Startup Physicians

Finding Your Why: How Physicians Can Build Careers by Solving the Right Problem with Dr. David Johnson

• Alison Curfman, M.D. • Season 1 • Episode 8

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In this episode, I sit down with my friend and colleague, Dr. David Johnson, to talk about his unconventional career path from urologic oncology to health services research, payers, and now healthcare startups. David shares his journey of discovering the misalignment in healthcare incentives, particularly in value-based care, and how that realization led him to pivot into healthcare innovation.

We dive into the challenges and opportunities for physicians looking to create a larger impact beyond individual patient care, and David offers some powerful insights on how to transition into startups, healthcare policy, and business. If you've ever wondered how to apply your medical expertise to solve systemic problems in healthcare—without giving up clinical practice—this episode is for you.

Dr. David Johnson was raised in North Carolina and stayed in-state for his education, earning an Economics degree from Duke and completing his MD/MPH and urology residency at UNC. His passion for improving cancer diagnosis and treatment led him to a fellowship in urologic oncology at UCLA and health services research through the National Clinician Scholars Program, where he discovered value-based care as a bridge between clinical practice, public health, and economics. He returned to NC as Medical Director of Value Transformation at BCBS NC, leading specialty value-based care initiatives to align financial incentives with high-quality, efficient care. After nearly three years, he joined Rubicon Founders to build provider-led health services organizations that transform how healthcare is delivered and paid for.

 

Episode Highlights:

 [00:48] Kicking off the conversation with Dr. David Johnson and his unique journey in medicine and healthcare innovation.

[01:53] How David discovered his passion for urologic oncology and realized that some surgeries might be doing more harm than good.

[05:47] Discussing how financial incentives in medicine often reward procedures rather than patient outcomes.

[09:21] How an introduction to Patrick Conway at Blue Cross North Carolina changed David’s career trajectory and led him into value-based care.

[14:00] The importance of carving your own career and balancing clinical work with healthcare innovation.

[19:17] How David’s work in value-based care led him to healthcare startups and incubating a new oncology company.

[24:08]– Challenging the traditional physician mindset that payers and investors are "the enemy" and instead seeing them as potential partners in healthcare transformation.

[28:40] How to identify the problems you’re passionate about, find like-minded people, and transition into the startup world.

[35:41] Reflections on the startup journey, learning new skills, and staying connected to clinical practice.

 

Resources:

Dr. David Johnson’s LinkedIn: https://www.linkedin.com/in/david-johnson-54308410/ 

Checkout our services at StartupPhysicians.com

If you enjoyed this episode, please subscribe to the podcast, rate, and leave a review. Don’t forget to share this episode with fellow physicians who might be interested in startups. Together, we can shape the future of healthcare! See you next time.

Dr. David Johnson:

Your startups make you one way that you're able to have the impact that you want and to solve a problem that you really care about. It's a very powerful way, if it's done right, but it's not the only way to make an impact from from one to many. And I really encourage people to think about what is the problem that they feel fundamentally very passionate about, that they want to solve, and then find others that are like minded and thinking in the same way, that are doing something about it, and then just have conversations with them and learn about what they're doing, express interest in contributing to that cause, and tell them why it matters to you, what you see day to day in the clinic, and how it affects your ability to provide good patient care, and really be crisp on what it is that interests you and what you want to spend all day working on and all night thinking about.

Alison Curfman:

Welcome to StartUp physicians. Please Like and follow our show to join our community of physicians who are re imagining healthcare delivery. Hi everyone, and welcome back to startup physicians. I'm your host. Dr Allison Kirkman, and I am excited to have my friend and colleague, Dr David Johnson on the show today. Hi David, thanks for coming on. Of course. Hi Allison. Good to see you. Great. Well, David and I first crossed paths when we were both at a firm in Nashville called Rubicon founders. I was incubating the concept for imagine, and we hit it off because he is someone who's fascinating, has a very interesting background and career as a physician, and has gone through a number of different avenues to solve problems that he felt were important to solve. So David, I would love if you could start by just walking us through your journey, how you ended up on such a different place than most physicians do, and kind of your thoughts about, you know, some of those opportunities you had along the way?

Dr. David Johnson:

Yeah, absolutely. I sometimes wonder how I ended up in this type of position as well. So I essentially started my journey in a very typical fashion, going to med school at UNC Chapel Hill, and I was really interested in cancer and doing surgery, and really had no definite path for my clinical future. And ended up finding urology and specifically urologic oncology is something that I found very interesting. It kind of checked all the boxes from what I wanted to do clinically and the types of patients I wanted to take care of. And then, you know, when I learned about urologic oncology, two of the diseases that we treat most frequently, prostate cancer and kidney cancer, we have survival rates after surgery of like 98% and I was like, well, that's that's exactly what I want to do. I just want to cure everyone that I that I operate on. And it sounded too good to be true, and in fact, it ended up being too good to be true. And I later found out that a lot of the cancers that were being operated on with prostate and early, small, localized kidney cancers actually weren't harmful to patients at all, but our surgeries were. And so I found this out, as you know, a third year in med school, and I thought that was really interesting, both from the intellectual standpoint that we could be hurting people that have cancer by doing surgery on them, but it was also, you know, really interesting public health question. And so I took a step back and did my Master's in Public Health at UNC as well, between my third and fourth year, and was really focused on how you separate what's good for a population versus sort of that one on one patient interaction. And so really focused on the concept of, you know, helping patients make really good decisions that are personalized, and assessing their values when making a decision around a preference sensitive condition like localized prostate cancer, and my focus is really on appropriateness of care and quality improvement and sort of matching the right treatment for the right patient at the right time. So I went into my residency and really focused on health services research and outcomes research, but with sort of a slant on appropriateness. So, you know, did some work on the percentage of kidney surgeries that we do on patients for suspected cancer that turned out to be benign tumors. And so basically, these are, by definition, low value services, so we added no benefit to patients. Potentially, maybe we're, you know, relieving some anxiety, you could argue that, but we're causing them harm and cost. And so it's a low value service. It turns out a fairly high percentage of kidney tumors are removed that are that are benign. So this whole idea of appropriateness of care, cost, quality, shared decision making was like the through line of of my residency. And so when I went to fellowship at UCLA to do more health services research and do my urological oncology specialization, I kind of circled back to what I'd actually learned during my public health time, which was actually 2010 when the. Was coming out. So all this new promise of, oh, this value based care movements kind of start changing the way we practice, changing the financial incentives. And so here I was, like, seven, eight years later, and there was really nothing in the way of value based care for specialists, other than maybe the bundle payments for joint replacement. And so I think the thing that really interested me the most around that time, and what guided what I did for my research projects, and then what's led me to my first job out of fellowship, was the concept that the thing that needs to happen first, the things that the thing that needs to change first, is financial incentives need to be changed for specialists so that we're rewarded for delivering high quality care at a lower cost, not necessarily for doing sort

Alison Curfman:

of more, doing more and more surgeries. Yeah, yeah. Prostate cancer

Dr. David Johnson:

is the sort of the prime example for that, which just also happened to be my clinical interest. And so I just found that sort of the right mix of value based care my clinical interests, and merging those together was what I wanted to focus my time on in fellowship. And so did a research project that was looking at sort of the financial outcomes at UCLA for prostate surgeries and modeling what would happen if we went from fee for service to sort of a bundle payment construct, and making the case that if we improve quality under a Value Based Payment construct, we can actually improve costs and revenue for the health system. So there's a win win win, patients do better, and then financially, the health system is better off as well, which was in direct contrast to other research studies that I had read that were modeling out actually hospitals do better if patients are sicker and have a worse outcome and come back to the hospital more frequently after after surgeries. There's a really interesting Jama surgery paper about this, which showed, the longer they stayed in the hospital, the more they were readmitted, the better the you know, the hospital does financially and fee for service, the

Alison Curfman:

worse. Yeah, and that's just like such a direct misalignment, direct

Dr. David Johnson:

misalignment. And so I was looking to prove the opposite with what I was doing. So I quickly realized that no one really cared about, you know, a small prostate cancer pilot demonstration project and and so ended up meeting Patrick Conway, who was the former director of CMMI, who was also an alumni of the same fellowship that I did at one of our conferences. And we just started talking about, you know, what I was interested in conceptually, and I was thinking about doing a research hybrid job out of fellowship. And at that time, he had left CMMI, where he had done all sort of the foundational work on Value Based Payment Models for traditional Medicare. His major focus was really on value based care, centered around primary care providers or health systems. And he was then, at that time, the CEO of Blue Cross, North Carolina, and was essentially building a mini CMMI within the, you know, the health plan, which happened to be the state where I grew up in.

Alison Curfman:

And for people that don't know that, CMMI is the Center for Medicaid and Medicare innovation, which is organization within the federal government that focuses a lot on, how do we rebuild payment models and population health models to serve populations better? Yeah,

Dr. David Johnson:

thank you. Yeah. They're really the test bed for these alternative payment models, where they realign incentives and then see what happens in terms of cost and quality, and determines whether that's going to be something that is, you know, codified into statutory regulation in the future or not. And

Alison Curfman:

Patrick Conway is a pediatrician. Yes, we both have that connection with him. And it's interesting how an introduction it sounds like at a conference led to a completely different path for you exactly,

Dr. David Johnson:

and that's precisely what happened. I was talking to him about why I thought value based care was interesting, why I was frustrated as a specialist who wanted to deliver high value care that, you know, it was harder to do that than it was to just operate on everybody. That's how we make money, that's how we're that's what we're trained to do, and

Alison Curfman:

that's how the system is incentivized. The system is

Dr. David Johnson:

set up exactly. And so his response was, hey, I'm doing this thing in North Carolina. We're really trying to innovate. We have a plan for what we're going to do with primary care in our statewide ACO network, but we really don't have a blueprint for how we're going to engage specialists in value based care. And so he said, Why don't you look into coming on as a medical director for specialty value based care transformation? And I met the CMO at the time, Rahul Raj Kumar, who was with him at CMMI, another very innovative physician, and, you know, a thought leader. For in value based care in general, and just a really wonderful person that my future boss, Troy Smith, and a couple other people that Patrick had brought from CMMI who were just brilliant, innovative thinkers on alternative payment models and redefining the financial incentives. And, you know, I was hesitant at first, to be honest. I mean, my dad was a private practice physician in North Carolina, and the payer was always the enemy. Growing up, always antagonistic. It was part of the reason he retired early, just the fighting with insurance companies all the time just gets exhausting. And so my first job out of fellowship took a little bit of convincing my dad that you probably

Alison Curfman:

were not ever anticipating that you're gonna go work for a payer.

Dr. David Johnson:

Never, not at all. And my fellowship mentor, Dr Marc little and is, you know, one of the fathers of health services research, and I think I broke his heart as well going into the payer side. But you know, what I saw was the opportunity to follow what had been interesting to me about this whole question of, Why is it so hard to improve quality? Why is it so hard to do the right thing for patients in our current system? And if my thesis was the first thing that needs to change is the financial incentives, and the only way we can do that is by changing the way we're reimbursed and the types of payment models that we function under a payer was the best place to do that. And I kind of happened into this really interesting situation in North Carolina. You know, that was my first job at a fellowship. Ended up as at a payer, designing new payment models.

Unknown:

Did you have a financial background or an MBA or econ major in college?

Dr. David Johnson:

Because I always kind of found this stuff interesting, but I knew nothing about health insurance. I didn't even know what Medicare Advantage was when I started, which is really, really embarrassing. It's kind of funny. But learning on the job

Alison Curfman:

you do clinical work, you knew what people deal with and what how physicians make decisions and and how the healthcare system works, right? Exactly, exactly. So you're applying your knowledge in a new way to a problem that really mattered to you, right?

Dr. David Johnson:

And what I did do during my fellowship is really dig into sort of the fundamentals of a payment model and sort of a risk contract, just from, you know, desktop reading and understanding what was out there in terms of, you know, population health payment models, episodic bundle payment models, the demonstrations that CMMI had done and other payers had done, and just trying to wrap my arms around what an alternative payment model is and how that can potentially be operationalized in today's world and into clinical practice. So yeah, that was my first stop at Blue Cross in North Carolina. Very

Alison Curfman:

cool. What was next for you? Were you still practicing? I mean, some people, yeah, try and balance the two.

Dr. David Johnson:

When I was negotiating my role at Blue Cross North Carolina, you know, I did my residency at UNC Chapel Hill, and my chairman at the time was very supportive of of all this type of work. And so I got a one day a week clinical position at UNC, where I got, I get to operate. I get to see patients in clinic. I get to do the multi disciplinary Cancer Clinic one day a month. And then I, you know, have I do robotic surgeries with a fourth year resident a couple times a month. And so it's, it's really a perfect blend of being part of the academic department, but sort of bringing something a little bit different than the typical, the typical role. And the interesting thing is that one of my, one of my colleagues at UNC, did the exact same fellowship that I did. I literally took over his patients when he left UCLA to go back to UNC and I came to UCLA as a fellow. He handed off patients to me on July 1. He's doing a pure academic research hybrid job at UNC and so same training, but really this very different path based on sort of a single decision, single sort of chance encounter. Yeah.

Alison Curfman:

I mean, it's like, all about people, you know, and whether you are, are open to conversations and talking about ideas, and when, when you're inspired by things, other people are inspired by things, and you make connections. And I think, you know, I've talked to some other physicians who they're, one of their core messages is, you carve your own path. You may think like, Oh, my only options are clinical 100% or clinical 80% and research 20% or, you know, it's just the thought of operating one day a week and then working at a health plan the rest of the time probably does not cross anyone's minds, because I think you're the only person I know who's ever done

Dr. David Johnson:

that. No, I agree. I mean, I think that's that's the hardest part, honestly, is solving for the clinical piece and finding a place that kind of fulfills the need to do what we train so long to do. I mean, I was 36 when I finished my training. I didn't want to. To stop operating or stop taking care of patients, because I love doing it, but I also felt like there was this opportunity to do something, you know, different and outside of the clinical realm, that I wanted to have it all but, but honestly, I wouldn't have done the Blue Cross North Carolina job if I hadn't had the UNC urology as well. So absolutely.

Alison Curfman:

I mean, I get asked that a lot too, because I still practice pediatric emergency medicine, and like you, I trained for 10 years, four years of med school, three years of residency, three years of fellowship. Yours might have been a little longer, but 10 years to develop a skill set, and especially a specialty that's highly procedural. I get asked a lot like, how much do you need to work clinically to stay relevant clinically and stay up on your knowledge? And I mean, I put a lot of effort into that, and I know you do too, and even though you and I both have very different paths from most physicians, I think the core idea is that you can practice medicine a lot of different ways. And I still very deeply am connected to the work of individually seeing patients. And I feel like when I was full time as a practicing physician, my impact was really a one to one impact. So like I would see a patient, I would impact them and their family, and then moving into this new world of building companies, I felt like I was able to really create a one to many impact. So I am impacting more kids with my ideas, and the ways that I've approached that, and the ways that we've built built systems around that, then, then just seeing individual patients, one at a time,

Dr. David Johnson:

right? Yeah, exactly. I think the those of us that are willing to, you know, take risks like join a payer instead of going full time practice, have this strive to do that, to affect the one to many. And I think it is, you know, it's a little bit disconcerting to not do what you just trained for half your life to do all the time. But I think what I tell a lot of my friends who asked me about my experience and what it's like on the other side, and I think the perspectives that we learn, even starting in med school and that just become ingrained in a practicing physician's mind, of like, what life is like in a clinic is incredibly valuable, because no one on the private equity side or the finance side or the VC side is going to know what it's like to tell a patient that they have, you know, terminal cancer or that that the surgery did not go very well, or that their kid in the emergency room is, you know, not going to make it. We can learn how to do spreadsheets and modeling and PowerPoints, but our perspective on the day to day of a clinical experience and an encounter with other humans is incredibly valuable. And I think there's a lot of digital health solutions. There's a lot of companies that try to do something that haven't incorporated the clinical perspective early enough and end up completely missing the MARC, where a physician with sort of almost any physician who just went through med school and has taken care of patients could have told them very early on that something wasn't quite right, or this, this is not going to fly. And I think that perspective is is sorely missing in a lot of the stuff that you know is happening in healthcare innovation, and why physicians who are willing to, you know, lend their advice and their experience to whether it's a startup, a large practice or a private equity backed platform, we need more physician voices at that table. And so there's tons of opportunity. I think

Alison Curfman:

absolutely. And some of us have to kind of like, get over our biases that, like, payers are evil private equity is evil. Like I had people be like, don't you kind of feel like you sold your soul to the devil, like going to work for private equity? I'm like, No, I feel like I created a company that's impacting 10s of 1000s of chronic kids. And frankly, it works better when you build it in a system where it makes money, because I built it at a nonprofit health system and it got shut down. It ran out of funding, right? So I think that we have to be able to change our perspective and stop thinking in such a siloed way about different aspects of the healthcare system,

Dr. David Johnson:

yeah, and I think that that's a good transition to so how I landed at Rubicon founders, I think it was probably very similar to your experience. You know, I had learned a lot about specialty value based care from my seat at Blue Cross, designing payment models, but also learning about new health services solutions on the provider side that were coming to plans to try to sell what they're what they're doing, and a lot of times, they were trying to sell into the plan to get reimbursement for another transactional thing, whether it was a diagnostic or, you know, a digital management platform. In my mind, I was there's a tons of really amazing, innovative clinical ideas that just don't work that well in feet. For service. It's like moving a mountain to try to get that reimbursed. And fee for service, and it doesn't actually capture the value of what what it's offering. I continue to get more and more exposure to, you know, venture backed or private equity backed health services solutions on the provider enablement side, and got to learn about what worked and what didn't, what were the characteristics of a solution that a payer wanted to buy and roll out in order to become aligned with the healthcare delivery system, as opposed to antagonistic and that's really, in my mind, the goal of the value based care is to have the payer be a partner in delivering the right care to patients and reimbursing appropriately for good quality care. And the way to do that is for the provider or the delivery system to take on some sort of quote financial risk, and that is through an alternative payment contract. Now the the term risk is obviously loaded, and providers shouldn't be taking sort of or they shouldn't be putting their business on their livelihood on the line through a financial contract. That's not the goal. The goal is really to align them and have them be incentivized to deliver better care at a lower cost, more efficient. And to do that, you have to get more upstream and start preventing bad things from happening, start identifying chronic conditions early or exacerbations early, which is not something that specialists spend a lot of time trying to do or thinking about because it doesn't make any sense to do. It's not what we're trained to do. We typically think that's well as primary care's job once they come to us, I'm going to use the hammer that I was trained with to hit the nail when I met the Rubicon founders group. When was that? That was in late 2021, and you know, they were working on sort of a concept of what, how do we move oncology in this value based care direction? And because I had done some work with oncology payment models. At Blue Cross partnered with UNC Chapel Hill to help design sort of a payment model. It didn't work. Actually, my attempt at Blue Cross, North Carolina, to put together a oncology Value Based Payment Model was unsuccessful, and so I sort of had learned from that and knew what we needed to do on the physician enablement side to be successful in oncology, value based care. And so I started out as an informal advisor, and then joined the company full time because the perspectives that I was able to bring, I think, were helping the incredibly talented and smart team that was, you know, trying to figure out what we were going to do in the oncology space, what we were going to either build or invest in. It helped direct their their thinking.

Alison Curfman:

That was absolutely my experience as well. And I think it's worth noting that not all firms are as committed to that as Rubicon founders and Adam Buller and I felt like my voice as a physician was was so valued, it was considered critical when we were building the Imagine model. And I know you and I were, you know, both at Rubicon at the same time, and I really, truly think this is a firm that that cares a lot about getting the model right, and knows that you need clinicians to be able to to create that. So I think you and I were both incredibly fortunate to both have have met each other in that, in that role, but also to work with a firm where they're bringing this wealth of knowledge around value based care and contracting and financial modeling and healthcare economics and and we were able to really bring that clinical side of things to different companies that we were building.

Dr. David Johnson:

Yeah, yeah. And I think, you know, back to the point you made about broadening your your horizon on, you know what, what's out there in healthcare, and not immediately saying health plans are bad. I met a lot of amazing people at the health plan that really are trying to do the same thing that we as clinicians are trying to,

Alison Curfman:

believe it or not, they can be mission driven, and they can be mission driven too.

Dr. David Johnson:

Absolutely, there's just they have a different set of tools and a different perspective on how they can actually do that. And that might appear misaligned with, you know, clinical care, but I agree, there are a ton of people who are mission driven at the plan and who really care about the population of North Carolina, and have been there for 20 years trying to help improve access and affordability to healthcare. Same thing on the private equity side, there's no other way. And so we're very close to launching a physician enablement company in the oncology space, where we're only reimbursed, and we're we only do well as a company if patients have better outcomes, and we're putting sort of the entire business model on the line, and we're putting our money where our mouth is to deliver on those outcomes in partnership with medical oncologists. It's taken, you know, about three years to get to the point where we're ready to launch this company and. To your point, the clinical model has to be

Alison Curfman:

solid, solid, more

Dr. David Johnson:

than solid at this point, like, very evident, like, foolproof, that this is going to be successful, and that's how we de risk companies for launch at Rubicon, as you well know. But I think the idea that a private equity firm over here is the same as a private equity firm over here is very, very different, because you really have to look at not the funding behind the entity. It's what is the entity going to do and how is it going to make money? And in our case, it only makes money if patients do better. And so what is, what better way to align financial incentives than to have a value based enablement company for cancer patients who have tons of needs, who have tons of services that you know are not well reimbursed in fee for service that Community Oncology practices struggle to pay for, and actually often do at a loss because the patients need it. And so if we can flip that financial incentive and make the supportive care services that patients need, a profit center for the practice through value based contracting, and really what it hopefully is going to be able to do is reallocate dollars that are currently going to hospitals for bad outcomes, for patients having a complication or admission or A readmission or unnecessary end of life care, and reallocating that back into the provider healthcare system, delivery system at the practice level for things that patients actually want and need and that are good for patients. And so, you know, I think the long circle is thinking about how these things work from an academic standpoint, the research like, what are the problems that we're trying to solve? What are the low value inappropriate care that happens day to day? That's health services research. We define problems and sort of, we identify them, then going to the plan to try to change the financial construct under which physicians practice, and then coming back around to actually helping physicians be successful in these value based contra contracts, rather, and, you know, relying on those initial, you know, the health services research findings of where is the opportunity to actually, you know, make a difference in outcomes and have that Be, as you mentioned, you know, financially supported, and something that, you know, if we can have it make money and have it be tied to good patient outcomes, then we accomplish that, that win win, and we get providers more resources. We get patients more things that they need.

Alison Curfman:

Yeah, absolutely. I think you and I have, in some ways, very similar paths that we started in a very academic research metrics, focused problem, focused career path, took a crazy veer off, off the path in a way that really was chasing an opportunity, that was an opportunity to make a much bigger impact and to also gain a lot of skills and perspective and look at things from a different angle, and then, of course, crossing paths and meeting each other at Rubicon. And before we started recording, you were saying some very interesting things about you know, both of us have a ton of physicians come to us say, like, your job is so cool. How do I work in startups? And obviously this podcast has been one of my responses to those inbound requests and helping bring inspiring stories to physicians to hear about other ways people have approached things. But I really loved what you were saying about what is your response to doctors who say, like, startups sound cool? How do I work in startups? You

Dr. David Johnson:

know, I think neither of us had the goal or intention of founding a company or working in the startup world or the private equity world. And I think my when I reflect on how I went to the plan and then found myself at Rubicon and founding this company is really the common thread was there was something that I found really interesting, that I wanted to help solve, and that was, if we realign financial incentives to actually reward good quality and delivering efficient health care, could we improve sort of, the experience of both being a doctor and being a patient under that environment? And so I was really pursuing the idea of learning more about that question, and started with research. It then went to being on the payer side, and then ultimately found myself on sort of the founding startup side, just because I was continue to follow a question that I found very interesting. And I think what I what I typically say to people who ask me that question is, you know, startups might be one way that you're able to have the impact that you want and to solve a problem that you really care about. It's a very powerful way, if it's done right. But it's not the only way to make an impact from from one to many. And I really encourage people to think about what is the problem that. That they feel fundamentally very passionate, passionate about, that they want to solve. And then find others that are like minded and thinking in the same way, that are doing something about it. And then just have conversations with them and learn about what they're doing, express interest in contributing to that that cause, and tell them why it matters to you, what you see day to day in the clinic, and how it affects your ability to provide good patient care. What causes you to be burnt out with the fee for service environment and really be crisp on what it is that interests you and what you want to spend, you know, all day working on and all night thinking about, and if it happens to end up that there's someone doing a startup that could use your advice or direction, being an advisor is a great place to start demonstrating your value and just, you know, inherent perspectives that you don't even know you have that are like mind blowing to some of these people doing doing startups and the finance types, and showing your value that way, and then sort of taking on more and more responsibility. Yeah,

Alison Curfman:

it's such an interesting perspective, because when I think about it, starting a startup was not on my, you know, roadmap or bingo card. I would have never, ever guessed that. This is what I would have done. I was following a problem. It was, it was something that was like palpable in my practice, just how hard life was for these kids and their families. And that led me to lead a small program at a non profit health system and and just continue to to press the issue and ask the question like, how can we make this better? And and my involvement and that helped me to really deeply understand these families that we were serving, and even when I mean, you mentioned a payment model that failed like a failure in your career, and we probably learned so much from that. And technically, my my program failed to it lost funding, and it succeeded clinically, but failed financially, and that was exactly the pathway into building the next thing and the one that did work. I love that perspective. I think that I recently speaking to a group of physicians, and I asked them to raise their hand if they could think of a problem in healthcare that affected their patients. And of course, 100% of the people raised their hand because we all feel it. And I asked if anyone had any idea of how they would approach that problem, or a way, a possible solution to that problem. And of course, again, they all have perspective on that. I told them, you're all thinking of a different problem, like you're all coming at this from a very different perspective. I would have never been thinking about benign prostate cancer surgeries. You know that that's a very unique perspective that you had from caring for patients, and you probably wouldn't have been thinking a whole lot about kids with G tubes, but we're all bringing a different set of knowledge and skills and life experience and experience with that human interaction, understanding what your patients are going through and where their challenges are. And I just think you're right that we have knowledge and skills that are can be mind blowing to a different environment, that these people who are working on building companies may have no idea what the problem is or how to solve it from, like, the very detailed clinical lens. So I think

Dr. David Johnson:

the cool part also is the reverse. I mean, I've learned so much about how to take an idea that's clinical and put that into a business model and then actually make that reality. So you're right. I think we contribute in a lot of ways for these health services. You know, healthcare delivery companies where, you know, the product is an experience for a patient and oftentimes for a provider as well. But like the infrastructure and the knowledge to go from a clinical idea to a business like imagine and hopefully, like the one we're launching in oncology, you know, requires a totally different perspective. So it's really fun to partner with, those types of people. And then the other thing I'd say about, you know, startup world is it's not as glamorous as it sounds, as you know, I think, you know, there's a lot of I can be a little gritty, sometimes a little gritty. I've done more Excel and PowerPoint than I ever thought I would do, but it's what it requires at this, at this point of the company's life side, life cycle. And so, you know, we there's parts of every job that that we don't love and that are rote and and the same thing with with startups. But I think having the mission at the center of, you know, everything, everything that we're doing, both with patient care and then also with the sort of, you know, non clinical path that people want to take, making sure that that's, you know, aligned with what you really care about, what you're passionate about trying to solve, and that you're going to end up in a good spot. It might take a while, but that would be my advice.

Alison Curfman:

Yeah, absolutely. And I. I definitely gained a ton of skills spending the time that I spent at incubating, imagine, at Rubicon. And I don't know if you had this experience at one point, they were like, Allison, doesn't know how to pitch. We're gonna do something called, let's do a murder board. I was like, What the heck is a murder like? We're gonna put you in front of everyone. You're gonna talk about imagine, and then we're all gonna, like, attack you. Oh, a lot of fun, but definitely improved my pitching skills. So it's definitely taking on new, new skills that you you don't have when you're in a new environment. But I'm sure you've, you've learned just as much as I have, if not more, from being around people with different backgrounds. So I

Dr. David Johnson:

always say my clinical days are the like, that's the day I know what I'm doing, and then the other days I'm sort of learning of my pants, which is the way I like it. But it does, does take some adjustment, for

Alison Curfman:

sure, that is interesting, because I feel like, super, like, chill and comfortable when I'm in the ER now, because I'm like, Oh, this might my, my, like, very straightforward day. Yeah, yeah, exactly, yeah. Well, awesome. Well, I can include your LinkedIn in the show notes, if anyone wants to reach out to you. I am so grateful for your perspective and your friendship and just the way that we've been able to help each other with our careers. And thank you so much for coming on today, absolutely

Dr. David Johnson:

and thank you and really inspired by what you did with imagine and what they continue to do. And so it's something that we're very, very proud about at Rubicon, and I'm cheering on and helping as much as I possibly can with it. It's a much needed thing in our healthcare world. So thank you for your

Alison Curfman:

thank you so much, and congrats on the company that you're launching. And and thank you everyone for listening today. Again, if you want to reach out to David, I'll put his LinkedIn in the show notes. And I hope this was inspiring to all of you as it was to me that we all we all have skills, we all have ideas, we all have problems we want to solve, and sometimes all it takes is following that problem, and it can lead to interesting opportunities if you're willing to take them. So thanks everyone, and I'll see you soon. Thank you for listening to startup positions. Don't forget to like, follow and share. You.