More than four years ago, I received an offer to join the founding team of a healthcare startup building an innovative home-based primary care and pharmacy model for older adults managing high-risk and complex health conditions. CMS reimbursements for chronic care management, remote patient monitoring, and home-based practice were expanding in ways that made the timing feel almost deliberate. After 20 years spanning direct clinical practice in community health and federally qualified health centers, public health program development, and healthcare nonprofit leadership, it felt like a natural next chapter and a welcome challenge. I said yes.
What followed was the most professionally challenging experience of my career. It was also the experience that most expanded what I believed was possible for it.
Clinicians are being recruited earlier and more often into startup environments. The health tech boom, digital health, remote patient monitoring, new care delivery models, and expanded reimbursement structures have created genuine opportunities at every stage of a company's development. Physicians, PAs, NPs, pharmacists, physical therapists, and others are finding roles in care delivery, product design, user experience, and clinical strategy at pre-seed through Series B and beyond. Here is what I wish someone had told me before I walked in the door.
Clinical Instincts and Clinical Habits Are Not the Same Thing
Clinicians are trained to seek consensus before acting. We present findings before drawing conclusions. We document thoroughly before moving forward. In my first months at the startup, I felt the friction of those habits immediately. My instinct to pause and build consensus read as indecision. Speed was currency. Decisions were made with incomplete information, and the culture rewarded those who could tolerate that ambiguity without stalling. Adapting to that pace did not mean abandoning clinical standards. It meant recognizing that the norms governing authority and momentum were genuinely different.
The Clinical Voice in the Room Belongs to You
When I joined the company, I realized quickly that my role was more than answering clinical questions when they arose. It was to ask the clinical questions no one else in the room knew to raise. Usability. Workflow. Safety. Trust. These are not afterthoughts in healthcare product development. They are precisely the reasons products fail when clinical perspective is absent from the design process. Founders and technologists are often exceptional at what they do and, through no fault of their own, genuinely underinformed about how care actually happens at the bedside. I learned to stop waiting to be asked and to start treating that gap as the core of my contribution.
Business Fluency Is a Clinical Skill Worth Developing
I did not arrive knowing how to build a pitch deck, create a clinical onboarding program from nothing, or defend a patient care initiative inside a budget conversation. I learned all of it. The process was humbling and, at times, deeply uncomfortable. What made the difference was committing to the learning rather than waiting for someone else to translate the business world into clinical language on my behalf. The clinicians I have watched struggle most in startup environments are not those who lacked clinical expertise. They are those who declined to develop business fluency and found themselves sidelined from the decisions that mattered most.
Isolation Is an Early Hire Reality
There is a particular loneliness in being the only clinician in most meetings. In the early days, my full-time colleagues were the head of operations, a head of sales, and a head of pharmacy. The clinical perspective was mine alone to carry. I second-guessed my instincts regularly, questioning whether my hesitations represented clinical wisdom or resistance to change. The honest answer was usually both. That tension is not a problem to be resolved. It is where the most important work gets done. Finding other clinicians navigating similar transitions changed my experience considerably. That community is growing, and the shared reality of early clinical leadership is worth discussing honestly rather than presenting as seamless confidence.
Know the Stage Before You Accept the Role
For years, the default pattern in healthcare innovation was predictable: clinicians were brought in late, after core decisions had already been made. Products were built and then tested for clinical fit. Care models were designed and then handed to clinical teams to operationalize. The consequences showed up in adoption rates, safety gaps, and clinician distrust. That is changing. Clinicians are increasingly being recruited at the founding stage, before the product is built and before the culture is set, and that shift matters enormously for patients, clinicians, and companies.
Understanding the role and the stage before accepting matters as much as anything else. An early-stage company needs a clinical architect. A growth-stage company may need an operational leader, a revenue driver, or an oversight structure for APP collaboration. A later-stage company may need a fractional executive or advisor who brings credibility without full-time commitment. None of these roles is lesser. All of them require knowing which one you are walking into.
Which Path Brought You Here Matters
The clinician entering health tech today arrives from one of several directions. Some are medical school graduates who did not complete residency, bringing foundational knowledge but limited bedside experience. Transparency about that training gap matters as much as confidence in what the degree represents. Others are practicing clinicians who have left direct patient care entirely, which requires an honest reckoning with what is being left behind, not just what is being gained. The largest group, and in my observation the most sustainable model, is the clinician who does both: maintaining active practice while taking on fractional, advisory, or executive roles. That clinical thread is professionally credible. It keeps instincts sharp and authority intact in every room you walk into.
There is a growing ecosystem of clinician communities, podcasts, and resources designed to support nontraditional and combined career paths into health tech. These are not side hustle networks. They are professional development communities for clinicians who understand that diversifying expertise is how they remain relevant in a rapidly shifting landscape. Update a LinkedIn profile and follow clinicians navigating the business and entrepreneurship space. Observe how they position themselves and how they describe clinical work in terms of organizational impact.
Then turn that lens on your own story. Every committee served, every candidate interviewed, every new hire trained, every lecture delivered represents transferable leadership experience. Volunteer in small ways within your professional association. Attend one nonclinical session at a conference. Introduce yourself to one person working at the crossroads of medicine and industry. Think of it the way a financial advisor thinks about portfolio diversification: start small, be consistent, and let the compounding work. The clinicians best positioned for what healthcare is becoming are those who began expanding their range long before they felt ready.
Whether a startup is the right environment is a question most clinicians cannot answer until they have lived it. That uncertainty is not a reason to stay out. It is a reason to go in with eyes open. There is also a persistent perception among some founders and investors that clinicians are too risk-averse to thrive in fast-moving organizations. That perception is worth understanding and, where possible, worth proving wrong.
The next generation of healthcare delivery and healthcare products cannot be built successfully without clinicians at the table. We bring something that cannot be replicated by even the most talented technologist or the most experienced operator: the direct, embodied knowledge of what it means to care for a patient. With peer community, expanded business education, and proactive mentorship, we have an opportunity to shape the future of healthcare in ways that were not available to previous generations.
If you have transitioned into health tech, which clinical habit did you find most difficult to unlearn? Share in the comments.
Helen Tanner, MPH, MPAS, PA-C, is a clinician executive whose career spans community health, public health leadership, and early-stage healthcare companies. She is the founder of The Early Hires, a podcast and peer community for clinicians in startup and high-growth healthcare environments.
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