Martin Shen with employees
Mobile health seeks to remedy some of the challenges facing today’s doctors and patients
In China, the “uberization” of everything continues. Car owners are equipping their vehicles with multiple car-hailing platforms; homeowners list rooms in their apartments for temporary stays; cooks open their homes to strangers wanting a homemade meal. And now doctors are getting in on the game, providing a myriad of healthcare-related services, all accessible by mobile phone. Companies in the mobile health industry span the spectrum of healthcare-related needs, from ones that book appointments and solicit doctors’ answers to ones offering services tailored for specific diseases.
Though the industry’s regulatory framework is still developing, the Chinese government’s attitude of encouragement to doctors to engage in private practice as a complement to their full-time hospital work, combined with the demand by consumers for easy-access healthcare, has boosted growth. Clearstate, a healthcare market research company, estimates that the mobile health industry in China will grow by 60 percent between 2015 and 2018 and become the second-largest market globally. Research firm iiMedia made similar estimations, predicting that the market will exceed RMB10 billion by the end of 2017.
One player in the industry is Xingren Yishen (杏仁医生), meaning “Trusted Doctors”, an application that describes itself as a “mobile partner” to the doctors of China’s overburdened hospitals. Its capabilities include an integration with WeChat through which doctors and patients can communicate, management tools for doctors to track the health and recovery of their patients, and access to the evidence-based clinical resource, UpToDate, as well as China’s leading drug reference database.
Doctors can also supplement their income by offering consultation services via the app. The benefit to patients signing on to the fee-based VIP service (Trusted Doctors takes a cut of that fee) is that they gain, in China terms, unprecedented access to their doctors. Through the app, patients can talk with their doctors about a range of issues. They can ask follow-up questions after consultations, solicit advice on foods to eat and avoid, and inquire about symptoms, treatment options and prescriptions.
As the Trusted Doctors’ WeChat page, asks: Why take time off work or wait hours in line to see your doctor?
Frustrated doctor reinactments
Trusted Doctors was founded by Martin Shen, a physician with 18 years of healthcare industry experience. After graduating from medical school in Australia, he joined the Australian Navy, participating in peacekeeping and counterterrorism missions, and worked in the Australian public healthcare system. In China, he worked as deputy general manager of Beijing United Family Hospital before moving into healthcare IT with Computer Sciences Corporation and Siemens Healthcare. Then he started his own company.
Shen attributes his decision to leave corporate life and enter the world of startups to two factors. “I was at Siemens Healthcare for almost six years, leading our healthcare IT business. And at that point, I really saw that there must be a better way of doing things,” says Shen. “Looking at corporates, we often have great vision, but not necessarily great execution. And I think that’s where startups have the advantage, being able to be more nimble, more flexible, seeing the opportunity and executing directly. We don’t have the resources that a multinational might have, but we certainly have the enthusiasm and the drive.”
The other, bigger motivation came from his father’s pancreatic cancer diagnosis, which personalized the problems in the healthcare industry and drove him to improve the situation. Shen’s choices were either staying at Siemens for another 10 years and rising up the management hierarchy or trying to make a difference by founding a start-up. He chose the latter.
Shen’s first company was launched in 2013 under the name Kanchufang (看处看处方), with a mission to democratize healthcare information by creating a patient-driven healthcare management platform — in essence, a community for patients to exchange treatment options and find better answers to their healthcare questions. The company didn’t take off, but Shen learned that despite having an engaged core group of users, the majority of patients showed little interest in proactively controlling their own healthcare.
“What we discovered was that there is one source of information that a patient will listen to and that’s their own physician. So in 2014, we pivoted to Trusted Doctors,” says Shen. “Our goal hasn’t changed.”
The decision was a wise one. Months after securing their pre-A funding and becoming Trusted Doctors, Shen and his team secured RMB30 million in A-round funding from Sequoia and, a year later, RMB200 million in B-round funding from FountainVest. Today, over 400,000 credential-verified physicians from mostly public hospitals have signed up and, from a staff of five in 2013, it has grown to a staff of 530, with 34 offices across the country.
Shen attributes the success of his fundraising efforts to his team. “At the end of the day, if I look at my angel round, my pre-A round, the main reason we raised funding was really the team. Recognition by the VC that they believed in us and that we would be able to drive the business to completion,” he says.
Raising an army
The Shanghai headquarters of Trusted Doctors resembles a typical startup. The brightly-lit open office space is packed with rows of workstations and glass offices. Meeting rooms hug the exterior walls, there’s a small theater-like arena, and pantry nooks where team members can bond over lunch. Stuffed animals and Marvel figurines embellish employee desks. A banner that parodies the typical red-and-white propaganda street banners found around China declares: Xingren’s iron army sweeps away all obstacles, pioneers and breaks new ground, unique to its industry (杏仁铁军杏仁铁军 所向披靡 开疆拓土 行业唯一所向披靡 开疆拓土 行业唯一).
Apart from Shen and a few others in senior management, the employees are fresh-faced in both outlook and age. Shen emphasizes the need to hire and train the right mix of people from IT and healthcare backgrounds. Instead of delegating hiring to an HR department, every manager is responsible for his or her own team, including hiring, firing and setting goals. Instead of a matrix-type organization, every employee reports to only one boss. KPIs in the traditional sense — measurable functional goals linked to performance reviews — are avoided, as they are seen as a crutch that leads to inefficient organization.
“I’ll give you an example,” says Shen. “If you set goals for a developer to have ‘x’ number of bugs and more stable code, the immediate thing that they will do is obviously decrease scope in every version, or need another two weeks to complete. But in the startup world, we’re all aligned together — bugs or what have you are things we all need to avoid.”
All senior managers attend new employee training and invest time in their staff’s career development. For some employees, that development opportunity is key to their retention in an industry that, according to Shen, now has over 1,000 companies vying for space and talent.
“It’s very free and gives me a lot of personal space to grow,” says Stan Jin, the company’s social media manager, contrasting the work environment at Trusted Doctors with his former work as a local hospital doctor, where he felt confined by a lack of institutional creativity and bottlenecked career growth.
“I think hospitals need that innovative spirit to develop, but at hospitals they will think my kind of creative personality is not professional. Here [at Trusted Doctors] they will support my ideas,” he says.
One of those ideas is now a series of viral WeChat videos (WeChat ID: drxingren), produced by and starring Jin, that focus on the daily frustrations and emotions of the hospital practitioner. In one clip, Jin gives humorous examples of the different kinds of patients a doctor is likely to encounter; in another, he waxes lyrical on the importance of the doctor’s pen.
At your service
The videos are lighthearted, but they aim to convey the message that Trusted Doctors is a trusted partner. Hunter You, head of marketing and previously at tech giant Alibaba, believes that establishing an equitable relationship with doctors is essential. After joining, he decided to shift the mindset of sales representatives charged with introducing the app to doctors.
“What I discovered from going along to doctor visits with [sales representatives] is that the purpose of our platform is to help optimize doctors’ work. But I discovered that the team members who came from a pharmaceutical or medical equipment background continued to interact with doctors based on how they used to interact — that is, selling them them products,” he says.
Today the sales pitch is that of a partner offering a free service that helps physicians manage busy careers. This means conducting regular visits to doctors who have installed the app, so as to be on-call in offering their help and assistance.
“Last year, we discovered that just adding new doctors is meaningless because, even though we add new users every day, if you don’t provide additional service and they don’t know how to use it, they will not use it. So we built a new consultant team. Every consultant will be responsible for two hospitals. Their work is not to add new doctors but to see the same doctor regularly, to teach them how to better use the app, to explain how it can help them,” says You. “In providing this service, the doctors increase their trust in us.”
Assessments of the service are conducted regularly. While many competitors outsource their sales teams, Trusted Doctors only uses in-house staff. Progress is monitored and discussed at morning and evening meetings. When problems arise, everyone helps find solutions. Set procedures are used to handle doctor complaints, and recruitment information that is found to be forged leads to immediate dismissal.
According to You, the management system gives employees a sense of clarity. “They will know what their values are. They will know what kind of person the company likes, and what kind of person they don’t like. They know how to work so as to be able to develop within the company.”
Q&A with Trusted Doctors founder and CEO Martin Shen
How important is it for a foreign entrepreneur wanting to run a startup in China to get a Chinese partner?
I think it’s critical that you actually understand China yourself. I’m the only English speaker in my whole company. I’m not saying English language or a predominantly foreigner-based team won’t be successful in China, but you need to find your niche. If you’re a predominantly foreigner-based team, and your story is that you’re taking on the China market, you may very well have a competitive advantage, but it will be very hard to get VC funding. So being very practical, I think that’s one aspect. But the other aspect is that having a local team, a Chinese partner, is essential if you want to do the Chinese market. And to have someone that you work well with.
What specifically is the greatest value that a Chinese partner adds?
I think if you want to do the China market, if you’re a foreigner, you definitely should have someone from the local market partnering with you, to take the strengths and the weaknesses of both sides and meld them together. So I guess I wouldn’t really emphasize the China side, I’d more emphasize just finding the right partner. Other than Western and Chinese, I would say you need industry expertise. And understanding how the Internet works in China is critical. It’s very different. The operational effort that you need to drive things on the Internet is in no way to be underestimated. Whoever said the Internet is cheap is telling lies, because it’s very expensive to do an Internet business.
What has been the most difficult part of your job so far?
Everything’s difficult (laughs). I think driving the business is hard, I think managing the investors and raising funding is hard, I think hiring people is hard. When you have no money and you’re hiring people, you’re spending the effort and sharing the dream with everybody. Everything is difficult. I won’t single out anything as being more difficult than the rest.
If you could go back in time and share advice with yourself at day one, what would you say?
I probably wouldn’t do it. Even though we’ve probably already gone to the top five or top one percent of startups, to have raised the C-round and grown to this stage, the chances of getting to this stage if I look back are very, very low. And the effort and time that we’ve spent over those years exceeds massively what you would have expected. So if I had to do this again, I may not have done it, knowing what I know now. Because your chance of success are not that high. But having said that, if you are going to do it, you’d better put everything into it, and you’d better prepare yourself for the five-, 10-year long timeframe.