Manan Shah
@MananShahmd
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Acquired an old medical practice. Scaled it nationally at (YC W21) Tweet about building a healthcare startup, allergies, ENT
Fix your allergies for life
Joined April 2014
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Pinned Tweet
Starting a healthcare company sounds like ‘changing healthcare’ but often means answering the phone yourself, learning graphic design, and packaging and mailing stuff to patients yourself.
@telmudic
@ESYudkowsky
A nontrivial part of the value of YC is that we give people a high-status brand under which to do low-status things. Being able to tell your parents "I got funded by YC" gives you cover to do things that don't scale.
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@DrZedZha
It’s only after we build trust that patients can be vulnerable. This is a solid reminder.
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@_amolk
No one tells you in training: ‘lunch break’ means the time you call back 20 patients, answer 50 emails, and do other unpaid work
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@HandtevyMD
@PBCFR
As an ENT can confirm- nothing is scarier than a serious peds post tonsil bleed.
Are they sending whole blood now with EMS?
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@ankurnagpal
food evolved based on the environment. If you’re a manual laborer at a farm in India for hours a day Indian food is probably ok. If you’re a desk worker it’s a recipe for metabolic syndrome.
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We paid our health insurance premium and somehow united says we have no coverage.
I’m a physician- literally work with insurers daily- and I still can’t navigate the system.
Everyone else is totally hosed.
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@bobjherman
Interesting side effect of the ACA’s limit on insurers ability to take only 15-20% profit on insurance dollars, is they decided instead to get into the other 85% by also owning the doctors.
Show me the incentive and I’ll show you the outcome.
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@JSinghDO
Outside of academic centers if you’re a jerk you won’t survive.
Medicine, like every other business, rewards those who are nice/play well with others.
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@alex_valaitis
@chrissyfarr
@Spotify
Happy to see imaging costs going down. If used appropriately this is great. But I worry that broad imaging will just lead to tons of unnecessary procedures.
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@vkhosla
Actually you want your oncologist armed with the advice of the AI that read 5,000 papers, but also the humanity and ability to understand your specific goals of a human and know that all papers aren’t created equally.
The future is a combination.
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@anothercohen
Ent here: surprisingly no one here has said use Afrin.
You can’t use it for more than 2-3 days because it begins to be addicting to the nose, but it works pretty well for a day or two.
Can also use the Sudafed that requires you to give your id. OTC doesn’t work as well.
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@DrCasteelEM
Medicine is a vocational school
always thought it funny people paid so much more for a brand med school
Makes sense for MBA/finance where job ops differ
But anatomy and phys is literally same at every school
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@_ali_taylor
Medicine is vast so hard to be king of all trades- find a Primary with empathy/humility and they’ll get you 90% of the way. If they know good specialists they’ll get you the last 10%.
We do personalized treatment for allergies. It’s a scope we can be the best at.
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Wether docs like ‘preventative scans’ or not, it’s coming.
Sure it will lead to false positives - but I think people just want to know and it *feels* like it helps.
(Also- yes I follow Kim on insta. Don’t judge. She’s a marketing guru)
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Ozempic/Telehealth/ai aren’t dangerous.
Using them *without* a caring provider IS.
I wrote about why health startups need caring providers at the helm to ensure patients are safe.
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Healthcare startups:
Dtc: cacs too high
Employer benefits: companies are cutting
Hospitals: long sales cycles
Insurers: just mean.
Turns out you just have to make something patients want that works. The ‘hacks’ don’t work in this economy.
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lol people are worried about AI making healthcare decisions for them instead of their doctor
Meanwhile some random MBA at the health insurance co has actually been directing what medicine they can get for *years*
@sulmoney
U doctors just went school to have an insurance company just make the decisions for you. < how’s that? LOL
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Our online practice blew past the revenue of our physical location in no time.
The innovation wasn’t zoom though.
It was that we redesigned every part around ‘how can we make this easier for patients.’
It was that simple. But also so hard.
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Everyone detests when their doctor runs late 🤬.
But with only 15 mins one extra patient question can delay the doc.
But if docs keep appointment times long- it takes weeks to see a specialist.
Patients aren’t happy either way.
What is the solution?
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We’re super excited to help more patients get access to the allergy care they deserve!
Congrats
@aakashdotio
,
@MananShahmd
, and team
@wyndlyhealth
on the $2M raise!
Wyndly (YC S21) combines telehealth and direct-to-consumer care to provide personalized immunotherapy treatment plans from real doctors, so you can fix your allergies from home:
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@halletecco
Most of why small practices are being scooped up is due to facility fee versus physician fee changes.
Over 10 years facility or hospital payments have gone up while doctor payments have gone down.
So docs have to join hospital groups to survive. Not always best for pts.
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Fun fact: it’s cheaper for you to see a doctor NOT associated with a hospital.
Google the ‘facility fee’. It’s why hospitals buy those doctors.
Independent docs save the system 💰
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@EM_RESUS
As doctors we’re good at identifying broken bones/tumors/bleeding.
But if you have pain, do the tests to rule out bad things and then stop.
Docs will keep giving meds if you keep ask- but often the rx is worse then the disease.
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@Austen
Wanna get wild?
Google MLR and how a policy aimed at limiting insurer profit lead to them just employing hundreds of thousands of doctors so they could capture their profit too.
Unintended consequences often dominate outcomes of regulation
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The greatest trick insurers ever pulled was convincing the public the doctors and nurses *taking care of you* are the ones who are paid too much
UnitedHealth Chair, Executives Sold $102 Million in Stock Before US Probe Became Public
There’s no indication that the trades were executed according to scheduled trading plans in filings related to the transactions. UnitedHealth said officers and directors must get clearance…
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@KennethCassel
Doctor here- we literally know the cause. Sweat mixes with bacteria and release an odor.
Weird take to say it’s not real.
Certainly could understand some concerns around chemicals in certain deodorants.
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@hubermanlab
I think maybe if you’re going to a primary care. But what does being fit have to do with being good at cancer surgery?
Too easy to judge based on aesthetics. Personally I want a technically skilled surgeon/don’t care about looks.
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How did we get 11K people interested in…allergies?
1) focus on your niche. Answer every question someone has.
2) we spoke simply and clearly.
@garrytan
taught us at YC: No jargon
3) I’m not funny or good at dancing. I was just myself. People can feel authenticity.
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@Sthanu5
Tongue lipoma! Abscess= more inflamed, cav hemangioma=more vascular/purple, mucocele= more often ventral tongue, sialolith- yellow and in salivary glands
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The economics of US medicine need to be reworked.
But maybe cool it with the ‘healthcare sucks’ takes?
Our colleagues are out here doing incredible things.
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@chrissyfarr
Epic lobbies to make it harder for you to have access to your health records. All so they can sell more software.
Hate that your doctor has no access to data from the hospital next door? Thanks epic.
Sure she’s successful- but at what cost.
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The culture of healthcare training is ruining medicine.
We’re programmed to be risk averse. Good for their patients.
But this culture leads to docs taking safe, corporate jobs.
—> MBAs rule the docs, take a cut, and prices rise. Badfor patients.
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Last night I suddenly lost hearing in my right ear. 👂🏽
Seen this with patients thousands of times- but hearing my own kids voices distorted hit hard.
On treatment, low recovery odds but🤞🏽gets better.
Good reminder health isn’t guaranteed.
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‘A healthy person can have 100 problems.
A sick person only has 1’
Trying to remember/empathize as I go through all my patient messages this am and they’re all marked as urgent.
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@sweatystartup
I feel personally attacked 😀
It’s not for everyone- and def not the economic picture it’s sold to be-
but it’s quite satisfying when you heal people.
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@DavidSteensma
Hardest thing in medicine is patients simply want your time- and they deserve a certain amount of it- but hard to explain to someone sick that you can’t call back because it’s family time.
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Had to make an emergency airway on someone this weekend.
The call they made to their kids on the way to the OR ‘this is serious I might not make it’ was gut wrenching.
All went well but immedietly called my parents afterwards. Life comes at you fast.
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@Brendalope
@RunninNP
@_amolk
Real talk my dad is a retired general surgeon and his kidney function apparently shows the years of dehydration.
Probably time for the ‘it’s a weakness to take a break’ narrative to end.
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Almost all doctors love the patients. Hate the payment system. Solve this and your startup will crush.
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Medical practices are essentially SMB’s.
Moat is the medical license/Corp practice of medicine laws.
Used to be the problem was owner had to do the work- but this is changing. NP’s PA’s can help w/ work. And as PE backed groups fail more docs will go independent.
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Medical practice hack:
the receptionist who worked their way up to MA and then biller will be a better office manager than any Stanford MBA.
MBAs won’t sit on hold with United for hours, but hustlers will but also manage multiple millions in revenue
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@DutchRojas
Fun fact- the surgeon likely made more by using cash fee. They didn’t have to pay staff for hours to collect. $ came immedeitly. And you saved. Everyone won.
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The New York Times reached out to us for a quote on allergies!
Years ago we paid PR people to try and get us articles. Didn’t work.
Learned from creators on here like
@chrissyfarr
-if you build content, they’ll come. More below.
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@nealkhosla
If you pay on complexity suddenly every patient is coded sicker.
If you pay on outcomes only the healthy and easy patients get treatment.
You pay based on time and everything gets longer.
Show me the incentive and I’ll show you the outcome.
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I wish my startup gave me ‘passive income’ like the threadbois taking ice baths.
But it’s doesn’t.
It’s hard work and takes lots of hours.
If you love the work it works.
Thankful we live in a place where I can enjoy the hours when I’m off.
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@pbleic
As an ENT/thyroid surgeon I can verify this is a great explanation of dangers.
Even with awareness- we still over screen and I spend a lot of time convincing patients *not* to have surgery. But hard when a radiologist told them they have a tumor.
More isn’t always better.
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Tons of RCM co’s in healthcare. They all suck. Why is that? Just want a billing co that would actually collect…..
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@jareddashevsky
I see a future where it scribes me saying ‘patient needs an albuterol inhaler’ and the AI auto asks me ‘would you like to send via Amazon pharmacy?’ And cvs feels the hurt.
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Hospital signage: take the steps! Stay healthy!
Hospital lobby: 🍫🍬🍬🍬🍬
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@AlpacaAurelius
ENT here: It’s not just the breathing- our jaws developed more when we spent more time eating chewier foods.
Processed soft foods of today don’t help.
But yes- breathing through the nose is important hence worth fixing allergies/sinusitis/sleep
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@bhallcpa
Use this: no lights, encourage creativity, keeps them busy. Just as good as a tablet.
Screens themselves aren’t bad.
It’s that they encourage passivity. We want our kids active in the world.
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fundraising is cool an all- but hearing from patients is where it's at
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@alex_valaitis
@chrissyfarr
@Spotify
Interestingly this paper shows that depending on where the ‘unexpected mass’ is the rate of it being concerning varies highly.
If we can factor this in could avoid unneeded procedures…
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75% of conferences is texting people saying ‘I’m here- wait where are you?’
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Guys I hurt my back deadlifting and Im considering buying a device to help get my socks on.
Is this what 38 feels like!? 🩼
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Media: AI is taking over healthcare!
Reality: everything still done with paperwork
@ALiS0NLAURA
@AbridgeHQ
can we get some help here!?
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@doclauravater
What about the partners that start screaming when the er calls
‘This doesn’t sound like an ent problem!!’
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Startup life: excited all week for my blocked off deep work time.
Ten mins in: emergency that consumes my entire day. 🤷🏽♂️
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Taking a patient to OR *now* who’s supposed to get married at 3PM today.
Usually speed and surgery are a bad combo. But I think I can get bleeding stopped and get him out in time for the tux.
Think I can do it!??? Gonna be a hell of a story.
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Someone tweeted that protein shakes are just adult baby formula and I can’t stop thinking about it.
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We open a clinic and other docs immediately try to intimidate us.
It’s sad we’re all brainwashed like this.
Instead of recognizing if wait times are long patients deserve better access.
We aren’t competing against each other. We’re competing with poor health.
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3am trips to the hospital aren’t awesome.
But it’s incredible I can show up here in the middle of the night and there’s a team here ready/able to help me and my patient
Hospitals are def expensive -but the people in the system are incredible.
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One theme I constantly repeat as a doctor:
We’re good at finding physical findings: tumors, broken bones etc.
But subjective aches and pains? We have no idea what’s causing them and we just trying stuff hoping it’ll work. And often it won’t.
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If we told people 50 years ago the magic we could do here today they wouldn’t have believed us.
Healthcare needs fixing- but it’s still a modern miracle.
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@Dr_RShatsky
Every one worrying about AI practicing medicine
Meanwhile admins with no medical experience are practicing medicine today
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@DutchRojas
Physicians *used* to own practices though. But the ACA capped insurer profits on insurance to 15-20, so they bought up all the docs.
Insurers are now largest employers of docs. And it hasn’t helped costs.
Law of unintended consequences
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Best birthday gift to myself. These are ridiculous.
#muddybites
@tyler_devos
@JeremiahPrummer
@CalebPolley
@i_am_tweetNG
@QueenDTC
@connorrolain
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I wanted to decorate the nursery.
My wife didn’t let me.
She was worried about ‘the kids having nightmares’
Meanwhile, they still don’t know their anatomy.
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I love when biz owners walk around the restaurant. Shows they care and nice to see face behind the place.
This is part of why I’ll always see Pts for Wyndly. I also just like medicine.
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Climbing the grand for a few days. Holding back from tweeting awful entrepreneurial climbing cliches.🧗🏽♂️
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Your healthcare data was hacked by a foreign actor this year
and most people never even heard about it.
Some say ‘meh’ but I have serious concerns.
@christymaginn
Imagine when the prescription history of celebrities, executives, and senior government and military officials are used to blackmail them.
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@halletecco
Healthcare is 1/5th of gdp.
Affects everyone.
System is awful.
Hard problem to fix- but also too enticing not to try.
Thanks for putting out great articles to help us!
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Why focus on allergies for my startup? Because it’s personal. Not sure what my exposure was- but I look scary until the Zyrtec kicks in!
#allergies
#startups
#allergiessuck
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Thanks to
@QueenDTC
for organizing an awesome dinner last night. So sweet to get to see
@babb_sophia
@kdlafrance
@JeremiahPrummer
and other friends in real life!
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Healthcare: we’re changing the world
Also healthcare: this is how we communicate
Points to whoever can recognize this model.
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Medicare Advantage: we’re changing healthcare!
Actuality: it’s just upcoding
They promised us flying cars...
We got an iPhone turned into a Blackberry.
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@halletecco
@Dr_Bugenstein
@jennystojkovic
Fun fact: investor world/whole world is small and how you handle one affects how everyone treats you.
Certainly looks like gender had an effect. But regardless, best to be kind to everyone.
Investors don’t owe you anything.
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I had a choice between becoming bitter- or creating the type of healthcare I enjoyed.
Starting a startup is hard and initially financially scary- but working for the system is certainly harder.
The past few weeks, my social media algorithm has been flooding my feed with physicians wanting to leave medicine. Here are some of the posts I've seen 🧵
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This is incredible advice for young docs.
But terrifying this is what’s required to ‘survive’ our training.
Who will care for you when your old if the smart folks stop going into medicine?
There aren’t enough martyrs for all of us.
Just finished a grueling medical residency 🏥
Supposed to be the hardest years of your life. You age quite a bit (pics day 1 vs graduation)👴
But there are biological and psychological tricks to make it much smoother 🧑🔬
This is how I played residency on EASY mode 👇
🧵
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To avoid potentially life threatening outcomes in healthcare…we rely solely on patients (who don’t have medical training) to remember complex medical disease names or medications. 🤔
Because it’s too hard for EMRs to communicate 🤷🏽♂️
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I handle nosebleeds every day.
Today my little one falls and gets one. 👃🩸
I start wiping it away with a towel. This does nothing-I just didn’t like seeing her bleed.
Took a sec, but I remembered to hold pressure/it stopd
We can’t be our own docs.
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Anyone can climb a mountain- but having a guide showed us the fastest route and best ski lines.
@ycombinator
was like a guide for our business. Cost equity- but helped us get there faster.
If you’re a doc who wants to change healthcare find
@SurbhiSarnaSF
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Roses are red,
Makes me feel blue,
That your care isn’t just
between your doctor and you.
because of this complexity
it's not just what's diagnosed
but often what might pay
your doctor the most. 😢
#HealthPolicyValentines
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@mariots
You’re trying to innovate in one of the hardest and most regulated fields
& competing against massively entrenched insurers
David and Goliath level game. But everyone wants a better healthcare experience and if you can improve insurance - that’s massive.
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@missanabeem
I am a physician. And every time we switch insurance I pretend I will understand the benefits, read the fine print for 45 mins, and then give up and roll the dice.
Hope the family never needs care cuz I have no idea what I’ll be charged.
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People spend days picking the best restaurant based on reviews…
but pick a surgeon because ‘it was on the insurance list’ 🤷🏽♂️
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Funny story. ENTs sometimes implant a magnet into the skull for hearing aids.
A kid we implanted apparently sticks metal stuff to his head and freaks out his teachers who don’t know he’s had surgery. 😂
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@ALiS0NLAURA
@AbridgeHQ
Haha I’m a massive fan of you all.
AI notes sounds great. But scribes/templates do the same.
Nice to have. But not biggest problem for docs.
Burnout is from endless phone calls, prior auths, insurance co nonsense and useless MOC requirements.
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Every few days I’m reminded how much network/luck matters in a startup.
It’s unfair but true.
Part of why we did YC. For first time founders was massive.
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Ran at sea level just now after living at altitude. Felt like I was on drugs.
Can confirm denver is a cheat code.
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The job of an entrepreneur is to "figure it out"
-writing a contract
-negotiating terms
-finding vendors
Even if you've never done it.
But in healthcare there are literally landmines that if you step on you lose your license/hurt humans.
It's not just hipaa 🧨
The issue we’re facing with healthcare, specifically private practice SMBs, is that people took the “here in my garage” advice originally intended for laundromats and vending machines and applied it to healthcare.
What could possibly go wrong.
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Where will our generation go for community when we’re older?
Working with the elderly church/VFW’s/clubs are so important for community.
Not sure our generation has that- and feels concerning. Social media can’t replace in person community.
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