Interview Guest: Shiv Gaglani (Twitter: @ShivGaglani)
Role: Founder & CEO of Osmosis
On Shiv: While attending Johns Hopkins School of Medicine after undergrad at Harvard, Shiv Gaglani had the idea for Osmosis, a medical and health education technology platform that makes online learning more efficient. Through his hard work and good fortune, Shiv received funding from firms like Greycroft and Felicis Ventures and Osmosis now serves thousands of clinicians and caregivers at institutions around the world (www.osmosis.org/world) .
On the Interview: We talk about a number of topics, but here are just a few:
His background and idea creation of Osmosis
The difference between static and fluid education
How COVID-19 has affected the business
How to stay mentally fit while setting ambitious goals for you and your team
I hope you all enjoy it! This interview stays on my theme of healthcare-related interviews and I look forward to doing more. Still working on my mental health deep dive which I want to flesh out as much as possible before releasing.
Lukas: First I'd love to discuss your background a little bit. You got your undergrad from Harvard, studied medicine at Johns Hopkins, got your MBA back at Harvard, and you founded Osmosis. What was your thought process studying both medicine and business? Was that always the plan?
Shiv: Hey, Lukas, thanks for having me on. Yeah, so great question, I've always been interested in scale and creating things. When I was an undergrad, I created the Harvard College Undergraduate Research Association (HCURA) and wrote a two books on education. I really loved the ability to take an idea from start to finish, or as Peter Thiel says, you know, zero to one. So when I was in med school, I met my co-founder, Ryan Haynes, and we just decided to start building a tool that would make learning medicine easier. During my deferral of med school, I went to business school because I wanted to expand my network and knew that I wanted to keep building Osmosis. So the first money in the company was actually my business school professors, and then after that, Greycroft and Felicis Ventures came.
Lukas: That is fascinating. It's great that you got to build in that time of leave. How did the idea for Osmosis come about in medical school with your Co-Founder?
Shiv: So we actually were serendipitously put in the same anatomy group. My last name is Gaglani, his last name is Haynes and Hopkins happened to group students alphabetically by last name . Ryan is kind of a genius. He received a PhD in neuroscience before going to med school, and he taught himself to code at the age of 11. And so his nickname at Hopkins Med was Dr. Zuckerberg; he was always in the back of the lecture hall coding. So we became fast friends and started realizing how learning medicine was very different than learning engineering, or neuroscience for three reasons. One, it's super vast, there's way too much information for any one person to know. Number two, it's very dynamic. ew drugs, therapies, and guidelines guidelines come out every year, and in some cases, diseases, right like this time last year, none of us knew what Coronavirus is or was. Now, it's all everyone talks about. And so, because of medicines’ dynamic nature, you have to update your knowledge and be a lifelong learner. Number three, it's high stakes. If you forget how to factor or forget how to conjugate a French verb, that's not going to kill anybody. But if you forget to prescribe pulmonary function tests to somebody taking Bleomycin for testicular cancer, you may actually hurt their life and hurt your career in the process. Because of those three reasons, we wanted to build a platform that would basically help solve for some of that by connecting the dots, incorporating evidence-based education. And so we started hacking around and then within a few months of releasing it at Hopkins we began hearing from friends of classmates at other schools who wanted to use it We thought there was something there and we decided to take a year off, scare our parents in the process, and do a tech incubator (DreamIt Health), and that's a summer scale from a couple hundred Hopkins students to 5,000 students and we've sort of taken off from there.
Lukas: That's an incredible story. I thought it was really interesting, what you said about the dynamic nature of Osmosis. I was wondering what makes Osmosis more fluid versus traditional education that is more static.
Shiv: Yeah, really good question. So a lot of platforms are designed from start to finish right there are course based, hey, you learned about XYZ on a certain date, you take a test, you pass it, you're done, right? Osmosis was designed very differently. So, for example, we know that Lukas at WashU learned about cystic fibrosis today. Let's say it's October 15. When we update our video on cystic fibrosis, whether that's six months from now or six years from now, based on the guidelines changing, you will get an update saying that something you once knew has changed. And ideally, you'd receive continuing education credit for it. But maybe you didn't go into a field where you're going to see any patients with cystic fibrosis, in which case you won't get that update. But obviously, if you become an endocrinologist, you become a pulmonologist, you probably want to be paying for that type of information. So that's just one example of one feature. Another example is our team that makes our content used to run Khan Academy Health and Medicine led by our Chief Medical Officer, Dr. Rishi Desai, who I became friends with during med school.. He went to med school before me, but we became friends at TEDMED. And he joined us because we had this technology that would let us basically update those videos faster. A lot of our Osmosis videos are scene based. So like a 10 minute video on hypertension, will consist of, say 20 scenes. And so it makes it easier to update the content because only one or two or three scenes will change. So we can just kind of go in and splice out the outdated scenes and make new scenes based on the guideline changing. So those are just two examples of how we've built the platform from the ground up to adapt to the dynamic nature of health education.
Lukas: These continuing education units must be a major differentiator for you from competitors like Khan Academy.
Shiv: So Sal Khan, whom we’ve had on our podcast (https://www.osmosis.org/raisethelinepodcast/education-for-anyone-anywhere-salman-khan-founder-and-ceo-khan-academy) wants to focus on K-12, primarily, including building the Khan Lab school. And that's largely why Rishi and the team decided to leave, you know, they were doubling down on K-12. Rishi and the team wanted to get even deeper with healthcare and go do more things in the healthcare environment. I'll take your second question first, you know, Sal mostly as the voiceover person for all of his blackboard-style. chalkboard videos, I'm sure you and many others have continued to use them. They're wonderful, and he did a great job. But learning medicine is a bit different because there's too much information that you want it to be more scripted. So all of our videos are scripted. They tend to be shorter than the unscripted videos that they were doing at Khan Academy. Number two, it's whiteboard-style, as opposed to blackboard-style, which allows us to use more colorful visualizations. So if you really want to understand how an embryo develops, or how the heart pumps, you want some really good medical illustrations, you can't just use that kind of scratchy text, which is good for math, but not good for learning medicine. That's another example of how we change it. And then we've also built an internal tool we call Osmosify, which lets us produce videos at scale, and recycle a lot of assets. So those are some of the differences. In terms of continuing medical education, that's required. So to be a physician and nurse, PA, or any other clinician, you've got to have a commitment to lifelong learning and updating your skillset. An example is in many states, you have to have a certain amount of opioid education for continuing education given the opioid epidemic. And so a lot of physicians and others are provided stipends by their health systems to do that CME. So this year, because of COVID, we accelerated our launch into continuing education, we launched a three hour CME course with partners like Teachable and Coursera. That's been taken over 100,000 times. And now most of our content over 1,800 videos is in the process of getting CME accredited. And that has great ramifications from a vision perspective, which lets us reach even more people where they're at, because if they have to do CME, now they can use Osmosis for it. But number two, from a business model perspective, right, because you, your audiences, people who are and want to be entrepreneurs, it really helps us expand our lifetime value with our customers. Because we started with just medical students and now we have, you know, over 1.2 million registered medical, nursing, and physician assistant students around the world, but we tend to lose them right after they finish school. But by implementing CME, we may increase our LTV, the long long term value of that customer relationship. So it's been good for the business overall.
Lukas: It's saved me a few times. Do you see Osmosis as something for students to use on top of their existing university education? Or independently?
Shiv: Really good question. So a lot of schools approached us because they want to make their medical education more efficient. For example, the University of Vermont is a partner of ours. They're one of over 100 partners now. And they approached us because they wanted to go from a two year preclinical heavily lecture-based curriculum to a one year one and a half year very active learning curriculum, where instead of their faculty being staged on stages, where only 10 to 15% of their class was showing up, you probably know this as a current college student. You know, they wanted to have their faculty do more active learning, problem-based and case-based sessions. But to do that, they needed to be able to get those one hour lectures into five or 10 minute bite sized videos, which their faculty were not developing. But Osmosis already has a content library. So in many ways, for a lot of schools, we've replaced their didactic curriculum, allowing their faculty to be more active in learning, and other places is a supplement. It's, you know, here's your lectures, and then Osmosis will help you understand those better and pass those tests. But the really big, hairy, audacious goal for Osmosis is that eventually we get our own accreditation, and we get our own certification. So I wrote this Forbes article and gave this TEDx talk last year in 2019. called “Could you get an MD online?” And obviously, there's some components of that, like the actual clinical apprenticeship or surgery, if that's where you want to go where you need to do that in person, you can prepare for virtual reality or other simulations. But the whole idea is how do we make it faster and cheaper to make high quality clinicians and remote learning and online learning is certainly a component of that.
Lukas: Yeah, and certainly, with recent events, online learning has become more accepted and more necessary. What kind of growth have you seen due to recent events with COVID?
Shiv: Yeah, it's really interesting. There's this Lenin quote that I like sharing with my team and other partners, it's, “There are decades where nothing happens. And there are weeks where decades happen.” And so certainly over the past six months, we've seen a lot of changes. Everything from state accreditation bodies, making it easier to get jobs in healthcare, because of the shortages to universities and health systems, deciding on contracts faster. So in Q3 alone, we were able to have 29 new schools join us, including our first Ivy League school, Penn. That's been really great, where we've now have over 100, because of Q3, and the shift to online learning. Another example is we have a lot of B2C or end user traffic groups. So another thing that happened because of COVID is we saw massive spikes in consumer traffic. We are a health education company, and we got a lot of our traffic in the first place from releasing our videos on YouTube and on Wikipedia. So if you look up opioids or you look up to see fibrosis on either side, you'll find an osmosis video. And we have 1.8 million YouTube subscribers, and a lot of those are patients and family members. And so one thing COVID has done is it's not only improved the standing of health professionals in society as being healthcare heroes and first responders. There's a lot of tailwinds and how do we support them. But then also, it's made average people very interested in how vaccines have been developed and how viruses are transmitted. So in Q2, particularly, our chief medical officer was on the news all the time, you know, with Anderson Cooper with Ken Jeong from Community and The Hangover. And so that led to a ton of brand awareness and recognition for Osmosis that sort of carried us forward, where we've had record traffic months and record B2C revenue month as well.
Lukas: I'd now like to move on speaking that out. I'd now like to move on speak a little bit about your role as CEO. I was wondering how do you set goals for yourself? And how do you keep and how do you keep yourself on track when there's so many different tasks to focus on?
Shiv: That's a really good question. And the roles changed a lot. So as the company grows faster and faster, the people in the company have to grow really fast, too. And I think it's for a fast growing company, it's very hard for any individual to keep growing as quickly as the company needs them to, which is where there's a delta between, you know, the people who got us to, you know, 5 million revenue. And then as we're going from five to 20, you know, the people who we need to bring in the right people who are used to that sort of processes. The most important quality I need as CEO is being able to understand my shortcomings and the team’s shortcomings and backfill for those. And so just right now, in Q4, we have actually made a bit of a structural change, where I am very external facing, basically working to bring in some very big partners, like I was very active in the Penn relationship. And as a host of others, like YouTube we have a deal with 23andMe and a few others, as well as investors, because there's been a lot of investor interest in online learning and healthcare, digital health. And so that's how my role is and in the interim, our chief medical officer, Rishi is actually serving as internal president. And so he's helping manage day to day operations, as far as goals, I think it starts with quarterly goals, right, we use the OKR framework. And so we have a general sense of the quarterly goals and how those go into the Northstar metrics for the year. But those have had to change a lot because of COVID. And then how do you boil on the quarterly goals into weekly goals is a big big challenge. So, my leadership team and I meet obviously weekly, we have daily standup, but on our slack that asks us what our major priority is for that day. And we mostly just hold ourselves accountable and it starts with that, as opposed to needing to, you know, nitpick and hold everyone else accountable.
Lukas: Yeah, that makes a lot of sense. How do you stay, you know, given these high demands, hours, how do you stay mentally fit? What do you do to maybe take your mind off of all the craziness and that can sometimes lead to a tighter focus?
Shiv: Honestly, it's a very stressful year. And it's been a bit like running a sprint for a marathon. And so I need to do a better job. And I think a lot of people in general need to carve in self-care time. We have a health coach on the team, Ishan who checks in with everyone on the team, including me, every week at least. And I have a pretty regular eloton and meditation practice and then just otherwise try creating some distance like scheduling real blocks of time where I'm not working on Osmosis.I'm lucky to live in Salt Lake City, Utah, where there's tons of hiking and soon winter's coming up. So hopefully the snowboard season won’t be cut short like it was this past winter. Yeah, so I think i think it's a really good question and very important for anyone listening to put that first.
Lukas: Awesome. Thanks for coming on Shiv this was a real pleasure.
Shiv: Thanks again for inviting me. It's been a pleasure and if any of your audience wants to connect at some point, they can just go to osmosis.org and drop us a line. I'd love to hear from them.
Moderator: Lukas Steinbock (Co-Founder at The Takeoff. Senior at Washington University in St. Louis. Growth Marketing Intern at BlueSprig.)
I’m on Twitter @lukassteinbock 👋
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