’s where venture capital comes in. Once we raised that round, I think we can package what we call Sensory Halo, the backpack into a commercial product, and right now it looks like a lab product with wires and [laughs] we need to make it look attractive and easy to wear. That’s my long answer to say, I don’t know yet. I think we’re probably looking at a year or two before we can start taking orders on Sensory Halo. I want us to be on a good financial footing by showing that we can grow sales with DragonFly before we kind of overpromise and underdeliver, I’d rather we do the opposite and overdeliver.
Gabriella: Absolutely. So, one quick note because you just brought something very, very quickly. What is the difference between an angel investor and a venture capitalist?
Van Krishnamoorthy: Sure. Some of these terms are quite variable, but for us the way that played out with TNT is that when JR first started thinking about commercializing this before he recruited me, he actually had an angel investor. It was a high net worth individual who put in a sizable amount and was able to get him started on that path of going from a research tool to creating prototypes that could be tested by real world users outside of the clinical research setting. So, an angel investor for us and I think quite commonly is somebody who typically has a real passion for that area, something that connects them. This angel investor had a relative who has severe visual impairment. So, it was a personal connection for that investor.
Typically, they put in some sort of investment once or twice, and it’s to really go from a commercial idea to something more tangible. Whereas as you progress, you grow, you need to be able to pay people to reward them for all their kind of sweat labor early, equity-based labor. For that, you have to raise a more sizable round and also from someone, or some organization, or institution, or company that can continue to invest as you hit milestones. In the startup world there’s typically a venture capital firm because when you raise a certain round, you hit certain milestones, then you go for the next round. That path has been well laid out and used throughout the world. So, you’re seeing it more and more in New York City. New York City is now a top five place for tech startups. It’s something has been done for over a decade in Silicon Valley and in San Francisco. So, it’s a very familiar path.
Venture capital funds raised the money often from angel investors and from healthcare organizations and from companies whereas an angel is directly investing into that startup or that individual who wants to create something. It’s like writing a grant every six months is the equivalent of an angel investor versus if you get something sizable enough that you can stay running for two, three years as you hit milestones that would be venture capital investment.
Gabriella: Well, thank you for that clarification. I think that helps a lot for our potential physician entrepreneurs out there listening. Dr. Van Krishnamoorthy, thank you so much for being our guest today. I learned a ton, and I have no doubt that our audience will too. Thank you and all the best with TNT, and in fact, the website is feeltnt.com. If anybody is interested in checking out DragonFly, I think this is really going to make a huge impact on the lives of so many people. So, thank you, again, for all that you do.
Van Krishnamoorthy: Thank you and thanks for having me.
Jen: Other jobs, you can ask your boss for advice. But as physicians, we’re expected to have all the answers from above and below. Wouldn’t be great if you were part of an online community of likeminded physicians facilitated by experienced coaches who specialize in working with doctors. Because then for every problem that you’ve got, you’ve got several potential solutions from your colleagues across the nation as your secret weapon. If that sounds appealing to you, our program DocWorking Thrive may be just for you. Please check us out docworking.com. It’s D-O-C-W-O-R-K-I-N-G dotcom or email me, [email protected]
Amanda: This is Amanda Taran. I’m the producer of DocWorking: The Whole Physician Podcast. Please don’t forget to like and subscribe, and thank you for listening.