THE EARLY HIRES · ISSUE 3 · NOVEMBER 2026
A note from Helen
Welcome to the third issue of The Early Hires!
October flew past, so November gets two issues. It was a full stretch. I recorded conversations with some incredible clinician leaders, with episodes now lined up into 2027. The Early Hires has its first sponsors. And I have taken on new startup advising engagement in the ENT biotech space.
If your to-do list is full of other people's next steps, this one is for you. It starts in a temple in Bali and ends with five phrases to try in your next one-on-one.
This month: Hand It Back
Watch Out, Shiny Things
Years ago, my husband and I traveled to Bali. It is one of the most magical places I have ever been.
I had been to Asia once before, to Sri Lanka, helping with the rebuild after the 2004 Indian Ocean tsunami. That is where I saw my first Buddhist temples: beautiful, serene, and mostly elephants, with a few monkeys here and there.
Bali was different. At Uluwatu, a Hindu temple on a cliff above the Indian Ocean, around 600 long-tailed macaques live on the grounds. Locally, they are believed to guard the temple from negative energy.
These monkeys were seriously in charge. They took everything they could get: cameras, sunglasses, earrings, rings. Watch out, shiny things! It was amazing, and I was also ready to get out of there before they pounced. 🐒🐒
A few weeks ago, monkeys came up again in a very different setting.
The Next Move Is the Monkey
In Alison Fragale's Likeable Badass Accelerator, a woman in my cohort said she was struggling to delegate. Alison, who is one of my favorite authors and acclaimed psychologist, pointed her to a classic Harvard Business Review article by William Oncken Jr. and Donald Wass, "Management Time: Who's Got the Monkey?"
The idea is simple. Every problem has a next move, and that next move is the monkey. When someone brings you a problem and you say, "Let me get back to you," the monkey jumps off their back and onto yours. Now they are waiting on you.
It is one of HBR's best-selling reprints ever. In clinical leadership, I had never heard it mentioned. I wish someone had handed it to me in my first year at an early-stage startup.
I Kept Every Monkey (and Barely Had a Team)
It was just a few months in and I was scared to delegate. It was not that I did not trust my team - the tiny team I had at that time... I just did not have the answers yet.
The company was changing every week. The plan I made on Monday was out of date by Thursday. So I kept everything: my monkeys and my team's monkeys. The funny part is that I barely had a team. I would onboard someone, then stay close and double check everything. The monkeys piled up on my back, my shoulders, my arms.
A little over a year in, I almost sank under the weight. And I really frustrated the people I had hired, who were ready to own more than I was giving them.
Eventually I had no choice. We worked through it together, and today those same hires are leaders in the organization who come to me as a trusted advisor.
The truth about early-stage companies is that nobody has the answers. Not the founders. Not the board. Not you. That turns out to be the reason to delegate, not the reason to wait.
What I Would Do Differently in Year One
Hand off the next step, not the answer. You are a good boss even when you do not know the answer. Set the guardrails and the goal, then let your team figure it out and present back.
Let the people closest to the problem own it. They usually see it more clearly than you do.
Watch your clinical instincts. We are trained to own the order, the callback, the follow-up. In a startup, that instinct can quietly make you the bottleneck. Check whether you are protecting a real safety line or just "how it has always been done."
Notice the phrase "let me get back to you." Every time you say it, ask whether that monkey is really yours. I am notorious for this one. It needs a star next to it.
Try These Lines for Your Next One-on-One
Oncken and Wass had a rule: every monkey needs a clear next step and a set time to check back in, or it ends up on the manager's back. Some example phrases to get things started:
"What do you think we should do?"
"Bring me two options and tell me which one you would pick."
"Take a first pass, and we will look at it together Thursday."
"What do you need from me to keep this moving?"
"This one is yours. Loop me in if it touches patient safety."
Pick One. Try It Out.
You may not get this right all at once. I did not. Give yourself grace.
Write one phrase on a sticky note and post it on your computer for your next meeting with a direct report. See how it feels, and watch what happens. The sooner you give the monkeys back, the sooner your team grows into the job, and the sooner you have room to do yours.
Queue These Pod Episodes Up for Your Commute
Ask About the Job, Not Just the Title from Healthcare Startup Attorney
Rebecca Gwilt, JD, co-founder and managing partner of Elevare Law, is usually the one posting about what went wrong. So I asked her for the green flags instead. Two every clinician should hear:
A real job, with real sign-off authority. Some companies hire a clinician to put a name on the slide deck, with no real responsibility behind it. That risk lands hardest on you, because it is your license. What matters legally is the job, not the title. Look for a defined way to sign off on decisions that touch patients, including "businessy" ones like advertising, pricing, and intake.
Get your own attorney at the start, not the exit. Your leverage is highest when they are trying to hire you. Rebecca's rule of thumb: a straightforward equity review should not cost more than about a thousand dollars.
Know the Order of the Blocks from a Clinical Psychologist building in Tech
Sophie Klarskov Petersen | LinkedIn is a psychologist in Copenhagen and Clinical Product Manager at Aisel. She is our first psychologist and our first guest building outside the U.S. Two takeaways:
You bring the workflow. Sophie's image: the engineers have all the Lego pieces, and she tells them which one goes first. Does this happen before the visit, during it, or after? Do clinicians even need it?
Stay in the problem longer than feels natural. We are trained to solve, so we jump to solutions fast. Sophie's biggest growth has been scoping the problem clearly, then letting design and engineering bring the options. (Sound familiar? That is giving back the monkey.)
Thank you to our inaugural sponsor: Hey Health Tech
If you’re a clinician curious about health tech, Hey Health Tech is a newsletter and community helping healthcare professionals understand the industry, discover new career opportunities, and connect with people working in tech. Learn more at heyhealthtech.com.
Going to AIMed26? Come Say Hi.
Curious where AI in medicine is actually headed? AIMed26 runs November 11 to 13 in Orlando. It is clinician-led and usually draws more than 1,000 clinicians from over 50 subspecialties, alongside health system leaders, startup founders, investors, educators, and payers.
The program covers AI from hospital systems to startups to clinical education, including Chief AI Officer sessions, a startup pitch competition, and a one-day course from the American Board of AI in Medicine (ABAIM).
I will be co-hosting the Physician Associates Networking Session on Friday, November 13. If you are going, come find me! Use code [NETWORK] for 25% off registration.
Four Ways to Stay Connected
Visit theearlyhires.com. On the site you can:
Listen. Every episode, all in one place.
Download. The Clinician's Startup Field Guide, free.
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Recommend a guest. Tell me who you would love to hear on the show.
And stay tuned. Exciting new ways to connect with me and other clinical leaders in startups are coming soon.
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Reply to this email and tell me which monkey you are handing back this week and HOW!? I would love to hear from you.
Thank you for all you do!
Helen