Dr. Carl Smart on Pulmonary Critical Care, the MD/MBA Path, and Investing in the Future of Healthcare

On the Underdog Physician podcast, Dr. Carl Smart, a pulmonary and critical care specialist in Charlotte, North Carolina, discusses his journey from being born in Jamaica to studying chemistry at Fordham, attending Temple for medical school, and choosing pulmonary/critical care after reading CHEST and being drawn to ICU innovation and procedures. He explains how private-practice exposure to business plans and the rise of HMOs and corporate medicine led him to start a hospitalist program in the mid-1990s and pursue an MBA at Wake Forest to better understand finance and operations. Smart shares operational lessons on efficiency (including “just-in-time” concepts), his view that generative AI will transform the healthcare value chain while raising job-displacement and regulatory/ethical concerns, and the origins and thesis of Black Pearl Global Investment focused on affordability, access, and outcomes. He emphasizes founder tenacity, strong teams, realistic goals, and learning from failure, describes his intensive daily schedule across clinical and VC work, and outlines a legacy centered on scalable patient impact.

00:00 Guest Introduction

00:35 Redoing the Intro

02:20 Carl’s Origin Story

03:27 Why Pulmonary Critical Care

04:50 Path to Business Leadership

08:14 Why Get an MBA

10:13 Operational Efficiency Lessons

12:04 Generative AI in Healthcare

15:45 Black Pearl Global Investment Thesis

18:29 What VCs Look For

21:15 Founder Advice and AI Reality

23:13 Embracing Failure

24:47 Work Life Integration

26:13 Staying Calm Under Pressure

28:00 Legacy and Closing

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