How to Start a Startup

Starting a startup as a physician founder feels a lot like leading morning rounds.

You show up before dawn—fueled mostly by coffee and misplaced optimism—armed with a list of patients (or in this case, problems) you need to solve.

The team is a mix of personalities:

• The eager intern — your first hire, who doesn’t yet know what a cap table is.

• The skeptical senior resident — your co-founder who corrects everything you say.

• The attending — the investor who occasionally rounds with you just to ask, “So when’s the discharge?”

You move room to room, assessing pain points, adjusting the plan, and trying to get buy-in from everyone from nursing staff to family members—all while clutching your Starbucks.

It’s part medicine, part project management, and all controlled chaos—exactly what startup life feels like, just with fewer vitals and more valuations.

From Pager to Pitch Deck

Most doctors never trained to speak in the language of valuations or venture rounds.

We were fluent in empathy, not EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization).

As I continue my clinical work while also teaching healthcare policy and working in one of the country’s oldest venture capital firms, I realized that physicians naturally possess the DNA of founders—we problem-solve under pressure, multitask to absurd degrees, and somehow still remember Mrs. Jones’s A1C trend from two years ago.

But moving into startup land means reprogramming your reflexes.

Instead of ordering a CT, you build an MVP (and no, that’s not a “most valuable patient”).

Diagnose, Then Design

Physicians are built for root cause analysis; our differentials just shift.

Instead of figuring out why someone is short of breath, you’re diagnosing why medication adherence fails at scale or why prior authorizations feel like watching molasses in January.

Good startups begin by identifying friction—something every clinician has in abundance.

Scrub nurses, take note: the chaos in your daily workflow might just be your next pitch deck.

If you’re still in the “but is my idea any good?” phase, apply the same rigor you’d bring to a patient encounter:

• Gather data.

• Prototype.

• Seek peer review.

Remember: in startups, “peer review” means a group of caffeinated engineers poking holes in your assumptions, then sending you a Figma file at 2 a.m.

Clinical Trials of Capital

Once you’ve validated your concept and gotten more than one “that’s clever” from your colleagues, it’s time to raise capital.

Venture capitalists—as I’ve learned from sitting on both sides of the table at NEA—respond to evidence, just a different kind than randomized controlled trials.

They want proof of traction, scalability, and grit.

Your business plan is your protocol, your metrics your endpoints, and your burn rate your hemoglobin.

Keep too much burn, and funders will want to transfuse equity out of you.

The early fundraising process often feels like applying for prior authorization from the world’s most skeptical payors.

You’ll pitch, pivot, and pitch again.

As venture investors like to remind us: the product isn’t your app or your platform—it’s you.

A founder who is coachable, analytically sound, and adaptable will often raise money faster than one with the “perfect” idea but no willingness to evolve.

Clinical humility = founder superpower.

The Round You’ll Never Forget

Every founder remembers their first seed round.

It’s like your first 24-hour call: exciting, disorienting, and full of flawed documentation.

Whether you’re raising $250K from angels or $5 million from institutional VCs, transparency and storytelling matter.

Think of it as consent—if your investors truly understand the risks and still say yes, you’ve done your job well.

And don’t get too hung up on cap tables early on.

Physicians love precision (I once recalculated patient satisfaction scores on my lunch break), but valuation math is more art than evidence-based science.

Your job is to stay credible, not clairvoyant.

Maintain Your Clinical Vitals

Startup life will test your mental and physical resilience more than residency did.

You’ll trade overnight shifts for all-nighters fueled by pitch decks and panic.

Our clinical discipline can protect us here—routine, delegation, and boundaries aren’t luxuries; they’re what prevent your company from flatlining.

Keeping one foot in clinical work, even part-time, maintains empathy—the most underappreciated equity in healthcare innovation.

After all, the best health tech should never forget the warmth of human touch behind every click.

Empathy as a Business Strategy

Every venture capitalist I respect—from Ben Horowitz to Aileen Lee—will tell you: culture eats strategy for breakfast.

As physicians, we’ve already mastered culture creation: a mix of precision, humanity, and triage-level teamwork.

Bring that to your startup.

• Hire people smarter than you (they’ll arrive pre-caffeinated).

• Create psychological safety.

• Listen to user feedback, even when it makes you ache with defensiveness.

When mistakes happen—and they will—treat them like a morbidity and mortality conference: no blame, just learning.

The best founders, like the best doctors, admit when they almost killed the patient—then fix the root cause so it never happens again.

When in Doubt, Round with Purpose

Whether you’re rounding on metrics or milestones, set a weekly checkpoint:

• What’s your hypothesis?

• What changed?

• What needs to pivot?

Build your feedback loops like a well-run ICU team—alive, responsive, and always learning.

Code Startup, Called and Saved

If all this sounds daunting—good.

Starting a startup should feel a little like medicine: messy, meaningful, and filled with uncertainty.

But remember: you’ve spent a career operating under conditions where minutes matter and empathy heals.

You already know what it takes to lead in crisis—now you’re just transferring that skill set from patients to products.

🩺 Kavita K. Patel, MD, MS is a practicing internist, Venture Partner at New Enterprise Associates, and Professor at Stanford University. @kavitapmd