The Fifth Burner: What It Really Takes to Build Something That Changes the World

A Conversation with Josh Makower, MD Stanford Biodesign Co-Founder, Serial Innovator and One of the Most Impactful Physicians You Have Never Heard Of

By Dr. Kalpana Sundar | June 2025

Most people know the Four Burner Theory. The idea that your life runs on four burners work, family, health and friendships and that to reach a certain level of achievement something has to give.

But what happens when you have built more than most people could imagine in one lifetime and you are still fully in it? Still curious. Still building. Still showing up for the people around you?

That is when I started thinking about the fifth burner.

I sat down with Josh Makower for this episode of Gloves Off and somewhere in the middle of our conversation it hit me. There are people who do not just manage the four burners. They find a way to run on something deeper. A different kind of fuel. And that is what I wanted to understand.

I have known Josh for years. We first crossed paths when Acclarent was still a startup. He was building something that would change how we treated patients and I was one of the early physicians using that technology in my ear, nose and throat and head and neck surgery practice. The device revolutionized minimally invasive sinus surgery. It was precise, patient centered and it worked. Acclarent was later acquired by Johnson and Johnson. That is one company out of more than ten.

About Josh Makower

Josh Makower is the Yock Family Professor of Medicine and Bioengineering at the Stanford University Schools of Medicine and Engineering and the Byers Family Director and Co-Founder of the Stanford Mussallem Center for Biodesign, one of the most influential health innovation programs in the world. He is the Founder and Executive Chairman of ExploraMed, a medical device incubator that has created over ten companies since 1995. His portfolio includes companies acquired by Johnson and Johnson, Medtronic, CR Bard and Teleflex. He is a Senior Advisor to Patient Square Capital and an Advisory Venture Partner with Sofinnova Partners. He sits on the boards of multiple companies including Elevage Medical, Moximed, Willow, Coravin and SetPoint Medical.

He holds over 300 patents across cardiology, orthopedics, ENT, women's health, drug delivery, aesthetics, urology and more. He has an MD from NYU School of Medicine, an MBA from Columbia University and a degree in Mechanical Engineering from MIT. He is a Member of the National Academy of Engineering, a Fellow of the National Academy of Inventors and was awarded an Honorary Doctorate of Science from the University of Galway in 2024 for his transformative impact on the Irish Medtech Innovation Ecosystem.

I say all of this not to impress you. I say it so you understand that when someone like this sits down and gets honest with you, you listen differently.

What His Day Actually Looks Like

One of the things I love about having conversations in a private room rather than on a public stage is that people stop performing. Josh talked openly about what his days actually look like. The rhythm of building alongside other people. What energizes him about collaboration and what drains it. The parts of the work that still light him up after decades of doing this and the parts that do not.

It was not a highlight reel. It was a real picture of what it looks like to be deeply inside the work of building things that matter. And what struck me was this… the joy is real. The challenges are real. And he does not pretend otherwise.

The Part Nobody Talks About

At some point in our conversation Josh talked about family. About balancing the pull of work you feel genuinely called to do with the people you love most. About what that actually looks like day to day. Not in theory. On a Tuesday.

Here is what I noticed. Men carry this too. The same tension that we talk about so openly when it comes to women in medicine and business: the guilt, the push and pull, the question of whether you are showing up enough in every direction men feel it. They just tend to carry it quietly.

Josh did not carry it quietly in our conversation. And that is why this episode matters.

What the Fifth Burner Actually Is

After we finished recording I kept thinking about what he had shared. And I realized that the people who build at this level are not just managing four burners better than everyone else. They have found something else. A fifth burner. Something that integrates work and life rather than pitting them against each other. A sense of purpose so clear that it becomes the organizing principle for everything else.

That is not something you find on a stage or in a bio. It is something you find in a real conversation. And that is exactly what this episode is.

Three Things That Stayed With Me

The way he described collaboration not just as a strategy but as something he genuinely values and has built his entire model around. Building with people, not just alongside them.

The honesty about what he does not enjoy. Most people at his level only talk about what they love. He talked about both. That kind of self awareness is rare.

The way he talked about family. Not as a checkbox but as something woven into the fabric of who he is. That landed differently than I expected.

Want to Go Deeper?

This blog is the overview. The full conversation lives inside my private community where Josh said things he simply would not say on a public platform. That is the whole point of Gloves Off. Real conversations in private rooms.

Join the Life Mastery community here and the full episode is waiting for you inside:https://www.skool.com/life-mastery-2022/about

About Dr. Kalpana Sundar

Dr. Kalpana Sundar is a physician who spent 20 years in ear, nose and throat and head and neck surgery, and owned her own medical spa, before leaving clinical medicine to build something she could not find inside the system. After experiencing burnout, moral injury and a growing frustration with a medical model that managed symptoms instead of transforming lives, she walked away from the OR and toward a new mission. Today she works at the intersection of vitality, wealth and impact, helping entrepreneurs, high performers and professionals reclaim their health and live on their own terms. She is also the author of Beauty Unbound and is currently writing her second book Who Told You That: Unlearning the Rules of Sex, Money and Power in Midlife.drkalpanasundar.com