21 - Dr. Brian Bowman - Landing the Plane (and Acting!): täielik transkriptsioon

there because we over we didn't oversell it. It was that the space told us you have whatever it is, 150 seats, 200 seats. It did not have 150 seats. And so ⁓ we ran into that problem. Where were you sitting for the for the event? Do you remember? Not really. I I was not up close, but I had a full okay. That's what I that's what I Yeah, okay. So you so we had to add a couple rows of chairs all the way up front. And it was like we were at a tent revival because it was a hundred degrees in the room, cause everyone We squished everyone in and one person left about ten minutes into it and said, I I don't want to do this, which is fine. That's someone's prerogative. But I was like, dude, you missed like six solid hours of fire hose. I was a I mean, that's my memory of it. And it was hot and it was sweaty and it was fast and it was ⁓ and everyone complained. The food was mediocre and the and these giant cement poles cut in the way of everything. But at at at the same time we walked out and I was like, That was great. You know, like the energy was there. Right. ⁓ a packed room like that just is it's like being at a rock concert. And ⁓ forgotten that I had forgotten about that. Cause my memory of meeting you for the first time, and so you're you're surely right, I'm wrong, but was when I went to your practice. And I don't know if your view of how you became a PCC client is the same as mine. All right, so I'll tell you my version of the story and you can tell me how wrong I was. All right. So ⁓ We were coordinating you, all right, or whatever you want to call it. We were doing sales with you. You have a big group. You're gonna tell us about your group in a second. But you have a big group with a lot of of voices and opinions and ⁓ you were you were working with some of the usual suspects in the EHR search, and I thought we'd had some really good like I I felt really positive about how it was going. You guys were like connecting to us and everything like that. And you sent me an email. I bet I can dig it out. And you sent me an email and said, Ship, hey, thank you. You guys have been great. ⁓ I just wanna let you know that however we're going with this other vendor over here. And it's a vendor that to this day is not particularly well exp respected. Okay, that's all I'm gonna say. It's not our direct competitors, it's just to one of these other competitors. And I I don't know, I was I don't know what got into me because I I think I've done this once, maybe twice in my career. I sent you a note and I said, you know what? I totally understand if you've gone with another vendor, but seriously, those guys? And I think I even wrote in it, I thought you were smarter than that. Because I was mad. And you said, you replied to me right away. You said, you know what? Come back down here. I'll give you one more shot at it. And I flew down there with Scott Child. He used to work here. ⁓ I'm I went to my first Panera ever, because you had a Panera like in the parking lot nearby or something. Because we grabbed sandwiches. Yeah. We grabbed a huge thing. of like a massive thing of sandwiches. We show up and we did another kind of sweaty demo in your waiting room. Like there were t a ton of people there. And I walked out of there going, I have no idea how that went. I have no idea how that went. And you c and then you said I think you sent me an email like the next day. I should have looked this stuff up. And you were like, That did it. And I was it was one of the few times in my entire career where I felt really vindicated about saying like, no, no, no. I don't and and you had said like it wasn't you. You're Your partners were focused on the cost, of course. ⁓ but it was one of the few times I said ⁓ 'cause I was like, I thought Dr. Bowman understood value versus cost. And you did, but you just that was my I've I've held that memory forever. It's really interesting. ⁓ I I remember you coming to the meeting the first time. ⁓ and I think you were in our small boardroom then. Okay. So one of one of my One of ⁓ our partners who's now retired, who was very active in making our practice strong, said, asked you why us, why did you want us as a client, which I thought was an interesting kind of take, you know. And ⁓ and I remember you pointing at me and saying him ⁓ because I got it. I understood what this was about and that getting ⁓ a new practice management system wasn't about saving money, it was about generating money. kind of idea. I don't think you said all of that, but you you said because he's he gets it. He gets what's important about it. I remember that part. ⁓ but that's that's the fun of ⁓ being ⁓ a junior partner in a seven partner practice that, you know, had been around for twenty plus years and had been successful. ⁓ that you come in and bring in ideas and ⁓ you're you can sell as much as you want, but everybody has to be on board, or at least the majority has to be on board. Yep. Yeah. And that's a that's the the benefit and the drawback to having a partnership. You got a lot of you got a lot of thought partnership. You've got ⁓ you've got support, you got people are better at things than you are, but it moves slowly and inefficiently. It sure does. That was two thousand and eight. Is that when that was when we joined in on partner? ⁓ I can look it up, but I it feels like two thousand and eight. Yeah, it was seven or eight, 'cause then EHR was eleven, I think, when we went live with that. ⁓ I remember. You guys were kind of early in the ⁓ in the EHR process. ⁓ you were not you you were not afraid. Your practice well, you know what, this is a good segue. Dr. Bowman, tell me about your practice. And it was ⁓ by the way, it was March twenty first, two thousand. So there you go. So great practice. ⁓ we are celebrating our fiftieth anniversary this year as a practice in Kerry, North Carolina. ⁓ started as one doc and as Our county grew in our area, the county grew, but they just kept adding on people. I

joined, let's see, that was 2001. So about 20, yeah, it makes sense. 25 years into their existence. They had had some rough times with joining into an HMO that went bankrupt and ⁓ they had to sue to buy themselves back out. And that was my first year there that they were finally able to clear debt ⁓ from that buyout. So they were clinically good, a lot of really good. trained people at that point. They had, they were gun shy about partnerships because of that experience. And ⁓ but they're all, they were all ⁓ community-minded. They had all spent their time in the community. They were well respected. It's a great practice. And then after I joined, it continued to get bigger, ⁓ ended up with three offices. We have 17 providers now, full and part-time ⁓ in those three different spaces. And then all of the All of the growth that goes along with that, both clinically, financially, the way we run the practice, the way we structure the practice, we've probably had three or four different ways that we've managed over the years. Yeah. It's like ⁓ it's like Winston Churchill said about America. It America always does the right thing after exhausting every other solution. We we found out, you know, coming back to that that par different partners have different expertise and different things that they're really, really good at or passionate about. ⁓ we we burned through practice managers ⁓ about one every two to three years until maybe fifteen years ago, we ditched the idea and and we decided that we all had we all had our interests that we're we were poking the practice manager about. And those things were of different importance, but different different varieties, different different priorities. Different priorities in the big picture, even though it might be a priority for you. Right. ⁓ and so we finally gave gave up and decided that our partners needed to be because we were already hands-on from a thought perspective, that we needed to be more hands-on from an actual running the practice perspective. And we had different management ways that we handled clinical staff and all sorts of things. And and so we got ideas from other practices in our area. And North Carolina's a pretty amazing place from for general pediatricians. ⁓ there's ⁓ While while we all run our business, we all share ideas and and collaborate and try to make actually the Well, I'll just gonna I'm gonna insert an ad to anyone listening. If you're a pediatrician in a sad state, I would put North Carolina maybe at the top of my list of states to move to to be a pediatrician. It's I mean and there's ⁓ you just the ⁓ North Carolina does some things and largely, you know, with the support of friends of ours, all right, ⁓ you and me yours and mine. ⁓ but North Carolina does some things that make it a good place to practice medicine, be an entrepreneur and deliver quality care. I mean, that's unlike most other states. Anyway, sorry, that was just an ad for North Carolina. No, I and and I I completely agree, obviously a hundred percent. You don't realize you have it until you start talking to people in other places. ⁓ and you expect shoes to drop 'cause you're reading about, you know, in the in the late 2000s of everything that was happening with managed care in New Jersey and New York and Connecticut. And you're like, all right, it's gonna come down the coast. It's gonna hit us. And it, you know, kind of never did. ⁓ and I think in large part that was because of the consortiums we had that we were able to negotiate with our state Medicaid program, ⁓ the managed Medicaid. And and ⁓ and we all kind of work together. And it it it it makes for a cool place to kind of work and you can kind of focus on what can we do for everybody and instead of what can they do to carve out my little my success compared to everybody else. Yeah. So that's what I'm I think the zeitgeist the zeitgeist of pediatricians is that when they collectively bargain, they generally bargain for the kids and not themselves. They do just enough to take care of business. Whereas of course other specialties probably say this about each other and everything else. But ⁓ other specialties put themselves first. And that's why your the organizational results of your work in North Carolina don't lead to a drain on the healthcare system. They lead to the healthier children becoming adults, which is an apps that's what bends the curve. Not spending a few more dollars on pediatrics. What's what what bends the curve is kids going into their twenty first year, not obese, vaccinated. You know, what you know there's only I I always pick that one 'cause it's the most expensive one. But like If you get one out of a hundred kids, two out of a hundred kids to maybe eat healthy when they wouldn't have, that's that bends the curve. Not any of the, you know, not any of the other prior off nonsense or anything like that. Yeah. And when when all of that Medicaid negotiation was going on, it was never a matter of, you know, pay us more because this is what we do. It was like, pay us more, but let us do this to show how valuable we are that we've done this. ⁓ let's prove to you that this was the right kind of investment. Cause I think in in some parts it was like, sure, they can pay us whatever they want, but but you know, in three years, if we haven't shown we're worth it, they're gonna take all that money away. ⁓ but if we if we have a background that shows that we're being clinically successful and and delivering good care and care coordination and and all of those things that we know dogmatically improve the care of kids, then that that should carry on. It it's harder to argue with us. when when we want to keep getting paid what we're getting paid. Yeah, well and half of half, I don't know what the number is, but a huge chunk of what you ask for ultimately is can you just make our jobs easier? If you make our jobs easier enough, we're not we won't even talk about the money. All right.

Because then our our business becomes frictionless enough that the money matters less. We only care about the money when I have to hire three people just to keep up with some requirement or some paperwork nonsense or, you know, some data exchange thing. That's what kills you. Right. And a lot of the discussions with rollout but and just using again this managed Medicaid as the example, ⁓ were were centered on administrative burden. And and that was what was kept coming back as being ⁓ yeah, we didn't get paid, but the reason we didn't get paid is because they needed every different group needed a different way of submitting it. And we had all agreed about reducing administrative burden. So let let you let's make sure that that still happens. So ⁓ and I think that was a huge concession that the managed Medicaid program allowed was that they were going to force the private equities involved and all of that to have to do this the same thing for everybody instead of making the pediatricians do things different for everybody else. It was huge. Huge. Yeah. And and ⁓ and like I don't know specifically ⁓ what the ⁓ who to who to give that credit to, but it was a you know, there's certainly a group effort. But you're doing this also in not the most red state in America, but not a blue state, you know. ⁓ we are staunchly purple for short. Yep. And ⁓ yeah, because all of your legislatures don't your legislators don't get to come out a rally. You know, the the people who are making these decisions, you've got a lot of people who historically are hard sells on spending money, especially for kids. And you guys did it. So ⁓ no, it is impressive. So no but we did we barely got started. So we heard about your practice a little bit. ⁓ I want to hear about your career. How did you when did you realize you wanted to be a pediatrician? It was it was kind of late in the process. So ⁓ started medic medical school when I was weighing the differences between going to medical school and graduate school because I thought I wanted to do a lots of science. ⁓ kind of how I had staged my undergraduate career. I knew my mom had always wanted me to go to medical school. She wanted me to be a doctor. And so it was always kind of there in my head. You are the first person to tell me that you did it because your mom was there's portion of that that's yeah, but I did I took my MCATs and I took my GREs and I interviewed at medical schools and grad schools and MD PhD programs, which I thought would be perfect. ⁓ and ⁓ didn't get into any of those. ⁓ and ⁓ ultimately ended up at medical school. It was actually kind of a, you know ⁓ a cool story that I was interviewing at Johns Hopkins or Center for Human Genetics, ⁓ because I thought I wanted to do genetics research. And ⁓ the director of the program said, Hey, if you want to come here, come here. I can get some money for you. He she said, but you've already gotten into Duke Medical School. And if you think you can stomach medical school for four years, do that because you'll have more doors open. So ⁓ so ended up sliding into the back of the getting finding a fellowship for the MD PhD program. So I spent a lot of time in school. Yep. Yep. ⁓ and did research in and brain development, came out, was like, all right, I'm either gonna be a neurologist or developmental pediatrician and trying to figure all that out. Yep. ⁓ and was one night I was working in the emergency room, the Pede's emergency room, had to go read an x-ray. To get there from where I was, you have to walk through the adult ER ⁓ to get to the radiology reading room. And so I left my patients. I think I know where this is going. You know where this is going. I I left my patients who were crying in diapers and walked through another part of the hospital of patients crying in diapers. And then do you know which set I preferred? I just made up my mind where what I want to do. And then still in residency, thought I was gonna do a fellowship and ⁓ at at some point I was we were working on child three and decided, you know, I probably need to make some money. Time to make some money, time to get a paycheck. And not not like there isn't any developmental or behavioral pediatrics in general pediatrics. So I've been plenty satisfied with that degree. But but it was that kind of that kind of road to for me being a pediatrician and then ultimately, you know, a general pediatrician. So you literally had like a a f lightning bolt that said I remember it. I it I remember the walk. Yeah. ⁓ I have all these memories. Nothing like that. Nothing like that. I have memories of when I this is gonna sound ridiculous. I can tell you about times in my life where suddenly something made sense to me and I almost feel like I could feel my brain shift. Like and and ⁓ you you know that didn't happen, but it's I remember I can give you very specifically, I remember ⁓ I'm trying to like san not sanitize this, but make this less dorky. ⁓ there was a band that ⁓ I had some friends who said, ⁓ you've got to listen to this band. You gotta listen to this band. They're so great. I know you'll like it. And it and to make a long story short, it's a very extreme metal band. All right. So mostly to if I played it for you, it would sound like static. You know, and it's scre people screaming and and I had had it on in the background on my headphones for like a week or two because my friends kept saying, ⁓ no, no, this album is great. I'm like, Ugh, I'm not getting it. And then and then one day I was hyping or doing something. And in the back of the song, the band played a hunting horn. Cause these are Swedish, you know, guys. They're talking about being outside and being Vikings and everything or whatever. So the in the back, way in the back, you hear this woo-hoo. And as soon as the note notes happened, all of a sudden I heard the music. All of a sudden all the notes fell into place. And it was like right in the middle of the song. I was like, ⁓ my,

now I can hear it. I like I did not it can't I there was nothing to anchor me into the rhythms, the melodies or anything. It was just Chaos and then I saw I was like seeing patterns in a in a TV, you know, with the with the snow on it. And ⁓ I I feel like my brain moved when that happened. And so yours is a much nicer and more important version of that story. But to me, maybe. Yeah. Well, you became a pediatrician, and that's a good one. So, ⁓ as we were talking before we hopped on here, ⁓ you're in a very transitory part of your career at the moment, or transitional. I don't know what what the right adjective is. ⁓ so why don't you ⁓ tell us a little bit about that? Sure. There's a bunch of different motivators between one being I I knew I knew at some point I wanted to travel, I wanted to have adventures, and that doesn't always fit with a week vacation here and there. ⁓ as working whatever job you're working. and I could see as time was going on that I was fortunate enough to be able to build a little retirement nest egg and had said in my head I wanted to retire by the time I was sixty or sixty two. And I'm kind of on that track. ⁓ I had also had partners who kept working. Man, they kept working and and these were sort of the folks who established the practice. And and as they kept working, I was thinking, when are they gonna enjoy? When are they gonna get out? And kind of reap their rewards of their success and the time and the energy that they put in. And I wasn't seeing it. And I was like, that's not that's not going to be me. And I know there's generational pieces of that. You know, physicians for generations have ⁓ that has been their identity of I am I am a physician. And when I'm not a physician, I don't know what I am anymore, who I am anymore. Right. Yep. And I know a lot of the things that have connected us are things that are outside of work. ⁓ some of the scouting things, some of sports related stuff, games, you know, all of that. And so I've had plenty of other interests and I want to be able to have the physical body to pursue some of those interests. And as as our practice was evolving, we've had we've had other people who've wanted to transition into other careers and have sort of stepped back and we sort of had to come up with rules ⁓ for what you were allowed to do and remain a partner or not remain a partner, which makes complete sense. Yep. And so I was able to pull back and be a part-time partner, but we could only do that for a year. And now I am a part-time employed physician. And ⁓ and there had been as involved as I was with the practice. So, you know, I got billing and coding and then I got contract negotiations and then I got quality metrics and, you know, then I got ⁓ PCMH and mostly because Other people didn't You had all the money things. I did. so I other people either didn't have the capacity or didn't have the desire to make those things happen. Yep. And then and then in the past two or three years, we've had

younger partners who are certainly accomplished and smart. And so I've been, you know, kind of, hey, come to this meeting with me. You should go to that. We let's go meet some people. And and so it was easier for me to sort of say, I'm out, because they have other people who are doing it. I'm not leaving anybody in the love my practice. We ha I think we have a great practice. ⁓ and I know I've been instrumental in bringing it to where it is in 2026. And it's hard to leave behind if you don't think you have caretakers after that. But I I think we have decent caretakers. That is the I mean, PCC loses clients to that period, succession planning. People who don't have a plan and they're like, okay, I'm done. Now what do I do? You know, I made a promise to myself or whatever that I'm done in six months or a year. And that is not enough time to hand a practice off. ⁓ the best quote, this is going to be my quote for 2026, is a combination of something two different people said. ⁓ it was Nola Ernest and Susan Sorota, and I'm just combining their sentences. And that is delegation is leadership training. Leadership training is succession planning. And ⁓ those two sentences together, I'm like, that they they sort of changed my I both of those things are obvious. And we all know we need to do succession planning, but it's like saying we all need to we all know we need to save for a rainy day, but you can't do your succession planning by clicking a box on your 401k thing. You just just do 7% of my time succession planning. No what you always put it off. And the f you know, you guys, you guys did a couple you your practice is one of the fewest large practices I've ever worked with without a strong practice manager. Where the partners bear the burden, that actually works. That actually works. Overwhelmingly, it's a bad idea. ⁓ but if you have discipline and communication and understanding and a delegation of work, it's actually a stronger thing. I'm working with a practice right now, your size, a long-term practice manager who's good, controls everything. She's retiring, and they don't know what to do. And they are having They're gonna work it out. They're they're they're doing the thing that most people don't do, which they're communicating and they're working on it. Like that's this is like marriage counseling one on one. But they it's a they have to do this fast and that's hard. And you you also know this because I know I know you know it 'cause we've talked about it. Boy, you don't really know someone until they get put in charge of something, do you? You really don't. Some someone very smart can suddenly be very stupid when they're in charge. And sometimes and I say I like I say that about myself. It's remarkable. ⁓ not every doctor is designed to lead people. And when that's how I ended up with all of those things, right? It's not I was it's not gimme, gimme, gimme, gimme. It was like, hey, I tried this out and I can't figure it out. All right, then I'll

do it. 'cause it's it 'cause it has it has to get done, right? So if it doesn't get done, w was our practice gonna fold? No. But like you were mentioning the money, you know, going to your My first meeting with you, we might have increased our receipts to a hundred thousand dollars that year. Well, there's one year we did PCMH and it pushed us into a diff different payment level with Blue Cross Blue Shield and it was nearly a million dollars difference from one year to the next. ⁓ yeah. So part part of me was like, Yay. Part of me was like, dang it. I wish this person would have done it last year. That would have been cool. but to your point, it's you can't ask people to do something that they Can't do, but you don't know it sometimes until they try and Yeah, you gotta get pe people no one's perfect, no one shows up being a natural leader. Very few people do. ⁓ I think doctors like attorneys and a few other professions, but main mainly doctors and attorneys, by virtue of being the smartest kids in their class all along, just assume that they're good at everything. I mean, I see this all the time. And why do I have a job? Because you're not all good at everything. Like that's it's just the way it is. But your office and yes, we're on this podcast right now and you're making it all sound like it was smooth sailing. And we know it wasn't. Like, but if we definitely was not, but you you broadly have spoken about it and you work on it and you and and you have a plan. And you just said you actually said something that I'm like gonna go put in my back pocket because I I think one of the first consulting gigs I ever got. was for a practice that was trying to manage how to deal with a part-time partner. And they didn't have anything in their ⁓ their ⁓ partnership agreement about it. And and that was I had like a four or five year run where the every call I was getting every month was, ⁓ we just had one of our partners say he's not taking call anymore. We just have a partner said he's not covering Saturdays. And I'm like, well what does your partnership agreement say? And they say nothing. Well what are you going to do about it then like And y what you guys did is said, Yeah, you can do it for a year. And that gives everyone a runway. Everyone a runway. And here it f also follows one of the biggest pieces of advice that I give to people. Put it in writing. Like put it in writing. You want to be a part-time partner. What you're saying is like I'm trying to land the plane, but if I flip the switch off, that doesn't work for me. If I flip the switch off, it doesn't work for you. You need me around. Like I know where all the passwords are figuratively and literally sometimes. Like this gives us you You have announced your transition time. You get the benefit of being a partner for another and you get to figure yourself out. It's a very humane way to manage that. And ⁓ it also let me ask you, because I don't know the answer this qu do you in your partnership agreement, like you you have that clause in there or that section in there, I presume for someone planning to retire. Okay. Would it also ⁓ address someone who has some other reason to be part time for a year? Like an injury or a family crisis or something? Or do you have something like if you had said, if you were forty-five and a partner and you had said, I over the next year, I can only be part time because I need to take care of my mom, would that have would you have been able to go into that phase and then get out of it, or would you have had to say something else? I'm just curious. Yeah, I I think if the if the intent was coming back full time, nothing in our agreement that addresses that specifically. I've never seen anyone do it. Yeah, yeah. But I think from a ⁓ from a a group of partners who care about each other. and even though we often disagreed, we care about each other. ⁓ I we probably would have worked through it. ⁓ part of part of that is how our pay is is set up. We are completely a hundred percent productivity. ⁓ so I that's right. I for totally forgot. If if if they're working two or three days a week, they're making two to th two or three days worth of money. That doesn't hurt me, ⁓ financially. It hurts the practice a little bit 'cause you generate more money than you get paid even at the partnership level. but ⁓ but it's not a drain on me for you to be working at that level. That's I forgot about that part of it. You don't have a guaranteed salary. Like I don't have to pay this person seventy five just but yeah. You you and I both know practices who struggle with this and ⁓ there is no right answer and it's about the culture of the practice. But there's that tension between the partnership as a security blanket or as a safety net for someone who who suddenly can't work for a certain period of time or ha is and that's life. But how much how much do you give someone before the partnership has to say and how do you do that in a humane way? It's it's a a constant struggle. And I've seen people exploit it massively, and I've seen people get wrecked by it and harming the partnership. And ⁓ it's a tough one. Yeah. That would be tough. ⁓ it it's you know, we certainly have ways of getting through short term disability and ways of sort of helping support somebody through if they have to be away for a while, but having to cut back hours is almost kind of different than just having to having to go away. I would have loved to have been able, I was inspired by a meeting I went to with you all the last time it was in Burlington and ⁓ that the ⁓ you all can do a sabbatical of some degree ⁓ after years of service. And I thought Man, that would be really cool. Would I would I work one? I know one practice who allows it, who does it. They have it built in. It was I didn't even try to sell it to mine because I knew what would happen. And and not not And now you understand. But now you're gonna go on a permit sabbatical. So that'll be Yeah, the

rule the rule at PCC is if you've worked here for twenty years, you can get a three month sabbatical at any time that's reasonable. And ⁓ I think at the end of your sabbatical, you're supposed to come back and give a little presentation to the to people to to know what you did. And some of the sabbaticals ⁓ people have come back with have been really fascinating. Like I'm like, ⁓ that's cool. And others, ⁓ others you're like, Okay, it was vacation. That's okay, that's cool. You know, it's whatever whatever you do. ⁓ I just I think about it for myself and I'm like, I don't know what I would do. I ha it's not like I am bored for long in my life ever. Okay. I'm good like you at finding things to do. I just don't know what thing I would focus on for three months. I would have to s I would have to come up with a plan that was three one month things. I'm gonna travel for a month, I'm gonna play guitar for a month, and I'm gonna play tennis for a month. Like that's what I were I like I'd have to layer this whole thing, but I'm I'm incapable of that. So I just I just go along Well my wife is was concerned. One of my partners who had all he did was work. ⁓ He didn't have a lot of outside things in his life that he was involved in, which I I was I had been accused appropriately of being over involved outside of work and in community kinds of stuff. and we were at a different retirement party and he was there and and my wife talked to his wife and she said, ⁓ it's been really hard because he's bored. And so my wife was like, ⁓ I'm scared you're gonna be bored. I'm like, Really? Really? You know me. Do you come on? Do you see all these books I haven't read? Do you see all this like Yeah yeah. I I I'm hoping I I am of an age where I think about that for myself. I watch my parents and and and I'm just like I don't think I'm good at puttering. I don't think I'm good at puttering. But your point about like I you want to be of fit body enough that you can do some of the stuff, that's you know, I don't know, e fifty five, everything since then has been like you can see the I can see the end zone. ⁓ that's that's tough. And yeah, well with one hip replacement before I'm sixty, with the family history of knee replacements, and knowing on my knees have been in injected more times than probably they should have. It's like I got I have a fixed set of time. Yeah. I I knee replacement is in my future, one hundred percent. I tore my ⁓ C L at like right at the N C E two years ago, or just but the week before the N C E and ⁓ it's I'm not the same, but I've I've three siblings. I am the only one of the four of us who doesn't have serious hardware in his feet. And b both of my brothers are looking at ankle replacements. And I'm like, Ankle replacements? That's a I'm like, my sister had to her like if you do an X ray, she looks like the Terminator. My sister said she had to get rid of thousands of dollars of boots and shoes with high heels because she can no longer wear high heels. Like phys physically can't get in them because her foot doesn't Yeah. Yep. And Yeah, I don't think we were made to live this long. We kinda weren't. But but ⁓ that's okay. We'll push the limits as long as we can. There you go. All right. So I'm all right I'm gonna bring it back to being a pediatrician. You and I can talk for like two hours. ⁓ yeah. ⁓ here's my here I got two questions for you. As a pediatrician right now, what's keeping you up at night? Pediatrician, what teaches me? And they ⁓ you can ⁓ as a as Brian Bowman, what's keeping you up at night? How about that? It's it is as a pediatrician what keeps me up at night 'cause I don't I don't know that we have enough time for all the other stuff. It's the it's the direction well two things. One is the the direction of where ⁓ public policy that is not tied to ⁓ improved public health that is ⁓ shaping care. ⁓ trying to very carefully stated as vague as possible with that. It it's it's worrisome. it it's ⁓ from the beginning when the when the assault on vaccines has started, my one of my biggest concerns has been is this going to get to a point are they going to take away ⁓ the Veries program? Is that gonna go away? And then the protection for the insurance companies and the doctors gonna go away from frivolous lawsuits. And then the insurance are the vaccine manufacturers going to decide it's not worth their while to make a fifteen dollar polio vaccine, that their margin has got to be tiny compared to other things that they could do. And then are we going to have all of this nasty, awful stuff coming back? And part of the answer is yes, but not because the vaccine manufacturers are refusing to make it. But when is that going to happen? When are they going to say it's not worth my bottom line to make a DTAP vaccine? Because my margin on that is pennies versus making some other monoclonal antibody where my margin is $1,000 per dose. ⁓ and that worries me ⁓ of how many how many kids are going to have to die. before we decide that this path is not the right one. Well in the year two thousand we I think we announced that measles was eradicated and we've had the second consecutive year of record setting measles volume. And not very far from you either. Like have you any in your county? ⁓ we we had a case in the county but not a transmission in the county. Yeah. Yeah, we we've been we've been pretty ⁓ safe up here so far, but it's not like Vermont is great at immunizing. ⁓ it's every every state has the same pattern that I've seen. Pockets of pockets of strong immunization, largely urban. As soon as you go outside of town, everyone wants to be free to be you and me until they get sick, but whatever. And that ⁓ that demographic is is unusual because there are there are folks on the right and the left that are kind of in that. So it's you can't pigeonhole their rationale for deciding for themselves what's best for them. Well, the bottom and I mean, you go far enough in either direction, you

just come right back around. That's yeah. Yeah. ⁓ so as a pediatrician though, or as the person Brian Bowman. Person, not Dr. Brian Bowman. ⁓ what e what excites you these days? What what what gets you out of bed in the morning? What do you what do you look forward to? Looks I and this might sound cliche, but I I look forward to next adventures. I look forward to learning new things and it's not necessarily out of a book or going and taking a class or it's it's ⁓ going places, meeting people. seeing things. You know, we as a as a family, three, four years ago, we kind of stopped giving lots of gifts at like Christmas. Yeah. And and so now for our kids, they're adult children. ⁓ they don't need stuff anymore. Yep. The ⁓ they ⁓ we pay for an adventure a year. Where do you want to go? What do you want to do? You're gonna where are you gonna go do this or go do that? And sometimes we end up doing it together because it just works. But ⁓ sometimes not. ⁓ so and so we're trying and I think our kids get it, just knowing our kids, that it's kinda about going and doing and seeing and participating in in life and in nature. And and so those are the kind of things that I I get excited about. Next adventure planned. Next adventure is next adventure is September. A group of guys here locally that I met all through scouting. They're all scout were scout leaders. We've we've done a Kentucky Bourbon Trail twice. And this year we are doing a Scotch whiskey whiskey tour. So we're spending ten days in Scotland. ⁓ as a group of six. So do you have you ever adopted a fifty-eight-year-old son? Come on along. One of one of my one of the people who's become integral in our in our trips and ⁓ has even come into town a a couple of times just for little events we have here. ⁓ I grew up with him in Saint Louis and he lives in Omaha. So he's like my best friend from elementary school, but all my current friends know him and like him and we all get along and he's going to Scotland with us too. So ⁓ that's amazing. Have you been to Scotland before? You must have. I have been. Yeah. Beautiful. It is absolutely beautiful there. Yeah. I ⁓ our honeymoon was Ireland and I've been to Sc Scotland and Northern England and you you just feel like, Wow You know, if I if I live in Vermont and I get and I go to any of these places and I get blown away. Okay. Right. I'm like, what does someone from Florida think of this place? What does someone from Arizona or Texas, you know? ⁓ all right. So one place, I'm gonna ask you one place that one place that I've been, my wife has traveled all over the world. All right. She's been everywhere. But and she at some point in our relationship, she took over the vacations. Like I used to do all the vacations and I was a pretty good planner. But she just wanted to go to other it's like she got You what it was? She would read like the New York Times and they would have an article in the travel leisure section. And next thing I know, we had tickets to go somewhere. And we've been to some really interesting places, like cool places. The place and I would go back to every one of them, all right. ⁓ and we had adventures, like true adventures, which and there's n at you're there's no substitute for the feeling that you get at the time and later. It is the best thing. The place that I did not get enough of though, where there was so much left to explore when we left, and I'm not talking about obvious places like London or Copenhagen or anything like that, like because those are all like I could spend all all kinds of time there. ⁓ was Malta. And Malta was Malta was like, for me, it was like ADD, right? So are you a museum person, first of all? Yeah. Okay. I mean it's not huge on museum. It's not huge on museums. It's not like being in Europe. I it's it is in Europe, but it's not like being in the main season in Europe. But you could in the same day go from a beach To a post-medieval fishing village, to a prehistoric underground limestone ⁓ community caves, like where they lived underground, all right? All like all within 10 minutes. And and that's sort of like ADH. And also, if you watch Game of Thrones, like the scenes when she's like when they're she's walking through town, it's a famous scene. All those cute that's that's Malta and the the billion dollar yachts that are in the ⁓ in the little docking place. And then you then you go to the Carvaggio Museum. All of this stuff happens within this concentrated space. ⁓ that was I really enjoyed Malta. ⁓ it's a weird place. I mean it's it's like the ⁓ it's like the the ⁓ what do you call it like the financial crimes capital thing of the world. Yeah. but well it has it has a very specific tax law on the f in free it for the United States. And I think this it might be true of other countries. I don't know. Where ⁓ all of if your your Maltese money isn't taxed, I guess, or I don't know the exact thing. And it's an exception. So the amount of money laundering that happens in that country is gigantic. ⁓ which is nice to be around, but I don't, you know, it's a nice place to visit. They have a golden visa program for retirees. Not that's related to that. Not that I've looked. But yeah. It is rel it is related to that very that is that it's one so I'll ask you before I ask you my final question, if you could suggest a cool place to visit that people might not think about what would it be? One of our favorite adventure vacations ⁓ was in northern Norway in the wintertime. So we had ⁓ about seven days in Tromsel and surrounding communities. So no s no never saw the sun. While we were there. Just saw dawn and dusk, which is like the most hours apart. Eagle Scout answer I've ever heard, but keep going. Did w did you stay in a Eagle Scout? I've created a lot of Eagle Scouts. Now the f the first few nights we stayed at this it was called a farm hotel. It was a bed and breakfast, had individual little buildings for for folks. They had goats and they had sheep and

they had all of this stuff and it was right on ⁓ the fjord and it was amazing, super amazing. And then we stayed in town in Tromso for another few nights. ⁓ but but the the snowshoeing, nature watching, you know, rain you you see reindeer like you see deer here, and they're just walking around. And they're so much bigger. And they're huge, yeah. And they're beautiful. And Northern Lights sort of hunts ⁓ that we did there. So it was and it was cold, but ⁓ people are super friendly and and the food was good. It was it was a really cool trip. All right, noted. I mean I know that I would I would enjoy those three countries up there, you know. And yeah just the the ost the what's the word I want the austerity of it? That's not quite the right word, but the the ⁓ the cold doesn't bother me obviously and and it's a way of living that I I do understand just by b you know being by where you live. Yeah. And though though theirs is like two layers above what we did here. They are coastal. You know, it's we did a winter trip into central Sweden looking for the northern lights there. And that was cold, but they were they're landlocked. And and so the winds start and they don't stop and there's nothing that's generating heat from, you know, even the as cold as the North Sea is, it's still warmer than the ground. Right. Right, right. So it it really wasn't terribly, terribly cold. ⁓ Well, like I I but like I say up here, I don't care if it's cold. It's if there's no snow. Like if there's no snow, why do I live here? If there's no if it's not interesting, like if there's no snow and it's just cold, I can move to New Jersey. Like or you know, upstate New York or something. Actually, that's a bad example 'cause they always have more snow. But the ⁓ the environment makes the difference. So all right. So last question. Yep. Because you and I are just gonna segue out like for the next four hours. If you could if you could go back and give your whatever, 30 year old self advice, what advice would you give? See, I've had such a good career and I've had such a good life. That's that's really hard. ⁓ 'cause I don't know that I would do a whole lot different. Which ⁓ how blessed am I to be able to say that? with all of the different things that could have gone on. Yeah, yes, absolute privilege. ⁓ yeah. I I think if I would say anything, it would be if you don't think you're completely happy where you are, change it. Don't you don't have to feel like Don't settle. Don't settle. Yeah. I tell people, you have one career. You have one nest to build. Don't don't end your career sad because you didn't speak up for yourself. So that's good if you're the only one that said that. And that's something I say in a lot of my talks. I didn't ask you to say that, so but it worked out. And it's not that I would have it's not like I settled, but I did in some aspects. Right. Because you have all the different things that make you happy person. You did so consciously. You said, These things are acceptable to me and everything is you're gonna compromise to some extent. Like you don't get everything you want, but you decided which things are most important and how are you gonna set how are you gonna settle these things in a way that's fair to my partners, which is huge. all right. Well, Doctor Bowman, thank you. I really appreciate it. ⁓ I told you this would only go about thirty f thirty-five minutes. Here we are. Tangents and tangents. They keep getting longer. I got I gotta figure Originally the goal was to do twenty minutes so someone could listen to it on the way to work. And I'm they're getting longer and longer. So anyway, I knew I knew ours would be a good one. No, no, no. I like I don't know what to take out. And they're like I listen to it on people like pediatricians are professional talkers and you're just good at you you don't waste words. You tell the story right. So saying, ⁓ I'm gonna I'm gonna do a podcast with pediatricians as guests, it's like money guaranteed. You're all good. ⁓ I'll tell you something. I I've I've had ⁓ a dozen, two dozen former students who've shadowed me over the years, either in high school or college. ⁓ and it becoming more important to do now with work work ⁓ workforce shortages and so forth. But Totally. A kid I knew who was an Eagle Scout in my troop, who was a patient in my practice, ⁓ shadowed me and and he asked me this question. What from you the rest of your life, not medical, do you think has been the biggest influence on you as a pediatrician? Wow. Wow. What was your answer? My answer, and this is what reminded me of it, was kind of what you were just talking about. It was acting. Because there's times I have to act like I care what you're saying. ⁓ but I might not. I might not. And it's but like there's another thing. There's there's times I have to act like I'm not scared. ⁓ because your kid might have something terrible. Yeah. You have to be strong when when in order for someone else to be strong. And there's times that I have to act silly because a kid doesn't want to me to be near ⁓ and and so I have to do something ridiculous or say things a certain way to be able to enter into their space. But ⁓ I've I've I've shared that with a lot of different people, including new partners, ⁓ when, you know, they're getting feedback about because they have all the information, right? They have they know more than me at this point in their careers. And ⁓ but they would get feedback from patients about, well, they did this and they said that. And I'd say, you know, acting, make sure you know what you're saying when you say it. A lot of pediatricians won't don't like this, but I'm gonna say it I'll say it 'cause I'm not one. Most of your work isn't clinically that hard. Clinically. You don't spare and every day s you run into something where you have to slow down and think about it. But most of the time what you're doing is engaging with someone. You're building a relationship with somebody. Huge part of your job is giving moms confidence. Like it's that's a huge part of your job. And you could have zero clinical training and do that. I'm not advocating for that. I'm just saying, like and that part, that human interact if you didn't care about the human interaction, you'd be a pathologist. Like that's like or an anesthesiologist. And and that part, I know that med schools are better about it now. I know they're men are better about it now. And even though a huge I I think the majority of pediatricians are actually inter one on one, you guys are you one on one, you are never bad. Like I can have a conversation with any pediatrician every time. I never struggle. Okay, maybe that's a little bit me too, but It's real it's really just a little bit. Just a little bit. But it no, it's like you you are all ⁓ you are all world class empaths and that's that makes all the difference. And that's an empath would care to would would want to look like you're caring when you can't When you're really wondering like, ⁓ d what do I what am I having for dinner? How do I make this person feel? That's a an empath cares how they make someone feel. And that's like that is without question. To meet your your s your strongest ⁓ the the the strongest and most most important thing you do. I think there's truth to that for sure. All I said I was gonna end it like five minutes ago and we just keep going. Sorry, I threw out that other anecdote. That was on me. It's not yours. That was on me. That your stuff is gold. I'm I just keep going. ⁓ well Dr. Bowman, thank you. It you were as good as I thought you would be. You're perfect. And ⁓ good luck. I'm sure you'll stay in touch. You know, send us a postcard from the top of Norway. Awesome. It's been great, Chip. Always good to talk to you. Thanks. Bye bye. Thank you for listening. More information can be found in our show notes. Production and editing by Chip Hart, Allie Squires, and Chris Forlio. Music by Challenger C. I'm Mark Herney.