Ten years ago I left medical school at Johns Hopkins to pursue a question I had become obsessed with: Could you get an MD online? It was the riskiest decision I had ever made and one that not only worried my parents, but frankly gave me palpitations too.
At the time my co-founder and I had just started working on a learning platform called Osmosis.org which was how we and many of our classmates were acing our own exams at Hopkins. The vision was to make medical education more efficient and enjoyable by incorporating evidence-based techniques such as flipped classroom and test-enhanced learning; delightful user experiences and machine learning-enabled personalized recommendations pioneered by companies like Facebook and Netflix; and novel content formats such as short videos given how rapidly the world was becoming more visual and digital.
Our experience since we took the leap and left medical school is perfectly captured by this quote from Bill Gates: “Most people overestimate what they can do in one year and underestimate what they can do in ten years.”
What began as a side project used by our class of 120 medical students would grow beyond our wildest dreams to reach well over 3 million learners around the world – enough to fill 25,000 lecture halls at Johns Hopkins – and across all health professional programs including nursing, physician assistant, pharmacy, and dentistry, and even patients and their family members. Ultimately this reach and impact led to our successful acquisition by the 140-year-old medical & scientific publisher, Elsevier, known for titles such as The Lancet, Cell, and Gray’s Anatomy, and which has been a perfect match both from a cultural and growth perspective.
While I was having a wonderful time and learning a tremendous amount “in the real world” by growing Osmosis from two to 100 employees and 0 to 200+ institutional partners, my original goal of becoming a doctor – which was first forged in a hospital in South Africa – kept hanging on by a thread.
The author on his first day back at the Johns Hopkins School of Medicine
Given Osmosis’s scale and successful exit, I surprised many of my friends earlier this year with my decision to swap out the techy Patagonia vest for a short white coat by going back to Hopkins Med as a third-year medical student. The choice was the culmination of months of thinking that ultimately boiled down to these six reasons:
- Directly helping patients is an incredible privilege which provides deep purpose. As I’ve written about in the book Success Mindsets, there is a natural tension between pursuing scale versus direct impact. While growing Osmosis to millions of learners has been incredibly fulfilling, I’ve missed the ability to help someone directly on a 1:1 level. This purpose is further deepened by the nature of their problems: “A healthy man wants a thousand things. A sick man only wants one.” (Confucius). Put another way, illness has a habit of clarifying to people what’s most important to them. Healthcare professionals are privileged to be able to be there for patients on what may be the worst day of their life, with an open heart and the knowledge and skills to help them return to a state of wellbeing. Even at Osmosis the initiatives that have fulfilled me the most are the ones that have the most direct impact on patients, such as our focus on the often-ignored rare disorder community through The Year of the Zebra. Our simple and clear video style – while originally developed for medical students – has fortunately appealed to countless patients and family members who’ve submitted thousands of comments such as this one: “As someone who was diagnosed with premature ovarian failure at the age of 14, it’s nice to finally know what’s going on because I didn’t understand a single thing my doctor said except for the fact I wasn’t able to have kids. Thank you so much for this , I’m glad to have a better understanding of it!” This desire to connect 1:1 with patients who have incredibly diverse life experiences and circumstances has already been validated in my first few weeks back at Hopkins, so I’m excited to rotate through the various services ranging from pediatrics to neurology.
- Learning medicine has never been more engaging and efficient. The key reason Osmosis succeeded is because we had “skin in the game” and literally put ourselves in our customer’s shoes. I’m back to learning by Osmosis daily and am confidently betting my own medical studies on the quality and efficacy of what we’ve created. Additionally, now that we’re part of the Elsevier family, I have access to leading complementary resources such as the Complete Anatomy platform for anatomy review and surgery clerkship prep as well as ClinicalKey Student for thousands of USMLE practice questions and access to category-defining books like Nelson Pediatrics. Plus, the human body is fascinating so I’m thrilled to have the opportunity to resume learning about how we work.
- “Raising the Line”requires both clinical and entrepreneurial experience. Our healthcare system has immense challenges ranging from the massive global shortage of healthcare workers to the cost and inaccessibility of life-saving medicines. Over the past three years I’ve had the opportunity to interview hundreds of leaders for the Raise the Line podcast such as Dr. Sheila Davis of Partners in Health who spoke about global health equity; Mark Cuban who shared his team’s work to make drugs less expensive; Dr. Eric Topol who discussed the future of AI and digital health; Dr. Ashish Jha who talked about strengthening our public health system; and Arianna Huffington who tackled the topic of provider burnout. It’s clear that we need innovative models in order to “raise the line,” or strengthen our healthcare system, so I’m looking forward to both directly seeing how concepts we discussed on the podcast are applied within the healthcare system as well as building clinical experience to combine with my entrepreneurial background to hopefully contribute to these solutions.
- Doing hard things can be profoundly fulfilling. “Do one thing every day that scares you. Those small things that make us uncomfortable help us build courage to do the work we do.” When writing those famous words, Eleanor Roosevelt was channeling the Stoic philosophy of practiced discomfort which I’ve empirically found to be transformational. In recent years however, I’ve noticed that I’ve mostly practiced physical discomfort, from daily cold showers and a Winter Expedition plunging into icy water with Wim Hof to running an IronMan and climbing Kilimanjaro for rare disease awareness. Transitioning from running a 100-person company with plenty of autonomy to being at the bottom-of-the-totem-pole again and studying intensely as a medical student has already been a tremendous challenge – precisely why it’s worth pursuing. As I go through medical school I’m paying attention to (and reframing) two emotions in particular: fear and frustration. Fear is an opportunity for growth, and one I’ve already experienced in simulated patient encounters such as a recent one where a baby mannequin went into supraventricular tachycardia and we had to figure out how to respond within minutes. Frustration is an opportunity for innovation – indeed, it was frustration at how inefficient the medical education system is (e.g. hundreds of long and passive lectures) that led to the founding of Osmosis. Our healthcare system is full of opportunities for improvement so I’m excited to experience these frustrations first-hand again.
- Creating the future. Related to this last point, one of the most compelling reasons for going back to medical school at Johns Hopkins specifically is its leading research in some very exciting areas. Two that I’ll call out are artificial intelligence (AI) and psychedelics. The recent development and release of generative AI tools such as ChatGPT has captured the public’s attention, and Hopkins has a track record of applying AI to meaningful healthcare problems such as detecting liver cancer and sepsis as well as pioneering innovations in areas such as “organoid intelligence” and brain-computer interfaces. The other area, psychedelics, has recently undergone a renaissance given the mental health crisis ranging from anxiety and depression to post-traumatic stress disorder and substance use disorders. This resurgence was in large part pioneered by Johns Hopkins researchers at the Center for Psychedelic and Consciousness Research who have published over 150 peer-reviewed papers and are actively running several clinical trials for conditions such as OCD and anorexia nervosa. It’s a fascinating time to be a student again and do electives with labs such as these that are creating our collective future.
- Accomplishing a personal and family dream. Last but not least, I’ve returned to medical school with the hopes of fulfilling a personal dream of mine nearly 30 years in the making from when I followed my physician father to the hospital he ran in South Africa. This excerpt from my original medical school application essays is as true today as it was nearly 15-years ago, “My determination to become a physician was initiated by a sense of compassion, advanced by the excitement and promise of medical research, and strengthened by the realization that doctors can simultaneously contribute to individual patients as well as general society through their leadership.” As with many dreams it’s not just my own, but also that of my family which just two generations ago were refugees during the India-Pakistan partition. The Philadelphia Business Journal captured this sentiment in my quip a decade ago when we had just left Hopkins the first time around: “Osmosis expects to raise funding early next year, which means Gaglani and Haynes will have to answer questions about whether they’ll return to med school. Gaglani said venture capitalists who would invest in the company “don’t want to hear [we’re] going back to med school, but our parents don’t want to hear [we’re] not going back to med school.”
Taken together, these reasons painted a persuasive picture for me to step back from daily operations at Osmosis – which is in more-than-capable hands with the mission-driven team at Elsevier – to return to the Johns Hopkins School of Medicine. While this is the present course, I’ve also lived enough to know that Mike Tyson’s famous saying that “Everybody has a plan until they get punched in the mouth” rings true. The last time I started medical school I made it through two years before encountering a problem that was compelling enough for me to leave to pursue it full-time, and fortunately for me and many more the result was Osmosis. While I’m keeping an open mind to this among other possibilities, I am grateful to already be back in Baltimore where I can hopefully “raise the line” as a future healthcare professional.
Feel free to follow along the journey via LinkedIn, Twitter, and YouTube.