Even now, when I give early stage founders advice, I usually say you need to build a community of founders around yourself because that’s the most helpful folks you’ll ever find. The first few years are trying to figure out stuff and it’s frustrating, extremely confusing, very stressful, and a lot of lost sleep. There’s a lot of lingo that you are expected to understand, there’s a certain way of engaging. - Jonathan Ng
Jonathan Ng is the CEO and Founder of Iterative Scopes, a pioneer in the application of artificial intelligence-based precision medicine to gastroenterology with the aim of establishing a new standard of care for the detection, and ultimately, treatment of gastrointestinal (GI) diseases. Iterative Scopes is a startup that spun out of MIT, recently raised $150 million in Series B financing to accelerate development of its core algorithmic innovations.
Jon has spent over 10 years working in various healthcare systems around the world and training at top healthcare institutions such as Massachusetts General Hospital. Through his work and experiences, he has been inspired to bring an appropriately focused application that could potentially eliminate the barriers within healthcare around the world. Prior to his work at Iterative Scopes, Jon has established two large pediatric facilities in Cambodia, as chairman and founder of Children of Cambodia. Children of Cambodia is a philanthropic organization that provides valuable healthcare training programs and establishes advanced pediatric facilities throughout southeast Asia. The foundation has helped establish Cambodia's first neonatal ICUs, pediatric burns units, and pediatric cardiothoracic surgery units at Angkor Hospital for Children.
Jon is the Strategic Director and Founder of Optimimed, a medical services startup in Singapore which works in partnership with large public hospitals to deliver optimized healthcare solutions through technological advancements. Jon also serves as a Medical officer in the Ministry of Health Singapore in hopes to transform healthcare delivery in Southeast Asia.
Jeremy Au: (00:30)
Hey, Jon, good to have you on the show after quite a long while.
Jonathan Ng: (00:38)
I think it’s been a year since you’ve tried to get me on.
Jeremy Au: (00:41)
Yeah, I think also because we know each other for the longest as well. Anyway, here we are, really excited to have you because we both started hanging out in Boston as Singaporean founders building something crazy in America and our paths since then have been quite interesting to say the least. So, really excited to share a bit more about your story. For those who don’t know you yet, how would you introduce yourself?
Jonathan Ng: (01:18)
I would introduce myself first and foremost as a Singaporean. Thanks for having me, by the way. I’m really excited to be here as well and I’m glad you finally managed to put me in after a year. And yeah, those were really fun times in Boston. I would describe myself as a second time founder, Singaporean, average kind of guy and with big dreams. So my own personal background, I’ve trained as a physician, trained in hospitals in developing countries, primarily Cambodia, for a good decade before moving out here to Boston. And yeah, I moved out here about four years ago to attend grad school and get my MBA at Harvard. That’s where I met you. Since then I’ve been running Iterative Scopes full time.
Jeremy Au: (02:00)
We still hang out because we both came from the same schools, but you decided to be a doctor. Why did you decide to be a doctor?
Jonathan Ng: (02:18)
I thought that medicine was a great way to help a lot of people and I really wanted to be a part of it. Not necessarily wanting to be a doctor per se, like a practicing clinician, but I wanted to help in health care in a big way. So that’s why I picked medicine for my undergrad degree.
Jeremy Au: (02:39)
Tell us more about what you were like as a medical student.
Jonathan Ng: (02:48)
I think I was studious as a medical student. I felt I had a lot of catching up to do given that I was playing my youth away and had so much to catch up on. The second was I felt a great deal of responsibility in that if I didn't understand something, I could harm someone. Frankly, I enjoyed it a ton as well. I think it was one of the first few times in my life that I sat down and studied a ton.
Jeremy Au: (03:35)
Could you share with us what you chose as your specialization?
Jonathan Ng: (03:47)
I wanted to be a heart surgeon for kids but couldn't complete my training because I broke my wrist in a car accident and also I didn't want to deal with overly anxious parents. Before I left clinical practice, I was planning on becoming a plastic surgeon, a reconstructive surgeon. The main reason for that was that there's more lateral flexibility in what you could and couldn't do compared to other disciplines.
Jeremy Au: (04:44)
How did it feel for you to have your trajectory changed when you broke your wrist in that car accident?
Jonathan Ng: (04:52)
I think it was actually really fortunate. In hindsight, it was actually a relief back in the day when I was practicing clinical medicine. I guess we would just constantly put our heads down and grind. And one of the things it doesn’t allow for is for you to examine the why’s. It doesn’t give you space to think and breathe. And so we rush into housemanship, which is a really rigorous and tiring year, and then you’re rushing to try and train a specialisation. The car accident and breaking my wrist really gave me some space to sit back for a bit and think about why I’m in medicine, why I’m in healthcare, realign myself and it was at that point in time where I was really handed this early opportunity. Through my experience in building hospitals in Cambodia to understand and participate in the macros of health care, and that’s what we really enjoyed. It would be a real pity to not be able to utilize those skills to help a ton of people, not just like surgery doesn’t help people, but it felt like a different skill and I felt like I wasn’t fully utilizing my skill sets.
Jeremy Au: (05:51)
We talked about that before and building hospitals in Cambodia was a big transition point for you. Could you share with us what you learnt from that?
Jonathan Ng: (06:07)
Yeah. For context, I set up a foundation of my friends and myself and we helped to build some of Cambodia’s first pediatric hospitals and pediatric facilities. Some of their first open heart surgery programs for kids. It provided me with a ton of perspective in many ways. So for example, like the full spectrum of how Healthcare is delivered, I also had the fortune of training at NUH, I also trained at Mass General as well in Boston. And these are some of the best hospitals in the world and in Asia. In Cambodia, that disparity is so stark it just provided a lens into how different and how difficult things could be without the right resources. It just made me believe that I could make a real difference if I tried.
Jeremy Au: (06:56)
You went from performing medicine into a foundational role. Could you share a little bit about that change?
Jonathan Ng: (07:18)
Just to be clear, the foundation started first before wanting to be a surgeon. I started it in Junior College. That car accident gave me some perspective and made me think which one I wanted to do in the long run and breaking my wrist gave me a lot of time to think about it.
Jeremy Au: (07:56)
What was the outcome of that?
Jonathan Ng: (08:07)
I joined the ministry of health for a bit and then pursued a graduate degree. Applied for a Fulbright scholarship and got a place in MIT and Harvard.
Jeremy Au: (08:41)
Then you started building your first enterprise for the first time. Could you share with us what that was like?
Jonathan Ng: (08:48)
Yeah. So my first company is in Singapore. My long term goal of trying to close the healthcare disparities and multiple ways of doing it either through building a foundation that builds hospitals or participating directly in care either as a physician or as a surgeon. And then right after that I bought my first company. It’s a company in Singapore and basically one of the things that frustrated me in Singapore was my oncology patients couldn’t get their scans done in time. Basically, there’s just too long of a wait time in public hospitals and no one wants to do anything about it. Those wait times were anywhere between three to six months. It still is in many parts of Singapore today where a lot of the hospitals refused to…well, they acknowledge it, but they refuse to do anything about it. And then there were many private centres that were willing to collaborate that had excess capacity in their MRI scanners and places like Paragon, there’s quite a number there. And it made no sense to me that wealthier patients could access the scan. Whereas the patients who I really wanted to help could not get their scans done in time basically because they were stuck In the queue and the public hospitals and it was really frustrating to me to see this over and over again. And so I decided to build a system which, on the front end, allowed patients to, well, allow public hospitals to have visibility into private center scheduling and availability of MRI scanners, and then on the back, move data from private centers back to public hospitals. So basically, allowing MRI scanners or MRI slots to become a single pool rather than two separate pools, or public and private healthcare, which Singapore is a small country, right? So my view is that it’s just resources across the country should just be optimized across the sector if you could. So that’s my first company, we built it, still alive and kicking. It's also having a couple hundred patients a month. It's mainly to continue to enable patients to receive the scans. I’ve had many, many patients come to me, even my friends, they’re like, oh, I didn’t know this company was yours. We just used it. And I’m like, great, my friends parents, I just had lunch with them. And they’re like, oh, we just used it. And it’s great. That really brings me a ton of pleasure. Just to be able to impact and help them help patients who need it now achieve their therapeutic goals faster.
Jeremy Au: (11:17)
That’s when you went to Boston to pursue a Master’s degree. What were you trying to learn at that point in time?
Jonathan Ng: (11:28)
Coming to Boston, I picked the city before I picked the schools. As I mentioned, I had worked in 2013. I was here for surgical training and trained at Mass General and was here for the Boston bombings as well. That one was really an eye opener. It showed me how a resilient, really top quality health care system could come together under stress, really pull through for their patients. The thing is, I really loved how there were tons of people involved and so passionate about various parts of healthcare, all the way from basic therapeutics, basic sciences, to care delivery. And, to me, there literally is no better place in the world to learn about health care than to engage with that. I really wanted to find myself back in Boston to be able to learn about it. I see myself as a concerned student of the healthcare sector and being able to help people. So, bringing myself back out here, exposing myself to it and challenging myself to be able to interact with the best minds in the world and learn from them was a huge goal for me.
Jeremy Au: (12:27)
I remember hearing people say that there’s another Singaporean founder that I should meet. I remember reaching out. What do you remember about us meeting?
Jonathan Ng: (12:45)
I know exactly how you reached out - through Facebook Messenger. You’re like, hey, your friend said I should hit you up, and then you’re like, wanna go Shanghai Fresh? Wanna go eat? Classic Singaporean. You’re probably wearing the same black colored polo T shirt, by the way. But basically, it’s like January and then sitting outside Shanghai fresh. Yeah, basically we just go for like Sunday morning dim sum and like totally hit it off. Also like we meet over good food. I think there were a great deal of similarities. I kinda recall you from secondary school from like a computer lab for playing too much. Apart from that there was a ton of similarity, I think, in the way we thought about the world. So, I thought that was super fascinating.
Jeremy Au: (13:43)
I think at that point, we were both founders who were figuring out the local ecosystem and figuring out the next stage.
Jonathan Ng: (13:53)
Well, let’s be clear here, you figured it out, I was still swimming around.
Jeremy Au: (13:58)
At the start. It’s like a freshman hanging out with a sophomore. It’s not necessarily that I was better, but I had a little bit more time. That’s also interesting seeing other founders in our cohort building stuff. Any reflections on that time from all the peers who have pushed out to build startups?
Jonathan Ng: (14:39)
For the reflection between us, I felt like the cultural context was like when we just got stuff and also the way we approach things were pretty similar. So I think it shows up in a cultural context and upbringing plays a big role, especially when you’re leading an organization and no guidance, it just plays a big role in how we make decisions. And so that kind of also made it super easy to hang out and whine about the same things in the same way in some way. It was kind of reinforcing, but I don't know if that was healthy or not, but it was fun. This is for like 2-3 years down the road. Since we were at an early stage who had, you know, I think even maybe three and a half years, four years, I think at least for the founders that were in our cohort. A little grit and smarts are truly the two biggest indicators of success. You know who's going to stick through it? Who’s going to figure it out, figure it, knock it out. Most folks are taking a big market anyway, but like, do you have enough grit and the smarts to go figure it out?
Jeremy Au: (15:35)
Talk about that shared dynamic, you persuaded me to move closer to you and we ended up becoming neighbours.
Jonathan Ng: (15:42)
You asked “Can I be your roommate”…I was like “No, but you can move next door”.
Jeremy Au: (15:50)
Let’s be real. I was living in a house and decided that if I were living far away from family and support network, I should live with other founders and I had a house full of founders, but I realized that the problem with living with other founders as roommates is they’re not really good on rental payments because it’s a tough job and all of us would cycle in and out really fast because the startup would have to move to a different part of the town or the country or move to the next stage or whatever it was and it made sense to get an apartment and I just moved in. It worked out.
Jonathan Ng: (16:31)
The 6 months you were living in the same complex was great. We even got a gym trainer.
Jeremy Au: (16:54)
I think one thing we did reflect on was dealing with the stress/community aspect of it because we were hanging out and we were cooking meals for each other, celebrating mini wins.
Jonathan Ng: (17:47)
It’s good fun. Even now, when I give early stage founders advice, I usually say you need to build a community of founders around yourself because that’s the most helpful folks you’ll find. The first few years are trying to figure out stuff and it’s frustrating, extremely confusing, very stressful, and a lot of lost sleep. There’s a lot of lingo that you are expected to understand, there’s a certain way of engaging. It was kinda nice to have you to help decode some of the stuff and bounce ideas off. I even remember looking at each other’s decks – my seed deck and your series A deck. Even though you had no idea what I was working on and I had no idea what your side was about either.
Jeremy Au: (19:02)
Yeah, I think the word for it is peer to peer. It’s a lonely experience being a founder because you’re disconnected, right? I remember my then girlfriend who became my fiancé and now my wife saying to me – “Can you please stop talking to me about startups and my parents were clueless. You get disconnected not because they don’t want to be understanding of you, it’s just a different world entirely.
Jonathan Ng: (19:36)
I think I was undergoing the same situation. Unfortunately, my girlfriend became my ex-girlfriend became…just nope!
Jeremy Au: (19:46)
Well, if it wasn’t meant to be, it wasn’t meant to be. That’s interesting as well because it’s not an easy path. Sometimes, there’s too much advice, sometimes there’s not much advice, and sometimes, there’s no advice.
Jonathan Ng: (20:02)
I find that when folks are one-off with their advice, it’s difficult to trust because they don’t really have context here. Whereas we were hanging out every day after work and it’s easier to trust that advice because you knew the context and understood. I could tell you about the head of engineering and you would already have the persona in your head already and could give advice that was contextualized instead of being all over the place which I find most people would give.
Jeremy Au: (20:44)
Yeah, and even mentors don’t have that context sometimes to truly understand.
Jonathan Ng: (21:04)
It’s still tough. Even if the mentors had context, they’d make different decisions based on circumstances. Maybe they’d have different amounts of money in the bank, they have a bigger or smaller family, no family, that kind of situation. Whereas as we were talking back then, we had a very similar background, outlook in life and even not having a big bank account, you’d be constrained in a certain way. It’s easier when we’re on the same level and the context behind his decisions is similar.
Jeremy Au: (21:51)
That’s the interesting part. The truth is you can be friends with lots of people but you’re not necessarily friends with everyone.
Jonathan Ng: (22:01)
I don’t know about you, I think you’re friends with everyone.
Jeremy Au: (22:05)
I mean, I’m friendly to everyone, but not everyone chooses to be friends with me. And the truth is that not everyone is a friend of mine as well because just because I’m helping someone, doesn’t mean that I trust them the same way they trust me so there’s no reciprocity. In that case, I’m more of a mentor or a friend to them, but they’re not necessarily a friend to me. So, there’s a form of peer-ness that happens when you’re both in the trenches at that time which is hard to find. But you find yourself in the same situation as well, raising series A, series B and people are coming to you for advice now. How do you feel about that?
Jonathan Ng: (22:50)
I think there were more people coming to you at your Series A than there were coming to me at Series B. I think you’re a much more approachable person. How do I feel about it…for me, I’m always happy to share. For myself, I still think of it as an early stage of my journey. I still feel like I don’t have many things figured out and still trying to learn as much as I can. A lot of things I do is quite atypical and I don’t want folks to over-generalize.
Jeremy Au: (23:49)
That’s the tricky part as well. Advice can be over-generalized. Any thoughts on how to deal with it?
Jonathan Ng: (24:07)
I think I do. As you previously said, I said to make sure that you caveat it well, make sure you give the context as much context as possible. You might feel it’s quite long-winded, like you’re saying too much. Like someone asks a direct question. I take like five more sentences. But I feel like giving the context and like making sure that the folks understand the context to it should make the decision.
Jeremy Au: (24:37)
That is an interesting point. In some contexts, being verbose can be seen as long winded, but context is also key and that’s when giving advice. Starting to move along here, going from doctor to founder and raising series A, B, and building out your company, could you share with us a time when you had been brave?
Jonathan Ng: (25:15)
Yeah, I think bravery is, at least for founders, is pretty much an everyday thing. You wake up and there’s a ton of unknown. It’s just so much that you’re walking into. For 5-10 minutes every morning you really have to steel yourself and understand that today could be really awesome. It could be really effin awesome. Could really be shit and you have no idea what you’re stepping into. And either way, you gotta be OK with it. Either way, you gotta come out on the other side and be like tomorrow is going to be a better day tomorrow. I’m gonna keep holding this company and I’m going to figure it out. I’m just thankful that I have such a great team and I’ve got such great mentor, great community around me that if I can’t figure it out myself, I’m going to muster all the resources. I’m going to bring together all the resources I have to try and figure it out and it’ll be OK. I think that’s the daily grind of a founder and taking 5 to 10 minutes every morning to just be still and steel yourself. For me, it’s walking to work and playing the same song and making sure that I am pumped up for my first meeting. It’s important to me because otherwise you really don’t know where you’ll end.
Jeremy Au: (26:18)
Tell us more about what that daily ritual looks like for you.
Jonathan Ng: (26:21)
For me, it’s pretty much like needing space with myself in some parts. Being intentional about waking up a little bit earlier, taking a walk, spending some time of yourself off to work, taking a detour again. I used to take one hour walks between office and home every day and just decompress. I’d call a board member, call a mentor, I call you...I just called you on Wednesday to talk things out. It’s not just therapeutic as well, but sometimes just hanging out with people you trust and people to share openly and then getting a different perspective sometimes opens a lot of different options that I wouldn’t have thought about myself. And I’m like, damn, this is really, really awesome, but also therapeutic and helps ‘cause sometimes the weight on your shoulders is pretty big.
Jeremy Au: (27:04)
Speaking of that weight. Why is it heavy?
Jonathan Ng: (27:09)
If you think about it from the company’s perspective, you have basically 110 people now working for Iterative Scopes and every decision I make, every communication I make changes so many lives. It causes so many people to do something. Every product decision I make will potentially impact thousands of patients, millions of patients. Those are weighty decisions. Am I doing the right thing? Am I deciding the right thing, bringing the right folks around the table to help me out, am I hiring right person? Am I designing my product in such a way that it truly helps the patient and not inadvertently hurt someone? These are like everyday questions as well as making decisions in the company. It does weigh on you. After all, it accumulates and sometimes, years later, you’re like, damn, maybe I shouldn’t have done that this way. Maybe I should have…I think the medical training comes in handy in medicine a lot of times we described this inability to…you shouldn’t beat yourself up too much over past things you perceive to be erroneous in the past because you just didn’t have the context, the experience at that time. You just use the maximum amount of data and maximum amount of information you had at that point in time and make the best decision. In retrospect, could have made a ton of better decisions. Yeah, but I just didn’t have the information, didn’t have the context and experience to go make it. But what’s important is to make sure that you’re keeping yourself on the ball there, keeping the feedback loops short and learning as fast as you can from it. I think that’s really important.
Jeremy Au: (28:34)
How do you take time out for yourself on a more regular basis to handle all that?
Jonathan Ng: (28:43)
Yeah, I think sometimes on tough days, on the really tough days, I just take an hour out and I pick a random computer game and I play it just to go down a rabbit hole. You know it as well. Other times I’m like I’m just too stressed out. I need to go on a trip and I book the next ticket out and I travel just to remove myself ‘cause sometimes you spin in circles. In the same environment, you kind of spin in circles. You’re not thinking out of the box. You’re not thinking creatively, ‘cause you’re just seeing the same problem in the same only one way of solving it in your mind, sometimes removing yourself from that environment helps you. Sometimes I fly down to San Francisco. I live in Boston, suddenly fly out to SF to meet some mentors ‘cause I’m like, I need a different perspective. I need to be in a different group of people so that I can maybe think about something differently or just pick up the phone then I. Thankfully I think I have an A class board who I can treat as friends and I pick up the phone and call them as well and then be like hey, I’ve got this problem. What do you think about it? You know other companies? What would you do if you were me and they don’t expect me to do what they say, but give me their frank opinion.
Jeremy Au: (29:52)
If you had a time machine, what advice would you have given yourself back when you were a medical student in your first year?
Jonathan Ng: (30:09)
Keep working out. After NS, I really let it go down downhill so fast. Oh my goodness. I think apart from that, honestly, I really wouldn’t change that much either. Enjoy the journey. I think it’s important to appreciate the choices you have made and just live with them. They all happen for a reason. I wouldn’t have repeated everything and like the choices I’ve made have led me here. I don’t have regrets. I’m here where I am today. I just enjoy the amount of empowerment I’ve had, the amount of friends I’ve made along the way. The number of mentors are looking out for me today. I’m just like these are like I could not ask for better and I’m just like you just gotta appreciate it and appreciate the journey.
Jeremy Au: (30:49)
There were many times when we were in The Suck like sucky positions, what advice would you give folks who are in those situations themselves and are struggling?
Jonathan Ng: (31:45)
I think one of the earliest skill sets that I learned to have was to talk openly about the problems I have and to describe it accurately. I think many people try to paint a really rosy picture around their startups or on themselves because of pressure to constantly be like, you know, that LinkedIn post stuff like proud to announce this everyday. Proud to announce something and we like know everyday cannot be like this. It’s the same thing about the body image problem - all these supermodels like posting up only success stories and linkedin. Instagram and you’re like, damn, why does everything look so good? And then you feel the pressure to need to do the same as well ‘cause you’re like, well, everyone is enjoying their life. I would say like that’s a recipe for disaster, right? So I know like when I hung out with you, we were telling something insane stories, right? I wouldn’t repeat them here. But like, the stories were pretty insane. Like what happened at work today. And you’re like, oh my God, how could this even happen? This wasn’t even the 99% probability that would happen. And someone did it and be able to share that. And being able to be like shared openly. Firstly, it is just being able to share the burden, like having someone to listen to you and having someone to like appreciate the difficulty is number one and two, I think inherently the folks around you want to help you out, but if you don’t give them a way to help you, don’t give them an accurate picture. It is really difficult to help you ‘cause imagine like for three years every day you’re saying like the sun is so bright, sky is so clear then one day you’re like, oh, I’m in this deep hole and then everyone is lIke, no context to it. They don’t understand how you landed there. I think that that makes it really tough for people to understand where you are in your journey. And it’s something I highly discourage founders to do ‘cause we all know it’s not that easy. I would advise founders to learn that skill. Especially if you’re in what Jeremy calls “The Suck”.
Jeremy Au: (33:30)
I think that’s a true statement that if you’re lying to yourself then you’re lying to other people and people can’t help you then. You reminded me so much of flashbacks of all the times
Jonathan Ng: (34:53)
I mean, there were some hard days. I was like Jeremy pull out the dashboards. Show them to me. What do the dashboards look like? Give me your metrics. And you’re like, I remember you hesitated for, like, a brief, like, 30 seconds. Yeah. OK. Yeah. It’s great. Yeah. Here goes. Haven’t showed this outside the company, but here goes. Yeah, I think I benefited a lot from the relationship, but talking to you on Wednesday. I was like, that’s the part which I missed the most, like having someone around to have all the same context and be able to like share their journey with and to be like super open about that stuff. Everyone should go and look for that someone.
Jeremy Au: (35:32)
Yeah, I think that’s the hardest part – finding your community or tribe and you can only find it by being truly open. Awesome. On that note, I’d love to wrap things up by sharing the three themes I learnt from this conversation. The first is thanks so much for sharing about your personal journey as a medical student and doctor to actually that car accident, changing the course of your trajectory from macro to micro to macro again, and then choosing to become a serial founder and to where you are today. So that was interesting. The second was about the requirement of having a true founder community, I think that was something that we discussed in the context of us in Boston being like buddies, I guess, neighbors dealing with similar troubles/dynamics. And I think lastly was talking about helpful daily rituals, but also some of the burdens and requirements of actually mitigating that which is about being truly open, being accurate about what’s going on, about finding people that you can trust to hang out with and to collaborate with. And so I thought that was really interesting to talk about how to actually mitigate the stress, on one level, but also the difficulty or the obstacles. Awesome. Thank you so much Jonathan, for coming on the show.
Jonathan Ng: (36:50)
Alright, man. Catch you around soon!