CTO Wisdom with Cat Miller | Beyond the Program

Tim Winkler: 00:00:00

Hey, listeners, Tim Winkler here, your host of The Pair Program. We've got exciting news introducing our latest partner series Beyond the Program. In these special episodes, we're passing the mic to some of our savvy former guests who are returning as guest hosts, get ready for unfiltered conversations, exclusive insights, and unexpected twist as our alumni pair up with their chosen guest. Each guest host is a trailblazing expert in a unique technical field. Think data, product management, and engineering, all with a keen focus on startups and career growth. Look out for these bonus episodes dropping every other week, bridging the gaps between our traditional pair program episodes. So buckle up and get ready to venture beyond the program. Enjoy.

Cat Miller: 00:00:51

Welcome

Eric Brooke: 00:00:53

to CTO Wisdom. My name is Eric Brooke. This series will talk with people who've led technology at organizations. We'll seek to understand some of the journeys of a person, explore what's successful, a current problem they're discovering or digging into, And what are they seeing in the wider tech market? Finally, we'll talk about some recommendations where they collect intelligence for them and their organization. I want to welcome to Cat Miller, um, who I'll be chatting with today. Hey Cat, could you give me an intro to yourself?

Cat Miller: 00:01:31

Yeah, absolutely. Uh, thanks, Eric. So my name is Cat Miller. I am CTO of Flatiron Health. We are a health tech company that seeks to improve and extend lives by learning from the experience of every person with cancer. Um, we're about a 1200 size company. Uh, and in 2018 we were acquired by Roche. So we're now a wholly owned subsidiary of Roche Group.

Eric Brooke: 00:01:53

Could I ask how many engineers you have at the moment?

Cat Miller: 00:01:56

Yeah, so of that 1200, about 400 are tech, um, or tech in some fashion, uh, probably 250 of those are traditional software engineering and the rest are, uh, security, I. T. Data science, um, those kinds of flavors of roles. Thanks, Kat.

Eric Brooke: 00:02:11

Um, so let's talk a little bit about your journey to your executive career. Tell

Cat Miller: 00:02:15

us. So, um, I guess how I got into technology in the first place was a bit by accident. So I feel like I've been falling into roles my whole life, um, you know, as a math person. And so I went to school for math, um, and, uh, decided that math wasn't fun and ended up in technology. Uh, for a long time, I didn't want to be a coder. I was like, ah, it seems awful to have to code all day, which is ironic because now it seems like it would be actually really fun to code all day. Um, and then I, I was in a number of startups. So my, my path has been startups and healthcare startups, uh, landed at Flatiron Health in 2014. And we were a growing company. I was quite a few years on the road at that point. And so I was, you know, voluntold into management as one does when you're a growing company. And had the privilege, honestly, to, um, grow in that space as the company got bigger, eventually, um, becoming VP of one of our business lines. And, uh, a year and a half ago becoming CTO of the company. Cool. Thank you for that, Kat.

Eric Brooke: 00:03:18

What would you say is the difference between, say, non exec roles, say the director role versus an exec role, say the VP or the CTO roles that you've

Cat Miller: 00:03:26

both done? Well, it's interesting. I actually thought that, um, the CTO role would just be like the VP role, but bigger. Um, as a VP, I probably had 120 people under me, and I felt like, you know, what's the difference, 100, 400? Um, and I actually feel like those are... Really different roles. Um, I think that, uh, things that I care about a lot more now than I did then. I think a lot about budgets. Um, it's not sexy, but it's real. It kind of the buck stops with me. I think a lot about, like, aligning different parts of the company. Certainly that's part of the role at different levels, but I think this, the extent to which that is a primary part of my job has shifted. Some of it's about just being a good team member to the rest of the exact team. So being a thought partner and working with them on projects. And then I think there's this element of like external, um, both visibility, but, but also actually more importantly, like understanding the external landscape, which is again, something that you can and probably should do as a director or VP, but is now kind of, it feels like a much more substantial part of my job to make sure we're not missing out on what we should be doing from the ecosystem. Awesome. Thank

Eric Brooke: 00:04:33

you. Um, In terms of that journey, what would you say helped you in that journey, kind of transition from the non exec to the exec roles?

Cat Miller: 00:04:45

Um, I definitely got some feedback along the way, uh, that frankly I didn't, I didn't like, and I didn't adjust well to at first. Around, um, my approach to problem solving, I think, like many, I was used to being, if not the smartest person in the room, someone who, like, had a really strong opinion. And so I would come into conversations with a pretty fully formed view of what I thought the outcome of that conversation should be, and it didn't, I was right, a decent percentage of the time and what I needed to learn is that didn't, that didn't matter. Um, it, what mattered was that I wasn't making space for other people and I wasn't making enough room. To, uh, bring others into the fold and have those conversations, you know, authentically and in a way that made them feel heard. Um, and so I think that was a huge adjustment that I had to make in order to show up as an executive is to kind of. Basically be able to roll with things better. Um, I think another flip side of that is also, uh, I think we, we at Flattern, we, we have this, uh, value, which is think yes before no, which I hated when we first rolled it out, which I think is really exemplifying of my problem, which is that I, again, I thought I had, like, I thought I knew what I needed to do and was like very set on like, this is my book of work. This is my team's book of work. And part of what I had to. Adjust to is like, actually, my job is to accomplish what my boss needs from me, and I have a lot of autonomy and how I do that. But when they tell me, actually, we really need to do this thing because it's really important for, you know, patient privacy, or we need to do this thing because, um, that's what our customers really need. I need to be willing to, like, roll with it and say, okay, what does this mean for me? And how do I. Reprioritize and that's something I think, um, was a challenge for me in the beginning. Thank you. Yeah, I

Eric Brooke: 00:06:31

definitely traveled some of that journey. Um, I, I remember that phrase, be curious, not judgmental is a really, even though you have that thought process, um, I often found if I'm really good at something and I stay really good and keep doing it, that leads doesn't leave space for other leaders to fill that space. So, yeah, I think, uh, a good aspect of that journey is really understanding those concepts.

Cat Miller: 00:06:55

I think it's also really relevant, um, when you do skip levels or have conversations with other people in the organization who sometimes, you know, start, start with the big guns, right? This is horrible. Or I really, you know, this thing is really problematic. Uh, it's, it helps to depersonalize a little bit to bring that curiosity and say. Okay, great. That is your perspective. And now I'm really interested in getting to the bottom of why you feel that way. Um, I think it's like, just, I mean, curiosity is such a good tool, but, um, it's, it's important to learn to wield it. Well, yeah,

Eric Brooke: 00:07:27

and it's a bit like the power of your words as an exec becomes so much more powerful than you realize. Um, to people and also getting feedback from people is harder as an exec from say, the average engineer, not all engineers, but like some.

Cat Miller: 00:07:42

Yeah, it's funny. I was actually just saying to someone yesterday that I feel like I'm really happy with where I am with that right now, which is that because I have the CTO role, when I say something, people like listen to it and like have to pay attention. But I feel that I'm very lucky that my team is also in a place where they don't feel like they have to jump to it. So it's not like cat said, um, oh, we should be, you know, expanding our snowflake usage. So everything has to be snowflake. They, they, like, respect me enough to process it, but they respect themselves enough to say, you know, what does that mean for me? Or maybe I shouldn't do that. Or maybe I'm not the right person. So I feel very, um, very blessed, honestly, at the moment to be in that situation. I've definitely observed. Situations where the exec is the, you know, 10, 000 pound gorilla and comes in and says something and, you know, wreaks havoc on all of the roadmaps. So, uh, it's a delicate balance that I'm, I'm always like very careful to, um, to sort of test the waters. That's

Eric Brooke: 00:08:34

great. Cause it feels like you've built psychological safety and have people that also have opinions of their own to kind of give you that back and forth. Awesome. Um, let's, um, step into what got you into technology to begin with? Like, why did you become a software engineer? Talked a little bit about math, but like, why software?

Cat Miller: 00:08:56

Um, so I, like I said, I liked math. And when I was in high school, um, that meant that, you know, I was certainly looking at tech schools for, um, for where I go to school. Uh, and MIT just felt like a very safe option, um, in the sense of I was never going to regret going there. Um, and so I went there thinking, Oh, I'll be, you know, maybe a math major, maybe I'll do a little philosophy on the side. Um, and then I got there and I realized that, um, university level math is very hard, um, and it's very different from competitive math and from, you know, the kind of practical stuff you learn in, you know, say calculus or Dickey Q or something like that. Uh, but what was true at the time. So I was in school in the early two thousands is that 33 percent of the school. Was in the computer science department, so 30 percent 33 percent of students were had at least 1 of their majors as computer science, including, like, all of my friends. And so it was almost like a cultural thing that I just, like, took the intro class because everyone took the intro class. It was like popular. Um, and I was like, oh, this is kind of fun. Um, and I would not say I ever really, there was never like a plan to get in technology into technology. There was just a, well, I guess I'm taking these classes. I guess I'm majoring in this thing. I guess if I major in this thing, that's maybe what I'm doing for my job. But I've never been confident if I looked more than 2 years out that it was necessarily going to be what I was going to be doing it. Just I also was, I think, lucky to be in at a time. If you think about, like, the early 2000s, there was the dot com bubble. But once we recovered from that, and sort of the 2004, 2005 era, I think up until very recently, there's been like a constant growth in technology. So it's always been a very, I'll say, easy place to be. Yeah.

Eric Brooke: 00:10:38

Um, awesome. What was, um, probably one of the surprising things that you found in whichever aspect of your career that you want to talk about, um, that you thought, Oh, I didn't expect that.

Cat Miller: 00:10:54

Um, I think I didn't expect, uh, the extent to which the more senior you get. The less where you came from in terms of function mattered. So in my early career, I was, I think I mentioned, I wasn't very excited to be coding all the time. Um, more out of ignorance than actual dislike, I think. And it took me, it took me a while to realize that being a manager of engineering, particularly being a director of engineering, yeah, you have some different responsibilities from being a director of product. But as you get more senior, your, your roles kind of converge and you are still a leader and you are still, um, helping to shape something and you are still thinking about strategy. And so I think what, uh, what I didn't know in the beginning was, I didn't know that, like, you know, starting out in a coding, you know, starting out as coding would eventually lead to a very similar place than starting out as an analyst or starting out as a product manager. Um, I'm not saying that my role is exactly the same as a chief product officer, nor that I could do it as well as a CPO, but there's a lot of similarities, and I just didn't kind of realize that how much that role would shift over time.

Eric Brooke: 00:12:04

Cool. Thank you. So let's talk a little bit about what does success look like in an executive role and what has helped you be successful?

Cat Miller: 00:12:16

Yeah, I mean, I think that, um, success for me, I mean, first of all, something that we've started to do, I think, much better in my company in recent years is, uh, actually have really clear, um, success criteria. And so my success criteria right now are actually not the success criteria would have had last year and probably not the ones I will have next year. Um, currently, I would say I'm, there's always the kind of expectation that engineering is. Delivering and, uh, you know, not slowing down the product. Uh, we're not having a lot of instability. There's sort of, I would almost call that table stakes engineering also that I'm filling my roles. Um, there's a certain amount of like. Org maintenance that is expected. Interestingly, although if any of that stuff was going wrong, I would certainly be called on it and rightly so. I think then a lot of ways what people evaluate me on is. The things beyond that. So how well am I controlling costs in that context of being able to continue to continue to deliver? Um, and, you know, a project that I, and I think many CEOs have have embarked on this year is. For example, how are we making sure that we're not missing the boat on generative AI? So when something new and transformative comes out, how do we enable the entire business? So the tech org, but also the non technical parts of the org, um, how do we help them kind of ease into using that? Um, and so those are my success criteria, you know, this year, you know, next year will maybe be similar, but I think that those criteria could easily change over time with the shape of the business and what the business needs. Yeah.

Eric Brooke: 00:13:48

So I hear you. So you're talking about that, like, actually your success is based on what does the business need based on the economy, the businesses in, um, with the progression of technology, which is consistent, um, that there's always something new coming out and can it help? And generative AI is definitely one of those leaps, um, which, um, we're all evaluating at the moment. Um, how do you know your team has been successful? Yeah.

Cat Miller: 00:14:17

Well, I might say being successful and healthy are like related but different, so I might talk about. Both, um, you know, my team being successful to me, this is kind of back to tech doesn't slow down the business or tech is enabling the business. I have never found metrics that I find perfect for this to some extent. The metric I like is. Are the managers and do the and the product managers, especially do they feel like we're moving quickly? Like, if I ask them, how fast does your tech team. You know, move and I give them, like, 3 options, like average below average or above average, like, are they above average? Um, or at least average. So there's a certain amount of, um, I think very much art to that, um, and sort of a sense of like, how difficult are the problems and how fast are they kind of moving through them? How fast are they unblocking? Um, when I think about is my team healthy or and these are related, of course, because I think 1 of the things that is a challenge and can hurt both of these is when you're, you're blocked a lot when you have a lot of like. Things that are not serving you as a, as a business, whether they are like flaky tests or whether they're, you know, uh, lots of, uh, hurdles to jump through, lots of blockers to work through. So for me, I get a lot of value from just conversations. Um, for me, this is certainly with my skip levels, um, and asking them very probing questions, you know, Uh, you ask someone how are things going and they say, say, okay, but you ask them, what's the worst thing that's happening to you right now? Or, you know, what's the worst team your team is facing your team is facing. You get a different answer. Um, so I like using really, uh, provocative questions that force someone to tell me what the worst thing that's going on is. I also, I have a chief of staff, I have an HRBP who, uh. It's nice to have other people who will sort of funnel me sentiment, um, you know, that other folks might feel more comfortable to approach them or let them know what's going on. And obviously, they're not going to, um, you know, remove it on a minute anonymity from those people, but they will tell me sort of the, you know, what they're hearing on the ground. So I, I, some people talk about walking the halls, I think, in a hybrid or remote. World, we're really not talking about that, but I, I do think it's, um, leveraging every conversation I have to get a sense for how are things going? How are people feeling? Like, what's what's the mood in the room?

Eric Brooke: 00:16:38

I really like the, the balance of success and health, um, because obviously that also feeds into retention, um, that people are enjoying the work they're doing and they feel good about it. They're more likely to stay. Um, would you say, so in terms of success and health, how would you interrelate performance inside that

Cat Miller: 00:16:58

as well? I've definitely seen, uh, success be hampered. By performance, and I mean, success, obviously, at an individual level, but also at a team level. And so, uh, something that I definitely think has shifted for us, uh, in the last year or so is a real focus on particularly leaders, um, managers, but also, I think, especially directors saying you are accountable for how well your teams are doing and how, how, like, successful they are, what their, what their pace is. Um, I think what's interesting about that is. Uh, direct, you know, directors sort of definitionally have a number of teams under them, and I think. In many cases, if a director were to sort of, they'd have an ability to stack rank their teams and say, this one was really fast. This one, like, not so much. And you, you want that to be within kind of a narrow set of parameters. And if it's not, you want them to address it. So I think it's really important to hold directors accountable for. Uh, the basically the pace of their teams and then let them hold the managers accountable. Um, you know, do the root cause analysis, figure out what's going on in some circumstances. It really is like, the thing they're doing is really hard or the technology they're working in is really hard or. We haven't given them, up skilled them in the things they need to be working in. You know, this team is working in React for the first time, so of course they're slow. Um, I think that's all the stuff that you can find out on the ground that, that I can't know from a, from a 10, 000 foot view. But if I hold my directors accountable to it and my VPs hold my directors accountable to it, like, that's, I think, been the sweet spot of, of, of that sort of, like, performance, um, accountability.

Eric Brooke: 00:18:38

Awesome. Thank you. Um, so is there something that you're trying to figure out at the moment or something you're kind of delving into that you're would like to talk

Cat Miller: 00:18:48

about? Yeah. So I think where we are as a company, um, we've been around for over a decade. I've been there for over nine years. And like I said, my background's in startups. And so I've been through this company as a startup for a lot of years. Uh, We were acquired, but we were acquired as a wholly owned subsidiary and given sort of the advice, like, keep doing what you're doing. Like, you're on a good path. Um, we want you to expand your reach and there's a, there's a set of incentives for us for a startup for someone, uh, for a company that is, you know, pre IPO or looking to be acquired, which is really about speed and getting as big a market as possible and not so much, at least historically on unit economics. Um, and I think, you know, this story may change given everything that's happened in the last year, but I would say very much. Historically, you see companies. Like Uber and others, like burning money, but they have, like, really high customer growth. They have really high revenue, and that's what folks are looking at. So we were in that stage for a long time, and now we are a mature company that is no longer in that sort of, we need to fight for the market in order to, for our right to exist. And we need to be thinking much more about that unit economics that like, what is our business? Like, what does our business end up being shaped like at the end of the day? Um, and those are different decisions. Um, is very, very rational as a, as a startup to throw a lot of money at compute and not worry about, um, your hygiene around, uh, your AWS, you know, bill necessarily, because one, your AWS bill probably isn't even that high because you don't have that many engineers to spike it up, but also you need that time. You need the engineering time to do other things, and you don't need it to, like, make sure you're tearing down a handful of EC2 instances or whatever. Um, I'm, I'm being like different people will have different philosophies on this and I'm not saying there's a right or wrong. I'm saying that is a, a type of thing that happens and your mileage may vary as to what's happened in any particular startup. But at some point that all comes home to roost when you realize that you have spent years with. That sort of attitude or that sort of philosophy, which, again, may have made a lot of sense and now you have a mature business that needs to look a certain way. And so my challenge, and it's my company's challenge as well, but I think it's mine, particularly in the tech space, because tech is a very, you know, it's a big cost center. Um, it's a very expensive part of running an organization. Is really how do we make that transition from, uh, having things that are hard to maintain or things that maybe weren't built with longevity in mind into a place where I mean, 1, there's less frustration. Like, I think I talked about cost, but I think frustration. Is it is an interesting cost proxy and that when people are blocked, they are not being productive. Um, so how do we smooth the paths, make it easier, have more robust systems and technology at a, at a lower cost point per revenue, like per dollar of revenue. Um, that's like, that's the challenge that we're working through right now as an organization. And it's, I think a lot on me to figure out how I nudge the organization. Cause these are also scary things. Like I am not talking about necessarily like removing people. But it's hard to talk about cost without getting that, um, you know, getting your, your hackles up a little bit about, like, are you, are you cutting? Are you making a smaller? Like, what does this mean? Um, and I'm really talking about, you know, controlled growth, um, which I think is really healthy. Uh, but there's definitely a, a, uh, a shift that has to happen in the organization to, to get to that place. So

Eric Brooke: 00:22:19

that's really helpful. So you're talking about like that stage where you're really scaling and growing to some degree about efficiency. And now you're trying to work out what does efficiency look like for us as an organization? Um, and that would include, I think, like, onboarding, how long things take. Is this part of our system too complex, so nobody can actually change it easily? Um, give us some, um, can you give us some specific

Cat Miller: 00:22:44

examples? Yeah, well, actually, it's, it's interesting you talk about onboarding because something that, that made me realize when you said that is, we've done this in some places. We are extremely efficient at onboarding, recruiting. Um, we were in hyper growth for many years. And so something we are very good at is. Bringing new engineer, you know, hiring new engineers, identifying them, um, bringing them in the door and getting them set up, uh, is something that we actually like invested a lot of energy. And because that's actually what we had to like, that's what we, where we ran into scaling problems in the past. So we have optimized things, um, maybe something, but, but we haven't necessarily done that in other parts of our system. So, um, you know, maybe an example is, uh, I think that infrastructure has been, I think, a challenge in the organization for a long time. And there's a number of reasons for that. I was an early engineer and I can say, I am not an infrastructure expert and I remember feeling the pain of, well, I don't really know how to do this and there's not really a best practice. There's not a way that we do this in the company. So I will just do whatever works. And when you bring up 20 systems that were each done. With someone with varying degrees of competence, you get a pretty, um, pretty diverse set of systems with, for example, diverse monitoring. Um, and so, uh, you know, we've, we've been in the process and are more or less at the end of the process of having all of our infrastructure be code through things like terraform. But I think what is now becoming true is, um, we're now moving to to Kubernetes and an EKS solution, which abstracts that problem even further. So, you know, I say we go from, we'd go from the phase of, uh, pushing buttons in an AWS console to get things up to, uh, using something like Terraform, you know, infrastructure as code all the way to manage infrastructure, central organization that, you know, maintains it. Um, leveraging companies like AWS, who are better at running infrastructure than we are, um, and honestly getting like cost savings, both in terms of the machines, but also in terms of the human maintenance as part of that. So. I don't think that's a unique journey and other companies will have done it at different points, depending on their needs, but I think that's an example of, uh, the kind of, uh, progression that, that we're on. Awesome. It's an

Eric Brooke: 00:25:00

exciting set of problems. Very different, as you say, to the earlier stage. We don't often get to, um. Were there any, um, other kind of areas as you kind of like step stages that, um, so you talked about infrastructure, you talked about onboarding is really, really good. Cause we got really good at that, um, other things that you haven't got to that you want to kind of explore a bit more.

Cat Miller: 00:25:23

Well, I think we need to continually get better at what it means to have a platform organization. Um, I know that this is hard because I read a lot of blog posts about how hard it is. Um, and I think this is a place where we've made a lot of progress, uh, but we as a company have at least 2 and depending on how you count it, 4 or 5 distinct businesses that are really very different from each other and built on, uh, different technologies for various reasons that are not going to change anytime soon. And so. It's been a challenge historically for us to understand what can profitably be moved centrally and what really needs to stay close to those businesses. So some things end up being easy. So, uh, you know, we use get lab, uh, that maintenance being the same across all those organizations. You know, that's a core piece of technology. Um, that makes sense to centralize and no one's raising their hand and saying, gee, I really want to own. You know, I want to own that. Um, but other things get more complicated. Even, you know, I just talked about E. K. S. Um, you know, ownership of of E. K. S. Clusters. Uh, if we're gonna have sort of one central cluster, then, of course, we would manage it centrally. Does it make sense? Are there different S. L. A. S. And different requirements for different parts of the organization? Um, and it's not a unique example. I think, um, that's one of the really interesting areas of how do you, how do you enable platform organization to be very effective and impactful on these different business units who have very different needs, uh, without the business is this business unit sort of feeling like. Oh, I really needed a thing and I couldn't get it. So screw that. I'm going to do it myself. Uh, there's, there's always this like tension, um, that I think has, has gotten a lot better over time. And I think part of that is getting ahead of things. So, so now our platform organizations are at a place where they're building things that are better. They've had enough time to be able to get ahead of the problems. And so now they're building things that make the other engineers go, wow, instead of building things that make the other engineers go, why didn't I have this six months ago? Um, and so that's been, I think, a major, like, tipping point and transformation of, like, making things easy and, and, and good rather than just making things possible. Um, so that's been a pretty, like, exciting evolution and one I think we very much need to continue and think about, again, what things belong centrally and what things belong, you know, very, very close to the teams that are using them.

Eric Brooke: 00:27:43

Awesome. Thanks Kat. So we talked a little bit about your journey, your team, what you're looking at. So I wanted to kind of step into what does your interaction with the board look like, um, to kind of get a bit of flavor, because that's often a mystery to many people before they get to kind of

Cat Miller: 00:28:00

CTO role. Well, I'm not sure that my board interaction is typical. Um, we're a wholly owned subsidiary, which means that our board is composed of Roche, um, executive members. Uh, and honestly, in a lot of cases, that means that board interactions are best managed by our CEO and COO, um, because these are folks who are perhaps closer to us than, than in other board situations. Um, and I will also say that being in the healthcare space and the health tech space, um, technology is not the only, or even necessarily the most important thing. Um, so our board is really interested in what problems we can solve, and they are also very representative of our customers. And so a lot of, um, I think a lot of like more standard board interactions for a more like classic tech company with a more classic board would look different. Um, but, but often I'm, I'm, you know, observing or, or, um, just kind of being aware of what's going on and, and making sure I'm clear on what are the constraints we're operating on, um, you know, really ingesting that sense of what is the context, um, but letting the CEO or COO kind of take the lead on, you know, financial reporting and other things. I would say more recently, everyone's interested in a I so, um, you know, making sure that we're, uh, doing a good job of talking to not just our board members, but, but, you know, generally folks about what our strategy is there. I think that has been a little bit of a shift. Um, and there's been a, like, a little bit more interest in having tech, um, take a leading role in talking about that. Um, but I think this is so what I, what I take from that is that this is the thing that will shift depending on, you know, where the risky parts of the organization are, or where the focus areas of the organization are. Um, but I think we're very lucky to have obviously very friendly, um, board who, who is very close to our business.

Eric Brooke: 00:29:49

Awesome. Thank you. Okay. So moving kind of outside, um, what are you seeing in the wider kind of tech market? You can. Determine the constraint of its health tech office. Why do you call? Um,

Cat Miller: 00:30:04

I mean, in the wider tech, uh, market. I mean, this is not new information. Definitely. There's a slowdown. And I think this focus on efficiency that I'm talking about is. Being felt more broadly, I certainly see it in startups that I'm advising around around their run rate and other things. So, um, I also think that, uh, you know, engineer salaries have been going up substantially for the last 20 years. And I've always wondered how that will end. I'm not saying that it's ended, but I do think that this is put in renewed pressure on, um, what, what do you need a software engineer to do? Or what do you need? Like, a really expert engineer to do? And what can you do in other ways? So I think the quality of low code and no code solutions has come along dramatically. Now, it's still not necessarily what you're going to use to build a production system. But I think, uh, there are places where in the past you've needed engineers and tech folks as glue where maybe that's becoming less true. Um, it's more possible. Google has tools to build, you know, apps, uh, with no code or low code solutions. Um, You know, just within their own ecosystem. A lot of folks are coming out with that. And even I would say, chat GPT has made it much easier for someone who has a little bit of background to get all the way to having something usable. So I definitely think there's going to be, isn't going to be more of a trend of how do we use engineers for the things only engineers can do and how do we kind of shift, um, Shift other kinds of work sort of down to or, you know, sideways to other functions or other types of humans closer to the closer to the business stakeholders. To be honest, it's a it's a good direction. Um, so that's, you know, I think definitely a thing that I see, um, I think health tech is really interesting and probably we shouldn't even talk about it as one thing because there are wildly different components of it. I definitely see a dynamic where, um, there's a, there's a decent number of companies that, uh, sort of started with a like tech enabled play. Um, so we're gonna make this better, um, through tech and what they end up building is kind of a concierge service. So I can think of a couple companies that are basically saying, here's the thing that's hard. Um, you know, in our tech, in our health ecosystem today, uh, we want to make it easier and like the, like the model that we have is basically like humans. Humans can help. And then we're going to use like tech to make those humans more efficient. Um, I've seen more like, that seems to be the play that's actually winning at the, at the moment in a lot of places because it is possible, um, you know, because like. You, you can make that thing better with humans and, and you probably can make those humans a little bit better with tech. Um, it's not sexy. It's not exciting. Like most people aren't like, great, I'm going to like, you know, make this call center of nurses, like, you know, um, able to do a better job, but I, but I do think that's where a lot of opportunity feels like it is right now. What I, where I hope we get to and where I think we are on the brink of is, uh, using tech to like fix a lot of the glue in the infrastructure, so. Um, take an insurance company, like if you're an insurance company and you have lots and lots of humans pouring over lots and lots of documents, um, you know, not only does that, you know, money because you're paying those people, but it takes time because humans take time to do things. And I think the more we can ease those kinds of, uh, interactions, or, or maybe another 1 is that is more relevant to flat iron, um, clinical trials, uh, when people are on clinical trials, their doctors are manually entering data into a database. Um, and it's the same data in many cases that was also contained in the, the electronic health record. So they're basically doing double entry. That is obviously inefficient. It makes practices unable to run as many trials. Um, it makes trials less appealing, uh, it leads to errors. And so there are all these opportunities for, um, I think technology to, uh, speed up. Again, kind of unsexy glue things that are in in the interstitials of of our healthcare ecosystem. Yeah, and I

Eric Brooke: 00:34:06

think customers would appreciate a faster healthcare system, a faster insurance system. Absolutely. Um, thanks for that, Kat. So let's talk about what's helped you grow, um, or helps you grow and scale as you've traveled your journey. Like, what are the things that, um, you would think were helpful for other CTOs or VP of Engineering or directors with ambitions to become executive?

Cat Miller: 00:34:31

Um, it's interesting how I was thinking about like books that I've read that really resonated for me. And I realized that the book that's been resonating for me lately is actually a book I read seven or eight years ago, which is called switch by Chip and Dan Heath and it's how to change things. Um, and I read it, like I said, quite a while ago, but the thing that sticks with me is this idea of looking for bright spots. So when you want to drive change, it's very hard to go from 0 to 1 and also eat unless you are like, deeply emesh in the problem. Your solution may not make any sense. Um, and so what you want to do instead is look for bright spots in the organization. Um, and that idea I use on a daily basis at this point, um, and it's funny because when I first read it, I was like, yeah, that makes sense. But it didn't, um, it didn't feel like it was part of my DNA. Like, I didn't think this is a book that I'm going to then be referencing, you know, a decade later. And so, uh, I think first of all, that specific book I think is great. And then I'm really grateful for a CTO who for a long time gave all his underlings, um, just like books he was reading, um, and sort of, you know, in a very subtle, you know, in that sort of, um, social engineering way of like, if I give you this book, then you have to read it. Um, I'm grateful for sort of being forced into consuming some of that material that I wouldn't have done done by myself. Um, so that I really appreciate. I would say now a thing I do is whenever I'm introduced to a CTO who is at a company is similar to my scale. I absolutely pump them for information. I become like 20 questions. I, um, I have like, you know, a whole host of questions that I will ask and then I will try to get them to be like, I will try to get an email so that I can come back to them with questions later. And obviously I'm, you know, so it's a 2 way street, but, um, I. Yeah. I very much value having peers who are facing similar problems at other organizations. It's helpful to understand the lay of the land. It's helpful to understand what isn't isn't working. Um, and it's comforting, you know, sometimes you're at, you're in this job and you're like, wow, these things aren't going well, or why is this thing so hard? Everyone else, like, talks about it. Like, it's super easy. And then you talk to CTOs that have gone through it and you get the real story behind it and not the sort of varnished public version. And you realize that there is actually, um, you know, there's, there's like, a lot of nuance there. It can be really helpful. So, um, I was told this many years ago and I didn't take it seriously. And now I do, you know, build a peer network, um, make sure that you have. Folks that you relate to, to talk about any of the challenges that come up and, and that you can email and say, like, how do you think about geodiff compensation? Um, you know, those are, uh, networks that provide that are great too. Um, but I, you know, that's something that that's been really important for me.

Eric Brooke: 00:37:25

Are there specific networks or communities in New York that are helpful for future tech leaders or tech leaders?

Cat Miller: 00:37:32

Um, 1 community that I'm a part of that I've gotten a decent amount of value from is 1stmark, um, has a CTO guild network, uh, which, uh, they're pretty good about finding people and reaching out for their events. And that kind of gets you on the mailing list. But, um, that they have basically a community and a mailing list that has been really good for again, these kinds of questions of, um, there is a thread this week about snowflake spend, which is, Very interesting to me. Also, even though I was not the one who sent it, I find that almost universally the questions and answers there end up being really relevant to me. Um, you know, what's the ratio of, um, PMs to engineering in your organization? Um, it's a great way to get, like, a lot of different answers, um, to, to, like, these kind of fundamental questions and kind of gut check yourself. Um, so that's been that's been really nice. Um, and that. You know, I think a lot of the connections I've made this year have really been about looking at events and making kind of informed decisions about where do I think I'll be able to, you know, connect to people who, who, um, are running companies that are sort of similar scale to mine. Um, and might have sort of a similar ethos or similar interest in, in, um, sort of exchange in that kind of information. Cool.

Eric Brooke: 00:38:45

Um, one of the question Kat for you, um, we don't have to put this in, but I'll ask the question and see if you feel good about it. Cause I didn't add it in the list is, um, what do you do

Cat Miller: 00:38:54

for fun? Ooh, what do I do for fun? Um, I'm a competitive archer, so I'm usually at the archery range a couple days a week. I live in New York City, and I can tell you that no one should pay to live in this city without taking advantage of something about it. Um, for me, the cultural institutions that matter are, I love Broadway and I love theater, and so I'm also a big theater nerd. I think last year I probably saw almost everything that was on Broadway. Um, and, uh, so that's like a, something that, um, has been really important to me to continue to enjoy. Living in this vibrant and bustling, but also very challenging city at times.

Eric Brooke: 00:39:34

Kat, I really appreciate your time today and sharing your journey and sharing what you're seeing. Um, thank you very much. Thank

Cat Miller: 00:39:42

you.

Tim Winkler: 00:40:03

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