What are careers like going from academic heme/onc to pharma?

[gbwillner]

Dude, you've gotta be f-ing kidding me.

If any place wants me to do 50 interviews I'd be like f to the NO.

Pretty typical for a prominent institution for such a job. Even at Institution #1 above, it was probably like 20-35 interviews. I agree this was the most I have ever had to do. It represented no less than 5 visits to the institution, with the first 3 days of the first visit being 2 all-day interviews plus giving my talk. I had to interview with EVERY SINGLE MEMBER of the clinical department. I also had to interview with every single member of the research division I was to join. I also had to interview with several members of the hospital leadership, including the president/CEO and others. Subsequent visits were with select staff and researchers that I may collaborate with.

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[gbwillner]

OK, more of the story....

So I verbally accepted the offer from institution #4. I even arranged another onsite visit to get an apartment. Then I only needed to wait for the paperwork to get put together and sent to me. One of my best friends had at the time recently left the institution to take a job at Ohio State, and was wigging out because he accepted a position there, and the contract took like 4-6 months to materialize. He was about to lose it waiting for it to come, thinking there was some sort of conspiracy and they were going to leave him out in the cold and take another staff member after he resigned his current post. I had to talk him down before he torpedoed his new job (it did come eventually). So now it was my turn to sit and wait for the institution to put together a written agreement and send it my way.

And I waited.

And I waited.

While waiting, I kept working as Instructor at my institution. They really were not trying to push me out, but were also not willing to give me the Asst. Prof job and pay.

Then, one day, I get an interesting phone call. It went something like this....

"Hello?"
"Is this Dr. gbwillner?"
"Yes."
"This is [some guy] from [some headhunting group]. Have you ever thought about working in industry?"
"No."
"Would you consider working in industry?"
"I Don't know. I never thought about it. How did you get this number?"
"I can't tell you."
"That's weird. Well, what company are you recruiting for?"
"I can't tell you that either. If you would be interested in working for industry, I can send you some information about a job I was retained to find a suitable candidate for. If you are interested, let me know, and I can tell you more."
"Sure, whatever."

So I checked my email and there was an email from this guy with an attachment. That attachment had a job description, describing the expected roles and tasks for the Medical Director position being hired. It was in my wheelhouse in terms of clinical work and expertise in my field.

I emailed the headhunter back and said that I would be interested in finding out more about the position, along with my current CV. He told me then what the company was- a major, billion-dollar one. They were very interested in speaking with me as soon as possible for the position. Could I be there next week? They would make all the arrangements.

more tomorrow.

 

[SurfingDoctor]

OK, more of the story....

So I verbally accepted the offer from institution #4. I even arranged another onsite visit to get an apartment. Then I only needed to wait for the paperwork to get put together and sent to me. One of my best friends had at the time recently left the institution to take a job at Ohio State, and was wigging out because he accepted a position there, and the contract took like 4-6 months to materialize. He was about to lose it waiting for it to come, thinking there was some sort of conspiracy and they were going to leave him out in the cold and take another staff member after he resigned his current post. I had to talk him down before he torpedoed his new job (it did come eventually). So now it was my turn to sit and wait for the institution to put together a written agreement and send it my way.

And I waited.

And I waited.

While waiting, I kept working as Instructor at my institution. They really were not trying to push me out, but were also not willing to give me the Asst. Prof job and pay.

Then, one day, I get an interesting phone call. It went something like this....

"Hello?"
"Is this Dr. gbwillner?"
"Yes."
"This is [some guy] from [some headhunting group]. Have you ever thought about working in industry?"
"No."
"Would you consider working in industry?"
"I Don't know. I never thought about it. How did you get this number?"
"I can't tell you."
"That's weird. Well, what company are you recruiting for?"
"I can't tell you that either. If you would be interested in working for industry, I can send you some information about a job I was retained to find a suitable candidate for. If you are interested, let me know, and I can tell you more."
"Sure, whatever."

So I checked my email and there was an email from this guy with an attachment. That attachment had a job description, describing the expected roles and tasks for the Medical Director position being hired. It was in my wheelhouse in terms of clinical work and expertise in my field.

I emailed the headhunter back and said that I would be interested in finding out more about the position, along with my current CV. He told me then what the company was- a major, billion-dollar one. They were very interested in speaking with me as soon as possible for the position. Could I be there next week? They would make all the arrangements.

more tomorrow.

I have to say... I'm enjoying this story as it unfolds... it's like academic Squid Game...

 

[gbwillner]

Ok, I'm at an all-day conference today, but will add more to this serial as time permits. Where was I?

Right, the first interview.

I am told to pack warm. A few days before the interview, the CSO calls me and asks me if I like to ski. I tell him I've never ski'd before. He says he will arrange it so that I get a chance to hit the slopes. I get an agenda for the interview. It is not a sprawling list of 30 different faculty and administrators. The agenda looks like this:

day 1.
Arrive in the afternoon. Meet driver in baggage claim. Meet with CSO and other staff for fancy dinner. Check into hotel.

Day 2. Interview day.
1. CSO
2. CFO
3. CEO
4. Current Medical Director of relevant division
5. Lunch with staff
6. SVP R&D
7. Wrap up
8. SIght-seeing tour of city with realtor
8. Dinner with CSO (at his house!)

Day 3. Ski trip at nearby mountain. CSO will take you to the airport.

I will say that it was a bit surreal at the interview, going from meeting with countless Asst Profs in an academic department to face-to-face with the CEO of a billion-dollar company.

The interviews went well and it was nice to get pampered. They went all-out to make it look like they were a warm family, rather than the cut-throat corporate monsters that I expected.

They invited me to come back and gave me immediate feedback (on the trip to the airport)- namely that they wanted to make me an offer and that I was a good fit for them. They said they needed to know if I was interested, and I didn't need to respond now but they expected me to tell them very soon.

With that, I left.

More later.

 

[gbwillner]

More....

The next day, the headhunter called me to see how it went. I told him it went well and I had a good time at the interview. One issue I had was thar the job in the JD (job description) was really to turn their clinical operations with no role in R&D. I told him I would be far more interested in the role if I could do both (I am a physician scientist, after all).

He said he would relay the message and set up a follow-up call with the CSO.

I had to think about my options. Would I take this job over the academic dream job I had in hand? As it was, no. But if I could run the clinical operations AND have a hand in R&D, then isn't this close enough? What would I be missing?

I thought about what the monetary compensation would have to be to get me to leave the academic job. I thought a good line would be 2x.

So I had the follow-up call with the CSO, who formally made a job offer and asked me what I wanted financially. I told him 2x my academic salary. He laughed and said "no." They were prepared to pay between $200k and $250k plus some equity. Because their equity was getting pummeled I basically discounted this from my decision making.

I told him that I would consider the number as possibly satisfactory, but that I would likely be bored unless I could also have a hand in the R&D operations. I was told that they have never allowed this before because these were different divisions in the organization, but they would consider making a special case for me.

As I thought about this, I realized that even with the R&D role, given the same relative compensation, I would not take the job.

The CSO called me back and told me that it would cause a revolution at the company if I was allowed to have a hand in R&D when others were previously rebuffed. Was I still interested in the job?

I said thanks for the consideration, but "No."

 

[gbwillner]

Next chapter in the saga....

A few weeks later, I get another call from another headhunter. I don't know if they share a database or something. I never got a call from a headhunter before, and I get 2 in 3 weeks.

This time, the job is in the Southwest for a promising device manufacturer. It is for Medical Director as well, but of the research division. What else did I have to do? So I agreed to go.

This company was pretty different from the first. They were still a start up but had already gone through 3 rounds of funding and had raised about $100M. They spent years developing their product. Now they needed to develop a clinical research program to find a medical use for their machine.

The interview was a 1-day affair, but was in the town my parents live in. Like the last interview it was a half-day affair of actual interviews, then lunch with the executive team. They had sought me out because of my publications in the space around precision medicine. Just like a silicon valley company, they created the product and then were looking for a use for it. This is not generally a good approach. They wanted me to build a clinical research and trial organization to demonstrate a possible service with applicable intended use could be performed with their device.

I told them it was a tall order but was possible, and it would be fun to create such an organization and develop tests and trials.

They again told me I was a good fit, and offered me the job. They asked me how much I wanted. I realized I did not want this job more than my dream academic job. I also thought there was a high chance of failure. Additionally, the CSO was probably too frank with me, and told me that their goal was to demonstrate value for their machine and then sell the company. They had a 3 year runway and then said I could take my winnings and go on to the next project/company. I saw this as a huge negative, not just because of a low chance of success, but also because I didn't want to move my family across the country (even if my family was nearby) for only 3 years and then likely have to move again.

I gave my now standard response. I said 2x my academic salary. They laughed and said "No." They could pay $200-250k max, plus equity. I was not confident the equity would be worth anything and said, "good luck!" And was on my way home.

To my surprise, now 8 years later, these guys are still around.

 

[ChordaEpiphany]

Additionally, the CSO was probably too frank with me, and told me that their goal was to demonstrate value for their machine and then sell the company.

Am I crazy in saying this is the standard goal of any biotech/pharma startup? At least when I was in the start up space (2015ish), the vast majority of companies couldn't even hope to raise enough money for a phase III trial, so the outright goal was acquisition. This was also the party line in the NIH I-Corps programs for SBIR recipients. Your product is your company, and the customer is big pharma/biotech looking to acquire you or a piece of your pipeline.

Anyway, very much enjoying the saga.

 

[gbwillner]

Am I crazy in saying this is the standard goal of any biotech/pharma startup? At least when I was in the start up space (2015ish), the vast majority of companies couldn't even hope to raise enough money for a phase III trial, so the outright goal was acquisition. This was also the party line in the NIH I-Corps programs for SBIR recipients. Your product is your company, and the customer is big pharma/biotech looking to acquire you or a piece of your pipeline.

Anyway, very much enjoying the saga.

I don't think this is a stated goal. You sell the company if selling the company helps you get to your goal- that goal is to change the medical landscape or add a valuable medical service or product to the marketplace. Selling your company can add more capital to your quest to improve your odds of getting there. Sure, everyone wants to make money, but you can't sell your idea as "I want to make money. Will you buy me?"

 

[gbwillner]

Next chapter...

A few more weeks go by. I get another call from yet another headhunter. This time, when I asked how they got my cell phone number, they actually told me. They had recruited another senior staff member at my institution for this job, and he referred them to me.

This company was a startup, trying to create precision medicine services to rival a new and major bull in the marketplace. They had a lot of money, and were privately funded by a billionaire in Europe. They tried to launch there first but could not get traction, and thought this was because Europe was far behind the US, so they should launch services there. Unlike other US companies at the time, they realized that informatics, computation power, and statisticians were critical to success, so they had an army of both in Europe.

This job was in the South and 3 hrs away from my wife's family (not too far, not too close either). Location was Suburban, and in a master-planned, Stepford Wives-like community. They needed someone with expertise in the field to run the US medical operations as Medical Director.

This sounded interesting to me. Before any of the job searches mentioned above, even during fellowship I was recruited by academic centers who didn't understand the requirements of informatics to this process. These guys really seemed to get it.

I want to pause here and relate, with this experience so far, my thinking about what I saw at the time as the most critical factors to success for industry, and how this weighed in my decision making:

1. Funding. Do they have enough runway to realize the goals of the company? Alternately, will I be left out i. The cold and jobless after a cross-country move after months or a few years?

2. Informatics and computational support. Without this none of the goals can be realized.

3. Ability to still be creative and run research and development efforts, even if only for clinical service development. Otherwise I could just as well go into private practice.

4. Money. It's got to be at least more than the academic job I already accepted, because it was unlikely the job would be more desirable otherwise.

Based on these factors, this job had some appeal. I agreed to go on the interview.

One thing I found puzzling at the time is that I never got an agenda. Even the day before the interview I called and told them I had no idea where I was going or what time to be there. The secretary said, "Don't worry. We will send a driver for you. We will start as soon as you get here."

More later...

 

[SurfingDoctor]

Next chapter...

A few more weeks go by. I get another call from yet another headhunter. This time, when I asked how they got my cell phone number, they actually told me. They had recruited another senior staff member at my institution for this job, and he referred them to me.

This company was a startup, trying to create precision medicine services to rival a new and major bull in the marketplace. They had a lot of money, and were privately funded by a billionaire in Europe. They tried to launch there first but could not get traction, and thought this was because Europe was far behind the US, so they should launch services there. Unlike other US companies at the time, they realized that informatics, computation power, and statisticians were critical to success, so they had an army of both in Europe.

This job was in the South and 3 hrs away from my wife's family (not too far, not too close either). Location was Suburban, and in a master-planned, Stepford Wives-like community. They needed someone with expertise in the field to run the US medical operations as Medical Director.

This sounded interesting to me. Before any of the job searches mentioned above, even during fellowship I was recruited by academic centers who didn't understand the requirements of informatics to this process. These guys really seemed to get it.

I want to pause here and relate, with this experience so far, my thinking about what I saw at the time as the most critical factors to success for industry, and how this weighed in my decision making:

1. Funding. Do they have enough runway to realize the goals of the company? Alternately, will I be left out i. The cold and jobless after a cross-country move after months or a few years?

2. Informatics and computational support. Without this none of the goals can be realized.

3. Ability to still be creative and run research and development efforts, even if only for clinical service development. Otherwise I could just as well go into private practice.

4. Money. It's got to be at least more than the academic job I already accepted, because it was unlikely the job would be more desirable otherwise.

Based on these factors, this job had some appeal. I agreed to go on the interview.

One thing I found puzzling at the time is that I never got an agenda. Even the day before the interview I called and told them I had no idea where I was going or what time to be there. The secretary said, "Don't worry. We will send a driver for you. We will start as soon as you get here."

More later...

And then you were taken to a remote island and forced to play “red light, green light” against other applicants?

 

[gbwillner]

More on Industry Interview #3...

I meet the driver at the airport, and he drops me off at a fancy industrial park where the US company resides. I walk in and meet the secretary, that quickly greets me and takes me directly to the CEO's office. The CEO is a very nice guy, and tells me about the company, it's structure, and what they want to accomplish. Very lofty goals. Our talk is an hour long. He tells me they have been hiring for this position for more than 6 months and had yet to find just one suitable candidate till I showed up. I will say that I was already a bit of a KOL in this field given how early I was in tech development for precision medicine (going back to 2008). Who he was and how he got to be CEO of this company is also very interesting, but I have already spent too much time on unnecessary details.

I then met with the CMO. She was also very nice and gives me an overview of operations, the product, and how services have been deployed. Although she is very personable, it is also very apparent that she does not have a good understanding of the product or service, and that she really doesn't have a lot of experience in the clinical field or in acting as CMO. This becomes pretty relevant later. I think to myself during this interview that this company has everything- except clinical and scientific leadership that understands how this tech and service can be successfully deployed- the very thing I have expertise in.

I briefly meet with the CFO as well, and then the SVP of marketing/sales. Then I get a tour of the facility, and can see for myself how the services and teams work. It is clear to me none of them really know what they are doing. They show the tech to me, and I instantly see all it's flaws and why they must be having a LOT of trouble. They pride themselves in getting their services up and running in record time, but it is clear the service and product are highly flawed.

Then the executive team then takes me out to lunch at a nice steakhouse. It is just a nice lunch at a fancy steakhouse with the executive leadership of the company. And no one else. One thing of interest is that almost the entire C-Suite knew each other from before this venture. They all worked together in the C-Suite of a major national oncology provider network, and apparently were wholly pinched for this endeavor.

After lunch, the CEO asks me to come to his office. It takes him about 5 seconds to get to business- I don't even get a chance to sit down. "We think you are a great fit here and want to make you an offer," He says. "What will it take to get you to join us?"

I tell him thanks, but that I couldn't possibly make any such serious decisions so quickly, without even consulting my family.

"No problem." He says. "Come back next week. Bring your whole family for a weekend on us. We'll talk then. What do you say?"

"OK."

I leave for the airport thinking about what just transpired. I saw though a lot of their issues, even if they weren't stated. Going back to my 4 points for choosing an industry job, these guys met all the requirements. Still, some things were clearly off. They desperately needed expertise to move things forward- the one thing I had (and quite honestly, few others had at the time). I could come in and fill their missing piece of the jigsaw puzzle. Even then, did I want to take the risk, and did I desire this opportunity above my dream academic job (I'm just going to call it DAJ from now on) I had already verbally accepted?

I came home and relayed this to my wife, who to be clear has a very strong voice in any such decision making. I told her how it went, and that I was the missing piece to them having a successful product, in my estimation. However, weighing the pros/cons with the DAJ... I still did not think I wanted this job more. Like the others, I could not believe my luck in the current academic environment to get the offer that I did receive. What really could be better than that? On one hand, this job may not have any research component, but there would be a lot of tech development that I would be responsible for. Not the same, but this would still likely satisfy my scientific curiosity needs. On the other, I would lead medical affairs, and I do gravitate to positions of responsibility. I asked my wife for her thoughts and she was... not super helpful. But this was because her primary concern was not her happiness, but mine; whereas I did not want to sacrifice her happiness for my career either. It was a bit of an impasse for a while.

We did talk it out. A few facts were clear:
1. Industry job #3 (I3 for short) met my requirements (as I saw them at the time).
2. Wife clearly preferred the location of I3 to DAJ. She never really lived in a dense urban city before, and we had 2 kids at the time. Cost of living was a huge concern, and I3 was in a very nice area that was also much more affordable. It was also close to family for her, whereas DAJ we were at least a thousand miles away from any family for either of us.
3. I preferred DAJ location, even if it was more expensive.
4. It was clear that from a cost of living perspective, even if I got the same pay, that money would go twice as far.
5. I really could not see myself really favoring I3 above DAJ for my career.

"Let's just go next week, and see if anything changes?" She said.

Now, it turns out that one of my very best friends lives at the same town as I3. So we coordinated to stay with him at his sprawling estate for the return trip.

The whole family settles in for an early spring weekend and my buddy's house. We hit the pool, and he puts the hard sell on coming to his town and taking I3. He is in private practice and has made a fortune though luck and tenacity. He thinks I am crazy for even considering ADJ and living at the big expensive city location.

This trip included a tour with a realtor to check out the neighborhood. All the houses are palaces relative to the DOJ living conditions. Home prices appear to me to be trivialities.
I walk into the office the next day. This time, I needed to meet with the C-suite and key scientists in Europe for the final determination. Apparently they wanted final say on this hire, because they had been burned before (see CMO above). They seemed very sharp and affable. I had a good time speaking with them.
After that, it was another fancy steak lunch, at a different fancy steak restaurant. While this was going on, the Europeans' judgment was rendered. I was in.

We come aback from lunch, and the CEO again asks me into his office. I am tentative. How do I convey that I STILL would rather take the DAJ? He asks me what I thought of the company. I told him how impressive everything they'd built had been. He again tells me they wanted to make me an offer now that I had time to think about it. The offer would also include equity commensurate with my position in the C-suite of the company, generous bonus structure based on performance, and they would pay in full for moving expenses, PLUS a moving bonus.

"Here it comes," I thought, about the question I would be asked, and I was prepared with my stock response.
"How much do you want for salary?" He asks.
"2x my academic salary" I said (with actual number)."
He put out his big mitt of a hand towards me. "Done." He says. My jaw hit the floor.

To be continued...

 

[gbwillner]

Next chapter...

Within a few days I have a contract in hand with I3 and have my lawyer review and make corrections and modifications. I speak with my wife about what transpired. I start to believe that this job really could be as good for me as the DAJ. I still would prefer DAJ but the balance is starting to tip. I have an offer and contract in hand.

I contact my chair at DAJ and ask on the status of my contract with them. I realize that I have a bird in hand, and if their agreement was firmly in hand as well I can make make a rational decision, comparing apples to apples. Really I know that I would likely still take the DAJ. But the contract is still not ready. I inform him that I have a contract in hand from I3 and I need theirs as well. But it is simply not going to come in a reasonable time- one where I could choose between two positions.

I convince myself (with help from the wife and friend) that I3 is just as good a career move, plus in a location she likes better and, well, 4x the purchasing power. I sign I3's contract.

I need 3-4 months to wrap up my projects and get a new state medical license, but I3 (ok, my new employer) needs me right away. I agree to consult with them on an hourly basis until officially beginning my role, and they agree to pay me 2x my hourly rate at my new salary for this. The first think I do is get on a plane and fly to Europe to meet the leadership there. The trip lasts a week and I am very impressed with the team there. They have a lot of very smart scientists there, but again, no clinical experience or understanding of how to create or validate clinical services.

I travel to the new office for a few days every week until formally starting in early fall 2014.

I will have to stop the detail of this job and what happened after that, or you will get my life's story. What I will tell you, as you may have guessed, is that things did not go well at this company, despite my best efforts.

More on that next time.

 

[SurfingDoctor]

Not to derail the interesting look into industry, but this discussion made me think of this article. An oldie but a goodie...

Understanding Academic Medical Centers: Simone’s Maxims

Academic medical centers today represent a unique fusion of traditional academia, hospital functions, several levels of education, and, above all, patients. They are complex organizations trying to discharge an often conflicting melange of responsibilities. This complexity has grown in recent years

clincancerres.aacrjournals.org

 

[gbwillner]

Not to derail the interesting look into industry, but this discussion made me think of this article. An oldie but a goodie...

Understanding Academic Medical Centers: Simone’s Maxims

Academic medical centers today represent a unique fusion of traditional academia, hospital functions, several levels of education, and, above all, patients. They are complex organizations trying to discharge an often conflicting melange of responsibilities. This complexity has grown in recent years

clincancerres.aacrjournals.org

I loved this, thanks for sharing. 2 thoughts:

1. This is soooooo true; and
2. How the hell did this get published in AACR?

 

[SurfingDoctor]

I loved this, thanks for sharing. 2 thoughts:

1. This is soooooo true; and
2. How the hell did this get published in AACR?

Dude was director of St. Judes… ie he was probably on the editorial board.

 

[Fencer]

@gbwillner Thank you for sharing! I am looking forward to the middle ending, as you still writing the story.

 

[gbwillner]

OK, procrastination time... next chapter of my saga....

My initial ideas about the company were correct. When I started, I got the entire clinical team into my office, and basically told them all they were doing it wrong and we were staring over with the clinical service we offered. They were leveraging the European product for this service, which was flawed (as mentioned), so I scrapped the use of it and designed and deployed my own. This was shocking to them, but was necessary. When I began, the service they were rendering had no clients and no business, despite hiring an army of salesmen (thus leaving them in such a desperate state they were willing to pay me whatever I asked). With these changes, after a few months, business started to boom, and growth was exponential for the clinical service, and I quickly became the face of the US organization. The CMO (who was remote) basically gave me the keys and went home, almost never to be seen again.

Since the clinical offering was so complex, the salesman's job was quickly changed to "book an onsite meeting at the client facility with Dr. gbwillner", and I would go and explain our services and how they would improve patient care. It worked. I was quickly managing the entire US operation for the product and also integral to new clients and sales. I was also traveling to Europe quarterly, spending a month of each year there helping the development team better understand the product they were designing. Did I mention that a member of the C-Suite I was flying to Europe first class? Some of these tickets were more than $15K. The company spared NO expense on me and our needs.

Sounds great, right? This is an ideal situation, you may say to yourself. I cashed in for an opportunity that was engaging, provided interesting challenges, and provided me with instant responsibilities I was craving that I would need to wait a decade or more for in academia. I became the face of an organization and got to travel almost all 50 states and internationally. First class. Plus I was now being well-compensated. How remote those memories were of making $20K per year as an MSTP for 8 years! I now had a new Jag. 5.0L 480HP. For my birthday. Because I wanted it, that's why.

I'm going to stop here and let you all savor this. Let that feeling linger a bit. Take a deep breath and dream of it. It could happen to you.

Because in short order the dream would end, and every day would soon be the worst day of my life.

 

[SurfingDoctor]

To be frank, traveling that much sounds terrible and my wife and kids would probably hate me. As Simone's Maxims go... the grass is rarely greener.

 

[gbwillner]

To be frank, traveling that much sounds terrible and my wife and kids would probably hate me. As Simone's Maxims go... the grass is rarely greener.

True. To be fair, this was discussed in advance. I knew travel would be relatively frequent and I knew I would spend a month in Europe every year. This was part of the calculus, and my wife accepted this, although I don't think she realized just how much travel it would really be. The DAJ would also have a fair amount of travel for talks and conferences and meetings, but certainly not on the same scale. That said, travel turned out to be far more than either one of us could have anticipated, and I really wasn't in a position to refuse, being new and eager to make the enterprise succeed. By the end of 2014 I logged more than 90K miles on my airline (United). I remember getting "silver" status early on, and a representative came up to me to congratulate me and shake my hand. I thought that was weird because Silver is like everyone and their mother. By the end of the year I was Platinum. By 2015 I was in the super-secret "Global Services" status, and never had fewer than 120K miles in a year again until the pandemic.

 

[gbwillner]

Yes, Ks in general are money losing for an institution from a clinician standpoint. It’s more of the principle of it. By saying an institution will support an applicant (which is part of the proposal and an important review item) and them knowing full well that they won’t, it’s just so freaking dishonest. I mean, it wouldn’t be the first time some lied on a grant application (at no fault of the applicants in this regard), but it totally grinds my gears.

I know this was said a few days ago, but I wanted to also respond for the sake of trainees and residents, that just SUBMITTING the K08 application (signed by your institution and chairman) there is a promise of institutional support by the institution. The application has a written and signed statement that regardless of the outcome of the grant, the institution will support the applicant with funding and a position. So yes, my friend had a reason to be upset that despite getting the grant not getting the job, but even by not getting the grant, I was in the same boat.

 

[tr]

By the end of 2014 I logged more than 90K miles on my airline (United). I remember getting "silver" status early on, and a representative came up to me to congratulate me and shake my hand. I thought that was weird because Silver is like everyone and their mother. By the end of the year I was Platinum. By 2015 I was in the super-secret "Global Services" status, and never had fewer than 120K miles in a year again until the pandemic.

Wow that's like >20,000 sq ft of Arctic ice melt

 

[gbwillner]

Wow that's like >20,000 sq ft of Arctic ice melt

Could be worse. I could have mined a bitcoin or something.

 

[gbwillner]

Chapter IX- It all goes wrong (or, it was always wrong and I started to realize it)

Clinical services were expanding, revenues were going up. But the Europeans were very upset with me and the US org. Mainly this was due to me jettisoning their informatics application and "fixing the problem". Although I was working with the development team to make the necessary changes there, the fact it was not being used was causing a lot of grief. This was due that the core product the company produced, outside of the clinical service we were successfully deploying, was that thing I decommissioned and spent considerable effort convincing the company it was bad and needed to be completely redesigned.

On the Homefront, things were not really great after the honeymoon period. Despite tremendous growth in volume of services, there was not the expected generation of revenue. This was for several reasons, one that the company preferred to show growth of adoption over creating revenue. Additionally, performance of the service was VERY expensive, although by the end of 2014 I proposed ways to reduce the cost basis by 40% with a small amount of R&D funding, that was approved. The biggest problem, however, was in the expectation. See, when the US organization was formed, they hired an army of consultants to help them set up and sell the idea of the business to the investor. This included an insane prediction of volume and revenue that was completely detached from reality.

2014 ended with all-nighters in creating our budgets for 2 weeks for 2015. In late Dec, only European visit, I made sure I got complete buy-in for my proposed changes to the service and got complete verbal approval for my R&D budgets.

In early Jan 2015, our CEO was terminated. Don't feel too bad for him. He, and all the other C-suite (except me, apparently) had given themselves a sizable golden parachute. The CEO was not replaced. A new CEO for the European company was hired who would now also serve as the CEO of the US org as well. Now, let's talk about that great income and equity I was getting. Well, when I was told I was getting equity in the company, I was telling the truth. I was TOLD that. And sure, the contract reflected that as well. But it was surrounded in legalese that could be rug-pulled with the greatest of ease. Specifically, the contract mentioned that I would receive equity commensurate with my level in management according to the management equity incentive plan(tm). When I asked about this plan at contract negotiation, I was told by the CFO that "The board is reviewing it as we speak, and will vote on it in the next board meeting in 2 weeks!".

Guess when they approved that plan?

In Mid Jan 2015, our website, that had our services prominently featured, and our branding, and testimonials, and my face and blog posts and whatever we spent a fortune to develop suddenly disappeared. In its stead there was a crude website that only mentioned the informatics platform I had long abandoned for use.

I thought the company was full of smart people that wanted to build a successful company. This may have been true on some level. But we were in a turf battle for the heart and soul of the company, and didn't even know it. Soon, the entire US leadership was gone- except for me.

The bottom line here is that the US company was always seen by the European one as a façade, one with a singular purpose- to show the value of their platform. We were not doing that. Furthermore, we were losing money. They were going to rectify that, first by trying to have the Europeans run the company. But first they needed to right the ship. This was an IT/Software company, not a clinical services company. They wanted to make that clear. By mid 2015, we had lost most of our clinical revenue and clients as most thought we just folded. The sales team were (like 30 of them) were forbidden from even selling clinical services. We were growing services exponentially, then the rug was pulled.

More later....

 

[gbwillner]

Next chapter:

The new CEO and COO as mentioned before moved the direction of the company completely out of the clinical space. But the entire US operation was set up to perform medical services. It was awkward. When the leadership came to visit and when I went to Europe I did everything I could to let them know that the "product" they were trying to sell simply didn't work.

One thing of particular interest is how people described the product. Almost no one in the company understood it, or could even explain it or define it. It was nebulous. Maybe because of this, it could do anything. Whatever the problem was, it could probably solve it. This made it easy for management to sell the idea of it to anyone. It was the ultimate MacGuffin.

I would say, "Let me show you how the product performs in its intended use and you will see it does not work."
The typical response from management was "that's your problem. My problem is to grow and lead this company"
The typical response from the development team management (the people who founded the company and product) was "You are just using it wrong."

It was a frustrating experience. My thought at the time was:

How can I demonstrate to the team that the system does not work as intended? We are all intelligent people and want to run a successful company. I just have to find a way to do this... Once they realize this we can start from the ground up, use the clinical service to improve the product and then have a launching point for a successful and profitable company...

I was naïve.

You see, the new CEO was hired because he went before the investor and the board and sold them a vision. They in turn sold him one. The vision he (the CEO) was sold was that the product was the most sophisticated, important, and valuable piece of tech ever developed. The only reason it failed in Europe was because they were ahead of the market and didn't know how to run a such an advanced company. The only reason they could not sell it in the US was because of poor US leadership that didn't "understand" the product and how awesome it was. Presentations from development on the use of the product I noticed usually did not use the product at all to arrive at the solutions presented. The vision the CEO sold the investor and the board was that he would take this company and take it to IPO, and that we would raise more than $1B for it. That was his goal. He told them to go big or go home. They increased the budget for the company to $75M/year for 2015. He promised sales in 2015, doubling in 2016, quadrupling in 2017. They went all in with him, and this is really what lead to the removal of the US leadership.

That budget didn't include my budget for improving my services. No one could tell me where my R&D money was, and when I asked if I could begin my process improvement work I was told *shrug*. "It's not in the budget."

The budget did include for a lot more sales people, who would focus exclusively on the product. We would maintain clinical service operations too, but this was the red-headed stepchild of the company. We had an Management Retreat in the Alps (we got our priorities straight!) and talked about strategy. The sales team that was initially hired for selling the service- the one that was successful- started to revolt. The European leadership basically stopped even bothering to visit the US office.

I felt like Cassandra from Greek mythology. You know the story. No? Well quickly- she was totally hawt and Apollo really wanted her bad. To woo her, he gave her the gift of prophesy. Then he really put on the moves. But she was a sworn virgin and priestess for Apollo. So she rebuffed him. Apollo was not very happy about that. Instead of taking back the gift of prophesy, he cursed her. The curse was that all her prophesies would come true, but no one would ever believe them. This was me at this company.

But reality (that apparently only I could ever see) eventually did set in. By mid-2015, as I predicted and told everyone, we had exactly $0 in revenue from sales of the useless tech. I explained that there was still time to turn things around and focus on the one thing that would work- the service. The CEO had no options but to start to listen. He course-corrected and focused more on the service again. he gave us more resources and told the Europeans the strategy would once again be on BOTH lines of business. The tech development and founders were pissed. But the CEO needed the revenue he promised. Well, really that was impossible, but he needed something. We spent a lot of time with IPO consultants and built a fancy new office building in Europe. But the bottom line was the same.

With the resumed resources on the service, our volumes and revenues began to grow again. With the improvements I had made to the service we able to scale much better than before. Eventually I needed to hire an Assistant Director and a larger staff. Things were FINALLY turning back around!!! All my hard work was going to pay off. We were going to leverage the service to make the necessary improvements to the technology, rather than the other way around. By the end of 2015 the clinical service was close to breaking even. A few more improvements and our division would be profitable.

By the end of the year, the CEO planned to expand our budgets even more (to $85M). We settled in to the end of the year in the US Org, happy that things were finally headed in the right direction. By the end of 2015, I still thought that we were going to make it. I really did, even if management was blind to the problems with the company and product.

 

[gbwillner]

The carrot and the stick (the next chapter)

At our peak in late 2015, the US Org had close to 100 employees. The European office was more than 200.

Christmas 2015 felt typical and surreal for this company. The CEO put together a presentation for the company that defined our new goals and directions (that now also included patient-centric apps) that ran over 2 hrs long and was held on the construction site of the new building that was about to open. The fragmented and directionless nature of the company, as demonstrated by this meandering talk, would be obvious to any external observer. But internally it was just business as usual- two separate organizations that disliked each other and constantly plotted the overthrow of the other, divisions (particularly in Europe) that operated as silos and actively sabotaged each other, egos driving decisions, and most just putting their heads down and saying nothing.

2016 kicked off to a shocking-not-so-shocking development. The CEO was fired by the board for failing to deliver even the most basic promises made. He was replaced by the Chairman of the Board- the founder of the company who was also a minor investor in the company, and of old European aristocratic blood. This move was supposed to be temporary until they could find another patsy, er, CEO, to run the organization.

The new CEO came in and said all the right things. I actually had a great rapport with him in my tenure with the company. He was understanding and seemed to actually listen.

He came to the US office to meet the staff and survey what we had and what we were doing. I had lengthy discussions with him about my experiences and visions for how we could turn things around. He promised that we would put more resources and effort back into the clinical services, and he wanted a best-in-class business and was willing to make the necessary improvements and commitments. He expected me to be more involved in all aspects of operations.

It was all I could ask for.

"What else can I do for you?" He asked.

"I want you to see the clinical team use the product. In 2 years no CEO or COO has been willing to even see the product in action. Will you please just see what it actually is and how it actually works?"

This was a pivotal moment in the history of this company. Its fate hung in the balance. If he was an honest broker and actually cared about success for the company (as most of us would define it anyway) he would recognize its failings and be forced to make corrective actions. He would see that the clinical services are the only thing of value to the company now and support that, while going back to the drawing board on the "product".

"Ok." He said.

I set it up that other members of the clinical team would walk through our operations and demonstrate how the product was intended to be used, but rather, how it could not be used for that purpose. It could not be me because my constant criticisms of it had me labeled as a "wet blanket" by the European development team and I wanted to remove any possible bias or perception of bias from his view.

It went pretty much as I expected. Sort of. I caught up to him after the demonstration.

"I had no idea it was so bad," he said with a grimace on his face. "We are going to have to make major changes. You are going to need to help us redesign the platform. Thank you so much for being so honest about this. No one in the European office has been honest with me about the failings of the system and have been keeping a lot of this from me. We are going to have major changes, I can promise you that."

With that, he left. I had done it. This was my zenith, and things were finally going to go the right way- my way.

If you believe that, you haven't really been paying attention.

 

[ChordaEpiphany]

At any point in all of this, weren't you tempted to match the company MO and simply oversell them on the potential of the clinical services so they'd care about them? I've seen more than a few pitches from startup biotech companies, and I don't think I've seen anyone successfully sell the idea to the business folks/investors by being realistic. Even in the therapeutics space, where profit will be made or lost entirely at the whim of a regulatory decision and hard data, it's almost like they want to be sold on the idea rather than invest in a solid product. I figured it was either ignorance or they were hoping for "wild potential" to result in an exit at an inflated valuation before anyone actually tests the product.

The company I worked for before my MSTP had similar lofty ideals and tried to sell a real product and a real company, with a deep pipeline and realistic goals. That approach failed miserably. At one point every single employee except for me was laid off (and I went 6 months later, luckily with med school starting in 2 months). They've since recovered, but only after a complete restructuring of their leadership and vision. I'd love to hear your thoughts on whether or not my assessment on this is correct in the industry as a whole. It seems like the science will always come second to the pitch and that the cautious uncertainty so heavily emphasized in academics is really just a hindrance in the business world. You're almost better off overselling and failing spectacularly, because if you paint a realistic vision with the appropriate "ifs" and "maybes" then you're doomed from the start.

 

[tortuga87]

It seems like the science will always come second to the pitch and that the cautious uncertainty so heavily emphasized in academics is really just a hindrance in the business world. You're almost better off overselling and failing spectacularly, because if you paint a realistic vision with the appropriate "ifs" and "maybes" then you're doomed from the start.

Depressing reality right there

 

[gbwillner]

At any point in all of this, weren't you tempted to match the company MO and simply oversell them on the potential of the clinical services so they'd care about them

No, not for a second. No offense, but f#$ck that. That's how you get into this mess in the first place. Also, it is only a temporary solution. As you will see as the story unfolds, this strategy backfires almost always. Eventually, you can't make good on your promises and you become the fall guy.

Regarding what they "want to be sold" on, I will have more on this later as well. There is a lot more to what is happening at these companies than trying to make the best product or most revenue. There is also a fair amount of toxic and self-defeating, self-promoting anterior motives that can sabotage and otherwise-promising endeavor.

Lastly, as it turns out, there is nothing I could have done to make them care about it.

 

[gbwillner]

The facade is lifted

Early 2016 proceeded in the right direction. I went to Europe for an extended period and walked the management and the dev and R&D teams through the process of how the medical services work, and laid out requirements for what the product SHOULD look like. I was now managing meetings with the developers directly and providing system requirements. This part was perfect. I informed the team that I expected this process to take about 3 years to get the product to production. In meetings with European execs I planned out the process, stating I had laid out the basic requirements, and I expected the draft requirements (the tasks and epics) to be sent to me for me for approval. Everyone agreed.

Then there was the political fallout. As you can imagine, not everyone was happy with the turn of events. The company had spent 5-6 years in developing the last product and fought tooth and nail for it, only to see it (finally and mercifully) get put down. They backed the wrong horse and there would be consequences. The new CEO announced they would hire a new US leadership team since the last one was decimated and not really ever replaced. He told me if anyone was safe in this process it would be me, because I was the only one who seemed to know what was going on. Lets just say that although I always dealt and gave requirements directly to the dev team leadership and founders and we had a good professional relationship, this was now very strained. I had called their baby ugly, and I had done so in a very open way they could not control.

A new team of US middle management was hired (project managers) and a new US CEO/CMO was also hired. This guy had been a successful biotech CEO before. As usual, I had to interview and approve all US hires. But not for CEO/CMO, which I verbally dissented to. My thought on this was that they were probably giving this guy the usual load of BS on the product they had, and didn't want me to be honest and warn him about the difficulties he would need to overcome on the job he was considering. Also, even though I was sad that I was being passed over for this formal role (despite being de facto CMO for over a year), I was happy to hopefully have another knowledgeable physician in a leadership role that would have my back (at least once he understood the issues).

Of course, once he was on boarded, my suspicions were confirmed. When I went through the company issues with him so he knew what they all were, I heard the same tired tropes: that I was a "wet blanket," and that things were not as bad as I say. Again, reality does set in, so being deceitful is only a temporary solution. Of note, we made sure he had go/no go decision making for clinical products globally. And our product was for clinical use, so now we would have control over the release of any product.

To address the issue of Development leadership, a new European director of Dev was hired from a another successful company. Actually this hire started with the prior CEO, but he was seen by the new CEO as independent of the past Dev team and made SVP of development. I made sure to go over the issues with the past system to see what could be kept and what needed to be jettisoned.

In an important management meeting in early spring, the new SVP had discussed having all the requirements done and expected the improved and "new" product development done in 3 months, and expected deployment in late summer/fall 2016.

"Here we go again," I thought. The requirements were not sent to me for approval to make sure they understood. The timeline was wholly unrealistic. Just as we finally had hit the reset button, we were already moving in the wrong direction. I confronted the new SVP about my review and approval of his Dev plans, as we agreed, and he said there wasn't time for it and it wasn't needed. He told me he knew what the product was and what it needed to be. That he's done this for big company XXX and this was nothing. His ego quickly filled the room, and he basically told me to stay in my lane.

But this wasn't the only bombshell. I got a call shortly thereafter from the new SVP of operations that I did hire and interview. His words were devastating. "You're not going to like this," he said. "But it has been decided that we will be winding down and ceasing all medical services operations in the US by the end of the year." After expressing my shock at this development, he concluded: "we need to know if you are on board with the plan."

 

[gbwillner]

A glimpse of what was to come (a short interlude)

As mentioned before, I was well-compensated for my role. Well, sort of. No less than 1/3 of my total comp was tied to my bonus. My bonus was dependant on my personal job performance, not company performance. So while I saw in early 2016 an company-wide communication stating that due to a lack of anticipated revenue in 2015, annual bonuses would not be paid, I didn't really worry too much (although I did feel bad for everyone else who did not have such terms stated in their contracts) because I never had a negative job performance review. To the contrary.
But then my bonus did not materialize. When I took this to company legal counsel, I was told there was nothing they could do, sorry.

I eventually needed to get my lawyer to threaten lawsuit if they did not pay, after several months of going nowhere. This finally did it, and this consession on their part timed itself with the latter events of the narrative above. But it was a sign of things to come.

 

[gbwillner]

The new Direction.

You may be wondering (if you are still reading), "why would a company abandon its only revenue generating enterprise, and the only thing that could tie their product and development to the real world (its intended purpose), when they are rebooting their product and have nothing else to deliver? Well, keep thinking about that- I will address it at the end of the narrative of my trials and what I learned from the process.

Back to the story. I protested. I pleaded the above statement. It made no difference. And the news didn't stop there.

The new US CMO/CEO let me know that in addition to shuttering medical services in the US, the company was relocating to an East-coast office, and that I would need to pack up and move there, if I wanted to keep my job.

Question to you all: what would you do in my scenario??? Let's discuss before we continue.

 

[StilgarMD]

The new Direction.

You may be wondering (if you are still reading), "why would a company abandon its only revenue generating enterprise, and the only thing that could tie their product and development to the real world (its intended purpose), when they are rebooting their product and have nothing else to deliver? Well, keep thinking about that- I will address it at the end of the narrative of my trials and what I learned from the process.

Back to the story. I protested. I pleaded the above statement. It made no difference. And the news didn't stop there.

The new US CMO/CEO let me know that in addition to shuttering medical services in the US, the company was relocating to an East-coast office, and that I would need to pack up and move there, if I wanted to keep my job.

Question to you all: what would you do in my scenario??? Let's discuss before we continue.

I am very confused for just this reason. I am sort of dismayed w/ Academia (just defended my PhD) atm and thought in industry, there was a type of accountability and 'contact with the real world' with which a lot of academic non-sense wouldn't survive. It seems I forgot there are core human tendencies which motivate problems in both domains. As a total outsider on this, it seems like ego driving a lot of choices for these folks, and perhaps the desire to save face - you don't spend years proselytizing about a thing and then go 'Oh right I was full of it' without losing a lot of credibility and maybe even investors.

I'd have emailed DAJ and said "Still need someone?" I don't know how these types of transitions are done, especially in that direction, but that's the way I'd go. Or if I knew of a competitor in the field doing something similar, I'd see if I could work for them.

 

[Fencer]

My 10-year interaction as co-founder of a start-up (as a side venture) had many similar lessons to Dr. @gbwillner odyssey. The egos that dismissed realistic projections of product adoption were what killed them. For my start-up, I recall 3 lofty unrealistic projections from smart groups (bad assumptions) talking of an up to $8 B business opportunity. Five CEOs later, the company dismantled a talented team that was too heavy in sales reps and corporate structure but too small in R&D. That is another story. Thank you gbwillner for sharing... While start-ups have more adrenaline on day-to-day basis, critical mistakes are still done by humans misjudging information. If you keep publishing, academia has a lot of excitement...

 

[gbwillner]

The dismantling

With the madness in the background, our clinical service, up to this time, was continuing to grow and improve. My Asst. Director asked me who my realtor had been because he was looking to buy a house. My response:

"Are you nuts?"

Once the decision was rendered, things started moving pretty quickly. A few weeks later (I would say Spring 2016) there was a "surprise" announcement to management that the COO from Europe and legal counsel and the head of HR would be visiting the next day. They arrived one evening, and said they needed to make an announcement to the entire US ORG the next day. It went about as you expect. They basically announced the decision to wind down US clinical operations by the end of the year to focus on product development. That the office would relocate to the East Coast city. Oh, yeah, and that about 1/2 the staff needed to pack up their stuff and go- today would be their last day.

The goal was to wind down and still deliver services until the last possible moment. But there was no planning with staff (me) who actually ran operations, so I was not made aware of these moves in advance so I did not advise how to do this as seamlessly as possible. It was chaos.

And so it was, in an early day in March, when my Asst Director, who was an MSTP and did residency and fellowship at a top institution, never did anything less than be a stellar student and employee, found himself unemployed with no severance at the end of the month.

About another 1/4 of the staff would be let go at a later time, and the last 1/4 or so would be expected to relocate to the new office.

Back to the question... "are you on board?"... What would you, reading this narrative (if there are any left at this point in the story) do???

 

[SurfingDoctor]

The dismantling

With the madness in the background, our clinical service, up to this time, was continuing to grow and improve. My Asst. Director asked me who my realtor had been because he was looking to buy a house. My response:

"Are you nuts?"

Once the decision was rendered, things started moving pretty quickly. A few weeks later (I would say Spring 2016) there was a "surprise" announcement to management that the COO from Europe and legal counsel and the head of HR would be visiting the next day. They arrived one evening, and said they needed to make an announcement to the entire US ORG the next day. It went about as you expect. They basically announced the decision to wind down US clinical operations by the end of the year to focus on product development. That the office would relocate to the East Coast city. Oh, yeah, and that about 1/2 the staff needed to pack up their stuff and go- today would be their last day.

The goal was to wind down and still deliver services until the last possible moment. But there was no planning with staff (me) who actually ran operations, so I was not made aware of these moves in advance so I did not advise how to do this as seamlessly as possible. It was chaos.

And so it was, in an early day in March, when my Asst Director, who was an MSTP and did residency and fellowship at a top institution, never did anything less than be a stellar student and employee, found himself unemployed with no severance at the end of the month.

About another 1/4 of the staff would be let go at a later time, and the last 1/4 or so would be expected to relocate to the new office.

Back to the question... "are you on board?"... What would you, reading this narrative (if there are any left at this point in the story) do???

Look for another job. The Titanic hit the iceberg long ago in your story and it's ones responsibility to see that they don't go down with the ship (and get to a life boat too... not just the piece of wood with Rose laying on it).

 

[ChordaEpiphany]

The dismantling

With the madness in the background, our clinical service, up to this time, was continuing to grow and improve. My Asst. Director asked me who my realtor had been because he was looking to buy a house. My response:

"Are you nuts?"

Once the decision was rendered, things started moving pretty quickly. A few weeks later (I would say Spring 2016) there was a "surprise" announcement to management that the COO from Europe and legal counsel and the head of HR would be visiting the next day. They arrived one evening, and said they needed to make an announcement to the entire US ORG the next day. It went about as you expect. They basically announced the decision to wind down US clinical operations by the end of the year to focus on product development. That the office would relocate to the East Coast city. Oh, yeah, and that about 1/2 the staff needed to pack up their stuff and go- today would be their last day.

The goal was to wind down and still deliver services until the last possible moment. But there was no planning with staff (me) who actually ran operations, so I was not made aware of these moves in advance so I did not advise how to do this as seamlessly as possible. It was chaos.

And so it was, in an early day in March, when my Asst Director, who was an MSTP and did residency and fellowship at a top institution, never did anything less than be a stellar student and employee, found himself unemployed with no severance at the end of the month.

About another 1/4 of the staff would be let go at a later time, and the last 1/4 or so would be expected to relocate to the new office.

Back to the question... "are you on board?"... What would you, reading this narrative (if there are any left at this point in the story) do???

We have the spoilers already, so it sounds like it's new job time, obviously searching very quietly. Maybe there are some other considerations, like vesting, but it sounds like you have no faith in the company or its stock at this point.

I'm also curious how your asst director came into the picture. You got lured into this gig with a C-suite position that pays 2x academic salary. I'm assuming assistant director pays much less, probably similar to 1x academic salary. What would inspire someone with a top tier residency and fellowship to take such a position when presumably they could take a 50/50 job elsewhere, have greater job security, probably make more, and still retain their clinical training?

Also, in what way were you better positioned compared to your asst director to get offered such a high position at a similar career stage? Was it your caliber of research/resume, area of expertise, luck?

 

[gbwillner]

I'm also curious how your asst director came into the picture. You got lured into this gig with a C-suite position that pays 2x academic salary. I'm assuming assistant director pays much less, probably similar to 1x academic salary. What would inspire someone with a top tier residency and fellowship to take such a position when presumably they could take a 50/50 job elsewhere, have greater job security, probably make more, and still retain their clinical training?

Also, in what way were you better positioned compared to your asst director to get offered such a high position at a similar career stage? Was it your caliber of research/resume, area of expertise, luck?

I would argue we were not in similar positions to begin, as I was already faculty and having done a post-doc in my department. I was also well-published and a leader in the novel field. He was wrapping up fellowship, and would have needed to leave for a job somewhere. I offered him a great deal, probably 1.5 to 2x what he could have received in academia.

The other major difference was totally external to our resumes. I joined a company flush with cash that was DESPERATE. He joined the company because he was a good candidate for the role, but I had a lot of options for a #2. The MARKET was a major differentiator here. Sometimes you meet the CMO, SVP. or director of a major and successful company and ask, "how did this random dude get this job?" A lot of the time it's just timing and coincidence. If you join a little venture for $200k because you are desperate for a job and no one else will have you, and because or often in spite of you that company IPOs for $5B or something, congrats- you are now worth millions probably and an exec in a billion-dollar company. But you may have had little to nothing to do with that development.

 

[gbwillner]

What I did...

OK, a flash update to this story, since it seems you guys want it to move forward a bit.

I did NOT leave the company, as most of you have suggested.

Why not? Did I disagree with your assessments of the state of the company? And it's future? Nope, not really. I started off in 2014 by thinking I was part of something great. By 2015 I realized there were a lot of problems, but I knew I could fix them and could help steer the company around and make it successful. I'd never really failed before- why would now be any different? We all want this thing to go in the right direction, don't we? By now, in 2016, I had made the realization... This company was NOT going to be successful. But it did not mean that I could not be successful in it.

Choosing to bail on a high(er) paying job is risk and fear-inducing. Fear that you will have to relocate. Fear that you will be unemployed. Fear that you will have to settle for another job you don't like just to pay the bills. It takes a lot of balls to say "f**k this place, I'm out", even if your rational mind tells you this is the best option.

It is fairly easy to just put your head down and keep going. This is what most people do in this circumstance. There were SVPs from the US leadership in 2015 and early 2016 that implored me to get out before it was too late. But I didn't. Knowing when to bail is a learned skill. I had not yet learned this lesson.

However, I was not prepared to leave clinical work behind. I asked the Europeans to let me buy back 15% of my time (for a 20% haircut on salary) to start my own clinical services company. I would work for them in developing their product (I also enjoyed that work), but would NOT relocate. They agreed.

 

[ChordaEpiphany]

I would argue we were not in similar positions to begin, as I was already faculty and having done a post-doc in my department. I was also well-published and a leader in the novel field. He was wrapping up fellowship, and would have needed to leave for a job somewhere. I offered him a great deal, probably 1.5 to 2x what he could have received in academia.

Ah, my impression was that your post-doc was actually part of your PSTP. So I thought your journey was basically: MSTP --> PSTP (I was assuming IM-->Sub) --> Instructor of Medicine attending position (temporary/waiting for tenure track to open up) --> Scooped by I3 instead of DAJ.

However, I was not prepared to leave clinical work behind. I asked the Europeans to let me buy back 15% of my time (for a 20% haircut on salary) to start my own clinical services company. I would work for them in developing their product (I also enjoyed that work), but would NOT relocate. They agreed.

So were you working in a clinical environment during these first two years? As in, were you seeing patients for the sake of implementing the clinical service? Or by clinical work do you mean developing technology for clinical services vs. moving in whatever direction the Europeans wanted to go.

 

[gbwillner]

Ah, my impression was that your post-doc was actually part of your PSTP. So I thought your journey was basically: MSTP --> PSTP (I was assuming IM-->Sub) --> Instructor of Medicine attending position (temporary/waiting for tenure track to open up) --> Scooped by I3 instead of DAJ.

So were you working in a clinical environment during these first two years? As in, were you seeing patients for the sake of implementing the clinical service? Or by clinical work do you mean developing technology for clinical services vs. moving in whatever direction the Europeans wanted to go.

Yes, the Instructorship was sort of promised up-front as part of the PSTP. But this does not make you NOT faculty. I had a contract and everything. I was a member of the academic staff.

When I stated we were offering medical services, I mean just that. Specifically, this is precision medicine related, so you can infer from that molecular diagnostic testing for patient care. Only doing tech development is fun, but I wasn't about to let my medical training go to waste.

 

[SurfingDoctor]

What I did...

OK, a flash update to this story, since it seems you guys want it to move forward a bit.

I did NOT leave the company, as most of you have suggested.

Why not? Did I disagree with your assessments of the state of the company? And it's future? Nope, not really. I started off in 2014 by thinking I was part of something great. By 2015 I realized there were a lot of problems, but I knew I could fix them and could help steer the company around and make it successful. I'd never really failed before- why would now be any different? We all want this thing to go in the right direction, don't we? By now, in 2016, I had made the realization... This company was NOT going to be successful. But it did not mean that I could not be successful in it.

Choosing to bail on a high(er) paying job is risk and fear-inducing. Fear that you will have to relocate. Fear that you will be unemployed. Fear that you will have to settle for another job you don't like just to pay the bills. It takes a lot of balls to say "f**k this place, I'm out", even if your rational mind tells you this is the best option.

It is fairly easy to just put your head down and keep going. This is what most people do in this circumstance. There were SVPs from the US leadership in 2015 and early 2016 that implored me to get out before it was too late. But I didn't. Knowing when to bail is a learned skill. I had not yet learned this lesson.

However, I was not prepared to leave clinical work behind. I asked the Europeans to let me buy back 15% of my time (for a 20% haircut on salary) to start my own clinical services company. I would work for them in developing their product (I also enjoyed that work), but would NOT relocate. They agreed.

Whoa, you offered to take a 20% pay cut in a company you knew wasn't going to successful with leadership you didn't like, just to stay on to see it through? As you stated that "takes a lot of balls".

I guess the most important question is knowing now what you didn't know then, would you make the same decision? The most important lesson in failure is learning and growth.

 

[gbwillner]

Whoa, you offered to take a 20% pay cut in a company you knew wasn't going to successful with leadership you didn't like, just to stay on to see it through? As you stated that "takes a lot of balls".

I guess the most important question is knowing now what you didn't know then, would you make the same decision? The most important lesson in failure is learning and growth.

At the time I saw this as "hedging my bet".

What I got in the deal:
1. Title change to "Executive Medical Director"
2. freedom to render medical services through my own company (consulting and patient services) WITHOUT their interference
...that's it.

What I gave up:
1. 20% haircut
2. Change in contract that stated my bonus was discretionary (they learned their lesson, apparently) and based on COMPANY performance
3. They removed provisions regarding equity in my contract. After more than 2 years, the board had never passed the "management incentive plan", so I never received any equity. That said, I was working for a zombie company, so I gladly gave them this one.

This does sound like a bad deal, and knowing what I know now, did I make the right decision? Things turned out pretty good for me in the end, although there was a lot of pain a little later. Remember I had a large network and started gaining revenue through my own company pretty quickly. Additionally, the company gave up doing medical services... and they would eventually need those from me. And I would make them pay for it.

The 20% haircut was rough, and even rougher was the fact that the company never again paid a bonus to anyone because there was no revenue. My salary was now only 15% more than the DAJ!!!! That said, through my own company, I was able to make substantial revenue, and by the end of 2016 I had more than made up for my losses and in 2017 I was getting 1.5x from my company (total 2017 revenue was like 3x DAJ). So this was a win in the revenue dept.

That said, I got offers to leave for other companies that I rejected. The first came in 2015, and that one stung for a long time. I worked a company to try to gain revenue and engage in collaboration with them, which of course fell through. But they were impressed with me and asked to to take an Executive Medical Director role with them. However, It had not been more than a year and a half since I last relocated and wasn't interested in uprooting my family again so quickly (and I thought I could still fix everything), AND relocating to San Francisco (this was a requirement). Of course, that company went on to IPO and is now worth more than $10B. So had I made the move I would have made tens of millions in equity.

At this point I will leave it to you guys- do you want me to detail how this ship sank in gory details, or do I skip ahead to other endeavors (and just skim through the ending)?

 

[SurfingDoctor]

At the time I saw this as "hedging my bet".

What I got in the deal:
1. Title change to "Executive Medical Director"
2. freedom to render medical services through my own company (consulting and patient services) WITHOUT their interference
...that's it.

What I gave up:
1. 20% haircut
2. Change in contract that stated my bonus was discretionary (they learned their lesson, apparently) and based on COMPANY performance
3. They removed provisions regarding equity in my contract. After more than 2 years, the board had never passed the "management incentive plan", so I never received any equity. That said, I was working for a zombie company, so I gladly gave them this one.

This does sound like a bad deal, and knowing what I know now, did I make the right decision? Things turned out pretty good for me in the end, although there was a lot of pain a little later. Remember I had a large network and started gaining revenue through my own company pretty quickly. Additionally, the company gave up doing medical services... and they would eventually need those from me. And I would make them pay for it.

The 20% haircut was rough, and even rougher was the fact that the company never again paid a bonus to anyone because there was no revenue. My salary was now only 15% more than the DAJ!!!! That said, through my own company, I was able to make substantial revenue, and by the end of 2016 I had more than made up for my losses and in 2017 I was getting 1.5x from my company (total 2017 revenue was like 3x DAJ). So this was a win in the revenue dept.

That said, I got offers to leave for other companies that I rejected. The first came in 2015, and that one stung for a long time. I worked a company to try to gain revenue and engage in collaboration with them, which of course fell through. But they were impressed with me and asked to to take an Executive Medical Director role with them. However, It had not been more than a year and a half since I last relocated and wasn't interested in uprooting my family again so quickly (and I thought I could still fix everything), AND relocating to San Francisco (this was a requirement). Of course, that company went on to IPO and is now worth more than $10B. So had I made the move I would have made tens of millions in equity.

At this point I will leave it to you guys- do you want me to detail how this ship sank in gory details, or do I skip ahead to other endeavors (and just skim through the ending)?

I don’t quite understand. You took a 20% pay cut but they paid you instead in consultant fees later on? I assume this is after you no longer worked for them?

 

[DrDriven07]

At the time I saw this as "hedging my bet".

What I got in the deal:
1. Title change to "Executive Medical Director"
2. freedom to render medical services through my own company (consulting and patient services) WITHOUT their interference
...that's it.

What I gave up:
1. 20% haircut
2. Change in contract that stated my bonus was discretionary (they learned their lesson, apparently) and based on COMPANY performance
3. They removed provisions regarding equity in my contract. After more than 2 years, the board had never passed the "management incentive plan", so I never received any equity. That said, I was working for a zombie company, so I gladly gave them this one.

This does sound like a bad deal, and knowing what I know now, did I make the right decision? Things turned out pretty good for me in the end, although there was a lot of pain a little later. Remember I had a large network and started gaining revenue through my own company pretty quickly. Additionally, the company gave up doing medical services... and they would eventually need those from me. And I would make them pay for it.

The 20% haircut was rough, and even rougher was the fact that the company never again paid a bonus to anyone because there was no revenue. My salary was now only 15% more than the DAJ!!!! That said, through my own company, I was able to make substantial revenue, and by the end of 2016 I had more than made up for my losses and in 2017 I was getting 1.5x from my company (total 2017 revenue was like 3x DAJ). So this was a win in the revenue dept.

That said, I got offers to leave for other companies that I rejected. The first came in 2015, and that one stung for a long time. I worked a company to try to gain revenue and engage in collaboration with them, which of course fell through. But they were impressed with me and asked to to take an Executive Medical Director role with them. However, It had not been more than a year and a half since I last relocated and wasn't interested in uprooting my family again so quickly (and I thought I could still fix everything), AND relocating to San Francisco (this was a requirement). Of course, that company went on to IPO and is now worth more than $10B. So had I made the move I would have made tens of millions in equity.

At this point I will leave it to you guys- do you want me to detail how this ship sank in gory details, or do I skip ahead to other endeavors (and just skim through the ending)?

+1 for gory details.

Need to refill my bucket of popcorn first

 

[gbwillner]

I don’t quite understand. You took a 20% pay cut but they paid you instead in consultant fees later on? I assume this is after you no longer worked for them?

Nope. I mean that they paid me for being their director AND for my company's medical services. At the same time.

To clarify, I bought back 15% of my time for launching and running my own company. My company didn't compete with theirs, and they couldn't interfere with it.

 

[SurfingDoctor]

Nope. I mean that they paid me for being their director AND for my company's medical services. At the same time.

To clarify, I bought back 15% of my time for launching and running my own company. My company didn't compete with theirs, and they couldn't interfere with it.

Well, that is a terrible business model on their end. They sound like buffoons.

It also sounds like you took advantage of their ineptitude. Good for you.

 

[gbwillner]

The (relative) calm before the storm

And so it was that out of about 100 US employees, less than 10 relocated to the NE for the newly-acquired 10k sq ft facility that would be the new US headquarters over the next 6 months. The sales team was already remote, but were shorn down to a bare-mimimum of an experienced SVP and novice team who were willing to stay on with nothing to sell and just maintain current clinical service clients. Because the company expected product sales in 3 months (the expected delivery date), they paid guaranteed commissions to retain the sales force. And then I was working remote from the old location, along with bare-bones staff needed to keep the lights on for our services until the end of the year.

I would travel between offices and make sure the CMO/CEO was aware of the issues and my concerns. I told him the deadline was not possible, and that we should do rigorous testing on the product before launching it for clinical use. He agreed since he had global authority to launch, or not launch the product.

Meanwhile, I was given the go ahead to create a new medical affairs team in the new NE office- not for delivering clinical services but to build clinical content for the product. I put together another great team for this purpose. I was still flying to Europe to coordinate with the development team. But I had little engagement directly with the SVP. Oh yeah, they basically just stopped inviting me to management meetings by this time. That's how it was.

In late summer/early fall 2016 the Europeans held a large party for the launch of the new product.

The MA team tested the product, and it did not meet our validation criteria. I informed the CMO, and advised him not to launch. After several discussions, including gripes from the European Dev leadership that I was just a hater or something, it was decided than an independent auditor with expertise would come in and evaluate the product to see if it was ready or not. This person was an expert statistician and responsible for several FDA submissions.

In the meantime, I was asked to look at CVs for another associate Medical Director they wanted to hire. Kind of odd at this time to hire one, but I was told by the CMO that they really wanted a full-time person on site in the NE office to work with me. I could see the writing on the wall. Around this time they hired a head of business development. Let's call him "Mr. X". His job was to find other business opportunities or collaborations for our company and product in the US. He was very inquisitive. But others, like the SVP of sales, instantly did not like him. He will become very relevant later on. Mr. X started frequent travel to Europe to meet with leadership there.

Ultimately it was determined that the data did not support putting the product as it was into production and that it needed further development.

The clinical service, and all remaining staff for it were gone. The office was shuttered on Dec 31. All my focus was now on product development, marketing, and corporate strategy.

And then more news. the CMO of about 9 months unexpectedly announced his retirement for "personal reasons."

It was early 2017 already, but Winter was Coming.

 

[tortuga87]

What strikes me about all these posts by gbwillner is the amount of politic-ing going on. He said this, she did that, someone quit unexpectedly, ppl not being on same page, not being invited to meetings, etc. There are very few lines about the steps in the actual tech development.

I am not sure if this is correct, but I cant help but read in between the lines; nearly all of the turmoil is coming from interpersonal toxicity rather than frustration about the details of the tech

 

[gbwillner]

What strikes me about all these posts by gbwillner is the amount of politic-ing going on. He said this, she did that, someone quit unexpectedly, ppl not being on same page, not being invited to meetings, etc. There are very few lines about the steps in the actual tech development.

I am not sure if this is correct, but I cant help but read in between the lines; nearly all of the turmoil is coming from interpersonal toxicity rather than frustration about the details of the tech

This is what a dysfunctional company looks like. And unfortunately, that is most start ups, and probably most companies in general to some extent.

However, you cannot dissociate all of the toxicity from the tech. While, yes, these are personality conflicts at play, they only exist (or really, bubble to the surface) because people are under stress. People are under stress because things are not going well. And ultimately, things are not going well because of the tech.

In reflection, I cannot help but wonder how well CEO #2 would have faired in "going big or going home" if the product actually worked.

If corporate structure is poor (as was the case here), you cannot resolve these conflicts. Much like our political discourse today. There is often no incentive to fix problems, and an incentive (save your own @ss) for perpetuating it. I saw this at play again and again.

 

[gbwillner]

Exit interview

As the CMO was packing up his office I scheduled a talk with him. I thought that I could learn something from him before he left. Maybe some departing words of wisdom?

I asked him why he was really leaving. What were his thoughts about the future of the company? Surely he was leaving because he saw it was hopeless and that despite promises, he had no agency. That was it right?

Nope, it was for personal reasons, he said. It was like getting blood from a stone.

I asked for what advice he could impart.

"You are a bright guy and will go far. You will be a CMO soon somewhere if you keep at it. But you really need to shut up and do what you are told."

OK, I am paraphrasing the last sentence. But I found it pretty disgusting. Isn't it better to just be honest? To call out BS when you see it? That approach certainly didn't get him where he was or had been. And here he saw the ship sinking and his parting words were pretty much "I'm getting on this row boat. Everything is fine. Here are the keys! I'll call in a few days. Bye!"

I started to think maybe the problem was me. Maybe I'm just a bad employee.