Building in healthcare means confronting a difficult reality: the system can sometimes reward treatment more than prevention.

In this episode, Dr. TJ Malvar of Pilgrim Health shares how he thinks about aligning business incentives with better patient outcomes, while building a company that can remain commercially sustainable.

He also opens up about the pressure of startup life, the moments of doubt, and why staying close to the problem matters when motivation starts to fade.

00:00:37 – Why healthcare can feel like a journey without a guide

00:02:32 – Dr. TJ's hustle: improving healthcare for families and communities

00:07:09 – How TJ found his way into medicine

00:13:16 – Surviving hospital rotations and 24-hour duties

00:18:56 – Becoming a doctor, working as a GP, and discovering the business world

00:19:58 – Why TJ needed to work after medical school

00:25:26 – Taking on the family business and learning to do everything

00:31:15 – Practicing medicine while helping run the family business

00:34:51 – The grant that helped TJ expand his community health work

00:35:47 – Running a free clinic while getting involved in local politics

00:39:22 – The pandemic, sustainability, and the limits of grant-funded work

00:43:14 – Learning about customer lifetime value and sustainable business

00:48:46 – The idea of aligning commercial incentives with healthcare goals

00:52:20 – Joining a startup and learning the startup ecosystem from the inside

00:57:36 – Why failure became part of Dr. TJ's founder journey

01:00:29 – Building healthcare around relationships instead of transactions

01:03:25 – Learning from other healthcare practitioners and validating the idea

01:07:21 – Validating demand through a subscription model

01:10:12 – Learning through accelerators, founders, and the startup community

01:14:31 – Why founders can't control everything but can stay committed to the problem

01:16:51 – Building a team and community around Pilgrim Health

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