A startup founder reached out asking for help with his product. The target market was doctors. What he wanted, specifically, was an advisor to guide his product development. And in exchange? Nothing.
I told him I offer paid consultations for startups. In fact, I routinely provide consulting services to startups, investment firms, and corporations and have done so for years. He told me he doesn’t pay to talk to providers.
Let me translate that. I’m an orthopedic surgeon. He wanted my clinical expertise, my years of training, and my specialty knowledge so he could build his product, monetize it, and keep all the revenue. And I was supposed to do that for free. Because doctors are generous, because we’re altruistic, because somewhere in our training we were taught that our time exists in service of everyone else.
That applies to patients. It does not apply to someone else’s business.
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Some founders may genuinely want to make a positive impact on our healthcare system. That’s a legitimate motivation, but it still doesn’t justify asking a physician to work for free while they profit from the product. Good intentions and fair compensation are not mutually exclusive. A founder can care deeply about improving our healthcare system and still be expected to pay for the expertise that makes it possible.
Accountants and engineers are paid for their expertise without question. Attorneys charge by the hour for a phone call, and I’ve seen some charge down to the minute for any overages. Nobody complains about that. It’s expected. Physicians are the profession people still feel entitled to access for free, because we’re conditioned to say yes, and because saying no gets read as unkind rather than as a boundary.
Then there’s the word he used: “provider.” If you work in healthcare, you know what that word represents. It’s a flattening, meant to diminish doctors and erase any distinction between healthcare professionals. He may not have known what he was saying. Or he may have known exactly what he was saying. Either way, my answer was the same. No.
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There’s a second layer to this that people outside medicine rarely think about: time. It’s not just about wanting to help. Even when founders are willing to pay, they often underestimate what an hour of a physician’s time actually costs to give.
As a practicing hand surgeon, I perform complex surgeries and make high-stakes decisions in the OR on a regular basis. I also run my own practice. My day starts before most people wake up, and there is no open hour sitting around waiting to be filled. I give everything to my patients without a second thought. But when someone asks a full-time surgeon for “just an hour,” they’re not asking to be fit into my day. They’re asking me to take that hour from somewhere else: sleep, family, dinner, the one hour I had to finally sit down. Someone with a 9-to-5 schedule can often give an hour and lose nothing. A full-time surgeon cannot. My time isn’t just valuable. It’s finite in a way most people never have to think about.
So I say no to unpaid consulting. It’s not because I don’t want to help founders build better products. Some of the most meaningful innovation in healthcare comes from founders who make the effort to understand the people they’re building for. I have personally enjoyed collaborating with many of them. However, if your business depends on physician expertise to succeed, that expertise is worth paying for. Time is finite. I only work with people who respect me and value mine, and I encourage other physicians to do the same.
He wanted my clinical expertise, my years of training, and my specialty knowledge so he could build his product, monetize it, and keep all the revenue. And I was supposed to do that for free.
