Welcome to the first monthly edition of The Early Hires.

A quick word on how we got here. This started as a Slack community for clinicians in startups, and some of you joined it early. I built part of it, and then I decided to pause. What I wanted was a place to do real work, one issue at a time, that reaches you without asking you to log into one more thing. So for now, the community lives here, in your inbox. I may come back to community building later, and if I do, you will be the first to know.

Here is the shape of it for now. One issue a month. Practical and honest, aimed at the real decisions clinicians face and encounter in startup life, not the inspiration. This month, we start with hiring and, specifically, job descriptions for roles that are very likely to evolve.

You are the clinical leader. Depending on the stage, you may be the only or one of the few clinicians in the room.

The company has decided it is time to hire, clinical and non-clinical support both, and that work has landed with you.

This is not an “established” organization. There is no talent acquisition team down the hall to hand this to. No hiring committee. No competency library. No interview guide someone built three years ago and keeps in a shared drive.

There may not be a desk ready for this person. Or a badge. Or an onboarding week. Or a written workflow for them to follow once they arrive.

Hiring starts next week.

So where do you actually start?

Very few clinical leaders are taught this before they are doing it. Starting here, without the systems in place, is how it usually begins.

Start with the job description. It is the earliest thing you control, it takes an afternoon, and it is where most early stage attrition begins.

Read a stack of health tech postings and the same sentences keep appearing: Fast-paced, high-growth environment. Comfortable with ambiguity. Thrives in a startup setting. Wears many hats.

None of it is untrue. But what does all of that even mean?

A clinician who has spent twelve years in a hospital system reads "comfortable with ambiguity" and pictures a clinic day where the schedule ran long. They do not picture a company where the care model they were hired to deliver may be rebuilt twice before their first anniversary.

Those phrases have been used so widely that they no longer transmit anything.

And the information is available whether you share it or not. Health tech job boards now list total funding, last raise, and company age right next to the posting. A candidate who knows to look can find your stage in about ninety seconds. Leaving it out does not protect the company. It selects for the applicant who did not know to check - which may be the majority.

This is not a soft problem and it is not a new one. Industrial and organizational psychology has studied it for decades under the name realistic job preview.

The finding is consistent. Giving candidates a balanced and accurate picture of the work is associated with lower voluntary turnover and more accurate expectations going in.

The more useful finding came later. A meta-analytic path analysis covering 52 studies and roughly seventeen thousand people examined why realistic previews reduce turnover. The primary mechanism was not that expectations were met. It was the candidate's perception that the organization had been honest with them.

“People do not usually stay long-term because the job matched the description. They stay (or are more likely to) because you told them the truth when you did not have to, and that told them something about who they were joining.”

One more finding, and it should change how you think about the cost of transparency. Realistic previews lower job acceptance among candidates who already have exposure to that kind of work, and raise acceptance among candidates who have none.

For a clinician coming out of a hospital system with no startup experience, telling them exactly what early stage feels like on a Tuesday may make them more likely to say yes, not less.

Swap them in or add them to what you already have.

That last one will cost you applicants. However, it will save you the six-month pit-in-your-stomach departure.

These days almost no one writes a job description from scratch. You open a chatbot, ask it for one, and edit whatever it gives you. Pay close attention to what comes back when you ask in general terms, because it tends to be the same handful of phrases we have all read a hundred times: fast-paced and high-growth, comfortable with ambiguity, wears many hats. All the language we just agreed does not actually tell a candidate anything.

When you describe a generic company, you get a generic company in return, which is really just the average of every job posting ever written, and the average is where all of those clichés come from.

What changes the result is the prompt itself. When you take a few minutes to describe not only where the role is heading but where you actually are today, the tool has something real to work with: the stage you are at, what you have already built and what you have not, what a genuinely hard week looks like, and all the parts most postings quietly leave out.

Here is a prompt you can copy and adapt:

You are helping me write a job description for an early-stage healthcare startup. I want a realistic preview of the work, not a polished pitch. Here is where we actually are right now:

•     Role: [title, and who it reports to]

•     Stage and size: [for example, Series A, 30 people, 3 clinicians]

•     What already exists: [systems, workflows, onboarding that are built]

•     What does not exist yet: [what this person will build or figure out]

•     What a hard week looks like: [the real friction, in plain terms]

•     What will keep changing: [care model, product, priorities, and how often]

•     Non-negotiables: [what this person must be able to do on day one]"

Write it so a clinician coming straight from a hospital system or clinic understands what they are walking into. Do not use the phrases fast-paced, high-growth, wears many hats, or comfortable with ambiguity. Be specific instead. Where the role is genuinely hard, say so plainly.

In the end the result is only ever as honest as what you put into it. Feed it the polished version and it will give the polish right back to you, but give it the real picture and it will write the posting the right candidate actually needs to read.

(If you are doing this regularly, you can set up skills that reflect voice and brand of company to prevent having to type “Do not use phrases…” every time you prompt. )

I have watched it happen from the outside. A healthcare startup hires a group of accomplished hospital clinicians/leaders, none of whom have worked inside an early stage company. Strong records. Real credibility. Nobody explains the stage, because to the people already inside it, the stage is simply the weather. Within a year, several are gone.

Not one of them was a bad hire. The supports were not built. The framework was not there. The culture had never been described out loud. They accepted a picture of a company, and the picture belonged to a later stage than the one they walked into.

Nobody lied to anyone. That is exactly what makes it so common.

Then the clarity has to survive scale

The job description is the start, not the whole intervention. As you grow, more people speak on your behalf, and every one of them can sell a version of the company that does not exist yet.

When we brought on an external recruiter, the first thing I did was train them on our stage. Not the mission, not the benefits. Where we actually were, what was built, what was not, and how to say it to a candidate without softening it. A recruiter who does not know your stage will sell your best version by default. That is what they are hired to do, and it is not their failure if nobody told them otherwise.

By the time a candidate reached me, they had heard it once already. I said it again anyway, and I added the part a recruiter cannot deliver: what our culture asked of people, and what a hard week actually looked like.

Then I asked whether they were still interested.

The ones who said yes at that point were the ones who stayed.

Worth noting that the research supports this sequencing. Previews delivered after acceptance still reduce turnover. The conversation you have in week one is not redundant. It is part of the same intervention.

As a company matures, the frameworks exist. The onboarding week is real. The workflow is written down. The language in a posting can get shorter because the reality behind it needs less explanation.

That is the point. The language should match the stage.

What does not change is that somebody has to decide what the posting will be honest about. At an early stage company, that somebody is usually you.

One thing to do this week: pull up every open posting you have and run each one through the four swaps above. It takes twenty minutes, and it changes who applies.

Each issue I point you to something, or someone, worth your attention.

This month it is a person. Laura Demuth, MSN, NP-BC, SVP of People and Patients with Curology. If this issue is about setting up a team with honesty, Laura is who I recommend learning from on what happens next: how leaders are actually evaluated, what makes someone rise, and the red flags to watch for. We got into all of it on the podcast this past week, and it is the natural companion to everything above.

(Not a paid spot. Just genuinely worth your time.)

Listen. The Early Hires podcast features clinicians who joined healthcare startups early, in candid conversations about leading, building, and navigating startup life. New episodes land alongside the newsletter. Listen to the podcast.

Share. If this issue was useful, forward it to the clinician leader who needs it, and send them the podcast too. Word of mouth is how this grows.

Helen