Hustling at Work: What's the difference between a TechBro and a Junior Faculty Member in Medicine

Uber for cats and CT screening for homeless people

A few years ago, a colleague of mine was applying for, and eventually received, a grant to study lung cancer screening in a vulnerable population. One day, we were having coffee, and she mused.

“Look at these 20 year old tech start up people. 8 of them living in a house. Spending day and night coding. All dreaming that they will make it big. It’s sad to watch, knowing how few will succeed. What a sad way to spend your twenties trying to make an uber for cats.”

She knew I had little understanding and little sympathy for technology makers, so I sipped my coffee and nodded along.

“How many hours are you putting into your project?” I asked.

“OMG, it’s all encompassing. When I am not in clinic, or on service, I am writing the proposal, editing it, and coordinating the team. I dunno like 70 hours a week. If we don’t get funded, <the boss> says we might use internal funds. So it is going to happen, and I have to prepare. I almost wish I were back in residency. It was easier then. I feel bad for <her child>— sometimes I barely see her before she goes down— but she has <her husband>.”

<her child> was her 18 month old.

I nodded and sipped my coffee.

Of course, I didn’t want to say it, but I could not escape the irony. On the one hand, my colleague was critical of these young tech people for burning the midnight oil in pursuit of their startups. And, indeed many of these startup ideas are silly, and most will not succeed.

But on the other hand, here she was, a 30 something year old, working day on night on trying to expand lung cancer screening— an intervention that does not improve mortality— to people who literally need everything BUT lung cancer screening. Her project was useless from a medical and public health standpoint.

She was also in a different stage of life than the start-up kids. Arguably, she had better reasons not to waste her time. And the start-up kids had something that she did not have: a small chance of massive upside.

The most her research could possibly accomplish is to improve her own career— screening ain’t helping the vulnerable folks. That improvement might be to ‘accelerate’ her 7 year assistant to associate professor timeline to 5 years. This might improve her lifetime earnings by a couple hundred thousand dollars over a career.

In contrast, the most these young tech people stood to gain was both a. it is possible their idea would actually be useful to others and b. even if not, even if it is the lung cancer screening of tech, they might make….

…. tens or hundreds of millions.

The difference was several orders of magnitude.

Hustling. That’s what some people do in all industries. Young people in tech. Slightly older people in medical careers. I always admire people who hustle, even though I often wonder what the point of their work is. One thing I know for sure is that no matter how stupid and low yield and pointless and futile ideas might be in silicon valley— and believe me I live here and know just how bad it can be— ideas in medical research are often even more stupid and low yield and pointless and futile and worse of all harmful to human beings.

Give me a tech-bro hustling to create a driverless car service to transport cats when you on vacation over a 100 early career K award investigators studying how to expand lung cancer screening to homeless people.

I think many of us in medicine, particularly those who generate medical research, need someone to splash them with a bucket of ice water. Your research is probably pretty close to pointless. The benefit to patients might be borderline zero. The amount of time you are spending on it is catastrophic. You are missing out on spending time with family or on vacation in pursuit of this madness. Think about the tech bro in a dirty, drafty San Francisco house, sleeping on a mattress on the floor, drinking Nespresso, and coding all day, and consider perhaps that what you are doing might not be any better… except with less upside.

This video is about useless screening in vulnerable groups but not the person I knew, but explains the idea better.