Medicine has been evolving and the debate about medical education has gained more space in Brazil. In this sense, the demands of the medical professional - given their centrality in the health chain - have also attracted attention. In this sense, Sanar emerged combining knowledge and technology to meet some of these needs and assist in the journey of doctors and other health professionals with content and products that accompany them throughout their careers. In an exclusive interview, Ubiraci Mercês, founder and CEO of Sanar, tells about the history of undertaking, challenges, and shares some perspectives regarding medical education in Brazil.
Below are the main excerpts from the interview:
What is Sanar's story?
Sanar started in 2014. Basically, we started by making pages on Facebook and YouTube on top of “painpoints” from the doctor's life. When medical students graduate, they have 60 specialties to choose from, for example. But which specialty is the best for his life? The course has a lot of content and he thinks “how can I have a practical guide for my training?” So we started to set up these micro communities for these pains, serving with basic content and that's how they grew a lot.
As we managed these communities, we began to discover needs in the doctor in a way that no one was looking at. From there, we began to build deeper content collaboratively. We even brought together hundreds of medical professionals to write a single material. In this process, SanarFlix appeared in 2017, which became known as Netflix of Medicine, the first digital platform to support students for graduation. Over time, we incorporated other pain affecting medical students, such as preparation for residencies, training in the most relevant Emergency topics - to enable them to work safely on duty after graduation - and thus we were able to become the medical education product with the highest number of paid users in Latin America. Then Sanar Up appeared, which was the first credit product for medical students. Always with the same logic of discovering an imminent need and creating the most appropriate solution at the right time.
Today we have become a platform for the doctor's entire professional life: we are partners from the moment he steps into college until his last professional day. Sanar's goal is to help reinvent doctors and expand their capacities to deal with the health system, which in turn is constantly changing. We currently do this through the delivery of assertive content, specialized skills training, and credit. Our daily life is about nurturing a strong relationship of trust with the doctor.
What is the biggest challenge you have encountered in the middle of this journey?
There were several. The first challenge was to be able, on the one hand, to understand the demands and evolutions of medicine and to be able to distribute this content quickly, accessible and with extreme care for the quality of what was being produced. The point is that medicine is evolving faster and this happens because there is pressure from science, technology, etc., a situation that is just beginning. The derivation of this is that we have medical protocols, for example, that change every year. Medical content is always under high renewal. In addition, the “jurisprudence” of medicine is unique: a scientific innovation taking place in China is, in theory, valid for the entire world. But the distribution of that content doesn't happen at the same speed. It often gets stuck in silos, unfortunately.
Today we see a great structural difficulty in the sector to enable doctors to learn new procedures, some on the frontier of medicine, which are in line with what the Brazilian health system needs and which generate a lot of value for the patient. We've been solving these challenges since we started Healing.
We also had challenges in other dimensions, such as team building and culture. We were born in Salvador, but we know that there is a very large concentration of technology and of the entire mass of specialized talent in São Paulo. So it was a challenge to “pierce that bubble”. We were able to succeed by recruiting young talents, who, in addition to their high cognitive capacity, had a great desire to make it happen, but who had no experience. They were exposed to more complex challenges than they could handle and to very challenging environments. It was these factors that helped build a resilient talent company.
Another challenge was not having the famous Sanar subtitle — “the Y health company”. When we started it seemed that it was important for Brazilian entrepreneurs to look at The Wall Street newspaper and simply replicate what was emerging out there for Brazil. We weren't in that bubble and that was very important because we traced a very particular journey, with a thesis that even challenged some existing heuristics in the capture industry. It was challenging to explain the company and how we were going to invest the money at the time.
We know that there is a discussion about changes in relation to a medical education curriculum thinking about contemplating digitalization, social changes, etc. How do you see that the public sector and the market have been responding to these challenges? Do you have a good perspective for these changes?
First, it's important to take a step back and understand what's happening and how medical training takes place. There is a medical initiative going to the interior of Brazil and this is very important. It is proven that medical training in the interior helps doctors to penetrate this region. But there is still a lack of specialists and teachers in the interior, access is not simple.
Another fact is that a very important part of medical education is specialization. Basically, this stage is served by the residences, which are fed by the government. As I said before, medicine is evolving very fast and it is necessary to have non-trivial investments in space. Today there are not enough vacancies in homes and Brazil needs specialists, especially in those geographies that I mentioned.
But it is important to emphasize that medical training is basically based on three things: a good teacher, a good practical teaching field with a good method. I would say that these should be the number 1, 2, and 3 concerns in the industry. But neither can we overlook the fact that medical students have changed, either because they are more connected or because they have another social and economic characteristic.
That said, the market needs to understand that Medicine requires a lot of investment. It also needs to take the long-term incrementability approach, that is, small continuous improvements over time. If you enter into the logic of maximum efficiency with the prism of short-term returns, it can greatly harm these points and create challenges to build a network of teachers who are well qualified with the new learning languages and a practical field of excellence. We know the potential impact of this in the future.
The government, which in turn helps to make one of the best educational programs I know, which is medical residency, has difficulty making the investment to the same extent that medicine and the person evolve. For example, new procedures at the frontier of medicine, such as robotics, require more expensive equipment. That's a challenge. Associated with this factor, we see that medical education will need to undergo an evolution to accompany a new generational doctor that is emerging. We're learning that nothing is so static in a world that's transforming its fundamentals. The government has its challenges in making these investments at the speed that is necessary.
And what do you see of the medical education scene in the international context?
There is the American model, on the one hand, in which it takes a long time to train a specialist doctor. The training is very strict, but very slow. On the other hand, there are some countries that train specialist doctors in a simpler way, mainly because of a structural condition. In other words, they do not address more complex topics in great depth and end up not entering so much into the high medical complexity.
By the way, I would say that Brazil is at an optimal point in this spectrum and has great potential for medical education. This is because we have very good teachers, the medical training requirement is adequate, with an adequate level of regulation. I understand that Brazil has a fertile environment to become a major benchmark in the world.
And does Sanar have any companies that served as a benchmark or not?
We don't have, we don't copy any models. We didn't emerge in the bubble and that empowered us enough to build our story as we believed. So we ended up being innovative and we are the only company that involves doctors with a single platform from the moment they set foot in college until their last professional day, delivering content, training and credit to unlock professional potential. Now, for each of those pieces of our solutions we have references, but it wasn't a “Ctrl C, Ctrl V”.
What are Sanar's next steps?
The doctor is still one of the most important parts of health, because most of the decisions in this chain, which is one of the largest industries in the world, pass through him. So, every 0.01% improvement that is generated for this professional has a brutal impact on the health system. We saw that the doctor was not as well cared for as it might seem. We noticed that no player looks at the doctor in an integrated way. And then Sanar has products for almost 15 years of medical journey and our vision is to continue consolidating ourselves with a unique platform for this professional. We want to be the great platform for his life.
What advice would you give to future health entrepreneurs? What do you understand to be a market with good demand today in Brazil?
Would love to have the answer to that question! I will answer starting with an insight to try to bring some opportunities. I live in Bahia, which has 15 million inhabitants. If I ask people which cities they remember here, they will definitely be able to say a maximum of 10 to 12. The combined population of these cities will represent around 6 to 7 million people. I ask, where are the other 9 million people? Who performs the precision diagnosis? If someone has an emergency, will they have to go to a city 500 km away? About 60% of the state's population is spread across several cities with these conditions. Health is very “municipal” and is being underserved, as the cost of operating in these places is often incompatible with the financial capacity of municipalities. This is not seen on a daily basis, but this is Brazil.
I also understand that the highly complex health of large centers is very well resolved. There are opportunities, but it's well resolved. However, when you look at low and medium complexity health, not only is it unresolved, but there are also many gaps. There is a lack of access to procedures, such as cataract surgery, for example.
The most apparent opportunities lie in the combination of these two factors. Certainly, technology and good entrepreneurs will help solve this problem.
Another tip I would give is about the modus operandis in space. Health is a large market, but it's important to understand that it is made up of several small pieces. It's no use coming up with the logic of fintechs that you're in a 100 billion real market and that you'll have a single solution to unlock this. In my view, to set up a good business in the sector, the entrepreneur must be comfortable dealing with a level of complexity of the business model that grows over time, as he will have to be ready to unlock new opportunities pari-passu to the journey. So, patience and platform thinking are the ingredients for dealing with this scenario — if you think about it, a hospital is it. Finally, the logic of growing super fast is not recommended, as long as the trade-off is known and the entrepreneur has taken that risk into his strategy.
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