Dr. Jay Joshi believes the health care system is dysfunctional. So he's doing things his way.

After working for a practice in Portage for a year and a half, he decided to go it alone. He opened an office in Munster, where he could focus on keeping patients well rather than just racking up services he could bill insurers for.

He's willing to use all the tools at his disposal to help patients. He does appointments in person, online, or by text or email. He offers virtual reality for smoking cessation. He lets medical technology companies pilot their applications at his office.

"I felt that starting on my own, I could really create a one-on-one experience and cultivate a sense of culture where patients feel respected and receive that additional level of care," said Joshi, 32.

"In hospital systems and other practices, I felt they were set in the traditional, ineffective way of having patients come in, out, in a revolving-door mechanism, without worrying about outcomes. To create a truly outcomes-based clinic, I felt I had to do it my own way."

Joshi possesses one of the major qualities necessary to succeeding as an entrepreneur nowadays: a savviness with technology. But he's also not much different from the successful solo business owners who came before him. He identified a need in a field he had experience in, and went for it.

"Traditionally, entrepreneurs have to understand the market and if they have an opportunity. That's fundamentally the most, most, most important thing," said Lorri Feldt, regional director of the Northwest Indiana Small Business Development Center.

"What's certainly changed over time is obviously the impact of technology and how we communicate with one another, how we promote new businesses. The digital presence and use of social media are so much more important than they've ever been," Feldt said. "An entrepreneur with some skill in that area, or at least an understanding of how these tools can be used, makes a huge difference."

While younger people are often more proficient in technology and social media, they are less likely than their older counterparts to become entrepreneurs. The rate of self-employment among Americans ages 15 to 34 has been gradually declining since 1990, the U.S. Small Business Administration found.

Feldt believes the heavy student debt young people currently are carrying causes them to look for steady employment rather than risk going it on their own.

But with about 12,000 new startups being founded in Indiana annually and only about half of them expected to last five years, having the skills to be a successful entrepreneur are as important as ever.

Health coaching inspires idea

Allyson Straka, of Chesterton, was working as a health coach when she stumbled on a business opportunity. She would encourage her clients to drink a daily smoothie of dark, leafy green vegetables, one of the main things missing from the modern American diet. But in three years, her clients hardly ever did.

"People didn't have time to make the smoothie. They would buy the ingredients, and they'd rot in the fridge," she said. "I thought, 'How do you make green smoothies easier for people to make?' "

Her idea: selling pouches of chopped frozen fruits and vegetables that people just have to put in the blender.

A year ago, she founded Frozen Garden, the Valparaiso-based company that sells the ready-to-make smoothie packets.

The business has since opened its own store, started shipping to 33 states via its online ordering system, and begun selling its product at several grocers and restaurants in Northwest Indiana, Chicagoland and South Bend.

In the process, Straka, 38, has learned a lot about what it takes to run your own business.

"Surround yourself with supportive people who you are comfortable bouncing ideas off of," she recommended.

"I have an amazing team. Ellyn (Vogel) and Cheryl (Levrio) started this with me. I'm the owner but they're co-founders. I couldn't have done it without them. We hired a chef who's our production manager. He knows about things in the culinary world we didn't necessarily know about. It's about continuing to hire the right people and not being afraid to let go of people who aren't the right fits. In a small company, every single person matters."

She said entrepreneurs also have to be willing to adapt.

"You have to make changes based on what's selling and what's not," she said. "Whether it's a certain flavor or avenue for selling, if it's not working you can't be afraid to cut it and move on to something else."

Feldt, of the Small Business Development Center, said Straka shares a trait with many Region entrepreneurs: She created a tangible product.

"We make things here in Northwest Indiana," Feldt said. "There's a lot of manufacturing still here. Maybe some of these entrepreneurs have had experience in industry in some fashion. When (the regional Small Business Development Center directors) met together across the state, it really jumps out at you that we have more represented here who are developing a device, an industrial product, an invention of some kind."

Job loss leads to opportunity

Michaline Tomich was working for a Chicago design firm in 2001 when she put in her two week's notice. Her boss told her she could leave immediately.

Tomich was in the middle of a branding project for Church's Chicken, the Atlanta-based fast food chain. She arranged a meeting with the company and pitched her idea. Church's liked it, but didn't hire freelancers.

So Tomich incorporated, as Mixdesign, initially working out of her Griffith apartment.

She now has a studio in Schererville, a sister company called Happy Day that does promotion and event planning, and does branding for numerous businesses around the Region and country.

"Going in, you just have to be excited and enthusiastic and passionate and love what you do," she said.

But don't expect to spend all your time focusing on your passion, she said. In Tomich's case, designing is now a small part of her job.

"You're going to be managing people and expectations and clients," the 42-year-old said. "Your outlet for that thing you're good at becomes less hands-on and more managed."

She said that, early on, it was important for her to have strong mentors. Through her company, that's a service she now provides to others.

"If somebody is considering (starting a company), I would talk to a lot of other entrepreneurs," she said.

"We're in the business of bringing ideas to life. There are lots of entrepreneur types we've worked with. Most of all, you've got to want it really bad and love what you do. On your really, really bad days, you're going to ask yourself why you did this. You've got to really love it."

Joshi, the Munster doctor, also helps guide other medical entrepreneurs. As a medical intern, Joshi developed a device that measures the urine output in catheters. Now he's giving back.

He lets medical technology firms try out their products in his practice, such as a virtual reality program for quitting smoking and a company that helps patients price-shop for imaging services.

He also started an investing group called MD Angels, made up about of about 40 physicians from the Midwest. It funds startups such as a business developing a prosthetic to improve knee surgery outcomes, and an online company that provides continuing medical education to doctors.

"I think the best way for health care to really move forward is physicians taking a leading role in innovation, either cultivating it themselves, or creating an environment conducive to adoption," he said. "It's not sustainable the way physicians are currently practicing."


Giles is the health reporter for The Times, covering the business of health care as well as consumer and public health. He previously wrote about health for the Lawrence (Kansas) Journal-World. He is a graduate of Northern Illinois University.