Making Pharmacy Easier | Derek Borkowski, PharmD, Pyrls Founder & CEO

Speech to text:

Mike Koelzer, Host: [00:00:00] Derek for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today. My 

Derek Borkowski, Pyrls: name is Derek Borkowski. I'm a pharmacist and a software engineer, and I'm excited to share my story going from a kid, wanting to be a community pharmacist to in the middle of pharmacy school, getting interested in startups and technology, and now afterschool going from being a community pharmacist to working in my own internet company, 

Mike Koelzer, Host: Derek I'm jealous because you know, code well.

Well enough, did you study that officially or was that on the side? 

Derek Borkowski, Pyrls: Actually during pharmacy school, an internship I was doing at a startup once I got interested in. I would, the startup I was working at was focused on medication adherence. It was called my meds here in Minneapolis, and I basically went and knocked on the door and said, Hey, is there, I'm a pharmacy student?

I think I'm interested in technology. Is there any way I can help here? And so long story short, they gave me an opportunity to come in and help kind of keep track of like drugs on an Excel sheet that would go into our app. But what they found was I [00:01:00] actually would love giving suggestions to like the engineers in the product team.

I'd be like, Hey, can we add this feature? I think it'd be, I think patients would really like this, or I think the clinicians would really like this. And after a while, like the engineers, you know, they would humor me as a little, you know, a pharmacy student giving me suggestions. But one of my good friends, who's a mentor.

He said to me, one time pulled me aside one time and said, Hey, Derek, you know, we love the energy you bring, you know, you can actually learn some of this programming stuff. And I think it would help you explain to the engineers a little better. What's, you know, you're trying to communicate to them and further you might understand the difficulty of.

It's easy to change the color of a button, but, and we might be able to get to that, but changing the whole outlook of our app is maybe not something we can get to tomorrow. So I think you'd enjoy that. And so I was like, oh, okay. Um, okay, where do I start? And, you know, long story short, that's how I got started kind of self teaching myself programming.

And it went from yeah, a little hobby where I was interested in, just understanding some basics to becoming sort of obsessed with it throughout my third, fourth year in pharmacy school. And then into my nights and [00:02:00] weekends as a practicing pharmacist, 

Mike Koelzer, Host: If I showed up at a company like that right now, they wouldn't think I was a beggar or they would think I was having a heart attack at my age or something like that.

I couldn't just show up and become a 

Derek Borkowski, Pyrls: coder. Yeah, certainly it was one of those moments that I look back upon and like how grateful I am to the moments team and especially the CEO. There's a major mentor of mine. He's uh, he's another clinician who started his own internet company. And I didn't know, I didn't know what I was getting into or what, you know, it would, it would set me down.

I appreciate 

Mike Koelzer, Host: It was probably in our pharmacy, oh, 20 years ago or so we needed medical equipment rental software, and I thought, well, there's nothing. I found it very great online. I said, I'll have a local company build me a rental software. And they had a program. I think it was called something like FileMaker pro.

It was FileMaker pro. That was an old program. And then, the selling point of FileMaker pro was you can code stuff and then you'll learn how to do [00:03:00] it. So I said, okay, I'll spend a couple thousand bucks on this rental program and then I'll know how to do it. So we got this thing done and I was able to change, I think the red button to gray, like two years later when we needed to, but that's a cool thing.

If you learn code, like you'll learn code, is it like learning one language, like learning German and then you don't know the other languages or when you learn it, do all the coding languages then become easier. 

Derek Borkowski, Pyrls: Yeah. That's a really good question. I would definitely compare it to potentially learning a new language.

And so certainly once you learn, so the programming language that I'm far and away most fluent in is JavaScript. And however, when I see Python code, which is another property language, I don't immediately necessarily know what's going on, but if I look closely at it, you can recognize similar patterns.

And just yet, like in German, it's like, I'm going to learn how to say hello. So you can tell when somebody is trying to like, say hello in a different language, or you're trying to describe an [00:04:00] action, especially for pharmacists who get interested in programming. Actually the first thing immediately after that, that conversation I told you about where I started learning programming, I actually went out and started trying to learn mobile app programming because that's where.

You know, we had a mobile app and I thought that sounded really fun to make iOS apps. And I immediately ran headfirst into a wall because it takes a little bit of time to get the fundamentals in place. And it's actually kind of complicated, it's more complicated than, say , making websites. And it's actually also true of data analytics, which is something that's real, or informatics, which is really popular for people who want to try and learn.

And so the thing that I got lucky on was I started learning website programming, which in my mind is probably the most, the easiest place to get. Because there's a really fast feedback loop on learning. You can basically in 10 minutes, learn how to make a website because the Cody write can immediately be executed on your Google Chrome browser.

But if you're ready in mobile app code, it's [00:05:00] actually not as easy as like you'll write it from your computer. And so getting it to run on your phone is a really complicated process. So you can't really see that feedback right away. Yeah. And then that kind of is, can detour you. And so it was certainly like, oh, I just said, hello on the website.

Now let me see if I can turn the color pink. Okay, great. I did that. And so there's this really fast feedback loop with website development. It's the same with data analytics. So a lot of pharmacists want to learn data analytics. I think it's a really valuable skill because you see all this cool healthcare data at a big company.

And that is really cool. But when you're trying to learn a lot of times, you have to use tutorials or websites where they give you practice data. That's really boring. Like here's some like baseball statistics from 1970, which might be interesting to some people actually I'd find that interesting, but it's not, you, you don't get the immediate feedback loop on like answering really cool healthcare questions with data.

And so that's where I do think the starting point for someone learning programming, especially if you don't really know what you're getting into. I lucked out kind of starting in the area that [00:06:00] resonated with me the most, 

Mike Koelzer, Host: my website for our pharmacy. I made that, but only in the sense that I've got this, you know, website program that you say, okay, I want this button to go there.

And that button to go there. But as an old fart like me, if I wanted to dabble in programming still, let's say I wanted to give a total of. 10 hours to programming like five, two hour sessions at my desk, you know, just to tap into it. Where would I start? Would it be just like getting on Google? Would I start a real easy coding thing just to kind of get my feet wet?

What would you start with right now for like 10 hours? Just to jump into it. There's 

two 

Derek Borkowski, Pyrls: things that are most important here. Number one, there's lots of great resources, but number two, you might have to have some kind of idea of what you're trying to do. Like am I trying to make a website or am I trying to analyze data?

There's this perfect YouTube video I can think of from one of my, there's all kinds of amazing [00:07:00] instructors on YouTube. And I could send you a one hour video where it basically says, I'm going to take you from nothing to putting a website on the internet and they will teach you the basic HTML code you need to do.

And they'll show you how to get on the internet by the end of that hour. And so that in particular, again, if websites were your. That would be like the first place I would send somebody because you're going to get this incredible positive feedback loop of having your website on the internet. And now it's like, oh wow.

Imagine what I can do. And then you're going to be motivated to like, oh, I want to add a button out. Okay, let me see how to do that. And so in just a little bit of time, certainly you can get your feet wet in programming, especially for people who want to work in technology or pharmacists who want to work in technology programming.

You don't necessarily have to do programming, a dirty little secret of mine, even though I'm the CEO of my business, I actually hate the business stuff. Okay. Keeping track of the accounting, the books, the, the quote, unquote like MBA knowledge. I, that doesn't resonate with me. And so I'm very much a believer in, you know, double down on your strengths and collaborate for your [00:08:00] weaknesses.

So for a pharmacist, I would say, like you mentioned 10 hours of programming. That would be more than enough time to understand, know whether or not you think programming resonates with you and whether you should proceed or not. 

Mike Koelzer, Host: Shark tank comes to town. And I say, Derek, Like it or not, you have to go out on the shark tank set right now.

What business are you talking about and what are you asking the sharks to help you with? If anything, here's why I ask it that way. Sometimes. I wouldn't go on shark tank because if I had the numbers that they demand on shark tank, they say, how much have you sold? You know, when you say, oh, this much, this is way too small for us.

If I had the numbers they were asking for, I wouldn't even get the sharks involved. I would bootstrap it up to that amount. But let's say you have to get on a shark tank. What of your products are you talking about? What are you saying about it? [00:09:00] And then what would you ask the sharks for? 

Derek Borkowski, Pyrls: Yeah, actually right now I'm kind of, my business is doing something similar.

So we're currently just about to finish up the Y Combinator accelerator, where in order to get into this program, it was basically a shark tank pitch. So we had, I had to do a 10 minute zoom call where you pitch your company a 10 minute interview to pitch your company, and then either they take you in the accelerator or not.

So let's hear some of that pitch. The main thing that my business is building right now is a product called pearls. And so I started building this. And my nights and weekends around being a pharmacist at a large community pharmacy chain and essentially a need I noticed for myself personally, while I was on rotations in community pharmacy was having faster access to counseling points.

When my preceptor would be like, Hey Derek, go counsel this patient on these new drugs. And I was scrambled to use the existing references. And I was like, you know, fishing, obviously there's a patient information section, but even among that, I was fishing for the information I needed. So what we're setting out to build now is this product called pearls, which I would best compare it right now [00:10:00] to like a digital version of the top 400 drug study cards, like the most commonly prescribed drugs.

So yeah, we summarize the clinical pearls and the counseling points for different medications and kind of the unique insight that I'm pitching that we're doing is, you know, the existing references. Oh, cool. Medical information references. You know, it's not a novel idea. I'm sure they're written on stone tablets, medical information way back in the day.

Right. But basically the products we have today are sort of like digital versions of encyclopedias. So they're big books with topics, even the drug pages. Right? And so you have to kind of go fishing for what you need depending on what you're doing. And so what I would notice, especially at like at, in my role as the big chain is you would have a patient come ask you a question.

And very often I'd be like 80% sure of the answer. So at that point I had two options. I would either go back to my computer terminal and do the research on existing references or Google to make myself a hundred percent. Sure of the answer I was going to give the patient, but that might take me a few minutes.

The [00:11:00] prescriptions are piling up. People are honking their horns in the drive-through there's angry customer stairs. The manager is trying to get them out about our metrics. So oftentimes what pharmacists and doctors and nurses are forced to do is give the patient an answer you're a hundred percent sure of, but it only kind of partially answers their question.

So what referrals, what we're trying to do is we're building a new medical information reference that supports specific workflows you're doing like I'm about to counsel a patient. So you click that button in pearls, or I'm about to do a clinical review. You know, I just got a new prescription and I'm deciding if I should approve.

That's a clinical review. So here's the, we show you here's the clinical review points, or if you're a doctor I'm about to prescribe a drug, what are the clinical review points? I need to have top of mind in order to do this workflow. So that's my pitch to the shark tank. And then how big is the market? Well, I just described that, you know, right now there's, um, you know, there's over 300,000 pharmacists and over a million doctors.

There's basically 8 million clinicians total in the United States that are all having hundreds of dollars per user, per year paid on them either through themselves [00:12:00] or through, or the health system is, you know, paying for access on a group level. And so I say, well, there's an existing part. There's already money being spent on these types of tools and we can do it even better than those.

Mike Koelzer, Host: Do you 

dislike any of the sharks? Do you know the sharks by name? 

Derek Borkowski, Pyrls: Um, w only the, uh, you know, mark, mark Cuban and, um, 

Mike Koelzer, Host: and Mr. Wonderful. 

Derek Borkowski, Pyrls: Yeah, exactly. I was, uh, I was picturing, you know, his, um, his demeanor there, but yes, Mr. Wonderful 

Mike Koelzer, Host: couple of gals 

Derek Borkowski, Pyrls: of gals. 

Mike Koelzer, Host: Are there any of them that rub you the wrong way? 

Derek Borkowski, Pyrls: No. I like how they have a variety of opinions.

Because that's actually the thing, especially about early in early stage businesses. Everyone has a different thesis. And so I think that's maybe one of the nice things about the show is you hear, even though it's a little bit, you know, hyperbolized I think, and made for TV, you do get to see the real life fact that investors have a wide variety of opinions and they don't, and, and it's very much an art.

Mike Koelzer, Host: You're going to get three questions from [00:13:00] the sharks and they're going to make you sweat a little bit. What are the three questions? What are the most difficult three questions you can imagine them asking you and then what would your response be? 

Derek Borkowski, Pyrls: Well, for me personally, one of the things I run into nowadays, because the type of investors I do talk to are, you know, Silicon valley venture capitalists or, or, or tech generalists.

And so I have to start by explaining what the heck we, you know, my product even is, oh, it's a new medical information reference. That's kind of boring. That's not very sexy. That's not. Um, for example, there's companies in my current Y Combinator batch that are mining asteroids or, you know, doing, you know, you could have any wild dreams.

So for me, one of the challenges is relaying the importance to clinicians that having, you know, practice information right at your fingertips, how important that is, what number two, they'll say, well, what, why doesn't one of these existing competitors? Like why couldn't they just do what you're doing? And so, you know, I'll explain that both pearls [00:14:00] and other references that exist, we all get our information from the same places.

You know, the FDA publishes is the foundational source for drug information. Then there's clinical practice guidelines. Then there's primary literature. You know, these are. This is where we get the information that we, you know, use in practice. And so what I explained to them is actually, it's not as simple as existing references, moving their content around on the page.

You know, we are starting from, we actually worked backwards from the interface of our product and then built our database schema to support that. So actually competitors would have to basically start from scratch and do all the work that we have in order to replicate our product. And they have no incentive to do so right now.

And the last question I would say, you know, it's, it's actually, it's something I, uh, you know, I, I, I appreciate it. And, uh, you're a first time founder, what the heck do you know about this? How are you going to make sales to a health system? You know, uh, and actually, you know, my answer to [00:15:00] that is oftentimes you'll hear that being naive is often exactly what you needed to know that, you know, if, if you know too much, then you actually think you can't do something where my naivete of first-time founders often is what leads them to try things that others wouldn't venture out and do.

How 

Mike Koelzer, Host: Does that work? Then the pharmacist has this in their pocket. They pull out pearls, it's an app they're bopping around on it. And then they get the best counseling points. 

Derek Borkowski, Pyrls: Yeah. Yep. So we have both a website and a mobile app, but I would say that, yeah, the mobile app is probably 60, 40 times more used than the website.

Um, and so yeah, by far the most common use case that current customers of pearls will use is looking up. You can see in, you know, the usage. Looking for a drug and then clicking on the counseling points. So that's by far, what we know is the most, most, uh, value add feature. The next thing is that we'll also have a lot of nice comparison charts or [00:16:00] summaries of pharmacotherapy.

For example, with diabetes, we have nice summaries on when is this drug supposed to be used versus when is this drug supposed to be used? So that I would say is the other sort of differentiated type of content that people are coming to pearls for. Where do 

Mike Koelzer, Host: people bail off your site and has that caused you to change 

Derek Borkowski, Pyrls: things?

Yeah. Well, I would certainly say having an early stage internet startup, like mine, you always feel like you're kind of like, like your business is. And the customers are like pouring water into it. And you have a bunch of holes where you're losing things, you know, like, yeah, they definitely, I just think back to like the first, whatever, several months that pearls were out there.

And I'm like, oh, there were so many missed opportunities to ask customers. Why don't you come back? Even now there's, um, you know, places that we lose, that we would have no way of detecting, um, or knowing. And so, yeah, actually this sprint comes back to a really important principle, which is there's this thing in startups, I guess, actually, any business where as soon as somebody [00:17:00] signs up for your product, you want to Ram them head first as fast as you can into an aha moment.

So basically as soon as they sign up, you want them to perceive and get some sort of value. So for us, what that is, is like I mentioned, one thing, people besides counseling points, people really like our charts. And so as soon as you come into the platform and actually a lot of our marketing, it goes w um, is, is focused around, just sign up for pearls and get, get these, we have the best inhalers chart.

If you work, if you're trying to impair, you know, in your community pharmacy, if you're trying. What you see quickly or what inhalers that one again, we have the best inhalers chart in the country. And so we, we try and put that in your hands as soon as you sign up for the product so that even if you don't go and explore or go through our complete tutorial, um, you know, you'll have some sort of aha and that actually brings you back to another thing, which is, there's also this interesting challenge when you're a new company where you don't want to introduce too much friction into the process.

So, you know, our signup page, even still now, all you have to do, like right on the [00:18:00] homepage of pearls, it asks for your email and it says get started. And then that brings you to where you can put your password in and get started, where a lot of websites will gather your name, your position, your address, and then someone falls out.

So there's, but then you know, less about that user. So maybe the person who signed up and left is somebody who'd never have paid, but you don't know anything about them. And so there's always this fine balance, especially in the early stages. And especially when you're selling to consumers like we do versus.

Where we have to keep the friction minimal, but also try to make this happen as early and often as possible. 

Mike Koelzer, Host: You also have that kind of a dilemma, I imagine on settings, right? Because you want enough settings to make it feel like it's theirs, but you also don't want a page with a bunch of parameters. They have to set, like, I think of LinkedIn to a decent system, but you go into their notifications, you know, and they ask you, are you looking online?

Email or push, and then there's [00:19:00] probably 60 settings for each arm is just too many, but you have to deal with that. I'm 

Derek Borkowski, Pyrls: sure. Yeah, definitely. And that's something that we've so far kept to a minimum and actually one thing I will mention that I like about LinkedIn's interface that I think we should probably incorporate into ours is they have, it feels like everywhere they have that like progress bar, you know, like on your profile says like you're a rookie versus intermediate versus all-star.

And I feel like that's something we should probably put on pearls is like, okay, now you've checked out the charts, but you still haven't checked out these things. And so it's kind of like a low friction way of saying like, uh, like gamifying the experience of having. Give yourself a tour without forcing someone to go through a tutorial where they're annoyed and like, all right, I'm leaving.

Mike Koelzer, Host: I hate those odors because whenever I'm on a pharmacy program, to me, they always say, Mike, you should consider going to pharmacy school. 

Derek Borkowski, Pyrls: Um, Mike, how would you like this pharmacy intern job at the hospital? 

Mike Koelzer, Host: Yeah. How many people are focused on 

Derek Borkowski, Pyrls: Pearl? We'll give you a quick backstory on that. So, yeah, pearls.

So I went, I left [00:20:00] my daytime, my full-time pharmacist jobs in January of 2020. And I started bootstrapping this by myself. And at the time it was just myself. And then I had a handful of contract pharmacist, advisors who were clinical experts in different areas that I would, you know, that all the content would get reviewed through before we push it live.

And so since then, I'm actually just over the course of the last, you know, year. I also had some interns join my team, some pharmacists and interns who would help with information collection. And then over the last few months, my first full-time hire actually started. He's another pharmacist programmer like myself.

And then just in the last few weeks, another pharmacist, um, designer actually joined our team to help with the build out more user experiences and graphic design tools. And the last person that's on our team, um, is actually a physician assistant who I met through an entrepreneurial program.

Who's helping manage our social media and help build our roadmap for building features for those in medicine. So there's one common theme of [00:21:00] everybody involved. It's the clinical background, which I think is what the differentiator of our company is, is that we have, you know, everyone is also the end user of our product.

Some of the things that kept me going in the first year was like, well, if nobody wants this, I want this, you know, I'm trying to build this, you know, cause I was still Moonlight, um, until just this last summer. And so I, you know, I would field test my product. I'd write down notes. Scraps of paper, what drugs I should add that night to what features needed to be added to make this better.

And so that was, um, that wasn't continued to be. I think one of the things that's unique about the TNS collaborating on this, when 

Mike Koelzer, Host: I hear bootstrapping, I think of maybe not a ton of debt, you're kind of growing from zero and kind of going as you go. Was there any step in the process where you had to jump off the cliff and take a lot of financial risks besides leaving your job?

Or were you able to grow on a steady incline? 

Derek Borkowski, Pyrls: When I first got interested in startups in technology, I actually did learn about this Y [00:22:00] Combinator accelerator I'm doing now, which is a venture capital firm who makes an investment in your company. And I thought that applying to their program was the only way that you could start an internet business.

Like if they didn't accept you, then you didn't have a good idea. Um, and so. The first time I applied to them, I got an interview and they only interviewed like single digit percent of people that apply and they get, they get, they get five digit, 10 tens of thousands of applications, a batch. And so I was like, wow, this, they must, this must be a good idea.

Long story short. I flew out to Silicon valley where they flew you in for your 10 minute interview. I had a lightning fast 10 minute interview and was immediately shown the door and got my rejection email later that night, really. But this was around my full-time jobs. And so at that point though, I was like, I don't care.

I'm going to go after this. So this was about October of 2019. And so by January I had left my full-time job. So. Some money in the bank, um, and said, all right, I'm gonna, I'm gonna go on in this. And so let me just preface the next part of this by saying, I come from a [00:23:00] middle-class family with healthy parents.

I'm an only child. I have a wife, who's also a pharmacist. So I, I would not describe myself as even if I would have lost every single one of my money and, and got deeply into debt. I'm still in a pretty safe scenario compared to some people, right? Like you, you could imagine people with much more risk than I took.

Sure. But that being said, yeah, I, January, 2020, I had some money in my bank and over the course of 2020, I basically rode that to zero. Um, but I was, um, a hammer. If we were engaged at the time I was with my, my, my now wife and we made a deal. Basically. So, and also I forgot that the biggest part of why this wasn't that risky for me was I was still employed in the float pool as a pharmacist.

So I could still pick up pharmacist shifts if they were available. So what we did was either between money I made from pearls or working Walgreens shifts, I had to find, or spending my money, I had saved up. I had to find a way to pay half of [00:24:00] everything. So half of our rent, half of our food, half of our expenses.

And if I couldn't do that, then I needed to go get a job again. And so that plan actually worked out really well because it sort of put like rules to the game that kind of prevented the risk. Like we had a plan, okay. If I can't pay half of everything, well, then I need to stop towards the end of 2020 when the business started to sort of pull its own weight and things started to go the opposite direction where I could start to work fewer shifts, less money, no money coming out of savings.

Um, you know, and I could start to put money back into savings. And then, yeah, just this last summer. So. July of 2020 was when I took my first venture capital investment. Um, and so it kind of switched from bootstrapping to now operate in the business, you know, with that in mind, 

Mike Koelzer, Host: I understand the whole thing about how these multi hundreds of billionaires, you know, I understand the only owner, a part of the company, let's say, you know, basles owns a part of Amazon, a small part basically.

And there are [00:25:00] hundreds of billions of dollars. I get that, but I come from the scarce world, the pharmacy where I'm like, I don't want anybody to own any of my stuff because it's such a scarcity of profit that I don't want to give any of it away, but obviously to bring venture capital in either, you've got to feel like you're on your last leg or you have to have that dream of saying this is going to be so big and the VC's gonna make it big that I'm willing to give up.

Some of the profit or their percentage. What's your mindset going into saying that you need venture capital. 

Derek Borkowski, Pyrls: If you take any investment, it's either because it lets you move faster or do something you couldn't do otherwise. And so I would say in the case of my business, it really helped us move faster pearls.

It probably takes about eight hours per drug page. Um, so, you know, to make them, and then at the expense, like to make each like additional drug that goes into pearls in the price that we can charge for [00:26:00] pearls is directly correlated with how big our drug library is. So, you know, we chart when Perls was first launched, we only had about a hundred medications in it.

And now we have, you know, I'm at, like I said, in that 400 range. And so we charge more accordingly, you know? And so I could have definitely kept, you know, putting one drug in and, you know, at a time and then doing the marketing. But w w w what I was really excited about to partner with, you know, with venture intake, venture capital investment, was so that we could, you know, move faster.

And actually one of the, one of my issues now is, or that, you know, they joke about this in, in white commonary a little bit, or have is, you know, I, I, I am a booster. I was born a bootstrapper. And so I, I still have a bootstrapper mentality, which when you're venture backed, if you're making a profit, that's not a good thing, but hold on, hold on.

It's because you should be investing that profit immediately into something to grow. If you got 

Mike Koelzer, Host: profit sitting around, you're not growing quickly 

Derek Borkowski, Pyrls: enough. Exactly. So as soon as we have, you know, which by the time we took venture capital, we were, you know, paying my, you know, my money. It was paying me and it was paying, you know, the things that we [00:27:00] needed to pay.

And so, yeah, at the point now it's any extra money we have. We need to be putting that back into more marketing or hiring another person to help make more, more content so that we can charge more for our product so that we can make more money so that we can put it back into more marketing so that we can charge more.

Yeah. 

Mike Koelzer, Host: W we come from the mindset of wanting to hold onto the money, but they want to keep 

Derek Borkowski, Pyrls: investing it. Jeff Bezos has this regret minimization framework, which is if you're trying to make a decision today and you can't decide, just picture yourself on your deathbed and say, what would that person have wanted to do?

And so, for me, even if I jumped my, bring myself to age 40, my regret minimization framework says there's no better time for me to try and start and grow a business as big as it can be to try and bring, you know, a new impact to the world in, in basically the only, so the pulse check, I just need to constantly have for myself as am I still enjoying this because that's actually what with, especially with venture backed businesses.

One of the biggest reasons that venture backed businesses fail is [00:28:00] because the founders. Um, because it is a different type of pace. Um, that's again, if you're, if you're working with good investors, like I am, they don't force you to make unhealthy growth. Um, and they, they remind you, this is actually a common Combinator saying via cockroach, which means the number, the number one, the number one rule of startups is don't die.

And so, yeah, it is certainly, you know, a goal as long as possible to make sure I am still in control of all the decisions, even if there are other people on my cap table, if you're going to go with the mindset that you want to make a big business, you know, having a small slice of a big pie is, is, is, is more than having the whole, the whole small pie.

And so, and, and, you know, so again, I'm just at the stage in my life where I'm really enjoying what I'm working on. I'm enjoying the chance to work with a wide variety of people. And, and I, I really do just sort of feel like, you know, each day that I'm on that I'm riding the most fun rollercoaster. Um, I could, I could.

Mike Koelzer, Host: One of my guests had said when I talked about not wanting a partner, because our [00:29:00] family business is only one person from each generation, my grandpa and dad, our past, and so on the benevolent dictator of this generation. But there's no way I'd like any of my siblings involved with this. It just wouldn't work out.

And so I always moan about the idea of having a partner, but this one guest I had was saying that he never would have wanted to build a business alone because with the hours and the, I guess, many of the hours, maybe the stress is just too lonely. It's great to have that comradery in this. Do you consider yourself lonely?

Do you consider the people that you're working with now as mental comrades? 

Derek Borkowski, Pyrls: Yeah. You know, I definitely do, probably consider myself more like, you know, an introvert, um, like a lot of people do, but one thing that I'll hear my wife comment on not too often is, oh, you're such an only child. Um, and so I do certainly think that, you know, growing up an only child, you know, I, you could lock me in a room and I will entertain myself with a speck of dust on the ground.

I don't, I don't mind it. Um, but I [00:30:00] just, again, I'm always just amazed by when you do work with people, how there's always just new ideas that you never would have thought of for yourself. And, and that is, and that is really, that is unique. There's always interest. 

Mike Koelzer, Host: I remember when I first graduated, I went down to our leadership training school with NCPA and a thought that sticks with me is that they said, all right, we're going to drop you into Alaska.

You know, figured if we're going to drop you into Alaska and see if you can find your way out. So then we all figured this out on our own. And then they, I think they put us together as a group. And then they said already, now you have an hour to be with these six people and think about how you're gonna get out.

And then, you know, we all put these ideas together. And I remember that somehow they went around and they judged like individuals. Ideas versus group ideas. And every time the group idea just worked out better, you know, even if you used 80% from one person you're still picking up a 20% [00:31:00] better idea from someone else in the group.

Derek Borkowski, Pyrls: Yeah. I think it's a law of the universe. Right. Like, it's just, it's incredible how it happens that way. And so that's certainly where, yeah. Even though I would, I don't know that I necessarily get lonely and I think it's really important that I haven't gotten lonely over the last two years of doing this.

Um, it's such a, it's such an add in such a beautiful thing. Um, I feel so grateful to work with the people I do. 

Mike Koelzer, Host: I always say if I wasn't an attorney, I'd probably bill for, you know, 120 hours a week because the business is always on your mind. Are these long days for you,

For our listeners, Derek just started crying. 

Derek Borkowski, Pyrls: Well, no, I'm blessed. I may have too many riches in my life. But meaning like hanging out with my wonderful friends and family, but like this past weekend extra, my wife was out of town and it was just me and the dog. And so I sat here and coded all weekend and it was, there was nothing like, there's nothing more fun than working than working on pearls.

And, [00:32:00] um, it's still that way. So yeah, it's on my mind all day 

Mike Koelzer, Host: in this crazy world with this new war going on and canceling culture, you know, social media, all of that stuff. There's a certain peacefulness about focusing on one thing, this hobby of my podcast, you know, in this crazy world, it's fun sometimes just to focus, it seems to pull your mind and form.

Crazy in this world, you know, it's just a way to let, to say, okay, for some reason, the stars have lined up to say that this is where I belong right now and I'm comfortable with it. 

Derek Borkowski, Pyrls: Um, no, definitely. Obviously, there's never been another time to live where so many things are competing for our attention.

And so I certainly also feel the naturalness that like focus actually like, you know, brings back to, um, you know, the lived experience. 

Mike Koelzer, Host: Do you wake up any days and say, ah, crap, I gotta do that this day of the [00:33:00] month, or this is coming up, you know, two days from now, what is that? 

Derek Borkowski, Pyrls: Certainly my meetings with my accountant.

Um, even though, um, even though before the accountants were, it was worse. Because then I have to deal with stuff myself. So still as the founder, I'm still, you know, one of the three full-time team members here. And so a lot of the work that needs to be done, which is writing code and doing content creation, these things require.

D like days of a clean, open schedule. And so it's funny as much as I do love, like having meetings, it can be frustrating when I can't create like 72 hours for myself to get back to, you know, writing code or, or, or doing content. Um, and then otherwise, yeah, I certainly think that, um, I am somebody who unfortunately requires seven, eight hours of sleep.

Like I know when I get six hours or four or five hours of sleep, a few days in a row, I start having the demons start saying, nobody's going to want pearls. Um, you know, this, this isn't, this isn't going to work. And then, and so I'd just be like, well, okay, that means I need to go to bed. [00:34:00] 

Mike Koelzer, Host: When you say code, give me an idea.

Like, if I ask this question to me, when I was, let's say designing my website, here's what I would say. Okay. I go on this page and ask myself how big of a font do I want? And I do this and I have a box that says, do you want the box in the left or the center or the right. Okay. So that's like a thought I had with just setting up this simple website.

Give me your trickiest. Do you like thinking, okay? Comma, comma slash a slash what do you mean by coding? What's going through your head. Give me a minute of what's going through your head in these 72 hours. 

Derek Borkowski, Pyrls: Yeah. So especially from my, from my end, the type of programming I do, it's very much about the user experience.

So I'll use the example of something that we recently launched that took a while to do so we just recently launched a drug interactions checker inside of pearls. Um, and so this is actually where I'm very grateful to my new team member. Uh, David who's another pharmacist and engineer. He is more of a backend [00:35:00] developer than I am, meaning he took the database from the company we licensed from, opened it up, wired it up and started feeding and creating feeds where interactions can be.

And then on my end, what I do is I design the interface that the user, that the actual user, um, does to like work the drug interactions checker. So yeah, my personal process, and especially going back to the start of this conversation, you asked what I'd compare it to from my end. I kind of feel like a sculptor or like a woodworker, like I'm very much like, Hmm.

What do you want this chair to look like? And then, and then, and then you work backwards from, okay, well, how do I, okay. Like I picture the experience and then it's like, okay, now how do we reverse engineer the coat that is. 

Mike Koelzer, Host: When you're coding, are you putting in dashes and hashes and blips and bleeps in that?

Or are you saying, I want this column to be center justified instead of left or right. Justified, you know, which of those two, is that closer to, 

Derek Borkowski, Pyrls: uh, the former? Yep. So, but yeah, so it's [00:36:00] what dashes and bleeps make it center justified or right. Justified. 

Mike Koelzer, Host: You could reinvent the whole wheel on this, but typically what you're doing is you're, you've got some like base things in you're telling those what to do.

So the coding is telling you where to put a column. You're not inventing the column every time you're telling them another program where to put something that's kind of made 

Derek Borkowski, Pyrls: already. Yeah, exactly. And actually a lot of programming is copy and pasting like code, like from elsewhere. So just like actually just like pharmacists, like, or we'll use whatever pearls, right.

To look up, like, you're like the pharmacist will be like, I want to counsel a patient on this drug. Like I know what I want to do and I know where to get the information, so, okay. I'm going to, for that, I'm going to go to pearls and look up, look up that. So yeah, literally am I in. Okay, I'm trying to move this button to the left.

So let me just, if I don't remember it off hand, I'll just Google quick. Like, um, what's the CSS code to center? This, this, this, this photo. Okay, great. Oh, there it is. Yep. Okay. Got it. Click, click, click, click click. [00:37:00] So yeah, it's, it's a, it's kind of a it's, it's just, it's almost like pharmacy in that way. Or like, or like any domain, 

Mike Koelzer, Host: because some of that coding that's out there.

I mean, these are the horror stories of having like a million lines of code and you've done something wrong in line 328 and in effect something in line 500,000 or something like that. I mean, those stuff's out there right. 

Derek Borkowski, Pyrls: 10 years ago, I would not have been able to start this business. Software development moves as fast as oncology pharmacy.

Um, you know, software development moves so fast. So actually even 10 years ago, if you were to want to make a company like mine, I would have had to basically. Three separate skill sets, one to do the website once do the iOS app. And once you have the Android app, and then further even taken back another 10 years, I would have had to buy a server tower from Dell, bring it into my house.

And so nowadays it's so seamless to build simple or to build like, I guess like just general products. So with, [00:38:00] with, it's just a relatively recent development that with one programming language JavaScript, for example, I can actually write, um, Android apps, iOS apps, and websites and server code off the same thing and further.

And I'm sure everyone's heard of the cloud, like AWS, Amazon web services or Google cloud platform. So we use Google cloud platform and that's where all like pearls is hosted on Google cloud platform. So I don't need to have a tower running out of my apartment here for the website to run. And so, yeah, this would, this would not be possible.

Like it would, it would not have been possible for me to start this by myself. If it wasn't for modern programming. 

Mike Koelzer, Host: Technology always wants to get smaller and you know, more streamlined and all that kind of stuff. But I think about a program like pearls and I'm thinking, I don't really want it on a smaller phone.

I want an on this size phone, the size of the phone, I already got as small as it needed to be for me. And now there's things out there like I suppose, glasses and having this show up in the [00:39:00] back of your hand, because you've got some skin tattoos. Think about like a hundred years from now, where would pearls be a hundred years from now?

What is it going to show up on? Is it going to be in your glasses? Is it going to be connected to your vocal cords and you just open your mouth out? And this information just comes out with how you think about it taking a hundred years out of your program. What does it look like? 

Derek Borkowski, Pyrls: Yeah. So, you know, the best medical information reference.

So I think once you look something up, you never have to look it up again because maybe you. And so that's actually, yeah, let me just speak maybe more, a little more, um, theoretical. So I think an issue that fundamentally one technology makes things better is when it re when it was, when it removes friction.

So one of the best examples of innovation I like to give is like, when we, when we decided in the mid 20th century to put fluorine in water or yeah. Flooding to fluoride in water supplies, now a whole bunch of people have better dental health just for drinking the same old [00:40:00] water. They already drink.

They meant to do anything 

Mike Koelzer, Host: of all the things. I think grand rapids was the first city that added fluoridated water. I mean, 

Derek Borkowski, Pyrls: that's amazing. And yeah, I love that, 

Mike Koelzer, Host: But that's something that you just tripped over. I had 

Derek Borkowski, Pyrls: to happen then oftentimes, like you mentioned, you like glasses and all this stuff. I think that's where we've learned, actually, maybe over the last decade, you know, as, as digital things have become more prominent, it's been like, oh, why don't we make it?

And there was the whole, let's make an app for everything. And then like, we learned that like, when people would make apps for every single person like habits or for healthcare, and actually the app introduced friction, it was another step to open up the app and have to record something, you know, or, or to open up the app to have to do something.

And so that's where, yeah, I do think, you know, if, I think from first principles, like what you were saying there, it's like, okay, what does Pearl is trying to accomplish? Well, we're trying to make whatever the most contemporary piece of clinical knowledge that there is about any subject usable for a clinician, [00:41:00] right.

When they need it, you know, without introducing friction. But I certainly can't describe to you what that looks like, and I can think of lots of, you know, it's going to be, it's going to be, and that's the art of entrepreneurship, I guess. And so, yeah, we'll see. 

Mike Koelzer, Host: I was talking to someone, I think they gave the example of Elon Musk, but I'm going to kind of quote him.

I don't know if it was him or not, but something like if the consumer of the self-driving car, if they have two. Put any input into it that's too much. Or that's friction, something like that. He was saying like, you shouldn't have to put your car into reverse when you're next to a curb, you know, looking backward.

I forget what it was, but it was like any input that's needed, like user error. Now I know it's not to that degree, but it's like, it's an example of zero friction, if you can. 

Derek Borkowski, Pyrls: Yeah, no, that's where you think of things like, you know, welcome to segways. Didn't work the first time, but now, you know, you have lime and bird working and it's just something about the way that because of [00:42:00] new, modern mobile technology, it's actually, you know, there's a lot lower friction to like using one of those devices.

And so that's where your timing is. Very important. And so there may have been like, you know, you, you mentioned like, oh, glasses or something, other things, which, you know, I agree. I'm like, oh yeah. Some of these things didn't really work, but like, it would be curious to see what sorts of technology changes can, you know, if they, if they make the timing for certain ideas to be better because they do that because of whatever, the fundamental friction point that, that made an idea kind of not work, it could be different in the future.

Mike Koelzer, Host: What was your reference there on the segway? What were the two things that came 

Derek Borkowski, Pyrls: out of that? So, um, you know, segues just really didn't seem to work, but they're, they're not too much different than like the bird scooters, you know, like how people can rent those scooters to drive around. Like, it's like, well, how come the segways couldn't have kind of been done?

I've seen people like myself, or I was maybe too young to remember all of the segway stuff, but like, you know, it's not much different in concept. And so just the fact that like [00:43:00] wireless technology works fast enough to allow. Renting a scooter just to start driving it and to stop driving it. Um, simple enough, uh, that it, that it made it a, you know, a value add to people's transportation.

Mike Koelzer, Host: I never thought about that. Or those scooters, they don't use the, and I know you weren't implying this necessarily, but they don't necessarily use the segway, like spinning things inside of the machines. And those don't, those don't 

Derek Borkowski, Pyrls: like electric scooters, 

Mike Koelzer, Host: You know what, they're good for. They're good for putting drunks on them at night.

And they don't have a rear light on them and getting their legs tangled up and cracking their femur. We had a customer come in, you know, saying that it's like those things don't mix very well. No, I think I know a couple people personally that have wrecked from their face down to their broken legs on most things.

I don't think it was going to be around all that 

Derek Borkowski, Pyrls: long. Yeah. It's uh, I would say, I feel like I've heard about them certainly less, especially since COVID, when people are doing less traveling. And so, yeah. We'll see what the, if they, um, [00:44:00] you know, what things look like, and they're all parked all over the place.

Yeah. And certainly people don't treat them like they're their own, so, yeah. Oh, that's 

Mike Koelzer, Host: right. Because I've walked up to some of them and you know, they're all like, things always look better from a distance. Like when I, well, what do they say? The grass is always greener. You know, I came up to my house and I got a broken doorbell and you know, the porch, I know needs painting and things like that, but it seems like every other house in the area looks perfect.

Well, they have the same problems that you'd have. But anyways, you'd go up to these segway things on their own. They're all dinged up and all 

Derek Borkowski, Pyrls: that stuff. Yeah. I've seen a couple in the Mississippi river here in downtown Minneapolis. Yeah. Is 

Mike Koelzer, Host: That right? Yeah. They're always parked in weird spots. Like these bikes are just all over the place and that Derek, I know that you've come from some other software ideas.

What other holes do you see in the market? If it wasn't Pearl. 

Derek Borkowski, Pyrls: The original thing I was, um, wanting to do after graduation was actually start one of these digital pharmacies that you see. [00:45:00] Like, I, I actually, when I was a first year at first, first, and my third year in pharmacy school, I took part in the NCPA business plan competition.

And, um, I, it's still my dream to apply technology properly to some sort of healthcare services delivery. And so I think of all the efforts that have been put in. Thus far are super Valiant. You know, like I, I admire all the entrepreneurs who've undertaken in, in, you know, in all, you know, all of it, but obviously, you know, like, especially like let's take digital pharmacies, for example, there hasn't really been a way to make it profitable.

Are 

Mike Koelzer, Host: you talking like the hymns and those kinds of things that focused on one product kind of 

Derek Borkowski, Pyrls: pharmacies? Well, I actually think you have those ones that are focused on one specific therapeutic area stack. I think they potentially seem to be doing at least better margins potentially then like full service pharmacies.

Um, but yeah, just, I, it is certainly, I, I explored a business plan after graduation, you know, like, like many of, um, Oh, is there any way we, you know, cause if I had another life I'm very jealous of, you know, independent, [00:46:00] like independent pharmacy, you, you you've had Kyle McCormick on in the past. Who's a, a friend of mine who I love living vicariously.

I think we kind of live vicariously through each other's businesses. I 

Mike Koelzer, Host: started this today by saying I was jealous of the coders. And here you are saying, you'd rather be in the independent shoes. So that's 

Derek Borkowski, Pyrls: funny. Yeah. No, well, in some ways I view myself as a 20, as a 21st century, independent pharmacist, you know, not that we, you know, you're just a, you know, I'm a pharmacist, who's building his own business.

Right. Isn't that, isn't that independent, you know, isn't that a benefit? Um, yes, exactly. Yeah. So I would certainly love to, you know, see if technology can find ways to. Build, you know, um, I guess supplement create, create margins for our profession and things that add value to patients. So it's, you know, it's unfortunate that we're in a, in a, in a day and age now where, you know, the based on just all the pharmacoeconomic, uh, forces, you know, the product margins are, are what they are.

And so then they take away from the ability of pharmacists to perform. Incredibly valuable services to patients. And so [00:47:00] that's certainly a space that I, you know, someday hope to spend more time working in. So 

Mike Koelzer, Host: you're actually the independent pharmacist of the future, because if you were to open up an independent pharmacy, now they'd say, well, what is it going to be?

And they'd say, well, you know, you listen to all the associations. It's no longer focused on products. It's information, you know? And so independent pharmacists say, all right, well, what I'm going to just do sit here and Toro, my thumbs, you not only product, how am I going to make money on that? You know?

And so you come in as this independent pharmacist idea from the future and you've made a profit or a making a profit on information on medicine. Without an actual product. So you're there, you're the independent pharmacist of the future. 

Derek Borkowski, Pyrls: I really, I resonate with that in another way. Yeah. I definitely think, yeah, we, we hear about in our profession, we need to find more ways for [00:48:00] pharmacists to get paid for their cognitive abilities.

Right. And so, yeah, I would definitely view the ability for me to start this business in the very beginning was purely based upon my combination of my technical skills with my cognitive abilities of a pharmacist. I like to joke I'm a five out of 10 pharmacist and a five out of 10 engineer, but a 10 out of 10 engineer with no pharmacy domain expertise could not have built pillows and a 10 minutes and pharmacist with no technical expertise, clinical pearls, take a look at another several of the guests you've had on like, like Tim Holbrook's another friend and mentor of mine.

He's built a business that's differentiated itself because it is pharmacy domain knowledge, right? He's because of his understanding of the pharmacist, he's built a financial services business, and there's so many others that I would also view as using their cognitive abilities differently.

Their business. I haven't 

Mike Koelzer, Host: monetized this podcast. As of yet, someday, I may have made this podcast a hundred percent example, and someday I may monetize. Thank you. And I may monetize on individual things with advertisements or else. I would say it monetizes [00:49:00] me because if something doesn't happen at the pharmacy, well, I can call up the 150 guests I've had and say, Hey, I'm on the street now, you know, but I've had a friend say, well, you should broaden it.

Don't do pharmacy. It's like, whoa. So do a general show and take on Joe Rogan. No. Do a more focused show on marketing and take on Gary V no, but I can do the business pharmacy podcast much better than Rogan, much better than Gary V. They don't know the area. And so if you niche down enough, not too small, but dish not enough.

Your goal. 

Derek Borkowski, Pyrls: No, it's a hundred percent true. And this is, this is something they actually teach us again at Y Combinator. You'll read this. This is really important to start. It's in the early days, especially in the early days, but you can build your whole business on this. It's much more important. It's infinitely more important to have 10 people love you, then have a thousand people like you.

Because once you start with the 10 people who love [00:50:00] you, then you grow your product by supplementing it to make the 11th person love you. And the 12th person loves you. But if you start by having a thousand people who like you, then nobody likes you, then you're exactly. Then you're not as good as any of those areas.

And so the other, the other joke as well, but just make sure your don't become a trombone oil salesman because that market is too small. Um, um, and so I, I very much resonate with you doing things that, you know, do start with an unscalable, potentially unscalable idea. As long as it's making some number of small number of people, 10 out of 10, love you, and then build from there, 

Mike Koelzer, Host: Seth golden.

Do you know Seth Goden, Seth Goden says build your business. Um, the smallest viable population. So just what we're talking about there, it has to be big enough because you can't sell the oil to the trombone. People has to be big enough, but as soon as you find a viable option, define a however you [00:51:00] want to define viable, whether you get your kicks out of that, or whether it's something in the future, whether it is a current monetization, but once you find that smallest population don't go any bigger than that, because that's where those lovers of you 

Derek Borkowski, Pyrls: are.

And it's actually, I'll take it back to what we mentioned about like future pharmacy ideas that you meant when you asked me, that's actually what I kind of like about like the hymns and the hers and the nurses is they're trying to make a 10 out of 10 experience for one therapeutic area, and then they can expand to replicate that experience for others.

And that's why I think that that's fundamentally like a better place to start than making it for all purposes. Okay. Experience 

Mike Koelzer, Host: These companies that start to lose their focus Ellison the other day, like I think it was dollar shave club. No, no, no, no, no. It wasn't a dollar shave club. It was to escape these razors for your body.

And the ad I heard was man scapes, you know, lotions, you know, shampoos, you know, for areas above your belt line, you know, something like this, they start to expand the, [00:52:00] use, their name, they expand. And it sounds good until somebody comes in and really narrows down that market again, 

Derek Borkowski, Pyrls: bundling and unbundling, bundling and unbundling.

That's the, that's the eternal cycle of Netflix, put everything in one place. And now there's HBO and Disney plus, and the bundle on bundle. It's the, it's the ever ending cycle bundling 

Mike Koelzer, Host: and unbundling. That's right. It's never ending, it focuses down on Ben and expands and then someone comes in and out, focuses them again.

This never ending cycle. There's a million examples of that. It's fascinating 

Derek Borkowski, Pyrls: when you can't stop seeing it everywhere too. Right. 

Mike Koelzer, Host: Right, right. I mean like your thing, you know, you could have pearls. That could be going well. And pretty soon, you know, you have, you know, a thousand drugs and then somebody comes in and finds a way to just focus on bioavailability drugs and your life.

Derek Borkowski, Pyrls: Yep. Well that must be out of the world. Like that's kinda how things move forward too, it's like the new bundle comes in and makes things [00:53:00] better than the previously unbillable solution. And then somebody on bundles, one part of it in a better way. And then, and then someone comes back and re bundles this new, better unbundled to a bundle.

And so, yeah, I a hundred, actually, one of my big, like existential risks to our business is, you know, one thing we're doing really well is connecting with like the next generation of Columbia. We have an Instagram account with like 13,000 followers. And then the next medical reference of all like, you know, the names, you know, you know, the drug reference names, the next, the next company with the biggest Instagram following has 500 followers and they have, you know, they have no presence.

I'm just waiting for the next social media platform to come out where somebody undercuts, you know? And so that's what that slice is. 

Mike Koelzer, Host: If right now someone said to you. No more pharmacy stuff, no pearls, no other medical app kind of thing. What would be another area that you would get into if they said no more medical stuff?

Derek Borkowski, Pyrls: Yeah. I think a guilty pleasure of mine personally is like [00:54:00] sports. If I couldn't do this anymore, I think I would maybe try and go be like a youth football sports coach. So I got to do a little bit of that when I was an undergrad and yeah, I really miss one thing I miss about sports. And again, this is no, I'm not making any kind of political statement here, but one thing we're missing in society is leadership and that's where like in sports, I just there's so much good feeling in.

Um, and the police do not take my statement for being political. I'm talking with society just with, especially what we talked about earlier. Like all of the ways. Pop culture tries to pull our attention in so many directions. And, um, and it almost unbundled the individual. Um, I, I really would love to get back into it and be in an environment around like, honestly, like just where there's teams and where there's coaching, where there's sports.

And like I mentioned, I still love like, you know, being by myself and doing, you know, and, and being an introvert, but that's something I do miss. And I, I think I would, uh, would go into that realm. There's 

Mike Koelzer, Host: a psychiatrist I listened to online [00:55:00] quite a bit. And, um, he talks about something that's missing in today's society and maybe parents.

Teaching their kids is that idea of play. And so he uses the example. If he says, if you put two rats into a cage and one rat is certainly the dominant rat, let's say it's 50% bigger and rougher. He said that if you put them both into an environment, three out of 10 times that strong rat lets the lesser rat win in a play fight kind of thing.

Because if the bigger rat doesn't allow the younger rat to win, once in a while, the younger rat doesn't want to play anymore game over, they take their ball and go home. He was saying that competition. The reason for competition is not really to find, especially in games, it's not to find the winner and the loser it's to it's the old phrase.

It's not who [00:56:00] wins or loses. It's how you play the game. That's true because if you don't win and lose, correct. If you don't reciprocate somehow either through, you might win, but at least you're showing respect for that kind of thing. If you don't reciprocate somehow the game's over, you know, and we're seeing so much of that now, I think in society game's over, you know, cancel culture, all that kind of stuff.

I 

Derek Borkowski, Pyrls: haven't thought about it that way. And that, that resonates with me for sure. 

Mike Koelzer, Host: What's a cool week look like for you 10 years from now, what company are you running? What are you doing? How many hours a week are you working? That kind of thing. 

Derek Borkowski, Pyrls: You're asking me to set up at a funny time in life. So I can remember like, even right now, like I mentioned, I'm, I'm in the middle of this, this Y Combinator accelerator, which is one of the top, you know, what would have been one of my dreams.

And I joked with some friends the other day, you know, they were, you know, saying things to a man. My 24 year old self would have been so excited about this, but now as a. Rough gruff, you know, 28 years old, you know, I'm, [00:57:00] I'm starting to appreciate other things more. Like I heard someone say on a podcast, like it was a, it was actually a sports podcast.

So the one guy who lives in California and his dad lives in Boston and his dad came to visit him and his friend joked. Oh, that was probably like the 40th time. You're going to see your dad again, before he dies. I saw that as a bill Simmons podcast, it's 

Mike Koelzer, Host: Like the dad, he's going to die in seven years. And you see him three times a year, you're going to see them 21 more times kind of thing, something like that.

Derek Borkowski, Pyrls: Yes, exactly. And so for me, that's been a huge focus lately, too. So that's how I kind of, I'm keeping to myself, I feel like the balance of not getting too swept up in this business stuff is like trying to really regret minimization for him or trying to really keep close. Like how many more times can I see my parents?

You know, they live a couple hours away. My wife's family lives more than that. A couple of states away. How many times can we make sure we see them? You know, You have those moments. And so, yeah, so 10 years from now, that might be too far for me to think ahead. Um, and I, and I feel good about the fact that I just hope 10 years from now, I won't be regretting a balance of, of, of those important, important moments.

Mike Koelzer, Host: If you [00:58:00] went in right now to a graduating class of pharmacy students, what would your life spiel be to them? Assuming that you liked the road you took to this point, and you talked about earlier about taking the chances now and so on, what would you tell a class of graduating pharmacy 

Derek Borkowski, Pyrls: students? Yeah, I would say I have some opinions here.

Um, and so I, and I'll preface it by saying I'm still very bullish on pharmacy. Um, despite what you hear and, and it's because of maybe the path I've taken. So healthcare is, I think, uniquely an area that has yet to be, you know, uh, or has so much potential, you know, innovation. But it's not a low-hanging fruit sector because there's so much domain expertise required to apply technical solutions to problems.

And so one thing I wish would happen actually is I wish all pharmacy schools could make their program last [00:59:00] three years. Instead of, you know, there's a few that do it now. One of the didactic years may get, you know, get, we need more rotations, um, and make them three years long because the four years is really killer actually to like someone who's applying to pharmacy school.

I think it's very, I think it'd be a very smart career path to say, I want to go to pharmacy school to get clinical domain expertise and then take it to technology. But four years is just too long and there's too much of an opportunity cost where if it was three years and because uniquely I've noticed pharmacists have a really unique clinical skillset.

So doctors say you go to a medicine program, you get very siloed into one area, even though you are the. The boss in health care, you know, they're the big fish, you know, MDs, but they're very siloed and healthcare where pharmacists, because basically you're kind of a de facto chronic diseases specialist, which is what 80% of patients actually deal with.

That was one thing I was most shocked by when I was on fourth year rotations and I was working on my acute care rotation. [01:00:00] I remember saying to my preceptor, is it just the same 30 people who come in and out of here every week? Like I said, you know, in other professions, like I would say, even like physician associates or assistants and nurse practitioners, they also kind of get siloed, even though they're pretty high level, pretty deep domain experts, they get kind of siloed.

And then there's other professions that I would say don't quite have the extent of domain knowledge that pharmacists do. Like a pharm D in some ways is almost like being a healthcare domain expert generalist, which then you can come into lots of other, like non traditional types of. And that is like in technology companies or, or in an illegal practice, right.

A financial practice and really bring the law and really have an understanding of how healthcare is delivered. Um, where, again, some other professionals, I would say don't quite have a high enough degree of education or patience, you know, patient, you know, decision-making and some other professions are almost too siloed.

Like many doctors don't understand, you know, so many things about how they understand the [01:01:00] medicine super well, but not how care gets in the hands of patients, AKA insurance and all these other things. So I think that is, that would be my, you know, speech to, to students would be, you ha you are a healthcare domain expert, just because the job market for traditional pharmacy roles may seem a certain way.

Don't undervalue the domain expertise you have. And I hope that more linear paths to roles where healthcare domain expertise can be applied happen. Like, for example, when I was a first year in pharmacy school in 2014, Between when I graduated in 2018, the number of industry fellowships, almost text. And so, you know, like to go into the pharmaceutical industry as a medical science liaison or a regulatory affairs specialist.

And so I'd love to see that like, like my company, for example, we're going to be launching a drug information fellowship or is slash you know, digital health. And I think there's other companies where we need to, you know, create more pharmacists who are doing non-traditional [01:02:00] roles. See if you can find a way to create a linear path to that role.

Um, and cause I think fellowships to nicely bridged the like compensation issue, cause like an entry level data analyst doesn't make as much money as an entry-level pharmacist makes, but an issue with that pharmacist isn't really going to be good enough at data analytics to be better than the data analyst in like a healthcare role.

But after a year of fellowship, I think you could justify the pain after a year after a year of fellowship. And after you, you're certain that these, that, that. The applicant has successfully melded their healthcare domain expertise with the industry. They're trying to apply it to then I think they actually there's, there's, there's no longer actually a ceiling on what they, what they could be worth in some of these other industries, you know, there's product managers and, and engineer managers at, at Amazon that make, you know, $700,000 a year, you know?

And so we can, we can get people with pharm, DS into roles that no longer have, um, limitations to where, how they're applying their knowledge. 

Mike Koelzer, Host: Let's say you're going in as a, as a graduating class. [01:03:00] You're not trying to sell them in pharmacies anymore. They've already chosen pharmacy, but everybody can use a pep-talk, especially when you're $170,000 in debt.

And you've just spent seven, eight years in school. Everybody can use a pep talk on why their degree is a hot degree. 

Derek Borkowski, Pyrls: I, this is what I would tell them for sure. And I think, and I hope that again, especially in this would especially help if we could make pharmacy school three years. I think it's, you know, if we can, that people wouldn't be wanting to go to the pharmacy for this.

Mike Koelzer, Host: Derek. I had Tim Albert on the show and I started off saying, my dad, pharmacy was a four-year degree, great degree to have to then either at the time he then maybe didn't have MBAs, but great degree to go into med school or a dentist or, you know, whatever you wanted to do further on than just your bachelor's degree.

But I told Tim, as far as I know, I ain't no world traveler, but as far as I know over in Europe, they don't repeat the first two years of college with redoing your junior and senior year of high school. So in my opinion, you get rid of the freshmen [01:04:00] sophomore year of. College, you know, all the English over again in psychology and biology, all that stuff you already learned in high school.

So you get rid of that and then you make pharmacy, especially community pharmacy, make it like a tour three-year program and then maybe pharm D or clinical or something. Maybe you go an extra year or something, but turn the whole damn thing into three years versus seven years, and then watch what the entrepreneurs can do when they're 20,000 in debt instead of 170,000 in debt.

And maybe they're five years 

Derek Borkowski, Pyrls: younger, where I thought you were going with that is the first year of pharmacy school is like redoing the last year of your biochemistry degree, you know, for a lot of people. And so I think as soon as possible pharmacy schools need to get pharmacists students in front of patients, you learn everything on API's, but let's cut to the chase when you, when you're in your fourth year is when you really.

A whole bunch of stuff. And now, you know, the other years are certainly important to get you safe and prepared for that. And I realize it's a, it's a logistical nightmare to [01:05:00] coordinate these practice experiences for pharmacy school. So I understand that's a challenge, but what you go to pharmacy school for is, is the patient care that that's what actually, whether you don't want to do that or not.

What I learned on my app is, is what is, makes me different than somebody who is a programmer 

Mike Koelzer, Host: Abby's as your last year of school with your different internships in that right. Fourth year, right? You'd take the idea of skipping the last two years of high school. So you wipe out the first and second year of college, and you're saying the first year of pharmacy school is also a repeat.

Are we down now to one year of classes and one year of internships, is it a two year program? 

Derek Borkowski, Pyrls: Sure. And I do think with more practice, the practice experiences can not be cut. So, you know, the physician assistant or associates, um, you know, they're transitioning in the name, they do two years year round. Right. Um, and so I think, yeah, you can make it, uh, make a farm, be a three-year or two year, year round program.

And no matter [01:06:00] what, yeah. We just, you need to, like, you need to cover the more patient care more patient care, because that's where the that's the differentiating skill 

Mike Koelzer, Host: sets. That's where your program comes in, because the knowledge you've got is the knowledge at your fingertips of the charts and the drugs and the names and all that kind of stuff.

It's learning how to pull that knowledge out with patients over that two year period. 

Derek Borkowski, Pyrls: Yeah. In my, you know, kind of in my non-traditional role, now, the advice I would give my kicking and screaming third year pharmacy students self would be, Hey man, you might want to think about doing a three-month community pharmacy residency like that.

Cause like, even though like. Always kind of towards the end of my pharmacy school, I was angling to do non-traditional careers. The patient care knowledge is actually what differentiates me in this non-traditional role. And so, you know, if I, if I could insert something into my life, it would have been like, if I could have fit like an ambulatory care residency into, into my life, somewhere between graduating and, and what I'm doing now, I I'd have, you know, the clinical knowledge, it would be, what's unique about what I'm applying, you know, what we're applying to software with, you know, with [01:07:00] pearls, 

Mike Koelzer, Host: you can take a hundred people that came from different directions.

Some learn biology, some as a physician assistant, some that went to med school and maybe didn't finish through and then take business people and take programmers and all that. You can throw a hundred people in there. And really one of the differential things is that pharmacists not exclusively, but pharmacists are the ones that have spent time on this broad spectrum with 

Derek Borkowski, Pyrls: patients.

Exactly. And making decisions, you know? So, yeah. So I think the core part of pharmacy school is learning pharmacotherapy. So you may need to learn that in class, and then as soon as you do that, then you need to. It goes to patients and is applied to pharmacotherapy. 

Mike Koelzer, Host: Well, Derek, we solve the world's problems today.

Derek Borkowski, Pyrls: I'm glad that let this, let this set the record straight 

Mike Koelzer, Host: congratulations on where you've come from so far, and it's going to be fun, seeing where you're going. 

Derek Borkowski, Pyrls: Yeah, no, thanks so much, Mike, for letting me come on here and give me a platform and I really appreciate it. And, everything else that the show is bringing to the screen is very valuable.

Thank you for this opportunity. Thanks [01:08:00] so much, Mike. Thank you, Derek.