Is the traditional academic path failing doctors who want to innovate? For many physicians, the dream of impacting patient care on a massive scale feels out of reach within the slow-moving world of grants and publications. This episode explores the alternative: the dynamic and rapidly evolving physician career paths in health tech. We're joined by Dr. Shrujal Baxi, a physician executive and former Chief Medical Officer at Iterative Health, who shares her incredible journey from being a top medical oncologist at Memorial Sloan Kettering to becoming a leader at pioneering tech companies like Flatiron Health, Verana Health, and Iterative Health.
Dr. Baxi reveals the critical moment she realized academic research, despite its rigor, couldn't deliver solutions at the speed technology could. This conversation is a masterclass for any doctor questioning their career trajectory, offering a candid look at the challenges and rewards of transitioning from the clinic to the tech industry. We dive deep into how her skills as a clinician became her greatest asset in corporate settings, the pivotal role of real-world evidence in shaping modern medicine, and the future of AI in medicine. If you've ever wondered how to commercialize a great idea to truly help patients or what the role of clinicians in tech companies truly entails, this discussion provides the roadmap. Dr. Baxi breaks down her experience working on everything from large-scale data sets in oncology to using computer vision for endoscopy in gastroenterology, demonstrating the vast opportunities available for physicians outside of traditional practice. This episode isn't just a story; it's a guide to forging impactful physician career paths in health tech, exploring the academia vs industry for physicians debate, and understanding how to build a scalable solution that changes patient lives.
Episode Resources:
Introduction
Dr. Trevor Royce: Welcome to Health Tech Remedy. This is the next installment of our bonus series on physician innovators, where we sit down with doctors who step 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 by my co-host, Tim Showalter.
Dr. Tim Showalter: This is 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 leaders. I will flag for our fans who listen only for Paul Gerrard, which is many of you, we are unfortunately not going to have him with us today. We'll do our best to soldier on. But if you're here for Paul, please wait for the next episode.
Dr. Trevor Royce: I gotta say, Tim, even without Paul, it's worth sticking around for this one because we're thrilled to continue the series with Shrujal Baxi. She's a physician executive who's worn many hats during her career, including most recently as chief medical officer at Iterative Health. We'll hear about Iterative Health and what they've worked on and Shrujal's story.
She trained as a medical oncologist, held academic faculty positions, and went on to leadership roles at Flatiron Health and Verana Health, and of course, Iterative Health most recently. We both had the chance to work with her at Flatiron Health, and she's just a terrific colleague and collaborator.
Dr. Tim Showalter: Yeah, in all seriousness, I'll say after having the chance to work with her at Flatiron, you should definitely stick around and listen to her, despite Paul not being here today.
Dr. Trevor Royce: Shrujal, thanks so much for speaking with us today.
Dr. Shrujal Baxi: I'm happy to be here. It's good to see you guys.
Dr. Shrujal Baxi’s Origin Story: From Oncology to Health Services Research
Dr. Trevor Royce: I think with any good story, it starts with the beginning. And it would be great for our listeners to hear about your career, Art. And starting from the beginning, where you trained, what brought you to medicine, how you found your way to oncology. And of course, ultimately, we're going to want to hear about the amazing things you've done on the industry side.
Dr. Shrujal Baxi: I guess we can go all the way back. The decision to do oncology actually came pretty early because when I was 18, my mom was diagnosed with breast cancer for the first time. She's fine. She's doing great. But I remember how poorly the physician spoke to her and how much fear she had, which I now, in retrospect, realize was an early stage breast cancer.
Many millions of women had come before her. The path was well, well paved of what was going to happen. And if the physician had taken just five more minutes of time, he could have saved her so much anxiety and worry. And I think even in that moment, something felt wrong. And I decided that there was something here that maybe I wanted to be part of.
Fast forward, I do internal medicine residency. And as a resident, you can imagine you spend a lot of time in the hospital. And in the hospital, you see a lot of the worst of what oncology does to people and their families. And again, I started to pick up on a trend, which is communication and speaking to patients, setting realistic expectations.
Dr. Shrujal Baxi: I think it had value beyond just taking care of cancer, but it helped patients and their family members start to make decisions and plan accordingly. And I felt a good doctor not only knows medicine, but actually can add to that feeling of someone actually cares about you. I was lucky. I worked with some doctors at Memorial Sloan Kettering when I was a resident who showed me the opportunities for clinical trials and how clinical trials start to fit into the picture of taking care of patients with cancer.
And so it was a no-brainer when push came to shove. I think that after I finished training that I would do my fellowship in oncology and was lucky enough to match at Sloan Kettering. When I got to Sloan Kettering, I was an oddball because I wasn't a translational scientist. I wasn't a clinical trialist. So I came in with a research goal or passion that really revolved around understanding how care delivery changes outcomes or could change outcomes. And the science of, I think, health outcomes and health service research had really come into its own when I started my career. And so I was lucky. I had a lot of really thoughtful mentors who tried to guide me in this less walked path of how to get grants to do this stuff well.
Dr. Shrujal Baxi: And so fast forward, now I'm doing it and I'm seeing some of the challenges that happened because along the way, this research went from looking at large databases to identify trends and describe what's happening to actually developing solutions that were going to change the outcomes using the scientific principle, randomized controlled studies, prospective interventions. And a lot of the solutions were based on a backbone of technology.
Dr. Trevor Royce: This is great. I'll just kind of chime in to say, for context for the listeners, Sloan Kettering is one of a handful of really historically prominent health services research institutions. And I feel like you hit that at just the perfect time where this whole field was developing.
Dr. Shrujal Baxi: I believe in the right place at the right time combined with you make your own luck. And I really, I hit the jackpot in terms of the location I was at, the resources we had, the mentors and the future thinking that the doctors around me and the researchers around me were pushing the boundaries on. It really was the perfect storm for someone like me who didn't even know when I was back in public health school what health tech, it didn't exist. And so that actually evolved as I was at Sloan Kettering.
The Turning Point: Questioning the Pace of Academic Research
Dr. Trevor Royce: And in your mind, were you still envisioning a career in academia at this point?
Dr. Shrujal Baxi: Oh, I never thought I would leave academics. I could in my head. I had seen the path. You move up the ranks from assistant attending to, I had it in my head of what I was going to do. And I was writing the grants. I was writing the papers. I was attending conferences. I was sitting on panels. It was the right thing.
Dr. Shrujal Baxi: The moment where I started to even entertain leaving academics was at a conference where I saw researchers who've come before me read out amazing results from phase three studies on interventions that they had created using technology to improve outcomes. So one was in conversations with patients with lung cancer to reduce the burden of hospice by getting them into hospice earlier and benefiting from that additional times in terms of quality of life, their family's experience, et cetera.
It was a brilliant study. It was randomized. They did everything right. But by the time they published it, the technology was already two and a half years old. And the idea was three and a half years old, because that's how long it took to write the grant, get the funding, set up the study, do the research, report it out. And still, despite doing everything right, there wasn't a natural company or someone who was going to take that technology on and then commercialize it.
Dr. Shrujal Baxi: And I was like, wow, all that work. And yes, the patients in the study benefited. And maybe the patients at the institution that they come from will benefit as a institutional project. But you and I both know at this point, in order to really impact large populations of patients, your technology actually has to be commercialized at a scale that can reach the patients you're hopefully trying to help.
And so that was when I first started even considering that if I wanted to do this and I wanted my time to impact the patients the way that I was thinking about it, I might need to find a different path. Now, I will say... Since I left academics in 2017, I think the private-public partnership of these academic centers, these researchers and technology companies has accelerated. And so if I was there today, I'm not sure I would have the same feelings. But back then, the technology that was coming from startups was far outpacing the technology that we were able to build under the rubric of an academic center.
Making the Leap to Flatiron Health: Translating Clinical Skills to a Tech Environment
Dr. Tim Showalter: Shrujal. It's so great to hear this background. We overlapped at Flatiron Health and I loved hearing your wisdom and insights at that time. But then it's nice to hear about your career before then. Your academic career, you're at a premier institution and you're involved in some cutting edge research. And then obviously you made this bold decision to leave and go in to work in health technology and particularly at Flatiron Health, which had this really impressive contribution to real-world evidence and built that space. Can you take us back to what that decision was like? What really drove you to step into your role at Flatiron?
Dr. Shrujal Baxi: The role at Flatiron happened serendipitously, which now it sounds, as I say it out loud, most of my career seems to have fallen that path. But I had consulted for Flatiron while I was at Memorial, helping them build out a specific data set in head and neck cancer, which is where my clinical practice is. And they at the time were ready to grow and wanted me to come check it out and see what I thought.
And I took the leap thinking that and now you guys will both laugh because you understand when I say this. I thought I was going to do it for two years. And I was going to learn the tricks that they had to build technology at scale. And I was going to bring it back to Memorial. And we were going to do the same thing at Memorial because in my heart, I never was going to leave Memorial. I believe in the institution. I believe it's a place where good care is given.
And I wanted to do cool research and I want to build cool things. And so I'm going to go learn how they do it and then I'll bring it back. And then I left. And I think for the first six months, in my head, I was still always going to go back if they would take me. There's an assumption there. But I could not get over the pace of...
Dr. Shrujal Baxi: Met and fit my personality so much better. I like iterating. I like whiteboarding. I like thinking about new things in different ways. I liked partnering with people from other backgrounds, engineers or product folks, to really think about what is it that I'm trying to describe and having them help me make it real, as opposed to in academics when I owned all of that. And it just seemed for someone whose personality is quick and decisions and action, I like the action-oriented nature of how health technology works. And then on a personal level, it allowed me to explore sides of myself that my medicine academic role did not let me ever own.
Dr. Shrujal Baxi: Different institutions are different, but at Memorial, I would never manage people. I would influence people, but they would all manage up into other lines. Whereas at Flatiron, I got my first chance to be a manager. And that's a side of me I didn't really know much about. Flatiron gave me a chance to really explore public speaking. That was not something that was part of my day-to-day when I was at Memorial.
And the thing that probably worked well for me in practice made me effective at Flatiron, which is the ability to take complex, sometimes very technical information. And I don't mean technical like engineering technical. I mean technical like cancer technical and translate it for whomever. In clinic, we do that for our patients. We take really complex ideas. We break it down. This is really what we're saying. Here are the three things in front of us. This is what we're going to think about. This is how we're going to find out which one to do.
We do the same thing as clinicians and tech companies. We break down complex ideas. We provide insights into what happens when you put this in the real world. And we share that with product. We share that with engineers who don't have the luxury of having been in the environment that they're building for.
Dr. Shrujal Baxi: And it turns out that those skills actually have a ton of value in this environment. And in my younger days, I was more ambitious. And it turns out that my path to success was faster in this environment where these skills are highly valued. And I could get off of a more traditional track of, after five years, you go this. And then after 10 years, you do this. It just suited me better.
The Value of Clinicians in Bridging Tech, Providers, and Patients
Dr. Trevor Royce: Yeah, I kind of want to double down on that concept. I feel like sometimes we take for granted what we can provide as clinicians and researchers. And it's that deep clinical expertise and connecting what you're building to the patient and how it impacts the patient and their experience. And if we stay true to that, we can actually really influence and impact these companies that are doing tremendous technological innovations.
Dr. Shrujal Baxi: I think so. I think one of the fallacies, though, of many tech companies, and maybe here I say something a little bit more controversial, which is I think most technology companies are building solutions for the providers or the health care systems. And the goal is what health services researchers are trying to solve for, which is the benefit to the patient.
But in order for the tech to be adopted and used, you're actually really solving at the level of the provider system. And if your tech can make something that they do better, smarter, faster, the goal then is at the end that the patients are going to benefit, whether it's patients at a population level because you improve drug delivery or it's patients in a particular health system because you've now enabled them to see their information.
But ultimately, the idea that what I do today is going to help a patient requires this implementation science that I think is really coming to bear. And a lot of first-generation tech companies miss that step. And I'm interested as new companies are coming forward and the tech is getting easier to see who's really going to get that implementation step right.
Dr. Tim Showalter: It sort of ties back to your original point where you're watching great research results that don't change practice. Companies and building a product are going to be integral to implementation ultimately?
Dr. Shrujal Baxi: That's right. And so maybe what I'm seeing sometimes is it used to be great research that never changed the patient experience. But what if now we're building great technology, but it never changes the patient experience? So in this environment, I'm actually thinking more about how do we, and to your question, Trevor, how do we make sure that the tech is solving the problem that the providers are identifying with?
And how are we going to help them take what we're building and turn it into a solution that works for their system? And as a tech company, we're always thinking about how do we build a single solution that scales? Because if you just start building bespoke solutions, it gets really hard to scale a company. And so what is that right balance of we're going to, we're going to create a little widget that works for your system. But the widget is easy enough to build on this backbone of a company that can scale?
And I think that that's often the challenge that the clinicians are trying to address, which is what's good enough that it solves for the bigger problem? And then how do we help an individual provider, healthcare system, whatever the target audience is, actually use our tech effectively?
Dr. Trevor Royce: Yeah, absolutely. I'm going to paraphrase here a little bit, but in a perfect system, what would benefit the providers would also, of course, benefit their patients. And what we're hearing is those two are definitely not the same thing, but maybe that's a nice north star for your ultimate products.
Dr. Shrujal Baxi: That's right. And or if our goal is to, let's say our goal is for patients to be fully informed at the time of a decision or for the physicians to have access to all the data at a certain point in time, or we want patients to have access to the latest medications. Those are all laudable goals and we want those things. But when we back up into what is broken, that's preventing that from happening, that's where the tech solution usually lives.
And the person that needs to adopt that, that's the providers of, however, the, Whether it be the pharmacists, the nurses, the doctors, the administrators, the life sciences. We haven't really talked about them as a major user of health technology. The insurance companies. There's so many different people that take something to make the patient's experience good or bad. And who are you solving for and how are you going to solve for them? I think the clinicians can have an important part of that thought process.
Beyond Oncology: Scaling Real-World Evidence at Verana Health
Dr. Tim Showalter: Absolutely. It's well said. I want to shift a little bit because I got to work with you at Flatiron, but I haven't really caught up with you based on the work that you've done since then at Verana and then also at Iterative. Maybe drill down for our listeners to a little bit of examples of the work you were involved with with those teams. Starting with Verana, could you give us a little bit more information about what sort of challenges and opportunities you were focused on with that team?
Dr. Shrujal Baxi: So Verana is a really interesting company that was, I think, born out of a hypothesis that real-world evidence in any disease area has value to help improve care delivery. And I think it's a strong hypothesis and I think they've done a really good job bearing it out. But Verana was a company that initiated an ophthalmology. It was a partnership between the Verana Health folks and the American Academy of Ophthalmology (AAO). And that was the way that Verana was created, which is it partnered with large professional societies that.
Dr. Shrujal Baxi: To become the tech arm that would help them take their registry data and use it, one, to fulfill MIPS measures that the professional societies had offered to their members who shared their data with them. And then two, to see if that same data could be cleaned and curated and be research grade in order to answer questions about outcomes, drug efficacy, safety, and all of that using a predominantly tech forward approach, which was, I think, second generation.
What we had at Flatiron back in the day, and it's very different now, but back in the day, it was tech-enabled abstraction, but it was still a human that was at the end of the line that was using all the technology to abstract at a scale that had never been available before. And a set of QA measures that made sure that the data was high quality. That was the crux of the unstructured data at Flatiron.
Dr. Shrujal Baxi: Verana took the leap forward outside of oncology and said in ophthalmology, urology, and at one point neurology, can we do the same thing with structured unstructured data with a lot softer human touch and use natural language processing as the approach? What was interesting about Verana and probably my first foray at the time into clinical trials was this idea that maybe you could use this data not only to answer research questions in a retrospective manner, but what if you could use this data to help flag patients who might be eligible for clinical trials.
And that was the partnership between Verana and sponsors. Hey, what if we could find a way to surface patients for clinicians who do research to be like, hey, these might be the 10 people in your practice who could be eligible for this trial that you have. And so that was the basis of their business. And I think, there's a lot of learnings there. I think oncology is unique in some ways in the way that we document and how closely we follow patients and what we document.
Dr. Shrujal Baxi: I've said to anyone who'll listen that real-world data from the EHR is only as good as the stuff the physicians put in their notes. And if you're pulling real-world data from a practice that writes a half a paragraph a visit, you only get what's in that paragraph. We can't make that up. But if you have practices that have a lot of information, then technology is primed to try to pull it out.
That was Verana. And I got my first taste of living in a world outside of oncology. And Verana really made me comfortable to understand what is applicable and not applicable when you get out of oncology. Sometimes you have to leave it to see it. And I saw it. And I attended ophthalmology conferences and neurology conferences and urology conferences. And I got to see the flavor of physicians, the research questions that are being asked, how practice patterns are different, et cetera.
Pioneering AI in Medicine: Computer Vision and Clinical Trials at Iterative Health
Dr. Shrujal Baxi: And when I met Jonathan Ng, who's the CEO founder of Iterative, and he was building a company in gastroenterology, I had the courage to take the leap because I knew I could survive outside of oncology and joined his company as he was building out the next generation. I don't know when the generations will end, but the next generation of technology, which was computer vision based models for endoscopy. For the listeners who know, gastroenterologists do a lot of scoping.
Dr. Shrujal Baxi: And he had this idea that you could use AI to read the patterns of the visualizations to create insights into what you were seeing. And they had already, by the time I joined FDA approved medical device using their models at point of care for screening colonoscopies. And I got to learn about medical devices and regulations around them and brand new. We learn on the job as clinicians and health tech sometimes.
And the other side of the business was really focused on inflammatory bowel disease where endoscopy plays a really important role for eligibility and following disease response. And the company decided to go after endpoints and think about the scientific evidence that would need to be generated in order to really move the needle and get AI as a part of how endpoints in clinical trials are considered for a disease where endoscopy plays a really.
Dr. Shrujal Baxi: They haven't quite figured it out. There's a lot of gastroenterologists and researchers who have a lot of concerns about the current endpoints and how they're measuring the benefit of drugs. I learned about a lot of diseases I had never learned about, which is always exciting. And I learned about computer vision, brand spanking new, but there's never a dull moment in our worlds.
And so the third arm, which continues the story of clinical trials, is can you use endoscopy videos in real time to identify patients who have severe IBD during their scopes and use that to flag potentially eligible patients for clinical trials? And back to this idea of right place, right time. During COVID, IBD studies basically came to a halt for all the reasons you can imagine. Patients just weren't coming out. Nobody was getting colonoscopies, etc. And so Iterative was there at a time when they had a solution that was solving a major problem for sponsors and for researchers who had opened studies that they weren't getting patients onto. So they serve as this intermediary between sponsors and sites.
Dr. Shrujal Baxi: And so that was a new way to think about screening for patients. And over time, it turns out EHR data really matters when you're thinking about clinical trials. And now they have AI models running on the EHR. So that was my, that's Iterative as a company. My role was, scientific lead, thinking about the regulatory arm quality for the device and supporting the work as they engage with gastroenterologists in the space.
The Road Ahead: Dr. Baxi on the Future of Health Tech and Early-Stage Innovation
Dr. Trevor Royce: So you shared an amazing journey, and it started in academia, clinical practice, health services research to the industry side of true data science, large-scale data sets, specialty and disease site-specific interactions with professional organizations and quality controls. Again, continuing down this data science and technology path, all the way to a much brighter, beyond oncology, all the things that we just heard about at Iterative Health as CMO. And despite all that, that incredible journey, it feels to me like you're just getting started a little bit. So I'd love to hear a little bit about where you think the field is going in health technology broadly, and specifically, if you're willing to share anything of interest, what's next on your mind for you and your journey?
Dr. Shrujal Baxi: It's an important question, and one I ask myself on a daily. I, in some ways, I am in a place in my career that I never imagined I would be, not because I didn't have confidence, but because this just didn't exist. And so I tell young medical students or fellows who reach out, you don't even know yet what is coming. And I suspect my future jobs don't exist. It's not that there's a job in a company that exists and I want it. It's actually not how I think about things. I look for opportunities to learn. So any job I take has to have a component of I'm going to learn something I don't already know. And I think that that's actually really important.
Dr. Shrujal Baxi: Served me well as I've picked opportunities along the way. And my next opportunity, I'm not quite ready to share it, but I'm actually going to go even earlier. So Flatiron, when I joined, I tell people, was six weeks before they announced their acquisition. And so I really got to be part of a company that scaled. When I got there, I was around 400. By the time I left Flatiron, we were at 1400 or something like that. So I got to watch what it takes to scale a company that has a strong culture and a strong product market fit. And how do you take that and make it bigger? Then I went to Verana. Verana was younger. It was a younger company. It was still figuring out product market fit. It was figuring out its cogs.
Dr. Shrujal Baxi: And I got to figure out how to build a medical team in the context of a multidisciplinary, multi-disease-related org. Then I went to Iterative, which was a Series B, and all the things that come with that, good and bad. And I got to learn how to be part of an executive team and how do you make decisions collectively? How do you balance the science against the MVP? How do you time your choices scientifically against where the space is at? Because you can't move faster than regulators are ready to move. And so how do you pepper the publications? How do you tell a story for a company? And now I think I'm ready to go even further back and join something new and.
Dr. Shrujal Baxi: Inform the product itself from the beginning. And so that's the next challenge I would like to take on. And think about things like funding. How do you not only create a product, but create a value proposition? How do you think about broader commercialization? How did those choices impact who you're building for and how you build your product? Those are very non-clinician things, and yet, I think having a clinician at the table from the beginning for the right company could actually, one, save time, and two, potentially lead to a truly practice-changing product if it's done well. So that's my goal.
Dr. Tim Showalter: Well, I will say on behalf of the podcast, we would love to highlight that company in the future. So we'll have to have you back representing that.
Dr. Shrujal Baxi: As soon as it's ready, I will bring it back. I'd love to talk to you guys.
Dr. Tim Showalter: Well, thanks so much for your time, Shrujal. It's amazing to hear the overall arc of your career and your life before Flatiron and the stops you've had afterwards. I expect continued major impacts from you over time.
Dr. Shrujal Baxi: I returned the request for both of you to keep doing your amazing things and keep me posted on all the good stuff. Thank you for having me. Bye, guys.
Dr. Trevor Royce: That's it for this episode of Health Tech Remedy Presents Physician Innovators. Be sure to subscribe and follow us on your favorite podcast platform. And if you know a physician innovator who we should feature, reach out. We'd love to hear their story. Thanks again. We'll see you next time.
