Executive Column: Gur Roschwalb

About ‘The Executive Series’

Through ‘The Executive Series’, The Commentator provides its readership with access to the thoughts and experiences of highly accomplished individuals in the business world. The column has a conversational style and expresses the unique story of each business leader, including their motivations, struggles, successes and failures. ‘The Executive Series’ also serves as a forum for a broader conversation about leadership in business and in life.

About Dr. Gur Roshwalb (adapted from Bloomberg and CrunchBase):

Dr. Roshwalb currently serves Chief Executive Officer of Akari Therapeutics, a position he has held since 2013. Prior to his current role, Dr. Gur Roshwalb was a Vice President at Venrock, where he was an investment professional on the healthcare team investing in both private and public companies. Prior to this he was a vice president and equity analyst at Piper Jaffray, publishing research on specialty pharmaceutical companies. Prior to Piper, Dr. Roshwalb was in private practice in New York following residency training in internal medicine at Mount Sinai Medical Center, where he served as Chief Resident.  Dr. Roshwalb obtained his medical degree from Albert Einstein College of Medicine of Yeshiva University, his MBA from the NYU Stern School of Business and a B.A. from Columbia University.

Michael Shavolian: Tell me about your first leadership role.

I would identify my first leadership role probably in residency. I graduated Albert Einstein in the class of 1994 and then I went into Internal Medicine. In your first year as an intern you learn how to practice as a physician but at the end of that year you are expected to transition over to being a resident where you have to lead the other interns who are taking care of patients and that was my first leadership role.  

MS: What did you take from it throughout your career?

When you start out as an intern you have a resident [in charge of you]; and you are learning to be a doctor. You’ll see, for example, that a patient has an abnormal temperature and you will go to the resident and say: “Mr. So and So has a fever”. But when you are the resident you have to come up with what to do. So in the beginning of your internship it’s: “I don't know what to do”.  You’re learning. You’re afraid to make comments or make decisions. But by the end of the year you are a resident and you have to make those decisions. It is a transition from identifying a problem to creating a solution that’s an important evolution for anybody practicing to be a physician. The lesson I learned was: to not only state the problem but to also offer a possible solution. Meaning to say: “Mr. So and So has a fever, this is what I think the problem is, this is what I would like to do about it and get your agreement”. And that was probably the first real lesson: transitioning to being a leader is making sure that you can get your team members to not just come to you with problems but to think deeply about the underlying issues and bring you solutions.

MS: How did you first become interested in the pharmaceutical world?

From a very young age I was programmed to become a physician. It was either: lawyer, doctor, Indian chief…and the last one was out.

When I left residency I went into private practice. One of the things I was very interested in then, in 1998, was electronic medical records. I was trying to get the medical group to use EMR and they came back to me and said “It is a nice idea but there is no return on investment for us,” assuming, for example, $25,000 per physician per year for a license of some product. At that time I decided “Great. If it’s going to cost too much, I will go write my own”, which I did. That got me into the world of business.

At that point I had decided I was going to transition out of medicine and I had to decide where to transition. I had a lot of computer skills and medical skills but no other skills. My wife at the time decided to get an MBA, I liked what she was learning and found it exciting, and so I got an MBA as I recognized I needed something to help me make the transition. I needed a company that would take someone without business skills and train them because they want to leverage their medical skills. The most common of those places are management consulting and Wall Street. I ended up getting a job as an equity analyst at a bank called Piper Jaffray.

MS: You were on the traditional medical path: medical school to internist to resident and then private practice, but then in 2004 you made the switch to become a biotechnology equity analyst. What motivated you to make this switch?

I was unfulfilled. Learning medicine was very exciting and challenging. But the actual practice as a general practitioner, diagnosing and treating diabetes, hypertension and colds was not exciting to me. You definitely help individual people, without a doubt. But it often becomes just a scramble. At that time the average intern at his peak, in around 2000, was making $180,000 a year, maybe $200,000 if you are lucky. If that was the case how was I going to raise a family and send them to private Jewish day school? That was an issue. So if you combine the fact that I didn't feel I was making enough money together with the fact that I was clearly not intellectually fulfilled, I realized I had to make a change. And I recognized that when I started to write my own electronic medical record program. Here I was, I had the time to explore data basing, spend hours playing on the computer writing code, and being excited by that because it was intellectually stimulating.

What was the hardest part of this transition?

I made the transition when I was 36; I had a couple of kids at the time. And in such a circumstance you have to be able to take a risk. You leave a job which nearly guarantees steady pay--you will have patients as long as you can communicate with people--and take a new job on Wall Street and become one of the older people surrounded by a lot of young people. It is not so easy to take a step back in pay--there is a certain golden handcuff and you are taking on inherent risk.

MS: What intangible skills do you think are most critical to success in the business world today?

Communication. I don’t just mean to sell what you need to sell but also to listen what others have to say, to understand motivations and where other people are trying to get to and to translate back to other people where you’re trying to go.

MS: How do you compare the management of a medical practice to that of a pharmaceutical company?

It is a difficult question to answer because there are many different models of medical practice. A large medical practice of hundreds of doctors is still like running a company. But a small practice of 3-5 people is much different.

MS: Why do you think many doctors are unsatisfied today?

The major reason why most medical doctors are unsatisfied is because they don't know how to run a business. Mostly they think of running a business as: “I see patients, I collect bills, and I move on”. That gives you very little understanding of what a business actually is: where are the patients coming from, what are the demographics, how do you get them, who are your higher paying patients, what are your costs? At the end of the day it is about profit not about revenue. A lot of physicians don't recognize all these factors that go into running a business and do a really horrible job and feel dissatisfied. And they don't realize that they have something at hand which they need to run like a business.

They complain about all these things that are actual business model problems. But they focus the issues externally on the insurance companies, for example, without realizing that the problem is in their business model. They train you how to take care of a patient at medical school, they train you to do that really well, but they teach you nothing about running a business. So when faced with actual business problems, you don't know how to handle them, or you don't handle them, or you handle them poorly, or you are like a headless chicken: you have one approach on Monday and a different approach on Tuesday. This leads to frustration for not treating something like it is.

MS: What was the toughest moment of your career?

I once made a mistake in treating a patient--it happens. In business there is a concept of root causes where one understands why something doesn’t go right-this is very important. I learned a lesson there which is don't be afraid to ask for help. It is okay to double check things. Even if you are the chief resident and you think you know, go ahead and ask, make sure you know, especially when it comes to somebody’s life.

MS: What do you look for when hiring?

I will first tell you what I don’t like: people who tell me “It’s not my job”. I don’t just want somebody who knows how to do their specific job. I never want to hear from somebody it’s not my job. We all staple--I staple, I file, I do stuff--and I am the head of the company.

I look for people who have flexible minds and who act as part of the team who say: “I am going to get this done, and if I don't know how to do it, I am going to figure out how to do it, and if I need help, I will ask for help.” Needless to say, for certain positions some experiences and skill sets are perquisites. I want somebody who will be open and flexible, willing to learn and up to the challenge.

MS: What factors do you consider to be a must-have for any company worth joining?

You want a place where you’re happy going to work.

And of course, a company that follows the laws--you want to make sure that you feel what is going on there is honest. In a situation where you’re not sure the company is on the up and up, don’t stay there. Because even though you may do nothing wrong, you might be tarred with the reputation of that company. For example, Galleon, a hedge fund collapsed after one of its leaders went to jail. An analyst I know who had worked at Galleon had a very hard time getting another job--the employees were tainted because of their association with Galleon. Make sure what is going on there is honest.

MS: What do you do on an ‘average’ day?

I talk to investors, I comment on protocols, I review drug design, I meet with members of the management team, we do regulatory stuff- and a lot of phone calls. But there is no average day. Everyday is a lot of fun here- it is exciting. Circling to my earlier comment regarding where should you work? Work where you’re happy.