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Dr.Erika Hamden is a TED fellow, Ph.D. Astrophysicist, and Assistant Professor at the University of Arizona who has been nominated by NASA for the Presidential Early Career Award for Scientists and Engineers in 2019. Erika leads the team building FIREBALL, a project funded by NASA which is a large telescope that hangs from a giant balloon at the very edge of space and looks for clues on how our stars are created. Erika’s scientific endeavors have received close to $4 million in grant funding from partners like NASA and MSF.

She got her A.B., in Astronomy & Astrophysics from Harvard, a Ph.D., in Astronomy from Colombia and did her Postdoctoral Fellow at California Institute of Technology. 

Despite these achievements, Erika struggled early-on when she first attended college. She felt anxious and didn’t quite fit into student life. She dropped out of MIT after a short attendance period and worked at a local bookstore for 1 year. Oddly enough, she thought that maybe she was one of those smart people that couldn’t thrive in high-pressure situations.

She finally gathered her courage to try her luck at college again and got into Harvard. She gave herself permission to not ace everything, but rather ease into it. Her willingness to try again led to a career as an astrophysicist and innovator. She shares that being at the edge of what’s known, meaning, work to discover the unknown through cutting edge initiatives, has proved to teach her some of her most important lessons on failure and resilience.

Scientists fail 90% of the time as they navigate uncharted paths and Erika’s relationship to failure and resilience is fundamental in her success. In a candid discussion, she shares the ups and downs in her riveting journey to discover the universe.

Tune in to get the full conversation and learn about:

• • • Launching telescopes into space
    • FIREBALL project
    • What it takes to stand at the edge of what’s known
    • How to deal with failure
    • What role resilience plays in success
    • Science at it’s finest
    • Leadership lessons
    • How to manage a team
    • Dealing with uncertainty

Dr.Erika Hamden’s biography:

Dr.Erika Hamden is an astrophysicist.

She studies the universe. She builds telescopes and spectrographs to observe (mostly) hydrogen in its faintest and most diffuse forms throughout our galaxy and the universe. Primarily in the ultraviolet, but sometimes the visible.

She’s leading a proposal for a Small Explorer class UV telescope called Hyperion.

She’s a professor at the University of Arizona.

Dr. Erika Hamden used to be a chef.

Her instagram is excellent but her CV is something else.

Dr.Erika Hamden’s e-mail address is: hamden at email dot arizona dot edu

Connect with Dr.Erika Hamden:

• Website
• Twitter
• Linkedin
• Instagram

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This is a picture of FIREBALL (the telescope that is supported by an air balloon) next to the moon, sent by your very own Dr.Erika Hamden and co.

Full Transcription:

Erika Hamden:  I was a pretty nerdy kid, oblivious about a lot of things actually.

Tanya:  That’s Professor Erika Hamden, TED fellow, Ph.D. Astrophysicist, and Assistant Professor at the University of Arizona who was nominated by NASA for the Presidential Early Career Award for Scientists and Engineers in 2019. Erika leads the team building FIREBALL, a project funded by NASA which is a large telescope that hangs from a giant balloon at the very edge of space and looks for clues on how our stars are created. Erika’s scientific endeavors have received close to four million in grant funding from partners like NASA and MSF.

Erika Hamden:  My family, I have four sisters. I am the second to last one, so there was a lot of us around. In some ways, that was nice because no one gets too much focused attention. I spent a lot of time reading. I was always trying to talk somebody into driving me to the bookstore or the library so I could get more books. 

Tanya:  What were you reading?

Erika Hamden:  All sorts of things. I would read fiction and non-fiction. Partly, I wanted to always go to the bookstore because I just liked to look at all the new books that were out and peruse things. I developed this method of trying to figure out whether a book would – whether I would like it or not based on the cover, and the back page, the back description, and then the first couple pages. I just read almost anything if it caught my attention.

For a while, I had a phase where I was super into Star Wars novelization stuff. There’s a whole bunch of Star Wars books. I read a ton of them from the mid-’90s. I would get into things and just read a lot about it. Then I would go to a different subject. I varied all over.

Yeah, I read a lot. I was always really good in school. My family was super into academics, so we all had to get good grades. I always did my homework.

Tanya:  Where did you grow up?

Erika Hamden:  I grew up in New Jersey in a suburb of New York City called Montclair that actually Buzz Aldrin is from.   

Tanya: Oh my God, yeah. That’s amazing. First of all, I was just in Montclair Sunday.

Erika Hamden:  Oh, awesome.

Tanya:  Yeah, my uncle lives there. Yeah, no, beautiful suburb. 

Erika Hamden:  Yeah, it’s a really nice town. The schools were great.

Tanya:  Is that where Buzz is from?

Erika Hamden:  Yeah, he was born in the hospital in the next town over, but he grew up in Montclair. He went to my middle school, which at the time when I attended was called Mount Hebron and then they renamed it a couple of years ago to Buzz Aldrin Middle School. Then he went to the same high school. I met him one time actually when I was a senior in high school. He asked whether we still played football on the same field and stuff.

Tanya: Oh, wow, that must have been such an honor for you.

Erika Hamden:  Yeah, I used to joke in middle school. There’s a bust of him in the entrance lobby. I would say one day there was going to be a bust of me there, too.

Tanya:  It very well might be. You’re getting there. You really are on a path to potentially uncover some incredible spatial stuff that we don’t know. What initially sparked your interest in space and specifically stars?

Erika Hamden:  I actually have a very particular incident that I feel started it. I was in second grade. I remember I was sitting reading on the couch, I think. My mom came over and she was making dinner. She had the news on. She said, “Oh, there was just a story about how scientists want to come up with a new name for the Big Bang. There’s a contest that people can enter so I think you should enter the contest.”

I looked at her and I was like, “Oh, what’s the Big Bang?” Since she was making dinner, she was too busy to explain the mysteries of the universe to me. She said, “Oh, go look it up.” I went upstairs. We had an encyclopedia, so I looked it up in the encyclopedia. I remember reading the entry. That was the first time that I realized that space was a thing.

It talked about the beginning of the universe. Then in the back of the encyclopedia, the last volume was an atlas. I remember going to the atlas, and in the end, it had a map of the solar system, and then it had a map of the galaxy, and then it had a map of the known universe. I read all of that. I just was like, oh my God, this is the greatest thing I have ever heard of. That was basically it.

Tanya:  How old were you?

Erika Hamden:  I think I was seven or eight. I knew how to read and I learned how to read in first grade. Yeah, I think I was seven.

Tanya:  Wow, so your love for space really started at a young age?

Erika Hamden:  Yeah, as soon as I learned that space was a thing, I was into it. Then I immediately wanted to be an astronaut because I was like, well if space is so awesome, I want to go there.

Tanya:  Wow, and is that still one of – a goal of yours to go there to [05:24]?

Erika Hamden:  It is, yeah. It’s a goal of mine. I’ve talked to a few astronauts and they always say that you should do the things that you love. If along the way, you can qualify for being an astronaut, then that’s great, but the odds of it are so low that you can’t design your whole life around something that is very unlikely to happen. I’ve tried to take that advice and do the stuff that I love. I still am qualified, so I’m going to try the next time around. I also know, well, the odds are small, but I’m going to give it a shot.

Tanya:  What do you need to qualify?

Erika Hamden: The very base qualifications are very basic. You need a bachelor’s degree in a hard science and then some years of experience in your fields. It could be engineering, or math, or if you have a Ph.D., then that meets the years of experience qualification. You have to be in good health and have good vision. That might be it. There’s very few actual requirements.

Then they will take the applicants and they split them into qualified versus highly qualified. Then they really only consider the highly qualified people. For that, they consider things like do you know how to scuba dive? Do you speak another language? What kind of experience do you have in a difficult environment or isolated conditions?

Do you know how to fly a plane? Are you the type of person that someone would want to be stuck in a tiny spaceship with for six months? They say things like, would someone want to go on a camping trip with you where you have to rely on the other person, but also you have a good attitude?

Tanya:  Wow, yeah, those are a little bit more ambiguous for sure. Okay, well, hopefully, you’ll get there. You’ve done work at the Jet Propulsion Labs which is connected with NASA just to switch gears a little bit. What was that experience like? What were you working on?

Erika Hamden:  The experience was awesome. I started in 2008 as a grad student. I was a grad student at Columbia. I worked on this project that was at JPL. I remember the first time that I went there to start working on a project. You’re driving on the highway and then the exit it says NASA JPL next exit.

I was so thrilled because JPL builds Mars Rovers. They build all these satellites that have gone to the outer planets. They built Voyager. I just have admired the work that they do for a really long time, so it was very thrilling to go there.

The project I was working on was this new type of detector technology that we were trying to develop to be very efficient in the ultraviolet. At the time, I didn’t know very much. It was my second year of grad school. I was drawn in this team of people who had been developing these detectors. I was going to work on one aspect of making them work better.

Tanya:  Just for people that don’t know, what is the purpose of working on these detectors? What do they do?

Erika Hamden:  In general, for building telescopes of any kind, the detector is really the heart of the telescope. It’s the most important component. It really sets a lot of the telescope capabilities. Most people associate telescopes with the big mirror; that is important, too, but the detector is really a key component.

What we were trying to do is develop this different type of detector technology. In the ultraviolet, the technology has lagged a lot compared to other wavelength ranges in astronomy. We were trying to develop this new sensor that was easier to operate; it’s easier to fabricate; it’s cheaper to make. Historically, this type of sensor didn’t work in the UV, and so we were – because the previous technology that had been used on a bunch of space missions was really not very efficient. For every 100 photons that hit the detector, it would actually record maybe 10 of them. That’s not a lot. We were working on this new technology that would be able to detect between 60 and 90% of the photons. 

Tanya:  Just so that I understand what you’re saying, basically the telescope would only record about 10% of what it was seeing?

Erika Hamden:  That’s just for the light sensor. The rest of the telescope also has different losses like every photon that hits a mirror, some of them get absorbed and they don’t necessarily reflect. The overall throughput of these telescopes is really low, but the detector is a huge part of that. If your detector only is 10% efficient versus 60 or 80% efficient, it makes a big difference.

Tanya:  Wow, no kidding; okay. 

Erika Hamden:  Yeah, the detectors at the time, we didn’t know if they were going to work or not. That’s the whole point of discovery, but they had a lot of potential. We thought it was worth putting basically years of work into it.

Tanya:  What did you actually accomplish in your time there?

Erika Hamden:  In addition to having a great time in all of my trips to JPL because it’s just a super cool place, you can go visit the Mars Rovers. They have these clean rooms. There’s viewing galleries where you can go and see the progress. They just build the most incredible stuff there.

We were successful in developing this detector. When we started, we had a couple of different technologies that we needed to try out individually, and then try them out altogether, and then show that they were robust and that they would work under a variety of conditions. Then the final step of that was actually putting the detector in a telescope and flying it to say, look, this even works in a telescope in the exact environment that we anticipate. FIREBALL was actually in addition to doing interesting science. The idea of it was to prove that this detector technology that we’ve been working on for a really long time would actually work.

Tanya:  Amazing; okay, before we get into FIREBALL because that’s a super interesting topic, how many people were on your team at JPL?

Erika Hamden:  At the time that started, it was a pretty small group. The woman that led the team, she’s still at JPL. Her name is [11:38 Sholay Nexodd]. She originated really the foundational technology that made this type of detector work in the UV. She was our group leader. Then there was me and maybe just a handful of other people, I want to say like three or four who were doing some of that initial basic work and testing.

Then as we progressed and as it seemed like the sensors were working, that group started hiring more people. I joke with them that I started as a grad student and then they’ve since hired three or four people that do the job that I was doing. They definitely expanded. They do a lot more detectors now since it’s much less experimental. They just have a much bigger – which I’m still a part of. I’m still working with them. This proposal that I’m writing right now uses the detectors. I was just on a telecom with the whole team [12:34] all about what we were going to do. 

Tanya:  Yeah, I’m assuming it’s just this beginning?

Erika Hamden:  Yes.

Tanya:  You guys have lots and lots of work to do. How long did it take you to develop this sensor where before it was capturing about 10 photons or about 10% of all the stuff and you got it to 60 or 70? What was the period? 

Erika Hamden:  That took about three years from the beginning to our very first sign that it worked. Then it took another – yeah, so those three years just we had proof from other things like we tested it out on just bare silicon wafers, not on actual detectors, but just test wafers. I could say, oh, it works in that environment, but that’s really different from saying it works in a real detector. Yeah, it took three years of mostly messing things up before we finally got it right. Then after that, it took another two years before I would say that we felt really good about the process and that we could make it work for anything. Then until the final flight, like the actual flight when we put it on FIREBALL, that was ten years.

Tanya:  Wow; okay, let’s talk about FIREBALL. What is FIREBALL?

Erika Hamden:  FIREBALL is a telescope; it’s an ultraviolet telescope. The name stands for the Faint Intergalactic-medium Redshifted Emission Balloon which is a very long acronym, so we now call it that.

Tanya:  Thank you for that.

Erika Hamden:  Sometimes, even I forget one of the words in that.

Tanya:  Yeah, that’s a long one; okay.

Erika Hamden:  Yeah, we call it FIREBALL. The version of the telescope that we flew in September was actually a second iteration, so we call it FIREBALL 2 because there was a FIREBALL 1. It’s an ultraviolet telescope which means that it has to be – in order to do its observations, we have to be above most of the atmosphere. If you have a UV telescope, you either have to do it from space or the stratosphere. Those are your options because ultraviolet light is the kind of light that gives us a sunburn but the atmosphere luckily for us, it blocks most of the UV light that is coming off of the sun or just from space. UV light is really damaging to DNA, to people’s skin. That’s one of the causes of skin cancer. It’s also damaging to all of your space hardware.

FIREBALL is weird for a telescope because it’s not actually a space telescope, but it’s not ground-based telescope; instead, it’s a balloon telescope. It goes up on these giant weather balloons. In our case, it observes for one night. It’s this strange hybrid of an atmospheric experiment, but we’re looking at space.

Tanya: Why just one night, like a 24-hour period?

Erika Hamden:  Mostly due to the FAA requirements and the fact that we want to get it back. You send it up, and the balloon – there’ s a branch of NASA that’s called the Columbia Scientific Balloon Facilities, CSBF. They do the balloon launches. They have a whole team of weather people.

The weather people determine once the balloon goes all the way up to the stratosphere, goes to 130,000 feet, they determine its potential trajectory across the United States. We do these launches from New Mexico. They’ll calculate, okay, if we launch today, then the balloon will ascend to 130,000 feet. Then the wind at that altitude is heading west at 20 knots. That means that we’re going to be above California in 15 hours.

The problem with being above California is that in order to come – to bring the telescope down, we have to pass through LAX airspace. The balloon people are friends with the FAA and they can make some accommodations. If we pass through other airspace like if you’re coming down in the middle of Arizona, there’s probably no major airport there, so that’s fine. If you’re coming down in the Texas panhandle, that’s probably fine, too, but if you’re coming down through LAX airspace, there’s no way that they will let you do that.

Once you hit California, you either have to cut down immediately or you have to fly all the way above California, across it, and then ditch in the Pacific Ocean. California is a very hard stop on where you can allow the balloon to go, so partly that sets the limit. Then in the other direction, if the wind is heading east, you can’t fly over Dallas. It just starts to get – the airspace becomes a lot busier. Even though we’re floating above it all, we still have to come down at some point. That sets the east-west limit. The wind tends not to go too far north or south although there are restrictions like we can’t fly into Mexico I think for obvious reasons.

Tanya:  FIREBALL is an incredible project which has involved a lot of different people, and entities, and players. How was it conceived? How do you get something like that green light?

Erika Hamden:  It was conceived in the early to mid-2000s by Chris Martin, the PI who was a professor at Caltech. Basically, the first thing that you do is you come up with a science question like what do you want to know about the universe that you don’t know and you also can’t find out using the telescopes that exist already? You have to motivate it and say, we want to do this really interesting thing, but we can’t do it any other way, so we need to build a telescope. Once you have that question, that actually – the question sets almost everything about the rest of the mission. It will set what type of telescope do you need. For our science question about trying to observe hydrogen around these distant galaxies, we need a UV telescope.

Tanya:  What’s the interest in observing hydrogen around the galaxies?

Erika Hamden:  It’s basically to understand how galaxies evolve through time. We look out into the universe and you can see galaxies. They have this wide, wonderful variety of shapes, and colors, and sizes. We can explain like, okay, well we see this is a newly formed galaxy. It’s making lots of new stars. It’s blue-colored because new stars are blue. It’s like a spiral versus this other galaxy that has no new stars in it. 

We can talk about their present state, but we can’t necessarily explain why they have these two different patents. What’s different from a galaxy that has lots of new stars versus a galaxy that has no new stars? We think that the reason is the environment that they’re in. A galaxy with lots of new stars has a connection to the larger – these large clouds of hydrogen that we think are in the what we call the intergalactic-medium, the space between galaxies. A galaxy that has big reservoirs of hydrogen flowing into it, those reservoirs will sustain star formation in the galaxy. A galaxy that doesn’t have those reservoirs, it’s not going to be able to keep making stars. It’s going to run out of hydrogen.

We think that the nature and the size of those reservoirs’ changes throughout the history of the universe. If you look at really distant old galaxies, they’re going to have a different hydrogen reservoir than ones that are right nearby to us. FIREBALL is trying to look at a very particular age of galaxy to understand the hydrogen reservoirs that are around galaxies of that age. It’s one step in a bigger question which is, what’s happening throughout the history of the universe; not just at the one stage that FIREBALL’s looking at, but earlier and later? It’s a really fundamental question.

Tanya: Yes, it is.

Erika Hamden:  Why do galaxies look the way that they do?

Tanya:  Awesome; and then in terms of green light, you were green-lighting the FIREBALL. You mentioned that it was originally created and then you had to come up with the big question and inquiry which sets the path forward for it. Then what needs to happen?

Erika Hamden:  At that point, you build a science team and you figure out, okay, how are we going to actually construct this? Chris, the PI, he had a long-standing collaboration with a number of scientists in France. The French have a very long history of ballooning and ultraviolet science, so that was a natural connection.

Basically, the process is like, Chris wrote a proposal to NASA and describes the mission. Then the French team also writes a proposal to the French space agency to describe the mission. Then both of those have to get funded. Then you can build, start building the telescope.

That proposal process is open. NASA has a website where they publish what they call Announcements of Opportunity, OAs, where you can propose to different calls. In principle, it’s straightforward, but in practice, it’s complicated because you have to do an initial design of your mission before you can actually propose it. You have to do a little work ahead of time. Then once you get the funding to build it, then you can start doing detailed designs and refining things. 

Tanya:  How much money did you estimated that you needed for FIREBALL to get it launched? 

Erika Hamden:  FIREBALL 1 had flown in 2006 and 2009. That was before I really worked on it. The team realized that they needed to improve the telescope and make the detector better in order to actually do the science we wanted to do. That’s partly what motivated my detector work.

Then we re-proposed in I want to say 2012 to reformulate the spectrograph to make it more efficient. That’s when changed from just FIREBALL to being FIREBALL 2. The total mission has been going on for I’d say for 15 years. Probably between the French and the US, the contribution is about $20 million.

Tanya:  Wow; and has the mission ever succeeded in actually addressing the initial inquiry to date?

Erika Hamden:  I hesitate to say no. We’re still working on the data from the most recent flight. I think we will have – we’ll be able to extract something, but it won’t be a complete success. The flight in 2018 for FIREBALL 2, we have – we did prove a lot of things. The technology development we have been able to prove that it worked in a space-like environment.

That’s part of the function of these missions. It’s not just to do the science, but it’s also to do technology development because NASA is very conservative about what it puts into space. If you want to purpose a detector for a space telescope, you have to show that it’s going to work in space which is a little bit of a catch 22 because you can’t send it to space until you’ve proved that it would work in space. Doing these balloon flights is an acceptable alternative.

In that sense, it was a success that we tested the detectors. We tested a bunch of other new technology that the French have contributed and that we had added. From a technology standpoint, it’s been great. From an observing hydrogen standpoint, it has been frustrating.

Tanya:  You talked about the flight in 2018. You gave a brilliant TED talk about that, which by the way, I highly recommend anybody listening to go check out the TED talk. Erika was just really incredible on failure actually. Can you talk about the flight and some of the most challenging parts as well as the thing that you’re most proud of?

Erika Hamden:  Yeah, the flight was in September of 2018. We had actually been in – we do the flights from Fort Sumner, New Mexico, this little town. We had been there for about eight weeks, six weeks by the time we actually had the flight. We’re testing things out. We’ve put everything together. We checked that it works. Then we wait for the weather to be good.

Finally, after a long time, on the morning of September 22, we – the weather was good. Everything looked great and so we had our launch. The telescope ascended up to the stratosphere. That was really a thrilling experience for me because I almost never thought it was really going to happen. I had been working on it for so long that it just seemed like this endless thing. Then we finally got it off the ground.

It took off at 10:30. It takes about three hours to reach the float altitude. Then we wait for the sun to set because it’s a UV telescope; we needed the sun to be down to do the observations of space. Throughout the day, we were just checking that we could still communicate with it. We all took a nap. 

Then that evening, we got back to the base where we work. We were starting our operations. I was running the mission control. I remember telling the person who was taking the log, I would read out the altitude every so often. I remember I’m reading the altitude out and I’m like why is this number still going down? Because it drops a little bit and then it’s supposed to stabilize. It did not stabilize; it kept falling.

Eventually, about an hour after sunset, the balloon people came downstairs, and they told us that there was a hole in the balloon. That’s why we kept losing altitude. The altitude is really important for us because the lower you are in the atmosphere, the more the UV light gets blocked. The altitude was such a crucial thing.

All of our equipment actually worked beautifully which was a nice. Maybe that’s my favorite thing about the day that we worked so hard on all of these different complicated components and they all worked really well. Then the altitude was so low by the time the sun set that we really didn’t get a lot of good data. The more time went on, the farther we dropped. We were scrambling to change from our planned targets to something brighter that at least we could just get some data, a brighter object. We ended up pointing at Andromeda because Andromeda is a super bright UV source even though that was not at all in our science plan, but by the end of the night – or not even by the end of the night; it was a few hours in. We just were like, well, we need to look at the brightest thing around.

That was really a huge disappointment. It was the kind of thing that we can’t plan for because we don’t do the balloon launches and we can’t control it. That’s a thing that happens sometimes with them. Personally, when they told us, I was – we were so in it and I was like I do not have time to have an emotional response to this new development.

The next day, I cried. It was a huge accomplishment that we got the telescope off the ground, and we had built it, and it worked, but still, that one tiny piece that would have told us that the mission was a total success, that we – we didn’t have that. It was really hard because I – and I talk about this in the TED talk. It made me think a lot about why I do the things that I do and what keeps me going in times when, inevitably, things go wrong. In some senses, it’s been a point of reflection. If everything had worked, I wouldn’t have stopped to really think about why I do the work I do. I’ve tried to at least take the positive things out of that experience.

Tanya:  Actually, the people that are listening, on your website, you have this incredible, and you also show it on your TED talk, this incredible picture of FIREBALL 2 that is out there in space right next to the moon. It’s pretty amazing. When you see that, obviously, it’s a huge bittersweet moment like you just shared.

What was the conversations like the next day within the team? How do you pick yourself up and keep going? What do you say to the team? What were the internal discussions like if I was a fly on the wall?

Erika Hamden:  One of the great things about the team – well, all the people on the team I’m really grateful to work with. A number of them, they have a lot of experience in balloon flights in general for FIREBALL. There are people who have been on it since the very beginning. They all have had experiences where you do the flight and then something goes wrong. For them, there was no question. One of the French guys came up to me the next day and he was like, alright, so when are we going again? He was 100% ready for trying the next time. 

For the newer people, I think – this was my first balloon flight, and so for me, I would put myself into that category of, I had to really work through the feelings of let’s say we do this again and the same thing happens, will it be worth it to me. I think from my position now, I would say, yes, absolutely. You get way more out of it than just the data at the very end and so that process is worthwhile. I think the other members, who are new, they’ve all had to make that assessment for themselves.

The internal discussions, we had a meeting of everybody – actually, we had a party. It was that we rent houses in this town and so I had them run over to the house I had rented, I made a bunch of food, we all brought a ton of drinks and we tried to just be positive about having made it through a flight because that was a huge accomplishment. Not let what happened take away from the fact that we had done it. I would say we were mostly positive.

Since then, we’ve had a lot of discussions about, okay, what do we do need to do – what can we improve for next time, what do we keep the same, more logistics of getting it put back together for the next time around.

Tanya:  It sounds like you were pointing to this, the more senior people, the time in which they were ready to go again and jump back on it, was very, very small. It happened, things didn’t go well, when are we doing it again versus this was your first flight and you really had to work through that emotion. That’s actually a really great way to experience failure and process it. First of all, what did you learn about that on failure, and what do you think, perhaps, allowed the more senior people to reduce the time they maybe felt bad and to get back on it?

Erika:  For me, I feel like personally I learned that I can get through anything. That experience, from the launch to when it crashed and we had to go get it, I would say that was one of the best and also one of the worst days of my life. Having been able to get through it and do all the stuff that I needed to do in the moment, I felt very proud of myself. Then being able to think back on it and try to understand how can I go into the same situation again? That’s been something I’ve had to figure out. Am I prepared to rebuild this telescope, show up, again, in this tiny town in New Mexico and do this all over again, knowing that the outcome could be the same? That I feel like I’ve thought about it and I think it’s worth it because I don’t know that the outcome will be the same, so I’m willing to take that risk, just because I think the payoff of understanding is worth it.

I think for the senior people on the team, they’ve just seen everything. They’ve been through a lot and so they know that this one failure is not a killer, but there’s no endpoint. We try again and then we get better results the next time. They can see that this process is iterative, that and the, I don’t know, wisdom that comes with age.

Tanya:  That’s also a muscle. That’s something I was wondering, resilience. You said FIREBall initially started in 2006. That was the first launch, right but when did it actually start?

Erika:  Yeah. It started in 2002 or 3.

Tanya:  Yeah, so from 2002 to today, 17 years, that takes commitment, and unquestionably you guys are going to get there, it’s just a matter of time. You’re going to work through whatever needs to get worked through. Resilience, what are your thoughts on that and what has it taken, from your standpoint, to keep going?

Erika:  Resilience is really – you can think of it is like a muscle that you can choose to exercise and the more you use it, the better you get at it. I sometimes think about it as self-knowledge or confidence. I know that I will be able to do something, or that I can handle whatever gets thrown at me. I guess those two are probably two sides of the same coin. I think for me, really the first serious experience that I had was going to college and dropping out of college and realizing after I dropped out of college that I was still a valuable person who mattered. I was able to rebuild my sense of self and go to college again and succeed and feel like I could take this devastating experience and move passed it and use it to inform my future choices.

Tanya:  What made you drop out of college because your academic accomplishments are outstanding, completely academic. What happened?

Erika:  I went to MIT and I was 18. Maybe all freshmen are very naïve but I was especially naïve. You asked me what I was like as a kid, and I don’t think I was that different. When I was a teenager, I liked to read. I was very straightforward. I thought that people were going to go to MIT because they really loved science and they wanted to discovery things. Then the reality of college was just not what I was anticipating, and I wasn’t really equipped to deal with that. I didn’t know how to do things for myself or, I don’t know, soothe myself. I felt a lot of anxiety and I had panic attacks, which I never used to have.

MIT, it may be better, I don’t know, but they, sort of, said, “Well, you can just leave, if you want.”  That’s what I did. I just dropped out and they took my name off of things. That was really hard because my whole identity was about academic achievements.

Tanya:  Yeah, I can imagine.

Erika:  Then I took the rest of that year, I worked at a Borders in the café and I read a lot of books. I worked –

Tanya:  [26:38] 

Erika:  Yeah, I took classes at the [Youth Montclair State], the university in our town. Yeah, I just tried to exist and figure out what actually drove me, and to make sure that my identity and my choices were around things that I wanted to do and not what I thought people wanted me to do.

Tanya:  That’s a big one. That’s a huge one, actually. I just want to highlight this because what you said is so important and it’s something that I hear over and over and I’ve also experienced. When you’re doing something that is not in alignment with your higher purposes, whatever that is, you get these signs: anxiety, depression, no energy. It’s just like, life feels clunky. It sounds like that’s – it’s amazing that you were astute enough to recognize that and put a pause because most people don’t. They go through it.

Erika:  Push through it, yeah.

Tanya:  Yeah.

Erika:  I struggled with that too because I don’t want to be a quitter, I didn’t want to be a quitter. There’s a lot of stigma about just saying, now I need to give up.

Tanya:  Even if that’s the right thing to do.

Erika:  Yeah, and for me it absolutely was. I would joke with my graduate school adviser about how I didn’t have a lot of grit because I have no tolerance for just being stuck in a bad situation. I don’t do all-nighters because I know I need to sleep. You could interpret that as I’m not committed or I’m not going to do whatever it takes. I guess, from my perspective, I feel like I know what I need to do the work that I love and so I have to do those things first.

Tanya:  There’s also not one way of doing it.

Erika:  Yeah. For me, I have to be happy every day in my work and in the place where I am, to keep going. I guess the lesson I really learned was I need to – at MIT, I wasn’t happy and I wasn’t taking the steps that I needed to make myself happy, and I didn’t even know what those steps were. Now, I know what I need and I know how to get it and I do not let anything keep me from that. 

Tanya:  You spent a year – you said a year, reading a lot of books, working at Borders, taking classes at the local university. At what point did something click for you and you’re like, okay, I’m ready to go back out?

Erika:  I would actually say that it didn’t really happen until I was back in college. I reapplied to college and I knew that I was ready to stop living at my parents’ house. When I got to Harvard, which is where I ended up going, that first day I was so scared. I was like, what if the same – what if I just can’t go to college. What if I’m one of those smart people who is unable to perform in a stressful environment. I had all these fears and I just was like; I’m going to take this one day at a time. I signed up for classes that I felt would make me happy and would keep me interested, and I gave myself permission to do okay and make it through the semester. It took a while to really feel like I could do it. I had to be kind with myself about being scared and give myself leeway to have all those feelings and not just assume that everything was going to be perfect.

I think that’s helped a lot to – even when we were doing the balloon flights and we’re in this tiny town in New Mexico and it’s really stressful and there’s nothing to do for fun, but I know from – now, from all these experiences, I know, okay, if I have the right food with me, if I make sure that we have a good schedule, that we take breaks, that we sleep, that we take the time to have fun, that we’ll be able to get through it and it will be enjoyable. At the time – I remember driving home from MIT in my parents’ car, they had come to pick me up, and feeling like I was so worthless and like my life was over. Now I look back on that and I feel like that was the bravest, most valuable thing that I could have ever done.

Tanya:  Absolutely, yeah.

Erika:  I’m really glad that 18-year old Erika did that.

Tanya:  That’s amazing!  First of all, thank you for sharing that because it takes balls. It’s a very vulnerable moment. Especially coming form somebody that has received so many unbelievable awards, and the Presidential Early Career Award for Scientists and Engineers, 2019, nominated by NASA, TED fellow –

Erika:  Yeah, I’m very thrilled at that.

Tanya:  Yeah, I’m even nervous about reading some of these awards because I probably will mispronounce them, it sounds so great. That’s incredible. It seems like the experience that happened to you in college, at least initially, allowed you to trust yourself and trust that you are going to make the right decisions for you. That’s your path and since then, you’ve accomplished some incredible things. That’s amazing. Actually, I’m going to quote you for a second, something that you said in your TED talk, which I thought was pretty amazing. You said, “Discovery is mostly about finding things that don’t work, and failure is inevitable when you’re pushing the boundaries of knowledge.”  As someone that primarily deals with the unknown – it’s an uncharted path. Nobody’s telling you, Erika, if you do this, this, this, you’ll get there. You’re completely unchartered.

What does it take from you to really hold that space and tackle some of these enormous inquiries and questions?

Erika:  I’ve had to get comfortable with being uncomfortable all the time. I’ve spent so many days – I’ve even told people working on the detector stuff, I’ve said, my God, I wish someone else had done this so I knew what to do. I tell myself, I’m like, Chris, the professor I worked with at CalTech, the PI of FIREBall, so many times he says, “If it was easy, someone else would have done it.”  I have to remind myself that what I’m doing is hard and no one has done it before and that’s why it’s hard so it’ okay. I can’t ever guarantee that I’ve going to discover something, I can’t know that it’s going to work, but I also know that if I don’t try, then I’m definitely never going to find out.

I think that’s actually part of what keeps me going is the fact that I insist on being happy in it every day. I have a good life. I work with people I like and admire. I still find the problems interesting. That helps keep me going because I can’t rely on a discovery as the thing that will make it worthwhile. I don’t know if that’s ever going to happen, so it has to be worthwhile today.

Tanya:  That’s very interesting. It’s a different context that you apply to your work and your life. Instead of being hungry for a major discovery and being miserable in the meantime, whether it happens or not you invented, or created, for yourself a context of, I’m going to enjoy the journey, working with people that I love, and be happy in my work and connect to the actual enquiry and the mission.

Erika:  Yeah. 

Tanya:  That’s very powerful. In other words, nothing changed except the context that you created for yourself.

Erika:  Yeah.

Tanya:  Amazing. That is brilliant, brilliant. Okay, so what are you working on now?

Erika:  Right now, I’m working on a proposal for a new space telescope. This is my own idea, which is pretty exciting because up until now, I’ve really been carrying out other people’s ideas. This is first mission that I’m PI of. It’s an ultraviolet space telescope called Hyperion. It’s designed to observe clouds of hydrogen in our own galaxy that are parts of star-forming regions. Right now, we don’t know what is required. We can’t look at a nebula in the galaxy and say, in 2 million years this will form this many stars. Even though the process is it should be something we can understand, right now we don’t have that level of knowledge yet. This telescope is focused on that, on trying to understand the origin of stars. The tag line is that it’s a Hyperion origin of the stars.

Tanya:  Very nice. Who are you going to submit the proposal to?

Erika:  This is also a submission to NASA. It’s due on August 1st, which as of this recording, is not that long from now. We’re going to submit it actually on Monday because we have to do it a couple of days ahead of time, for logistical purposes. I have six days until it’s done and we’re in the final stage of just polishing things. The cost of this telescope size for NASA is modest, it’s $145 million, which is a lot of money, but compared to a Hubble space telescope, it’s a small telescope. I’m working on it with people from Ball Aerospace and Ames Research Center and JPL. It’s been a really interesting process, to take something from just an idea, like my science question, all the way to a concept for a mission and it’s been a really great time.

Tanya:  When do you know if NASA is going to give you the grant?

Erika:  We’ll find out probably in December. It goes through a big review process.

Tanya:  I can imagine. You’re asking $145 million; did I get that right?

Erika:  Yes.

Tanya:  Wow!  Well, I’m sure that if this project gets approved, which I really hope it does, the learning when you’re really the architect of the idea, is brutal, but it’s unbelievable.

Erika:  Yeah, it’s already been brutal.

Tanya:  Yeah, I can imagine. What about FIREBall? Are you still planning to launch, I guess, FIREBall-3 in 2020?

Erika:  It’s going to be just like a second launch of FIREBall-2 because we’re not really going to change too many things about it. Our plan is, yes, for 2020. As soon as this is submitted, I’m going to France to work on it. Partly, the schedule depends on how things shake out with other balloon missions. The campaign for this year is starting and we have to see who flies, how the weather is and then that will determine where we are in the list of missions for next year, but we’re still going. There is another team member who’s taking over some of my responsibilities so that she can get experience running the team too, so I have a little bit less work to do on it. 

Tanya:  Okay that’s great. Given that this will not be your first rodeo, I’m sure the ups and downs will be a little bit smoother.

Do you have a funny or interesting story that sticks out in our mind about your time working at the labs or any other project?

Erika:  I have a lot of funny stories about being in New Mexico for the balloon launches. The town has very limited – there’s a very small grocery store and the food options are pretty slim. Half of the team is French and they really like their food. One night, we were doing this night-time test and one of the French guys didn’t have anything to do at that moment, so he came over and was chatting with me. He was like, “You know, Erika, I have to tell you that I am so tired of eating white bread and Cheddar cheese!”  I’m like, [Johan], you can buy Brie from the Wholefoods in Albuquerque. It’s two and a half hours away. They’re so funny. They’re so great at what they do and they’re such lovely people but he just like that day he had had it and I was like, you can eat other things. 

Tanya:  The French take their bread and their cheese very seriously, and rightfully so.

Erika:  Partly in my role as running the team, I want all of my team members to be happy and fulfilled and so I had French cheese Fed-Ex’d in from Murray’s Cheese shop in New York City. Two days later, I gave him a box and I was like, Johan, for you!

Tanya:  Oh my God!  What was his reaction?

Erika:  He was so excited and all of them were so excited and they like – I think they don’t really appreciate the power of Fed-Ex and [51:15]. They could not believe. They were like, how did you get this? How did this happen? I was like, we can get anything in America in two days.

Tanya:  That’s awesome. This is a really, really awesome example of a way to just connect with your team and really keep them motivated. Going through such a long process and such a challenging process, how do you get your team motivated and connected

Erika:  Well, I think the most important thing is that I make sure that they know that I really value their time. People do a job because they care about it and because they need the money, but I want them to know that it’s not – I think that their time is the most valuable thing that they have and so I’m not going to waste it. They know that if I ask them to do something it’s important, and I only ask them to do things that I think are important. That helps a lot that people really trust you with their time, if they know that you think that they’re valuable.

Then I pay close attention to what motivates people because different people are motivated by different things and so they need to be treated in a different way. The French are a good example because to manage them, they prefer to know all the bad things right away. They don’t want me to tell them everything that worked; they’re not concerned with that. They want to know what’s wrong and what needs to be fixed. Whereas some of the grad students who are still starting out, I can’t just leave with a giant list of everything that they did wrong, they will feel attacked, so I have to handle them in a different way.

I just pay really close attention to individual people and try and treat them in a way that is respectful but also – I change my style depending on what I think they need and then I adjust that. It’s like a continuous process, which requires a lot of attention. I have to really pay attention, but I feel like that’s the way I can get good work out of them and they can be happy and feel supported. I think that also contributes. The people that were in New Mexico with me, all of them have said that they’ll come back.

Tanya:  Wow that’s an incredible testament to your leadership. That’s actually one of the signals that we look for in a great leader. Do people follow you? In your case, the answer is yes. That’s great.

Erika:  We had been there in 2017 and we didn’t even get a flight and everyone came back. I think that’s also because they all know, on their own, why they’re doing it.

Tanya:  Erika, how do people get in touch with you, if they want to check in, keep up to date?

Erika:  You can follow me on Instagram. I’m tooting my own horn now, but I have an excellent Instagram account. I post one post a day but I try and find something that is beautiful in my life every day, so it changes. Sometimes it’s about my work and sometimes it’s my cactuses at my house. I have an active Instagram and the handle’s just my name, erika.hamden, so follow me on Instagram. I have a Twitter account, that’s also @erikahamden and that’s a lot more science and technically focused. Yeah, those are the best ways. I have a website, which does not have a ton of information. You can see my very technical CV and links to my papers, which are also very technical.

Tanya:  They can also see the picture of FIREBall-2 next to the moon, which is amazing.

Erika:  Yes, and I am working on a website that I will link to on my personal website. That’s about Hyperion, the mission that I’m proposing. 

Tanya:  That’s awesome. Well, Erika, thank you so much for taking the time amidst the final deadline to submit the upcoming project, I really appreciate it and I wish you all the best. I’m going to send a lot of positive energy for this project. Amazing, amazing story. Thank you so much.

Erika:  Thank you so much for having me, it’s been really great talking with you.

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First-time founder and Harvard grad Carlos Reines, who was nominated by the World Economic Forum as Young Global Leader opens up about his tragic childhood accident and how that shaped his life-work today through RubiconMD — an eConsult platform that connects clinicians to top specialists. Now serving over 5,000 primary care physicians in 37 States, RubiconMD has saved over 2.5 Million days of patients waiting for specialist consults, which is almost 7,000 years.

Carlos talks about his struggles early-on when he launched RubiconMD and how, after many iterations, he designed a dialed-in hiring process to assemble a top tier team that not only has individuals with world-caliber credentials but that act as a team and feel connected to the mission of the company– democratizing and improving access to quality healthcare.

In this episode you will learn about:

• • • Healthcare innovation
    • Leadership
    • Leadership Mistakes
    • Building a startup
    • Managing and scaling a team
    • Raising capital
    • Company Culture
    • Effective Feedback

 

About Carlos Reines:

Carlos is one of the cofounders at RubiconMD. The company was founded in 2013 with a driving vision of democratizing medical expertise so that providers can offer every patient the care they deserve.

Originally from Spain, he’s passionate about leveraging technology to drive change in healthcare.

Prior to RubiconMD, Carlos led a division at Telefonica, one of the largest telecom companies in the world. He began his career at Siemens Healthcare.

He earned Masters’ in both Bioengineering and Telecom Management in Madrid, and an MBA from Harvard.

Connect with Carlos Reines:

Linkedin
Twitter
Website

* * *

Full Transcription:

Carlos:  I think I always had an easy one because my dad’s name is Carlos as well. I don’t think they had to break that too much.

Tanya:  That’s great, so they followed the wonderful Spanish tradition on naming. 

Carlos:  Yeah, absolutely.

Tanya:  That’s Carlos Reines, Harvard grad and entrepreneur who raised $20 million for his startup RubiconMD, an eConsult platform that connects clinicians to top specialists. Now serving over 5,000 primary care physicians in 37 states in the US, RubiconMD has saved over 2.5 million days of patients waiting for specialist consults, which turns out to be almost 7,000 years.

Carlos:  I grew up in Madrid. Actually, all my family is in Madrid. I was born and raised there, lived in the center of the city for the first few years, and then we went to the suburbs when I was about 5 or 6. I’ve really been in Madrid most of my life. When I was 22 is the first time that I went to study abroad. Through different work experiences and educational experiences, I’ve ended up spending time in the Netherlands, in Germany, and obviously, a lot of time in the US.

Tanya:  If you were to describe yourself as a kid, how would you describe yourself?

Carlos:  I was the only child, only nephew, only me, no cousins, for ten years. My mother is the oldest of six. On my dad’s side, his uncle never had children, so for about ten years, I was there by myself. I was getting a lot of love from the entire family.

Tanya:  I can imagine. 

Carlos:  At the same time, I was dying to get some folks around. I wanted to have cousins. I wanted to have siblings. In Spain, there is a big tradition in Christmas that the Three Magic Kings will bring you games and toys, and when I was a kid and I would write my letter, I would never ask for any games or toys. I just wanted to have a brother or a sister. I wanted to have that for a long time. It never happened, so I grew up as an only child. At some point, my parents had friends that lived outside of Madrid, and their son moved to Madrid for college. He was about five years older than I am, and he went to live with us. For three years, all of us had – I had an older brother, and it was an awesome experience.

Tanya:  I can imagine. After all that time, it must’ve felt great to have company. 

Carlos:  Absolutely.

Tanya:  Something important happened when you were a child.

Carlos:  When I was 8, I was playing on the street with other kids. We were playing with slingshots. It was just kids who are the street, and I was hiding behind the car. Unfortunately, somebody was incredibly accurate, and they hit me in the eye. That was actually a pretty severe accident that triggered three very complex surgeries. Probably over the span of two years, I lived half of the time either admitted to the hospital or sitting in an ophthalmologist office. I couldn’t go out. I couldn’t play with other kids. I had to be incredibly diligent with my eye drops. 

That was actually very tough. As an 8-year-old, all you want to do is to be outside and then play and not have to worry about anything, and I had to go through a lot of complications. Eventually, I had the surgery where the ophthalmologist said the best thing we can do is stabilize the eye, and this is something that you should reevaluate whether you can have more surgeries or there is any path forward maybe in 15 or 20 years as an adult. That was between age 8 and age 10, roughly. 

Tanya:  Wow! That’s brutal. How did that influence who you are today and shape your outlook on life?

Carlos:  I think it influenced me in many ways. I wish I didn’t have that accident, but at the same time, I’m very grateful for all the things that I’ve learned out of that experience. I think mostly on – probably on three different levels. The first is what I do now was definitely influenced by what happened to me, right? I decided to become a healthcare technology entrepreneur, and I started RubiconMD. This is, obviously, years later. This is only a few years ago, but out of that experience, I grew the motivation to want to fix healthcare because I had experienced myself just of not having access to the right care at the right time. I knew that somebody had to fix it. Eventually, that’s where I gained the strength to go pursue this mission that I’m working on now, so one was in shaping what I wanted to do.

I think, two, I’m also really grateful for a lot of the strong relationships that I’ve been able to develop, very close with really everyone in my family, so at the time of the accident, I felt incredibly supported. There wasn’t a day where I was at the hospital and I didn’t have either my parents, my uncle, my aunt, someone sitting with me. I think that is reflected in now it’s 20 years later or 20 or 30 years later; I have incredibly strong relationships with them, with everyone in my family and also friendships. I remember when this happened, and I had to go back to school. I couldn’t go out and play outside. I had to stay in the classroom, and I had to use my drops. One of my friends at the time would stay with me every single break. Instead of going out to play soccer or whatnot, stayed indoors playing with me. He was the one putting the drops in my eyes. Again, almost 30 years later, he’s one of my best friends now. I think of a lot of those relationships really solidified, and those are really priceless.

Tanya:  How did you handle the person, the child that caused the accident?

Carlos:  I didn’t, really. This happened when I was 8. At 8 years old, you barely understand what’s going on, what’s happening. I don’t think I ever saw that kid ever again or spoke to him again. Not because I didn’t want to. It’s just the following two years I was, basically, at hospitals and doctors’ offices, and after that, we never had an opportunity to reconnect. I think one thing that’s interesting is that you really don’t understand what’s going on, and I think, for me, it was probably, I don’t know, maybe five years later or so when I was growing up, when I was going through adolescence that I started to realize that I had gone through a pretty serious accident and understand a little bit of the implications. It was probably more difficult in those years than it was originally. As a kid, I was just cruising through life.

Tanya:  Yeah, I can imagine. Do you feel affected in any way by what happened to you today, or what is going on with your eye?

Carlos:  No, not really. The good news is that we are born with two eyes, so despite having pretty limited or not really any useful vision in that left eye, I can do everything normally. It didn’t stop me from being able to drive, being able to play sports, or have a perfectly normal life. I don’t think it’s put any restrictions into anything that I do, but I do think that I’ve developed a lot of capabilities that I probably wouldn’t have developed if I didn’t go through this. I think a lot of that is pretty well reflected and really helpful as I’m going through the entrepreneurship journey, which is a brutal experience. A lot of the things that I learned at the time, being able to work through challenges, jump through hoops, or remove any hurdles that are put in your way, I think the perseverance that you need as an entrepreneur, I think I found a lot of that in having to figure out life going through a lot of the challenges as a kid.

Tanya:  Yeah, I mean, that’s unquestionable that your accident was the training ground for your career. Not only as an entrepreneur, but in healthcare, you were firsthand affected by the problems that you’re actually trying to solve today. How did you get into your entrepreneurial journey?

Carlos:  It really started in 2012. Up until that time or before that, I was in Madrid. I was working for Telefonica, which is one of the largest telecos in the world, and I actually had a really cool job. I was part of this corporate unit. It was called the Global Chief Technology Office, and we would do technology projects across all of 25 countries where the company operates. We would be standardized in best practices, technology guidelines, choosing solutions; that everybody rolls out the same technology and be more effective. I got to interact with, really, all the areas of the business.

Then a friend convinced me to apply to business school and to apply to schools in the US, and in 2012, I found myself packing and moving to Boston to start business school at Harvard. Going in, I knew I had – so before that, I had worked for Siemens and Telefonica, two massive companies. I thought this is the perfect transition to try something else, to go early stage. Why not, to start something myself? I really spent my first year in business school going to a lot of the entrepreneurship events in Cambridge. There are startup weekends and hackathons virtually every week.

By going to a lot of those, eventually, in March of 2013, I met my co-founder, Gil, at a Hacking Medicine event at MIT where he was pitching the idea. He was also inspired by personal experience where his grandmother had a brain tumor. She was from Barbados, and she had to travel to Boston for surgery and then for the postop care. He was also frustrated with the limitations of accessing care, and the two of us worked together through that weekend. We found that this is an idea that made a lot of sense. We were excited about that we could execute, and on top of that, we got along really well. We had very complimentary styles, and we decided to start a company together.

Tanya:  Wow! That’s RubiconMD.

Carlos:  That’s RubiconMD, yeah. Basically, what we do – so the two toughest problems in healthcare in the US – probably number one is, obviously, the fact healthcare is an incredibly expensive sector with almost 20% of the GDP spent in healthcare. That’s twice as much as any other advanced country of their healthcare expenditure relative to the GDP with it actually achieving better population health metrics, and then on top of that, you have about half of the country who really struggle with access to care. We quantified that more than 50% of the population in the US have real challenges accessing a specialist, and that’s real unfortunate. We decided to tackle a dual problem by letting primary care clinicians submit electronic consults to specialists, so whenever a PCP has a case that’s a bit more complex, what they do is they access our platform. They type up a brief description of other patients. They ask a question, and they send it to a specialty. We have a top specialist review and get back to them with their impressions and recommendations in a matter of hours, and that allows the primary care clinician to make a much more informed decision and diagnosis, treatment plan, and next steps for the patient.

Tanya:  I mean, I think that, first of all, what you’re doing at RubiconMD is pretty amazing. I can’t tell you how many times I went to a pediatrician or a general practitioner and said what’s going on here? They send me to God knows who, and it takes time to get the appointment. You’re looking at months before you even get to loop back with the primary care physician. It’s frustrating, so that’s amazing. How many clinicians and primary care physicians do you serve?

Carlos:  Oh, we must have probably about 5,000 clinicians across the country. We are present in 37 states working really with all flavors of primary care. One thing that’s fascinating is that you just share your experience. It was frustrating that you probably wasted time and money and things that were not really necessary, but one thing is that you could afford it. Even if it was painful, you had access to care. About 60% of what we do is safety-net populations, uninsured, undocumented, Medicaid patients that are looking at wait times measured probably in months if not years. One of the things that’s really fascinating of what we do is that we are bridging that access gap for the most underinsured populations who are now through their primary care clinician getting access to the expertise of some of the best specialists in the country, and that’s where we are executing on our mission of democratizing access to medical expertise.

Tanya:  I love it. That’s amazing. How big is your team now? 

Carlos:  We are about 45 or 50 people, most of us headquartered in New York City. Then we have West Coast office in San Francisco, and we also have a few remote engineers based in Spain.

Tanya:  Amazing, all the key locations. I just want to shift gears a little bit. In terms of what it took to actually begin the company – well, first, what do you do at Rubicon? What’s your job? 

Carlos:  As the president and co-founder, I oversee the delivery side of things, so I work very closely with the product team helping inform a lot of the road map and future decisions with the input that I get from the market. I work closely with the operations team; help them build for scale. I work closely with the implementation customer success teams, and they are supported by what we called user engagement. It’s, basically, we’ve taken the approach in a loop – all the learnings that traditional tech companies have in their growth hacking teams and adapted it to bring it to healthcare so that we could do rapid experimentation and learning around the things that work for clinician engagement with technology. Those are the teams that I oversee. I think, as a founder, I can’t get out of being on the road a lot of the time, so probably a good portion of my time is still dedicated to business development and checking in with our partners.

Tanya:  Okay, yes, and aside your actual job, you have a bazillion other jobs. Your job is to just make the company successful, whatever it takes. When you start a company in the early days, it’s brutal. It takes a lot. What were the early days of RubiconMD like for you?

Carlos:  Yeah, so the early days were actually really hard and, at the same time, really fun starting the business. I was my first year of business school when I met my co-founder March of 2013 over that weekend at a Hacking Medicine event at MIT, and then we followed up, did a second hackathon about a month later. It was called 3 Day Startup, and we won best pitch. Then we said, well, this actually has a lot of potential. I think there’s an opportunity to build a business here, so shortly after that, we incorporated the company. That summer, I moved to New York, and that’s when we worked on developing the first prototype. We found one clinician who wanted to give it a shot, someone who had trained with Gil’s brother or had trained Gil’s brother in Connecticut, and we recruited maybe three or four specialist. That’s all we had at the time, one PCP, and I think one cardiologist, one dermatologist, one orthopedic surgeon. Not more than that. 

We built a prototype that I put together, a very simple MVP. It was just the front end. What the person would do is they would access the “platform,” platform in quotes. They would submit a consult. I would get that, and I would have to do everything manually. I would have to run those cases manually to the specialist. When I got their responses back, I had to go back and tweet the front end of the platform, so it was incredibly manual. 

We did that for probably about 200 consults, and then we regroup with this primary care physician in Connecticut. He said something that was fascinating. He said, “Well, first of all, this is the most doctor-to-doctor communication I’ve had in ten years, and on top of that, I’m not only learning things, but I’m also able to improve care for my patients who would have otherwise not had the ability to go see a specialist and maybe would’ve had to end up in the ED. I’m actually not only doing better care, but I’m also generating big cost savings for the system.” That was for us the biggest validation. We had a clinician who was getting a lot of value clinically, and his patients were benefiting a ton. That’s when we decided to raise a little bit of capital and start building a team and to actually build a legit platform.

Tanya:  What was one of the toughest moments professionally you had to deal with as a leader?

Carlos:  I think the first year was brutal for me because I was still in business school. We applied to an incubator. They said we’ll take you guys if you drop out of school. I was already going back. I was already starting projects with classmates. I was really using every class to apply to the business. We decided that it made more sense for me to finish business school, but that also meant that I was doing two things at the same time, right? I was starting a business from the beginning, and I was going through my second year of business school, and that was brutal.

I remember days where I would go to class in the morning, and then I had to get in a car, drive to New York. We were meeting with investors or a potential customer, or we were talking about the product and then drive back. Many days I find myself – it was midnight. I was dead tired, and I had to do a lot of homework and reading for the next day so eventually managed to go through both. I still got a lot of value out of school. At the same time, we continued to grow the business, but it was brutal. I remember the last days where I was like I can’t take one more class, one more case, or I’m going to break.

Tanya:  I can’t even imagine. That’s so crazy. At what point did you start to raise capital and really see your team grow?

Carlos:  The first capital we raised was when we – before we launched that really early pilot, we had some basic cost that we had to face before we could start operating. Things like liability insurance and funds to pay the specialists and just the basic things. The first time was actually pretty interesting. We had met this person through a friend of ours, and he was the former CEO of a very large health plan. We connected with him, and we was initially just an advisor. He started to give us his take on how this could fit into healthcare. What are the things that we should have in place? Eventually became a little bit of a more formal advice. We were checking in with him regularly.

We asked him, what would be your advice? We’re at a point where we need to raise some capital. Do you recommend us to start by going to a fund, going to a few angels? What do you think? He offered himself. He said, “Well, if I was interested, would you guys take an investment from me?” It was very natural. Of course we would, right? He had been incredibly helpful already.

That’s how we found our first investor. It was very natural, and then a lot of angels piled up on top of it. He obviously brought the credibility.

Tanya:  It was a strong signal.

Carlos:  Exactly, then we had other investors who were maybe stronger in tech but having someone who’s such a healthcare expert, a physician, a manager, CEO to back our model, it was a strong signal. Probably the first half a million dollars we had raised was through super angels. Then we started working with some of these early stage health IT funds that invested. That was our seed round. Which from the first check ‘til we closed it, we probably kept it open for about a year. We were just raising capital as we were getting more traction, and eventually, it was about 1.3 million that we raised with a combination of angel funds and one strategic investor that joined the round at the end.

Tanya:  At what point did you start thinking about RubiconMD’s culture?

Carlos:  That probably happened after we did our Series A. Our Series A was about a year and a half after we had closed our seed round, and that was the first time that we went through multiple hires. Right up until that time, it had been the three founders at the beginning and super-early employees that were part of the founding team so a very small team. When we started to bring more people onboard, it’s when we realized that the culture was going to be incredibly important. We didn’t get it right the first time. I think through the first iterations of hires, we brought people who were really good but maybe weren’t the best cultural fit for what we wanted to – where we wanted evolve. I think, as we were growing the team and through some of these successes or failures in growing the team, we started to realize the importance that having a strong culture would have for the company. Where we are today, I think culture is incredibly central for us. We dedicate a lot of time, resources, and attention to it, and I think it’s one of the key assets of RubiconMD.

Tanya:  Awesome, and what is RubiconMD’s culture?

Carlos:  We define our value system human, agile, innovative, and collaborative. I think that’s a good characterization of what you would see across the board in the team. First of all, I think I told you my personal story, and I shared a little bit about my co-founder’s personal story for why we do this. When I look inside the RubiconMD team, almost everyone or everyone has a reason why they’re doing this, right? They could be doing something else that’s maybe more comfortable, or it has more perks, but they’re all here because they are incredibly mission driven. They want to change the world through their skillset. I think that’s number one characteristic, very, very strong mission in the team. Number two, we’ve been able to attract really talented individuals that thrive really well in the craziness of the startup journey, right? You need folks that are the – that can function autonomously and that want to be pushed really hard and can solve really hard problems and collaborate really well with each other, so I’m very proud of the talent that we’ve been able to bring onboard. 

The third element of our culture is diversity. You would think that for a company that has to work really fast and that’s, basically, optimizing for having folks that are mission driven that you could expect that most of us would be the same or have the same backgrounds, and I think it’s quite the opposite. Some people refer to us as the UN of startups. We have so much variety in terms of countries of origin, backgrounds, races, gender. I think we’re about 60% female represented across the board, right? It’s not that we have just a very large marketing team with a lot of women in it. No, we have female representation across the entire company in leadership. Even at the board of the company we have female representation.

The beauty of this is that diversity has never been – we’ve never pushed for that. We’ve never even thought about or quotas or anything like that. It’s happened naturally. I think as we’ve been able to grow a more and more diverse culture, it also becomes a magnet for people who thrive in that environment, and that, in a way, becomes a self-fulfilling prophecy.

Tanya:  That’s amazing. I mean, the fact that it happened naturally and it wasn’t in response to what’s going on in the environment today in business, that’s amazing. What type of resources do you use to really keep yourself engaged and growing as a leader?

Carlos:  I put a lot of attention to it. There are several things that I do. Number one, inside the company, I think it’s incredibly important to encourage a culture of feedback, open, transparent, honest 360 feedback. We have that in place, but I particularly push really hard folks in the team to be very candid. That’s the only way I can learn about my limitations and work on getting better, so that’s from the inside.

Tanya:  How do they provide you feedback? Do you have a quarterly meeting or a survey that goes out? What’s the setup of that feedback loop?

Carlos:  We have a lot of things in place. This culture is so important. Our head of people in culture spent a lot of time working on it. Twice a year we do employee reviews. Those are reviews by their manager, but in between those cycles, we have peer review sessions so that we can get feedback from a personal level to the organization and from everybody. It is a time consuming activity. It takes a lot of resources, but I think it’s incredibly worth it.

Then we encourage feedback, and we enable multiple talents to provide it. There are folks that will be very comfortable providing direct feedback to a person and identifying themselves as the authors of that feedback, and there are folks who are more comfortable just giving in a more anonymous way. What we do is we have each manager collect feedback from different sources, and they package it up, and then they deliver it to an employee. Where somebody is comfortable and wants to provide more one-to-one direct feedback, they’re welcomed and encouraged to do that. If people prefer to provide it in a way that’s a bit more anonymous because they don’t want to potentially harm a relationship, that’s also fine. All we want to do is the people – make sure that people have enough content for them to understand what are the areas where they can keep improving, and also, what are the areas where they are doing really well and that other people appreciate?

Tanya:  Just curious, what was one of the pieces of feedback that you got that was impactful for you? 

Carlos:  I think, one of the pieces of feedback that I’ve received, it was very insightful is that there’s feedback on feedback, right? I spent a lot of time providing constructive feedback because I feel like I owe it to the employees. It’s my job to make sure that everyone here is getting better and better and learning new things every day. I have a very natural tendency to focus on the constructive feedback. Folks really appreciate to also learn what are the things that are working well? Not just to get the pat on the back but to be aware that, something they are doing, it’s actually very effective, and they need to keep doing it. That was a very important piece of feedback. That I should spend more time also on the positive feedback and reinforcing the things that are going well as much as I do on the constructive feedback, and what are the elements where folks need to work on to improve?

Tanya:  Really, encouraging not just for what needs to be improved but also what’s working, which makes sense. When things are working, you don’t put as much thought. They just work.

Carlos:  Right, and I think that’s a – that’s why I naturally go to how can we better? It’s that obsession with we keep growing, but I think it’s a very fair point to also recognize people when they do things well.

Tanya:  Yeah, absolutely. What was your favorite or your most influential leadership or management book that you read recently?

Carlos:  I’ve been reading a lot recently around hiring. Probably one of the most important and at the same time one of the most underrated functions at any company or qualities in many leaders is recruiting and talent management. I don’t understand why in many places HR remains a function that’s a little down or not properly respected. The most important asset for most of the companies and definitely for us is the human capital, the talent that we have onboard.

Tanya:  Without a question, yeah.

Carlos:  I’ve learned that a great employee who is mission driven, highly motivated, and whose performance is really high is incredibly valuable. I spent a lot of time reading about the topic either – in particular, two books that I found really helpful around improving the hiring processes and talent management. Those were Work Rules!. It’s a book by Laszlo Bock. He was the former head of people at Google. From that one, I took away – I guess one thing they did, it was fascinating, is that they mapped all hiring processes, and they understood the ratings that people had given. They map it out to how that correlates to the success of the hire in the job. After tens of thousands of hires, you start to see some interesting trends, so they have a pretty thoughtful framework for how to structure an interview. It’s very natural for us when we are interviewing someone to just go back to all right, this is the job description. I want to know what you did in the past, and then I’m going to make a decision on whether you’re a good fit for this job or not.

I think that’s short sided because that’s only one of the elements. I think in that book –we’ve tweaked it a bit, but our framework now is we look at a candidate. We want to understand what are their leadership styles? How would they fit with our culture? What’s their general cognitive ability? What’s their role-based knowledge for what they’ve done in the past, but also, what’s their role-based aptitude? What are the things that they’ve done in the past? Even if they weren’t exactly doing this job, how do they prepare them to do the work that we’re going to be asking them to do? We found that by having different categories and letting people focus on specific items of those we are being able to have a much more effective and less biased hiring process.

That was incredibly effective from that book, and then the other one that I also found very interesting is a book – I think it was called Who. It’s, again, a hiring method, and they take you through all the steps that you need to have in place before you go out and start searching for a candidate around properly defining the job and define what are the metrics for success?. Getting internal alignment in the team around what are the things that we’re going to be looking for as we start to bring candidates onboard? Really elevating the team’s ability to be better recruiters and better searchers of talent for the company.

Tanya:  That’s super interesting so trying to solve the hiring problem, which is a huge one and at the basis of building a team, really.

Carlos:  Absolutely.

Tanya:  Awesome, so last question, what is next for RubiconMD?

Carlos:  It’s been a little over 5 years since we started the business with about 5,000 clinicians using RubiconMD. When you look at the stats, they are very impressive. Primary care clinicians report that, when they use eConsults, 80% of the times they are able to significantly improve the patient’s care plan. Seventy percent of the times they are building capacity. They’re not just helping patients at one point in time. They’re learning things that they will use in future patient care, and they are avoiding more than half of the times unnecessary referrals, duplicate tests, unnecessary [36:20] cost. It’s been more than proven that this has a ton of impact on the quality of care delivered and the costs that are being taken away from the system and the patient experience. We’ve taken away more than two and a half million patient wait days. That’s time that would have stood in between the patient and the right care plan, particularly for the most underinsured population.

Tanya:  Carlos, let me just make sure I understand that, 2.5 million wait days you said?

Carlos:  Yeah, that’s correct.

Tanya:  In other words, 2.5 million days that patients avoided waiting to go see an expert and get the care that they needed.

Carlos:  Exactly.

Tanya:  Wow!

Carlos:  If they didn’t have eConsults, they would’ve had to wait all that time to get to the right care plan, if they ever were able to get to the right care plan, which in many places they can’t.

Tanya:  Wow! That’s almost a lifetime or more.

Carlos:  Yeah, the model is incredibly effective. It works really well. Five thousand clinicians is just scratching the surface. There are almost half a million primary care clinicians in the country, and this works really well. Healthcare is very fragmented, so incentives are not always aligned. As much as I would like to see all financial incentives be aligned towards improving outcomes, improving the patient experience, and reducing the cost of care, that’s not necessarily the case for a big portion of the system, but we’re working really hard to work through those challenges. We live in a world where five or ten years from now there shouldn’t be any primary care clinician in the country and why not eventually in the world who doesn’t use eConsults as part of their practice because these are incredibly beneficial for patient care.

Tanya:  Yeah, I mean, it makes so much sense. How do people get in touch with you?

Carlos:  Anyone who wants to get more info on RubiconMD can find us online at rubiconmd.com, and for anyone who wants to contact me directly and get anymore insights, carlos@rubiconmd.com is my email. Feel free to reach out, particularly if you are a mission driven individual who cares about improving access to care. I’d love to connect with you.

Tanya:  Amazing, Carlos, thank you so much for spending the time and sharing your amazing personal story and what you’re doing with RubiconMD.

Carlos:  Thanks so much for having me, Tanya. I really enjoyed it.