Why Starting a Business During Residency Might Be the Smartest Move You Make (Not the Craziest One)
I started PayScopeMD as a PGY-2. Not after residency. Not once things calm down, because they don't. I started it during the year everyone warns you is the worst possible time to add one more thing to your plate.
I get why people raise an eyebrow. But residency might be one of the best windows you'll get to start something. Not despite the chaos. Partly because of it.
1. You're already running teams — just in scrubs
Entrepreneurship and medicine have more in common than people think. As physicians, we lead by default. Every shift we coordinate nursing, RT, students, consultants, and patients. We delegate, build trust fast, and make calls with incomplete data. Those same skills map directly onto business: running meetings, managing your people, earning stakeholder trust, knowing when to step in and when to let your team run. The context changes. The muscle doesn't.
2. Business, like medicine, is a language
Once you know the language, you know the game. Medicine has its own vocabulary, workflows, and unwritten rules that take years to internalize. Business is the same: cap tables, burn rates, customer acquisition, unit economics, contracts, go-to-market. At first it sounds foreign. Then you realize it's just a system. The same discipline that got you through medical school, learn the language, then operate inside it, is what lets you move in the founder world.
3. Business expenses can offset resident-level taxes
Legitimate business costs — software, part of your laptop, courses, business-related travel — are deductible against business income, and depending on structure, some can offset other income too. It's not a loophole; it's how running a business works. On a resident salary, that matters more than people think. (Talk to a CPA about your setup — I'm not one.)
4. Equity compounds. A paycheck doesn't.
Your attending salary jump is real and it's coming. But a paycheck stops the second you stop showing up. Equity in something you built keeps compounding whether or not you clock in. Starting now means by the time I'm an attending, I'm not starting from zero. I'll already have runway, real users, and a long list of mistakes behind me.
5. One important catch: know what your institution can claim
Here's the part nobody warns you about. Academic institutions often have conflict-of-interest and IP policies requiring you to disclose outside equity, startups, and financial interests, sometimes going back or forward 12 months. Some tech transfer policies can claim a stake in IP developed using institutional time, resources, data, or facilities, depending on your contract and how the work was created. The takeaway isn't don't build; it's read your COI and IP policy before you assume it's 100% yours, and disclose early rather than getting asked about it later. (This is exactly the kind of clause I look for when reviewing physician contracts for PayScope.)
6. It gives you a different kind of balance, not just money
This is the one I didn't expect. Building PayScope hasn't just been a side project — it's given me a different headspace. Medicine, especially intern year, can consume your whole identity if you let it. Having something else to build and care about has been a real outlet, not a drain. It's pulled me into a different world — new people, new market, conversations that have nothing to do with rounding or boards. I've built a whole new community around this that feels like family, entirely outside of medicine. If I'm honest, it's helped with burnout more than anything a wellness committee has suggested.
7. Clinical training and founder skills reinforce each other
Residency teaches you to make decisions with incomplete information, under time pressure, with real consequences if you're wrong. That's also the entire job of an early-stage founder. Triage what's urgent versus what can wait. Work with imperfect data. Stay calm when something breaks. That transfers directly. I'm not building despite being in training. I'm building with a skill set most first-time founders spend years developing the hard way.
8. You already have the network most founders spend years trying to build
If you're building something adjacent to medicine, you already have the audience and trust outside founders spend years and marketing budgets earning. Co-residents, attendings, med school classmates, specialty societies — that's a warm network. Nobody has to be convinced you understand the problem. You live it every shift.
The honest caveat
None of this means it's easy, or right for everyone. Residency is demanding, and adding a company means real trade-offs — sleep, time, sometimes both. This isn't a you can do it all effortlessly post. It's a the timing math is better than people assume post. If you're going to build something eventually, there's a real case that the resident years — not after them — are when the odds are in your favor.
I'm building PayScopeMD, an AI-powered contract analysis platform for physicians, as a PGY-2. If you're a resident thinking about building something of your own, I'd love to hear what you're working on.