For Healthcare Leaders, The Pros and Cons of Working for a Startup Company


Many healthcare workers who have spent the past two years in challenging situations throughout the Covid-19 pandemic are suddenly finding themselves without a job as hospitals and health systems are eliminating roles amidst cashflow challenges. Those who have been lucky enough to retain their roles are finding themselves saddled with additional work and struggling with severe burnout.

All in all, a lot of healthcare workers are exploring alternative career pathways and considering making a pivot from their initial career trajectory.

Startup companies in healthcare are thriving, even while the systemic failures of the historical healthcare sector were laid bare—and many healthcare workers are finding themselves wondering about the possibility of going to go work for one.

Indeed, working for a startup company can be a fascinating and valuable experience. There can be some downsides to it as well. There are some important areas to consider before making the leap to working for a startup company. We will review some of the most important ones for anyone considering making this switch.

Greater Flexibility and Longer Hours

Most employees coming from the healthcare sector are used to having to work around clinical coverage needs to ensure compliance with regulations for patient safety. It’s quite challenging, in fact, to find a healthcare employee who hasn’t worked through at least several holidays or had to work less-than-ideal shifts for long periods of time.

To be fair, flexibility in schedule can be very role-specific, so while it is tough to generalize across all types of healthcare workers, it is fairly consistent to have to work around the operating hours of the clinic or the hospital, regardless of the specific role.

The scheduling flexibility that is commonly found in working for a startup company may be a very refreshing change of pace because this type of schedule tends to be much more work product-oriented as opposed to gapless coverage being the primary driver.

That said, the hours are likely to be longer overall, and they generally don’t include overtime pay for that time. Similarly, deadlines and due dates associated with work product deliverables can still fall on dates that are inconvenient for you, and if you struggle with personal time management, you are also likely to struggle in an unavoidably nebulous role with a startup company.

However, if you can manage your time well, and you can plan ahead with effective strategies for navigating how to tackle new projects, you may thrive in this type of company.

Potential for Rapid Growth?

If you look at the data, most startup companies will go belly-up within the first few years. The exact numbers will vary from one industry to the next, but there is no single sector within the economy where successes will outnumber the failures of new companies.

If you do choose to work for a startup company, it is critical to ensure you have saved a cushion for yourself to prepare for this high possibility of suddenly losing work, and often you may not receive the last paycheck or two if the company has filed for bankruptcy because creditors will be paid before you are.

On the other hand, to be part of a successful startup company that ends up making it big can be a once-in-a-lifetime opportunity to reach unexpected levels of financial and personal career success. That is, to many, the greatest potential upside of working for a startup company and what drives many to pursue opportunities with startup companies quite aggressively.

If you have the resources saved and the time flexibility to be able to take risks of that nature, it is hard to argue against it, given the massive potential upside.

Also, consider that there is a range of risks, depending on where the startup is at that moment. A startup several years down the road that’s approaching scaling time will be more stable than one started within the past year, though there are always exceptions. These questions will often be brought up at the final stages of an interview with one of these companies. You should not accept an offer before having a reasonable understanding of the financial health of the company unless you have substantial savings set aside. This is generally not something discussed in traditional interviews with established companies but very frequently for a startup.

Lower Pay, But a More Passionate Work Environment

On average, the people who choose to work at a startup company will feel much greater and genuine passion for their work: what they want to achieve as part of the organization and its mission to change something about the world.

Within the environment of a startup, you will unfailingly find yourself surrounded by people who are passionate, which can be deeply fulfilling if your enthusiasm is just as genuine as theirs and if you truly align with the cause that is associated with the vision of the organization.

Remember that a startup company exists because a person (or a team) has identified a problem, developed a potentially unique solution, and wanted to push this into the market and change things. It can feel very powerful to be a part of something larger than yourself in this way.

It’s important to remember that a startup company has a chance of being a lucrative decision, but is not guaranteed. One study found that, on average, employees who choose to work for a startup will earn 17 percent less over the following decade than those who work for established firms.

The reason this number seems so large is that it is also calculating the impact of the high number of startup companies that fold within their first several years, which is a reality that cannot be ignored. But what was so interesting about that study, in particular, is that it found employees who chose to work for a startup, even after it failed, tended not to return to established workplaces, but rather continued working for startups!

Indeed, the passionate work environment seems to be very alluring for some individuals, and you may be one of them.

Opportunity to Own Equity

Because of the often lower-than-average pay and generally higher workload, a startup company will frequently provide employees who are there at the earliest stages with an opportunity to own equity in the company. While this won’t be true across the board, it is common enough to mention here.

It is important to be wary of what you are giving to the company in exchange for the equity, as much as it is important to critically assess if the equity will realize value in the future. If the company fails, owning part of it will bring you no benefit.

Do not bank on the equity for part of your financial strategy too early; assume it will not have worth, and you can be pleasantly surprised if the company is successful. Perhaps you may even play a role in the company achieving that success.

A Valuable Experience

Whether the company is successful or not, few would argue against the value of the hard and soft skills that can be learned by taking on a role in a startup company. With limited cash, most people in a startup will be working the equivalent of several partial roles bundled into their jobs, and contributing a fair amount of sweat equity, so to speak.

The fast-paced environment—with the need to constantly be identifying and filling various gaps as the company—offer a host of learning opportunities and unique experiences that bring tremendous benefit to almost everyone who takes on a role.

In general, the benefit of the experience and the skills that can be taken from working at a startup are of great value both to the individual and to the resume for future applications.

Elizabeth Bradford Kneeland, MBA
Elizabeth Bradford Kneeland, MBA

Elizabeth Kneeland is a telemedicine and sleep medicine innovator living in Philadelphia. As the director for Crozer Health System sleep labs, she oversaw the process, staff, and technology required to diagnosis a wide range of sleep disorders. Her career focus has straddled novel operational and financial modeling, as well as traditional academic research, providing her with a unique perspective in programmatic development and care optimization strategy.

Kneeland built the first for-profit telemedicine program for the University of Pennsylvania Health System in 2015. She also has helped build and scale sleep medicine startups in the U.S., as well as in China and Taiwan. She has co-authored publications in peer-reviewed journals on topics ranging from device validation to clinician-level educational interventions and has been an invited speaker at medical conferences throughout the U.S., China, and Taiwan.

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