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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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.
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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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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.

Clinical Leadership in Healthcare Startups: What Clinicians Learn Navigating Growth, Risk, and Operational Strategy

Helen is joined by Tim Talbert, nurse practitioner, veteran, and healthcare executive who spent more than a decade leading clinical teams inside healthcare startups. Tim began his career in clinic-based primary care before stepping into an early-stage company delivering high-acuity care directly in patients’ homes. He led teams of advanced practice providers while partnering closely with operations to align clinical outcomes with business priorities.

Tim grew alongside the organization as it raised more than $700 million and expanded nationally. He took on increasing leadership responsibility while navigating hypergrowth, operational restructuring, and leadership transitions common in venture-backed healthcare companies.

Helen and Tim explore what clinicians learn when they step inside startup environments and explain how clinical training encourages algorithmic thinking while startup leadership requires systems thinking and comfort with uncertainty.

The episode offers a practical look at how clinicians translate frontline experience into leadership and healthcare innovation.

About Tim Talbert

Tim Talbert is a nurse practitioner, veteran, and healthcare executive with more than a decade of experience leading clinical teams inside healthcare startups. He began his career in clinic-based primary care before stepping into an early-stage company delivering high-acuity care directly in patients’ homes.

Tim entered the organization in a market-level leadership role, balancing clinical care with operational oversight while leading teams of advanced practice providers. Over the course of the company’s rapid expansion, he grew alongside the organization as it raised more than $700 million and expanded nationally.

Today, he serves as President of Clinical Operations at HealthBridge, where he splits time between patient care and operational leadership. His work focuses on improving the transition from hospital to home through virtual care, care coordination, and collaboration with home health teams to reduce readmissions and close gaps in care delivery.

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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.

In this episode, Helen sits down with Dipu Patel, DMSc, MPAS, ABAIM, PA-C, educator, innovation leader, and immediate past president of the PA Education Association. Dipu serves as professor and vice chair for innovation at the University of Pittsburgh PA program, where her work focuses on digital health, artificial intelligence, quality improvement, and preparing clinicians for the future of care.

Before stepping into academic leadership, Dipu spent 20 years in clinical practice and later served as director of clinical pathways at a healthcare technology startup. She breaks down what it takes for clinicians to move from delivering care inside systems to influencing the systems and technologies that define care delivery. Dipu explains why systems thinking matters more than clinical thinking when translating workflows for engineers, why trust is part of implementation, and why ROI in healthcare cannot only be financial.

The conversation explores why PA programs must embed leadership training into curricula, why clinicians need AI literacy now, and why raising your hand for roles outside your comfort zone pays dividends years later.

For clinicians navigating innovation, education, or startup work, this episode delivers clarity on building the future of healthcare.

Mentioned in the Episode:

• Digital Health, Telemedicine and Beyond
• PA Education Association (PAEA)
• University of Pittsburgh PA Program

About Dr. Dipu

Dipu Patel, DMSc, MPAS, ABAIM, PA-C is a clinician, professor, author, and national speaker working at the intersection of digital health, artificial intelligence, and medical education. She focuses on helping academic institutions, healthcare organizations, and professional associations move from reactive technology adoption to intentional system design that supports clinical reasoning, professionalism, and patient-centered care.

With a career spanning clinical practice, academic leadership, innovation strategy, and board governance, Dipu collaborates with institutions to translate emerging technologies into practical, ethical, and sustainable educational and clinical practices. Her work centers on AI in health professions education, digital health strategy, simulation, and systems thinking—ensuring healthcare innovation remains grounded in human-centered care.

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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.

From Underserved Care to Startup Leadership: Why Gap-Closing Translates Across Both Worlds

In this episode, Helen sits down with Dr. Neil Patel, a family physician with more than 20 years of clinical practice and over 15 years as an early clinical leader in healthcare startups. Neil was part of the founding team at Iora Health and later served as Chief Health Officer at Patina Health, carrying lessons across multiple stages of company building, including growth, scale, and closure.

Neil reflects on how his early career in underserved and FQHC settings shaped the way he approaches innovation. He explains why clinicians drawn to community health are often the same people pulled toward startups — not because the environments are similar, but because both require identifying gaps and building solutions where infrastructure is incomplete.

The conversation explores why humility is a core leadership skill, why starting from a blank slate is often the real cheat code to innovation, and how listening like a clinician translates directly into leading teams, products, and organizations. Neil also shares how serving freelancers at Iora expanded his definition of “underserved,” why access to care is one of the most overlooked areas for innovation, and why founding teams work better when responsibility for outcomes is shared.

This episode goes deep on closing gaps rather than chasing solutions — and why meaningful innovation happens when leaders stay humble enough to let patients, teams, and data lead the work.

For clinicians navigating startup life, this conversation offers grounded perspective from someone who has lived multiple chapters — and chosen to start over.

Mentioned in the Episode:

• Latino Health Access

About Dr. Patel

Dr. Neil Patel is a family physician with more than 20 years of clinical practice and over 15 years as an early clinical leader in healthcare startups. He was part of the founding team at Iora Health, an early innovator in primary care, and later served as Chief Health Officer at Patina Health, a geriatric care startup focused on reimagining aging through virtual and home-based care.

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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.

Just because you are doing everything right clinically does not mean the organization will survive.

In this episode, Helen sits down with Katie Davis, a nurse practitioner and clinician executive who has spent more than two decades building care models across hospital systems and early-stage healthcare startups. Katie has served as a founding and early clinical leader in multiple venture-backed companies, helping design and operationalize care for high-risk populations in fast-moving environments.

Katie shares her path from taking a 50 percent pay cut to join her first telehealth startup to spending five years building a clinically successful company that ultimately shut down. She reflects on the hard lessons that came with that experience and how it reshaped the way she leads.

Together, Helen and Katie unpack the shift many clinicians struggle with in startups, moving from being the person who flags every risk to the leader who says yes and figures out how to make it work. They explore the tension between mission and margin, why a growth mindset matters more than perfection, and how failure becomes a necessary teacher when building something new.

Now running her own fractional leadership practice, Health Shift Leaders, Katie is focused on helping clinicians learn the business of healthcare faster and with fewer painful lessons. This conversation is full of honest insight for any clinician navigating startup leadership, uncertainty, and growth.

Must-Hear Insights and Key Moments

• Her first startup built telehealth for skilled nursing facilities before it was commonly done.
• Katie shifted from pointing out obstacles to saying yes and figuring out how to make things work
• Board relationships from her first startup created opportunities years later

Mentioned in the episode:

• HealthShift Leaders
• Y Combinator
• The Heart of Healthcare Podcast

About Katie

Katie Davis is a board-certified adult gerontology acute care nurse practitioner and advanced forensic nurse with over 20 years of experience across hospital systems, health tech, telemedicine, and post-acute care. She has served as a founding and early clinical leader in multiple healthcare startups, building and scaling clinical operations for high-risk populations.

Katie spent five years at her first telehealth startup serving skilled nursing facilities and four years at her second startup, where she was the first nurse practitioner hired and helped scale operations to 15,000 patients per month. She is the founder of HealthShift Leaders, a fractional leadership practice, and is building a new company focused on teaching clinicians the business of healthcare.

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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.
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Patient safety is job one. Everything else is negotiable.

The Early Hires launches with Dr. Adam Perry — a geriatrician and ER physician who has helped build home-based and senior care models across early- and mid-stage healthcare companies. He has served as a Chief Medical Officer and Regional Medical Director, and he is now the founder of Health Span Partners.

In this pilot episode, Dr. Perry breaks down what clinician leaders need to understand on day one: early-stage work is about protecting patient safety while learning how the business stays alive. Mid-stage work is different — more resources, more complexity, and harder decisions about what to standardize, refine, and scale.

You will hear why clinicians must become interpreters between business and clinical teams, how to translate clinical risk into language executives actually act on, and the uncomfortable truth many clinicians miss: you are often the revenue engine — through your work, your NPI, and even your licensure. He also shares what to ask before you sign an offer, how to think about equity, and why “who owns the company” shapes everything.

If you are considering a startup role — or already in the ambiguity of early clinical leadership — this episode is a practical reset on how to lead with clarity, protect patients, and stay aligned with reality.

Welcome to The Early Hires.

Must-Hear Insights and Key Moments

• In early-stage startups, clinician leaders are first and foremost advocates for patient safety — one of the few priorities that rarely requires translation to the business side.
• Dr. Perry recommends getting legal or accounting advice on equity offers because the structures vary dramatically

Mentioned in the episode:

• GUIDE Dementia Care Program
• Healthspan Partners
• American College of Healthcare Executives (ACHE)
• John Hartford Foundation
• Gary and Mary West Foundation

About Dr. Perry

Dr. Adam Perry is a geriatrician and emergency medicine physician with over 20 years of experience building innovative care models for older adults. He has served as Chief Medical Officer and Regional Medical Director for early and mid-stage healthcare startups focused on home-based acute care, hospital at home, and primary care.

A John Hartford Foundation fellow, Dr. Perry helped lead the geriatric emergency department movement nationwide. He is currently founder of Healthspan Partners, participating in the CMS Guide Dementia Care program, delivering home-based care to older adults with dementia across multiple states.

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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.