Career Reinvention After Leadership Shakeups | Amy Hay (Part 3/4)

Intro - 00:00:06: Welcome to the Biotech Startups Podcast by Excedr. Join us as we speak with first-time founders, serial entrepreneurs, and experienced investors about the challenges and triumphs of running a biotech startup from pre-seed to IPO with your host, Jon Chee.

In our last episode, Amy shared how she became an administrative fellow at MD Anderson and worked with Dr. James Cox to bring proton therapy to Houston, while also opening MD Anderson's first successful satellite clinic in Bellaire. If you missed it, check out Part 2.

In Part 3, Amy talks about the high-stakes journey of raising $125 million to build MD Anderson's Proton Therapy Center and how the September 11th attacks forced a complete pivot from Wall Street investors to firefighters' and police officers' pension funds who believed in the mission, not just the returns. She shares the moment she realized she was getting bored after the Proton Center launched and how that restlessness led her to global oncology work with the Einstein Center in Brazil, where she learned that plug-and-play healthcare models don't work across cultures. She also discusses building the MD Anderson Cancer Network to expand the institution's expertise across the U.S. and internationally, her consulting work in Nigeria, and why the 2016 leadership change at MD Anderson became a painful but pivotal turning point that forced her to reinvent herself.

Amy Hay - 00:01:55: Maybe as an aside, one of the mentors that I have is a gentleman by the name of Henrique Neves, who is the COO at Albert Einstein in Brazil. I met him, gosh, we say now 15 years ago—because I don't like to say 20 because that sounds very old. But he says he remembers me being young, sitting in the back of the room, not having a seat at the table, and just absorbing everything.

Over time, I have continued to work for Einstein, and I still do to this day. Right now, I'm sitting here doing this podcast with you and helping them on their journey across oncology. When I started working with them—when I was at Protons and then back at Anderson—we developed their first oncology clinic. We tried to mimic it from MD Anderson. They became one of the MD Anderson members, and that was actually a moment in time that I tell everyone.

I was young, and I was passionate. I felt like Anderson is an incredible organization, which it is. But just because it works in Houston, Texas, doesn't mean it's going to work in São Paulo, Brazil, or in Dublin, Ireland. It has to work with the people, the culture, and the energy. You can get the same effect, but you have to tailor it. So, lesson learned.

I came into Einstein, and I started consulting with them. We developed the oncology program, and we developed all of these beautiful clinics in which there were no physician offices. They were all just clinic rooms. Well, in Brazil, the culture is the doctor stays in the room and he has his office there, or her office there, and the patient comes in and out. The doctor has their clinic room and their office together. We eliminated that because Anderson doesn't need it, so why should Brazil need it?

We opened up that oncology clinic, and you could hear crickets because nobody was there. It was one of those moments where I realized you can't just plug and play human beings. It doesn't work. You've got to understand what's important to them. Sometimes you have to make sacrifices; sometimes you don't. But you have to be able to focus on the outcome you want, not necessarily how you get there.

We ended up having to demolish all of those clinical rooms and set them up in a way that the culture accepted, and all of a sudden, they were full. Fast forward, Albert Einstein today was just ranked number 17 in oncology in the world. They're one of the top innovation sites, and a lot of my focus right now with them is developing the next stage of precision medicine with cell therapies, diagnostics, advanced AI, and multi-omics. So, it shows you the value of how you can start very small in creation with the right people, tailor the approach, let them own it and breathe it, and support them—and that will grow. That will eventually become something that you're very proud of.

Jon Chee - 00:05:10: That's amazing. I love that lesson. It's convenient to have a plug-and-play, "what works here will work there" mentality. But I totally agree. You really have to dig in, know your personnel, and understand what the norms are and why they do what they do. Because without it, exactly as you said, you're going to have to start from scratch again. You're going to have to demolish the clinics. People have different ways of life, and being receptive to that and meeting people where they are is a critical lesson.

If we take this to any business, if you create a tool or product and assume people will come—no way. You gotta meet people where they are.

Amy Hay - 00:05:58: Exactly. That's well said. You have to meet people where they are. I have a great anecdote you just made me remember; I haven't thought about it in a long time.

During those years when I was in that role at Anderson and I was focused internationally, we had a chance to do some consulting work to develop a cancer program in Africa. The team didn't understand why they would not just follow our protocols for their CT—how they would flow a CT out, how the patient would come in, how they would do the image. Why wouldn't they pull our protocols? This should be easy.

So, we took a field trip over there, and we met with the physicist who was running the program. It was at a hospital that was on a backup generator for their power. Their OR had no doors. They had no windows on their facility. Their CT machine was hooked up to a generator, and when they did a scan, that meant part of the hospital lights went out.

Jon Chee - 00:06:55: Wow.

Amy Hay - 00:06:56: That's why they couldn't follow our protocols. Just having that moment and talking to this unbelievably educated physicist who was there—I wish I remembered his name because I'd love to find him. He came from an incredible education, and he was there because he was passionate. That was his home; it was actually in Abuja, Nigeria.

He said, "Look, I do whatever I have to do to get the very best scan I can get. Is it going to be the scan that you would get in an academic medical center in the United States? No. But, honestly, for that patient, that's probably what they need. They need what I can give them, and I'm going to do everything in my power, even if it takes duct tape to get it done."

There's a little bit of that which I think we all need to remember. Sometimes you have to do it differently. As long as it achieves the same value, who cares? If it gets that patient what they need, okay.

Jon Chee - 00:07:56: That's exactly it. Not being too precious about it. I think we can all get really precious about it—"It's this process, this way, mine." Then you have this moment where you realize, "Oh, that's why my way does not work." So I love that, and I think that applies broadly.

I'll take the flip side to that. There are sometimes people where it's "my way or the highway," and it ends up working out. It's not impossible, but I would say that's a very rare outlier. The example that comes to my head is the Steve Jobs style where he says, "No, you guys need to understand the smartphone." But I would bet in most cases, more often than not, that's an outlier.

So, it sounds like you've really expanded from being more United States-centric, and now you're global in nature. You're seeing perspectives from folks all over the world, and this sounds like a really sweet gig at MD Anderson. When did you know it was time to leave MD Anderson?

Amy Hay - 00:09:15: That's a really good question. It was interesting because hindsight is always 20/20. In 1996, I had that naive checklist. I wanted to be on the 11th floor. I wanted to do this and that. I wanted to learn, and I wanted to have these mentors. I was very lucky, and I worked very hard to accomplish many of them.

By 2016, we now had a cancer network in the United States that was really blossoming. I had, with a team, developed the MD Anderson first location in Arizona with Banner. We developed the second location in New Jersey with Cooper. We had a center underway in Florida with Baptist and Scripps in California, and it was running. We were making an impact, it was powerful, and we started growing.

Then I took a little bit of a perspective of, "I need to start being a mentor, too." I had been, for so many years, the mentee. I'd been learning and learning. I was at a point where I needed to start giving some of that back. I started really developing multiple people that were interested and wanted to be part of it, trying to give them the opportunity. I'm proud of that because I think it's so important to always take a step back and give back along the way. Sometimes early in your career, you can't because you're still fledgling. But as you get older, take a moment to give back. Take a moment when you don't have to talk to somebody who's young and growing, or young and struggling, and share your experiences.

As time went on at Anderson, I also realized that I was getting lazy. The deals were very similar, and I could do them now. I'd proven that. While I really enjoyed it and I still believed in what I was doing, the world was also conspiring against me to make me make some changes. As my husband likes to say, I am the luckiest unluckiest person you've ever met.

In 2016, it was another pivotal year at Anderson. New president coming in, new C-suites. The president's priorities were not really global expansion for a lot of very good reasons. I knew that my time was probably coming to an end. I will say it was probably the most humbling, perhaps painful period, because I had then been at MD Anderson for 20 years. It had defined me. I went there right out of college. Even with Protons, I wasn't really gone; I was just down the street. And 20 years later, while I was so very proud of what I had done and the people that I had met—these incredible superstars of cancer research—it was hard to go. It wasn't easy. It was a little bit of a hit in the stomach right when you think you're at the top of your game, and something takes your legs out from underneath you, and you don't even see it coming.

It probably took me five years to talk about it, but now I tell this story as often as I can to young people because my husband was right: I'm the luckiest unluckiest person in the world. It was probably the best thing that ever happened to me because it forced me to break out again, to do something different, to be creative, and to learn. I feel like the moment that you stop being curious in your job is the moment you need to run out the front door.

Jon Chee - 00:13:06: Yeah.

Amy Hay - 00:13:06: Because you're getting complacent, and I don't want to be a complacent person. The day that I left Anderson, I got in my car, and I called my mentor in Brazil, Henrique Neves. I was very upset. My whole world had just gone upside down overnight. And he told me something that, still to this day, is one of my mantras.

He said, "Amy, really creative, smart people that are passionate for the right reason—you could do anything. You could take that passion and put it in healthcare. You could take that passion and put it in banking. You could take that passion and put it in oil and gas or airlines. You could do any of that. So give yourself a moment and decide what you want to do."

He said that from experience. Henrique, in his career, started as a lawyer, then he went into oil and gas, then he actually ran an airline that was going bankrupt, and then he pivoted into running the Albert Einstein Institute in Brazil, which is the number one hospital in all of Brazil and Latin America—an incredibly innovative place. But his journey started as a lawyer in London, in the Amazon in oil and gas, and in the airline industry because he really believed in that mantra: If you're passionate, curious, and willing to learn and take some risk, you can do anything you want to. You can flip industries. Actually, quite honestly, there's more value in that often because you come to that industry thinking differently, so you're offering value at the table.

All that to say, while that was a personally difficult inflection point for me, it was also one of tremendous growth. A good reminder—and I tell this to my kids all the time—we're all replaceable. The moment that you stop growing, stop learning, and stop being curious, you're standing still. It's like a shark. Sharks don't stand still. You've got to keep going. If you find yourself in a position where you're no longer interested or curious, it's time to pivot.

So with that, what I did is I took a few months and I licked my wounds. I actually went to Brazil and helped them with the cancer program and got some new things going. Then I came back renewed because I had decided that I wanted to open up my own consulting shop. I wanted to focus on how to bring together doctors and researchers but then add in pharma, big data, and a mentality of innovation, startup, biotech, and medtech.

I put together a very small—but it was so much fun—consulting firm called Evolv, a purposely chosen name because it felt like it was my evolution. I was trying to take all the pieces that I'd learned and bring them together to see if I could find a value proposition. My clients spanned from Albert Einstein in Brazil to Varian Medical in medtech, to a few digital startups, to a non-profit in Australia. I was really trying to carefully select clients that I thought in some way would benefit the other clients.

I did that for about three years and learned a tremendous amount. Again, it was like drinking from the fire hose. I mean, with Pharma 101 and Artificial Intelligence 101, I just absorbed and absorbed.

Ultimately, right before another world inflection, the pandemic hit. Right before the pandemic, I was very lucky in that Varian Medical Systems, who was one of my clients, said, "Hey, we really want to grow our international business. As a medtech company, we don't have the internal knowledge on clinical delivery, and you do. And now you bridge the academic medicine to community medicine to medtech. So can you help us dial together?"

I sold my company to Varian right before the full-fledged pandemic. Again, unluckiest, luckiest person, because I would have gone bankrupt in the pandemic. Everything shut down. As a sole consultant, I would have gone bankrupt. I went in-house, and that was actually another interesting pivot point because I really then used the opportunity to understand in great detail the medtech side, especially on the diagnostics. So, another inflection point.

Jon Chee - 00:18:02: That's super cool. It's exactly what you talked about earlier: when faced with an obstacle or a hardship or a crisis, don't let it go to waste. How do we take this, learn from it, and create something new? Which you definitely did. Instead of intrapreneurship, this was proper "I'm doing this solo" entrepreneurship.

And what perfect timing, too. Absolutely amazing timing. And talk about learning a bunch of stuff. You went through an acquisition process and working with tons of different clientele. I would imagine there were so many lessons you could absorb from that. As you were taking all these learned skill sets, now you're at Varian. What was the job to be done? How did you approach it? And how was that experience?

Amy Hay - 00:19:01: It's a good example of how I first came into Varian really to help them develop and bridge this medtech-to-provider gap. One of the first things I did was take a piece of paper out from my MD Anderson playbook, and we negotiated a deal in the Philippines with AC Health to build a new cancer hospital. So, leveraging what I'd done before. But this time, the angle was a little bit different. It wasn't about necessarily the connection of the doctors. It was about how do we develop the right environment, the infrastructure, and the equipment to create a cancer program, and then supply the doctors with all the tools so they could do it themselves there locally.

As I went through that at Varian, it was really an exciting time because I always say I was the odd man out at Varian because I came to it with a completely different perspective. Most of the people at that time were in a sales organization. They sold linear accelerators—the best linear accelerators in the world—but they sold, if you will, a widget. I was never able to be like that because I didn't believe in selling a widget. I believed in providing access to therapeutics and providing supportive tools to doctors.

So as I came into Varian, I was the odd man out. I thought about things differently. I didn't want to talk about selling a linac. I wanted to talk about developing a cancer program, and, oh, by the way, they're going to need a linac. That, I think, was a new approach for Varian.

I was fortunate enough that I was able to rise into a position in which I was running their strategy and business development because I do think having that different perspective really served me well. It made my ideas different because I'd experienced different things, and I think it contributed to the overall good.

The other thing that it did is that as Siemens Healthineers acquired Varian, it also put me in a position of being able to bridge the two organizations because I could see more on the digital diagnostic side versus the therapeutic side. I understood from being in the clinic how the two camps exist in silos. They're completely integrated no matter what. So I think that was a real opportunity for me to learn. I got a lot of my expertise in diagnostics from those years with Siemens Healthineers and Varian. So, again, back to that constant growing. These things are all opportunities to just absorb knowledge and then try to apply it in a different way and see if it works.

Jon Chee - 00:22:02: Absolutely. And when you joined Varian, how big was the company?

Amy Hay - 00:22:08: It was a global company, so I would guess 5,000 employees maybe. I would have to look it up. Global company, but nothing compared to Siemens Healthineers. It was like this giant absorbing them, and that's also a transition for a lot of people.

Jon Chee - 00:22:24: That's what I was going to ask. You went from MD Anderson, a very large organization, to your own startup, and then now you're at 5,000 people—still a lot of people, but not Siemens.

Amy Hay - 00:22:37: Yep. Global conglomerate. I think that's a really important point that I haven't really thought about—the pivot back and forth between those two mindsets. I think that's a skill set that takes time. Believe me, there are times now where I'm like, "Okay, you need a timeout. Go to your room and get yourself together," because it is difficult.

When Siemens acquired Varian, there were kind of two heaps, if you will. Perfectly understandable. You had people that had been at Varian their entire career, 40 years. That was who they were and what they believed in, and it represented them. And now you have this very large company that's orange instead of blue—that's brand new. So there is a camp of people who were tried-and-true Varian, which was, to be quite frank, the majority. That's a very normal takeover/acquisition scenario. It's human nature.

I think because of my background, I kind of saw it as fun. It's like an opportunity. Now, instead of having just Varian, I got this bigger Siemens Healthineers, and they've got all this cool stuff that I don't know about. So it's the decision of: are you going to leverage this to learn and grow, or are you going to stay entrenched? The people that leveraged it have done amazingly well, and I am very proud of their work.

Ashley Smith is a great example. She is a brilliant woman who was at Varian working on their information systems. She rose in her position and now is really leading at Varian, but absolutely part of the fiber of Siemens Healthineers now. So it's taking that moment to pivot and embrace the opportunity, which I think I did, and I really enjoyed it. It was a learning opportunity and definitely a learning opportunity with people that thought about things differently.

I think that is another one of those value points that often gets ignored: you should seek out different opinions. You should want to do that because that's either going to make you more firm in your belief or it's going to force you to think of alternatives.

So I stayed at Siemens Healthineers Varian for about three or four years. I was very fortunate in that I was given quite a lot of ability to develop the strategy myself and really implement it—not just develop and not just execute deals, but then actually see them through and make sure they're successful where you hand them off.

During that process, I was again working with my mentor and some fellows at Albert Einstein, and we started talking about their next journey for their cancer program, which was precision medicine. It's time. They'd grown. They had incredible doctors now, multidisciplinary care. They were doing research. So what's next?

What was next for them is we developed a precision medicine plan that had three spokes. One spoke was cell therapy. The second spoke was Theranostics, and then the third was Multi-omics, all in the context of this incredible digital infrastructure that was going to create knowledge. Through that, I picked up my handy Rolodex and called a couple of friends, and I said, "Who do you know in cell therapy? And not just in cell therapy research, but who has bridged the divide between academic and industry?"

Because in cell therapy, you see even on the biotech side, you're either in the academic side for the pure academic pursuit—which is incredible and important, and we need that—or you're on more the industry side, which is the manufacturing side, more in pursuit of commercialization and margin. We need both. But who has done this in a successful way in which you harness the value and the spirit of the academic side but then was able to translate it into a scalable industry to make a profit margin so you could help more patients?

At that point, I got introduced to Jason Bock, who runs the CTMC, the Cell Therapy Manufacturing Center in Houston, Texas, which is a joint venture between MD Anderson Cancer Center and Resilience. And it really was just that. The irony of it is, I tell this story and it always kind of makes me giggle because here I was, spent 20 years at Anderson, left—it was kind of devastating and hard, and I had to pick myself up—did all these other things. Never in a million years did I think that I would full circle it all the way back. And that's exactly what I did.

Jon Chee - 00:27:49: It always comes full circle.

Amy Hay - 00:27:51: I know. Again, back to the history comment. So as I was introducing Albert Einstein to CTMC, I was also drinking from a fire hose, learning biotech as fast as humanly possible, and also became enamored with their business model behind that, which is really that transition of harnessing the value on both sides of the academic and the industry curve.

So I made a really hard choice to leave Siemens Healthineers. On bad days, I often think I made a mistake. On good days, I know I didn't. But it was really a pivot for me that was based on passion. It wasn't based on money. It wasn't based on my boss or the personalities. It was based on the fact that I was so curious and excited about making a difference in cell therapy. I didn't really have a choice. I needed to be part of it.

Jon Chee - 00:28:49: Love that. A couple of things stood out before diving into CTMC. I know a lot of the time with acquisitions, it's almost like organ rejection, but it doesn't have to be organ rejection. If you think of it as exactly what you said—as an opportunity to learn from this other organization—it's just another opportunity. It might not be the same exact thing that you're used to. You're now part of, presumably, a well-resourced knowledge hub. And, yeah, they might do things a little bit differently, but there's always something you can learn.

There's also something to be said that some people thrive in smaller organizations. When I think about entrepreneurs, sometimes people really thrive in the zero-to-one phase. That's just the pocket for them, and they're like, "I need to keep doing that." And then some people are like, "one-to-n." Like, they're just like, "We can really scale this thing." And then there are folks who can kind of do the flex that you're talking about: zero-to-one, oh great, I can also do one-to-n and kind of do that full spectrum. But I think regardless of whatever camp you might fall into, you can always learn something from the zero-to-one folks and also the one-to-n folks and have that help sharpen your skill set.

Looking back on Varian Siemens, were there any key lessons from the Varian side of the house or key lessons from Siemens that you take with you to this day? Or perhaps folks who particularly stood out to you if you were to put them into their own kind of buckets?

Amy Hay - 00:30:26: No, that's a great question. And I think that one of the things that I really took away from that is looking at both sides of the equation as reality, whether we like it or not. You are going to feel one way if you are being acquired versus you are going to feel another way if you are the person acquiring.

I think that was probably one of the most important lessons: listening and appreciating, but then trying to pivot to the positive with people and showing them that this is an opportunity, not a regression. Your pool is bigger. Your yard is bigger. I do think that's a really important piece.

I would say the other piece that I think about quite a bit is how to manage the human being during that. Are you better off pulling the Band-Aid off? Are you better off just taking it off piece by piece? There's two sides of that camp. I think that the honest truth, like everything in life, is it's a happy medium. Maybe you slowly get the edges ready to go, but then you rip it off. Because at a certain point, we do better as humans when we have structure and we can understand the environment. Indecision is a space where not a lot of people thrive in. Those that do are unbelievable.

Jon Chee - 00:31:56: Yeah.

Amy Hay - 00:31:57: But if you're leading an organization, I believe you need to think through the human psychology of change and onboarding. And that's not an easy thing. I'm really pleased to see, since I've left Varian and Siemens Healthineers, I think this last year, Siemens Healthineers has made some huge strides in bringing Varian into the fold. Really, we're all one company, and I think that's going to pay off for them over time.

Jon Chee - 00:32:26: Yep, absolutely. And I think this is something I think about when folks are joining forces. I always am curious: do you integrate or not? If you think of the Roche-Genentech example, Genentech's like this distinct entity, and that seemed to work for them. But there's also plenty of examples where the integration makes a lot of sense. I don't have the answer, but I always am curious when do you do either/or? When is it the right decision to keep it distinct? I don't know. It was just something I was scratching my head about.

Amy Hay - 00:32:58: No, I think it's a good question. When I think about that, to me—because so much of my strategy thinking is built on synergies and alignment and how do we incentivize—the only situation I would see where you wouldn't want to integrate is if the entities and the purpose of the organizations are not aligned. Because, otherwise, you should be able to find a value add.

But, again, to your point, there's examples where they've kept components separate and they've thrived. But in a world where we're all, especially in the medical side, driven by how do we make it scalable, how do we make it cheaper, how do we make it accessible? With all of those driving forces, how do you not look for every point of integration?

Jon Chee - 00:33:49: Yep. Totally. And that's a great point, I think, especially in our industry. Scale economies matter, super matter, especially how capital intensive our space is. So now you've decided to join forces over at CTMC.

Outro - 00:34:07: That's all for this episode of the Biotech Startups Podcast with Amy Hay. Join us next time for Part 4 where Amy recounts founding her consulting firm, Evolv, selling it to Varian Medical Systems right before the pandemic, and navigating the cultural shift when Siemens Healthineers acquired Varian. She'll also unpack her transition to CTMC, how the organization is derisking cell therapy development by providing end-to-end services from Phase 1 to commercialization, and why business model innovation, not just scientific innovation, is key to democratizing access to advanced therapies.

If you enjoy the show, subscribe, leave a review, or share it with a friend. Thanks for listening, and see you next time. The Biotech Startups Podcast is produced by Excedr. Don't want to miss an episode? Search for the Biotech Startups Podcast wherever you get your podcasts and click subscribe. Excedr provides research labs with equipment leases on founder-friendly terms to support path to exceptional outcomes. To learn more, visit our website, www.excedr.com. On behalf of the team here at Excedr, thanks for listening.

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