From Primary Care to Startup Leadership: Why Clinicians Matter Most in Early Chaos

Andrew Shiflett, PA-C, brings more than a decade of experience in complex primary care and was one of the first clinical hires at a Series A mobile primary care startup. Joining within the first months of the company’s life, Andrew stepped into patient homes without playbooks. He had no formal title, but a role as the clinician others trusted to navigate uncertainty and advocate for their needs.

In this conversation, Andrew reflects on leaving a stable practice for the unpredictability of startup life, weighing risk against opportunity while raising a young family. He shares candid stories of knocking on doors with nothing but a stethoscope and a printed schedule, building trust with patients in underserved communities, and learning to translate clinical realities into business language.

Helen and Andrew revisit pivotal moments, including advocating against a productivity-based compensation model that threatened clinician retention and patient outcomes. The importance of clinician voices in shaping startup culture, the responsibility of early hires to smooth the path, and the leadership that emerges when clinicians step into uncharted territory.

This episode is for clinicians considering the leap into startups, leaders building early teams, and anyone curious about how frontline expertise drives innovation.

Must-Hear Insights and Key Moments

• Andrew was one of the earliest clinical hires at a Series A mobile primary care startup, stepping into patient homes without established systems.
• Leaving a secure practice in Richmond for startup chaos, he weighed risk against stability while raising a young family.
• Clinician leadership emerged without a formal title, as colleagues relied on him to navigate uncertainty and raise concerns to leadership
• Knocking on doors with no playbook showed the realities of startup medicine and the physical demands of home‑based care.
• Dog years of startup life meant each month felt like a year in traditional practice.
• Trust before titles became the foundation for patient care and clinician advocacy in early chaos.
• Partnering with Helen Tanner, he pushed back against productivity‑based compensation models that threatened retention and outcomes.
• Building the plane while flying captured the challenge of asking patients to trust a system still being created
• From Series A chaos to a $13B Series E Medicare Advantage startup, Andrew’s journey shows how clinicians shape healthcare innovation.

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Join The Early Hires Community

Are you a clinician navigating startup life? The only way to access our private Slack community is by visiting www.theearlyhires.com.

Head to the website to request access and join clinicians who are building, leading, and navigating the realities of early-stage healthcare companies.

Share your challenges. Share your wins. Ask your questions.

Start at www.theearlyhires.com.
The conversation continues there.

Leading Without a Playbook: Why Executive Coaching Matters in Early-Stage Startups

Lupe Prado is an executive coach who works with leaders across startups, private equity, and corporate organizations. For over seven years, she has helped high-performing professionals navigate leadership growth, career transitions, and complex workplace dynamics. Lupe built her career in accounting, and financial reporting. After experiencing burnout early in her career, she sought out coaching herself. Ultimately led her to pursue a master’s degree in leadership, and organizational development with concentration in executive coaching and to launch her own coaching practice.

Lupe explores with Helen what executive coaching is behind the scenes, particularly for leaders operating in a fast paced startup environment. She shares the common themes in startup leaders seeking support, including self-doubt, and the loneliness that often accompanies senior roles. They cover the practical approaches leaders use to seek meaningful feedback, and build support systems as responsibility grows.

Lupe explains how leaders can sustain performance by strengthening foundational habits by developing tools to manage pressure and internal criticism.

For clinicians moving into startup leadership roles, these insights offer a clearer understanding of how coaching can provide perspective, strengthen decision-making, and support leadership development in environments where the structure is still evolving.

About Lupe

Lupe Prado is an executive coach who has worked with leaders across startups, private equity, consulting, and corporate for more than 7 years. Her work focuses on supporting high-performing professionals as they navigate leadership growth, career transitions, and complex environments.

Before becoming a coach, she began her career in accounting and financial reporting. After experiencing burnout early in her career, she sought out coaching herself. It was an experience that led her to pursue a master’s degree in leadership and organizational development with executive coaching.

Lupe now works with leaders across industries, helping build perspective, and navigate the pressures that often accompany senior leadership roles. Her coaching frequently supports startup leaders in a fast-paced environments, where expectations evolve quickly and structures are developing.

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Follow The Early Hires

• LinkedIn
• Website

Follow Helen Tanner

• LinkedIn

Join The Early Hires Community

Are you a clinician navigating startup life? The only way to access our private Slack community is by visiting www.theearlyhires.com.

Head to the website to request access and join clinicians who are building, leading, and navigating the realities of early-stage healthcare companies.

Share your challenges. Share your wins. Ask your questions.

Start at www.theearlyhires.com.
The conversation continues there.