#10 Shiv Gaglani

Rethinking medical education for the 21st century clinicians and caregivers around the world.

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

Hello, boys and girls. Welcome to this episode of seeking Satya podcast. My guest today is Shiv Gaglani. He’s the co founder and CEO of Osmosis, a medical education company. I’ve invited him here on the podcast to talk about osmosis, how he conceived the idea and built it up, uh, to where it is today. Hey Shiv.


Thanks for having me.

Awesome. I wanted to find a lot about your current company, how you launched it and how you’re 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? What were your initial years growing up? Yeah, happy to.

Um, so I, uh, I was born in Namibia in Subsaharan Africa, and my dad is a retired general practice physician and a mom’s a physical therapist. And they had moved from India, um, where my sister was born and they were born. Uh, to go to Africa, to practice. Um, and then they moved us from Namibia to South Africa, right outside of Durban for a couple of years.

Um, and then, uh, then we moved to Florida because there was a large need for physical therapists. And my mom, uh, being one sod is a great opportunity for her children to, um, take the next step in terms of their educations. Continuing westward migration. And so a group in Florida between, um, 1995 and 2006 finished high school there, uh, in a area of the state called Cape Canaveral, which is where the Charlotte’s takeoff.

Um, that’s where my area code is three, two, one, three, two, one lift off. Um, and then I went to college in Boston, went to Harvard, did a engineering degree. I took a year off after I finished that before going to medical school, which is where I started a company, I suppose. So your mom was a physical therapist and that probably had some influence on you on your current initiatives, but I know you’re done a few others before you launch your current company, small since like, could you share a lesson or two from the other projects that you have done, like smartphone.

A physical patient promise. I’ve seen this, I think quantified care and med guided. If I’m not mistaken, those are all initiative that you started or you’re part of, I guess, right? Yeah. So I liked the word they used projects, um, because they really were just projects. I mean, there’s a, a lot of students who have great ideas and, and, and wind up starting something, uh, they get, maybe they do a tech incubator or they went to hackathon and, um, they start slipping up.

And really osmosis is the only company that I’ve done. It’s the only company I’ve cofounded and been part of that really went from being project to company. Um, you know, the theme B between all of the stuff that I’ve learned is, um, passion. Like basically one of my business school professors said was she, if 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 out of osmosis, but some of the other things we had dabbled with, like the smartphone of physical, which became quantified care.

It really shaped my world view on what’s possible and digital health. Um, 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 added and then, and then grow it to the stage where we feel we are right now with osmosis.

Yeah, I heard you. I think I have heard you in one of the other podcasts. So you talked about you don’t make things or you don’t make an impact by starting things, but by finishing things, uh, I really wanted to spend a minute or two on that because that’s one of the problems that I’ve my soul 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.

Yeah. So I will caveat it by saying it’s really important to know when to quit something, right. When to, when to start going to go further. Um, just cause you don’t want to say the sunk cost fallacy, a lot of people take, um, And I think the biggest thing for me, like osmosis, didn’t it didn’t feel like, Oh, I have to stick it through.

Um, it just was the one major thing I kept doing that was just fun. Like, I mean, it’s been a really different journey and there’s definitely been hard days and hurt heart month even. Um, but overall the trend has been up into the right and, uh, 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, um, Um, a flywheel effect where things will, you know, keep, keep turning. And even without much more energy, there’s like a momentum. Um, and we certainly feel that with house Moses or a doom loop, which is where, you know, things that you keep trying to push it and like it keeps hitting walls.

Listen, there’s only so many times something you hit a wall before you breakthrough, but generally I think we start a podcast and, um, something you and I were talking about before the show, they give the illusion of overnight successes. Uh, and generally there’s no such thing as an overnight success, that jokes that it’s an overnight success, 10 years in the making.

Right. So if you had to describe those monsters, 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. You mentioned that. Cause our team, uh, before they joined us, uh, started Khan Academy, health and medicine. And so that’s our, our chief medical officer, dr.

Rishi Dessai was the head of Khan Academy, health and medicine. Um, however, if I was describing me 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. Okay. We train medicals, medical, nursing day professionals, but we also have a lot of patients and family members who consume our content because, um, 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’ll help you care for them better. Anyone like caregiver per se, or is it anyone who cares about being healthy? Brilliant. Anyone? I mean, so we have a lot of content in nutrition that people consume just for themselves.

Um, we had a comment this week from a patient, a person who has preeclampsia, um, and she sent that video to her father, um, to understand her preeclampsia. Um, that’s definitely the, it’s not our business model. That’s just our value add to the world. Um, the business model really is the end to end training.

We do for. Uh, medical nursing and PA students in schools. Um, but as we keep growing and get, get a bigger and bigger audience that’s, um, the goal is to be able to, uh, to reach as many people who care for other people. Got it. How big is this Moses? And when did you start, as you said, flywheel, right? I’m sure it was not like you didn’t start like yesterday.

How big is it? How have you grown steadily over the years? Yeah, so I divided into three phases, phase one was the student phase. Um, so the project phase 2012 is when we officially started the company. Um, mostly the only reason we made it a company, it 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, now we need a name for this thing. And so, um, that was a student phase, still the medical students at Hopkins. I went to business school then in Boston. And so. Uh, the first four years were really just kind of hacking things together. We went, we do get a couple of thousand users.

We started getting tens of thousands and hundreds of thousands of revenue from that, but it 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, um, 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 cofounder. 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 realized, okay, we need a little more money to do this because if we want to totally virtualized 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.

Um, and the first money in where my business school professors followed by. Some pretty impressive list of medical angel investors who then got us into some venture funds like Ray Croft. Um, so that was phase two, which is platform, project meets content starting to really grow quickly. Um, last year we crossed a million YouTube subscribers and that was a big milestone for us.

Mmm. And we cross, you know, we went into the seven figure revenue, uh, uh, 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.

Oh, it was only when we started releasing it on YouTube where we’re like, Oh wow, like a bunch of 10 to 15% of our comics are from patients and family 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 has projected, I catapulted this, this next category, which is how do we go from just being a supplement training, healthcare workers.

For curriculum and tests doing primary and work with the a hundred schools. We now sell to, to be like build end to end programs, to get people into meaningful jobs. So we’ve entered into a much bigger, more ambitious phase, um, phase now. Got it. And the, just to take a step back on that mean you’ve packed a lot into it.

And just to talk about the initial struggles, like the MVP, the minimum viable park, people talk about it 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 do pay for it. So you can actually produce high quality content. How did that happen? Yeah, so the first MVP was just basically, um, our medical classmates at Hopkins were using it. So we had, um, a lot of empathy with the end user because we were the end user. We were trying to solve our own problem.

Um, and so that was where we went from billing, like a really. I guess Reed Hoffman says you gotta be ashamed of your first MVP, otherwise VP. So really shameful, um, like platform, uh, to crowdsource questions and flashcards. And then we realized, okay, we need good, better content to go from a couple thousand users to.

Tens or hundreds of thousands or millions of users. Um, and so the first couple of videos that I suppose this were also kind of janky and shameful. Um, but our video production team like solved a lot of the kinks. We built internal software to improve it. Um, and we really listened to the customers. So we, one reason we put her on YouTube in such a public forum were so we can get as many comments as we did that helped us refine it.

So one comment specifically led to. Us adding a recaps at the end of every video, which has been super popular for us. And it’s led to a lot of, uh, you know, um, SEO improvements, search engine optimization, because now we have these recaps for every video too. Right. And YouTube has always been part of your strategy from day one in terms of getting people and the support content.

Yep. Exactly. Yeah, cause, cause that’s top of the funnel for us. And so many people are looking up things on YouTube and Google. Um, and so that’s where we started really building a lot of our traction. Why did you choose to do it this way as opposed to being part of an existing, um, Coursera or one of those big platforms like that you do me or your Udacity?

Yeah. Um, one was the, uh, our ability to create our own platform. Like a lot of those platforms are meant for general courses. Um, medical education is different in that. Uh, 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, because if you’re a physician or you’re a medical student who learn with assmosis 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. Um, and so you have to update your knowledge of course, Coursera.

And you’d ask the, we know those guys. Well, they’re actually part of my own podcast. I’ve interviewed them, but, um, they, um, 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, as the knowledge changes.

Yup. That makes sense. I think I’m going through this journey. I want to touch on the, uh, I guess the emotional aspect of it is like, are you, I mean, you put your MD on hold if I’m not mistaken. Yeah. Yeah. What was that? It’s surprise to your friends, family. How is it that you’re able to go through this? Are you afraid of failing on giving up on this amazing MD path?

What is the deal there? Yeah, it’s funny. Um, you know, my, I mentioned my mom’s a physical therapist. My dad’s a 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. Um, Actually my sister’s an entrepreneur, she and her husband started a bunch of dollars.

So, you know, it was dearest, it was one year off to do the tech incubator and then I went to business school. And then by that point, it was just so clear that we were so passionate about the scale that 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. Um, right. Like as a health professional, you’re fairly limited in 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, um, I haven’t ruled out going back to med school, but right now I really enjoy what I do with us. Mostly. I keep hearing you saying that somebody need so empowering, which is like, um, billing.

Uh, that flywheel the moment I’m in small steps. And, uh, 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 Mmm. You can share with the audience in your journey so far.

Yeah, definitely. I think, um, I mean, a couple realizing that the core strategy wasn’t working and we needed a content strategy was pretty. Pretty important. Um, 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 it would be sufficient, but we were wrong.

And that’s where we had to kind of swallow that embarrassment and like bring on the team that ran con Academy and build up content. Mmm. The, I like to analogize, like building company, like climbing a mountain range, like we are. Really I’m excited about the mountain we’re on, but things get harder. Um, so they don’t just get easier.

And there are a lot of things that you miss about it. So like my cofounder and I have a lot more people between us, like working on things, um, and that’s important to scale, but like, because we weren’t meeting weekly, our relationship was degrading a bit. Uh, and this is someone who was my best man at my wedding.

And, um, 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 we were just hacking together were pretty dark having to just confront that and saying, look, if we continued on the path, we’re on, we’re going to be one. Those countless stories of cofounders are brothers.

Like they embody brothers. 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 our, you know, really in good, good spirits now again. Um, but I was getting pretty dark. Um, and so the natural, like human, emotional side of building a company 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 cofounder and try to. Make things right. Um, I wonder if, uh, how many people actually take that because it’s a little bit scary, I guess, to have that kind of a conference conversation, um, taking, uh, shifting gears a little bit, looking into the future. I know that you’re doing, um, a lot of video and I’ve actually done videos.

I was working at NBC universal before my job. Uh, 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 were 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 right.

People or whatever, is, is machine learning part of your strategy and how is it. Being implemented. Yeah, it has been, um, 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, um, and, uh, we’re documents.

And osmosis has an algorithm. It’s very common. An 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 recommendations. So we’ve been doing that actually for like, For years, but moving forward, cause you were a good friend of mine from business school is product manager at Amazon for, uh, AWS predict, um, which worked with Coursera and Netflix on the predictive tools.

Um, so, um, 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 cool. And I’m just on the futuristic side of things. What is your moonshot for last time? I was there. It’s 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 our semesters to be. So, um, we, and the vision again, is 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 will have, um, uh, our content in electronic health records and waiting rooms. Like they already are. Uh, we will have training programs for certified nurses assistants, um, who then go on to help code with other patients and people.

Um, really, we are just trying to create a world where people are more capable of caring. Like right now, that’s like the actual process of caring. How do you place an Ivy? How do you treat somebody who has a dementia? Um, those are like literal ways to care, but then in general, we’re trying to also, um, help people be more caring.

Um, so. We have a whole constant, like whole curriculum and empathy training. Um, one of our core six values, two of them want to start with the heart. The other is spread joy. Um, so we’re very values and mission driven company. Yeah. And I’ve 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 are really helping people become better caregivers. In whichever situation there may be family or professionals. Um, just a few rapid fire questions. You don’t have to answer the fast, but, uh, any a book particularly that comes to your mind that you’ve gifted a lot or recommended to people. I liked the Ben Horowitz books, hard thing about hard things.

And most recently what you do is who you are. Yeah. Awesome. Um, yeah, those are, I I’ve read the hard things work itself. Um, and I loved their blog as a late as 16 Z blog, of course. Um, and, uh, one piece of advice that you’d give yourself, knowing what you know now to your teenage self. Sorry. I think just don’t, um, there’ll be in a rush, like things, things work out just as long as it’s like the whole Louis pasture or quote that chance favors the prepared minds, or just spend your time be prepared and don’t be in a rush.

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. It’s 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, I think is a big deal.

Yeah. I think, I think humans are essential, right? Like everything’s going automation. Like in, in virtual, um, I mean, 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 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 care, the caring is the essence moving forward. Um, so I think that’s, that’s the big bet we’re taking that. There’ll be this counter counter movement where people realize. But they still want human connection in a world of automation and robots. Yeah, absolutely. Um, 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 at osmosis, the first one, start with the heart, start with the heart. Yeah. Awesome. Nice, great way to end that. Thanks a lot chip and I wish you the best. I hope to have a chance to talk to you again. Thank you very much. Thanks for having me on.