If you see a patient that's an hourly rate, you can make your hourly rate better and better, but it's still an hourly rate. But if you can do something that can be scaled without your effort, the software program being replicating itself or selling itself passively, that's the economic charm of the entrepreneurship.

You need a level of relentlessness and lack of ego, but also a significant amount of ego. At some point I have no ego in turn, because while we built this, we have failed every year. It's kind of exhausting work time, but you have to have a level of relentlessness. This is going to work out. I have done this before. I've got this because the rest of the team will fall a point if the leader has that.

If you introduce yourself, I'm Dr. Danish. They have a certain definition of a doctor in their mind, a view, a description, a past experience, a history. So that's where they're placing you immediately in that bucket.

It's very hard to walk into rooms as a brown Muslim woman was also young and a mother. Like all of that stacks against you. You almost have to be excellent just to get judged to be mediocre. You have to keep delivering and then after some time you have to have a shift and be like, I have now delivered.

Thank you so much for joining for our backup episode. We just wanted to make sure that we capture one of the things that we are unable to capture in our regular episodes, and that is in entrepreneurship. We have talked a lot about how to implement AI in healthcare, but who are the people who doing it is essentially startups. So I want to be very grateful to say that Danish Bhatti, friend of mine, is going to be able to have a casual conversation. And of course, my best friend in the world and my sister, we call it my twin sister. She's older than me, if you don't know. So Danish, reintroduce yourselves, then Saira, and then Saira ask the first question.

Thank you, Junaid. It's a pleasure to be here. So I'm Danish Bhatti. I'm a neurologist with substitutionary training in mood-borne disorders. My background is also mostly in academia, doing fellowship and then working in university programs, initially University of Nebraska and then recently University of Central Florida. My journey in entrepreneurship is not only helping launch a couple of companies, I've also been fortunate in advising some of the startups in early stages and have been investing as an angel investor at pre-seed and seed stage to healthcare startups and have been fortunate in gathering a very smart group of physician angel investors with which I help review these opportunities, look at pitch decks on a weekly basis and talk about new ideas. What excites me most is all this innovation and the journey and the challenges of finding a solution. Pleasure to be here

Yes, Dr. Kalia, which becomes really weird, you know, if somebody were walking to our family dinner and be like, Dr. Kalia, I feel like there's more of us that will be like, which one, which is a cool, cool position to be in. But coming back, my name is Sarah Kalia. I'm an associate professor of psychiatry. have an adjunct faculty position at UT Southwestern, and I'm the director for the Arizona State Programs, one state program being the Arizona Perinatal Psychiatry Access Line and the second being the Pediatric Psychiatry Access Line. And so my journey was more traditional. I did residency, created my own specialty because my brother went through multiple fellowships and I was like, I'm not doing that. So I'll just create a sub-specialty and just join into that that doesn't require at that time fellowship training. And then I was associate training director for six years. I started the perinatal psychiatry track and clinical service there. was medical director. I launched our neuro-therapeutics that groups, know, subgroup. And part of the issue with training and mental health work or even like, you know, healthcare is that the healthcare system isn't designed to take in sort of the increased workforce. So even within training more and more psychiatrists, reproductive psychiatrists, women's mental health work, the system wasn't absorbing that because it just didn't make sense. So we just kept having healthcare shortage areas and the women weren't getting served. And so I was like, something has to shift, which is where the idea of a psych access program came into be. The system, the plan is, the way it works is you take very limited FDGs, one to two psychiatrist FDGs of reproductive psychiatry, which is what I am, and you spread it across the state. So anyone across the entire state of Arizona can call us, get live access to a reproductive psychiatrist, child psychiatrist, and they will answer your questions. Because the reality is the real psychiatrist in all over America in general is family medicine, there'll be pediatrics. And that was kind of the idea, is how do you take something limited and spread it across so that you come at with a different perspective. We as physicians are trained to follow evidence-based pathways. So what made each of you step outside that standard clinical track, if you will?

So first of all, just to understand where we are in terms of global landscape. Number one, FDA has actually really gone through a complete phase shift within the last six months. Number one, they have changed how you're going to do digital devices. They have removed some of these devices that even requires FDA approval. Number two, software as medical device for AI is now going to have a real world evidence pathway rather than just testing pathway. And they have moved their process from FDA approval in the sense of pre-determined data analysis and results to continuous monitoring, et cetera. And then the last thing, they have opened up pathways from biologics to biosimilars and a ton of stuff that has came through. So when I was going into this journey, my whole point was to learn that, you know, these are what we call transformative technologies and how it's going to change the world it is. So that journey started with, and I always differ to ARC-INVEST. ARC-INVEST is what we actually have at this site. They use AI, AI, AI and Convergence. And I said, what the hell is this? And I realized at that point that this is going to be a transformative technology. What happened was that, that I know regulation always catches up. When my journey started three or four years ago, and now by evidence, FDA is also catching up. So going back to this, what we are living through a time of digital transformation, and the reason behind it, call it AI transformation, is that we are gonna see what we thought of standard, essentially, evidence. So in short, the journey started a few years ago when I realized that how we do things is not gonna be how we're gonna do things in the future. So that's my answer. I hope I answered you.

So was entrepreneurship something you planned for or something you got backed into either due to frustration or curiosity?

I'll let Danish answer first because then I'll come back to ABC of my decision process in frame.

Yeah, I stumbled into it. I wasn't thinking about it or planning for it. I was more into education and the way I stumbled into it was going more about education about the healthcare innovation. So as I was inviting people who were working on healthcare innovation, many of them actually are also founders or work with founders or work with startups. I think in America, there's a wonderful culture of universities creating IPs, creating products, launching companies. So I started running into people who were in academia, but also founders or part of startups. And that's how I got introduced to it. But I think now I started doing it more so because partly what Junaid said that it's how healthcare is changing and you feel like you're part of the change in healthcare, you're at the cutting edge.

So the core question was that why choose entrepreneurship when you can make shitload of money as a physician? So first number one, you don't make shitload of money. That's a freaking stupid idea, by the way, because physicians are now basically high on middle class. If that, let's just be honest, it's not gonna provide you with a core backing up. I mean, as a matter of fact, we talked about Sarah, she's in VA, and honestly, I would like to join VA because I really am worried about my healthcare costs in the future. So that's number one. Number two, you do something that is truly passion and purpose, right? Economics is always the factor that will push you. But the purpose is also what's going to keep you there and drive you. Those are two different things. My purpose was to save a life as if you saved a life for all mankind. That's how I based the company. And the idea is that I can save 100 million lives. And that's something I want to do in life. But long story short, what I'm trying to say is that, A, you should have a purpose-driven style, which most physicians do. But what they lack is the vision of the true transformational change that we're going through the world.

So how does uncertainty show up in your specialty or how did your specialty shape how you approach building something?

Yeah, I'm not sure that's necessary, to be honest when I work with entrepreneurs and look at the founding founders or ideas. They're not that many neurologists in this space. You me and Junaid are probably exception to the rule. We see lot more entrepreneurs in oncology, a lot more entrepreneurs in cardiology. So I don't think that speciality have anything unique about what make you an entrepreneur. I think just a quick comment or what Junaid was talking about, about the financial aspects of things. I think there has been a rapid monetary debasement over the last five years and that is gonna continue and accelerate. Dollar has been losing its purchasing power very fast. So two, three million dollars of saving used to be a good thing, a normal thing. So all the neurologists who were retiring used to target two to three million dollars as their retirement target. But as we know now already, that's not enough. So that leads to thinking on how you can scale the results of your effort. So I think that's what I was pointing out earlier is that if you see a patient, that is an hourly rate you can make your hourly rate better and better, but it's still an hourly rate. You can get paid for one hour of your physical effort. But if you can do something that can be scaled without your effort, you know, the software program being replicating itself or selling itself passively while you sleep, while you play, you do vacation. So that's the economic charm of entrepreneurship. And the other thing that Janait was pointing out was that it's the… is the innovation aspect. Some people really like the challenge of solving a problem, building something new. So that's what attracted me to entrepreneurship.

From a data perspective, there are basically two major routes of people who enter entrepreneurship, people who enter early. These are Stanford graduates or MIT graduates who go to YC Combinator, get their initial fund. They're generally founders and co-founders. The second route is the academia route, which you actually, has amazing work done by Saira to actually convince at the level of state to fund a psychiatry line for a subspecialty that did not exist. Insane, like if you really look at the academia entrepreneurship, where you have a purpose which can only be solved within an institutional framework. And she needs a, know, assistant professor, associate professor titles to even talk to governors and stuff, which I don't. So that's the beauty of the contrast. And the last one is me and Danish. And those are essentially people who are, by definition, mentors. What Danish is suggesting is a teacher-mentor mentality. What I'm saying is that the teacher-mentor model comes in as the founder and they come. Of all of the three things, the product-market fit is the most important.

Actually, that's interesting to me that you guys are not crediting neurology at all. Because in my head, I would credit neurology. Because to me, let me explain why, neurology is, to me, a specialty of incomplete data. And you're trained to pattern recognize in ambiguity, which is what you do from what I understand what you do is you are acting without imperfect data. Without that perfect data, you're still acting for adapting. Neurology is also systems thinking in a way that is very much driven into us,

The harder part is to think of the sequence of execution and then to actually go after it and go through it and then, and to keep adjusting. So you try, you kind of develop a roadmap and often what happens is that as you're going along, something comes along and the path stops. And then you have to fork it, find an alternate path, fork it out, go to that next route and keep making the way around that block. So you start with the most direct path, but you end up taking a long way around it, a winding way, because you keep hitting the roadblocks and keep, you know, sometimes they call it a pivot. To be honest, it's not really a pivot. It's just that you knew what your eventual goal was, eventual target was, but you had to keep finding your ways around it to get to that goal because it's never a direct path and execution. But execution is the biggest challenge. So, Junaid, what's your secret, man? And how do you do this, these kinds of executions? How are you so good at building teams and doing these executions? But what's the secret? How do I get better?

So first understanding how the daily world works, right? I mean, if you really look at this, the number one question is always unique answer to begin with and in mind. Where does your end go? Then you walk backwards and then you already know the problem, that's why you're the company. The question is, how do you use the first principles thinking to dissect the problem? How did I get better at it? And I was again, my prayers or whatever, my family's here in front of you that I became the director of Neurizen and director of Stroke. And then what I realized is that you need to understand the whole steps and break it down to every single node and then go walk backwards that how the tree would bear fruit. So each branch needs to be properly examined, confirmed, and then walk backwards again to the roots of the goal itself. So more important question for me is why execution fails? So question for you is. What do you feel like the three biggest reasons of execution failures are and and how do you prevent?

You need a level of relentlessness and lack of ego, but also a significant amount of ego. you know, at some point I have no ego in turn, because while we built this, we have failed every year. I have year at a time, and I can get the funding, your funding shows up six weeks before the last one is going to go out. It's kind of exhausting over time, but you have to have a level of like relentlessness. This is going to work out. I have done this before. I've got this because the rest of the team will fall apart if the leader has that. So it's relentlessness. It's knowing when to bring the ego into the room. A lot of physicians cannot deal with failure that on a level they have to deal with in a startup, not just a big massive failure, but almost a weekly failure that does happen. And then I think there's cognitive habits from medicine that really do help, but there's cognitive habits in medicine that can really restrict you also. So you need to be able to pick and choose cognitive flexibility. Do you have it or do you not?

Absolutely. So, Danish, what do you think in your opinion that you have talked to so many founders and failures and everything, what do think that execution failure stems from?

Um, you know, when we say execution failure, um, there are two elements, right? One is that you execute everything, but you don't get anything from it. Uh, and that's, uh, likely because of jumping too fast or too soon. Um, that balance is very hard to achieve. You don't want to just sit and think too much. You don't want to be in analysis paralysis, but at the same time, you just don't want to jump in blindly without thought for the target or goal at all. The other aspect of execution failure is just not executing at all or the analysis paralysis. I think that probably stems mostly from doubts. Either you're doubtful that you can do it or you can probably tell better about those. You know, there's a lot of issues in physicians. We have a lot of problem about feeling that we're an impersonator or feeling that, you know, we can't do things, you know. The physicians have one of the most highest achievers who are always unsure that they can achieve things. Who are always saying that they can get things done. They are highest achievers.

So number one, do believe that in the running, so let's start initiation problem. So initiation problem number one is imposter syndrome. I agree with you. Number two problem is that of course lack of resources and time. People don't understand that I'm currently doing two full time jobs. One is a clinical work and then the second one is my company. And that is insane to do it. And people, again, I'm grateful to my wife, my family, Saira, etc. Mom, everyone, my brothers, that is, you basically encouraged me. And then lastly, then you actually have founder by definition, a successful founder is by definition is action bias. What do mean by that action bias? No matter how good your strategy is, it is never going to pan out. You are going to say, what the hell was I thinking six months ago writing this?

So what resistance surprised you the most? Was it like administrative resistance to your ideas, peers, internal? Like what resistance took you by surprise as you were going on this journey?

Well, I'm going to divide into three things. Number one, expected industry-based resistance, EHR integrations, large players, cetera, which is common, expected, et cetera. Number two, interestingly, was behavior change is extremely hard. I mean, if you really look through the AI and if you really understand how it's progressing in different fields, there is a significant amount of lack of knowledge, which is one problem. But then more importantly, if you do have a knowledge, the lack of behavior change on that knowledge, which is wisdom. And then the last one is, in my opinion, is that exactly which is a corollary to what we call behavioral change. And then that behavior change does not need to be just for the founder. It needs to be the whole ecosystem around.

I would say very different. Like it's very hard to walk into rooms as a brown Muslim woman was also young. Like all of that stacks against you and a mother, you know. So all of those things start to stack against you in academic rooms and those rooms. I feel like if, you know, if I had a male co-founder with me or somebody like that, it would have made some of these starts easier in many ways to get this money off the ground. You almost have to be excellent just to get judged to be mediocre. And I think that's just part of the resistance internally in terms of convincing people. And so you have to keep delivering. And then after some time that you've been delivering, you have to have a shift in doing, I have now delivered.

As a matter of fact, I mean, and the biggest tag that you have is you're a physician. So no matter what you do, people are not going to think of you as an entrepreneur. Because people basically associate you professionally as a doctor. But long story, I agree with you 100 % that as a female entrepreneur, it is a higher job without a doubt and much more higher job. It's just insanely harder not to discount it. But I think I've seen enough women entrepreneurs, we have supported them like you said about physician.

If you introduce yourself, I'm Dr. Danish. They have a certain definition of a doctor in their mind, a view, a description, a past experience, a history. So that's where they're placing you immediately in that bucket. Okay. So I linked up everything and I gave it my CV and I said, okay, based on my history, my emails and everything, look at my CV and make a recommendation to me. It's like, okay, you have to, you're not presenting yourself as an entrepreneur. Nobody is going to think of me as an advisor or an investor or something like that because my CV is just screaming, oh, I'm a doctor, I'm a physician, I'm a neurologist.