In this edition, Robert Glassman, MD, talks about the “risky yet refreshing” transition from clinical practice to the financial world and explains how grand rounds saved his life.
When you began your career in medicine, who inspired you to pursue hematology?
I’ve been sparked by several mentors from distinct phases of my life. In science and hematology, there are four who come to mind. Douglas B. Cines, MD, was my attending during my internal medicine residency at the Hospital of the University of Pennsylvania. He was a true “triple threat” and the first one who got me excited about hematology.
Ralph Nachman, MD, was chair of medicine at Weill Cornell Medical College in New York, and he was another hematology triple threat who demonstrated exemplary leadership. He knew how to “cut to the chase.” In any presentation, he methodically extracted key points of the research or clinical case to share with the audience. (Editor’s note: Dr. Nachman also was the winner of the 2016 American Society of Hematology Basic Science Mentor Award.)
Morton Coleman, MD, was a creative and brilliant lymphoma specialist at Cornell. I learned so much from him about both hematology and life – wisdom that he imparted in a down-to-earth manner, splashed with wonderful humor. During my training, he was one of the few attendings who strongly supported my quest to enter the business world.
The late Hidesaburo Hanafusa, PhD, who won the 1982 Albert Lasker Basic Medical Research Award for his work demonstrating that oncogenes come from protooncogenes, played an important role in my career. He took me into his lab, even though I hadn’t a shred of research experience, and instilled in me a deep appreciation for rigorous scientific investigation.
Having explored a few career paths already, are there any other fields that you could see yourself pursuing?
Well, I have traversed four or five careers already – clinical medicine, laboratory research, management consulting, and public and private equity – but all involved health care and/or science to some extent.
Could I have been a great trial lawyer? Or a judge? Or a chef? I’m not sure, but I doubt it. Science, innovation, and taking care of people have always been my unwavering passions. I always felt privileged to be a doctor, touching someone’s life at his or her most tragic and needful moments. No matter what I did, science and medicine had to play a role. I suspect I am hardwired that way.
Looking back at where your career started and where it is now, what prompted you to leave clinical practice?
I’ll tell you what it wasn’t related to – money.
Truthfully, it was about making a difference. I had been programmed to think that being an academic clinician-scientist was the most reliable way to become “important.” However, during my time as a basic-science investigator and practicing physician, I learned that it is a risky and difficult path – even for the brightest and hardest-working doctors.
I remember one epiphany, in particular: I was working in the Rockefeller University library and noticed hundreds of journals on the bookshelves. I went over to them and randomly retrieved a recent issue of Molecular and Cellular Biology. I scanned several articles, each of which probably had taken a postdoctoral researcher a year-and-a-half to complete. By itself, the work in each article seemed incremental, like crossing the t’s and dotting the i’s, moving the field forward slowly and steadily. I wanted to do more.
Concurrently, and by happenstance, I was looking at an issue of The New England Journal of Medicine and ran across an advertisement from the management-consulting giant McKinsey & Company. The firm was increasingly working with pharmaceutical and biomedical companies and was recruiting MDs and PhDs who, according to the ad, “liked problem-solving.” On a whim, I decided to go through their interview process, which I found to be intellectually challenging.
I read about business and decided that, by combining newfound operational and strategic skills with those I had garnered in my decade of experience as a physician-scientist, I could make a difference through this alternative route to basic research.
I was offered the job and accepted it, making the riskiest, yet most refreshing, move in my career. After a few years, though, I found that the jobs I had wanted were not coming my way, so I again switched paths to private equity, and from there to banking.
“Risk aversity prevented me from doing more in my professional life, so I would advise people to avoid the ‘woulda-coulda-shouldas.’”
How did your life change after you made that initial transition out of the world of medicine?
It has changed in many ways. First of all, the stakes are different: At the end of the day, medicine is about life and death; business is about paper and money. An emergency in medicine is a code; an emergency in business is rushing to a board meeting.
Medicine is also a more “local” profession. Many clinician-scientists work close to home, and interact with colleagues and patients who live nearby. Business can be more global. I have traveled extensively and interact with a variety of individuals (biotech and pharmaceutical senior executives, entrepreneurs, lawyers, consultants, fellow bankers, research-and-development heads, investors, journalists, and analysts, to name a few) from all over the world. I also am now a member of Global Services on United Airlines and at the Diamond or Platinum level with many hotel chains – that’s not something I could have imagined for myself as a practicing clinician or basic-science researcher.
Of course, compensation also is different: In clinical medicine, compensation tends to be process-based (i.e., reimbursement for a service provided to patients and/or education to trainees), but in the business world, compensation is more product-based (i.e., based on performance outcomes). Failing to generate revenue can result in the proverbial pink slip. Furthermore, those in business are more subject to externalities like market conditions. When the banking crisis hit in 2009 and 2010, many of my peers lost jobs and life savings. Medicine is generally immune from this, as there is more of a fixed demand for health care.
What are your proudest accomplishments during your time in medicine? In business?
When I accepted the position at McKinsey & Company, I was one of the first trained doctors who swept into the business realm. I think that I provided a roadmap for many others to follow – some of whom have greatly surpassed me in achievements.
As an investor and an investment banker, where one of my tasks is to evaluate new drugs from biotechnology start-up companies, I have been peripherally instrumental to the development of some key innovations in medicine. That includes recombinant factors VIII and IX Fc fusion proteins while I was a board observer for Syntonix, and abiraterone, a drug that created a new paradigm in castration-resistant prostate cancer, while I consulted with Cougar Biotechnology (later acquired by Johnson & Johnson). With the latter, I worked closely with Cougar CEO Alan H. Auerbach in positioning the drug to buyers who brought it to the market – and, eventually, to the patients who needed it.
I am also proud of my time in clinical medicine and research, and the contributions I have continued to make there. I still write academic articles and give talks on trial design, data interpretation, and drug economics.
Have you had any major disappointments in your career – either in medicine or in industry? If so, how have you handled them?
I work in investment banking, so, of course there have been many disappointments. Investment banking involves selling your own and your firm’s capabilities, in terms of mergers and acquisitions and raising capital. I try to do so with ethics and deep substance – analogous to a builder who becomes a real-estate agent. Despite my valiant efforts and all the assistance already provided to the clients, they will sometimes choose my competitors over me.
I handle it by not letting these disappointments deter me. Coping requires a thick skin, which I developed by keeping perspective on the important things in life and maintaining the ability to laugh at myself. My medical training taught me about the fragility of human life, and the events of September 11, 2001, made the lesson ineffaceable. I was supposed to be at One World Trade Center that morning, but fortunately, I was asked last-minute to give heme/onc grand rounds at Weill Cornell. Yes, it’s true – grand rounds actually saved my life.
What lessons has your work life taught you? Is there any advice you’ve gleaned from traversing different careers that you would pass on to younger colleagues?
Risk aversity prevented me from doing more in my professional life, so I would advise people to avoid the “woulda-coulda-shouldas.”
Mark Twain once said, “Twenty years from now, you will be more disappointed by the things you didn’t do than by the ones you did do. So, throw off the bowlines. Sail away from the safe harbor.”
As a corollary, I would offer, “Follow your passion.” But I’d also add the buffer, “Be realistic.”
As the writer Calvin Trillin said about the burden of promise, “You have a knapsack, and all the time you’re growing up they keep stuffing promise into the knapsack. Pretty soon, it’s just too heavy to carry. You have to unpack.” You might be talented in a certain area, but even among childhood prodigies and superstars, few truly make a monumental difference in the world. So, find where you can make the most difference. Unload that knapsack to avoid being unsatisfied with anything less than stellar.