Medtech Angel Investments for Physicians

Medical technology (medtech) angel investments can be a great opportunity for physicians to engage as mentors with startup companies within their field of expertise. A cardiac surgeon, for instance, can offer expertise to an entrepreneur building a new stint. Typically the physician will make some level of investment and be heavily involved in the company, hopefully seeing it and their investment prosper.

Another route is to invest in multiple companies and be much less involved. Obviously, it would be difficult to offer day-to-day or even month-to-month mentorship for more than one or two companies as a busy physician. In this case, you need to be economical and look for resources to help you with your investment selection. Most major cities have angel investment groups that, for a nominal fee, will help you vet companies and offer other resources as you make your investment decision.

Your best option for plugging in to medtech angel investing in Seattle is WINGS.

Whichever route you take (mentor or passive investor), be aware of the risk and return. While not much has been written on the subject, the white paper “Returns to Angel Investors in Groups” by Robert Wiltbank and Warren Boeker does a nice job of setting the expectations.

Here are seven things you need to know when considering medtech angel investments:

  • Risk. 30% of your investments will fail. 30% will return your money. 10% will go big. 20% will return something. To succeed, you must understand this and have the wherewithal (assets) and stomach (guts) to ride out the losses.
  • Return. 27% IRR. Most of this coming from the 10% that are home runs. See Returns to Angel Investors in Groups.
  • Time horizon. Companies that fail (lemons), fail faster than those that succeed (plums). Proper investment requires patience and the ability to reinvest over periods of time.
  • Invest 5-10% of your portfolio assets. Your risk is concentrated and your return is dependent upon “home runs.” Subjecting more than 5-10% of your assets is just too risky.
  • Diversification. Single company risk is big with these investments. Prudent investment requires investing in at least 15 to 20 companies.
  • Involvement. If mentoring within your field of expertise is the desired path, how much time do you have to devote to it?
  • Do your due diligence, or depend on a group such as WINGS to help you do it. Success rates and due diligence are highly correlated.

If you’re serious about becoming a medtech angel investor, learn the local landscape. Spend some time with local groups, such as WINGS. Figure out how much you want to invest and what role you want to take on. Most importantly, know your downside risk, be mechanical in your decision-making and limit your investment to 5-10% of your total portfolio.

Living Fully: Dr. Albert (Skip) Edmonds, Retired Anesthesiologist

skipedmondsFrom the heights of K2 to the war struck Syrian-Jordan border, Albert (Skip) Edmonds’ journey is one of intrigue and insight. I had the pleasure of sitting down with him to hear his story.

As the son of a pediatrician, medicine presented itself as a likely career path for Skip at an early age, although his route was somewhat circuitous. Upon graduating from Williams College, he pursued oceanographic research in the Antarctic. He spent 200 days at sea, south of Australia in a 200-foot vessel, stomaching choppy waters. During this time, he was also able to pursue his love for mountaineering in the mountains of New Zealand.

After a year in the Antarctic, Skip was faced with a decision: Continue with oceanography and get a PhD, or pursue an MD. The variety of opportunities in medicine ultimately won out and Skip headed to Virginia for medical school.

Early in his career as a practicing physician, Skip put his mountaineering skills to the ultimate test as part of the first American expedition to K2 in 1978. Led by Jim Whitaker of REI, the group was 14 people strong. It was a long trip, beginning in mid-June and lasting well into October. Skip remembers the toughest elements being the weather and the confinement, not to mention dehydration and limited oxygen. Just when the group’s food supply was on the brink of depletion, there was a break in the weather and two groups of two made it to the summit in two successive days, marking the first American ascent of K2 and the third overall ascent.

After many years practicing medicine in Seattle, Skip was ready to retire. It was then that an opportunity to join Doctors Without Borders (DWB) presented itself. Skip was at his cabin in 2010 when the Haiti earthquake struck, and he immediately realized his skill set would be useful. He sent in his application to DWB and went through a rigorous selection process. DWB is very careful in selecting its members, and for good reason. Electricity is intermittent and the living conditions are tough. Experiencing third world medicine is a shock for most American physicians, and DWB wants to make sure each physician can not only handle it, but will want to come back for a second mission. Surgical missions are typically in trauma zones and last about a month, with physicians working around the clock. Non-surgical missions last 3-6 months and have a less intense daily schedule.

Skip says it’s the individual patients you remember the most. There is one 7-year-old Nigerian boy he remembers well. The boy was hit by a car and, after a dozen surgeries, lost both of his legs to infection. Despite his trial, the boy always had a smile for Skip and his colleagues and appreciated their work.

In 2012 he was stationed on the Syrian-Jordan border during the Syrian civil war. They could see the bombs going off a few kilometers away and patients were pouring in. It was an emotionally challenging experience. Skip and his team attempted to save one woman for over a month, and Skip recalled how brave she was to endure. Unfortunately, the infection eventually took her life.

His advice for physicians who are thinking about joining DWB is to do your homework. Make sure you understand it will be harder than you think. Something will come around the corner, either medically or culturally, that will shock you. In the end, Skip always learns an incredible amount on his missions. And, he takes home more than he is able to give back.

If you are interested in more information, you can visit the DWB website. Skip would also be happy to talk with you one-on-one; e-mail me and I will make the introduction.

Skip’s advice for life in general is to find something that occupies your head and that you love to do. It will take you away from the stresses of medicine, allowing you to unplug, decompress and approach your work with a clear head. For Skip, this is rock climbing because it takes total focus and concentration and doesn’t allow him to worry about the daily stresses of life.

The best piece of financial advice Skip ever received was to not try and do it himself. When the tech bubble popped in 1999 that became clear. Skip was in his late 40s at the time and lost half of his retirement nest egg. Later, he entrusted money to a friend and got burned. All in all, he had little interest for investing and therefore was not going to stay on top of it. Hiring a financial advisor allowed him to focus more on the things he really enjoys, like rock climbing.

How We Allocate 401(k) Retirement Plans

Knowing what we know about stock markets, how can we achieve the highest possible return with the lowest amount of risk? This is the primary question driving the allocations that follow. It’s a simple question that’s packed with layers of complexity.

Here’s a brief review of how we broke down the complexity to make it simple for you to execute.

  • Calculated risk
    • Stocks are riskier than bonds. History tells us you receive a higher return for taking this risk.iStock_000012549664XSmall
    • Certain stocks outperform other stocks – small cap and value stocks, for example.
  • Controlled risk
    • Do not put all your eggs in one basket.
    • Use high quality bonds to offset stock market risk.
    • Be patient. The best way to capture stock market returns is to stay invested and keep investing with your periodic 401(k) contributions.

Of course, the biggest factor in all of this is YOU. While we know how to develop retirement plan portfolios, we do not know your specific goals, objectives and values. Specifically, I can’t tell you whether you should be in the 100% stock allocation, the 60% stock 40% bond, or some iteration thereof. Can I assume that a 32-year-old who recently became a physician should take more risk in light of a longer investment horizon? Sure. But that changes for a physician in his forties, and for one who wants to retire early.

If you have specific questions about which mix to choose, shoot me an email at

Likewise, if your 401(k) is not listed on our site, send me your available investment options and I’d be happy to provide my thoughts.

Stretch for Time

iStock_32819864_XSmallPhysicians are stretched for time. Sleep and work alone can account for over 80% of the average physician’s day. Making the most of and stretching the remaining time is hugely important. A time budget can help. It will allow you to audit your current budget, get intentional about how you spend your time and find small chunks here and there – chunks that will add up quickly to stretch your day.

Start to create your time budget by outlining your day. Bucket each portion into categories: work, sleep, leisure, family time, etc. Next, identify holes in your time budget.

Typical holes come in the form of TV, social media, your daily commute, search engine rabbit holes and checking email. Naturally, these are the very same places you can find those extra chunks of time to make your day more meaningful.

  • The best solution for TV is to create a strict budget. If you have a favorite show, limit your viewing time to just that one show.
  • In the age of information, social media and email can be tough to manage. My advice is to allot time to each at the beginning and end of your day. It’s important to stay socially relevant, and checking in twice a day is more than enough to do so. Another helpful tip is to turn off push notifications. Doing so will ease the temptation of checking in.
  • Avoid search engine rabbit holes. In other words, getting lured in by something on the Internet and realizing 10 minutes later you have no idea where you started. We’re all guilty of doing this. My only advice is to stick to the task at hand. If you catch yourself drifting, snap out of it and close your browser.
  • Commuting is one of my favorite opportunities for picking up time. When I am walking to the bus, I listen to an educational podcast. This 15-minute chunk of time allows my first of two email checks for the day. I recently spoke with someone who read War and Peace over the course of a month on his daily walk to work. Talk about productivity!
  • Subcategory of email – Unsubscribe. If you signed up for a newsletter or service you no longer use, unsubscribe. It will shorten your daily email checks and close potential rabbit holes.

These time saving tactics serve two functions – purpose and productivity. By becoming more productive with your time, you can create a more purposeful day. Once you have identified your baseline budget and patched the holes, you can start to live a fuller life.

A Game of Numbers

iStock_54258976_XSmallDebt management is the increasingly larger elephant on the financial priorities list for a new physician. The average educational debt alone was $169,901 for the class of 2013 (Source: Association of American Medical Colleges). While it would be nice to focus exclusively on paying this down, you likely have competing demands – retirement savings and buying a home, for instance. Here’s a quick list of average figures and why you should manage all your financial demands:

  • Student debt – Assuming a total of $225,000 in Federal Direct Loans at 6% interest, the monthly payment for a 10-year payoff is $2,497. The sooner you’re done paying this, the better. If rates were much higher, say 10-12%, you would want to be even more aggressive with your repayment schedule. If rates were much lower, like 3-4%, it would be just the opposite. A silver lining is that you can deduct the interest paid on your tax return.
  • Mortgage – Assuming a $400,000 30-year fixed mortgage at 4.5%, the monthly payment is approximately $2,700. In this case, you’re borrowing against a real asset that’s going to have some level of appreciation – historically near the rate of inflation, which is 3%. An added benefit is that you can deduct the interest paid on your taxes, an important consideration for higher tax brackets.
  • Pre-tax 401(k) – This is a $17,500 per year maximum contribution, or $1,458 per month. By starting to save early you leverage the growth of capital markets. For example, if you contribute $1,458 a month over the next 30 years at 8% annual interest, you’ll accumulate $2,172,944. If you wait five years, that figure drops to $1,386,596.
  • Saving for your child’s education – This figure can vary widely. For example, do you want to fully fund? Private or public school? In state or out of state? For now, start by simply getting the ball rolling. Even if it’s $100 per month to start, get in the habit of saving now. In the not so distant future, you can reevaluate. If you start at birth, you have 18 years to set aside money in a tax-favorable investment. Just like with your 401(k), it’s an incredible opportunity to leverage the stock market. I think you’d agree it’s preferable to writing checks out of your bank account when your kids turn 18 and head off to college.

With an average first-year compensation of $224,693 (MGMA Physician Placement Starting Salary Survey, 2013), managing all four of these expenses should be financially feasible. If not, it might be a good time to review your budget. If you can continue to live like a resident for the first few years, saving money and reducing your debt, you’ll be able to retire earlier and with more financial security.