Zwade J. Marshall, MD, has demonstrated that successful entrepreneurship depends in large part on timing and strategic response to opportunity. He has built, expanded, acquired and financed businesses with an eye for—and insights into—their capacity as promising long-term opportunities.
However, “just because you can pursue something doesn’t mean you should,” he cautioned at the inaugural AMA Physician Entrepreneur Forum, held in Chicago. “Opportunity’s abundant, but your time and your money is not. So think and carefully assess each one that presents itself.”
The AMA Physician Entrepreneur Forum is part of the AMA Career Advancement Collective, a powerful new suite of educational programs and training that helps physicians develop and advance at every stage of their career.
In a little less than 20 years, Dr. Marshall—who is board-certified as an anesthesiologist and interventional spine specialist—has grown a single clinic into a multisite practice, built surgery centers and a laboratory, acquired and transformed an existing medical business and co-founded a financial services company, always applying lessons learned from one venture in building the next.
When personal experience reveals a market
Dr. Marshall, chief medical officer of Regenerative Spine & Pain Specialists and CEO of Doc2Doc Lending, attended medical school and earned a master’s degree in business at Emory University, then did his residency at Harvard, and in the process experienced the financial pain points that plague his peers. Relocation expenses from Atlanta to Boston were $17,000, but with more than $200,000 in educational debt, a credit score in the mid-600s and an intern’s salary, traditional lenders offered high interest rates or rejected his applications outright.
“It felt unfair. It wasn’t because of bad behavior, but the educational debt in my credit profile,” he recalled. Also, more than 30% of his Harvard classmates depended on credit cards or their families to get by day to day. “I thought that there must be a better way to solve this problem.”
That sparked his idea for a physician lending company based on the premise that physicians were good credit risks outside of conventional guidelines. He raised about $21 million, almost entirely from fellow physicians, and secured another $150 million in debt capacity. In less than 10 years, Doc2Doc has loaned more than $214 million.
Those funds come with advice around practicality and expectations.
“I often tell folks who borrow from us, ‘Don’t quit your day job just because you have an idea,’” said Dr. Marshall, an AMA member. “You’re more investible if you’ve got income and put your own money in first, and there are few things that make as much reliable money as being a physician.”
Timing, assets and infrastructure equal opportunity
Starting as a single-location practice with four exam rooms and a lab, Dr. Marshall strategically expanded in stages, first adding another physician, then an ambulatory surgery center, then additional locations and a second surgery center. Quite intentionally, each expansion was funded by revenue from existing operations.
“Grow your business with the proceeds of that business,” he advised. “If you’re growing faster than the business can fund its own growth without external investment, you’re probably one bad quarter away from failing. So be thoughtful about what’s needed to fuel growth over time.”
During his presentation at the AMA Physician Entrepreneur Forum, Dr. Marshall also detailed how he:
- Borrowed $384,000 to buy polymerase chain reaction (PCR) lab machines to offer COVID-19 testing, bringing in millions in revenue when the Delta variant hit.
- Purchased a successful weight-loss clinic after the physician owner died, modernizing and moving it to a new location.
Dr. Marshall’s history as an entrepreneur has been a carefully managed sequence in which one venture gave him the experience, assets, capital and insights to pursue the next. Recognizing pain points, maximizing existing assets, judiciously using capital and nurturing professional and personal relationships are real tactics that lead to financial success and personal satisfaction.
“It’s about timing, whatever the opportunity,” he said, also making the case for thinking beyond the notion that success is defined by huge valuations or “unicorn” exits. Growing a concern from $1 million to $5 million in recurring revenue is an admirable entrepreneurial accomplishment, he noted.
“There are many profitable businesses being led by miserable millionaires and you don’t want to be in that cohort,” he said. “Does the opportunity move you in the direction of the life that you want to live? If not, it’s not worth it. Never lose sight of the moment that you’re in while you’re in it.”
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