In this episode, Dr. Rishad Usmani sits down with Preston Alexander, co-founder of Forward Slash Health, a consultancy helping clinicians reclaim autonomy in medicine. From building furniture and rock climbing in Colorado to launching a medical device startup during the pandemic, Preston’s unconventional path shows how curiosity, grit, and timing can shape a career in healthcare entrepreneurship.
He opens up about his early days as a psychology and philosophy student, his accidental entrance into healthcare, and how witnessing the corporatization of medicine inspired his mission to empower doctors to lead the business side of care. Preston and Dr. Usmani discuss the broken incentives driving U.S. healthcare, why AI might make us forget how to think, and how to balance friction and optionality when building impactful products.
With candor and humor, Preston explores the lessons behind his successes and failures — from cold-calling hospitals during COVID to building a startup that helps physicians regain ownership of their work and their purpose.
(00:00 – 00:50) Intro & Cultural Shift: Why entrepreneurs are today’s “rockstars” — and the reality behind the glamor.
(01:00 – 03:00) Early Years: Studying psychology and philosophy at the University of Colorado and realizing traditional education wasn’t for him.
(03:00 – 04:50) Life After College: Building furniture, working in private jet interiors, and discovering an obsession with how businesses grow.
(05:00 – 06:20) The MBA “Scheme”: How Preston planned to fake being an MBA student, got accepted with a scholarship, and fell in love with business education.
(06:30 – 07:40) First Steps into Healthcare: Landing a job in medical devices with zero healthcare background and developing a passion for the industry.
(08:00 – 09:10) Learning Product Management: Why being responsible without authority in large organizations taught him entrepreneurial leadership.
(09:20 – 10:50) Starting His First Company: Building and launching a surgical warming device — weeks before the pandemic hit.
(10:50 – 12:10) Pandemic Challenges: Cold-calling hospitals in West Virginia during COVID and eventually selling the business in 2021.
(12:10 – 14:00) Writing and Reflection: How LinkedIn became his classroom, leading to The Healthcare Breakdown and a growing healthcare audience.
(14:10 – 15:00) The Birth of Forward Slash Health: Helping physicians take back the business of medicine and build sustainable, independent practices.
(15:10 – 19:30) Education & Unschooling: Rethinking how kids learn, why memorization kills curiosity, and the importance of teaching thinking, communication, and empathy.
(20:00 – 23:50) Entrepreneurship & Risk: Can entrepreneurship be taught? Preston explains how risk tolerance, adaptability, and resilience define success.
(24:00 – 25:40) Healthcare & Macro Systems: Understanding how capitalism, incentives, and insurance models shape the healthcare ecosystem.
(27:00 – 33:50) The History of Healthcare Finance: How Baylor University and Blue Cross/Blue Shield laid the foundations of modern health insurance.
(35:00 – 39:40) Losing Control: How clinicians lost autonomy as corporate consolidation reshaped care delivery.
(40:00 – 41:10) Cash-Based Care & New Models: Why direct-pay and independent clinics might represent the future of sustainable healthcare.
(41:20 – 46:20) AI, Thinking, and Humanity: Why Preston feels conflicted about AI’s promise and danger, and fears it could dull our ability to think deeply.
(46:40 – 48:50) Philosophy of Thought: What happens if thinking becomes obsolete — and whether a life of effortless happiness is truly human.
(49:10 – 54:20) Optionality vs. Friction: Lessons from product design and consulting on creating clarity through limits, not endless choice.
(54:30 – 55:00) Where to Find Preston: forwardslashhealth.com and LinkedIn for those ready to rethink healthcare.
