So You Want to Be a Clinician-Entrepreneur?

Amid the surge of emotions as newly minted doctors walk up the stage to receive their degrees—relief, joy, a sense of accomplishment—are dreams of the future. While some might be thinking of landing their dream placements, others might already be charting their way into plum specialisations or charting a path towards department chair. Hopefully, at least some of them are considering becoming clinician-entrepreneurs too, said Professor Lawrence Khek-Yu Ho, Director of the Centre for Innovation in Healthcare (CIH) at the National University Health System, Singapore.

As the director and co-founder of medical robotics company EndoMaster, Professor Ho is one of the few people in Singapore who can claim that title. Born out of a discussion in 2004 with co-founder Professor Louis Phee of Nanyang Technological University, Singapore, EndoMaster is now one of the country’s most well-funded medical technology (MedTech) startups, having raised S$20.5 million in Series B funding in 2017. Clinical trials are underway, and the company plans to launch its first product after obtaining European regulatory approval in the second half of 2019.

A gastroenterologist by training, Professor Ho wanted to develop a robot that could not only see inside the gastrointestinal tract but also perform surgery once inside the patient. Such a robot would not need to make any incisions, reducing the risk of complications and considerably shortening the patient’s hospital stay. However, initial prototypes that tried to reproduce the full functionality of a surgeon’s arms on the end of an endoscope proved to be too complex and unstable.

The Eureka moment for the Professors came during a meal of chili crab, while hosting a colleague visiting from Hong Kong. Instead of trying to replicate the multiple joints of an entire arm, the researchers decided to focus on just a finger and a thumb, similar to a crab’s claw. The simplified design, just a few millimetres long, fit easily on an endoscope.

But stumbling across a good idea is not enough, Professor Ho said. “Our initial idea in 2004 could not be translated, and even after we hit upon the crab idea in 2005, we had a long way to go from idea to innovation,” he said. “That was the time—between 2007 when we started the first animal trials, to 2011 when we succeeded in the first-in-human trials and formed the company—that we encountered failure after failure.”

The basic requirement for taking an idea through to innovation is having a team that is fully aligned and prepared to give it their all, he added.

“The next step, which is where many startups fail, is finding the right investor to help them scale up and be successful globally.”

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Thinking about innovation from the perspective of the investors is something that does not come naturally for many inventors, especially so for doctors who have been trained in a research setting, Professor Ho said. With each round of fund raising, startup founders need to remember that it is not just about how unique their ideas are, but about value creation, value addition and value sharing, he added.

“I think the main limiting factor is that many people don’t know how to create value from their innovations. They think that after they come up with something, they will have buy-in after pitching their ideas. That’s actually very naïve; nobody will believe it if you’re the only one who says it is good,” Professor Ho shared. “You need to be able to tell investors why you can help them get a return on their investment.”

Value creation is particularly important for MedTech startups, where the need to pass rightly stringent regulatory standards and cost considerations for patients mean a longer-than-normal development runway. “Because of these hurdles, a lot of would-be entrepreneurs either drop out or go for the low-hanging fruit,” Professor Ho said.

As the Director of CIH, Professor Ho sees it as his responsibility to help others close this gap and land their first investor. “We have lots of innovation in Singapore and many incubators,” he said. “When we set up the Centre, I realised that it is not our job to become yet another incubator or be an investment fund; there are already too many of them.”

Instead, CIH focuses on identifying the best innovations based on the strongest teams and then connecting them with investors, incubators and mentors so that the technologies will eventually reach the market.

Resistance to the adoption of new technologies is not the only challenge he observes in the MedTech sector, Professor Ho said. Finding good clinician-entrepreneurs is another significant challenge, as the way doctors are trained and selected hinders them from pursuing entrepreneurship.

“Doctors are very intelligent and driven people. Because they are so driven to succeed, they are very competitive and want their career trajectories to be as short and straight as possible,” Professor Ho said. “But what people forget is that the old career trajectory is geared towards retirement by around age 60. People are living much longer now. They may need many career recalibrations along the way and perhaps a broader vision when they start the journey.” 

Past generations of medical students were trained to possess “a kind of tunnel vision” during their residency years with one career path in mind—becoming a consultant, Professor Ho said. Describing today’s medical students and junior doctors as “some of Singapore’s brightest and best with so much to contribute to society”, Professor Ho said it is now time to train the next generation with multiple skill sets.

In parting advice for aspiring clinician-entrepreneurs hoping to successfully navigate the journey from idea to innovation and investment (3I’s), Professor Ho has a list of three corresponding P’s: Passion, perseverance and patronage, which he has learned from his mentor, Mr Philip Yeo, the Founding Chairman of CIH Health Horizons. 

“Passion is essential, but even with passion, what can you do? You need perseverance to overcome the many hurdles. But most importantly, somebody has to believe in you and be willing to pump in money, time and resources. You need a patron to reach adoption,” he shared.

Professor Ho will be speaking at our Investors Night: Accelerating Market Entry in MedTech Investments next week. Our Investors Night series brings together the community of venture capitalists, angel investors, and corporate VCs for knowledge sharing, networking and collaborations.

Investors Night is one of the many events we hold. We bring together great minds across the ecosystem to discuss, share and inspire ideas of innovation in deep tech regularly.