Full transcript of the interview below:
Dr. Dave
I’m here today with physician and CEO of Nomad Health, Dr. Alexi Nazem. Welcome to the show.
Dr. Alexi Nazem
It’s great to be here with you, David. I’m looking forward to our chat.
Dr. Dave
I’m looking forward to our chat too. I’m excited to hear about Nomad Health and how it all came to be. First, I’d like to start off with a little bit of background on you. So, if you could just fill us in on where you did your medical training and what your current practice of medicine looks like.
The idea of Nomad Health originated with Dr. Nazem and two cofounders who are also physicians.
Dr. Alexi Nazem
Sure. Yeah. So, I went to medical school at Yale School of Medicine in New Haven, Connecticut. From there, I went on to do training at Brigham and Women’s Hospital in internal medicine in Boston, with a special focus on primary care innovation as well as traditional internal medicine training. After that, I took a position on the faculty at Weill Cornell in New York City, where I am an attending on the hospitalist service…the hospital medicine department. I continue to practice as a hospitalist now, less than I used to, unfortunately. I see patients at the New York Presbyterian Hospital in Weill Cornell about one weekend a month. So, as I started the company a few years ago, I have slowly dialed back by day-to-day clinical; which I miss, but, of course, was the necessary choice.
Dr. Dave
Yeah. You always have to make a choice, especially if you’re talking about something like a startup company. I’m sure that takes a lot of time. So, I would love to get into that story because there may be other physicians listening out there that may have an idea for a startup or a business or something. I’m curious to go back and hear the story of when the idea for Nomad happened and those first initial steps.
Dr. Alexi Nazem
Sure. So, Nomad was started in 2015. Our third birthday just passed a couple of weeks ago.
Dr. Dave
Happy birthday.
Dr. Alexi Nazem
Thank you. So, the idea actually originated with two cofounders who are also physicians. They are neurosurgeons at Yale. I was working on something in a sort of related space, and as these things go, through brawny and motion all kind of cross over with each other. People who knew them, knew me; and people who knew me, knew them; and we all got together and started chatting, got excited about each other, and about the ideas that we were working on. In July 2015, we came together and founded Nomad. The rest, as they say, is history.
Dr. Dave
Very cool. Now, I’m interested in that initial phase. So, you all got together; you got this idea; it’s going back and forth; and you decided, I’m supposing, to form a company. I’m wondering what those initial steps look like. Are you talking about putting together a team? Are you talking about raising capital? I’m curious as to what those first steps were all about.
Nomad is a healthcare jobs marketplace for doctors, nurses, etc. go to find jobs, especially freelance short-term positions and vice versa.
Dr. Alexi Nazem
It’s all of those things, and even before that, is determining is there a there there. So, those conversations that I was talking about, were where we just started getting very excited about this together. We, as physicians, and also there were technologists who were part of the founding mix as well. The basic concepts for this company came up from our own experiences as physicians. So, let me just back up and say what Nomad is, very briefly.
We can dive into it more deeply later. Nomad is a healthcare jobs marketplace. So, a place where doctors, nurses, etc. can go to find jobs to get hired for, especially freelance short-term positions and vice versa…for healthcare facilities to hire them. As any doctor can attest, the process of finding a job and getting onboarded to a job in healthcare is really archaic and very inefficient. I’m sure all of us get those phone calls, emails, pages, and text messages; almost all of them unsolicited from recruiters. We all found that to be a very unfriendly experience.
This group of doctors realized that there was a problem with healthcare’s archaic onboarding process, so they developed a clear solution for it.
The further that we pulled that thread, the more we realized that this was a huge problem; a huge market; there’s a giant industry of recruiting agencies and staffing brokers in healthcare and they work like they had for thirty to forty years unchanged. So, we just kept pulling this thread, pulling this thread and seeing that there was a problem; there’s a clear solution, which is a technology-based marketplace; and there’s a giant market opportunity.
So, that was the very initial step, was figuring out that it sounded like a good business and there was a good solution. So, that’s where it all started. Then, once we established that foundation, it was very practical stuff…like we’ve got to find a team; we’ve got to form a corporation; and we have to raise capital. Frankly, that stuff never ends. I’m still doing that today.
Dr. Dave
For sure.
Dr. Alexi Nazem
That’s how it all started back in the Summer of 2015.
Dr. Dave
Well, I can attest to some of what you’re saying, because the emails I’ve gotten for a long time, I can ignore a little bit easier; but I started getting the unsolicited text messages, and that really does annoy me. So, I definitely understand what you’re saying there. So, looking at your company and thinking about a marketplace, if you will; I would think that it’s very difficult to bring together the supply, you know, the physicians; nurses; etc. with a demand for the work. So, I’m curious, when you guys were approaching this, what were some of the biggest challenges that you had to solve for creating this marketplace for Nomad?
Some of the biggest challenges for creating this marketplace for Nomad included building a company that catered to both sides of the market.
Dr. Alexi Nazem
Yeah. This is the absolute hardest part about building a marketplace. It’s the traditional cold start problem. It’s really hard to build up a supply and demand, to build up the two sides of the marketplace simultaneously; because you need one side to get the other side and vice versa.
Dr. Dave
Right.
Dr. Alexi Nazem
So, if there are no jobs on the platform, how can you interest any doctors to come and vice versa. If there are no doctors on the platform, how can you get any hospital or clinic to say “Yeah, sure. We’d love to work with you guys.” So, this is the existential problem that every early marketplace faces. So, what we tried to do was to figure out a way to do a little bit of a crab walk. You know, you get some of the supply side and then some more of the demand side; and then some more supply and then more demand.
So, what that really means is, building something that’s attractive to both sides when there is a limited amount of counterparties on the other side. So, from the perspective of the client, for example, for hospitals; we’d say to them, “Look, this is a totally free thing. You don’t have to pay until you have success. You can post as many jobs as you want to our platform.” We tried to build something that was pretty, functional, and that the business model was debt simple and impossible to ignore; so that they’d say, “Yeah. Why not? It’s a risk-free thing.”
So, you’re kind of faking one side of the equation. Once you have that tiny little bit, you’re off to the races. Then, you just have to parlay each one into a little bit more on the other side and back and forth, back and forth, and back and forth. Again, we’re still doing that today, but I have gotten over that cold start problem.
Dr. Dave
Got you. Thank you for explaining that. I love the analogy of the crab walk. Does part of that crab walk involve geography or regionalization initially? I’m also wondering, where is Nomad available today?
Dr. Alexi Nazem
Yeah. That’s a really smart question. So, when we started, we did restrict ourselves to a smaller geography. Our company is based in New York City, so we focused on the states right around New York City. We launched with four states: New York, New Jersey, Connecticut, and Massachusetts; and stuck with that narrow focus for a long time. Now, we’re in about thirty states, being most of the east coast; some of the south…California and Texas; and we just went into the upper Midwest over the Summer.
A lesson learned from raising capital included determining what was compelling about the opportunity, solution, and team that formed the company’s story.
Dr. Dave
Okay.
Dr. Alexi Nazem
Yeah. Our goal is to be across the country sometime in 2019.
Dr. Dave
Very good. I’m going to switch gears a little bit here. I’m curious as to some of the lessons learned from raising capital for something like this, because that certainly is a part of the equation. So, I’m wondering what your experience was like in that aspect.
Dr. Alexi Nazem
Yeah. This is one of the big challenges in any startup. Capital is life and cash is life in a company. You can have a brilliant idea, but if you don’t have the dollars to pursue it, you’re out of luck. So, that was an interesting challenge. I’d never raised capital before, but one of my cofounders had successfully raised capital multiple times before and had actually had success with previous startup companies. So, that provided a lot of credibility to our company.
The experience that I had was actually…I don’t want to call it pleasant, because it’s never entirely the easiest thing to do; but it was really exciting to go out there and kind of pitch the vision to others in the industry and convince them to hop on board with us. So, it was a question of determining what it was that was really compelling about the opportunity; compelling about the solution; and compelling about the team that was going to pursue it.
Defining that story was really, really important; because, frankly, that’s all you’ve got at that early point. You’ve just got a story, a hope and a prayer. You know? So, somebody has to, basically, believe that you’re going after the right stuff with the right people. So, that’s what those early capital raising conversations were all about.
Have an incredibly clear business model if you want to start a company in health tech.
Dr. Dave
Well, I can imagine if you’re going to need to convince people to believe in you enough to put their own cash down, you have to clarify your vision, I suppose, of all this in order to be able to effectively pitch that.
Dr. Alexi Nazem
For sure. Actually, I think this is one of the biggest challenges in any startup, but I think especially in healthcare. People have a challenge here, and if I can offer some unsolicited advice to any aspiring healthcare entrepreneur our there, it would be to have an incredibly clear; incredibly focused, ie: narrow, business mode; and really understand how you’re going to make money. I think one of the biggest pitfalls in health tech, especially, has been…well, this is something that should happen.
The idea is like…of course we should improve people’s blood pressure management and this app is going to help them do it. However, there’s no sense as to how you’re going to monetize that; and in healthcare, that is an instant death nail. So, for us, we were very lucky to have a clear business model going in and saying, “This is what we’re going to offer, and this is how we’re going to capture that value, and how we’re going to make money as a company.” So, being able to articulate that is of the utmost importance, especially for a healthcare startup.
Dr. Nazem wishes physicians learned more about the business side of healthcare.
Dr. Dave
Really quick follow-up there, because I think you’re so right there. Did a lot of that knowledge come from the physician side of your team, or was that more business or technical side? This is not stuff that you typically learn in medical school.
Dr. Alexi Nazem
That’s right. So, myself and also one of my cofounders are dual MD, MBA’s. So, we’ve seen our fair share of both sides of the market. As I’ve mentioned, some of my cofounders are serial entrepreneurs, so they’ve been through this ringer as well. So, all of us, actually, brought quite a rigorous and skeptical point of view to starting this company. We said, “Is this a business?” from the very beginning. I think that served us well. Frankly, I wish that a lot more of this stuff was taught in medical school. Healthcare is a giant business and I don’t think that every doctor should be trained on how to be an entrepreneur, per day; but healthcare is a giant business and to not understand the financial underpinnings of the system is to not understand how to operate well in that environment; even as a practicing clinician.
Dr. Dave
I agree with you there. I know you guys write some capital and I don’t know where you are in the life cycle of that, but if there are physicians listening and they’re on board with this idea of what Nomad health is doing; is there any opportunity for physicians to invest?
The top priorities for Nomad Health are growth and product development.
Dr. Alexi Nazem
At the moment, no. We’ve been well-capitalized with investor dollars. I think the best way for a clinician to get involved is to actually become a Nomad user. Also, there is a way to benefit from the growth of this company. We absolutely want to grow by people referring their colleagues. That is by far the best way to find really top-quality talent. So, we pay out referral fees to physicians and nurses who join our platform and refer their colleagues. At the moment, we’re not taking investment from anybody.
Dr. Dave
Got it. I understand. What are the top priorities for Nomad Health in the next year or so?
Dr. Alexi Nazem
Well, I think one of them you touched on, which is growth. We are trying to get our service offered to more places in the country and to more clinicians. So, that’s a big, big, big opportunity for us. The other is to really develop our product. I think we’ve got a great service out there, but there is plenty of room for improvement for new features that our clinicians and clients are coming to us and requesting. So, for us, it’s mostly about growth and optimization. Longer than one year, we are very interested in expanding the offering to other types of clinicians and to other types of jobs.
Another idea for doctors who want to create a healthcare startup is to determining if there is a business there in the first place.
In the long run, we would like to be just a healthcare jobs marketplace, not just a doctor jobs marketplace or a nurse jobs marketplace; but a place where advanced practice providers, Allied health professionals, and others in the clinical realm can find all the kinds of jobs that they want to do and vice versa…the clients who would want to hire them…the healthcare facilities that would want to hire them, could hire any type of clinician for any type of job…be it short-term freelance jobs or a full-time job. So, there’s plenty of growing left for us to do. The next year is mostly about capturing all of that opportunity that’s really right there hanging in front of us.
Dr. Dave
Got it. We’re getting to the second half of the interview…the part that I like to call the final five. What is your best advice for doctors that have an idea for a healthcare-type startup?
Dr. Alexi Nazem
Wow. So, I sort of already gave one piece of advice, which is if you want to do a healthcare startup, be absolutely certain that there’s a business there; not just that it’s a good idea that will help with part of your workflow or something for your patients. I mean, those are wonderful things to do, but unless you can get paid for it, it won’t be sustainable. So, really be self-critical and skeptical about whether or not there’s a real business there, I think is very important. I think another piece of advice, if I can give a couple…
Dr. Dave
Absolutely.
Think about the things that need to be done in healthcare right now.
Dr. Alexi Nazem
Is that I think these days, you’ve got to think about what are the things that need to be done in healthcare and what are the things that are challenging to do in healthcare? I think, from the need-to-be-done side, there’s a lot of basic infrastructural stuff that needs to happen in healthcare in order for us to achieve that next level of growth, improvement, and quality that we’re looking for.
So, I think a lot of companies that are focused on picks and shovels kind of opportunities, where it’s like hey, this is how you get data out of an EMR; or how we all speak the same language; or like what we’re doing at Nomad, getting great doctors and nurses into jobs. Something that is so fundamental to the way that the healthcare system operates, that’s the kind of stuff that needs to happen first; and then, you can start building really cool things on top of it. So, to take an analogy from recent history, you needed to have AOL and Google to be created in the first wave of the internet, in order for us to have Facebook and Uber in the second wave.
You have to have that sort of baseline stuff before you can start thinking about next gen stuff. In healthcare, I think a lot of people are jumping too far into the future saying “Oh, we’re going to do like artificial intelligence and clinical behavioral change” and all this kind of stuff, when we can’t even agree on a format for sharing basic patient information across venues of care.
Common challenges that health tech startups face can involve either looking too far into the future when we can’t even agree on how to share basic patient information.
So, that infrastructural stuff, I would say needs to be addressed; and those are great companies to focus on. Then, the things that are tough in healthcare, that I avoid like the plague, are anything that really involve very prolonged enterprise sales cycles, where you just get stuck in the eighteen-month procurement cycle for IT for a hospital. Don’t get into this scenario where you’re just doing pilot, after pilot, after pilot. You know, death by pilot is a very unpleasant way for a company to die. These are very common challenges that health tech startups face. I can keep blabbering on, but I don’t want to get stuck on the first one.
Dr. Dave
No. That was good, and it makes a lot of sense. So, thank you for sharing that. Is there a resource, other than your own, that you’d recommend that’s either related to learning more about healthcare startups or even something related to personal development that you found useful?
Dr. Alexi Nazem
That’s a great question. So, I think, like you said, we don’t learn a lot of this stuff in medical school, training, or practice. So, I’d say to try to get smart on a lot of this healthcare business stuff. There’s lots of great resources out there. There’s this really great firm called that’s based out of San Francisco.
Try to get smart on healthcare business stuff by checking out great resources.
They run a really good series of programs and conferences; they’ve got lots of really great materials online; they have catalogues of promising startups in the space. Sign up to their weekly newsletter; attend their conferences; and join that kind of stuff. I think that stuff is really, really helpful, because it’s a different lens on healthcare. It’s the businesspersons’ and technology persons’ lens on healthcare, and not the clinicians’ lens on healthcare. So, it’s a great source of knowledge and I’d say to read more of that kind of stuff. So, there’s a bunch of daily and weekly newsletters. I love the that Clifton Leaf puts out every day. I really like the email. So, there’s just a bunch of stuff to just fort of put yourself in that flow of information and you start seeing things, making connections, and learning a ton.
Dr. Dave
Thank you. We’ll definitely link up to all of those in the show notes as well. So, if people didn’t quite catch all of them, check out the website and we’ll have links to everything. I’m not sure if you have any children, but you can give either your best money tip or parenting tip, or both.
Dr. Nazem’s best financial tip.
Dr. Alexi Nazem
I don’t have kids, so I will not try to dispense parenting advice. What would I say? I would say on a money tip standpoint, just personal finance…I mean, I’m not a financial advisor or anything, so take everything I say with a grain of salt; but if you’re not yet in your retirement, you should be setting up an IRA. Any type of IRA…Roth IRA or whatever. Take advantage of all the elements of our tax … that allows you to save for the future. Similarly, I would invest whatever money you have saved into things like ETF’s, which are index funds. That’s just like a “set it and forget it” way to make money for your future. Definitely save and put that saved money into something that’s almost guaranteed to grow over the long haul.
Dr. Dave
Yeah, I agree. Definitely take everything you listen to on a podcast with a grain of salt, but I agree with you there. Saving and then automating those savings, and the investing, is a great tip. Looking back now, is there anything you wish you had done differently in your career so far?
Take advantage of the very smart people around you and maintain those relationships.
Dr. Alexi Nazem
Oh, gosh. That’s a great question. Well, I wish that I had at every stage taken more advantage of the very smart people around me and maintained those relationships. I’ve done a decent job of it, but those are the things that have always paid the greatest, both personal and professional dividends. So, really investing and finding out what is that special expertise that the guy that sits next to you has or take her out to lunch and build those kinds of professional connections. Be curious and learn a ton more, because you can only develop so much knowledge from your own experience. If you are fortunate enough to be in medicine, you’re probably around a lot of really smart people. I wish I had learned more from more people.
Your network is so important in the relationships that you develop.
Dr. Dave
I agree with you there. Your network is so important in the relationships that you develop. Like you said, being physicians, generally, we’re pretty blessed to be around some very sharp people. So, definitely take advantage of those relationships. We’re coming to the last question here. This is kind of a whimsical one. The one place you’d fly to tomorrow if you had no commitments and infinite resources?
Dr. Alexi Nazem
That’s an easy one for me. I’d fly to Zurich, Switzerland, because that’s where my fiancée lives; and I’d love to spend some more time with her. So, that’s where I’d go.
Dr. Dave
That is awesome. I actually got to spend a little bit of time in Switzerland back when I was in college. We did an overseas program and I got to spend close to a week, I think it was just outside of Zurich, and it was just beautiful out there. It was a wonderful, wonderful place.
Switzerland has an incredible healthcare system.
Dr. Alexi Nazem
It’s so pretty. You know what? It’s actually a good example. It’s kind of interesting that you asked this question and I said Switzerland, because we’re talking on a healthcare podcast. That’s a country where everything just kind of works. Everything is so well thought out and people participate appropriately in every system. Their healthcare system is interesting, their transportation system is interesting, and it all just kind of works. So, I recommend that every single one of your users go to Switzerland. It’s just an incredible place. It’s inspirational, especially for us healthcare nerds.
Dr. Dave
Yeah, for sure. I agree with you there. Is there anything I didn’t ask you either about yourself or the company that you’d like to mention?
Nomad Health is the best way for clinicians to find jobs and you can register for an account for free.
Dr. Alexi Nazem
I mean, I guess on the front of the company, I didn’t do a great job explaining what we do, but long story short, I think this is the best way for clinicians to find jobs; for healthcare facilities to hire clinicians; and we are looking to be better and I would absolutely love to hear the advice and suggestions of any of your smart listeners in the medical world. Come onto our site, nomadhealth.com. You can register an account for free, have at the product, and just tell us how it’s completely broken and should be fixed. We’d be very happy to hear that, and of course, we’d love to hear if you think it works well too. That’s it.
Dr. Dave
Perfect. We’ll definitely have links to in the show notes. You can definitely check it out there if you forget how to get there or anything like that. Dr. Alexi, thank you so much for all the insights and for giving us a glimpse backstage at , and for being a guest on Doctors Unbound.
Dr. Alexi Nazem
It is my absolute pleasure, David. Thank you for having me.
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