From Surgery to Startup: Building a Mission-Driven Company After a Stanford MBA

I didn't think it was going to be this way. But the most valuable, by far the most valuable thing that I got out of that MBA wasn't learning how to do GAAP accounting. I took a couple of classes like Paths to Power and Strategies Beyond Market and Formation of New Ventures. That really changed the game for me. But the number one thing that I got out of there is the network. If I hadn't built a network that I built at Stanford University, I never would have been able to sell my great tech. I never would have been able to get those doors open. Open for me.

Hi, everyone. Welcome back. Thank you so much for joining us today. I'm joined by Renee Casey, a former surgeon, Stanford mba, and now the founder and CEO of Metaloop, a platform using AI to reimagine how clinical research is conducted. He's also an adjunct professor at Stanford School of Medicine, a repeat founder, and someone whose career spans medicine, tech, teaching, and a personal mission. In this conversation, we'll explore what it means to reinvent yourself not just once, but many times. We'll talk about the experiences that led him to leave surgery behind and how a family health crisis sparked a bold new venture. We'll also talk about what he's learned about building with purpose in a complex and changing world. So thank you so much, Renee, for joining me. You've been a surgeon, a professor, an entrepreneur. When you look back, what's kind of the thread that connects everything for you?

Yeah, I guess when you're trained as a doctor. I was trained as a surgeon. You're. You're trained to fix acute problems that are in front of you. And I guess it just carried through my entrepreneurship journey where I built my first company, which was an EHR company, an electronic health records platform where I felt that that needed to be fixed and I felt compelled to try to fix it, build a new company out of it, which kind of propelled me to get over to the business side of things and not stay in surgery.

And what attracted you to the medical field in the first place?

I happened to be good in school. And back in the day, if you were good in school, they'd push you into a couple of preset careers. Medicine wasn't one of them, or being a lawyer or whatever. And I kind of followed this. I never really had a passion to become a doctor, but I certainly learned to love it when I started training, when I started in pre med, I immediately fell in love with it. So, yeah, I kind of stumbled onto it. I don't have any family. That's in there. I come from a very poor background and small village where people don't usually very few make it to go to medical school. I was one of the lucky ones.

Oh, that's awesome. And then how did you migrate towards.

Surgery when you're a medical student during clerkship, it gets you to rotate around in different, in different departments. And I stumbled into maxillofacial surgery and craniofacial surgery. I like the department, like the people that work there. I like the types of surgeries they were doing. It's, it's, it's not just, you know, orthopedic large bone type surgery you work with, with facial bones. And I was drawn to it.

That's cool. Yeah, it's cool. It's not a as common an area sometimes, you know, you come across, but it's a super fascinating area of medicine.

For sure it is. When, when you, you go into medicine, especially in surgery, you don't realize that although it's a cool job, when you're, you're, you're a young kid, you don't realize that it's a, it's a very taxing job. You have to, you have to show up for call, right? You're doing shift work for most of your career and it's a very, very hard job. That's, that's something they don't teach when, when you're getting trained. But as, as you know, I practice for a decade. It gets old fast. After a decade of getting up at 2am to go fix an orbital floor fracture, leaving your family at all times, in the night, on weekends. It's a cool job at the beginning, but it becomes very taxing on the body and the mind.

Yeah, I bet when you're a 20something bachelor, it's very different than having a family, being in your mid-30s or early 40s.

That's where definitely. Yeah, that's where you make the switch. I think again you're, you're a 28 year old surgeon. You know, it's, it's a lot of fun but the moment you start getting kids, you want to spend more time at home. It's, it's, it's a whole new story.

And was that kind of what motivated you to move more into the entrepreneur, entrepreneurship ecosystem?

I just trained in a big hospital in New York City and I'd used, you know, big ehr that they were using there and when I made it to my hospital where I was in attending, I, I really hated the software and I didn't want to use it I had no intention of, of opening up a company, but I went from being a poor student with a poor background to making a lot of, a lot of money. You know, day one as a surgeon, you're making crazy amounts of money. So one of my colleagues and I decided to hire an engineer. The first engineer out of pocket, had a lot of cash flow and started building this thing to, to just build a tool for ourselves to practice medicine or surgery better, faster, being more efficient. And as we were fixing our own problem, we realized that a lot of people had the same problem and a lot of people started asking us to buy the chr and we, that's where we decided to create a company. Within a couple of years we have, you know, well over a million patient records on the platform. You know, we're running winning RFPs against big tech and we were acquired by, by a big player that we were kind of disrupting a bit.

And what was that moment like? What kind of made you say, okay, now's the time to leave medicine and focus full time on, on my venture?

I actually kept on as a part time surgeon while I built that first company. Even through the acquisition, I was a part time surgeon. I was practicing a couple days a week and the rest was, I was the CEO of the company. Even when it was acquired, I stayed on with the acquisition and worked three days a week for that big corp. It wasn't after, it was when I, I, that ended and I went back to full time surgery that I, it just dawned on me that there's, there's many ways to, to use medical training, your medical knowledge. You can use it to, to build tech, can build tech products with that knowledge. And that's something that I never learned in school. And it's something however, that I, I, I feel Stanford does well. You know, there were 39, 000 companies built on campus that are now generating, you know, $2.3 trillion of annual recurring revenue, $2.3 trillion of revenue that's being generated each year by these 39,000 companies. One of the things they teach here at the med school is, is that you can do something else. You don't have to do surgery because you're becoming a surgeon. You could maybe use it to fix surgery. They teach you to think out of the box, rethink the way you're doing a surgery or rethink an instrument that you're using, or maybe develop a piece of tech that might help you better write prescriptions. For example, there's not many places in North America or anywhere in the world for that matter that teaches medicine in this new way. So I, it took me a long time. If I would have been, you know, if I would have been trained at Stanford, I think I might have left surgery a bit faster. I kind of stumbled onto business by fixing an issue that was in front of me and became, you know, an entrepreneur by accident and st.

So interesting that you ended up doing an mba, right? Because we, we've worked with a couple of doctors who do an mba, but it's, it's not a common profile. Right. So what made you say, you know, I really think an MBA is the next step for me.

When I built, when I built that first company, that first CHR company, I didn't know what I was doing. You don't learn anything about business. Right. While you're, you're becoming a surgeon. And I didn't know what I was doing. I really, I really didn't. I was learning as I went Again Stanford, they have the MD MBA program where you do both at the same time. A lot of doctors end up in private practice where they're running their own practice. That is a business. Yeah, you should learn how to do business properly or get some, some business training to do that. And that's not taught in medical schools. You know, I really got a great first experience at entrepreneurship. I was lucky. I didn't know what I was doing. But I built product that I needed and it turned out that there was a need out there, but it doesn't always turn out that way. And I just wanted to do it again and I wanted to do it on the world stage this time. And you know, Stanford was, is an entrepreneurial MBA and it was easy to pick this one. So I did that one year mba. If you, if you come from a career, they let you do a one year MBA that they call the MSX program. And it was absolutely fantastic and game changing for me.

And what was maybe one of the most surprising things that you got out of your MBA that you didn't expect or didn't realize that you needed.

I didn't think it was going to be this way. But the most valuable, by far the most valuable thing that I got out of that MBA wasn't learning how to do GAAP accounting. It's great. But if I need to get accounting, I hire a CPA and they know a lot about accounting or I took a couple of classes like Paths to Power and Strategies Beyond Market and Formation of New Ventures. That really changed the game for me. But the number One thing that I got out of there is the network. I am convinced that if I had tried to build this company, especially dealing with the types of customers, you know, our main customers are our academic medical centers, they're pharma, big pharma, government. If I hadn't built a network that I built a Stanford University, I never would have been able to sell my great tech. I, I never would have been able to get those doors open. For me, it's, it's almost unfair, you know, especially in these days, it's hard to build a moat around tech. Tech can be built by AI today. Right. So you need something else to kind of put you apart from the rest of the pack. And that one thing is network. And that network can definitely be gained, not just out of Stanford. Stanford is definitely a great place because of the entrepreneurial minds that are coming out of here. And a lot of big companies like Google were built on campus. So all this network is still here and you have access to it. And I met people that are today completely changing my company on a day to day basis. So network is definitely number one thing that I gained from this Stanford experience.

And I love that you kind of gave a little bit more detail because I think a lot of people hear, oh, the network, and then they're like, you know, what does that mean? What does it mean to have a network? You know, how do you actually use an MBA network?

Right, Yeah, I can give you a couple of examples. I met so many people that are still very influential to me. I made it a point when I started school that any speaker that came to class, I was going to be that first annoying guy that would be at the front of the class at the end to meet that person. If you're coming to be a speaker at Stanford, you must be an important person. One of the people that I, I did that. It was one of the, one of my top classes that I took there. There's a few. It was a class by Jeff Pfeffer. Listen to his podcast. It's great. Jeff Pfeffer teaches a class called Paths to Power. So every class there's a very powerful individual that comes to class and talks about how they got to being a powerful person and how they're staying there. You learn the traits of powerful leaders. And one of the protagonists of the class was called Amir Rubin. Amir was the CEO of Stanford. Then he was at Optum, became the CEO of One Medical that was acquired by Amazon for $4 billion. A true rock star. And I met Amir and Amir just because that one connection, and there's many more. Amir became an investor in our company. He knows every CEO of healthcare organizations across the country. He opens all these doors for us to easily sell into AMCs. That is just one example. And I have many, a lot of people reach out to me and ask me what should I be looking for when I get to see Stanford, what should I talk about at my interview? And that network, it's not cliche. It can really change a career. It can change the face of your company. It can make the difference between building an okay company or a unicorn worth billions of dollars.

Yeah. And I think especially with kind of what we're seeing with AI Right. Flooding the market, so many different solutions, but also just so much information. Right. That it's become so easy to post, it's become so easy to kind of get your message out there that having that network, being able to kind of hack through all that noise, I mean, it's always been valuable, but I think at least for my clients, what I've seen, it's way more valuable than it's ever been.

It is, yeah. I agree with that.

And Metaloop, your current company, was born from something deeply personal. Can you tell us a little bit more about that story?

Yeah, sure. So again, I came from the medical world, I came from an EHR background and I saw how hard it was to use data and I wanted to build an AI company that would help use healthcare data to conduct research more easily. My daughter got very ill, she was diagnosed with rare disease and we started working on the platform to try to adapt it, to use big data to figure out this disease. That's how we got in there. And I was actually, it was during my stint at the Stanford GSB that this happened. So the team was very motivated to push us forward. It wasn't just about building a unicorn that was going to generate revenue. It was about finding a way to cure disease. And you can do it for one disease, you can do it for multiple diseases. And it becomes very personal. And that's when you start talking about mission, mission oriented companies. Right. That, that really try to fix world problems that could have huge impact.

And I think one of the things that I've noticed that's kind of a common denominator with Stanford students is that they are very mission oriented. Right. They want to build something that obviously is a unicorn and successful and an industry category creator, but also they want to do something that makes the world a better place. And within your company, how do you ensure that that mission oriented Culture permeates throughout the entire company and that your employees stay engaged with that mission.

As we've been moving along, we're about to close a series B here and sometimes we kind of lose track. It's growing so quickly that we're all of a sudden concentrating on product and concentrating on the top line or the bottom line on ebitda. I sometimes have to stop and say let's, let's get back to our roots here and talk to the company, to the employees about why we're really doing this. So it's just important to talk about this continuously about the mission of the company. A lot of missions are tacky, right? I think it'd be hard to have a mission oriented company if you're building, I don't know, a product that helps you transfer funds from one account to another. I have friends that are doing that and I love them. I'm just saying that here it is a bit easier to be like really Mission driven. That's the word I was looking for. I've been, I've been trying to think of that. Mission driven. It's easier when you're building product that can actually help each and every one of your employees. Like if ever their loved ones get sick or they get sick, it's something that could help their kids in the future. It's easier to drive that mission into them and, and keep them believing in the North Star.

So how did your experience building and exiting an early venture shape how you approached building this one?

Yeah, you definitely learned a lot. Again, when I started that first company, I didn't know what I was doing at all and I wasn't able to raise capital, so I had to bootstrap the company. It takes a couple of years for any company to become cash flow positive. So I was, I was floating the company with a colleague. I still remember vividly one Thursday, one Wednesday, payroll was the next day. It was $150,000 and it was $0 in the bank account. Our credit cards were full. So you learn a lot from that. We barely made a payroll contract came through and we, we were able to convince the bank to make us a loan. And it was crazy times and I did not want to go through that. So, you know, it was great to bootstrap a company because when you do, if you can make it through the archips of bootstrapping, when you sell, you own a hundred percent of the company. You don't have a board of directors that are your boss. You know, although I started this company, I have the board of directors that could fire me if I'm not doing a good job. Not, I'm not continuously growing, growing, growing on a day to day basis or quarter by quarter basis, they would fire me because they have a fiduciary duty to the, to the shareholders. It's not an emotional decision. It's the decision that they have to make. You have to deal with that when you're bootstrapping company. But I wanted, I wanted to raise capital. You know, it was clear to me that I wanted to be able to get out of the gates faster, grow the team quicker. As soon as we had an MVP is one of the examples of how this changed the way I looked at business. I also, you know, when I was building my first company, I had a couple of friends that were there. And any founder will tell you that it gets very, very rocky with anybody in your company. There's just like in your marriage, right? It gets rocky sometimes.

Yeah.

And I took it very, very personally the first time around and I knew to expect that this next time. So I learned a bunch of lessons. I definitely helped me grow as a, as a founder. I think I'm a better founder today because I did build that first, first company. I got a successful exit. And again, the Stanford GSB completely changed me as, as a leader, as an entrepreneur, I'm definitely a better, a better leader than I was before.

And now you're teaching. So what's something that you wish more of your students understood about what it takes to build a career that they're really passionate about?

Yeah, I believe that you, you should build a company around what you're good at. You know, it's like medicine, right? You, you get in there thinking it's your passion, not me. But a lot of people come in that, you know, thinking it's their passion. But after a couple of years, a passion becomes a job and a job becomes, is not fun for everyone. I, I think that it's important to do what you're really good at, what you're knowledgeable in, to start you off, number one. And number two, you know, what we do teach in, in the class is that it is going to get so, so difficult in whatever company you're building. Like everything out there is trying to kill you. You have competitors, you have, the markets are shifting, the economy's tanking. There's everything every single day is trying to break you. And the only people that make it through are the people that continuously solve problems on a daily basis. That is a secret sauce. It's Just like sheer willingness to go on and keep pushing. It's not necessarily about the quality. Your tech, your tech has to be fantastic, but it's about, you know, continuously working and, and understanding that it is the most difficult thing that you will ever accomplish in your life. Going through 14 years of surgical training, 10 years of a surgical career was nothing compared to the hardships of building a company. It is the hardest thing anybody can do. And it's, it's every single day. It's hard. It's hard. It's hard. There's always a problem being thrown at you, especially if you're in a leadership position in your company. At the end of the day, you do have fun days, thank goodness. But, but it's, it's a hard ride. But you get to, you know, you get to, at the end of the day to build great tech that's going to change millions of lives.

I love that because I think a lot of, at least clients that I work with that are in their mid-20s, they want to be entrepreneurs because they think it's glamorous, right? They think, oh, it's going to, I'm going to be a founder. I'm going to be on magazines. It's going to be so glamorous and cool. And there's definitely that side to it right when it, when it works out. But I think that what you mentioned is so sal. But it's mostly just a lot of grinding.

It's a lot of. Yeah, it is. It really is. And you know, you interview a lot of founders and you'll find that that is a common trait. If all successful founders have a, you know, have a rocky boat. One of our VCs keeps telling us for, for startups, the boat is always rocking. And that is correct. The boat is always rocking.

And for our final round, what's the one question that you think every founder should ask themselves before they start building?

Are you willing to make this type of commitment? This. Is your family willing for you to make this type of commitment? I think the it. On average, it takes six to 10 years to IPO a company. Are you willing to be poor for that time? As a, as a startup founder, your, your, your investors aren't going to let you get paid. Are you willing to not be able to support your family financially? Do you have enough cash, like personal capital in the bank to, to weather this? Are you willing to take that type of risk? Again, it does sound glamorous at the beginning, but it gets, it gets very hard very quickly. I mean, I was ready to do this. I'd experienced it one time and I wanted to do it again. My wife was ready to support me through this. Our kids are a bit older and we felt that we could make it through this, but we definitely had the discussion. So I really suggest to all founders to ask themselves these hard questions.

And of course, probably too. I mean, when was the last time you took a vacation? Right?

You don't. You do. You do go on vacation with your family, but a lot of it is spent on your phone or on your computer, closing deals, raising capital, taking meetings, putting out fires.

Yeah.

Yeah.

It all depends on you, right?

It does. Yeah.

Awesome. Well, Dr. Casey, thank you so much for joining us today. For listeners who want to follow your work or learn more about Metaloop, where should they go?

Metaloop AI M E D E L O O P A I Please reach.

Out and we'll include it in the show notes as well.

Thank you.

So you guys can check it out there. So thank you so much. I really, really appreciate your time.

Thank you.

And for all of you who are seeking to make bold moves in your career, visit our website@Ellen Lawless.com to learn more about working with us and applying to your dream school. We'll look forward to seeing guys on the next episode.