As a part of my interview series with leaders in healthcare, I had the pleasure to interview Shiv Gaglani. Shiv is the co-founder & CEO of Osmosis, a leading health education company with an audience of over 1.5 million current & future clinicians and their patients. He started Osmosis as a medical student at Johns Hopkins, from which he has taken a leave of absence, and earned his MBA from Harvard Business School. For his work at the intersection of healthcare and education he was named to the Forbes 30 under 30 list.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Thanks for the invitation to contribute! Career paths are often the product of passion and serendipity. I’ve had a passion for healthcare ever since my physician father used to take me to his hospital and I saw how he was magically able to take away pain from those he saw. I’d been working towards attending medical school since then. In terms of serendipity, during my first semester at Hopkins I was paired up with my co-founder at Osmosis, Ryan Haynes, simply because of the alphabetical proximity of our last names, and it was during those first few months that we began working on what has evolved into Osmosis.
Can you share the most interesting story that happened to you since you began leading your company?
As we’ve grown we’ve been fortunate to not only get more attendees and inbound requests to meet at the healthcare & education conferences we usually attend, but also to get “in-the-wild” sightings. Recently, this happened to me on a flight from Salt Lake City to Baltimore. The passenger sitting next to me noticed the Osmosis logo on my laptop and asked me if I use them too! He is an oral & maxillofacial surgeon who uses Osmosis to teach his residents about cardiovascular and respiratory physiology & pathophysiology. These sorts of random sightings are becoming increasingly common as our reach has grown.
Can you tell our readers a bit about why you are an authority in the healthcare field?
Osmosis is educating a generation of healthcare providers on everything from atrial fibrillation to health policies like MACRA/MIPS. Prior to Osmosis I co-founded The Patient Promise and The Smartphone Physical which have been featured by TEDMED, the BBC, USA Today, Time, and other media outlets. Along the way I’ve written hundreds of articles related to healthcare for Medgadget, The Healthcare Blog, Quartz, Fast Company, and Forbes.
What makes your company stand out? Can you share a story?
Though relatively young, Osmosis is having a global impact on the education of clinicians & caregivers alike. The former Khan Academy Medicine team joined us and has helped grow our YouTube channel from a few hundred back in 2015 to a million subscribers today. One specific story that resonates with our mission-driven team is the collaboration we forged with medical students in Syria. We provided thousands of them with completely free access to our entire online learning platform and in return a few dozen of them translated our videos into Arabic so their classmates and patients in the region could also benefit from the Osmosis videos. Here’s a short video about this collaboration: https://youtu.be/KeGvruygLvg
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Over the next decade, McKinsey estimates that another 50 million healthcare professionals will need to be trained globally to keep up with demand. Nine of the 15 fastest growing professions in the United States are in healthcare, and range from nurse practitioner and physician assistant to home health aide and genetic counselor. These jobs are in high demand due to the aging population as well as the automation and subsequent job loss in other sectors, such as retail and transportation. Osmosis is working to develop efficient, online pathways to train these future healthcare professionals and keep them updated through their practice. One specific example is that we are plugging into medical schools (more than two dozen have adopted Osmosis) and providing an efficient, engaging curriculum that can help their students progress through the curriculum faster and with better performance.
In addition, we have a growing audience of patients and family members who we are educating through our engaging video library so they can be more empowered to take control of their health journeys. 10–15% of our comments on our YouTube videos are directly from patients and family members. For example, on our video on Cushing Syndrome, Jeff commented: “My brother has been facing obesity problems for over 2 years. Even after multiple visits to various specialists we never understood what was happening with his body. Because of this video, we checked his cortisol levels and found out that it is 5 times the normal range. THANK YOU GUYS FOR THE VIDEO. Hopefully an endocrinologist will be able to help us out. Once again thanks a lot ”
Are you working on any exciting new projects now? How do you think that will help people?
We are officially releasing Osmosis Nursing and Osmosis Physician Assistant this year, which is an exciting development because Osmosis has primarily been working on Medicine to date. That being said, we’ve had 30,000 registered nurses and PAs organically sign up on our platform so anticipate seeing a lot more growth in these areas. We also are working on our first continuing medical education course so we can continue helping our learners as they enter practice, keeping them up-to-date on important clinical knowledge.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
I’ll share three in-depth examples:
- Set your vision, mission, and values as early as you can do so credibly. Decision-making has become easier with a clear vision, mission, and values, which took us a few years before we developed. We probably could have done so 1–2 years earlier, but hadn’t prioritized it before. Of course as the organization grows you should be prepared to revisit these, though not get in the habit of making too many changes. As a remote company, being able to highlight a teammate each week for excelling on each of our six values really helps us bring the team together even though we are spread across four continents.
- Bootstrapping is a double-edged sword. Bootstrapping early on taught us to be conservative with our runway and finances, which is an important instinct for all startups. However, one “hidden” cost was the time it took to reach our stage of traction and how the market dynamics changed in the meantime. Money comes and goes, but time just goes. When we raised our seed round from great investors like Greycroft and Coverys we were able to generate a lot more content and audience + revenue growth, which in turn has attracted more funding opportunities. Moving forward I’ll be more cognizant of the balancing act between bootstrapping and fundraising.
- Truly listen to your end-users. We were focused on building a technology platform for the first 2 years without as much focus on the actual content in the platform. While we listened in many ways to our end users, we didn’t heed their advice on one key aspect: content is king. Only three years in did we decide to bring on the team that used to run Khan Academy Medicine to generate our own video content library and that rapidly increased our growth.
Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
This is complex, multi-dimensional problem. A few of the contributing factors include:
- Higher prescription drug costs. Per capita spending on pharmaceuticals is higher in the US than in other high-income countries. A fragmented payer system, large marketing budgets (e.g. direct-to-consumer advertising), R&D costs, and other factors all contribute to this.
- Patient education & engagement. Behavior change is difficult and in the US we’re seeing this manifest as higher rates of co-morbidities & chronic conditions such as diabetes, hypertension, and COPD. This leads to more expensive care. Earlier interventions in the form of patient education & engagement could help reduce factors that contribute to these conditions such as tobacco, drug, and alcohol abuse.
- Salary expenses. Average healthcare provider salaries are higher in the US than in other countries, in part because the cost of student training & debt is so high. The median debt of a graduating medical student is $200,000 whereas in other countries it’s fully or heavily subsidized and thus lower salaries are expected.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
Many of the changes I know most about are related to how we educate our providers and empower our patients. Here are a few of the changes I’d make:
- Competency-based education. Most of healthcare education is time-based and does not take into account one’s past skills and experiences. For example, I met a respiratory therapist who had been practicing for 20 years before deciding to attend medical school. He had to go through the same four year MD program — including a basic 1.5-month pulmonary block — despite his years of learning & practicing in the field. If we enabled him to test out of specific parts of the curriculum he could be trained faster and less expensively.
- Reduced tuition for healthcare education. The median debt of a graduating medical student is $200,000, which influences salary expectations, specialty choice, and burnout. If we can more heavily subsidize healthcare education we’d be able to attract a more diverse set of clinicians and remove some barriers to their eventual practice. Innovative schools like NYU and Kaiser Permanente are already doing this.
- Childhood and family education to empower future patients. The Primary School is an innovative early childhood school co-founded by pediatrician, Dr. Priscilla Chan. One of its core activities is educating children, parents, and teachers about their health so that they can make wiser care decisions. We need a patient engagement movement so people take more responsibility of their own healthcare (e.g. avoiding or quitting tobacco use; choosing healthier food options) and it starts with education.
- Better end-of-life planning & care. Studies have shown improved outcomes for patients who are educated about and partake in end-of-life planning, such as palliative care. We need to leverage education and have a cultural shift in how we look at death so that more people opt for programs that allow them to live out their final time with dignity.
- Reduced prescription drug prices. We have to find financially sustainable ways to reduce prescription drug prices so people aren’t choosing between food and rent or their medicines.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
Many of the suggestions above can be tried on a hyperlocal level, as the innovative schools and healthcare systems I mentioned are doing. A Chinese proverb says that “A thousand mile journey begins with a single step.” It’s important to not stop trying to improve the status quo and fortunately there are individuals, corporations, communities, and leaders willing to do the heavy lifting even when no one else believes to make these changes.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I enjoy reading audiobooks from different fields and times, and in particular biographies such as Leadership in Turbulent Times by Doris Kearns Goodwin and The Innovators by Walter Isaacson. Creativity often comes from combining prior knowledge into something new and different. There are countless stories of innovations in healthcare that came from ideas taken from other fields. In addition, reading books from healthcare authors like Atul Gawande (most recently Being Mortal) have been influential because they offer a deep look into important issues facing healthcare, ranging from patient safety to the aging population.
How can our readers follow you on social media?
Osmosis can be found at @OsmosisMed (Instagram, Twitter), @OsmoseIt on Facebook, and https://www.linkedin.com/company/osmosis—knowledge-diffusion/. I’m @ShivGaglani.
Thank you so much for these insights! This was so inspiring!