The American and The Spaniard – Two Wild and Crazy Guys in Search of Physician Entrepreneurship

A Wild and Crazy Guy

1978 Album by Steve Martin, American Comedian

October 7, 2011 - I have just returned from Spain, where I saw my son ordained as an Episcopal Priest in Madrid and where I met with Luis G. Pareras, MD, PhD, MBA in Barcelona.

Peraras The Man

Peraras is Director of Innovation and Entrepreneurship at the Barcelona Medical Association. He is a neurosurgeon and a venture capitalist, did his residency in the U.S., holds a Global Executive MBA degree, frequently visits our country, and has dedicated his life to helping physicians analyze and launch new health care start-ups.

The Steve Jobs Connection

Two days after our meeting on October 3 , Steve Jobs , founder of Apple Computer, died in California . He was 56 years old. I mention this because Jobs was a wild and crazy guy. Peraras leads off his book Innovation and Entrepreneurship in the Healthcare Sector with this quote from Think Different, Apple, 1998.

“Here’s to the crazy ones, the misfits.
The rebels. The trouble makers.
The round pegs in the square holes.
The ones who see things differently.
They’re not fond of rules and
They have no respect for the status quo.
You can quote them, disagree with them, glorify, or vilify them.
But the only thing you can’t do
Is ignore them.
Because they change things.
They push the human race forward.
And while some may see them as
The crazy ones, we see genius
Because the people who are
Crazy enough to think
They can change the world.
Are the ones who do.”

Inscription in Book

After our two hour meeting, Peraras honored me by inscribing this note in my copy of his book,

“To Dick,
Because from the very first minute of our meeting I knew you were one of these… the crazy ones, the rebels.”

Takes One to Know One

It takes one to know one. In some ways, we were an odd couple – a 6’2” 230 pound bald white haired American and a 5’7” black –haired 150 pound Spaniard. But we shared certain things in common. I was the author of 10 books, he of 20. We had a common publisher – Nancy Collins of Greenbranch Publishing in Phoenix, Maryland. My last book The Health Reform Maze spoke of the American health reform law, PPACA, and its obstacles to innovation. His book told of how to overcome innovation obstacles. We were both pragmatists promoting wild ideas rather than ideologues conforming to any social system.

I suspect both of us would agree with Margaret Thatcher, The British Prime Minister, who said, “I have a deep skepticism about the ability of politicians to change the fundamentals of the economy or society; the best thing they can do is to create a framework in which people’s talents and virtues are mobilized not crushed.”

I thought of Ronald Reagan’s famous statement, “Government is not the solution, it is the problem.” True, government can set the tone for social consciousness. True, It can serve as a catalyst for innovation, but it is too inefficient and clumsy to innovate. The American and the Spaniard believed in “bottom-up” solutions rather than “top-down” solutions. The latter stifle innovation, rather than promoting it.

Meaningless of Term “Innovation”

The American and the Spaniard agreed the term “innovation” had become meaningless through overuse. It was a catch phrase lacking specificity. They preferred the word “entrepreneurship,” for it implied human ingenuity at its best. The Spaniard defined innovation, and its stepchild entrepreneurship, as “knowledge turned into money,” requiring specific ideas, business plans, teams of like-minded partners, marketing analyses, and venture capitalists. Entrepreneurs require more than ideas. They need money. Money may be a dirty word in socialist circles, but it is an essential incentive for social and health care success.

The American and the Spaniard were keenly aware of the profound differences between the U.S. and Spain. The Spanish health system was 80% socialist, the Americans 50% capitalist. Yet America was becoming more socialistic, and Spain more capitalistic. The Spaniard deeply understood these differences, having received much of his medical and business training in America. Perhaps that is why his book reads as if written by an American, and why most of his book’s references are to papers written by American MBAs.

The Spaniard has worked for years in the venture capital trenches and sat on the board of venture capital companies. The American was merely an observer of what start-up companies could do The Spaniard said he could listen for 5 minutes to a presentation of new idea, and he knew immediately if the idea had legs. As he put it, workable ideas spread from specific problems in search of a solution; unworkable ideas tended to be solutions in search of a problem.

Courage Rather than Analysis

The Spaniard’s remark brought to mind this quote from Peter Drucker’s 1966 book The Effective Executive,

“Courage rather than analysis dictates the truly important rules for identifying priorities:

• Pick the future as against the past;

• Focus on opportunity rather than problem;

• Choose your own direction – rather than climb on the bandwagon; and

• Aim high, aim for something that will make a difference, rather than for something that is ‘safe’ and easy to do.”

America The Innovative

The Spaniard liked Drucker’s rules so much he wrote them down. Our conversation turned towards what he thought of America. He said repeatedly “America is a great country.” He admired our freedom to choose between modes of health delivery. He thought government should encourage private venture capital and discourage innovation-killing regulations. He admired the Silicon Valley ethos and America’s great universities and health centers. He said he would perhaps like to live in America some day to help bring the fruits of our innovation to the rest of the world, including his beloved Spain.