Entrepreneur Rx_Andrew Le: Audio automatically transcribed by Sonix

Entrepreneur Rx_Andrew Le: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hey everybody, and welcome back to another episode of Entrepreneurs Rx. I'm your host, John Shufeldt. With me today is Dr. Andrew Le. Dr. Le graduated from Harvard Medical School. His BA was also from Harvard and he started the company after, we'll get into this in depth, he started a company called Buoy, which the more I read about it and look into it, it is like right up my alley as far as things I'm really interested in. And so this will be a really phenomenal podcast. So Andrew, thanks for joining.

Andrew Le:
Oh, thanks, John. Thanks for having me.

John Shufeldt:
All right. So let's, let's go back, you, first off, how did you end up in medical school? What was your background? And then give us that story.

Andrew Le:
Oh, sure. I think it was pretty typical story. I went through undergrad wanting to be a doctor, you know, first off, so applied straight from undergrad, went straight into medical school. I, my dream was to be a neurosurgeon because I think I'm a bit of a masochist and, and got through three years and then had kind of like a light bulb moment and did a kind of a 180 and in terms of my life path and started a company and have been running it ever since.

John Shufeldt:
So that's really cool. So. You got into what neurosurgery program did you start in?

Andrew Le:
Oh, I actually didn't get into neurosurgery program yet. I was about to apply.

John Shufeldt:
Oh, God, okay.

Andrew Le:
So, yeah, it was my, I finished my third year. I was going to take a year to do a master's in public policy at the Kennedy School. And then I came up with this idea for Buoy and I actually I remember I went to the Kennedy School for a week, two days really. And then in-lecture I got up and I was like, sorry, I can't do this. And I walked out and dropped out of the, the MPP program and started Buoy, ran it for three years on sabbatical from medical school, and then ultimately I had to go back because the school was basically like, you know, either you graduate or get out. And so I, for six months, kind of the team kept going. I was working kind of 18 hours, you know, I'd be 12 hours in the hospital and then 6 hours after work, you know, study or working on Buoy. And then I was able to graduate somehow, I don't know, and then just kept running the business, I never went to residency, and kind of the dream to be a practicing doctor died while a different dream bloomed.

John Shufeldt:
That's really cool. So, so I recently had a neurosurgeon on who left neurosurgery after seven years. She did, she did a medical school residency, practiced for seven years, and then started the company. And it takes, and I don't need to tell you this, but it takes a tremendous amount of guts to do what you did. I mean, because you have your lifelong dream, you know, you go to Harvard undergrad, Harvard Medical School, kind of the bastions of higher education in the US, and then say, the hell with this. You're like Elon Musk, you know, you're starting your PhD at Stanford and walk out the door and say, I have a bigger dream. I have to say, that's pretty cool. Well, go ahead.

Andrew Le:
Well, I was just going to say that's very generous of you to say, but to be really honest with you, there are a lot of risk mitigating factors that I kind of leaned into that helped me reduce the amount of courage that I needed to, to make the leap.

John Shufeldt:
So, so what was at risk? So that's interesting. So for, for example, so I've, I'm literally headed out this afternoon to do an EM shift, emergency medicine shift. And the one thing I always had to fall back on was if this all blows up and it blew up a few times, I could always go back and just focus on practicing medicine and, you know, have a great experience. What risk mitigate? So I was kind of a, you know, the P word in the sense that I didn't take the big leap of faith off the cliff. What risk mitigating factors did you have?

Andrew Le:
Yeah, and I think that there's a conception or there's a perception that you do need to take that kind of big leap. But in my view, it's more about getting started, and I think those are two different things. You can get started and still risk mitigate. And just like you did, John, I mean, your career is incredible and what you've been able to accomplish is incredible. And do you have a backup, like in place, that doesn't make anything you did any less courageous and amazing. So in my world, the way I thought about it was, I could have just finished medical school, and then started the business. But I was very intentional in starting the company before I finished. Reason being okay, let's say it doesn't work out, I can go back, I could, like your line of thinking, John. I could go back, finish my fourth year, apply for residency, and if anyone asks about those three years that I took off, I mean, I could have any number of reasons why I had to take those three years off.

John Shufeldt:
Yeah, a great reason.

Andrew Le:
Yeah. And then I would just go and be a doctor, and that would be my backup plan. And there was actually this really great book, The Originals, by Adam Grant, who's actually an advisor of Buoy, and in the book, he actually describes this decision about where there are founders who either take the leap and basically quit their full-time job, you know, jump into something wholehearted or those that keep their full-time job, but very importantly, they get started, meaning they try on the weekends to validate their ideas, validate their business model, validate business assumptions, and they have a fallback, which is, they can just keep working. And the research actually, if you were to pull 100 people and ask them like, hey, which one do you think is more successful? I would venture to guess that the majority would say the former that, you know, it's the folks that, you know, jumped off the cliff and just said, like, I'm going to do it. But actually, it turns out that the latter is more successful. And the reason why is that they are able to overcome a lot of what kills a business to begin with early, which is they're able to validate their business model, they're able to validate their business assumptions, many, many of which would have killed them had they not figured out where their assumptions were wrong. And so when you think about kind of the pressures of, okay, if I quit my job, let's say I have a mortgage or let's say I have some fixed costs in my life, like the intense pressure to just forget the experimentation that's necessary to figure out how to do it, you just kind of go for it, the likelihood of success while still there isn't mitigated from like a experimentation perspective. Versus the latter that kind of do-or-die pressure is not there, so you actually have the time and the space to incrementally learn and validate up until the point where it's so obvious that your business is legit, that you just go for it. And so kind of the same thing happened to me. For three years, I was on sabbatical, again, I had a fallback. If it doesn't, nothing works out. I just go back to school, and I had no fixed cost, I wasn't, you know, I wasn't married, I didn't have a house. You know, I was like, my fixed cost was zero, essentially. And then after three years, I was like, you know, this is a legitimate business. Like, we can make something really big out of this. So my decision point was either I can go back to residency and the business fails because I left, or I go back to residency in the business takes off and I missed out on this amazing opportunity. So the math was just like didn't work. So I was like, all right, you know what? I'll just stick with the business. But I had flipped over so many cards by then that I had way more information in terms of making my decision. The key, though, was I started and so anyway, sorry, I'll get off my soapbox, but that's like it.

John Shufeldt:
Awesome. So, so I've read Adam Grant before, but I've never even heard of the book the Originals. And, of course, I need to go read that, that sounds awesome. And it's really interesting, I would have thought that burn, the, you know, the burn the ships mentality with literally force, not quite for success but, but basically make, just get built, give you the resistance and perseverance you needed to succeed. But, but you're, but the corollary is true. It takes off a lot of the risk and a lot of things that kill startups is this lack of any lack of any revenue at all, that you can't support yourself or the business, so that's interesting. I've got to go right after you've read that book. So you mention that aha moment when you were in medical school or when you were in your first two days of the Kennedy School of Government, what was the aha moment like? What? What was that wake up call for you?

Andrew Le:
You know, the wake up call was, I guess, multifaceted. But the first one was my, one of my last rotations in, third year was in the emergency room, kind of right up your alley, John. And is that NGH in Boston, and I kept seeing all these patients who were Googling their symptoms and then reading something online and then showing up at NGH, and I was on these like 24 hour shifts. And I still remember at like 2 a.m., I saw a woman with a jammed finger, followed by a guy who had had an ulcer in his foot from a history of poorly controlled diabetes, those had also have become infected, and we had to amputate his leg because he was getting septic. And I still remember talking to the first person and be like, hey, you're fine, like, you should go home. And kind of this almost like, why is this person here? Like they have a jammed finger, and, you know, she pulls out these printouts from WebMD telling me why she thought her finger was broken and why she didn't think we should, that's why she had come in, that's why she had waited, And that was like a 2000 dollar visit that someone had to pay for. On the other hand, you know, the very next person, I'm like, hey, you know, I'm really sorry, sir, if you had come in a couple of days ago, could have saved your leg. He pulls out these printouts from the Internet to tell me, oh, you know, this is why I waited, this is why I don't think he should amputate. And right around then, unfortunately, I had a few family members get really sick. One of them being my dad, he had a mini stroke, TIA, I found out about it months later and he didn't go to the doctor like when he had the TIA and I was like, are you kidding me? Like, why don't you call me? I actually have two younger sisters who are both doctors too. So the guy has like infinite access to telemedicine, like free telemedicine, and well, he paid for it, but like in a different way, the marginal cost. I was like, why don't you call us? And he was like, Y¡you guys were working. Okay, why didn't you Google it to figure out what to do? And he was like, I don't trust what I find on Google. And for me, that was like this emotional aha, where I was like, there's got to be a better way, you know? And so it really just, you know, I was being taught, you know, using up to date, all these clinical papers. And I was like, if you can teach me with my leaky, leaky memory, you can teach a computer program. And if they just gave away the computer brand to the world, people would actually be able to consume care intelligently. And that was the aha, and so I started working on it during my summer going into the Kennedy School, had much the ideas, had the founding team kind of together and started at that, the Kennedy School, and I was like, I don't want to do this. Like I don't want to go write a paper right now. I want to go work on this, like this seems like way more important, so that's how it all kind of happened.

John Shufeldt:
So, so tell me, what is the what's the foundation of Buoy? I have a sense, I've obviously read about it, check the website out. But, but give everybody the background of Buoy and what, what you're aiming to do, what problem do you want to solve?

Andrew Le:
Yeah, and sorry, I should have, like, more cleanly told the story and describe kind of the idea, but.

John Shufeldt:
.....

Andrew Le:
Yeah. So, so the problem that I feel like I really became obsessed with was that the average person, the average patient, the average consumer isn't really able to make their own decision about what is the right next action for them, because they essentially almost have to become like a doctor combined with an insurance expert in real time. So there's this massive knowledge gap that prevents consumers from actually being able to consume and/or shop for care. Because we didn't have like, there's not a course in college or high school that taught you, like when you have knee pain, here's the differential diagnosis, here's how you should think about the knee pain, here are the possible diagnoses, you know, like this is not part of our our educational process. And so what ends up happening is that people, 72% of Americans start their healthcare journey by Googling their symptoms and essentially having to read articles online, regardless of the quality, trying to become a medical student or a doctor about your knee pain in real time is extremely difficult.

John Shufeldt:
While it's hurting you.

Andrew Le:
While it's hurting you, exactly. And you combo that with the complexity of American healthcare with like what's covered, what's not, it's just like it adds to the complexity in a way that just makes no sense. So we built this AI technology by, for four years, we basically locked ourselves in an apartment and did a meta analysis per diagnosis. So literally read the primary literature that roll up into a textbook like a up to date or a ... like and use those primary, that primary literature to build a massive statistical graph of medicine. So one that would understand like, oh, risk factors like smoking increase your risk of pneumonia by a factor of five based on these three papers, pneumonia has some probability based on these three papers. Pneumonia has some correlation with a fever of 90% based on these three papers. And so in building the graph, we could then build an AI program that was not a decision tree, which is how typical symptom checkers were built. This one would actually reason kind of like a clinician could reason where it's like okay, of the tens of thousands of questions I could possibly ask, I have a limited period of time with this person. Which one is statistically most relevant? I'll ask it, patient answers, in real time thousands of diagnoses get re-ranked, thousands of questions get re-ranked in, the next most logical question gets asked. We then launch that in 2017 with the idea that the more people use it, eventually we would get enough data to learn. And actually, that just happened earlier this year. So we've been live since 2017. So five years of data, we now have 30 million users who come to Buoy every single year looking for help on Buoy.com. And we've just kind of hit the threshold of enough data where, as people have used it and they told us what happened to them, where they were headed, what they think, what their doctor ended up telling them was wrong, we could actually learn and improve. And now when we release this newly machine learned algorithm, this means that every single person who sees it, actually, we can incrementally get better. And so that's what we've been doing as a kind of our core product. In terms of the company, generally speaking, we initially were selling to insurance companies and self-insured employers, and now we are actually turning into a marketplace where different services, whether it be digital health companies or over-the-counter products or soon to be brick and mortar doctors who are running their own practice can actually build on to Buoy, where the job of this marketplace is to make healthcare shoppable by the consumer by giving them the tools and knowledge and understanding of what a clinically trained and insurance trained individual would have at their fingertips. So you don't know what's going on, we can help you figure out what the likely differential is. If you know what the diagnosis already is, understanding what treatments are available and how to think through which one to take first, now, it enables a consumer to actually make real decisions about what the best next action is and actually transact that directly on Buoy. So that's where how we're evolving as a business.

John Shufeldt:
Okay, so, so, so I've worked with some other AI tools and I'm a on the board of one of them, that's for our providers actually, one of the things that always challenged me and I love AI, but one of things that always challenged me and I think you answered it, but the question is the relevance of it. So I go on Buoy and I put all my symptoms in and comes back and ask me questions and like you said, reorders the questions based on how I answer, which is AI, which is perfect. And then, and then it gives me, it gives me a suggestion, hey, I think you could have a migraine headache. And then I, I go to this doctor and, and I come back. And now, presuming the physician's right, I say to Buoy, oh, I don't have a migraine headache, I've got X, Y, Z, I have, I .... And the patient type ..... And then Buoy takes that information as if it's true, as if it's 100% accurate and puts it in. The question I have is, I guess, how do you know the outcome was actually the outcome? Because, you're affecting the algorithm and some risk factors, not the algorithm, the machine learning in some respects. How do we know it's true?

Andrew Le:
Yeah. The how do you know is true is actually one of the hardest problems to solve and our view, there's, we have two views on how to solve that problem. One is the law of large numbers.

John Shufeldt:
Yeah.

Andrew Le:
One of the reasons why we've been focused for so long on having Buoy be used by the most number of people of any AI product in this realm is you need the largest sample size. And so we've had tens of millions of users every single year, can use the product. And that, with that sample size, a lot of the, you can see signal from noise essentially with enough data. The other element, which is in development, but not yet something we have live, is this idea that, to your point, John, what is the truth? Is not really the first diagnosis potentially given by the doctor.

John Shufeldt:
Right.

Andrew Le:
It's really, if you like, if you think about it, if we had infinite time as a, as a, as a doctor with our patients, the real truth kind of plays out over until they basically resolve. So either you have like a gold standard diagnostic that you could do, in which case obviously that would be an answer. But otherwise, if there's not a gold standard diagnostic, you would just need the benefit of time to see how the disease evolved, to then ultimately make a call in terms of what the real underlying pathology was. So really, if you think about where the answer lies, okay, is it in the EMR? I would argue no. It's, a bit of the truth as in the EMR, but I wouldn't say the whole truth is in the EMR because hypothetically speaking, let's say a patient goes to you, John, you give an initial diagnosis, they go back to their primary care doctor. It's in a different EMR system. So if you integrate it with a single EMR system or there's not a way to kind of tie those two events together, one would argue that the truth is not in the EMR, is it in the claim data? I would argue also, no. What if a person goes to the doctor, gets an initial diagnosis that gets built to claims, you would argue, okay, well, maybe insurance people stick with the same insurer for two years, so in a two year time frame, you would be able to see what the truth was. Well, if I had debilitating back pain and I went to go see a doctor, I went home and I did the physical therapy that the doctor suggested and I got better. On paper, that actually looks exactly the same as someone who had debilitating back pain, went to the doctor, went home and just lived with the back pain for two years and didn't see anybody. The underlying diagnoses and also like what the outcome was, are totally different, but it's not really captured by claims either. I would argue that the true gold standard truth is either a gold standard diagnostic or what the patient told you what happened to them over a long period of time. And so the way we see about this is like building a longer term relationship with the patient such that we would actually know granularity of like when the resolution happened. And if you have that data, in many ways that data doesn't exist, which is really exciting because then from a feedback perspective, you know, doctors don't really have a report card. You know there's it's kind of hard for a doc to know like across my, my, my panel, was I right or was I wrong for a majority of those cases unless they did kind of circle back. If we could actually provide that data to an individual doc, I feel like that would be game changing in terms of understanding not just how good a doctor is, but for an individual doctor, how they can improve.

John Shufeldt:
Totally. So does a patient, so does the patient, they go on Buoy, they do this AI.driven assessment, do they, do they then print that out or does that go into the medical record? Is there any sort of interoperability with HIEs?

Andrew Le:
Not yet. So that's something that we're definitely working on. One of the use cases for tying into an HIE is much stronger with the build out of the marketplace than it was previously. I think one of the challenges we had was what is the value prop to the consumer in being able to pull down their medical records. We struggled with that value prop for a long time. So now, though, that we have this marketplace being built out, it becomes much more useful to have the medical record. And so that's on the roadmap now that we're evolving as a business.

John Shufeldt:
Right. What has been the biggest challenge that you've faced from the time, you know, we were back in medical school and had your aha moment, what are some of the challenges you face and how did you get over them?

Andrew Le:
Yeah, I would say the hardest external challenge and I want to make that distinction quickly is, the hardest external challenge has been figuring out the business model in healthcare. With the misalignment of incentives between the who provides the care typically, and then who pays for the care. It becomes very challenging to figure out who to align with, when and how. Combo with the fact that most players in healthcare are very large organizations. The sales cycle in healthcare is very slow, and so the pace at which you learn about whether your idea is good or not or whether your hypothesis is true or not, the pace is very slow. So as as compared to, I guess, more typical, let's say, a social network or any kind of direct to consumer business in other industries, the throughput is so quick that you're able to test and learn very quickly, in healthcare sales cycles for payers is multiple years sales cycle for employers, usually 12 to 18 months, maybe health systems 12 to 18 months on the shorter end, pharma a little bit faster. But if you think about the regulatory component, 6-12 months and then what's left become a you go direct to consumer, well, the willingness to pay out of pocket is somewhat focused on certain areas and not others, and so that is in and of itself challenging. And so figuring out the business model, I think, in healthcare is the hardest external challenge that we've been navigating for, for some time. And then I would say the biggest challenge overall through all of this has been an internal one. And that's really kind of overcoming my own imposter syndrome, and my own kind of fear of the unknown. I think being a doctor affords you so much certainty. You know, John, you referenced it, right? Like, you can make a very healthy living being a doctor and knowing you show up to work, you know, you see a certain number of patients, you go home and you have a great paycheck and the world looks at you in a certain way as as a doctor. And starting something yourself or running a business, there's so much more uncertainty, and that uncertainty is both external, but I think the bigger, the harder part is the internal piece of like waking up and being like, should I be doing this? Like, what am I doing with my life? Am I the right person to do this? Like I'm just a doctor? I'm just like, you know, I'm just a med student, I don't know what I'm doing, it's my first job, you know, like a lot of those internal demons and learning how to corral them and overcome them so that you could face every day with courage, you know, you can go after your business with courage is like, I would say, the one of the hardest things I've learned.

John Shufeldt:
Yeah, that's interesting. I used to call them my three, my 3 a.m. ceiling, ceiling fan talks, or I'd wake up and say, I just had a dark night of the soul. And I always go back to this Theodore Roosevelt poem that you probably know called Man in the Arena. And I've only read that it's on my wall, like ten feet away from me, I read it about 10,000 times. But it's funny. I always hear people talk and I'm like, dude, like, I'm the king of imposter syndrome. I'm like, I barely got out. I, you know, I could barely spell Harvard and would never have gotten into it. I barely got out of high school like I'm the king of having the imposter syndrome to this day. And so all these people are like, oh my god, I can't be perfect. I'm like, you know, I'm so far from perfect, and if I could do it, you can do it. But it's funny how many really competent people of which I don't believe I'm one, but how many really competent people have imposter syndrome.

Andrew Le:
Yeah. I actually read this amazing quote from the founder of social capital, Ex-Goldman Sachs exec who owned the Warriors and was kind of the initial leader of SPACs. And he said, you know, he's a billionaire. And he was like, the crazy thing about imposter syndrome is that the more successful you are, the worse it gets. Because with every new thing that you succeed and you're like, oh, should I shouldn't have done that. And so it's kind of like interesting. And it becomes the thing where I feel like one of the big unlocks in life is learning how to manage, and corral, and succeed within, in the face of that imposter syndrome.

John Shufeldt:
Yeah. Or do you let it paralyze you because you can't get out of your own way? And, you know, I'm you know, I always, I always meet people and I would say, oh my god, they're fragile perfect. And it's these kids and young adults who their whole life has just been so scripted and they've just nailed that at every step. And they have a little bit of discouragement and they just totally, you know, they break apart. I'm like, really, this this this knocked you off the rails? Because this to me seems like a normal, you know, before noon sort of thing. And I think there's so used to being, just dead on accurate with everything, they just can't take any sort of adversity. What, what adversity do you have growing up that is, you know, one of the things with being an entrepreneur is resilience, and you obviously have it. What did you what did you have growing up that steeled you for this job, for this role?

Andrew Le:
It's a good question, John, to be honest with you. My childhood was pristine. Like very loving parents. I succeeded at anything. I wanted to try to be honest with you. And yeah, like I was an athlete. And so I learned how to lose and pick yourself back up. But I wasn't an athlete to the extent that like, I personally think entrepreneurs that played sports in college and beyond have a lot of the training in terms of resilience necessary to make it as an entrepreneur because they're able to kind of pick themselves up after something very devastating that they've lost or they've had an injury or they're not able to continue their career, they're able to kind of pick themselves back up and keep going. I didn't have any of those types of life experiences, to be honest with you. What I did have was I had an immigrant story, and so my parents escaped from Vietnam on a boat after the Vietnam War, they almost died multiple times over, somehow made it here, and ever since I was a little kid, they told us their story of how they escaped from Vietnam on a boat with a 50% chance of living. And now that they're here, you know, it was all about like making the most of your, your, your, your opportunity, because you could have just grown up in Vietnam and had no opportunities at the time, now Vietnam thriving. But, you know, at the time that was very much true. And I think that was like a really big driver for me to always take the less, kind of beaten path and say, like, you know what, I'm going to take the risks that I want to take because there's only one life and I'm just going to keep going. And then over time, I think just having the entrepreneurial life I've been in it now for nine years, there's, every single day is really hard. And it's now steeled me to the point where something happens. And for the most part, like, I'm just keep going, you just got to keep running and, and just keep putting in the effort and showing up. That's so I would say I learned more in the, in the act of being an entrepreneur than I did previous to that. And then previous to that, I would say kind of my immigrant story really affected my life decision making.

John Shufeldt:
Yeah, I can imagine. I mean, I always go back to that old saying, fall down seven times, get up eight, because at the end of the day, you know, if you don't get up, you're going nowhere. But I can imagine growing up, sharing that story, you'd almost have to like, wow, I am really lucky. And I have to say, I don't have the same sort of story as I have an oddly similar perspective, I guess you could say. And but I'm like, wow, I'm really fortunate to be here, I am not going to let a day go by where I'm not just trying to kill it. That's, that's a pretty cool modus operandi. Cool. Well, Andrew, this has been great. I really appreciate it. Where can people find out more about you? Because you are truly inspiring.

Andrew Le:
Oh, very generous of you, but you can reach me at Andrew@BuoyHealth.com. That's my email, and then you can also find me on Twitter, Andrew_Le_MD, and you can also find me on LinkedIn. I actually don't know of my LinkedIn handle off the top of my head, but I'm sure if you just search Andrew and actually my last name is pronounced Le. I even mispronounced it myself. But you just find out Andrew Le and Buoy Health and you'll be able to find me.

John Shufeldt:
Thanks, Andrew. So I actually found you on LinkedIn, so you're actually relatively easy. Well, Andrew, this is great. Thank you so much. And we'll have everything in the show notes on how to contact him and Andrew's amazing background. So thank you very much.

Andrew Le:
Thanks, John. Thanks for having me. It was really fun.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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