Have you ever felt the pressure to follow a traditional career path, even when your gut tells you to forge a different one? For many doctors, the path is clear: train, practice, repeat. But what happens when your passion for impact extends beyond the bedside? This episode features one of the leading physician innovators who faced this exact dilemma and made the difficult choice to leave clinical practice for a career in technology and venture capital. We explore the emotional and professional challenges of stepping away from a traditional medical career and how that pivot can lead to an even greater scale of impact.
In this deep-dive conversation, Dr. Rebecca Mitchell, Co-founder and Managing Director of Scrub Capital, shares her incredible journey. We begin with her upbringing in rural Wisconsin, where early experiences with a strained healthcare system and personal loss due to medical errors ignited her passion to innovate in care delivery. Dr. Mitchell discusses the pivotal moment during medical school at UCSF when she realized her true calling was not in day-to-day practice but in building systems to scale medical expertise. This led her to a successful career in digital health product leadership, where she was instrumental in scaling remote patient monitoring programs at companies like Validic with Kaiser Permanente and, most notably, Livongo. At Livongo, she helped expand the company from a single-condition diabetes platform to a multi-condition service that treated over 10 million patients, showcasing the immense impact physician innovators can have in the tech industry.
Now, Dr. Mitchell is channeling that experience into her next chapter with Scrub Capital, a venture capital firm built on a powerful thesis: that early-stage health tech startups are more successful when guided by a diverse community of clinician investors. She explains how Scrub Capital functions, its focus on pre-seed to Series A companies, and its unique "community pitch" process that involves dozens of clinicians in the investment evaluation. This conversation provides an invaluable look at the burgeoning world of clinician-led venture capital and offers practical advice for doctors considering alternative career paths for physicians. Dr. Mitchell’s story is a compelling case study for any medical professional who believes their impact can be amplified through technology, business, and embracing a nonlinear career.
Introduction
Dr. Trevor Royce: Welcome to HealthTech Remedy. This is the next installment of our bonus series on physician innovators, where we sit down with doctors who've stepped beyond the clinic to create new solutions, lead in biotech and health tech, and shape the future of care delivery. I'm Trevor Royce, joined as always by my co-hosts, Tim Showalter and Paul Gerrard.
Dr. Tim Showalter: I'm Tim Showalter. In this series, we're exploring how physicians are applying their medical knowledge in unconventional ways, from building companies and products to driving change as investors and ecosystem builders.
Dr. Paul Gerrard: And I'm Paul Gerrard. We'll be learning how these physician innovators navigated their pivots, what inspired them, and what advice they have for others thinking beyond the bedside.
Dr. Tim Showalter: Today, we're thrilled to continue the series with Dr. Rebecca Mitchell. She's co-founder and managing director of Scrub Capital. She's a physician who has a unique and successful track record as a digital health product leader, one of the first actually, as well as an investor with a passion for improving the healthcare industry for patients and caregivers. Rebecca, thanks so much for speaking with us today.
Dr. Rebecca Mitchell: My pleasure to be here.
Dr. Tim Showalter: Well, I think there's a lot to cover. We already were talking about within a group. I think you've had such an interesting past, but I also think that your present is really fascinating for what you're up to with Scrub Capital. Can you maybe just before we hop in, everyone's going to want to hear about your background and how you got into medicine and the innovation story. But we'd love to hear first, just for our listeners, if you could explain what you're doing with Scrub Capital, what's the idea behind it, and what's the current status of that?
Introducing Scrub Capital: A Clinician-Led Venture Capital Firm
Dr. Rebecca Mitchell: Obviously my favorite topic these days alongside my family. The heart of the thesis of Scrub is that there are many, many early stage founders out there that have seen the light and understand that they need to be working closely with clinicians who understand the practice of medicine, the science. They've done the frontline care, but who are also believers in technology and innovation being the path out of our mess of the health care industry in 2025.
I and my co-founders, Christina Farr and Dr. Jonathan Slotkin, have been sitting as nodes in between these two communities trying to find each other for years. And what had been a trickle for years had become a tsunami of interest on both sides, both sides trying to find each other. So we said, how can we create a scalable vehicle to bring these groups together? And ultimately landed on the idea of an institutional VC firm for a couple of reasons. One, there's lots of expert communities out there that are amazing. Often the price point doesn't work for the earliest stage startups and candidly for the clinicians and their time on the other side. There's lots of incredible syndicates and other communities like that where people are writing individual angel checks together out there. We love working with them.
Unfortunately, as a company grows, those are usually wiped off the cap table as growth stage investors want to—they call it cleaning up the cap table, which is a terrible term, but that's what they do. They simplify it, really. And three, we wanted to create a vehicle that could put very meaningful capital leverage behind the expertise and the networks and the hearts of clinicians over time and these collaboration models with early stage founders and their teams. We believe that venture for all the mixed, I guess, results it has gotten to date when run by people who don't have this background and expertise, is an excellent way to become aligned with these companies and founders over the long term and just structurally give clinicians exposure to the upside of these companies that they're spending their time and their energy on.
Dr. Paul Gerrard: Thanks for that background. So I wanted to ask the big question here on what's your life story? How did you go from deciding you went to college at one point before you went to medical school? So what made you say time to go to medical school, become a doctor, and then ultimately pivot into a new direction?
Dr. Mitchell's Origin Story: From Rural Healthcare to a Global Mission
Dr. Rebecca Mitchell: We got to unfortunately go back even further than that to identify where all this came from. I had the pleasure of growing up in a beautiful but quite rural and scarce in terms of the health or infrastructure part of the United States, northern Wisconsin. Parents were both in health care and human services in different ways throughout my childhood. And I was just seeing up close all of the cliches that we talk about all of the time and the limitations of rural health care in the United States.
I think the hospital shut down several times while I was a kid. It happened again recently. Thankfully, it's about to reopen again. People still have wait times that stretch into months, if not longer. My family still lives in the region. And so I was always very attuned to the reality that individual clinicians, by and large, are incredible, talented people, but there are just places in the United States—and then later when I worked in global health, it became very clear the world—where the way that we are practicing, the typical infrastructure for care just isn't working for those communities. And of course, I later learned that that was also the case in very urban areas, so it wasn't contained to those environments.
But I have always had a passion for thinking about how can we bring the best of medical science, the best of care delivery to people, wherever they live in the world. Also sadly, I did have a couple personal experiences with family members that passed away due to completely avoidable medical errors and very overburdened systems, so that also definitely informed it. I was always very set on a path into medical school and medicine but knew that I wanted a huge portion of my career to be spent thinking about how we can take the science and pair it with smart uses of technology and business model innovation and create different ways of bringing the best of the best, in terms of clinicians and expertise, to people.
Dr. Trevor Royce: So it sounds like this idea of innovating in healthcare has been with you for a long time. And can you talk a little bit about how you went through the process of training for medicine, which is a long road, and then being comfortable with what your focus is today, which may not be as 100% patient facing as probably, I suspect, young Rebecca thought she would be when she started out on the medical school journey?
The Turning Point: Navigating the Difficult Decision to Leave Clinical Practice
Dr. Rebecca Mitchell: Yeah, no, definitely not the type of work I expected to be doing even in those early days when I knew I wanted to have a strong innovation thread in my work.
Even before medical school, I had the incredible experience to work with a nurse midwife at UC San Francisco who was focused on addressing obstetric hemorrhage in some of the most remote, resource-poor areas of the planet. And as all of you as physicians know, in those places, a lot of women die prematurely or have severe morbidities when they have complications post-pregnancy, postpartum, and then there aren't blood products, there aren't materials around to treat them. They have to be transported for hours, if not days. Really sad statistics.
And she had done the work of finding a solution with NASA. I won't go into great detail here, given the time limits we have, but had worked alongside NASA, researchers, clinicians, and scientists on the ground in different places in the world to design a product and then collect the data to show that it was absolutely possible to stabilize these women and get them into environments where they could be treated by experts with the correct materials and the correct professionals around the table. And literally as an early 20-year-old, even before attending medical school, I was a little peon on the team, helping with the research part of it. But I was seeing the power of this kind of cross-functional, cross-expert collaboration when people were willing to think from first principles and be creative about how to solve this big, entrenched clinical problem.
I was completely taken with being part of those teams and the solutions I saw coming there. And I quite literally watched women resuscitated from the brink of death and able to go back to their families. So it was a highly impactful experience and there was very little, no software. The heart of it was this creativity when people from very different parts of the planet and industries are working together.
I went to medical school out here in the San Francisco Bay Area at UC San Francisco. I loved medicine, loved all my colleagues. I'd say about halfway through medical school, I went through the brutal realization that the way I wanted to spend my time day to day was doing the kind of work that I'd been doing prior to medical school with that nurse midwife. And so I started working very part time with a couple of different digital health companies in the Bay Area that were just starting at the time. Back then, most physicians were very oriented around implementing electronic medical records. And so those companies were willing to take a little medical student like me. They couldn't get the real experts yet.
And it just confirmed for me that the work I live to do was actually bringing together people like yourself and helping engineers and data science and commercialization experts figure out how to work as partners with people that understood the medicine and the science and had real frontline patient experience. So I finished medical school, but I will tell you, it was the most difficult transition I've experienced in my life, owning that that was the work I was supposed to be doing when it was so different, not only from what I expected, but also what everybody was screaming in my face was expected of me.
I remember I submitted the match list. And at some point, I very clearly remember sitting sobbing on the stairway in my apartment, just knowing in my heart and in my gut that I was supposed to be pursuing this other path for how it was going to have impact in medicine. And it was a really challenging time, just to be completely, completely honest. And I hear a lot of people even now, when I'd say medicine as a whole is much more supportive of people having diverse career paths and nonlinear career paths, incorporating some of this work part or even full time into their career. Even now, people still struggle with this and talk about it behind closed doors and increasingly in social media.
So I will say for all the listeners, I'm always happy to have this conversation if that's a period that you are working through because it is very, very real and still very hard. But anyway, I finished medical school having made that decision and then spent the next 15 years doing product work, doing ops work, doing go-to-market leadership work at different companies. They all shared a similar thread, which is how do we bring expertise out of the four walls of clinics and health systems to people in their day-to-day lives in terms and using methods that fit into their daily lives.
Kept them engaged in their health over the long term. Just a couple examples, I had the fortune to partner with Kaiser Permanente at a company called Validic and helping to design some of their early patient monitoring programs for people living with chronic conditions. I will note that project actually came out of a physician in one of the regions who'd invented it in the first place. So credit where credit's due. It was very much a physician-led innovation that we then partnered with them to scale up. It's still in use today. In fact, I have a few family members that use the program, which is really cool.
And then, Livongo was probably the brand name people are most familiar with, but I joined that company fairly early when we were one chronic condition, diabetes, and one market, employer. And then was part of the product team as a leader, figuring out how to expand to multiple conditions, because, of course, people have multiple chronic conditions usually. And how we were going to reach people who had their healthcare covered through lots of different market segments, not just their employer, over time. I was with them through their IPO, the acquisition with Teladoc. Ultimately, at the end of my time there, I was responsible for product lines that were treating 10 million patients a year. And you can say what you will about how the stock price has done what it's done, as everyone has come to terms with how we should actually value services businesses.
But I guess when I reflect on the whole situation, I never present myself as a practicing physician in the trenches of a hospital or something like that. But I do very much feel that I have practiced a version of medicine across my career because I absolutely thought about all of those millions of people as my patients and felt intensely, intensely responsible for them in the same way that I did way back in medical school, when I was just a little med student running alongside the rest of the team.
Dr. Trevor Royce: That's a fantastic narrative, and I love the way you framed it. It just reminded me of something I saw on Twitter the other day, a popular follow called Sahil Bloom, I think is his name, where he said, quote, "It's perfectly okay to live a life that looks confusing to others." And I think about that all the time in medicine because there's so much peer pressure in medicine to take that traditional path. But when you reflect on your journey and the just incredible impact that you've had of building these services to access patients remotely and just the many hundreds of thousands, if not millions of patients you've been able to truly impact through this industry path, I think that's often underappreciated.
Lessons in Digital Health Product Leadership: A Livongo Case Study
Dr. Tim Showalter: Yeah, I just think if you think about the clinical impact, when you're in medical school, you think about, "You want to take care of your community." You basically took on this million, many millions of patients in your community that you're taking care of. And it's pretty remarkable to see that. The other thing that I think is fascinating is you hear these stories in health technology of these crystallized, stubborn clinicians who join the teams and they're often at odds with technology.
But when you think about a product manager, someone who's really in charge of an innovative product, you think about empathy and open-mindedness and sourcing feedback and putting it all together. And it seems as a clinician who's in that role, you're bringing something really special to the technology and to the overall team. So I'm curious, you've had a lot of experiences after medical school and along the way. Was there one particular experience that was your textbook or your boot camp for how to be a product leader in that role and how to be effective? What do you attribute your success to primarily?
Dr. Rebecca Mitchell: The secret sauce that always predictably led to success in terms of the product actually working—in terms of clinical outcomes, its commercial success, supporting the business to be successful. It's very similar to the approach we've taken at Scrub actually, and that is—again, I was never the person on the team that was like, "I'm speaking for all the physicians in medicine." That was not my role. It was as the leader bringing together the right people around the table and getting them to work well together towards a shared goal.
It was always when you could find a clinician—and I use the word clinician intentionally; sometimes it's not always the physician that is the right person for the role, it could be a nurse, could be PT/OT, whatever it is—ensuring that they had an equal seat at the table alongside those with other areas of expertise and ensuring the team culturally knew how to work together, setting clear processes that people could engage. And more than anything, getting everybody captured around that table, hearts and minds, and a sense of ownership in what they were building.
I think we way too often, especially in the clinician world, put people in silos where it's, "I'm only responsible for the quality element of this or the clinical outcomes perspective on this." When you free people to see the whole picture and sit alongside others that can build and experiment with them, you absolutely unlock magic, not only in the clinicians, but also in everybody else in that shared experience.
I will say, Livongo is so consistently framed as a company that was successful because we had an amazing sales team. It was successful because of Gwen Tolman. Absolutely true. The "and" to that that is never spoken about is that it was one of the highest functioning partnerships between clinicians in that business—both on the product team, also in the CMO's group and in sales—than I've ever experienced. And it came from the top where we had this chief medical officer who then became the president, Dr. Jennifer Schneider, who absolutely got it. And she created that culture and that way of working as a business very early on in its life cycle. So I do wish more people understood that about the business because it is one of the things absolutely worth emulating.
Dr. Tim Showalter: That's remarkable. Yeah, it seems if you can get everyone working together, so the clinicians are thinking like product leads and business managers and thinking about the commercial longevity of the program and you can get the technical people thinking about the clinical problems and everyone's empathetic and working together. It's just amazing in terms of the innovation.
Dr. Rebecca Mitchell: I think one of the grossest things that we do, honestly, is characterizing people as either "clinical" or "business people" in companies and in the world. How many business people do you know working in health care that are like, "Oh, I don't really actually care about people getting healthier"? That's just—they would work in a different industry. Let's be real. This is not the industry to go into if you don't care about those things.
The Scrub Capital Thesis: The Value of a Diverse Clinician Community
Dr. Tim Showalter: I never say. Well, I'm curious, with that in mind, though, I'm curious if you're explaining to maybe someone who's not in health care or just a random person seated on the airplane next to you about the value add for having clinicians involved in diligence and helping advise founders within Scrub Capital. I think of all these buckets, like understanding how the health system works, understanding how reimbursement incentives can affect prescribing behavior, all these different aspects where clinicians might have insights. What do you view as the biggest value add for the composition of investors and insights that Scrub Capital offers?
Dr. Rebecca Mitchell: First of all, I will give some credit where credit is due. You know who understands this better than anybody? The founders. I can't tell you, this whole firm was negative 10 days old, and we had people busting down our door so excited that something now existed where they could have a scalable, consistent way of interacting with people that we now have in the community. The people who don't get it, it's often surprising, but it's definitely not the people building the companies. They wisened up.
A couple of things. One of the things we knew was really important from day one in building Scrub was to have a large, extremely diverse community of clinicians. And assume that you need a care team that has different specialties within it—different levels, different focus areas of training, levels of training. The same thing is true in this community we've built to make it effective for collaborating with founders. There's around 850 of them now all over the country. They represent all different specialties and sub-specialties. We have physicians, we have nurses, we have NPs, we have PT, OT, dentists, pharmacists—a very intentional, diverse group.
Around a third of them are also current founders or past founders themselves. A large portion of them are leaders or recent leaders at major health systems. A large portion of them run big private practice groups. So there's a real wealth of both perspectives and real hand-on experience building businesses in the group. And so what the community can offer can be quite specific to the given company.
And often people think that we're only looking at and investing in companies that are quite literally workflow products of physicians. That is absolutely not true. We have the group to assess a company serving any market segment: plans, pharma, employer, yes, health systems, private practice groups. We have people that can help you with recruiting your first CMO, building your first medical advisory board.
Evaluating and giving feedback on how you're thinking about building a good bolus of research to support your innovation. We have people that have incredible networks that can open doors for you in different market channels. On that note, one of the really important beliefs that we have is not only are we going to see better companies and make better decisions when it comes to investing as a firm if we have clinicians really involved in that process—we have 40 clinicians involved in every single investment we make, for what it's worth, so lots of engagement. We also very much believe that when it is incredibly transparent to the entire community why we are investing in the companies we're investing in, how their peers, even if they weren't part of the process, had input into that situation, the introductions that are made and the willingness to pick up a call is completely different than if it's somebody who's just in a VC's rolodex.
People are doing these things because they really believe in the companies and the people building these companies—the hearts and the minds. And for some of them who are also LPs, the wallets are all aligned and wanting to make these businesses and people successful.
Dr. Paul Gerrard: Let me just pivot a little bit to talking about what happens when a company comes to you and is looking for funding. I guess, are you willing to share your target check size that you write, the size of company, and maybe how you interact with some of the other potential investors in a company?
Inside the Investment Process: How Scrub Capital Evaluates Startups
Dr. Rebecca Mitchell: To answer first what we do and don't invest in as a fund one—and this will, of course, evolve over time as we grow. In fund one, we're very focused on pre-seed through series A, although seed stage companies really are our sweet spot. We're writing a couple hundred thousand dollar checks in fund one. So we're really a strategic participant on the cap table, which makes it very friendly for other VCs that are leading the rounds to reach out and pull us in, which is increasingly what's happening with some of the really good companies that maybe aren't even coming to market.
We are very intentionally quite diverse in where we invest within healthcare. Really, the only area we won't invest in is where it's so time and capital intensive that it just doesn't make sense for a 10-year fund writing a couple hundred K checks. That is both because we believe we can, because of a diverse, amazing group working with us to see and select these companies and support them. It's also because we believe you really have to be as an early stage investor to be successful. As all of us know, there's different categories that go in and out of favor every couple years. And we don't control the larger market when our companies are trying to exit. So we want to ensure we have that diversification of different themes.
Beyond that, a couple of really important things to know about the experience of sharing an opportunity with us. One, we've very intentionally made ourselves easy to find. And for anybody who has an idea to share that idea with us, we have a form you can fill out and every single company that sends something is looked at seriously by one of the general partners on the team, myself, Jonathan Slotkin or Christina Farr. So it's very much not a situation where we're just putting up a website with no email and then we have to waste a bunch of time trying to find a warm introduction to us. We don't believe in that.
A GP is screening it initially for the classic quality indicators of a deal, ensuring it fits the parameters I just described. The other piece of it we're screening for, which is different than many firms, is we need to see a path to not only being successful financially, potentially, if we invested in this business, we also really need to believe that it's worth spending our time and our capital on in terms of its potential impact on human health and the whole industry. So we're not impact investors, I wouldn't call us that, but there very much is an "and" to our need for it to be able to show financial returns.
And then it gets into the really exciting, unique part. We bring the companies that make it through that initial gauntlet into what we call our community pitch. And that's where we have around 30 to 40 clinicians from the larger community joining and spending around an hour with those founders and whoever else they're going to bring in from their early team. And it really is a professional investment pitch. It's not just talking about the clinical aspects of the companies. And then the founders and the community members are in conversation for a good portion.
It ends up being both an opportunity for that group to ask some really good questions, which again, they're not usually just clinical. It's all across the business and the way they're building it and the opportunity and the round. But it's also just as much a taste of the kind of advising and support the founder would get in working with our community. And I'll say consistently founders that make it to that community pitch level and go through it often say, "Rebecca, we would do this and pay you for this, independent of your ability to write a check." It is just so valuable interfacing with these people, even if it's for only an hour.
And then we take those perspectives that are coming in after that community pitch and decide whether or not we're going to pursue diligence with the company. We are then putting together a much smaller group of people, including clinicians from the community relative to the questions we're going to ask. And then ultimately, we do have an investment committee that's making the final call. We believe that consensus doesn't tend to lead to good outcomes in venture investing, but it's very transparent and clear how we've used those perspectives from the larger community in driving the decision.
Dr. Trevor Royce: Just a quick practical follow up question on that. Do you include biotech or drug development in your thesis or is that outside of what you guys focus on?
Dr. Rebecca Mitchell: We are not doing drug development. We'll do some biotech. And again, it's about, if this is going to take 20 years to exit and be so capital intensive that we're going to get completely washed out. That's more what we're looking at rather than being super strict about a specific category. So unfortunately, drug development generally, no, but there is some flux in biotech. And we have invested in companies that I'd consider biotech. [Could not verify with context] is an example. And there's one that we've committed to, but I can't talk about out loud. Both biotech companies.
Dr. Trevor Royce: Fantastic. Yeah, as we start to close out, one question we like to ask everyone that comes on the innovation and physician innovator side of things is, are there any advice that you have for the many listeners hearing your story as they think about alternative paths or ways to bring their impact beyond the bedside?
Advice for Aspiring Physician Innovators: Embracing Risk and the Nonlinear Path
Dr. Rebecca Mitchell: I would say the most fulfilled, often impactful people I know in medicine are the ones that have been willing to take the nonlinear path and be really, really honest about their unique skills, what gives them energy and the time that we are living in. So it's a really interesting time. Look, it's uncomfortable, especially if you've grown up in the world of medicine, but lean into that. There's never been a better time to be creative and take some risks in your career.
And then second, it does speak to the risk part of this. I'm not the first person to say this, I'll be far from the last, but you do have to embrace some level of risk in taking a non-linear path or starting a company or whatever it is. And that's something that it's worth getting comfortable with earlier on in your career if you can. But I think people regularly under-index on the risk of taking a road that should be traveled and the great things that could happen in your life and for your patients and the larger world.
Dr. Trevor Royce: Yeah, very well said. And to tie it all together and wrap that up, I'm a true believer in the compounding of knowledge. And it's very clear how your experiences have very clearly led you to the next and to set yourself up for Scrub Capital as a very unique fund and a way to increase your impact.
Dr. Rebecca Mitchell: I appreciate that. It's a real honor to be able to run this fund. Best job I've ever had.
Dr. Trevor Royce: Well, thank you, Dr. Mitchell, for joining us. It's been great to hear your story, and that'll do it for this episode of Health Tech Remedy. Be sure to subscribe and follow us on your favorite podcast platform. And if you know any physician innovators who would enjoy being interviewed and be a part of this, give us a message and we'd love to hear their story. Thanks so much.
