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Amit of Doctor Insta: Delivering access to Medicine across India at Scale

Getting hurt in Hawaii, discovering Telemedicine and Delivering access to Medicine across India at Scale

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While vacationing with friends in Hawaii, Amit Munjal(@amit_munjal) ended up with a health issue. At that moment, he realized the power of a Virtual doctor and understood that his skepticism about Tele Medicine was wrong. And that was the spark to his venture – Doctor Insta.   While the Indian ecosystem with demarcations has multiple hierarchies, tiers and languages, Doctor Insta(@Doctorinsta) are making access to healthcare possible.  Listen to Amit of Doctor Insta talk about delivering access to medicine across India at scale.

Amit has derived influences from his previous avatar as an investment banker and a management consultant. In this episode, he shares his passion for quality healthcare and how he has been transforming healthcare in India.

Listen to Amit talk about Doctor Insta, Healthcare and more. 

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Amit's quotes on opportunity, starting up, funding etc.,

6:10

Most of the doctors are concentrated in bigger cities because they want a better lifestyle and amenities for their family members and children, which unfortunately, the villages and tier 3 cities do not offer to them. So with virtual health care it doesn’t matter where you are at and even the villagers or the smaller cities where these doctors do not prefer to practice, now can seek the consultations of the doctors sitting in bigger cities.

10:49

We have around 3.5 million users in India, with 150 large companies which have taken Doctor Insta solution for their employees. And by that, what I mean is that, let’s say, Krishna, that you’re running a 50,000 people organization, then you say, you know what I care about my employee health, I care about my employees happiness, and lifespan and longevity, because one, it’s the right thing to do. Second, it’s also very inter linked to the productivity levels. Unhappy, unhealthy employees would not be as productive as happy and healthy employees in any organization.

16:15

Whereas in this journey of democratizing healthcare for everyone, anytime and anywhere, I’m in my own small way enabling the improvement of health care in our country. And there’s nothing better than a gift of good health that you can give to yourself or to others. 

29:55

See some held true and some led to new discoveries in these realms. For example, in the past hour thing that people have phone and video as a medium to speak with the doctor, why would they choose chat? They may use chat for peripheral questions for the same doctor with whom they have consulted. Like Okay, so I had a consultation with Dr. Kumar, and I forgot to ask, how should I take this pill? 

49:39

It took us like three to four months to build to get ok traction? Yeah, you know, as an entrepreneur, you are always second guess about the road not taken all the time. I still do it while doing Dr. Insta, but I’m very bullish, very hopeful, very optimistic about virtual healthcare. 

51:45

Our credit is to say it in Steve Jobs language, you know, stay hungry, stay foolish. So, I was a little foolish not to realize that healthcare was three times harder and three times longer. If I’d known then I probably would have chosen something else. But in hindsight, I’m glad I did not know that at that point of time, because you know, no matter what you do in life, it does require a little bit of leap of faith and leap of faith could only happen to people who are not fully informed.

Image depicting medicines and money

Amit’s leap of faith in healthcare has truly touched the masses and is continuing to do so.

You will also like this entrepreneur's story: Abhishek Shah of Wellthy Therapeutics who is changing how people stay healthy: Season 1, Episode 31

Show Notes

@amit_munjal Follow Amita Munjal on Twitter

amit@doctorinsta.com Reach out to Amit, especially if you are building a healthcare startup

doctorinsta.com Visit Doctor Insta to get an appointment with a Virtual Doctor

Do catch some words used in the episode through the word cloud:

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Word Cloud for this episode

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Episode Transcript

(Automated Transcripy

SUMMARY KEYWORDS

doctor, patients, india, people, insta, krishna, healthcare, consultations, problem, employees, medicine, users, rural india, specialties, offer, platform, telemedicine, concerts, enabling, sexologist

SPEAKERS

Amit Munjal, Nida, Krishna Jonnakadla, Dr. Ritesh Malik

Krishna Jonnakadla  00:00

This is Maharajas of Scale, the podcast where we go behind the scenes and talk to founders who are demolishing the myths around building and scaling a big business in India. These are the stories that have shattered the assumptions around Indian consumers and are changing the game completely. I am Krishna Jonnakadla, serial entrepreneur, co founder of FLIT the fashion located in town and startup mentor bringing you these stories. Hey everyone, this is Krishna from Maharajas of Scale. Today we are speaking with Amit Munjal of Dr Insta that has been touching the lives of millions of people across India in a unique telemedicine business model. Amit, welcome to the show.

Amit Munjal  00:13

Thank you. Thank you Krishna, I appreciate you having me.

Krishna Jonnakadla  00:33

So Amit Dr. Insta. This is one of those things that all of us would think about doing at some point in time. It's a doctor a video call away and For a country like India, it would be you know godsend for a lot of people. If we see lines outside of doctors, clinics and I, the kind of crowd that you see in a lot of medical establishments, this this does not just feels like a lifesaver, but a saver on multiple friends fronts as well,

Amit Munjal  00:50

True that, Krishna and I can tell you, the around seven years back, that's how the idea came about. This was before the app ecosystem was as well developed worldwide, not just in India, but worldwide as it is now I was vacationing with some friends on a remote island of Hawaii and ended up having a small health issue. And a friend of mine popped out his iPhone and said that hey, listen, I'm aware of this new app, which helps you get connected to a doctor immediately. And you know, initially I was skeptical but being an island I had no better option. So I did this With the doctor on the continental US land, and to my surprise, I had a fantastic experience. And I figured that you know, in a country like India, which is one of the worst doctor to patient ratios, and even in bigger cities where people end up wasting three to four hours of time dealing with chaotic traffic, not so good parking infrastructure, and then waiting in the waiting rooms of the doctor, the service would be a fantastic value add, although in 2012 data was a issue in India, smartphone numbers were not that big in India. So I put this on the back burner and went about doing what I was doing, and then took a few more years to finally take the plunge. So and I'm glad in hindsight, I took that plunge in 2015. whereby we launched Dr. Insta services pan India, making people do these consults we are phone video and chat with our curated pool of doctors across 40 sub specialties and   since then we have been growing one day at a time, one step at a time. We also added some more features that we will talk about in the next few minutes.

Krishna Jonnakadla  03:11

So that's amazing. What's your personal background? Are you a physician?

Amit Munjal  03:15

No, Krishna, I have worked very closely with health care industry during my management consulting days, but I'm not a physician by background. I'm out and out a management professional. I did my undergrad in business and then MBA from Indiana University Bloomington Advanced Management from Harvard Business School, and then CFA charter from CFA Institute. West Virginia. us down no academic background. Thanks. professionally. I've done Tintin management consulting working with the CXO of very large companies. After that, I did a gig in mergers and acquisitions, working with a subsidiary of ING then I did in a Been banking and investment management both with Bank of America Merrill Lynch. And in my last role before I found a doctor in staff, I was the CFO for city holdings, which is a division of Citibank in us. So that's my professional background.

Krishna Jonnakadla  04:15

Wow. That's that's a long line of accomplishments, senior positions, and how did the brush with healthcare happened? What was it always something at the back of your mind?

Amit Munjal  04:26

It was. While in business school to I was heading the health care Academy. So that gave me good exposure to the healthcare industry as a whole from payers, which are insurance companies, health insurance companies, to providers, which are doctors and caregivers to the final users who are availing the services.

Krishna Jonnakadla  04:43

So been in the US have extensive exposure there. The US healthcare system, which is considered to be one of the greatest on the planet because of a variety of things that kind of drugs that they unveiled. The therapies they create and all the enabling laws that they have. A lot of people in India are not aware that if you walk into a hospital, regardless of whether you have insurance or not, the local law mandates that you have to treat the patient that creates its own set set of winners or losers. And right from the time of Barack Obama's first presidency, there has always been this huge controversy around health care given in such an advanced economy. creating something in healthcare is not that easy, given the amount of legislation that exists there, but India poses a totally different set of challenges. Why India? Why not somewhere else?

Amit Munjal  05:38

See, I can tell you that sometimes, being a Greenfield initiative in a country also opens some fantastic opportunities for you to grow and scale. For example, as you rightly mentioned in us, you have to be a state board certified doctor to offer Health care to the you residents of that particular state which means that if you are in California as a patient you cannot consult with a doctor from New York either in person or in a virtual manner unless you are actually in the state of New York where the doctor is a Board Certified life The doctor is like board certified in different states then the doctor can consult the patients from different states. Now if you look at India that means that and Krishna you in Bangalore right? That's right. So you're in Canada, I'm in go to go which is technically Haryana imagine virtual healthcare platform following the rules of us means that a doctor and cannot cannot do consultation with patients in Haryana through virtual manner. So we don't have restrictions which is fantastic a doctor in in Kashmir can do consultations, Pan India and which opens the telemedicine platform for More than it could in US market. So that's the beauty of this setup. The second thing is that in India we have one of the worst doctor to patient ratios. Most of the doctors are concentrated in bigger cities because they want the, you know, a better lifestyle and amenities for their family members and children, which unfortunately, the villages and here these cities do not offer to them. So with virtual health care doesn't matter where you are at and even the villagers or the smaller cities where these doctors do not prefer to practice now can seek the consultations of the doctors sitting in bigger cities. Third thing is that if you look at it from a doctor's perspective, it's the most beautiful thing that can happen to a doctor because the typical catchment area of a doctor is what 15 kilometers 20 kilometres Krishna.

Krishna Jonnakadla  07:42

That's still low I would say.

Amit Munjal  07:53

Yeah, so nobody will go to a doctor hundreds of thousands of miles away unless it is a life threatening issue. So infant 99% of the OBD consultation which are catering to moderate natured problems like fever, flu, you know backache, stomach ache, stomach bug, viral infection, UTI urinary tract infection for URI, upper respiratory tract infection or mental health issues like anxiety, stress, depression, dermatological issues. You know, these constitute vast majority of the OBD consultations. So a typical doctor now who's catchment area would have been limited to otherwise 15-20 kilometres can now see patients from all over the country and for a doctor to the fixed cost structure is next to none in this model, they don't have to commute to the hospital so they end up saving two hours of time in terms of not going to the hospital or coming back from the hospital in the evening, which means that for those two hours they do not get paid, but in virtual healthcare or telemedicine. They are free to time and make money during that time and give social IP more of their valuable time seeing more patients through this channel. So net net fantastic thing for the doctors also fantastic thing for the patients too, because even in bigger cities where the number of doctors is not a problem around you the challenges that you still end up wasting three to four hours of time because of traffic situation parking situation, and then willing in the waiting room of the doctor situation. Whereas with the platform like Dr. Insta, you can just stop the app and do the consultation as and when you want. Not just that in our society. In India, we have a huge social stigma around certain specialties like sexology, or even psychology has a huge social stigma. But with virtual health care, you know, you don't have to worry about the social stigma. You can do this concerts from the privacy and comfort of your home without worrying about Oh, if I go to that sexologist or the psychologist then I might be seen by my your circle of friends or acquaintances, as a result of it, my reputation would get tarnished. So that thought, you know, which prevents you from going to see a psychologist or sexologist because you feel that there is a social stigma around these specialties as a result of which the society will judge you in a very, very punitive manner, that root cause of the problem is solved because now you can just stop the app and do the consultations with the sexologist and psychologists.

Krishna Jonnakadla  10:29

Yeah, that's especially on the on those two fronts. Privacy and respect for the individual is definitely guaranteed on a platform like this, what has been the kind of scale something like this, which is so simple, so impactful? What have the results been so far? What kind of scale have you been able to achieve?

Amit Munjal  10:49

We have around 3.5 million users in India, with 150 large companies which are taken doctor is a solution for their employees. And by the What I mean is that, let's say, Krishna, that you're running a 50,000 people organization, then you say, Well, you know what I care about my employee health, I care about my employees happiness, and lifespan and longevity, because one, it's the right thing to do. Second, it's also very interlinked to the productivity levels, unhappy, unhealthy employees would not be as productive as happy and healthy employees in any organization. So there is a tangible as well as an intangible reason for any organization to have a solution like offering stuff, whereby employer our first offering start to all their employees, which means that employees and their dependents could do consults with the doctors of doctor in staff anytime they like without paying a single penny to the doctors. So it's free health care to all of them, not just that, we also couple it with our offline strategy of doing the hand holding for all these patients. So Dr Insta comes into the picture, let's say with 50,000 people organization of Krishna, and now we do a medical scoring or healthcare scoring of all these inputs. Based on that we put different employees in different buckets, there will be a segment which is very healthy and doesn't have any physical or mental health issues. And the plan for them is to help them maintain their fantastic equation in life so that they stay in the best of physical health and mental health. Then there is a segment of employees which have issues that said about physical health. physical health issues could also be ranging from Okay, I have got theological issues for 5000 employees. We are finding diabetes logic issues in the other 5000 employees. So in these cases, our cardiologists would be available online and offline. By offline I mean on site doing like the periodic cardio logical camps are these office locations of this company. Make sure that nobody falls off the wagon and these employees get consistent care from the cardiologists or from the diabetes largest of doctor in staff on site and if they need any follow up care then these same doctors are also available online to complete the service often not just that if these employees that you know, what can someone from Dr. Install also help in delivering of medicines or getting my diagnostic tests done, the doctor in store has those beautiful features inbuilt in the app. We have tieups with the all the meeting offline and online pharmacies as well as the diagnostic chains of the country. So we provide an end to end solution to our users. Not just that we found that the problem in India which was unlike us, which has a dedicated 911 number, which if you dial the ambulance comes to you right away. And then that last hour is very critical when it comes to saving the lives of the people who are having an emergency. With Dr Insta We enable now the ambulatory dispatch service. So no matter where you are in the country, doctor in style would be able to send you the ambulance in a very consistent and timely manner and take you to the hospital, which is nearest to you or the one that you're choosing to put.

Krishna Jonnakadla  14:18

One, start telemedicine. And these are the number of areas that you've been able to touch. What has been the personal journey? Ever since you dreamt up or thought about this or envision this in 2012? How easy or how difficult has it been? The Indian landscape can be frustrating and enabling both at the same time, what has been the personal journey?

Amit Munjal  14:43

I think the personal journey has been mixed bags. You know, there have been ups and downs peaks and valleys in this journey. For a very long time. We have been focusing on B to B to C as well as B to C. So the example of B to B to C is that employer would take doctor in stuff for all their employees independence. And the good example for b2c would be anyone can download the app and do the consultation on Pay As You Go basis or on a annual subscription plan basis with Dr. In stuff. b2c, just like in most industries is a major cash guzzling operation, it leads to a huge burn, and only then you see the results over a period of eight to 10 years. So while we are plugging away with B to C, in the best possible manner, taking into account our budget for ad spend as well, we have also been plugging away on B TO B To C, and it's in B to B to C  where we have gotten like 150 large companies taking Dr Instas solution for their employees.

Krishna Jonnakadla  15:48

So your own personal one, this business model was evolving. How did your own personal journey evolve with it?

Dr. Ritesh Malik  15:57

My personal journey has been intertwined with my professional life as an entrepreneur, you you eat, sleep, drink, the idea that has consumed you for most part, my personal journey has been very beautiful, by the way, because I feel that in my previous avatar in finance, the focus was only on shareholders, rare as in this journey of democratizing healthcare for everyone, anytime and anywhere. I'm in my own small way enabling the improvement of health care in our country. And there's nothing better than a gift of good health that you can give to yourself or to others. Also, virtual health care is a beautiful thing for the planet too, because it means a fewer hospitals are needed in this society to offer consultations to these patients because you are enabling most of these consultations. By leveraging the technology and and giving them health care no matter where they are at as a result of which no patient has to drive or take public transportation to a hospital and and add to the carbon footprint and fuel emission levels of the country. So triple bottom line focused is is the linchpin of my current model. The third component of the triple bottom line is hopefully it turns out to be a very good thing for our shareholders to entice to come so it will help better planet and hopefully profit for the shareholders.

Krishna Jonnakadla  17:34

When I was in the US and saw some telemedicine options. I was always thinking I hope somebody does telemedicine in India. But then again, I happen to have a bunch of doctors in the family my father in law is a pediatrician and he's widely there in the medical fraternity but along it must not have been easy. You need the support of Medical Council of India. The Indian Medical Association putting all this together. must not have been a slam dunk. What were some of those obstacles that you faced?

Amit Munjal  18:05

See, India laws are a little archaic. So the laws in India for healthcare were written before probably the invention of telephone. So, you know, the laws around telemedicine are very gray. But I personally met the health minister of the country and the health ministers of many other states, Pan India, and I was very, very glad to hear that, that top of the house in the government, there is a strong support for telemedicine because government realizes that India has two major problems, one that we briefly talked about, which is the number of doctors per thousand is one of the lowest in India in relation to other countries. And the second problem is the problem of self medication. Many people for lack of time end up self medicating and there are different various examples of self medication ranging from popping a pill at your home to walking up to a neighborhood to a pharmacy, asking the attendant there that, Oh, I should take this medicine or asking them, tell me, Hey, give me some medicine. And the attendant is not the best judge of your medical health. Anyways, attendant doesn't know much about health care, what attendant ends up giving is a strong antibiotic, which may or may not even be required for the problem that you're handling with this attendant would not care about your allergies, about other conflicts with the other medicines that you're taking. And that's a huge issue in Indian market. So and if you ask most of the people who are educated and doing this, which is walking up to a pharmacy and asking the attendant there, then one of the biggest reasons that you get to hear is that Oh, listen, I don't have time to go to a hospital. So I feel that if I take the medicine given to me by this attendant, hopefully I would feel better which means that I will not I have to go to hospital because I run a very busy life. And I won't have three to four hours of time to go to a clinic. So we are, in a way, helping these peoples who are time starved. To get the consultations with these doctors as quickly as possible. Without wasting four hours of time.

Krishna Jonnakadla  20:18

I possibly wouldn't find fault with them, given the kind of lines and waiting times that you tend to see at any primary or secondary or tertiary care center. First off, it takes about two to three hours to see an average doctor, even if he's there. Second off, you know, the conditions are not that great. And like you said, it is amazing how many industries and opportunity the state of the terrible state of our Indian infrastructure is creating, isn't it?

Amit Munjal  20:46

Correct.

Krishna Jonnakadla  20:46

From you know, home delivery of medicine to home delivery of food to home delivery of massage services, yoga therapist, whatnot, it feels like if we had better infrastructure, we possibly would have more efficient models but it's amazing. We also have another problem Don't you think I may be also have a quality problem we while we do have a quantity problem in the form of density because I in Karnataka, which is home to lots of medical colleges and when I personally wanted to, you know choose a stream after my 10 my father said there's so many doctors and engineers out there you know, you choose if you want to be one of them, the density problem is a problem. But there is also a quality problem is there not?

Amit Munjal  21:31

True Krishna, there is a quality problem. And that's why what we did a doctor in Star Wars, we have one of the most stringent selection screening and training platform for the doctors. We just don't onboard any doctor and every doctor with all due respect to the doctor community, doctors have to go through a very, you know, strict interview process. All the doctors have to have MD degrees and at least five years of post MD work experience that marquee hospitals or, you know, marquee name brand Medical Colleges of the country. So what it does is it automatically eliminates the weaker links of the chain. And if you are very good doctor only then you added a job for the interview. And now from this pool of very good doctors, we choose best in breed doctors, we just don't stop there. When we onboard these doctors. Then to add the end of every consultation, a patient has the opportunity to rate the doc. So from our curated pool of doctors because of crowdsourcing of thousands of ratings on daily basis or different doctors if a certain doctors rating drop below a certain below a certain threshold. Then we decommission the doctor from the platform. So the platform in itself has a survivorship bias and every single day they go crowdsourcing of these ratings and reviews of these doctors, the platform becomes superior and better, with better performing doctors at play, and the worst performing doctors getting filtered out of our value chain.

Krishna Jonnakadla  23:14

So let's talk about the B to B to C push, you spoke about the everything comes back to the density problem. And the other side of the density problem is access urban people, urban residents like you and me, we do not necessarily have an access problem. While we do have several doctors around us, there are the infrastructure and the weight issues or maybe lifestyle issues and infrastructure issues. But when we look at other parts of India, where there's absolutely no access whatsoever, I can understand in 2012, internet and data penetration was not that great now with the geo effect of, you know, data penetration wide being there widely, and much more powerful smartphones. Existing? Are you seeing the access problem for semi rural and semi urban places, getting better with platforms like yours?

Amit Munjal  24:09

So I was saying definitely, I see the data situation becoming far better in smaller cities and villages, as you rightly mentioned, than it used to be. India used to be one of the most pricey data sellers just a few years back. And now data is one of the cheapest things available to all of us. And not just that, even for the people who do not have smartphones. We have offered a solution to those people to that okay, over the period of time, we understand that you may migrate from a feature phone to smartphone but for now, you can have consultations with the doctor. So Dr. Insta using your feature phone to you can call our doctor in store number and then the call center inbound call center employee of Dr. Insta would get you connected with the doctors in this specialties of your choice.

Krishna Jonnakadla  25:04

So let's understand that journey a bit, given the numerous languages that exists out there. So for instance, let's say a patient in some part of remote part of Orissa uses Dr. instance there is a language barrier, is there a local person that's helping them to sort of finally find a doctor or all of this as they dial a number and then eventually, somebody comes online and then puts them in touch with the doctor is that how that happens?

Amit Munjal  25:30

So the way it happens is that we have solved this problem in a very simple manner. If you come to the app you already see which languages are different doctors conversant in, so you can cherry pick the one or from the many who are listed there as doctors who are competent to speak with you in your own native tongue. So if I have a Tamil speaking mother bought a colored speaking father and they want to communicate with the doctor In their own native language, their doctor is that you can easily do so. So all you have to do is choose the doctors who are conversant in those languages.

Krishna Jonnakadla  26:08

I see what are some interesting things that you have seen happen, I'm it from a semi rural, semi urban or even an urban perspective, something that you did not expect to see when you started this journey.

Amit Munjal  26:20

For sure. So, you know, I did not know initially, what would be the preferred medium for these patients who consultations with the doctors, whether it be phone, or video or chat, but couple of interesting things that I was able to see on recurring basis was one that for certain practice areas, there is a bias toward one communication medium over the other. And by that what I mean is that for sexologist patients, vast majority of these patients end up choosing phone and not the video now compare that to psychology. vast majority of the patients choose video and not the food. So very divergent trends. And then there are certain practice areas which are a no brainer like dermatology people choose video because they want to show something to the dermatologist so no brainer there are the what the stark contrast between psychology and psychology came as a surprise to me initially. Also, what we see is that for our b2b b2c users, the top three specialties are different from the top three specialties for our b2c users. So for example, for our b2b, b2c users, which are basically employees of the large companies that we are catering to the top three services that they choose when it comes to specialty are one general medicine to gynecology and three pediatrics, whereas for for the b2c users, the top please special is our number Number one, sexology number two psychology. And then number three general medicine. So general medicine is the common one between our B to B to C and B to C, although the rank order is different, but that was also interesting phenomenon proving the hypothesis that how, you know, the b2c users have a bigger social stigma in their mind in the field that are they have to look for it to life doctor in stuff to do consultations with the sexologist and psychologist rather than going to those psychologists and sexologist.

Krishna Jonnakadla  28:33

Could it also be that in a b2b to see scenario, the employees have some apprehension that the employer might know what kind of services that they may have availed?

Amit Munjal  28:42

I'm sure that apprehension is there, although there is a written commitment from our side that we don't infringe upon doctor patient privacy. And this is like super discreet, confidential and nobody would ever know. But having said this, you are right. I'm sure amongst Some people that apprehension would still be there. But the other driver along with that apprehension is also the fact that people who have sex illogical and psychological issues are actually searching for tools like Dr and stuff. So they are the ones seeking tools like Dr. Insta more than the other patients in other specialty areas.

Krishna Jonnakadla  29:21

Let's talk about the Indian user or the Indian consumer beyond the some of these obvious differences in terms of let's say sexology and dermatology the morgues? What were some of your foundational beliefs or beliefs that you started out with saying that, hey, I think the user is going to be this way or that way from a pricing perspective or a behavior perspective. What were some of those beliefs or foundational assumptions that you started off with have did they hold true or did you just end up discovering something totally new?

Amit Munjal  29:55

See is some held true and some are led to new discoveries in these realms, for example, in the past hour thing that people have phone and video as a medium to speak with the doctor, why would they choose chat? They may use chat for peripheral questions for the same doctor with whom they have consulted. Like Okay, so I had a consultation with Dr. Kumar. And I forgot to ask, how should I take this pill? Should I take an empty stomach on full stomach? Yeah, you can get those questions addressed through chat. But I'm I didn't realize that people would be asking questions after making the payments by chat as a preferred medium. And the reason became clear to me only when we took the plunge. The reason is to call that some people have, you know, specific questions that they feel not so comfortable about asking their close circle of friends or family members, like people in their late teens or early 20s having sex illogical issues, seeing it all, what should I do? I'm pregnant. Or what should I do to avoid pregnancy or or other such nature questions related to erectile dysfunction and stuff like that. So people are using chat at a far higher level than I had initially thought. The second set of users that we get are probably the working employees who are not permitted to carry their smartphones but can still go online using their computers and pose this questions through chat to the doctors. So I feel that those two must be the key drivers for chat as a as a equally prominent medium of choice or consultation with the doctors just like phone consults or video consults.

Krishna Jonnakadla  31:43

So let's talk about the density problem from a different angle. And since since you've been in the US for a while, anybody that goes for treatment in the US in any hospital sees that are witnesses that the nurses There tend to be far more trained, far more adept in, in, in many cases, for example, in my wife's case, on both the pregnancies, 80% of the diagnosis, the support, and the comforting all of that stuff was done by the nurses. In many cases, it's also a function of the economics of that system of physicians built time is so much more expensive, and therefore, as a result of that, it may have had that ratio. But still, it is surprising to see so much knowledge, so much training and so much skill with the nurses. Are you doing anything to improve that with let's say, some paramedics or nurses equipping them with some primary diagnosis, so therefore, you could improve the density angle in a different way, so that the initial diagnosis is all done by these people. And then the doctor actually looks at the diagnosis and maybe does one more final diagnosis concurs with the nurses on the paramedics analysis.

Amit Munjal  33:03

See, I think India is still a few years away from trusting the nurses as much as America does. I think you rightly said it better than anyone else good that nurses in America for more trained to diagnose these issues and and then here in India unfortunately the trust factor in terms of having a nurse diagnose the issue is not as much not just that the other major differences also that in us for your moderate natured specialty problem, even a GP general practitioner would be able to address it. Whereas here in India, people have a propensity to go to the specialist straight away, then going to a GP first and then going to a specialist if the patient is referred by a GP to a specialist. So as a result of that, we are not doing as much in that domain because we Virtual healthcare is relatively new. Second, it would be even tougher sell if we say that we are collecting our patients with the nurses, not with the specialist doctors. So because of the stage of the evolution of the health care system in India, I feel that we can't do it yet.

Krishna Jonnakadla  34:20

So let's, let's talk about another angle, you're doing thousands of consultations on a daily basis. Obviously, there is a mountain of data that is getting generated from this, which which is otherwise missing from a lot of caregivers over there, right? Because you are one integrated platform, you have so many specialties that you are offering. That would mean that you're able to structure this data, slice and dice and say, Okay, this is 80% of the queries come from here. This is where the primary diagnosis is. And this is where the cost is. So let's try and see if we can push out a Web MD kind of a platform for preliminary diagnosis so we can run These requests better or, you know, get get at least some minor queries answered. Are you seeing any any of those sorts of opportunities emerge?

Amit Munjal  35:10

Definitely. Over a period of time, as artificial intelligence and machine learning Evolve even more, we would be relying more and more on AI and ml machine learning to address these rudimentary issues that our users may have. For now, we we are using the healthcare chatbots of a large company called URMD, a UK based company and imagine your MD to be Web MD two point O when it comes to healthcare chatbots. So that's what we are leveraging in the back end to get those questions addressed from the larger patient pool. And I think in our blueprint, as we become evil more vague and have bigger pool of data to process the intent is to have our own in house, healthcare chatbots to address these questions and take it from there.

Krishna Jonnakadla  36:11

So in the day is not far off when we're going to possibly use natural language ability of artificial intelligent machines that can respond to patient questions like a normal human would. And the patient would not make out at all that it was not a human that was speaking to them, which could potentially improve the density problem and access problem in a big way for the rural and the semi rural locations.

Amit Munjal  36:37

Totally. Imagine living in a world where the next 7 billion people today on earth Imagine if the data is aggregated for 10s of millions of people. And and this artificial intelligence and machine learning could even help the doctors. So imagine Krishna you're walking to a doctor's office and doctor knows that I can treat Krishna problem with Medicine a or medicine be or medicine see. So, overall worldwide medicine a was able to provide relief to quality 50% people be was able to provide relief to 30% people and see was able to provide relief to 20% people. So, for now, Doctor is very likely to choose medicine a because there is a higher probability of Krishna getting a solution by medicine a but now, Doctor using AI and ml figures out that oh wait Krishna is a male. So, let me look at this trend for male population on with Krishna is off Indian descent. So let me add that variable as well and await Krishna is call it a 27 year old. So let me marry that fact with population which is in the same ballpark range of 25 to 30. Now using these variables, doctors the same PI database and figures out all the overall Madison a world 50% effective, but using these demographics Krishna being a male 27 year old of Indian descent medicine see has a 70% success rate. So, in the previous iteration where doctor would have given you first medicine ANF medicine he had not walked you would have gone to doctor again doctor whatever replace it or medicine be and as medicine do not work then doctor would have replaced it with medicine See, now, Doctor without much ado and with a higher degree of confidence gives you medicine see right off the bat because of the aggregation of all that millions of data points that are coming together, further enhancing the decision making of the doc so this can be possible in the world of tomorrow. I'm sure many entrepreneurs are already working on aggregating such medical data points and seeing how people react to these medicines and then factoring those demographics and other ethnicities into the equation.

Krishna Jonnakadla  39:01

So, how has your rural push been beyond the urban centers? How have you been able to scale the rural push Have you been able to scale there?

Amit Munjal  39:10

Rural push I can tell you is a little challenge and the reason it is challenging is because of the pricing pressure. If you have good specialist, MD doctor offering the consultation, then this good specialist MD doctor also expects a commensurate compensation for the time that they are giving. Now, in the rural India, the problem is around the pricing shock. So, if I offer the service office specialist, MD doctor, even at 200 rupees or 150 rupees per concert, it becomes a challenge for rural India, rural India would be happy to consume this service at 60 rupees or so, the problem is at 60 rupees, I have to give a large amount of that 60 rupees to a doctor who will not be emptied out there but will be Mbps dr only. And then the enablers of assistive ecommerce so these are like be at least village level entrepreneurs who are peddling your service in those villages getting those villages connected to the doctors also have expectations around decent compensation. Okay, so imagine you are in some village of Karnataka near you pick the name near Belgaum. Belgaum, there was a big city but let's take some village available and now you say okay, I'm offering consultation for 60 rupees a day okay, I'll give 45 rupees to the meds doctor, which seems on the low end for the meds doctor but let's run with that and maybe you know, 14 rupees or 15 rupees to the village I will entrepreneur enabling this service. Now for this really, unfortunately or fortunately he or she has other things to sell to this patient or the villager from ecommerce products to insurance to loans where he can Make far far more than 15 rupees that he would be making enabling Docker in concert. And that's why because of the acute pricing pressures in the rural India, we are not able to scale as much. Now with your podcast tool I request to all the large corporations which have their CSR budgets setting aside to leverage the rural platform of Dr in staff to enable you know, complimentary councils to these villagers paid for by the CSR rupees that they are set aside in their purchase. So, that probably is one way to deal with the situation. Second way to deal with the situation is since the model would work only in a socialistic setup, not in a capitalistic setup. I through your medium also request the different state governments because at the end of the day, health is a state subject in India or for the health minister. To offer a to life doctor in stuff all the residents of the state, imagine the state of Haryana has a population of 1.5 people. And for a few passes per person, the state of Haryana can offer a number to all the residents of the Haryana saying hey, dial this number, and you will get free concerts far more cheaper, far more efficient way to offer consultations to the villagers where they would otherwise have access to the doctors or you know, neck neck. It also reduces the overall health care spend for these states too, because a stitch at time prevents the other line. Imagine on day one day two of your figuring out that the patient has a dean so needs these tests versus, you know, a patient dealing with the trials and tribulations of acute pain like deja vu without even knowing that the patient has attained 2467 days and then hopping on a bus going to the nearest city and getting a treatment for day two. So that's far more expensive because this patient doesn't have much money to pay. So more likely than not he would land in a civil hospital consumer bed, they can get free medicines there as well hopefully. And this all could have been prevented if the patient has been treated from day one or day two, using a platform like Dr Insta.

Krishna Jonnakadla  43:18

What has been the most frustrating moment of this journey? There have been many positive ones what have been a couple of most frustrating ones?

Amit Munjal  43:28

The most frustrating moment, I have quite a few so it's hard to figure out which one was most frustrating. Every single day as an entrepreneur, you have to deal with different things. I know initially we wanted to have even less than friction for patients who enroll in doctor in stuff. So we would just take names and your phone number there was no odd validation necessary because in a lot that OTP is that expensive too or that time consuming to implement just that it adds one more layer fiction. So we offer doctor instances like that. But we learned the hard way that some people started abusing the platform. Some patients started in a way misbehaving with our female doctors. So we figured that Oh no, this is not the right way to go about it. Our female doctors should also feel euro protected on an environment like this, especially when it comes to sensitive specialties like psychology or psychology. So then we internalize the product. And we said rtmp validation is necessary this way, we would have a validated for number of the patient and patients would be or some bad apples who are screwing it up for all of us who would be extra careful about not abusing the platform. It's like, you know, back in the day when YouTube would let you post comments anonymously without taking your address or email at, you know, people would put all kinds of junk in their messages right beneath the videos, and then they started taking your legitimate Females and put put other checks and balances in place as a result of which there is far less abuse now, so same same thing for Dr. Insta as well. But it was frustrating to see that, you know, we are trying to do good deeds here by reducing the friction points for the patients and how some patients were trying to abuse the platform making our doctors less comfortable than we would have liked for them to be. Second frustration is the one that we talked about already about penetration in rural India. How we are struggling because of the pricing barriers of rural India where rural people don't have the kind of wallet that is required to offer good quality consultation service to these patients.

Krishna Jonnakadla  45:43

The tier two towns possibly don't have the pricing issue right. For instance, let's say I take Bangalore and on big so let's say between Bangalore and Kiribati which is an under but there's there are a clutch of tier two towns, which always so And again, one of the things that I keep sort of getting surprised is as soon as you step out of Bangalore, the quality of infrastructure everything drops by you know, drops drastically The roads are Bangalore roads are as it is very bad and you can imagine how those towns are and the number of doctors are 30 years ago the same doctors are still in circulation. There are very few new new caregivers getting added for their money is not a problem so dear to push would be more easier than complete rural push, I would imagine.

Amit Munjal  46:35

I agree and that's what you're doing. So we have a lot of patients coming to us from smaller cities like Varnasi, Patna, Jaipur, Chandigarh.

Krishna Jonnakadla  46:42

Right.

Amit Munjal  46:43

Teir two push has been with far less friction, then our tier one push. And when I say tier one, I'm talking about top 11 cities of the country. So that's what we are trying to do. And now it has been far more successful than rural India. as you rightly mentioned, in Tier One cities, the main problem is also the traffic as a result of which people end up wasting a far more time than they do in tier two cities. And also, the thing about tier two cities is that tier two cities, at least people have a little more time available to them. Then people in Tier One cities, imagine you are going to Office your office is like one hour away from home. Each way, you end up wasting two hours of time in office, and all of us have 24 hours in a given day anyways, and in Tier One cities, in a many husband and wives are working as a result or which time is always a scarcity. Empty or two has that problem too. But the problem is less there. But generally it's the husband who is working in tier two.

Krishna Jonnakadla  47:45

So what what have been some cherishing moments moments that you've absolutely enjoyed while doing this Amit.

Amit Munjal  47:51

I think, you know, when we initially launched the service, we would have to wait for a even a single call to come to our pool of the First, and after a few days, the number went to like low single digit number on daily basis. Soon it started ramping up to you know, in in its 10s hundreds. And now, you know, I'm glad that that number is in thousands. And hopefully next year as we speak this number, if it is in lacks nothing like it because that's where you get to provide the benefit of financial health care to people of India at a very, very mass level. I mean, if you look at the market, there are like 1 million doctors in the country. And I'm talking about allopathic doctors only, not the Irish doctors. Imagine like each doctor doing call it 50 OPD concerts in a day. So 1 million multiplied by 15 years. You're 15 million consoles happening every single day in India. And I feel that virtual healthcare can definitely leverage 2% of it in the next couple of years. So 2% of 15 million comes out to be around 1 million consoles happening every single day on virtual healthcare platform. And that's where you can say that you know what I am, in my own small way, bringing the healthcare benefit to 1 million lives every day in the country. So that would be a moment that we are all waiting for to happen for us in India.

Krishna Jonnakadla  49:20

How long was that initial phase when you didn't have calls? And that it? Did you at some point in time feel like, gosh, will be? Did we make a bad decision? Or are we early in the game? How long did it take for you to get some traction and what was what was going through your mind at that time?

Amit Munjal  49:39

It was like three to four months to build ok traction? Yeah, you know, as an entrepreneur, you always second guess about the Road Not Taken all the time. I still do it while doing Dr. Insta, but I'm very bullish, very hopeful, very optimistic about virtual healthcare. I've seen it evolving in different countries. us already has three or four large companies in this domain. China, our next door neighbor, which is a few years ahead of us, when it comes to virtual healthcare also has four large companies operating in this domain. So I think it's a matter of time before we reach that happy number of 1 million consults a day in India to do you have a founding team, I do have a core team. One of our core team members is a medical doctor, the other core team members out there not out and out engineer, the other founding team member is a dedicated and very well experienced business development person, right?

Krishna Jonnakadla  50:39

You got or founders or founding team members?

Amit Munjal  50:43

They are founding team members.

Krishna Jonnakadla  50:45

So you're a solo entrepreneur Amit?

Amit Munjal  50:47

I wouldn't call myself to be a solo entrepreneur because in this journey, many people have joined forces with me. So there are a lot of engineers, a lot of doctors a lot of business development people. Customers are people helping me in this initiative. We are also backed by institutional investors. So they are also enabling this journey forward. And all of them have helped us in whatever shape or form they put from human capital to financial capital. Because this journey is not a journey of a solo person. It does require a village to build a large company.

Krishna Jonnakadla  51:22

True, I suppose you would credit your earlier management and consulting experience because this is not an easy domain. It is not. Each startup has its own set of challenges, but there are lots of operationally intensive challenges in a domain like this one. So would you credit some of your past experience and to give you that kind of wherewithal to attempt something like this?

Amit Munjal  51:45

Our credit in Steve Jobs language, you know, stay hungry, stay foolish, that was a little foolish to not to realize that healthcare was three times harder and three times a day three times longer. If I'd known then I probably would have chosen something else. But in hindsight, I'm glad I did not know that at that point of time, because you know, no matter what you do in life, it does require a little bit of leap of faith and leap of faith will only happen to people who are not fully informed. Because if you feel that information is symmetric and available to everyone, nobody will do anything in life.

Krishna Jonnakadla  52:21

True. So on the symmetry part, the three and a half million users is a, you know, good chunk is a pretty big chunk. And I'm sure you've done a lot of interesting things. What are some things that you've done differently to get to that, that big of a user base?

Amit Munjal  52:39

See one of b2b b2c helped? As people started using our service people became our evangelists. Our users started promoting doctor instead to other users, corporations or to take doctor in staff or their employees started promoting Dr Insta  to other corporations. So the network effect This case helped us tremendously, both at retail level as well as at corporate level. Second thing was, you know, many users in the past would have an unsure if they still have the phone capacity issues in India. So the low end, smartphones don't let you keep as many apps as you would like to. And healthcare being healthcare as a product is not a product that you use multiple times in a day, you probably use it, you know, once in a few weeks or a few months, depending upon your need or your family. So initially, we had a really high proportion of app on installs. So that became a problem for us. And how we went about solving it also increased the dedication of the user users for Dr Insta because once you uninstalling it, then your probability of reinstall Falling it is far lower than you were keeping the app all the time. What would it be for this case was that one, we offered the patient record Management module of Doctor Insta, everybody wants free of cost. So now you can give your MRI x rays CT scans at one place at no charge for you can you can make them visible to the doctors when you're consulting with them as well. So once you start keeping all this now you're the last person to uninstalled the doctor and staff because you are more invested in the product. It's like, you know, many people use Facebook to save their photos. And these people would would never go very far away from Facebook because it has the repository of all their photos with their family members, all those amazing moments that they shared with their loved ones. Second thing that we did was we further enhanced about content team. So we started publishing blogs and health tips. We have crossed over he was on daily basis, so even on days when you are not using doctor in staff, you're still consuming the content through the healthcare blogs and tapes of doctor and stuff. The third thing that we did was we introduced this feature called see your own doctor. So in this case, let's say Krishna, as we are talking about the doctrines offers only a curated pool of counters. You say oh this is great. I love your curated pool of doctors but I already have a pre existing relationship with my own Dr. Kumar in Bangalore which I do not want to disrupt. Now the sad thing is Dr. Kumar is not online available, and I would like to do concerts with the same Dr. Kumar as a man I want using this tool to so what we did was we offered Dr. is free of cost to all these doctors that you want to onboard. They can do concerts with you at a time convenient to you both at a price that we need to put so using that feature Many people ended up choosing doctor and start to do concerts with their own doctors doctors started onboarding their other patients to a good thing for us is that we don't have to, you know do screening or acute screening of these doctors because the doctors are consulting only and only their current patients. So that comfort level is already there. If Krishna has been going to Dr. Kumar for the last 20 years, and Dr. Kumar is seeing Krishna, we are nobody to upset the applecart there. We let Krishna consult with Dr. Kumar, and pay Dr. Kumar, the fee that Krishna is comfortable with on Dr. Insta app, and that fee would go to Dr. Kumar. Anyways, we don't hair cut it in any shape or form. So approaches like these helped us tremendously in scaling up and also in increasing the stickiness of the app.

Krishna Jonnakadla  56:53

So before we wrap up, couple more. We've had a long conversation. interesting conversation couple more question. How Has doctrine start changed over the years? What has dr installment personally meant to you? And what defines Amit Munjal?

Amit Munjal  57:09

See, Dr. Insta definitely made me a far more humble individual than I was in the past. entrepreneurship as a whole is a very humbling experience. you experiment with hundreds of things. Most do not work and the some that work and the intent is to scale it up at the best possible price so that you don't end up burning a lot of money in the process. So i will say, if I have to pinpoint one thing that Dr. Insta made me, that would be a far more humble individual than I was.

Krishna Jonnakadla  57:42

Of all the things that you could do given your network. Why healthcare world where something else was something else not brewing in your mind at that point in time?

Amit Munjal  57:52

No, you know, I had 30 odd ideas to persue from aggro deck to Ed Tech to FinTech to help that, but because of my prior experience, and, and the feel good factor around delivering healthcare making people's lives better, was the key driver for me to choose this.

Krishna Jonnakadla  58:14

I'll end with this. And after that would like some closing comments from you, India is at a crossroads today, the doctor density problem is creating a lopsided set of incentives and advantages. So much so that a lot of ethics in especially in the medical profession are being turned on their head with extensive amounts of, you know, medical malpractice, given the scale that you have achieved. Is that is that an issue? If so, how have you solutioned for it?

Amit Munjal  58:48

We have put some fantastic checks and balances in place. We don't encourage our doctors to do on site consults for our patients. They can do online concerts, but onsite isn't known as a result of which it's very arm's length between the doctor and the patient. Also, you get to hear cases where by or a doctor practicing in a certain neighborhood was asking their patients to get medicines from a specific store for get diagnostic tests done from a specific lab. So when you are running it in an online manner, you're not creating any incentives for any of these doctors to get some, you know, backdoor deal, or under the table deal with those neighborhood pharmacies or diagnostic labs. So it's a far more transparent and far more ethical medium, then then the brick and mortar medium anyways, so we do our, you know, periodic quality assurance checks whereby we're dummy patients to concerts with these doctors and make sure that these doctors are meeting the ideology and philosophy of doctor is and doing these consultations in a arm's length, transparent manner. And there's nothing Hanky Panky happening there.

Krishna Jonnakadla  1:00:02

Who would know technology to the rescue? Amazing. I mean, it's been a great conversation. Lovely knowing you. And healthcare is a very touchy topic close to all of our hearts. It's one of those things that directly affects the quality of life of people. So kudos to what you've done. And I'm sure this is just scratching the surface of the possibilities, any closing comments before we say over and up?

Amit Munjal  1:00:28

So Krishna, first of all, thanks for your time to have me here and give me the opportunity to propagate my investors to your listeners. I appreciate your efforts as well in putting together mirages of scale and giving the entrepreneurs a might party platform or the podium to communicate to the fellow listeners as to what they are doing and what they're doing right and what they're doing wrong. I also welcome your listeners to reach out to me by emailing me if they have any feedback suggestions or thoughts about how we can improve the health care delivery in the Indian market for everyone, so that we could all join forces in further democratising healthcare pan India. So my email in that case, I hope I have the I have your permission to state my email here, Krishna.

Krishna Jonnakadla  1:01:22

Yes, please.

Amit Munjal  1:01:23

 Thanks. So my email is amit@doctorinsta.com. So I repeat amit@doctorinsta.com Please feel free to reach out to me with your suggestions or thoughts about further improving whatever we are doing in Indian market for making a seamless delivery of healthcare to everyone at any time. And anyway, thanks a lot. Krishna one more time. appreciate you having me.

Krishna Jonnakadla  1:01:55

Thank you Amit.

Nida  1:01:57

hope you enjoyed the story. If this story made a difference do you tell us by leaving a comment on the website or our social media channels help us spread the love by subscribing liking and sharing our show. We welcome speaker suggestions and collaborations write to me at heythere@maharajasofscale.com