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S1 E10 – Shiv Gaglani

On rethinking medical education for the 21st century clinicians and caregivers around the world and on finishing what we start.

Shiv Gaglani is the co-founder and chief executive officer of Osmosis.org, a leading health education platform with an audience of millions of current & future clinicians as well as their patients and family members. Shiv’s primary passion is developing innovative and scalable solutions in the fields of healthcare and education. In his spare time he enjoys spending time with his family, snowboarding, skiing, running, and flying.

“You don’t make the impact you want to have by starting things but by finishing them! –Shiv Gaglani”
Enjoy my conversation with Shiv

Show Notes & Links

Transcript Follows

Madhav 0:03
Hello boys and girls, welcome to this episode of Seeking Sathya podcast. My guest today is Shiv Gaglani. He’s the co founder and CEO of Osmosis medical education company. I’ve invited him here on the podcast to talk about osmosis, how he conceived the idea and built it up to where it is today. Hey, Shiv, welcome.

Shiv 0:23
Thanks for having me.

Madhav 0:25
So I wanted to find a lot about your, you know, current company, how he launched it, and how are you building it up and all that. But before we go there, could you spend just a couple of minutes on your childhood? Where did you grow up? And what were your initial years growing up?

Shiv 0:40
Yeah, happy to. So I was born in Namibia in Sub Saharan Africa. And my dad is a retired general practice physician that a mom’s a physical therapist, and they moved from India, where my sister was born, and they were born, to go to Africa to practice. And then they moved us from Namibia to South Africa, right outside of Durban for a couple years. And then, then we moved to Florida, because there was a large need for physical therapists. And my mom, being one side is a great opportunity for her children to take the next step in terms of their education. So there’s continuing westward migration. And so I grew up in Florida between 1995 and 2006, I finished high school there in a area of the state called Cape Canaveral, which is where the shuttles take off. That’s right, my area code is 321321. Liftoff. And then I went to college in Boston, went to Harvard did engineering degree, took a year off after I finished that before going to medical school, which is where I started, the company Osmosis,

so your mom was a physical therapist, and that probably had some influence on you and your current initiatives. But I know you’re done a few others before you launch your current company, small sales, like Could you share a lesson or two from the other projects that you have done like smartphone, physical patient promise? I’ve seen this I think quantified care and made gadget if I’m not mistaken, those are all initiative that you’ve started or you’re part of, I guess, right?

Yeah. So I like the word that use projects. Because they really were just projects. I mean, there’s a lot of students who have great ideas and then wind up starting something, they get maybe into a tech incubator, or they went to hackathon and they start something up. And really, osmosis is the only company that I’ve done. It’s only a company I’ve co founded and been part of that really went from being project to company.

You know, the theme between all of the stuff that I’ve learned is passion, like basically is what one of my business school professors said was Shiv, you don’t you don’t get paid for starting something you get paid for finishing it. Right that it takes full commitment to be able to take something from conception to fruition.

And we’re still on a journey, at Osmosis. But some of the other things we had dabbled with like the smartphone physical, which became codified care, really shaped my worldview on what’s possible in digital health. And I’m really glad we did them. But I think the one theme I’ve learned is that you have to be able to focus on on one thing in order to be exceptional at it and then grow it to the stage where we feel we are right now with all supposes.

Madhav 3:25
Yeah, I hear you. I think I have heard you in one of the other podcasts you talked about, you don’t make things you are you don’t make an impact by starting things. But by finishing things. I really wanted to spend a minute or two on that, because that’s one of the problems that I’ve myself faced. And I’ve also seen a few of my friends face that which is like, maybe it’s the shiny object syndrome, or whatever you want to call it. But how do you really get that kind of conviction to say this is the one and this is the one I’m going to go after? And I’m going to see through?

Shiv 3:56
Yeah, sure. Well, I will caveat it by saying it’s really important to know when to quit something right when to when it’s not going to go further. Just because you don’t want to it’s like the sunk cost fallacy a lot of people take.

And I think the biggest thing for me like osmosis didn’t, it didn’t feel like oh, I have to stick it through. It just was the one major thing I kept doing that was fun. Like, it’s been a really different journey.

And there’s definitely been hard days and hurt hard months even. But overall, the trend has been up and to the right. And we feel like we’re making an impact. And it’s kind of fed on itself. And at some point you get to what Jim Collins says is either the flywheel effect where things will, you know, keep keep turning and even without much more energy, there’s like momentum.

And we certainly feel that with cosmosis or a Doom loop, which is where you know, things you keep trying to push it and like it keeps hitting wall and there’s only so many times something hit a wall before you break through. But generally I think we start a podcast and Something you and I were talking about before the show, they give the illusion of overnight successes. And generally there’s no such thing as an overnight success. There’s a joke that it’s an overnight success 10 years in

Madhav 5:12
the making, right? So if you had to describe Osmosis for example, to a six year old, I was thinking about it. Is it like a Khan Academy for medical professionals? Or is that completely off? It’s funny,

Shiv 5:23
you mentioned that because our team before they joined us, started Khan Academy health and medicine. And so that’s how our chief medical officer Dr. Rishi decide was the head of Khan Academy health and medicine.

However, if I was describing to a six year old, basically what I would say is that we want to help as many people take care of other people as possible. Oh, we train medical, medical nursing professionals, but we also have a lot of patients and family members who consume our content. Because the vision of the company is everyone who cares for someone will learn by osmosis. So if you have children, you have parents, they have bodies, you have a body, you care about them as people. And so we have content that will help you care for them better.

Madhav 6:08
Anyone, like caregiver person, or is anyone who cares about being healthy?

Shiv 6:13
barely anyone I mean, so we have a lot of content and nutrition that people consume just for themselves. We had a comment this week from a patient a person who has preeclampsia. And she sent that video to her father, to understand her preeclampsia. That’s definitely the it’s not our business model. That’s just our value add to the world. The business model really is the end to end training we do for medical, nursing, and PA students in schools. But as we keep growing, we’re gonna get get a bigger and bigger audience. That’s the goal is to be able to reach as many people who care for other people

Madhav 6:50
got it? How big is Osmosis? And like, when did you start? And as you said, fly wing? Right? I’m sure it was not like you didn’t start like yesterday. How big is that? How have you grown steadily over the years?

Shiv 7:03
Yeah, so I divided into three phases. Phase One was the student phase. So the project phase 2012, is when we officially started the company. Mostly, the only reason we made it a company and wasn’t a project was we got a small grant. And we needed to have a bank account to put the money, right. So then we’re like, Okay, well, now we name for this thing. And so there was a student phase. So medical students at Hopkins, I went to business school and in Boston.

And so the first four years were really just kind of hacking things together, we went, we did get a couple 1000 users, we started getting 10s of 1000s, and hundreds of 1000s of revenue from that

but still felt like a project because we were we didn’t accept much outside funding, we did a tech incubator, but it wasn’t like a massive seed or series A. Then when I finished Business School, and we’re still working on the project. I was like, Well, now it’s time to be full time, we have more people, we have five full time people working on this, including my co founder, let’s actually think about making this much bigger. No, no reason to finish, like go back and finish med school right away. So phase two was when I brought on the team that used to run Khan Academy, health and medicine. And so then we realize, okay, we need a little more money to do this. Because if we want to totally virtualize medical school, at our rate,

it’s going to take us like five to seven years to build all that content.

So let’s think about, you know, maybe getting some external funding to build content faster. And the first money in were my business school professors, followed by some pretty impressive list of medical angel investors, who then got us into some venture funds, like Greycroft. So that was phase two, which is platform project meets content, starting to really grow quickly. Last year, we crossed a million YouTube subscribers, and that was a big milestone for us. And we crossed you know, we went into the seven figure revenue phase. And then last year, we, the ambitions grew like I’d like to say we had this vision for osmosis from the beginning.

Like that’s the narrative fallacy that often people talk about. But really, as we kept showing what we could do, like I didn’t, we didn’t know that this stuff would be appealing to patients.

When we started building it was only when we started releasing it on YouTube were like, oh, wow, like a bunch of 10 to 15% of our comments are from patients and founding members. So we’ve hit upon this like, really interesting content engine. And so we started getting a little more ambitious. And then last year did a series A which is project catapulted us into this next category, which is how do we go from just being a supplement training healthcare workers for curriculum and tests into being primary and work with the 100 schools we now sell to to like build end to end programs to get people into meaningful jobs. So we’ve entered into a much bigger and more ambitious phase, phase now

Madhav 9:48
gone under the just to take a step back on that mean, you packed a lot into it and just to talk about the initial struggles like the MVP the minimum viable funnel People talk about a lot. But if you had to just share a couple of thoughts on how did you build that initial one, because it’s sort of like a chicken and egg, I’m sure you are not video professionals or content professionals or any of that sort. But you needed the content to get people. And you needed, I guess, people to pay for it. So you can actually produce high quality content. How did that happen? Yes.

Shiv 10:22
So the first MVP was just basically, our medical classmates at Hopkins, were using it.

So we had a lot of empathy with the end user, because we were the end user, we were trying to solve our own problem.

And so that was where we went from building like a really, like, as Reid Hoffman says, You got to be ashamed of your first MVP, otherwise, on MVP, so really shameful, like platform, to crowdsource questions and flashcards. And then we realized, okay, we need good, better content to go from a couple of 1000 users to 10s, or hundreds of 1000s, if not millions of users. And so the first couple of videos that I suppose this, were also kind of janky, and shameful. But our video production team, like solved a lot of the kinks, we built internal software to improve it. And we really listen to the customers.

So we, one reason we put on YouTube in such a public forum, we’re so we can get as many comments as we did, that helped us refine it.

So one comment specifically led to us adding recaps at the end of every video, which has been super popular for us. And it’s led to a lot of, you know, SEO improvement search engine optimization, because now we have these recaps for every video to

Madhav 11:36
write, and YouTube has always been part of your strategy from day one. In terms of getting people and the store content.

Shiv 11:43
Yeah, exactly. Here, because it’s because that’s top of the funnel for us. And so many people are looking up things on YouTube and Google. And so that’s where we started really building a lot of attraction.

Madhav 11:54
Why did you choose to do it this way, as opposed to being part of an existing Coursera? Or one of those big platforms like that? Udemy or Udacity?

Shiv 12:04
Yeah, um, one was the, our ability to create our own platform, like a lot of those platforms are meant for general courses. Medical Education is different in that we wanted to build a platform and experience that was unique to health professionals. One example is whenever we update our content, everyone who’s ever consumed, that content gets an update, right? If you’re a physician, or you’re a medical student who learned with us, Osmosis, and you learned about cystic fibrosis, the guidelines for cystic fibrosis treatment change, right? Like that’s the nature of medicine, new diseases, like COVID come out. And so you have to update your knowledge of Coursera and Udacity. We know those guys, well, they’re actually part of my own podcasts, I’ve interviewed them. But they, they’re really general purpose courses in domains that may not change as much, or they have different requirements. Whereas for us, it’s like, very important for us to have that relationship with the end professional and update that user over time as the knowledge changes.

Madhav 13:02
Yep. Does that make sense? I think, going through this journey. I want to touch on the, I guess the emotional aspect of it is like, are you mean, you put your MD on hold? If I’m not mistaken? Yeah. And, oh, was that a surprise to your friends? family? How is it that you’re able to go through this? Are you afraid of failing and giving up on this amazing, MD? Pat, what is the deal there? Yeah, it’s funny.

Shiv 13:32
Um, you know, my I mentioned, my mom’s a physical therapist, my dad’s doctor, my sister’s a dentist. So I’m sort of the black sheep. I’m the only one who who went the entrepreneurship route. Actually, my sister’s an entrepreneur, she and her husband started a bunch of dental clinics. So you know, he was direct, it was one year off to do the tech incubator, and then I went to business school. And then by that point, it was so clear that we were so passionate about the scale we had reached and the potential ahead that I just kept being able to defer medical school. And so the the optionality is there. But my parents have always known this about me that I’m like, one thing, one reason entrepreneurship, so exciting to me, is

it’s a great way to dissociate your time from your impact.

Right? Like, as a health professional, you’re fairly limited and that you can see one patient every 10 minutes or 20 minutes. But as you know, this having built a website that reaches people in 170 plus countries, right, like you’re sleeping, and people are using something you created. Yeah, that’s really cool. And so I haven’t ruled out going back to med school, but right now I really enjoy what I do as Moses.

Madhav 14:41
I keep hearing you saying this. I mean, it’s so empowering, which is like building that flywheel, the momentum in small steps, and you might have a lot of dark moments, you might be afraid. It’s not like you’re not afraid that you might actually fail any dark moments. I mean, Anything that was like a darkest moment or teacher of some sorts that you can share with the audience in your journey so far?

Unknown Speaker 15:08
Yeah, definitely, I think, um,

Shiv 15:11
I mean, a couple, realizing that the core strategy wasn’t working, and we needed a content strategy was pretty, pretty important. It was tough to admit that we were wrong, like, our bet was that building just a product, the platform and then having people put their own content on would be sufficient. But we were wrong.

And that’s why we had to kind of swallow that embarrassment and like, bring on the team that ran Khan Academy and build up content. I like to analogize like, building a company like climbing a mountain range,

like we are really excited about the mountain Ron, but things get harder. So they don’t just get easier. And there are a lot of things that you miss about it. So like my co founder, and I have a lot more people between us like working on things. And that’s important to scale. But like because we weren’t meeting weekly, our relationship was degrading a bit. And this is something he was my best man at my wedding.

And but it got to the point of like, just really like, why are we like, why is our relationship so it doesn’t feel like the old days when you’re just hacking together? So pretty dark having to just confront that and saying, look, if we continue down the path we’re on, we’re going to be one of those countless stories of co founders

or brothers like the Ambani brothers who, like, just can’t even speak to each other anymore. So we had like our own intervention, and like, have reset our agreement and expectations, and are you really in good good spirits Now again, but I was getting pretty dark. And so the natural like human emotional side of building a company,

Madhav 16:44
that happens very naturally, because as you said, like as you grew, the team, the distance, I think, is just a natural thing. And you said you confronted it with the co founder and try to make things right. I wonder if how many people actually take that, because it’s a little bit scary, I guess, to have that kind of confident conversation. Taking shifting gears a little bit, looking into the future, I know that you’re doing a lot of video, and I’ve actually done videos, I was working at NBC Universal before my job at Dell right now. And producing content, producing high quality video is super hard. It takes a lot of time, a lot of creativity and talent. And I think machine learning can actually help a lot. Also, in this space. I was wondering if you’re thinking about it, that angle at all, or not like in terms of how you can use machine learning, to maybe recommend the right clips from these videos to write people, or whatever. is machine learning part of your strategy, and how is it being implemented?

Shiv 17:49
Yeah, it has been actually from the beginning, it was where we we met, I mentioned we had a platform, we have a platform where you can upload your own content, including your own PowerPoints, PDFs, and, and Word documents. And osmosis has an algorithm, it’s very common in ML algorithm called TF IDF, that will automatically index the words in each of those documents that are uploaded. And it’s used for search. But it’s also used for content recommendation. So we’ve been doing that actually for like, four years. But moving forward to a good friend of mine from Business School is a product manager at Amazon for AWS predict, which worked with Coursera and Netflix on the predictive tools. So we’re very interested in being able to recommend more content as well as search, right? So instead of having to watch even a seven minute video, which is pretty short, you could maybe search for and watch like just the 30 seconds that you need in the video, something already kind of being trialed by Google, but definitely something we’re interested in not as most as

Madhav 18:51
cool. And just on the futuristic side of things. What is your moonshot for osmosis? Like? Where do you see this? If you wake up five years from now, in a new world, where do you think you want to see us most has to be?

Shiv 19:05
So we have a vision again, as everyone who cares for someone will learn by osmosis.

And the big hairy audacious goal is by 2025 1 billion people will have learned by osmosis, so about 10% of the world by then,

which means it isn’t a billion doctors, it’s a billion people, because we’ll have our content in electronic health records and waiting rooms like they already are. We’ll have training programs for certified nursing assistants, who then go on to help countless other patients and people. Really, we are just trying to create a world where people are more capable of caring visit like right now that’s like the actual process of caring. How do you place an IV? How do you treat somebody who has dementia? Those are like literal ways to care. But then in general, we’re trying to also help people be more caring. So we have a whole concept like whole curriculum and empathy training. One of our core six values, two of them want to start with the heart. The other is spread joy. So we’re very values and mission driven company.

Madhav 20:09
Yeah, that actually was going to be my next question. But I guess how are we? How are you being useful to the world? I guess you’re really helping people become better caregivers. in whichever situation, they may be family or professionals. Just a few rapid fire questions, you don’t have to answer fast. But any book particularly that comes to your mind that you have gifted a lot or recommended to people.

Shiv 20:34
I like Ben Horowitz books, the hard thing about hard things. And most recently, what you do is who you are.

Madhav 20:40
Yeah, awesome. Yeah, those, I’ve read the hard things work. It’s awesome. And I love their blog as well, A to Z, a 16. z blog, of course. And one piece of advice that you’d give yourself knowing what you know, now, to your teenage self, sorry,

Shiv 20:57
I think just don’t, um,

don’t be in a rush like things, things work out, just as long as it’s like the holy pasture or quote, that chance favors the prepared mind.

So just spend your time prepared. And don’t be in a rush.

Madhav 21:11
Perfect. So just don’t be in a rush. Be patient. But also, going back to your earlier point, you also need to know when you want to give up I guess it’s a fine balance. But don’t be in a rush is really awesome. One truth you believe in that nobody else believes in, quote, unquote, nobody else. I guess this is the Peter Thiel thing. But I mean, really, like, if you’re trying to disrupt and create the next massive company, I guess you got to believe in something that most people don’t think is a big deal. Yeah,

Shiv 21:41
I think I think humans are essential, right? Like everything is going automation, like and virtual. We are a virtual company. We’re distributed. We do online learning. But I still think that humans are essential. And I think that’s the bet we’re taking by trying to create a more caring world because tons of other education companies are trying to get people to build your mobile apps and the next autonomous cars, which will disrupt millions of people’s jobs, which is fine.

But I think human human connection and caring is the essence moving forward. So I think that’s that’s the big bet we’re taking that there’ll be this counter movement where people realize that they still want human connection in a world of automation and robots.

Madhav 22:26
Yeah, perfect. Yeah. Absolutely. And then lastly, if you had a chance to write something on a full moon that the world can see. What would you write?

I think our value add osmosis, the first one, start with the heart.

Madhav 22:40
Start with the heart. Yeah. Awesome. Nice, great way to end that. Thanks a lot. And I wish you the best. I hope to have a chance to talk to you again.

Shiv 22:49
Thank you very much for being here. Thanks for having me

Unknown Speaker 22:51
on.

Transcribed by https://otter.ai

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