Brian Kenny:
In 1970, about 15 percent of adults in the United States met the clinical definition of obesity. By 1990, that number had doubled. Today it sits at 42 percent for adults and 19 percent for children and adolescents. That’s over a third of our nation’s population grappling with the health conditions that can result from obesity, including cardiovascular disease, diabetes, and joint problems among others, not to mention mental health challenges that arrive from the social stigma of being overweight.
And despite the 70 billion or so annual spend on weight loss programs and supplements, many find it nearly impossible to sustain the results. A stark reminder that obesity is a medical condition, one which the medical community has yet to fully embrace.
Today on Cold Call, we welcome Professor Jon Jachimowicz and case protagonist Brooke Boyarsky Pratt to discuss the case, “Choosing the Course of Passion: Brooke Boyarsky Pratt at Knownwell.” I’m your host Brian Kenny, and you’re listening to Cold Call on the HBR podcast network.
Jon Jachimowicz studies the experience antecedents and consequences of passion. Brooke Boyarsky Pratt is the founder and CEO of Knownwell and the protagonist in today’s case, and she’s also a graduate of HBS. Welcome both of you.
Jon Jachimowicz:
Thanks for having us.
Brooke Boyarsky Pratt:
Yeah, thanks so much for having us here. Thrilled to be here.
Brian Kenny:
A lot of people are dealing with this in one way or the other. If it’s not them, it’s a loved one. And I think they’re going to be really interested in hearing about your experience, Brooke, and the path that you chose to take. I’m going to start with you, Jon. Can you describe the central issue in the case and what your cold call is to the start the discussion in class?
Jon Jachimowicz:
Absolutely. So I think the case, really the fundamental issue is how do you know what it is that you are passionate about? And how do you figure out when to go for it? There’s so many things that we care about in life, but how do you know that this is the thing that you’re going to do full time, that you’re willing to leave your job for, that you’re willing to bet everything on. And then how do you do that day to day? You have to make so many decisions to actually make that happen. But then to do that in the context of obesity, I mean, it’s quoted in the case, it’s the last acceptable form of bias that we have in society. It’s normal for us to discriminate against people with obesity who are struggling with their weight, and so it was also really personally important for me to situate this case in an environment where I think we struggle to have honest and serious conversations with one another, and I think to the detriment of us all.
Brian Kenny:
How did you hear about Brooke, and what led you to decide to write the case?
Jon Jachimowicz:
Yeah, absolutely. So I read about Brooke from an announcement that she was being funded for the first time, and I thought, interesting somebody who’s being funded to do obesity care. And then I thought, “Aren’t there hundreds of companies that are doing obesity care? There’s tons of companies that do dialysis care when you have kidney disease, and so shouldn’t there be hundreds of companies doing obesity care?” And so I started doing research on this and I realized, wait a minute, there are no other companies doing obesity care. That’s weird.
And as I started digging more and more into Brooke’s story, I realized not only is the company interesting, but Brooke’s story is unique and fascinating for me because we have this assumption that if you want to pursue your passion, you have to do it when you’re young, when you are either straight out of college or right after grad school, that that’s the best time for you to pursue your passion. You don’t have commitments. That’s when you can take a risk. Brooke had a career for 10 years after graduating from HBS. She went on to have a very successful high paying career, and then she decided to go on and do this thing. So it goes against the norm of how we typically think about it. And I think it’s really important for people to see and understand you can pursue your passion across your career. It doesn’t have to be just at that one time point.
Brian Kenny:
Yeah. And I do want to talk more about that because I’m one of those people who may not know what my passion is, so maybe you can help me figure it out. But I think it’s really cool when people understand what it is and are able to do the kind of thing that Brooke did. Brooke, let me turn to you for a minute and let’s talk about Knownwell. Can you describe what Knownwell does and what inspired you to start the business, to make that leap?
Brooke Boyarsky Pratt:
We are the healthcare home for patients with overweight and obesity, and what that means is we do primary care and we do metabolic care or weight management, obesity medicine, you can call it a lot of things. But at its core, it means that you can come to us as you are. You can see us in person or in a clinic. We have a real exceptional specialist-led care team, and we can truly do everything for you. That would be within a primary care setting. So how that’s differentiated on the market, particularly with the craziness around GLP-1s right now is, as opposed to paying cash to fill out a three-minute survey to get a medication delivered to your door for obesity, for us, we’re an insurance-based covered program that welcomes you as you are and will take care of your holistic health needs. So that’s really Knownwell at its core.
Brian Kenny:
Okay. And what led you to make that leap?
Brooke Boyarsky Pratt:
It’s really interesting because I have had no experience in healthcare. The experience that I had, the longitudinal experience, was being a patient with obesity since childhood so much so that I gave the HBS graduation speech centered around my weight. And because I’ve moved a lot, I have felt very acutely what most Americans with overweight or obesity feel, which is the difficulty of finding a healthcare home, whether it’s a primary care doctor who doesn’t stigmatize you or assume you’re an idiot because of your weight, or the difficulty of accessing weight management services, and the frustration of not being able to do it in one place. So after experiencing that time and time again, city after city, I started getting curious about if there’s a better way to deliver care for patients.
Brian Kenny:
Yeah. Can you talk a little bit about your formative years and your background? The case does a good job describing your childhood and some of the things that you did before and after HBS. It would be interesting for people to hear about that, I think.
Brooke Boyarsky Pratt:
Sure. So I grew up in Dallas ultimately with a single mom, drug addicted, difficult dad. And I started really having obesity in preteen. And what was interesting at the time is my sister who had the same diet and the same activity level wasn’t gaining weight. If you look at my family, my mom is 120 pounds soaking wet and has never dieted, and my dad has struggled with obesity. So you see this interesting interchange of environment and genetics in what our family looks like.
Regardless of my activity level and my eating and trying every diet under the sun just continued to gain weight. Ultimately went to Penn for undergrad, kept gaining weight there, worked a couple years, went to HBS, but I was fortunate that my weight really didn’t hold me back growing up. I didn’t deal with a lot of bullying or anything like that, but it was something that I felt deep shame over. So it’s very near and dear to my heart in terms of it being passion of mine.
Brian Kenny:
Yeah. I’m wondering, as you thought about making this leap, what gave you pause about it? And I’m thinking particularly about the drive and ambition that you showed after you left HBS working for some pretty large reputable firms and rising and climbing that corporate ladder, you were in a pretty amazing position for somebody at a pretty young age in these large enterprises. What were the things that you thought about as you thought, “Gosh, should I actually do this or should I stay the path that I’m on?”
Brooke Boyarsky Pratt:
I had so many things that gave me pause. So I would say first I had just had a baby. So this was not an ideal time in my life to be starting a startup that would ultimately be a second child for me. The second of course was fears around compensation. So the idea of losing a very well-paying job to pursue something that was so uncertain financially was something that mattered a lot to me and took a lot to overcome. And then of course, I think, the question we all face of sort of imposter syndrome. Here you could argue I’m actually an imposter in the sense of I’m leading a healthcare services business and I had never been in healthcare before. All three of those combined made it difficult to jump.
Brian Kenny:
I feel like we could do a whole show about imposter syndrome alone. So it’s a fascinating phenomenon I think. Jon, let me come back to you for a second. One of the things we often hear about the sort of conventional wisdom is you should find a job that you’re passionate about. You should pursue your passion. You even mentioned it earlier people try to do that early on in their career. I guess this is a two-part question. One really is, what if you don’t know what your passion is? And the other is, for many people that would be a risk that’s too scary to take because financial security does matter.
Jon Jachimowicz:
There’s this common misconception that we have to pursue our passion through work. Work is one of the domains that you can pursue your passion. There are plenty of other domains that you can pursue your passion in and still be happy and lead a successful life. You can pursue your passion as a hobby in your community. You can be passionate about supporting your family. Those can all be things that are meaningful and important to you, and a job can be a conduit for you to actually help you accomplish that. I want to make clear that the research shows that no matter where you pursue your passion, it leads to the same beneficial outcomes for you. And if you don’t know yet what that is, then you have to go on a journey of self-discovery to test out what that might be. I think often if we don’t necessarily know what it is that we care about, it means that we need to dig a little bit deeper to testing hypotheses about ourselves. But the challenge is that we do less and less of that the older we get. We start arriving at this understanding that we are the most complete versions of ourselves. Daniel Gilbert in the psychology department at Harvard calls it the “end-of-history illusion.” That I’m now at the most complete version of myself that I’ve ever been and that I will change less in the future than I have changed in the past. Unfortunately or fortunately, research shows that we change just the same amount no matter how old you are. You change as much in your 20s, as in your 30s, as in your 40s. And it makes sense, our life circumstances change, but people think that they change less. And what that means is that they’re less likely to try to experiment, less likely to try new things or engage with new people, and so their views about themselves start to solidify.
And it makes it harder and harder for people to actually understand what it is that they care about. So it really becomes this self-reinforcing cycle. But then you also ask, what about the financial risks of pursuing work that you are passionate about? I think part of the challenge is that we live in a society where people who are passionate for their work are often underpaid. Many organizations believe that they can underpay their employees because they’re providing an amazing opportunity for people to pursue their passion. If you’ve watched the Dallas Cowboys documentary on Netflix, there’s a very long section that talks about how they’re all underpaid and should be paid more.
I think in the ’80s they were paid $30 per game, and that was the whole and complete salary, and the expectation was that you have to donate their back to the organization. But it’s challenging to think about jobs where you live in financial security and then not think, well, of course it’s a difficult thing to do, and you have to think about when are you willing to take that financial risk? You have to think about who might be more able to take that financial risk. If I grow up and I don’t have financial security and financial security is really important to me, and all the jobs out there that would allow me to pursue my passion, don’t offer me that level of financial security.
Well then of course, financial security just happens to rank higher in my values in a list of things that I want to accomplish in my life than pursuing my passion. So let me pursue a job that allows me to pursue my passion in a different way, in a different domain outside of work in a way, but I think it’s really complicated. But there’s a different security that I think we often miss when we talk about this. The emotional security of what it means to pursue your passion. It is really emotionally challenging to pursue work that you’re passionate about because you care so deeply about the outcomes, you care so deeply about what you do, it ends up becoming the most painful and most exhilarating emotional roller coaster.
Brooke can speak to that. That’s what she’s experienced in her career. People think that pursuing your passion is going to be easy, it’s going to be fun. We all know the adage, if you do what you love, you’ll never work another day in your life. Well, if you do what you love, it’s going to be really painful every single day of your life because you’re just so heavily invested in what it is that you do, and you’re going to be plagued by self-doubt and concerns over whether you’re good enough, whether you’re able to accomplish enough. And the answer is probably you won’t be because you are idealistic. That’s what it means to be passionate. And then living with that reality day to day is just going to be really, really painful.
Brian Kenny:
I’m not sure if I feel better or worse after that answer. Brooke, I’m going to turn back to you. My question for you is, when did you know that this was your passion, that this was something that you felt passionately about? When did it sort of crystallize in your mind?
Brooke Boyarsky Pratt:
First I would just say that I went through school and jobs and HBS, so jealous of people who knew what their passion was, particularly those who knew it professionally. I was not. I mean, there’s a reason I went to McKinsey after HBS. I was this constant leave the doors open kind of person. So I just want to say this wasn’t like I sat on it for 10 years. I felt this spark two years ago before I ultimately started Knownwell as I was trying to find a doctor in Chicago around this idea of what if there were a healthcare home for people like me?
And how I started realizing it was my passion was I couldn’t let it go. I was doing research at 2:00 A.M. I hadn’t done that since my McKinsey days. To try to understand the space better, I found myself calling old sectionmates and classmates who I hadn’t talked to in a decade who were in healthcare. And by my own actions, I could just tell that this was something that I was growing significantly more passionate about. And what was really interesting was at the time I kept trying to talk myself out of it because I had such a good gig and I had worked so hard for it.
But what just became very obvious to me was I started to feel like this is really what I was put on this earth to do as woo-woo as that sounds. And ultimately I came to a decision point at which I needed to decide if I were going to sign a longer term contract with my employer, that would’ve again been financially beneficial to do so. And I just had this very clear moment where I realized this will be a deathbed regret for me if I didn’t try to do this for the health of the country and for other people. And ultimately, that was the moment that I decided to leave.
Brian Kenny:
The case describes conversations that you had with people close to you as you thought about whether or not you should do this, and you got some very different advice from different people. Can you describe that a little bit?
Brooke Boyarsky Pratt:
Sure. I think of my brother-in-law, big financial security guy who’s a lawyer, very logical, and he was like, “This is insane. You have a great job. Go help people some other way. Keep your job.” And then people like my mom who understood me so deeply, and she’s an entrepreneur, mission-driven idealist herself, and when I got more and more serious, she just said, “I always knew it would ultimately be something like this for you that you would need to jump and do.” So I took all of that feedback to heart. I’m a big decision by committee kind of person, so it was actually helpful for me to understand both sides of how folks view the situation
Brian Kenny:
Yeah. And to consider all the possible angles of what you were about to do. Jon, just back to passion for a second. This is a little bit off the case, but what’s the difference between a hobby or an interest and a passion? I love golf. I don’t think I’d want to work in the golf industry because I feel then I love to play golf and probably in some ways it might ruin it for me. I get too close to it. Does that make sense?
Jon Jachimowicz:
I think it makes a lot of sense. I think fundamentally it’s a decision that you have to make about how central it is to who you are. Say you were passionate about golf, then it means that you want to be seen as somebody who loves golf so much. You want people to think of you as a golfer or a golf fanatic. That’s very different from saying, “I like playing golf. I enjoy it, but it’s not central to who I am.” So it’s really about how central it is to your story. And when Brooke and I were talking, part of the, I think where she’s at in her journey now is when she was at HBS over a decade ago, obesity was something that was in her mind, but it wasn’t something that you talked about much with other people.
So, it’s kind of like you just have to figure out when you’re crafting the narrative of your life, of who you are, what it is that you care about, how central do you want that thing to be? And then you have to make decisions that align with that in order for that to then actually become something that you’re passionate about.
Brian Kenny:
That’s a great distinction. Brooke, does that sort of ring true to you in your experience?
Brooke Boyarsky Pratt:
100 percent. I love the Dallas Cowboys, but it might be a passion in the sense of I watch them every week even with how difficult that is as a fan, but it’s not something that’s core to my identity, whereas this I simply couldn’t shake. I felt like I was put on this earth to do it. By the way, there is one other thing I want to add to what Jon said earlier. This idea of living your passion will be fun. There’s good research that shows that parents, they are less happy day to day, but potentially more fulfilled overall. That is exactly how I would describe being a founder. I am a lot less happy day to day. I have less money, I work harder and I’m way more stressed, but overall, I’m more fulfilled.
Brian Kenny:
Okay. Okay. What were some of the challenges that you didn’t expect when you made that move from the corporate world and all that that entails to being an entrepreneur founder.
Brooke Boyarsky Pratt:
First is that you have to be the one who jumps over and over again. So I had this moment where my co-founder called me right before I quit my job and told me, “Don’t quit. I don’t know if we can do it.” And she was the physician, right? I wouldn’t have done it without her. And I realized I’m just going to have to be the one who leaps because it’s so hard to do. And I thought, “Okay, this will be my one leap.” Actually every day you have to be the person as the founder who leaps and you have to hope others will follow you. So I think that’s from a global perspective the most challenging thing. And then the individual perspective, you really take for granted that someone runs payroll and someone does your I-9, and it turns out that someone is me. So it’s a different thing running a company day to day.
Brian Kenny:
Right. Jon, I’m wondering, when people do this and the people that you’ve looked at in addition to Brooke, is it common for people to sort of throw in the towel? They think, “This is what I wanted to do, this is what I meant to do, but you know what, I’m not up for it.”
Jon Jachimowicz:
It’s so easy to think that you know what it’s going to be like to pursue work that you’re passionate about and then realize that the day-to-day has nothing to do with what it is that you actually wanted to do. Brooke wants to do I-9s and do payroll, but that’s what most of her day-to-day job looks like. And so figuring out whether you are able to keep going despite day to day, that doesn’t necessarily align with what it is that you care about because you believe in the overarching mission or having a sense that you can craft what you’re doing day to day in a way that still makes you feel like you’re able to make that difference, I think that works entirely.
But it’s no secret that a lot of people enter jobs in order to pursue their passions, only to quit them because they become cynical and burn out. That happens again and again. We see this right now. We have a gigantic nursing shortage. We all know nurses are often attracted to pursue this line of work because they’re passionate for patient care and making a difference. Well, if so many nurses are entering nursing occupation, and we still have such a huge gap because a lot of them are leaving and becoming cynical, I think it shows us that there’s just this big disconnect. People might not necessarily know what they’re getting into, what they’re signing up for, and I think that’s really challenging.
Brian Kenny:
Yeah. Brooke, we haven’t really talked in much detail about Knownwell, and I want talk about that now because I want people to understand what it is you’re doing and what makes the experience different for obese people when they visit one of your clinics.
Brooke Boyarsky Pratt:
Absolutely. So most of healthcare is designed around patients in a lower BMI body size, and that can be the little thing. So our doorways are wider, our furniture is larger, our blood pressure cuffs always fit. If it’s stigmatizing and difficult to step on a scale and we need your weight, we can get it from sitting on one of our exam tables. So when you think about getting the little things right to make a person feel welcome, we’ve really emphasized that in our physical environment, and we’ve tried to mirror it in our virtual environment. So you can see us online, you don’t have to come in person. This is about how we’ve trained our physicians and our clinicians to be weight inclusive. The types of things that we ask you before and after a visit, we really try to take into account truly delivering patient-centered care for these patients. We are following what’s called a weight-inclusive versus a weight-normative approach, and that really means we help you be your healthiest and we don’t boil everything down to your body size.
Brian Kenny:
Yeah. Yeah. I mean, the case describes what the experience can be like for an obese person in the normal healthcare system. It sounded to me like it goes everywhere from just being dismissive to being downright rude to patients where doctors just don’t even want to take the time to understand or listen. Is that fair to say?
Brooke Boyarsky Pratt:
Oh, I mean the research, it’s overwhelming. So if you ask physicians, who are the patients you least like to treat? One study showed that patients with obesity were only second to active IV drug users. So what’s really unique about obesity is clinicians actually endorse an explicit weight bias. So this is them saying, “I don’t like seeing these patients.” It’s not an implicit. And we see from the research that patients feel that too. They’re canceling appointments, they’re avoiding care because they know they’ll have a stigmatizing experience. And I’ll just mention, a patient we had a few weeks ago was saying that she got on a scale at her PCP clinic, and the doctor walked by and just offhandedly said to her, “That number wouldn’t look so bad if you ate fewer big macs.” By the way, this is a woman who does marathons, who eats extremely clean. So look, I think clinicians are doing their best. I don’t think many are mean-spirited, but the amalgamation of these experiences lead patients to not want to seek care.
Brian Kenny:
And there’s also a misunderstanding as the case points out about the causes of obesity. And you just mentioned it there, it’s not always from poor eating or poor exercise habits, some of it’s genetics. It can be any number of things. Is that right?
Brooke Boyarsky Pratt:
Absolutely. I mean, look at me. HBS grad, went to Penn, did really well. I’ve worked hard in my career. I think most people would say I’m someone who’s shown discipline and drive, and yet I’ve been 150 pounds overweight. So I think if it were simply a matter of willpower there wouldn’t be people like me who existed, and it wouldn’t be such a prevalent problem. You mentioned earlier the amount of money that’s spent on diet and lifestyle. We have the data. Americans are willing to spend a tremendous amount of time, money, and energy on pure lifestyle interventions like Weight Watchers, and we have the data to know it doesn’t work for the vast majority of patients if they’re not in a real medical setting. So I hope that the conversation in the obesity space continues to shift from blame to support.
Brian Kenny:
Jon, let me ask you this because it’s always hard to ask the protagonist, even though we love having the protagonist on the show about their personal leadership style. So I’m going to ask you, how important is Brooke’s passion for this topic and her lived experience and her leadership style? How important is that to creating the kind of culture that makes Knownwell effective?
Jon Jachimowicz:
I think it’s absolutely vital and essential. I don’t think Knownwell would exist without Brooke’s passion. And it starts of just attracting people to come and work for her. How do you convince someone to come work for you when there is no company to join, when there is no business model, there is no revenue? The only thing you can go after is the founder. And at this point, you have a founder who is extremely skilled, she has an amazing resume, she has shown that she has the talent to produce. And at the same time she says, “You know what? I have this vision and I have this vision because I have my lived experience. I’ve done two years of research, and I think this is where we need to go.”
Well, you’re going to follow a leader like that into the fog of the unknown that a lot of startup is in order to figure out what you want to do to do that. But without her passion for this work, there is no following. There’s no one that joins you. There are no investors willing to invest in you. Investors want to have an implicit promise that you are going to deliver on what it is that you promised to do. Well, one of the signals that you can use is, how much does Brooke care about this? Because if she cares a lot about this, she’ll try to do everything she can in order to be successful, because it’s a personally relevant mission for it.
And then you see then every single thing that Knownwell does, when we talked to some of Brooke’s staff about how the clinics are structured and how patients are treated, it was clear that everything was based around making sure that patients don’t have the same experiences that Brooke had. And that was the yardstick. That was the metric that was being used to understand, are we treating patients well? But how can we actually do right by this group of people that’s been neglected for decades and decades in American healthcare? I think that’s the yardstick that’s being used, but that comes straight from Brooke’s passion for the work.
Brian Kenny:
Yeah. Brooke, how did you convince investors to take a leap on this with you? Those conversations I’m sure were interesting.
Brooke Boyarsky Pratt:
Not fun in the sense of when we went and raised our seed, the market had already turned. So very difficult to raise venture money, even more difficult for a click and mortar primary care focused startup. But I think a few things got investors really excited both at our seed and at our A. One was of course the market opportunity and the unmet need of patients. The second was a strong belief in our clinical expertise with my co-founder, Dr. Angela Fitch, and our clinical model for how we were going to treat patients.
And then certainly, I think the third was our founding team. Not just me, but all of our ability to show demonstrated impact in our careers before what we were willing to give up to pursue this passion, and the clarity with which we were driving to create the company. So that I got us over the hurdle at the seed. And then at the A, we were able to show really strong patient attraction and stickiness with patients as well as great clinical outcomes.
Brian Kenny:
And what are you learning from your patients as they go through the facility and they engage with your team? I’m sure some of those learnings were being fed right back into the model.
Brooke Boyarsky Pratt:
Absolutely. So the first is that it is so tremendously impactful for them to feel like they have found a healthcare home. I mean, we have patients who, they’re like, “My whole neighborhood goes to you guys now because I had such a great experience.” And it really is the small things. I mean, patients will often say to me, “The staff looked at me, they didn’t avert their eyes.” Or “I felt so comfortable in the furniture.” “My clinician asked me about me. They didn’t start with my weight.” It’s actually sad where the bar was. And then there’s certainly tactical things we’ve learned from patients about the kind of comprehensive care they’re treating and how else we can help them that we’re incorporating into the care model.
Brian Kenny:
Yeah. The case also mentions, I thought, very interestingly, you mentioned that your husband also has some weight challenges. And his experience in the medical profession was never the same as yours or was different than yours. Can you describe that?
Brooke Boyarsky Pratt:
Yeah. And you see this in the research too. There is a little bit of a gender split. So both men and women face a lot of stigma around obesity and body size, but for whatever reason, you see it significantly more felt and reported on by women which we could have a whole podcast on why-
Brian Kenny:
Yeah, we could.
Brooke Boyarsky Pratt:
… we think that is. But what’s interesting is I had asked my husband, did you ever feel like you were disparaged or ignored or minimized by physicians because of your weight? And he was like, “No, not really.” And our patients are about 70 percent women, that’s true of most obesity services. So is that societal? Is that emotional? I don’t know exactly what’s driving it, but there is this interesting distinction where the problem seems to be felt more acutely by women.
Brian Kenny:
Now, Jon, this is a business case, so we have to come back to the fundamental business question that part of the premise of the case is that, Brooke has at a crossroads here with Knownwell. She’s got to make a decision about where she wants to go from here. Can you just describe the issue there?
Jon Jachimowicz:
Yeah, absolutely. Fundamentally, it’s a question of how she wants to pursue her passion. What is it that she wants her day to day to look like and what she wants her impact to be long term? And she really has two options in front of her. She’s been successful in building out one clinic in the Massachusetts area, and she could accept money from friends and family, grow relatively slowly, build out a couple of clinics in the Massachusetts area, maybe in New England. And maybe after five to 10 years she would have 10, 15 clinics. She would have retained majority ownership over those clinics. She would have very high personal touch with all the patients that she would see. So she would actually get to see the impact that she has. She would make sure that every single patient is cared for well, that no patient falls through the cracks. And that could be one option for her.
The other option is she can go nationwide right away. She can scale this one clinic that she has and go across the whole country, take on venture capital money, which might mean giving away some control of the organization, not necessarily retaining majority ownership of the organization being pushed around by whatever VCs want you to do, which is often going fast in order to take majority market share. It might also mean that you might not necessarily be there for every single patient. That some patients maybe do fall through the cracks because scaling so fast. You’re hiring a lot of staff. Maybe you’re not able to uphold the same level of training. That’s a big risk. And also there’s a higher financial risk. There’s a higher possibility that this thing will fail if you grow very, very quickly. But the upside of scaling really quickly, think of the problem that we’re facing in this country. Think of the potential impact that we could have if we scale quickly. So fundamentally, it’s an organizational decision, what should Knownwell do? But at the end of the day, she founded this company. It’s a personal decision. What does she want her life to look like, day-to day? What does she want her life to amount to? Which is why I personally love this decision, and I love this case.
Brian Kenny:
Yeah. Yeah. Like so many HBS cases, there’s no wrong answer. There’s no completely right answer. And Brooke, I’m sure in your years of consulting, you probably saw a lot of firms go through similar kinds of difficult decisions. So I’m not going to ask you where you’re leaning. What I will ask, and this is my last question for you, and then I’ve got one more for you, Jon. So my last question for you is, what does success look like for Knownwell five years from now? As you think about into the future what would you be pleased with?
Brooke Boyarsky Pratt:
We are the preeminent healthcare home for patients with overweight and obesity across America. So for the next Brooke who moves to their next city and needs to find a physician or a clinical practice, it is obvious to them where they should go.
Brian Kenny:
Yeah. I have a sense for where she’s going with that, Jon, but I’m going to give you the last word in the case, in the podcast rather, which is what do you want people to remember about the Brooke Boyarsky Pratt case?
Jon Jachimowicz:
I think that how you pursue your passion can look very different for different people at different stages of their lives and career. We often have an idealistic model and expectation of what it looks like, but it comes in so many different shapes and forms that I think we should just be open to the idea that anybody can pursue their passion in any domain at any time point in their life, they just have to figure out what trade-offs and sacrifices they’re comfortable or not comfortable with.
Brian Kenny:
Yeah. Jon, Brooke, thank you so much for joining me on Cold Call.
Jon Jachimowicz:
Thank you so much for having us.
Brooke Boyarsky Pratt:
Thank you. Such a pleasure.
Brian Kenny:
If you enjoy Cold Call, you might like our other podcasts, After Hours, Climate Rising, Deep Purpose, IdeaCast, Managing the Future of Work, Skydeck, Think Big, Buy Small, and Women at Work, find them on Apple, Spotify, or wherever you listen. And if you could take a minute to rate and review us, we’d be grateful. If you have any suggestions or just want to say hello, we want to hear from you, email us at coldcall@hbs.edu. Thanks again for joining us, I’m your host Brian Kenny, and you’ve been listening to Cold Call, an official podcast of Harvard Business School and part of the HBR Podcast Network.
Brian Kenny:
In 1970, about 15 percent of adults in the United States met the clinical definition of obesity. By 1990, that number had doubled. Today it sits at 42 percent for adults and 19 percent for children and adolescents. That’s over a third of our nation’s population grappling with the health conditions that can result from obesity, including cardiovascular disease, diabetes, and joint problems among others, not to mention mental health challenges that arrive from the social stigma of being overweight.
And despite the 70 billion or so annual spend on weight loss programs and supplements, many find it nearly impossible to sustain the results. A stark reminder that obesity is a medical condition, one which the medical community has yet to fully embrace.
Today on Cold Call, we welcome Professor Jon Jachimowicz and case protagonist Brooke Boyarsky Pratt to discuss the case, “Choosing the Course of Passion: Brooke Boyarsky Pratt at Knownwell.” I’m your host Brian Kenny, and you’re listening to Cold Call on the HBR podcast network.
Jon Jachimowicz studies the experience antecedents and consequences of passion. Brooke Boyarsky Pratt is the founder and CEO of Knownwell and the protagonist in today’s case, and she’s also a graduate of HBS. Welcome both of you.
Jon Jachimowicz:
Thanks for having us.
Brooke Boyarsky Pratt:
Yeah, thanks so much for having us here. Thrilled to be here.
Brian Kenny:
A lot of people are dealing with this in one way or the other. If it’s not them, it’s a loved one. And I think they’re going to be really interested in hearing about your experience, Brooke, and the path that you chose to take. I’m going to start with you, Jon. Can you describe the central issue in the case and what your cold call is to the start the discussion in class?
Jon Jachimowicz:
Absolutely. So I think the case, really the fundamental issue is how do you know what it is that you are passionate about? And how do you figure out when to go for it? There’s so many things that we care about in life, but how do you know that this is the thing that you’re going to do full time, that you’re willing to leave your job for, that you’re willing to bet everything on. And then how do you do that day to day? You have to make so many decisions to actually make that happen. But then to do that in the context of obesity, I mean, it’s quoted in the case, it’s the last acceptable form of bias that we have in society. It’s normal for us to discriminate against people with obesity who are struggling with their weight, and so it was also really personally important for me to situate this case in an environment where I think we struggle to have honest and serious conversations with one another, and I think to the detriment of us all.
Brian Kenny:
How did you hear about Brooke, and what led you to decide to write the case?
Jon Jachimowicz:
Yeah, absolutely. So I read about Brooke from an announcement that she was being funded for the first time, and I thought, interesting somebody who’s being funded to do obesity care. And then I thought, “Aren’t there hundreds of companies that are doing obesity care? There’s tons of companies that do dialysis care when you have kidney disease, and so shouldn’t there be hundreds of companies doing obesity care?” And so I started doing research on this and I realized, wait a minute, there are no other companies doing obesity care. That’s weird.
And as I started digging more and more into Brooke’s story, I realized not only is the company interesting, but Brooke’s story is unique and fascinating for me because we have this assumption that if you want to pursue your passion, you have to do it when you’re young, when you are either straight out of college or right after grad school, that that’s the best time for you to pursue your passion. You don’t have commitments. That’s when you can take a risk. Brooke had a career for 10 years after graduating from HBS. She went on to have a very successful high paying career, and then she decided to go on and do this thing. So it goes against the norm of how we typically think about it. And I think it’s really important for people to see and understand you can pursue your passion across your career. It doesn’t have to be just at that one time point.
Brian Kenny:
Yeah. And I do want to talk more about that because I’m one of those people who may not know what my passion is, so maybe you can help me figure it out. But I think it’s really cool when people understand what it is and are able to do the kind of thing that Brooke did. Brooke, let me turn to you for a minute and let’s talk about Knownwell. Can you describe what Knownwell does and what inspired you to start the business, to make that leap?
Brooke Boyarsky Pratt:
We are the healthcare home for patients with overweight and obesity, and what that means is we do primary care and we do metabolic care or weight management, obesity medicine, you can call it a lot of things. But at its core, it means that you can come to us as you are. You can see us in person or in a clinic. We have a real exceptional specialist-led care team, and we can truly do everything for you. That would be within a primary care setting. So how that’s differentiated on the market, particularly with the craziness around GLP-1s right now is, as opposed to paying cash to fill out a three-minute survey to get a medication delivered to your door for obesity, for us, we’re an insurance-based covered program that welcomes you as you are and will take care of your holistic health needs. So that’s really Knownwell at its core.
Brian Kenny:
Okay. And what led you to make that leap?
Brooke Boyarsky Pratt:
It’s really interesting because I have had no experience in healthcare. The experience that I had, the longitudinal experience, was being a patient with obesity since childhood so much so that I gave the HBS graduation speech centered around my weight. And because I’ve moved a lot, I have felt very acutely what most Americans with overweight or obesity feel, which is the difficulty of finding a healthcare home, whether it’s a primary care doctor who doesn’t stigmatize you or assume you’re an idiot because of your weight, or the difficulty of accessing weight management services, and the frustration of not being able to do it in one place. So after experiencing that time and time again, city after city, I started getting curious about if there’s a better way to deliver care for patients.
Brian Kenny:
Yeah. Can you talk a little bit about your formative years and your background? The case does a good job describing your childhood and some of the things that you did before and after HBS. It would be interesting for people to hear about that, I think.
Brooke Boyarsky Pratt:
Sure. So I grew up in Dallas ultimately with a single mom, drug addicted, difficult dad. And I started really having obesity in preteen. And what was interesting at the time is my sister who had the same diet and the same activity level wasn’t gaining weight. If you look at my family, my mom is 120 pounds soaking wet and has never dieted, and my dad has struggled with obesity. So you see this interesting interchange of environment and genetics in what our family looks like.
Regardless of my activity level and my eating and trying every diet under the sun just continued to gain weight. Ultimately went to Penn for undergrad, kept gaining weight there, worked a couple years, went to HBS, but I was fortunate that my weight really didn’t hold me back growing up. I didn’t deal with a lot of bullying or anything like that, but it was something that I felt deep shame over. So it’s very near and dear to my heart in terms of it being passion of mine.
Brian Kenny:
Yeah. I’m wondering, as you thought about making this leap, what gave you pause about it? And I’m thinking particularly about the drive and ambition that you showed after you left HBS working for some pretty large reputable firms and rising and climbing that corporate ladder, you were in a pretty amazing position for somebody at a pretty young age in these large enterprises. What were the things that you thought about as you thought, “Gosh, should I actually do this or should I stay the path that I’m on?”
Brooke Boyarsky Pratt:
I had so many things that gave me pause. So I would say first I had just had a baby. So this was not an ideal time in my life to be starting a startup that would ultimately be a second child for me. The second of course was fears around compensation. So the idea of losing a very well-paying job to pursue something that was so uncertain financially was something that mattered a lot to me and took a lot to overcome. And then of course, I think, the question we all face of sort of imposter syndrome. Here you could argue I’m actually an imposter in the sense of I’m leading a healthcare services business and I had never been in healthcare before. All three of those combined made it difficult to jump.
Brian Kenny:
I feel like we could do a whole show about imposter syndrome alone. So it’s a fascinating phenomenon I think. Jon, let me come back to you for a second. One of the things we often hear about the sort of conventional wisdom is you should find a job that you’re passionate about. You should pursue your passion. You even mentioned it earlier people try to do that early on in their career. I guess this is a two-part question. One really is, what if you don’t know what your passion is? And the other is, for many people that would be a risk that’s too scary to take because financial security does matter.
Jon Jachimowicz:
There’s this common misconception that we have to pursue our passion through work. Work is one of the domains that you can pursue your passion. There are plenty of other domains that you can pursue your passion in and still be happy and lead a successful life. You can pursue your passion as a hobby in your community. You can be passionate about supporting your family. Those can all be things that are meaningful and important to you, and a job can be a conduit for you to actually help you accomplish that. I want to make clear that the research shows that no matter where you pursue your passion, it leads to the same beneficial outcomes for you. And if you don’t know yet what that is, then you have to go on a journey of self-discovery to test out what that might be. I think often if we don’t necessarily know what it is that we care about, it means that we need to dig a little bit deeper to testing hypotheses about ourselves. But the challenge is that we do less and less of that the older we get. We start arriving at this understanding that we are the most complete versions of ourselves. Daniel Gilbert in the psychology department at Harvard calls it the “end-of-history illusion.” That I’m now at the most complete version of myself that I’ve ever been and that I will change less in the future than I have changed in the past. Unfortunately or fortunately, research shows that we change just the same amount no matter how old you are. You change as much in your 20s, as in your 30s, as in your 40s. And it makes sense, our life circumstances change, but people think that they change less. And what that means is that they’re less likely to try to experiment, less likely to try new things or engage with new people, and so their views about themselves start to solidify.
And it makes it harder and harder for people to actually understand what it is that they care about. So it really becomes this self-reinforcing cycle. But then you also ask, what about the financial risks of pursuing work that you are passionate about? I think part of the challenge is that we live in a society where people who are passionate for their work are often underpaid. Many organizations believe that they can underpay their employees because they’re providing an amazing opportunity for people to pursue their passion. If you’ve watched the Dallas Cowboys documentary on Netflix, there’s a very long section that talks about how they’re all underpaid and should be paid more.
I think in the ’80s they were paid $30 per game, and that was the whole and complete salary, and the expectation was that you have to donate their back to the organization. But it’s challenging to think about jobs where you live in financial security and then not think, well, of course it’s a difficult thing to do, and you have to think about when are you willing to take that financial risk? You have to think about who might be more able to take that financial risk. If I grow up and I don’t have financial security and financial security is really important to me, and all the jobs out there that would allow me to pursue my passion, don’t offer me that level of financial security.
Well then of course, financial security just happens to rank higher in my values in a list of things that I want to accomplish in my life than pursuing my passion. So let me pursue a job that allows me to pursue my passion in a different way, in a different domain outside of work in a way, but I think it’s really complicated. But there’s a different security that I think we often miss when we talk about this. The emotional security of what it means to pursue your passion. It is really emotionally challenging to pursue work that you’re passionate about because you care so deeply about the outcomes, you care so deeply about what you do, it ends up becoming the most painful and most exhilarating emotional roller coaster.
Brooke can speak to that. That’s what she’s experienced in her career. People think that pursuing your passion is going to be easy, it’s going to be fun. We all know the adage, if you do what you love, you’ll never work another day in your life. Well, if you do what you love, it’s going to be really painful every single day of your life because you’re just so heavily invested in what it is that you do, and you’re going to be plagued by self-doubt and concerns over whether you’re good enough, whether you’re able to accomplish enough. And the answer is probably you won’t be because you are idealistic. That’s what it means to be passionate. And then living with that reality day to day is just going to be really, really painful.
Brian Kenny:
I’m not sure if I feel better or worse after that answer. Brooke, I’m going to turn back to you. My question for you is, when did you know that this was your passion, that this was something that you felt passionately about? When did it sort of crystallize in your mind?
Brooke Boyarsky Pratt:
First I would just say that I went through school and jobs and HBS, so jealous of people who knew what their passion was, particularly those who knew it professionally. I was not. I mean, there’s a reason I went to McKinsey after HBS. I was this constant leave the doors open kind of person. So I just want to say this wasn’t like I sat on it for 10 years. I felt this spark two years ago before I ultimately started Knownwell as I was trying to find a doctor in Chicago around this idea of what if there were a healthcare home for people like me?
And how I started realizing it was my passion was I couldn’t let it go. I was doing research at 2:00 A.M. I hadn’t done that since my McKinsey days. To try to understand the space better, I found myself calling old sectionmates and classmates who I hadn’t talked to in a decade who were in healthcare. And by my own actions, I could just tell that this was something that I was growing significantly more passionate about. And what was really interesting was at the time I kept trying to talk myself out of it because I had such a good gig and I had worked so hard for it.
But what just became very obvious to me was I started to feel like this is really what I was put on this earth to do as woo-woo as that sounds. And ultimately I came to a decision point at which I needed to decide if I were going to sign a longer term contract with my employer, that would’ve again been financially beneficial to do so. And I just had this very clear moment where I realized this will be a deathbed regret for me if I didn’t try to do this for the health of the country and for other people. And ultimately, that was the moment that I decided to leave.
Brian Kenny:
The case describes conversations that you had with people close to you as you thought about whether or not you should do this, and you got some very different advice from different people. Can you describe that a little bit?
Brooke Boyarsky Pratt:
Sure. I think of my brother-in-law, big financial security guy who’s a lawyer, very logical, and he was like, “This is insane. You have a great job. Go help people some other way. Keep your job.” And then people like my mom who understood me so deeply, and she’s an entrepreneur, mission-driven idealist herself, and when I got more and more serious, she just said, “I always knew it would ultimately be something like this for you that you would need to jump and do.” So I took all of that feedback to heart. I’m a big decision by committee kind of person, so it was actually helpful for me to understand both sides of how folks view the situation
Brian Kenny:
Yeah. And to consider all the possible angles of what you were about to do. Jon, just back to passion for a second. This is a little bit off the case, but what’s the difference between a hobby or an interest and a passion? I love golf. I don’t think I’d want to work in the golf industry because I feel then I love to play golf and probably in some ways it might ruin it for me. I get too close to it. Does that make sense?
Jon Jachimowicz:
I think it makes a lot of sense. I think fundamentally it’s a decision that you have to make about how central it is to who you are. Say you were passionate about golf, then it means that you want to be seen as somebody who loves golf so much. You want people to think of you as a golfer or a golf fanatic. That’s very different from saying, “I like playing golf. I enjoy it, but it’s not central to who I am.” So it’s really about how central it is to your story. And when Brooke and I were talking, part of the, I think where she’s at in her journey now is when she was at HBS over a decade ago, obesity was something that was in her mind, but it wasn’t something that you talked about much with other people.
So, it’s kind of like you just have to figure out when you’re crafting the narrative of your life, of who you are, what it is that you care about, how central do you want that thing to be? And then you have to make decisions that align with that in order for that to then actually become something that you’re passionate about.
Brian Kenny:
That’s a great distinction. Brooke, does that sort of ring true to you in your experience?
Brooke Boyarsky Pratt:
100 percent. I love the Dallas Cowboys, but it might be a passion in the sense of I watch them every week even with how difficult that is as a fan, but it’s not something that’s core to my identity, whereas this I simply couldn’t shake. I felt like I was put on this earth to do it. By the way, there is one other thing I want to add to what Jon said earlier. This idea of living your passion will be fun. There’s good research that shows that parents, they are less happy day to day, but potentially more fulfilled overall. That is exactly how I would describe being a founder. I am a lot less happy day to day. I have less money, I work harder and I’m way more stressed, but overall, I’m more fulfilled.
Brian Kenny:
Okay. Okay. What were some of the challenges that you didn’t expect when you made that move from the corporate world and all that that entails to being an entrepreneur founder.
Brooke Boyarsky Pratt:
First is that you have to be the one who jumps over and over again. So I had this moment where my co-founder called me right before I quit my job and told me, “Don’t quit. I don’t know if we can do it.” And she was the physician, right? I wouldn’t have done it without her. And I realized I’m just going to have to be the one who leaps because it’s so hard to do. And I thought, “Okay, this will be my one leap.” Actually every day you have to be the person as the founder who leaps and you have to hope others will follow you. So I think that’s from a global perspective the most challenging thing. And then the individual perspective, you really take for granted that someone runs payroll and someone does your I-9, and it turns out that someone is me. So it’s a different thing running a company day to day.
Brian Kenny:
Right. Jon, I’m wondering, when people do this and the people that you’ve looked at in addition to Brooke, is it common for people to sort of throw in the towel? They think, “This is what I wanted to do, this is what I meant to do, but you know what, I’m not up for it.”
Jon Jachimowicz:
It’s so easy to think that you know what it’s going to be like to pursue work that you’re passionate about and then realize that the day-to-day has nothing to do with what it is that you actually wanted to do. Brooke wants to do I-9s and do payroll, but that’s what most of her day-to-day job looks like. And so figuring out whether you are able to keep going despite day to day, that doesn’t necessarily align with what it is that you care about because you believe in the overarching mission or having a sense that you can craft what you’re doing day to day in a way that still makes you feel like you’re able to make that difference, I think that works entirely.
But it’s no secret that a lot of people enter jobs in order to pursue their passions, only to quit them because they become cynical and burn out. That happens again and again. We see this right now. We have a gigantic nursing shortage. We all know nurses are often attracted to pursue this line of work because they’re passionate for patient care and making a difference. Well, if so many nurses are entering nursing occupation, and we still have such a huge gap because a lot of them are leaving and becoming cynical, I think it shows us that there’s just this big disconnect. People might not necessarily know what they’re getting into, what they’re signing up for, and I think that’s really challenging.
Brian Kenny:
Yeah. Brooke, we haven’t really talked in much detail about Knownwell, and I want talk about that now because I want people to understand what it is you’re doing and what makes the experience different for obese people when they visit one of your clinics.
Brooke Boyarsky Pratt:
Absolutely. So most of healthcare is designed around patients in a lower BMI body size, and that can be the little thing. So our doorways are wider, our furniture is larger, our blood pressure cuffs always fit. If it’s stigmatizing and difficult to step on a scale and we need your weight, we can get it from sitting on one of our exam tables. So when you think about getting the little things right to make a person feel welcome, we’ve really emphasized that in our physical environment, and we’ve tried to mirror it in our virtual environment. So you can see us online, you don’t have to come in person. This is about how we’ve trained our physicians and our clinicians to be weight inclusive. The types of things that we ask you before and after a visit, we really try to take into account truly delivering patient-centered care for these patients. We are following what’s called a weight-inclusive versus a weight-normative approach, and that really means we help you be your healthiest and we don’t boil everything down to your body size.
Brian Kenny:
Yeah. Yeah. I mean, the case describes what the experience can be like for an obese person in the normal healthcare system. It sounded to me like it goes everywhere from just being dismissive to being downright rude to patients where doctors just don’t even want to take the time to understand or listen. Is that fair to say?
Brooke Boyarsky Pratt:
Oh, I mean the research, it’s overwhelming. So if you ask physicians, who are the patients you least like to treat? One study showed that patients with obesity were only second to active IV drug users. So what’s really unique about obesity is clinicians actually endorse an explicit weight bias. So this is them saying, “I don’t like seeing these patients.” It’s not an implicit. And we see from the research that patients feel that too. They’re canceling appointments, they’re avoiding care because they know they’ll have a stigmatizing experience. And I’ll just mention, a patient we had a few weeks ago was saying that she got on a scale at her PCP clinic, and the doctor walked by and just offhandedly said to her, “That number wouldn’t look so bad if you ate fewer big macs.” By the way, this is a woman who does marathons, who eats extremely clean. So look, I think clinicians are doing their best. I don’t think many are mean-spirited, but the amalgamation of these experiences lead patients to not want to seek care.
Brian Kenny:
And there’s also a misunderstanding as the case points out about the causes of obesity. And you just mentioned it there, it’s not always from poor eating or poor exercise habits, some of it’s genetics. It can be any number of things. Is that right?
Brooke Boyarsky Pratt:
Absolutely. I mean, look at me. HBS grad, went to Penn, did really well. I’ve worked hard in my career. I think most people would say I’m someone who’s shown discipline and drive, and yet I’ve been 150 pounds overweight. So I think if it were simply a matter of willpower there wouldn’t be people like me who existed, and it wouldn’t be such a prevalent problem. You mentioned earlier the amount of money that’s spent on diet and lifestyle. We have the data. Americans are willing to spend a tremendous amount of time, money, and energy on pure lifestyle interventions like Weight Watchers, and we have the data to know it doesn’t work for the vast majority of patients if they’re not in a real medical setting. So I hope that the conversation in the obesity space continues to shift from blame to support.
Brian Kenny:
Jon, let me ask you this because it’s always hard to ask the protagonist, even though we love having the protagonist on the show about their personal leadership style. So I’m going to ask you, how important is Brooke’s passion for this topic and her lived experience and her leadership style? How important is that to creating the kind of culture that makes Knownwell effective?
Jon Jachimowicz:
I think it’s absolutely vital and essential. I don’t think Knownwell would exist without Brooke’s passion. And it starts of just attracting people to come and work for her. How do you convince someone to come work for you when there is no company to join, when there is no business model, there is no revenue? The only thing you can go after is the founder. And at this point, you have a founder who is extremely skilled, she has an amazing resume, she has shown that she has the talent to produce. And at the same time she says, “You know what? I have this vision and I have this vision because I have my lived experience. I’ve done two years of research, and I think this is where we need to go.”
Well, you’re going to follow a leader like that into the fog of the unknown that a lot of startup is in order to figure out what you want to do to do that. But without her passion for this work, there is no following. There’s no one that joins you. There are no investors willing to invest in you. Investors want to have an implicit promise that you are going to deliver on what it is that you promised to do. Well, one of the signals that you can use is, how much does Brooke care about this? Because if she cares a lot about this, she’ll try to do everything she can in order to be successful, because it’s a personally relevant mission for it.
And then you see then every single thing that Knownwell does, when we talked to some of Brooke’s staff about how the clinics are structured and how patients are treated, it was clear that everything was based around making sure that patients don’t have the same experiences that Brooke had. And that was the yardstick. That was the metric that was being used to understand, are we treating patients well? But how can we actually do right by this group of people that’s been neglected for decades and decades in American healthcare? I think that’s the yardstick that’s being used, but that comes straight from Brooke’s passion for the work.
Brian Kenny:
Yeah. Brooke, how did you convince investors to take a leap on this with you? Those conversations I’m sure were interesting.
Brooke Boyarsky Pratt:
Not fun in the sense of when we went and raised our seed, the market had already turned. So very difficult to raise venture money, even more difficult for a click and mortar primary care focused startup. But I think a few things got investors really excited both at our seed and at our A. One was of course the market opportunity and the unmet need of patients. The second was a strong belief in our clinical expertise with my co-founder, Dr. Angela Fitch, and our clinical model for how we were going to treat patients.
And then certainly, I think the third was our founding team. Not just me, but all of our ability to show demonstrated impact in our careers before what we were willing to give up to pursue this passion, and the clarity with which we were driving to create the company. So that I got us over the hurdle at the seed. And then at the A, we were able to show really strong patient attraction and stickiness with patients as well as great clinical outcomes.
Brian Kenny:
And what are you learning from your patients as they go through the facility and they engage with your team? I’m sure some of those learnings were being fed right back into the model.
Brooke Boyarsky Pratt:
Absolutely. So the first is that it is so tremendously impactful for them to feel like they have found a healthcare home. I mean, we have patients who, they’re like, “My whole neighborhood goes to you guys now because I had such a great experience.” And it really is the small things. I mean, patients will often say to me, “The staff looked at me, they didn’t avert their eyes.” Or “I felt so comfortable in the furniture.” “My clinician asked me about me. They didn’t start with my weight.” It’s actually sad where the bar was. And then there’s certainly tactical things we’ve learned from patients about the kind of comprehensive care they’re treating and how else we can help them that we’re incorporating into the care model.
Brian Kenny:
Yeah. The case also mentions, I thought, very interestingly, you mentioned that your husband also has some weight challenges. And his experience in the medical profession was never the same as yours or was different than yours. Can you describe that?
Brooke Boyarsky Pratt:
Yeah. And you see this in the research too. There is a little bit of a gender split. So both men and women face a lot of stigma around obesity and body size, but for whatever reason, you see it significantly more felt and reported on by women which we could have a whole podcast on why-
Brian Kenny:
Yeah, we could.
Brooke Boyarsky Pratt:
… we think that is. But what’s interesting is I had asked my husband, did you ever feel like you were disparaged or ignored or minimized by physicians because of your weight? And he was like, “No, not really.” And our patients are about 70 percent women, that’s true of most obesity services. So is that societal? Is that emotional? I don’t know exactly what’s driving it, but there is this interesting distinction where the problem seems to be felt more acutely by women.
Brian Kenny:
Now, Jon, this is a business case, so we have to come back to the fundamental business question that part of the premise of the case is that, Brooke has at a crossroads here with Knownwell. She’s got to make a decision about where she wants to go from here. Can you just describe the issue there?
Jon Jachimowicz:
Yeah, absolutely. Fundamentally, it’s a question of how she wants to pursue her passion. What is it that she wants her day to day to look like and what she wants her impact to be long term? And she really has two options in front of her. She’s been successful in building out one clinic in the Massachusetts area, and she could accept money from friends and family, grow relatively slowly, build out a couple of clinics in the Massachusetts area, maybe in New England. And maybe after five to 10 years she would have 10, 15 clinics. She would have retained majority ownership over those clinics. She would have very high personal touch with all the patients that she would see. So she would actually get to see the impact that she has. She would make sure that every single patient is cared for well, that no patient falls through the cracks. And that could be one option for her.
The other option is she can go nationwide right away. She can scale this one clinic that she has and go across the whole country, take on venture capital money, which might mean giving away some control of the organization, not necessarily retaining majority ownership of the organization being pushed around by whatever VCs want you to do, which is often going fast in order to take majority market share. It might also mean that you might not necessarily be there for every single patient. That some patients maybe do fall through the cracks because scaling so fast. You’re hiring a lot of staff. Maybe you’re not able to uphold the same level of training. That’s a big risk. And also there’s a higher financial risk. There’s a higher possibility that this thing will fail if you grow very, very quickly. But the upside of scaling really quickly, think of the problem that we’re facing in this country. Think of the potential impact that we could have if we scale quickly. So fundamentally, it’s an organizational decision, what should Knownwell do? But at the end of the day, she founded this company. It’s a personal decision. What does she want her life to look like, day-to day? What does she want her life to amount to? Which is why I personally love this decision, and I love this case.
Brian Kenny:
Yeah. Yeah. Like so many HBS cases, there’s no wrong answer. There’s no completely right answer. And Brooke, I’m sure in your years of consulting, you probably saw a lot of firms go through similar kinds of difficult decisions. So I’m not going to ask you where you’re leaning. What I will ask, and this is my last question for you, and then I’ve got one more for you, Jon. So my last question for you is, what does success look like for Knownwell five years from now? As you think about into the future what would you be pleased with?
Brooke Boyarsky Pratt:
We are the preeminent healthcare home for patients with overweight and obesity across America. So for the next Brooke who moves to their next city and needs to find a physician or a clinical practice, it is obvious to them where they should go.
Brian Kenny:
Yeah. I have a sense for where she’s going with that, Jon, but I’m going to give you the last word in the case, in the podcast rather, which is what do you want people to remember about the Brooke Boyarsky Pratt case?
Jon Jachimowicz:
I think that how you pursue your passion can look very different for different people at different stages of their lives and career. We often have an idealistic model and expectation of what it looks like, but it comes in so many different shapes and forms that I think we should just be open to the idea that anybody can pursue their passion in any domain at any time point in their life, they just have to figure out what trade-offs and sacrifices they’re comfortable or not comfortable with.
Brian Kenny:
Yeah. Jon, Brooke, thank you so much for joining me on Cold Call.
Jon Jachimowicz:
Thank you so much for having us.
Brooke Boyarsky Pratt:
Thank you. Such a pleasure.
Brian Kenny:
If you enjoy Cold Call, you might like our other podcasts, After Hours, Climate Rising, Deep Purpose, IdeaCast, Managing the Future of Work, Skydeck, Think Big, Buy Small, and Women at Work, find them on Apple, Spotify, or wherever you listen. And if you could take a minute to rate and review us, we’d be grateful. If you have any suggestions or just want to say hello, we want to hear from you, email us at coldcall@hbs.edu. Thanks again for joining us, I’m your host Brian Kenny, and you’ve been listening to Cold Call, an official podcast of Harvard Business School and part of the HBR Podcast Network.
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