All right. Welcome back, everyone. Please take your seats. We're going to start our next session. It is really my honor and pleasure to present the Basil L. Hershowitz Endowed Lecture to Dr. Marla Dubinsky, who will be speaking to us today on Entrepreneurship in GI. So just a little bit about Dr. Hershowitz and this award. Truly a principal figure in the field of GI endoscopy and related diseases, ASGE honors the late Dr. Basil Hershowitz for his leadership and accomplishments through this annual lectureship. This lecture is presented by the ASGE Foundation and was established through the generous support of ASGE friends, trainees, and colleagues. Dr. Hershowitz led some of the most important initiatives in gastroenterology and endoscopy and reached the pinnacle of academic medicine as a teacher, basic scientist, mentor, clinician, and one of the fathers of modern medicine. In January 1957, he assembled the original prototype flexible fiber optic endoscope. This invention revolutionized the practice of gastroenterology and provided the basis for optical fiber communication in multiple industries. Please join me in welcoming Dr. Marla Dubinsky. She is the professor of pediatrics and medicine, chief of the division of pediatric gastroenterology nutrition, and co-director of the Susan and Leonard Feinstein IBD Clinical Center, all at Mount Sinai Kravis Children's Hospital, the ICAN School of Medicine at Mount Sinai in New York. And she will present this year's 2024 Basil Hershowitz Endowed Lecture entitled Entrepreneurship in GI. Thank you so much for this opportunity and this lectureship. Both of our families are actually from Lithuania, meaning his background as well as mine. So we've got a lot of history together as well. Hopefully I will live up to this honor. So I added a little bit of bedside to boardroom to the title because I think that really elicits some of the lessons learned along the way as we're trying to build our ideas and scale them to help more individuals suffering from chronic GI conditions. My disclosure today is that I am actually the CEO of a publicly traded company called Trellis Health. And I'll talk a little bit about it. It's less about what Trellis is, but more about the journey on how we take our ideas and scale. So what is physician entrepreneurship? Because, you know, how are we able to shape the future of health care delivery and innovation? I think some of the most important points are really how do we adopt ourselves as an entrepreneurial mindset? How do we proactively put ourselves and our ideas out into the open? Are we attracting opportunities, land them and turn them into successful ventures? And can we consider building a startup centered around ourselves or at least on one of our colleagues? And for me, it was my co-founder of Trellis Health, which is Dr. Lori Kiefer, who is really a world-renowned GI health psychologist or gastropsychologist who helped me see a different way of optimizing the management of chronic GI conditions, particularly inflammatory bowel disease. So not to go through the laundry list, but there are 10 essential key features of what it means to have or acquire an entrepreneurial mindset. And you're going to see a lot of yourselves in these, which is why I think physicians, although most of the time folks are saying we're not compatible with being entrepreneurial, I would venture to tell you it's quite the opposite. Creative and innovation have to be willing to be resilient because there's a lot of failures along the way. Vision as well as being goal-oriented, being able to adapt and be very flexible and pivot, understanding the market. Who are you selling to? It's not just about that you have a great idea, but are people actually going to pay for this idea? Can you actually create a business around this idea? And that's where a lot of people get stuck is how do I take it to a point where it actually can be built around a business. Obviously passion, perseverance, and determination takes us forward. Also being able to be problem solvers and resourceful. Again, you're going to see a lot of yourselves in it as physicians, very focused on who the customer is. Who are you really creating this for? Probably the hardest, not the hardest in that we're all leaders in our various roles in medicine, but I'm going to end the talk really focusing on what that means when you are building a team that are not nurses, other physicians, other folks who actually understand the doctor's mindset and sort of take the ability to get people on the bus. Also being able to continuously learn and adapt and develop networking and relationship building. And one thing that I realized is, you know, if you're a good person and you've helped a lot of people and you really build out your network and you've never asked for a favor before, don't be afraid now to actually open up and really tap into your network because it's all about relationships and people want to invest in you as a relationship. What are some misconceptions about doctors and entrepreneurs? So it's felt that the only way a doctor can be an entrepreneur is by running their own practice. Starting a health care business may seem easy for physicians. Physicians who become entrepreneurs are abandoning medicine. Entrepreneurship detracts from patient care and it's all about making money. We say, yeah, it is, but that's okay because it's reality is that I think we all enjoy some financial freedom. So we're actually very similar. We have strong critical thinking and problem solving. We're calm and clear headed under pressure. And I think we have the art of discipline. We gave up a decade or more of our lives to focus on a goal and persevered until we reached it. And as Steve Jobs said, I'm convinced that about half of what separates successful entrepreneurs from the non-successful ones is pure perseverance. Why we can? We're creative. We draw on it every day. We can network. We feel fulfilled by doing good. We love financial freedom and we have our own lived experience that we can bring to try and build our ideas and know that we can innovate health care and patient outcomes. Who better to do this than the individuals who have the lived experience and do this every day? So how can I start a biotech if I don't really want to run it? So you don't have to be the CEO to start your own biotech. You can form, assist in the forming. I'll talk a little bit about what a founder does. The new company, you can help develop the technology and participate in its value creation without having to leave your academic or clinical position. An academic scientist or physician CEO without prior business experience can sometimes be an impediment to raising capital because investors want to invest in experienced people. And just because you're not leading the organization, it doesn't mean you can't participate in shaping its future. And that's something that's really important as a founder who then wants someone else to take the baby on. You're handing your idea to an adopted parent. And so that is really an instrumental relationship about how you as a founder are actually participating in shaping the future of how you want your idea to be disseminated. So what's the role of a founder? Initially, you'll be the sole driving force, as I noted. Most likely, you'll be involved in helping to secure early funding for new venture grants, seed capital from angel investors. You're going to need to identify and recruit an experienced CEO or an experienced entrepreneur who can give you guidance on how to build the business and move the technology forward. By participating in an alternate role, this can better prepare you for the current or subsequent startup options where you may want to assume the CEO role. What are alternatives to taking a leadership role if I'm not going to be a CEO? Well, you can be the CMO. You can be the CSO. You can be the vice president of research and development. You can be anything you want to be. You can be just a scientific or medical advisor. You can sit on the SAB of the company and advise. Or you can just be a consultant and help them when they need it, touch base, and still be involved, but not directly involved in the day-to-day business operations. This is for the women in the room. This is taking a page for what really is characteristic of often type of female leadership. It doesn't have to be women CEOs, but it's certain characteristics that are brought forward that all of us as leaders who do want to lead a company, we need to think about more collaborative, tend to be more capital efficient, somewhat lead with more empathy and caring. They're typically multidimensional and also emotionally intelligent. These are five key characteristics that often relate to female leaders and female CEOs. I tried to take some of those as I transitioned from where I was, a co-founder and an SAB member, and then about a year into the company, been asked by the board to take over as CEO of the company. This is really my lived experience as I talk about this journey. Let's talk about the idea first. How do I take something that I'm really passionate about or build something around that I've been so frustrated that every time a patient has this, I wish it could have been different? How do I take that idea? You want to iron out your ideas first and foremost. You want to protect your know-how, if it's applicable, meaning patent filing, and fund your know-how. I think that's the part where for me it was to bring in some help. I'm going to walk you through how folks helped you decide how you secure funding to bring your idea into the market. Who do you tap into and how do you get the help that you need to even iron out your ideas? For many of us that are at academic centers, it's about actually connecting with our tech transfer office. You discuss your idea. They're there to tell you it's not quite ready. You need to do this. Maybe there's a company that I think would be interested in licensing your idea as opposed to starting a whole new company around your idea. They're really going to help you and they're also going to help bring in a new investor. That's really what they'll actually be able to help you. You have to know that they have their own policy when you come on that your ideas are owned by where you work, particularly in the academic setting, which is why our tech transfer office is really where you're going to go to even see what is possible. When it comes to your idea and protecting your idea, knowing your timelines are really important because you would work with your tech transfer office to talk about your idea. They'll hook you up with the IP lawyers and start mapping out what does your patent, how do you protect your know-how and ensure that the application actually reflects your method and it's not spun in a way that it doesn't give you the ability to even file a patent. Knowing all the patent guidelines and knowing your timeline because provisional is fast, but it's very variable on when your patent is issued with a patent number. I'm just going to show you a little bit about how the story went for myself and Lori as co-founders. For my frustration and my passion was that I really believe that care for IBD patients begins the second they leave the office. That 15 minutes of just checking their refills, seeing how much blood they're having in their stool, how many stools they're having, does not address the day-to-day burden of these chronic GI conditions, particularly with a very high mental health comorbidity tied to IBD. I figured out pretty early that the cost of IBD, not the medication, but the cost of IBD was really driven by the high mental health comorbidity that is in addition to a chronic physical complex condition. Lori Kiefer, who had been doing a lot of work with IBS and the functional disorders of brain-gut interaction, really helped me understand that what's happening to our patients with IBD is over time, the mental health and stress and worry and anxiety and depression has created now really this ongoing brain-gut axis issue. It's leading patients to behave in certain ways that are what we deem low resilient. I asked her to leave Northwestern, leave the esophageal space and come over. I said, let's focus on creating a way to measure an individual's resiliency and behaviors that they are practicing that are actually disease interfering, leading to all the cost of care that is driving a lot of the decision-making on the health plans, feeling they should sort of deny therapies because the total cost of care is going up. A way that they can do that is by denying effective therapies for our patients. They're focused on the wrong lens and they're focusing on the pharmacy spend and not the total cost of care. I had her build a way to measure somebody's resilience and then develop a playbook to completely empower people and build resilience in individuals with chronic GI health conditions. She did. Over approximately a four-year period, we validated it. Our tech transfer office put us in some incubator programs and really helped us hone in on the messaging. One thing I was clear on is that without the data and a way to associate how an investor was actually going to make money, it doesn't matter how excited I am about what I think is the best thing ever. It doesn't really matter how emotional I am around the idea that it helps people. I need to convince someone who asked to want to pay for it and say, you know what, the way the health care is going, this was like seven years ago, the way health care is going, it's more going in a value-based way. If I can convince an investor that they make money when we save a health plan a lot of money, that to them they can get around because they understand that the US health care system costs are just going up and people are desperately looking for ways to bring outside individuals in to help them save the money. So securing money is always interesting. How are you going to do that? How are you going to get people to actually pay for your idea? At the time for us, we actually went and we listed in the London Stock Exchange and went public rather than doing a traditional VC raise. This was a way to get capital quickly and we raised $45 million to actually get rocket fuel, really, to really launch the company, build the technology, build the team and get out there and really show that there's a business behind value-based enabling, meaning we are a company. We're not providing IBD care. We're not providing GI care. We're not providing any provider. We are solely digitizing and being able to empower individuals with the tools digitally and a plan that actually gives them the support for them to better self-manage because we all know that when patients are better self-managers, not catastrophizing, really in control of their health and becoming an active member of their health care, we actually save a boatload of money. I should note that for us, the money was when we increased someone's resilience, we lowered the hospitalizations in very complex IBD patients by 94%. You can go in and you could actually calculate based on your ROI and what percent savings you're going to save a health plan and then you start delivering on your promise. That was our journey. Not everybody has to have this journey, but I would have to tell you that you all know what happened on March 14th, 2020, COVID hit. Well, on March 13th, the bank account was supposed to receive the money, but the seed investor owned a lab. That's where more of their money came from as they owned diagnostic labs and so they knew that they would be shut down. Who knew that they happened to be one of the only labs in the US that made the preservative for the COVID antigen testing and therefore right in the middle of COVID said we're back in. Anything that's digital, behavioral, emotional, resilience, telehealth, the future of medicine, we're back in. That was quite a story, but I would have to tell you that without Sinai, who as you know, Mount Sinai closed, 2,000 acute care beds. You've seen beds in Central Park. You saw Javits. You saw on the ship that we had patients that Sinai still believes so much in this idea that they actually gave us money to keep the lights on and pay for the people, although they were not getting one ounce of revenue into the hospital. This was really another sign how important it is to connect with your tech transfer and if they believe in you, they will continue to support you along your journey. All right, it's go time. We got the money. Now we actually have to go and deliver. We need to build the team. We need to build the product. You need to build the technology. You need to build the brand. Why should someone believe? You need to build the business. How do you actually make money? Why should you get paid for this and then just go out and deliver? I want to end with something that I think is really important for all of us who are striving for leadership and understanding how to get the right people on the bus. I noted originally that for me, this was probably the biggest growth I had to do, which was to understand how to lead a team of technology, graphic designers, marketing. These are not things that I'm typically leading. I'm leading my fellows, my admin, as I noted, my nursing. I'm able to get a team together, common good, focus on the patient, deliver the best care to patients. I think this was really important for me to learn and understand, was to develop a culture that's just not about having a vision. It's showing your team that you actually know what the vision is and that you can execute. You don't want to accept mediocrity, but you also understand that mistakes will happen. You need to do it well with passion, and people will jump on. I think you want to know, people want to know, is she going to lead me? I may not believe and agree with her decisions, but I trust and respect that she's making the right decisions for the business. In order to do that, we all need to understand how we think. How is our brain wired? What is the preferences of how we lead or how we think? If we understand how we are thinking and the types of people we need to surround ourselves to execute successfully, you will understand how to be more aware and sensitive to how other people like to be led. You'll make more dynamic contributions in the team if you understand that you can build a team around things that you are not so strong in thought process around the way that you'd like to think about things. You will enjoy, obviously, more professionally and personally, but also understanding that how your mind thinks or your preferences doesn't reflect your skills or your ability. It's just, God, after 56 years, do you think I'm going to be able to develop a new way of thinking? This is how my brain is wired. I just gave you my age, but this is how my mind is wired. I have to understand that if I'm going to lead a team of people that may not know how I think. This is what I did. I got a coach to help me understand how my brain thinks. I want everybody in this room to put themselves in one of these four quadrants. Most of us have two. Maya already told me which quadrant she's in. There's a few of you who I can tell you which quadrants you're in, but you can start by thinking about, how do I think? How can I innovate and create and be able to build a team and execute successfully and think about where you live? Most people do have adjacents, meaning most are all right brain or all left brain. There's a few that have a diagonal, that they're diagonally opposite in their dominances. Within each of the left and the right, there are subcategories of how you think. Why is it important for us to know this as leaders if we are going to lead a company into executing? This is not an academic exercise. These are investors. You are responsible to the board and to the investors. It's a publicly traded company. I need to know what my strengths are and what I don't know. These are the qualities of leadership within each of these four quadrants, just having you understand how you can be an entrepreneur. You have to know what you're good at and what you're not good at. That is probably one of the most important things that I can impart on you. There are limitations when you have certain qualities that are stronger than others. Knowing that within these quadrants, you have to be aware that you may have qualities that may render you or actually decrease your leadership skill set. Understanding how you think is how you're going to be successful in taking a business to the market. This is my brain. I wanted to share with you the concept of where I've learned about what I am not good at. As Laurie, as a noted gastro psychologist says, you have selective empathy. I thought, God, I can never be a CEO because I don't have enough empathy. Then my coach said, you're not head of HR. You're not a teacher or a social worker. CEOs should not be leading with empathy. I felt a little bit better. The idea that it's not really how I'm leading because the team wants you to lead through accountability and competency. For me, the how and the why are my strengths and the what are close by. I knew that I need to surround myself with people who have a different preference in the way that they think and they work. Entrepreneurship, buckle up and enjoy the ride. It is a lot of hard work, but very exciting and rewarding. It is the experience that counts. You are going to fail. Don't be afraid to fail. Know what you don't know more than what you do know. Tenacity, adaptability, and vulnerability. Don't lose sight of what really matters. This, of course, is my family. Thank you.

Entrepreneurship in Gastroenterology

Bedside care

Business acumen

Healthcare innovation

Entrepreneurial mindset

Physician entrepreneurship