A surgeon's path to fixing healthcare - Ben Schwartz (Commons Clinic)

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Hi, Ben. Thanks for joining us today. Yeah, thanks
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for having me. You're currently leaving clinical
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medicine behind and your stethoscope or your
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hammer, as you might call it in the ortho world.
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And you're joining as a leadership at Commons
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Clinic. Tell me about your path and how did you
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get here? Right. So yeah, I've been in practice
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for 17 years with paediatric surgery, joint replacement.
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So a lot of hammering and sawing and malleting
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things into place. Very typical standard career
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for probably the first at least 10, 11 years
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for that career. And then about six, seven years
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ago. got interested in entrepreneurship, healthcare
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technology, got involved in some value -based
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care stuff in my own practice, and just kind
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of got to the point of my career where I started
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to think about, you know, what's next? What's
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my legacy? Am I going to do this forever or is
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there something more to my career? And so I started
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doing some angel investing, some advising with
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some companies, started to build a network by
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posting stuff on LinkedIn just to kind of drive
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conversations, get in front of people I wouldn't
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otherwise get in front of. And that led me to
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a guy called Nick Aubin, who's the CEO and founder
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of Commons Clinic. And what Commons Clinic was
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doing and is still doing was trying to build
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value -based care models, tech forward models.
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of care, like a new care delivery model surfaced
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or revolving around MSK initially, but with the
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goal to do multi -specialty at some point. So
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I had come up with this, what I thought was a
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brilliant idea of arthritis centers of excellence,
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where you get high quality surgeons you try to
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work with instead of against insurance companies,
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you incorporate technology into what you're doing,
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you revolve around outpatient centers and ASCs.
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And so I wrote this white paper. I put together
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this slide deck, but I had no idea at the time,
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like, well, what do I do with this? I didn't
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know how to get in front of investors. I was
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a full -time practice. I didn't really have the
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time to, you know, kind of pursue it. And then
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came across Commons Clinic and it turned out
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that they were already doing or building what
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I had kind of envisioned. And so met Nick. made
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a small angel investment in their seed round.
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This was probably three or four years ago and
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just kept in contact with them through the years.
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We would touch base every so often, trade notes,
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just riff on value -based MSK. I started my own
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blog about two years ago, just to kind of share
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more long form thoughts. And a lot of it was
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in line with still what Commons was doing, not
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necessarily intentionally, but just because we're
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pretty aligned on the thought process. So Nick
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reached out to me a year ago, said, hey, would
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you consider bringing your blog under our banner?
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I said, sure. Along with that, started doing
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some ad hoc. clinical consulting with their team
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here and there. And that just kind of grew from
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there became kind of this organic thing of they
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seem to like me, I like them seem to be a good
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fit. And it really kind of became where I saw
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my career evolving to and in terms of what I
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want my impact to be, how can I have impact in
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a higher, broader scale, larger scale? And what
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do I find fulfilling and You know, 17 years is
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a very fulfilling career. I'm proud of what I
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did in orthopedic surgery. I feel like I'm leaving
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at the height of my career. And then I think
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that's important to me to, you know, not be running
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away from my clinical career, but to be running
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towards something that I think could be more
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impactful and as fulfilling, if not more fulfilling,
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depending on how successful we are. What do you
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think you'll miss the most about your clinical
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career and what are some things you won't miss?
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I think I'll miss the most, particularly with
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joint replacements. The big part of the reason
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I decided to go into hip and knee replacements
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was you're solving a problem. You see arthritis
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on an x -ray. Somebody comes in, they're debilitated
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by it. In the span of a whatever hour long operation,
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you cut it out. That said, the arthritis is gone.
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They can never get arthritis again. The recovery
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for some might be longer than others. You're
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really curing arthritis. It may be kind of crude,
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but it's the best we have, and it works pretty
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well. And so I like that concrete part of it.
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I like the fact that you can take somebody that's
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debilitated and really restore their quality
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of life. Orthopedics is not usually life -threatening
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things, but it is function. It's limb. And so
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taking somebody that came limping in your clinic
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in pain that can't... do whatever, play golf,
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play with their grandkids, play pickleball, work,
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whatever it is, and then you do surgery on them
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and two weeks later they come in and they're
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walking better, they're off crutches, they're
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getting their quality of life back. That's very
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satisfying, that part of the job is very satisfying,
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so I'll miss that. What I won't miss probably
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is really just the frustrations I think that
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have crept in for everybody. in healthcare on
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the front lines and EMR gets blamed a lot. That's
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a part of it. But I think it's really death by
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a thousand cuts. I think it's EMR, it's regulations,
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it's reimbursement, it's insurance issues, it's
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staffing issues on the front lines because there's
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turnover and because there's understaffing and
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there's cuts everywhere. And so those things
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over time kind of really add up. And there's
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always so much that... as I found out, I think
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you can do within the system. You know, people
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are trying, but you run up against so many roadblocks
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that it just seemed like the only way to really
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make any headway was to kind of, you know, step
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outside of that and take a role like Commons
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where you're really trying to build not from
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outside, but from a little bit of a different
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perspective. I mean, Commons are the people that
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started Commons, Nick, Aubyn and Paulo. are not
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outsiders. They come from healthcare. They're
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not physicians, but they built in healthcare
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before. So they're not outsiders. They understand
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the healthcare issues. You said as you were working
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as an orthopedic surgeon, you felt like you needed
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to do something different. And maybe I'm putting
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my experience in yours a little bit here. Tell
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me a bit more about what sparked that entrepreneurship
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curiosity and is that something you think is
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innate or is that something that can be learned?
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I think it's innate. I think it might be latent
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for a lot of people. You know, in healthcare,
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it's pretty prescriptive, right? You go to college,
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you go to medical school, you go to residency,
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you go to fellowship. I mean, that's the typical
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track that you go out into practice. So there's
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not a whole lot. in that process that's necessarily
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entrepreneurship focused. I think if you're in
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private practice, you are running a small business.
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So in a sense, you are an entrepreneur. I think
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even if you're employed, you are managing your
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schedule, you are managing your views, whatever
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it is. So there is some form of entrepreneurship
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involved in that. Um, so I think it's, it's innate
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in us, but it's latent. And I think you just
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have to kind of uncover that for me. It was getting
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to a point in my career where the day -to -day
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became, I don't want to say easy because it's
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never easy. The day -to -day became more predictable
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though. I kind of knew how to prepare for each
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day. I knew what I needed to do to be prepared
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for the OR. I needed, I knew what I needed to
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do to be prepared for clinic. And so that part
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of it kind of slowed down for me and it freed
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up more mental capacity to start thinking about.
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other things. And on top of that, I was experiencing
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things sort of in my own career on the day to
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day that I felt like, you know, this could be
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done better. And let me figure out, are there
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ways to do it? Are there people that are already
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trying to do that? And that kind of brought me
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to the entrepreneur world of where are the people
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that are trying to fix these problems? What are
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the solutions that they're trying to bring? Let's
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talk about arthritis a little bit more. So I'm
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a family physician. I see quite a few patients
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and I do my own joint injections. There's been
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a lot of advancements at the edges that really
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haven't taken hold in the medical community,
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you know, PRP and stem cells and back in the
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day, prolotherapy, which is kind of out of favor
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now. What are your thoughts on you know, what
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is next in terms of arthritis treatment? Is it
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just, and maybe you have a different brand name
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there, here it's Sinvisc or Neuvisc, which is
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hyaluronic acid, cortisone and joint replacement,
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and then Tylenol and Advil, is that kind of the,
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all we need to know about arthritis, and if not,
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what's more and what's the future of arthritis
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care? Yeah, I think that's still the tried and
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true are still a lot of it. We've tried all these
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things. We have how ironic acid here. It's not
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covered by some of the insurance companies because
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the data on it is is mixed at best. Still do
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a lot of cortisone shots, still do NSAIDs, although
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fewer and fewer patients are really candidates
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for NSAIDs for whatever reason. They're on blood
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thinners, they have gastric issues, they have
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liver or kidney issues, and arthroplasty. So
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we've thrown a lot of things at joints and arthritis,
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and not a lot of them had staying power for whatever
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reason. And joint replacements ultimately are,
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I think, the best, most predictable long -term
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cure, I think. Hopefully we can get better preventing
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arthritis. I don't think you can prevent all
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of it, but I think there are certain things that
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we can do to maybe decrease the incidence of
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arthritis. First of all, there's nerve stimulation
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or nerve blocks and things like that that are
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coming along as pain relieving types of procedures.
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There's always companies working on injectables
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or things that try to support cartilage. I don't
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think there's any that have made it past the
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trial phase that have gotten out into mainstream
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usage. I think we're getting better maybe with
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detecting arthritis earlier, whether it's through
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advanced MRI imaging or analyzing synovial fluid
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to see if there are markers of early joint breakdown
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that maybe you can intervene a little bit earlier.
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I think someday. We'll either have gene therapy
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where we'll rearrange your genes and you won't
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get arthritis at all. Or maybe we'll be able
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to 3D print cartilage on a joint or do better
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with cartilage restoration. We've tried those
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things. It's been a mixed success, but somebody
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that's got advanced arthritis is beyond that
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point. So will we someday be able to open somebody's
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knee up and just kind of 3D print a cartilage
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matrix or cartilage on the ends of the bone?
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Possibly. Maybe in my lifetime. maybe in my lifetime,
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we'll have gene therapy to kind of prevent arthritis
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in the first place. But I don't think there's
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anything on the immediate horizon that's going
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to take the place of joint replacement for the
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patient with advanced arthritis. It sounds like
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your transition out of clinical medicine was
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more inspired by finding something to run forward
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to, as you said. A lot of my colleagues and to
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an extent me myself, our transition is running
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away from clinical medicine. Why do you think
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physicians are burning out? And did you burn
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out? And if you did, what protected you from
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burning out? Yeah, I think there was definitely
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times where I had symptoms of burnout. I don't
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know that I ever like, you know, fully. burnt
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out, but there were definitely times where it
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felt like, you know, you would show up and you
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would do your job. You didn't feel like you were,
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you know, making the impact that you intended
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to make when you got into health care. And that
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can be very frustrating, very, very deflating,
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because this is a challenging job. It's a stressful
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job. You know, it's a job that you put a lot
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of your life into. And it's it's more than a
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job. I think it is a career that. isn't just
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a nine to five. So for me, it really was getting
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involved in the entrepreneurship and realizing
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that. I think some of the burnout or a lot of
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the burnout maybe comes from thinking that you're
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hopeless and helpless in a situation, right?
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There's just nothing you can do about it. You
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show up every day and these problems exist and
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you're kind of shouting into the void or bang
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your head up against the wall. And I think that
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more than anything can be extremely frustrating
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for people to feel like, you know, you have no
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agency, you have no ability to change anything
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and getting involved in entrepreneurship and
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being around people that Some are grifting, some
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are in it for the wrong reasons, but a lot of
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them aren't. And being around people that maybe
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don't always 100 % understand what the problems
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are, but have an earnest interest in trying to
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solve them was refreshing. And then taking what
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I had learned from being on the front lines,
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my front line experience and being able to translate
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that to people that were building in healthcare,
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but maybe didn't have a great grip on what was
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going on on the front lines was... was satisfying.
00:13:07.519 --> 00:13:09.379
It kind of showed me that there is light at the
00:13:09.379 --> 00:13:10.860
end of the tunnel. There is somebody out there
00:13:10.860 --> 00:13:13.639
like Nick Alban and Commons Clinic that are bringing
00:13:13.639 --> 00:13:16.240
high level, you know, get your get your hands
00:13:16.240 --> 00:13:19.779
dirty solutions to health care. And that was
00:13:19.779 --> 00:13:22.120
very satisfying to me building a network and
00:13:22.120 --> 00:13:24.720
community online, starting to write and really
00:13:24.720 --> 00:13:26.659
kind of express those opinions and then have
00:13:26.659 --> 00:13:29.220
it resonate with people. You know, all those
00:13:29.220 --> 00:13:34.690
things, I think. really helped me kind of stave
00:13:34.690 --> 00:13:39.169
off that burnout and gave me renewed hope. I
00:13:39.169 --> 00:13:41.769
think that's tough. I think it takes time. It
00:13:41.769 --> 00:13:44.450
takes some risk to put yourself out there or
00:13:44.450 --> 00:13:47.169
get involved in some of these things. And so
00:13:47.169 --> 00:13:49.610
I don't think it's necessarily easy for everybody.
00:13:49.610 --> 00:13:51.850
It wasn't easy for me. And so I think you kind
00:13:51.850 --> 00:13:54.389
of get trapped in this cycle that you don't feel
00:13:54.389 --> 00:13:56.789
like there's any way out of. I think that's why
00:13:56.789 --> 00:13:58.889
a lot of people in this day and age are kind
00:13:58.889 --> 00:14:02.419
of burning out. I think there's a light at the
00:14:02.419 --> 00:14:03.519
end of the tunnel. I think it's going to take
00:14:03.519 --> 00:14:07.200
some time. I think things are cyclical. So I'm
00:14:07.200 --> 00:14:10.159
hopeful that at some point, not just through
00:14:10.159 --> 00:14:12.799
Commons Clinic, but in general, things get better
00:14:12.799 --> 00:14:14.919
on the front lines for the people that are delivering
00:14:14.919 --> 00:14:16.559
the care. It's not just doctors, it's nurses,
00:14:16.799 --> 00:14:18.860
it's physical therapists, it's case managers.
00:14:19.539 --> 00:14:22.279
I think just about everybody that touches a patient
00:14:22.279 --> 00:14:26.950
has experienced that. What would 20 year old
00:14:26.950 --> 00:14:29.169
Ben think of where you are today both in terms
00:14:29.169 --> 00:14:31.250
of your personal life and your professional life?
00:14:32.629 --> 00:14:34.990
I Think a personal life he'd be pretty happy.
00:14:34.990 --> 00:14:37.129
I mean, look, I can't complain. I have a great
00:14:37.129 --> 00:14:40.389
family You know, I've had success in my career,
00:14:40.509 --> 00:14:42.129
you know, not just in clinical medicine But some
00:14:42.129 --> 00:14:43.750
of the things I've done, you know outside of
00:14:43.750 --> 00:14:46.929
it side gig wise. So, you know, I live a very
00:14:46.929 --> 00:14:50.429
good life And I've been very fortunate in that
00:14:50.429 --> 00:14:53.429
way. So I think he'd be happy with where he was
00:14:53.789 --> 00:14:57.549
Personally, I think professionally, I think it
00:14:57.549 --> 00:15:00.230
would depend. If he knew the journey it would
00:15:00.230 --> 00:15:02.850
take to get there, I think he'd be like, oh,
00:15:02.970 --> 00:15:05.870
that's going to be a journey, residency, and
00:15:05.870 --> 00:15:09.450
fellowship, and early in your career struggles,
00:15:09.590 --> 00:15:13.090
and then making that pivot towards more leadership,
00:15:13.190 --> 00:15:15.590
entrepreneur type of stuff. I think if you saw.
00:15:16.120 --> 00:15:19.559
the end result. You know, he would be pretty
00:15:19.559 --> 00:15:23.340
happy and hopefully proud of future Ben, because
00:15:23.340 --> 00:15:25.639
because I'm really excited about, you know, where
00:15:25.639 --> 00:15:30.159
I've been, but also where I'm going. I don't
00:15:30.159 --> 00:15:32.480
know if you have kids and if so, how old they
00:15:32.480 --> 00:15:35.899
are. How old are your kids? So I have two daughters,
00:15:36.120 --> 00:15:38.419
14, who will be in high school next year and
00:15:38.419 --> 00:15:41.740
12. Okay, I have two daughters, 12 and five.
00:15:42.879 --> 00:15:46.450
If your daughters came to you, And they said
00:15:46.450 --> 00:15:49.450
they would like to become an orthopedic surgeon.
00:15:49.769 --> 00:15:52.789
What would you what would your response be? Yeah,
00:15:52.830 --> 00:15:54.929
I'm not one of those doctors. I was like, I'm
00:15:54.929 --> 00:15:57.450
crazy. Don't go into, you know, health care or
00:15:57.450 --> 00:16:00.470
whatever. I mean, look at the core of it when
00:16:00.470 --> 00:16:02.549
you strip away all the stuff that that makes
00:16:02.549 --> 00:16:05.399
it less appealing. It's still. a great profession.
00:16:05.639 --> 00:16:07.940
Unfortunately, I think we've lost a lot of what
00:16:07.940 --> 00:16:11.559
makes being a doctor great. But I think at the
00:16:11.559 --> 00:16:12.919
core of it, it's still there and you still have
00:16:12.919 --> 00:16:15.019
those moments. Like I was saying before, when
00:16:15.019 --> 00:16:17.299
you take that person that could barely walk when
00:16:17.299 --> 00:16:20.159
you first met them, some of them are even in
00:16:20.159 --> 00:16:23.659
wheelchairs or on walkers and they come in and
00:16:23.659 --> 00:16:26.330
you've... change their lives and some of them
00:16:26.330 --> 00:16:29.149
will tell you, look you changed my life. That's
00:16:29.149 --> 00:16:31.769
extremely rewarding and I think that's as close
00:16:31.769 --> 00:16:35.529
to a superpower as you can get. It doesn't always
00:16:35.529 --> 00:16:38.370
like that, clearly, but I think when it is it's
00:16:38.370 --> 00:16:40.330
very rewarding. I think I wish those moments
00:16:40.330 --> 00:16:43.590
were more common than they are now. So I would
00:16:43.590 --> 00:16:47.049
never, my approach when it comes to that is do
00:16:47.049 --> 00:16:50.100
what you find fulfilling. I'm here to guide you.
00:16:50.200 --> 00:16:52.120
If you're interested in being orthopedic surgeon,
00:16:52.120 --> 00:16:55.460
they're with you. Every step of the way, I would
00:16:55.460 --> 00:16:59.220
never let my own experience dissuade them from
00:16:59.220 --> 00:17:01.580
doing it. I would guide them and share my experiences,
00:17:01.580 --> 00:17:04.880
but I would never tell them, don't do it because
00:17:04.880 --> 00:17:11.299
X, Y and Z. Yeah, I've been I think if you ask
00:17:11.299 --> 00:17:14.160
physicians within and I'm going to just crossing
00:17:14.160 --> 00:17:18.920
the. the eight -year mark out of post residency.
00:17:19.319 --> 00:17:21.140
If you ask physicians around the five, six -year
00:17:21.140 --> 00:17:24.099
mark post residency, they will all say, we would
00:17:24.099 --> 00:17:26.779
never want our kids to be physicians. And then
00:17:26.779 --> 00:17:28.660
as you get more experience about other fields
00:17:28.660 --> 00:17:31.420
and how things work, you tend to get a better
00:17:31.420 --> 00:17:35.119
appreciation of how strong of a factor that immediate
00:17:35.119 --> 00:17:39.039
reward we get from our patients is, and how rare
00:17:39.039 --> 00:17:42.140
it is in other fields and other jobs. It could
00:17:42.140 --> 00:17:44.579
be congratulated every day and multiple times
00:17:44.579 --> 00:17:47.700
a day. Yeah the grass is always greener and you
00:17:47.700 --> 00:17:49.380
know the highs can be very high and the lows
00:17:49.380 --> 00:17:54.160
can be very low. And yeah I think that that five
00:17:54.160 --> 00:17:56.400
to six year mark you know you kind of you're
00:17:56.400 --> 00:17:58.839
not wide -eyed anymore you're experienced and
00:17:58.839 --> 00:18:00.720
then I think you start to feel the weight of
00:18:00.720 --> 00:18:03.900
some of that but if you can get past that period
00:18:03.900 --> 00:18:06.940
I think you learn to be a little bit easier on
00:18:06.940 --> 00:18:10.539
yourself a little bit less perfectionistic and
00:18:10.539 --> 00:18:13.890
realize that you know, it's not always going
00:18:13.890 --> 00:18:16.150
to be perfect. But at the end of the day, if
00:18:16.150 --> 00:18:19.049
you're doing the best you can, and most patients
00:18:19.049 --> 00:18:23.410
are doing well, you know, then you, I think you
00:18:23.410 --> 00:18:25.390
have to resist the tendency to be too hard on
00:18:25.390 --> 00:18:31.349
yourself. Do you think you live a balanced life?
00:18:31.390 --> 00:18:33.289
And this is coming from someone who has no balance
00:18:33.289 --> 00:18:36.529
in his life. And it's like, it's not a good thing,
00:18:36.529 --> 00:18:40.009
right? Because I work too much and right. Yeah,
00:18:40.009 --> 00:18:43.509
and I'm programmed to just work, work, work.
00:18:44.549 --> 00:18:46.769
And it's hard to undo that programming. Do you
00:18:46.769 --> 00:18:49.369
think you have that kind of inherent drive to
00:18:49.369 --> 00:18:51.150
work all the time? And if so, how do you offset
00:18:51.150 --> 00:18:53.910
that? Yeah, I think I have the drive. I think
00:18:53.910 --> 00:18:58.730
a lot of doctors have that drive. And so I've
00:18:58.730 --> 00:19:01.049
tried to be mindful, like, you know, as a full
00:19:01.049 --> 00:19:03.509
time clinical practice, I basically had almost
00:19:03.509 --> 00:19:07.259
a full time like sidekick job, but my responsibility
00:19:07.259 --> 00:19:10.240
while I was in practice was always to my patients.
00:19:10.299 --> 00:19:13.440
They came first. And then this other stuff was
00:19:13.440 --> 00:19:16.359
after hours on weekends between surgeries at
00:19:16.359 --> 00:19:19.140
lunch, you know, whatever it was. And then you
00:19:19.140 --> 00:19:21.099
have to be careful about stripping away all your
00:19:21.099 --> 00:19:24.220
free time and finding that balance. I mean, I've
00:19:23.920 --> 00:19:27.740
found the side gig work to be fulfilling and
00:19:27.740 --> 00:19:30.299
I found it to be they talk about work -life harmony
00:19:30.299 --> 00:19:32.460
instead of work -life balance and that means
00:19:32.460 --> 00:19:33.799
that you know some of the stuff if you're working
00:19:33.799 --> 00:19:35.539
all the time is always that sort of in harmony
00:19:35.539 --> 00:19:39.519
with your your life and not you know just work
00:19:39.519 --> 00:19:41.119
work work all the time or doesn't feel like work
00:19:41.119 --> 00:19:46.940
work work all the time is less taxing but I definitely
00:19:46.940 --> 00:19:49.440
had to learn how to kind of pull back and say,
00:19:49.539 --> 00:19:52.200
you know, to things or OK, it's time to shut
00:19:52.200 --> 00:19:55.920
it off. It's family time. You know, it's time
00:19:55.920 --> 00:19:58.240
to get away from it, because I think that can
00:19:58.240 --> 00:20:00.400
also obviously lead to burnout if you're not,
00:20:00.400 --> 00:20:02.420
you know, take enough time just to kind of give
00:20:02.420 --> 00:20:07.700
yourself a break. There seems to be a growing
00:20:07.700 --> 00:20:11.400
divide between leadership and health care, especially
00:20:11.400 --> 00:20:15.160
in hospitals and health systems and frontline.
00:20:15.470 --> 00:20:19.150
physicians. What do you think is the reason for
00:20:19.150 --> 00:20:22.049
that divide? And if you could change one thing
00:20:22.049 --> 00:20:25.930
about both camps, what would you change? I think
00:20:25.930 --> 00:20:29.589
the divide in part is because there's just become
00:20:29.589 --> 00:20:33.069
so many layers within the hospital health system.
00:20:33.869 --> 00:20:36.470
My dad was a hospital administrator growing up.
00:20:36.470 --> 00:20:39.910
This was the 1980s and early 90s and things were
00:20:39.910 --> 00:20:42.130
different. back then, there weren't like these
00:20:42.130 --> 00:20:45.130
multiple layers between him as the administrator,
00:20:45.289 --> 00:20:48.710
the CEO of the hospital and the doctors. You
00:20:48.710 --> 00:20:50.789
know, there was a very close connection for better
00:20:50.789 --> 00:20:52.849
or worse, because some of them could be kind
00:20:52.849 --> 00:20:56.049
of tough, doctors could be kind of tough. But
00:20:56.049 --> 00:20:59.670
now I feel like we have so many layers between.
00:20:59.920 --> 00:21:02.319
like what happens on the front lines and in the
00:21:02.319 --> 00:21:05.099
C -suite, I wish, you know, CEOs and now you
00:21:05.099 --> 00:21:06.880
have these big hospitals and health systems where
00:21:06.880 --> 00:21:09.740
the CEO of the health system might be, you know,
00:21:09.859 --> 00:21:12.140
three towns over and never even comes to the
00:21:12.140 --> 00:21:14.440
community hospital and really has a great grasp
00:21:14.440 --> 00:21:18.220
of what goes on on the front lines. I wish administrators,
00:21:18.680 --> 00:21:20.200
you know, the people that really are at the top
00:21:20.200 --> 00:21:22.200
making the decisions, spent more time on the
00:21:22.200 --> 00:21:24.799
front lines to understand, you know, what the
00:21:24.799 --> 00:21:27.359
challenges are because you don't get that looking
00:21:27.359 --> 00:21:29.619
at. spreadsheets or sitting in meetings all day,
00:21:29.700 --> 00:21:31.700
you have to actually be in there experiencing
00:21:31.700 --> 00:21:35.839
it. Um, you know, I think from a physician perspective,
00:21:35.839 --> 00:21:39.259
I think we've now developed this muscle where
00:21:39.259 --> 00:21:42.640
it's automatic, like, um, conflict when we're
00:21:42.640 --> 00:21:45.779
dealing with administrators and understand they're
00:21:45.779 --> 00:21:47.420
part of it too. You know, they have boards that
00:21:47.420 --> 00:21:49.880
they're answering to the bottom line and, you
00:21:49.880 --> 00:21:52.079
know, they're, they're responsible for fiscal
00:21:52.079 --> 00:21:54.279
results and, and things like that. And some of
00:21:54.279 --> 00:21:55.500
the things are out of their control in terms
00:21:55.500 --> 00:21:58.299
of regulations that are coming down from, you
00:21:58.299 --> 00:22:00.509
know, the government, from Jayco, from the state,
00:22:00.569 --> 00:22:03.569
whatever it is. So I think there's a middle ground
00:22:03.569 --> 00:22:06.450
there to realize that maybe look at it from each
00:22:06.450 --> 00:22:08.529
other's perspective a little bit more to have
00:22:08.529 --> 00:22:13.049
better understanding. What's something you've
00:22:13.049 --> 00:22:15.509
changed your mind on in the past couple of years?
00:22:16.930 --> 00:22:18.829
I think probably the biggest thing is I was pretty
00:22:18.829 --> 00:22:24.160
skeptical about this whole, you know, whole body
00:22:24.160 --> 00:22:27.839
MRI and lab work and wellness and prevention
00:22:27.839 --> 00:22:31.220
Type of thing. I know that's that's snake oil.
00:22:31.220 --> 00:22:33.900
I think a lot of it still is but you know, I've
00:22:33.900 --> 00:22:38.400
come around on the idea of Done appropriately
00:22:38.400 --> 00:22:41.660
early detection and having you know This more
00:22:41.660 --> 00:22:43.720
comprehensive lab work and really a deep dive
00:22:43.720 --> 00:22:45.980
in your health once a year or once every five
00:22:45.980 --> 00:22:49.240
years or whatever it is does make some sense.
00:22:49.359 --> 00:22:51.900
I think there's still the key of separating the
00:22:51.900 --> 00:22:54.519
signal from the noise, not chasing every lab
00:22:54.519 --> 00:22:56.920
value that's slightly out of range or every incidental
00:22:56.920 --> 00:23:01.150
oma. But I do think that there is a place for
00:23:01.150 --> 00:23:04.309
moving upstream a little bit, doing a better
00:23:04.309 --> 00:23:07.690
job servicing these things. Here in the US, I
00:23:07.690 --> 00:23:09.990
think your primary care has just been so compressed
00:23:09.990 --> 00:23:12.430
because of poor reimbursement, because patients
00:23:12.430 --> 00:23:15.269
are so complicated these days, and because there's
00:23:15.269 --> 00:23:18.650
just not enough time to spend with people that
00:23:18.650 --> 00:23:22.170
we don't get as deep a dive as maybe we should
00:23:22.170 --> 00:23:24.710
into some of these things. And a lot of insurance
00:23:24.710 --> 00:23:27.119
companies may not necessarily pay for because
00:23:27.119 --> 00:23:28.779
they can't see the, you know, some actuaries
00:23:28.779 --> 00:23:31.019
telling them it's not worth it. So, yeah, this
00:23:31.019 --> 00:23:35.180
whole idea of prevention early detection, you
00:23:35.180 --> 00:23:40.480
know, I've started to come around on. And do
00:23:40.480 --> 00:23:43.779
you have any thoughts on how we deal with the
00:23:43.779 --> 00:23:48.559
primary pushback we get on whole body MRIs incidentalomas
00:23:48.559 --> 00:23:52.579
and how we deal with them? Do you think that
00:23:52.579 --> 00:23:55.359
is a valid concern or do you think it's you know,
00:23:55.359 --> 00:23:58.759
we are the guinea pig generation for longevity
00:23:58.759 --> 00:24:03.160
and more focus on preventive health. Yeah, I
00:24:03.160 --> 00:24:06.119
think it's it's totally legitimate concern because,
00:24:06.119 --> 00:24:08.200
you know, MRIs, you know, has taken on sort of
00:24:08.200 --> 00:24:12.960
this mythical quality in you know, among patients
00:24:12.960 --> 00:24:17.059
that MRI sees all and MRI sees a lot and that
00:24:17.059 --> 00:24:19.960
can be a bad thing sometimes and that, you know,
00:24:19.960 --> 00:24:21.660
it doesn't necessarily give you an answer. It
00:24:21.660 --> 00:24:23.200
may see something, but it doesn't necessarily
00:24:23.200 --> 00:24:25.420
tell you what it is. It tells you what it might
00:24:25.420 --> 00:24:27.119
be potentially, and then you have to go chasing
00:24:27.119 --> 00:24:30.559
it. So I think that's definitely a concern. Hopefully,
00:24:30.759 --> 00:24:34.200
as this becomes more commonplace, we'll do better
00:24:34.200 --> 00:24:36.339
and better at separating the signal from the
00:24:36.339 --> 00:24:40.160
noise with body MRI with, you know, comprehensive
00:24:40.160 --> 00:24:43.000
labs. testing, you know, the argument, and this
00:24:43.000 --> 00:24:45.500
is part of what kind of changed my mind on it,
00:24:45.779 --> 00:24:48.200
is that, you know, should we not take advantage
00:24:48.200 --> 00:24:50.980
of this because there's the possibility of, you
00:24:50.980 --> 00:24:53.799
know, instead of Lomas or chasing thing. No,
00:24:53.920 --> 00:24:55.960
I mean, I think there's still a place for hey,
00:24:56.000 --> 00:24:58.900
let's learn. Let's maybe do it better over time.
00:24:58.940 --> 00:25:00.880
I think we still have an obligation to make sure
00:25:00.880 --> 00:25:04.259
we're not causing harm by, you know, over testing
00:25:04.259 --> 00:25:06.400
or leading to more interventions and things like
00:25:06.400 --> 00:25:08.799
that. And I think that still is to be determined.
00:25:08.799 --> 00:25:10.480
But it doesn't mean that there's not a place
00:25:10.480 --> 00:25:16.319
for figuring that out. You know, value based
00:25:16.319 --> 00:25:20.380
care, in theory, sounds amazing, right? You pay
00:25:20.380 --> 00:25:25.779
for outcomes, you pay for helping patients long
00:25:25.779 --> 00:25:30.680
-term. We all know outcomes are mostly driven
00:25:30.680 --> 00:25:34.700
by socioeconomic status, by gender, by race,
00:25:35.460 --> 00:25:40.240
and healthcare maybe contributes 20 % to your
00:25:40.240 --> 00:25:43.960
outcomes. So how do we design a value -based
00:25:43.960 --> 00:25:48.059
system which, you know, isn't just, okay, I'll
00:25:48.059 --> 00:25:54.599
just take care of, you know, because that's the
00:25:54.599 --> 00:25:58.019
group that's more likely to do the best. And
00:25:58.019 --> 00:26:00.940
people who can afford the treatment I offer will
00:26:00.940 --> 00:26:03.859
more likely benefit from it. So how do we design
00:26:03.859 --> 00:26:05.980
a value -based care system which deals with the
00:26:05.980 --> 00:26:08.660
confining variable that people who have more
00:26:08.660 --> 00:26:11.920
money to afford the best treatments are likely
00:26:11.920 --> 00:26:15.970
to have the best outcomes? Yeah, so you're sort
00:26:15.970 --> 00:26:17.890
of hinting at cherry picking and lemon dropping,
00:26:17.970 --> 00:26:20.970
which is one of the biggest criticisms, valid
00:26:20.970 --> 00:26:23.549
criticisms of value -based care. You know, we
00:26:23.549 --> 00:26:30.069
went into the CMS BPCIA program, which was for
00:26:30.069 --> 00:26:32.450
hip and knee replacements. It was voluntary,
00:26:32.589 --> 00:26:34.670
but we felt like we were doing a good enough
00:26:34.670 --> 00:26:37.390
job taking care of those patients, that we would
00:26:37.390 --> 00:26:40.910
have success in the program, and we did. You
00:26:40.910 --> 00:26:43.799
know, I... Tried not to change too much of what
00:26:43.799 --> 00:26:46.119
I was doing because before we went into the program
00:26:46.119 --> 00:26:48.240
I tried to stay on top of you know what's the
00:26:48.240 --> 00:26:51.240
latest and greatest in terms of you know treatment
00:26:51.240 --> 00:26:53.480
and I'm doing things that are appropriate not
00:26:53.480 --> 00:26:56.789
sending people to nursing homes after surgery
00:26:56.789 --> 00:26:59.210
or rehabs after surgery, sending them home because
00:26:59.210 --> 00:27:01.789
the data showed that those places were associated
00:27:01.789 --> 00:27:03.549
with increased complications, higher readmission
00:27:03.549 --> 00:27:05.809
rates. The data showed that people most people
00:27:05.809 --> 00:27:08.670
were safer going home into their own environment
00:27:08.670 --> 00:27:11.470
and trying to eliminate some of those low value
00:27:11.470 --> 00:27:14.569
treatments that drove up costs. So, you know,
00:27:14.609 --> 00:27:17.900
we still. optimized patients for surgery. We
00:27:17.900 --> 00:27:20.259
didn't say, no, you can't have surgery. We said,
00:27:20.539 --> 00:27:22.119
you're going to have surgery, but let's do some
00:27:22.119 --> 00:27:23.839
things first to get you healthier. And I think
00:27:23.839 --> 00:27:26.140
that was a good thing to get people healthier
00:27:26.140 --> 00:27:29.319
before surgery and reduce their risk of complications.
00:27:29.400 --> 00:27:31.619
If they were able to get there, then we operated
00:27:31.619 --> 00:27:34.859
on them. I think. Going forward, there has to
00:27:34.859 --> 00:27:38.019
be more sophistication in terms of how you restratify
00:27:38.019 --> 00:27:42.380
things to make sure that you're not disincentivizing
00:27:42.380 --> 00:27:45.519
treatment for more complex populations. I mean,
00:27:45.559 --> 00:27:48.180
they seem to be able to do some form of restratification
00:27:48.180 --> 00:27:51.440
for Medicare Advantage here. So I don't see why
00:27:51.440 --> 00:27:55.250
we couldn't do that for other forms of. value
00:27:55.250 --> 00:27:57.509
based care. So I think we just have to be a little
00:27:57.509 --> 00:27:59.809
bit more sophisticated with our models doesn't
00:27:59.809 --> 00:28:02.190
mean we have to make them more complicated necessarily.
00:28:02.190 --> 00:28:05.269
I think we need to make them simpler, but also
00:28:05.269 --> 00:28:07.910
have a reasonable restratification mechanism.
00:28:09.789 --> 00:28:12.890
This is a somewhat different question, although
00:28:12.890 --> 00:28:15.549
I assume it's parallel. What are your thoughts
00:28:15.549 --> 00:28:20.940
on universal basic income? Yeah, that's not something
00:28:20.940 --> 00:28:23.940
I have spent a ton of time thinking about I think
00:28:23.940 --> 00:28:27.160
there's merits to a there's pros and cons on
00:28:27.160 --> 00:28:28.980
both sides I think it's something we'll hear
00:28:28.980 --> 00:28:32.740
more about you know, with AI, if AI is going
00:28:32.740 --> 00:28:35.019
to take everybody's job, there's no jobs left.
00:28:35.140 --> 00:28:38.240
How do people live? Is it through a universal
00:28:38.240 --> 00:28:42.539
basic income? I think having a certain standard
00:28:42.539 --> 00:28:44.839
of living for people, either you have to increase
00:28:44.839 --> 00:28:47.299
the minimum wage so that people that are working
00:28:47.299 --> 00:28:49.720
hard are able to live. I mean, you shouldn't
00:28:49.720 --> 00:28:52.799
work a 40 hour a week job or multiple jobs and
00:28:52.799 --> 00:28:55.039
still not be able to live. So whether that's
00:28:55.039 --> 00:28:57.740
increasing minimum wage or universal basic income,
00:28:57.799 --> 00:29:02.119
I think ultimately that lifts everybody up and
00:29:02.119 --> 00:29:06.019
ties back to the idea that healthcare is deeply
00:29:06.019 --> 00:29:09.480
tied into social factors and things like that.
00:29:09.559 --> 00:29:13.079
So if we can get people living better, that's
00:29:13.079 --> 00:29:14.759
the solution I don't think is talked about enough
00:29:14.759 --> 00:29:17.880
in terms of solving healthcare because we always
00:29:17.880 --> 00:29:20.779
talk about how America has this terrible healthcare
00:29:20.779 --> 00:29:23.759
system and the outcomes. It's not that the outcomes
00:29:23.759 --> 00:29:26.630
are bad, it's that there's so many social factors,
00:29:26.690 --> 00:29:31.109
your access to care, access to mental health
00:29:31.109 --> 00:29:35.069
resources, you know, access to income. So we
00:29:35.069 --> 00:29:37.250
don't have violent deaths, we don't have people
00:29:37.250 --> 00:29:41.049
that are kind of forced to make poor health choices,
00:29:41.049 --> 00:29:46.450
because that's really all they can do. Why did
00:29:46.450 --> 00:29:49.309
you do an MBA? And is it something you'd recommend
00:29:49.309 --> 00:29:53.380
to physicians? I did it because as I got more
00:29:53.380 --> 00:29:56.660
involved in the entrepreneurship, investing,
00:29:57.180 --> 00:29:59.279
and even in my practice, I became a part owner
00:29:59.279 --> 00:30:03.599
in a surgery center. We ended up pursuing a private
00:30:03.599 --> 00:30:06.579
equity sale of our practice. I wanted to understand
00:30:06.579 --> 00:30:10.259
the language of business better. I didn't expect
00:30:10.259 --> 00:30:13.140
to walk into a Fortune 500 company and take over,
00:30:13.180 --> 00:30:16.210
but it was more... What does that mean? What's
00:30:16.210 --> 00:30:19.069
a P and L statement? What are leadership types?
00:30:19.289 --> 00:30:21.309
What is marketing? What are market for you? All
00:30:21.309 --> 00:30:25.089
these things just to try to understand them better.
00:30:26.470 --> 00:30:29.390
I did an online MBA. It was self -paced. It was
00:30:29.390 --> 00:30:31.809
very reasonably priced. I wasn't going to spend
00:30:31.809 --> 00:30:35.480
six figures and take. six months to a year out
00:30:35.480 --> 00:30:38.500
of my practice to go do it. I worked it into
00:30:38.500 --> 00:30:40.599
my practice because it was self -paced and it
00:30:40.599 --> 00:30:43.240
was very recently priced and I got out of it
00:30:43.240 --> 00:30:45.400
what I wanted to get out of it. I think if you
00:30:45.400 --> 00:30:48.059
go into an MBA thinking that getting that degree
00:30:48.059 --> 00:30:50.460
is going to magically just open doors for you,
00:30:50.480 --> 00:30:55.589
I think that's a mistaken notion. I don't think
00:30:55.589 --> 00:30:58.150
it's necessarily going to pry open a bunch of
00:30:58.150 --> 00:31:00.670
doors. And I worry a little bit that, as you
00:31:00.670 --> 00:31:02.509
talked about, if you have doctors that are sort
00:31:02.509 --> 00:31:05.289
of running away, that they feel like an MBA is
00:31:05.289 --> 00:31:08.109
going to be a thing that gives them that landing
00:31:08.109 --> 00:31:09.930
spot. I don't think that that's necessarily the
00:31:09.930 --> 00:31:12.250
case. Now, if you go to a Harvard Business School,
00:31:12.369 --> 00:31:17.089
or you go to Stanford GSB, or at MIT, and you
00:31:17.089 --> 00:31:19.730
go to those programs. probably at least you can
00:31:19.730 --> 00:31:22.089
network. You'll have good networking opportunities.
00:31:22.150 --> 00:31:23.970
It might open some doors for you, but you're
00:31:23.970 --> 00:31:26.049
going to spend a lot of money, a lot of time
00:31:26.049 --> 00:31:30.150
doing that. How have your startup investments
00:31:30.150 --> 00:31:33.869
gone and what was your diligence thesis or criteria?
00:31:35.309 --> 00:31:40.309
So far, let's see, maybe four or five years into
00:31:40.309 --> 00:31:45.890
it, it's been a mixed bag. So I think I've had
00:31:45.890 --> 00:31:50.069
my first Official exit as an angel investor the
00:31:50.069 --> 00:31:53.650
company got acquired. I got nothing Because I
00:31:53.650 --> 00:31:57.690
was an early angel investor. They raised money
00:31:57.690 --> 00:32:00.470
Quite a bit of money and then had a significant
00:32:00.470 --> 00:32:04.789
down round I my shares I didn't put in more money
00:32:04.789 --> 00:32:06.829
So my preferred shares got converted to common
00:32:06.829 --> 00:32:09.890
stock and then once they sold because they were
00:32:09.890 --> 00:32:12.390
you know underwater with the waterfalls I ended
00:32:12.390 --> 00:32:15.730
up with nothing So it was an interesting experience,
00:32:15.730 --> 00:32:18.359
but that didn't do so well. I've had a couple
00:32:18.359 --> 00:32:22.799
of others that flamed out. So I think I've made
00:32:22.799 --> 00:32:26.619
10 investments so far. So one exit where I got
00:32:26.619 --> 00:32:29.259
nothing, two that folded, the rest are still
00:32:29.259 --> 00:32:32.359
going. And the ones that are still going seem
00:32:32.359 --> 00:32:34.359
to be doing fairly well. I have another company
00:32:34.359 --> 00:32:38.200
that looks like it's on the verge of being acquired.
00:32:38.279 --> 00:32:41.329
And I probably will see. uh some return on investment
00:32:41.329 --> 00:32:44.269
and that was that'll be my first win i also so
00:32:44.269 --> 00:32:47.509
i got some stock options i wrote articles for
00:32:47.509 --> 00:32:50.980
doximity so doximity um has the op -med fellows
00:32:50.980 --> 00:32:53.119
program and i wrote a series of articles for
00:32:53.119 --> 00:32:55.339
them and they paid you in stock options and i
00:32:55.339 --> 00:32:57.859
was fortunate enough to get my stock options
00:32:57.859 --> 00:33:00.440
right before doximity went public and they were
00:33:00.440 --> 00:33:02.880
kind enough to double the stock options for us
00:33:02.880 --> 00:33:05.160
right before it went public so yeah it wasn't
00:33:05.160 --> 00:33:07.559
a huge amount of money but it was um it was a
00:33:07.559 --> 00:33:11.940
decent win and then i did some advising for uh
00:33:11.940 --> 00:33:15.480
another company that's well known in the digital
00:33:15.480 --> 00:33:19.000
health MSK space that will probably go public,
00:33:19.000 --> 00:33:21.519
I would guess, in the next year or two. I got
00:33:21.519 --> 00:33:24.579
some stock options or some options for doing
00:33:24.579 --> 00:33:26.720
that consulting work, and I exercise those options.
00:33:26.740 --> 00:33:31.599
And they've had a couple of buybacks, so to speak.
00:33:32.000 --> 00:33:33.380
And so I've been able to cash in some of those.
00:33:34.160 --> 00:33:37.099
So I guess I've had more success with my advisor
00:33:37.099 --> 00:33:39.380
shares than I have with my direct angel investments
00:33:39.380 --> 00:33:44.910
so far. And what was your criteria for the startups
00:33:44.910 --> 00:33:48.349
you picked? Yeah, the criteria was initially,
00:33:48.849 --> 00:33:51.970
is it something I feel like I can add value to
00:33:51.970 --> 00:33:55.950
and learn from, was initially my criteria. And
00:33:55.950 --> 00:33:58.289
then the criteria kind of became, was it something
00:33:58.289 --> 00:34:02.289
I believe in that's fixing a real problem? And
00:34:02.289 --> 00:34:05.609
then the criteria kind of became, do I believe
00:34:05.609 --> 00:34:09.530
in this founder? Does this person seem to have
00:34:09.530 --> 00:34:12.070
a clearer vision? Do they seem to be driven?
00:34:13.110 --> 00:34:15.070
So then it became kind of a combination of those
00:34:15.070 --> 00:34:17.449
things. So more of a gut feel. I can't tell you,
00:34:17.449 --> 00:34:21.630
I did a lot of high level VC level due diligence.
00:34:22.150 --> 00:34:25.130
And I never put in a ton of money. I kind of
00:34:25.130 --> 00:34:27.449
spread it out, small investments here or there.
00:34:27.489 --> 00:34:34.550
But it was just a really gut feel. What is something
00:34:34.550 --> 00:34:38.110
technical? Builders get wrong about healthcare.
00:34:40.030 --> 00:34:42.170
There's a lot in healthcare. I think from the
00:34:42.170 --> 00:34:45.550
outside and I think you'd probably agree that
00:34:45.550 --> 00:34:48.769
seems intuitive from the outside, but when you're
00:34:48.769 --> 00:34:50.610
in it, it's sort of counterintuitive and you
00:34:50.610 --> 00:34:54.489
don't understand like somebody was. tweeting
00:34:54.489 --> 00:34:58.210
recently about being frustrated about being on
00:34:58.210 --> 00:35:00.170
the wait list to be seen at a specialty clinic
00:35:00.170 --> 00:35:02.030
and their appointment was a couple of months
00:35:02.030 --> 00:35:04.849
out and they asked to be on a wait list for the
00:35:04.849 --> 00:35:06.610
appointment and then they happened to call up
00:35:06.610 --> 00:35:09.030
about something else and happened to just ask
00:35:09.030 --> 00:35:12.150
the person they talked to and were able to get
00:35:12.150 --> 00:35:14.429
in the next day. So it's like, how is this broken
00:35:14.429 --> 00:35:16.230
that they have this wait list and I've been on
00:35:16.230 --> 00:35:17.769
this wait list for two months. I just happened
00:35:17.769 --> 00:35:20.210
to randomly call up and got in the next day.
00:35:21.389 --> 00:35:25.010
And the reality is that scheduling is very complex
00:35:25.010 --> 00:35:26.510
and it seems like it's an easy thing to have
00:35:26.510 --> 00:35:28.110
a wait list somebody you know something opens
00:35:28.110 --> 00:35:29.449
up and somebody's going to get off the wait list
00:35:29.449 --> 00:35:32.030
but there's so much that goes on behind the scenes
00:35:32.030 --> 00:35:34.730
in terms of how you manage you know clinic appointments
00:35:34.730 --> 00:35:36.309
and somebody can't send their appointment the
00:35:36.309 --> 00:35:38.230
last minute and then having to somebody having
00:35:38.230 --> 00:35:39.949
to go through the wait list and call people and
00:35:39.949 --> 00:35:41.570
maybe the first three people you call don't pick
00:35:41.570 --> 00:35:43.909
up or they can't come in and now that person
00:35:43.909 --> 00:35:46.829
who's probably doing five other jobs is now having
00:35:46.829 --> 00:35:49.909
to spend time doing that, as opposed to it's
00:35:49.909 --> 00:35:51.989
just easier if somebody calls up that day and
00:35:51.989 --> 00:35:54.030
an appointment pops up that day. It's just easier
00:35:54.030 --> 00:35:56.510
to slot that person in than go through, you know,
00:35:56.670 --> 00:35:59.329
track down a wait list. Things like that. I mean,
00:35:59.329 --> 00:36:01.030
I think there's things that happen behind the
00:36:01.030 --> 00:36:04.710
scenes that are more complex and seem more straightforward
00:36:04.710 --> 00:36:06.610
from the outside. But then when you're in it
00:36:06.610 --> 00:36:08.289
and you've experienced, you realize there are
00:36:08.289 --> 00:36:09.909
things that maybe you're not considering that
00:36:09.909 --> 00:36:12.329
make it more complex. I'm not saying that's right.
00:36:12.449 --> 00:36:14.210
I'm not saying there aren't ways to make it less
00:36:14.210 --> 00:36:16.969
complex. But as it exists now, I think there's
00:36:16.969 --> 00:36:19.010
a complexity to even some of the things that
00:36:19.010 --> 00:36:22.269
seem really straightforward that people don't
00:36:22.269 --> 00:36:24.010
necessarily understand. A lot of it has to do
00:36:24.010 --> 00:36:27.130
with workflows of back office functions and things
00:36:27.130 --> 00:36:33.840
like that. What is the role of robotics and AI
00:36:33.840 --> 00:36:36.380
in ortho and what are you excited about for the
00:36:36.380 --> 00:36:40.059
future of ortho? So we've had a lot of robotics
00:36:40.059 --> 00:36:44.059
in ortho. I call it the robot wars And so there's
00:36:44.059 --> 00:36:46.019
robotic hip into your placement. That's really
00:36:46.019 --> 00:36:49.030
taken off. It's become more and more prevalent
00:36:49.030 --> 00:36:51.829
and I've done that in my career. If you look
00:36:51.829 --> 00:36:54.210
at the data, you know, the data isn't quite there
00:36:54.210 --> 00:36:56.809
yet in terms of superiority of robotics and like
00:36:56.809 --> 00:36:58.570
a lot of things in healthcare you have your camps,
00:36:58.869 --> 00:37:00.690
you know, people in robotic camp that say it's
00:37:00.690 --> 00:37:02.369
clearly better and people in non -robotic camp
00:37:02.369 --> 00:37:04.349
that say it's not and it's too expensive and
00:37:04.349 --> 00:37:07.210
it's, you know, blindly trusting technology.
00:37:07.869 --> 00:37:10.849
I think The potential is certainly there. I think
00:37:10.849 --> 00:37:12.610
we have to get more sophisticated with it. I
00:37:12.610 --> 00:37:14.889
think we have to learn how to use the robot better
00:37:14.889 --> 00:37:17.690
as a tool. So I think, you know, now the robots
00:37:17.690 --> 00:37:20.110
have been around for I think 10 years at least
00:37:20.110 --> 00:37:21.809
and we're gathering more data and we can look
00:37:21.809 --> 00:37:24.269
at that data and we can become better with the
00:37:24.269 --> 00:37:28.110
robots based on what we're data that we're gathering.
00:37:28.409 --> 00:37:30.769
And I think robotics will continue to. become
00:37:30.769 --> 00:37:32.570
higher and higher yield and eventually be proven
00:37:32.570 --> 00:37:36.690
to be superior probably to non -robotics. So
00:37:36.690 --> 00:37:39.269
I think AI will help us get there by taking in
00:37:39.269 --> 00:37:41.550
large amounts of data, unstructured data, structured
00:37:41.550 --> 00:37:44.190
data, you know, parsing through it and helping
00:37:44.190 --> 00:37:47.590
us figure out how best to use the robots and
00:37:47.590 --> 00:37:50.519
really personalize care. I think that's part
00:37:50.519 --> 00:37:53.099
of the challenge that we have particularly in
00:37:53.099 --> 00:37:55.820
hip and knee replacements is classically you're
00:37:55.820 --> 00:37:57.960
taught to kind of do it the same for everybody.
00:37:58.099 --> 00:38:00.139
But in reality, people's anatomy is different.
00:38:00.440 --> 00:38:02.300
We just don't know how it's different from one
00:38:02.300 --> 00:38:04.559
person to the next and how you tailor it from
00:38:04.559 --> 00:38:06.000
one person to the next. So you kind of treat
00:38:06.000 --> 00:38:08.059
everybody the same way. And you're going to capture
00:38:08.059 --> 00:38:12.800
80%, 90%, 75 % of people doing it the same for
00:38:12.800 --> 00:38:14.860
everybody. But you're going to have that 10 %
00:38:14.860 --> 00:38:18.800
to 20 % who don't need the standard hip or knee
00:38:18.800 --> 00:38:20.780
replacement needs something a little bit different.
00:38:20.820 --> 00:38:22.920
And we just don't have great tools to identify
00:38:22.920 --> 00:38:24.500
who those people are. And then even if we do
00:38:24.500 --> 00:38:26.659
identify them, what they do need. So I think
00:38:26.659 --> 00:38:29.820
robotics and AI are going to help us there. I
00:38:29.820 --> 00:38:32.500
think the other big thing with AI is being able
00:38:32.500 --> 00:38:35.940
to tailor non -surgical treatment or figure out
00:38:35.940 --> 00:38:39.260
what the best treatment is for that particular
00:38:39.260 --> 00:38:41.860
individual and be a little bit more personalized
00:38:41.860 --> 00:38:48.820
in terms of our treatments. Do you think AI will
00:38:48.820 --> 00:38:51.699
replace the family physician? And then do you
00:38:51.699 --> 00:38:54.019
think AI will replace the orthopedic surgeon?
00:38:54.500 --> 00:38:56.559
And if it does, which one will happen first?
00:38:57.739 --> 00:39:02.139
That's the hot button topic. I think the AI models
00:39:02.139 --> 00:39:04.260
will get better and better. It's very hard right
00:39:04.260 --> 00:39:08.380
now to, I think, parse through what's real and
00:39:08.380 --> 00:39:11.519
what's hype in terms of you pass USMLE or you
00:39:11.519 --> 00:39:14.300
pass this test, you pass that test. Well, I think
00:39:14.300 --> 00:39:17.840
people overestimate how much the sort of the
00:39:17.840 --> 00:39:20.699
diagnosis issue plays into things in health care.
00:39:20.820 --> 00:39:23.559
At least for orthopedics, the diagnosis isn't
00:39:23.559 --> 00:39:28.539
usually all that confusing or the diagnosis part
00:39:28.539 --> 00:39:30.820
of it isn't necessarily the hard part of it.
00:39:31.039 --> 00:39:34.199
The hard part of it is talking through the patient
00:39:34.199 --> 00:39:36.619
what the problem is, what the solutions are,
00:39:36.980 --> 00:39:39.980
choosing the right solution. what to do if the
00:39:39.980 --> 00:39:42.099
patient chooses a low value solution, what to
00:39:42.099 --> 00:39:44.440
do if the patient doesn't, you know, agree with
00:39:44.440 --> 00:39:46.380
the treatment recommendation. And I'm not sure
00:39:46.380 --> 00:39:48.940
that that's, you know, is that something AI is
00:39:48.940 --> 00:39:51.139
going to resolve? Is it something AI can't resolve?
00:39:51.340 --> 00:39:52.800
I think a lot of the companies that are pushing
00:39:52.800 --> 00:39:54.980
AI solutions don't want to, you know, be responsible
00:39:54.980 --> 00:39:57.739
for that, you know, discussion that decision
00:39:57.739 --> 00:40:00.400
making. So I mean, to get back to the original
00:40:00.400 --> 00:40:04.300
question, I think AI tools will help, but I think
00:40:04.300 --> 00:40:06.880
there's still the human element of medicine that
00:40:06.880 --> 00:40:11.699
people underestimate that You know, AI can seem
00:40:11.699 --> 00:40:14.360
empathetic, but at the end of the day, you know,
00:40:14.500 --> 00:40:16.679
how far is a patient going to be willing to go
00:40:16.679 --> 00:40:19.199
back and forth with the AI before they want somebody
00:40:19.199 --> 00:40:22.500
to, you know, really discuss with them or give
00:40:22.500 --> 00:40:25.860
them, you know, a little bit of a more less prescriptive
00:40:25.860 --> 00:40:28.940
answer, I guess, for lack of a better term. Will
00:40:28.940 --> 00:40:32.320
AI replace family physicians or orthopedic surgeons
00:40:32.320 --> 00:40:36.110
first? I think there's definitely a future where
00:40:36.110 --> 00:40:39.150
robots are able to do a hip or knee replacement
00:40:39.150 --> 00:40:43.110
without the surgeon needing to touch the robot.
00:40:43.230 --> 00:40:45.010
I think there are already companies working on
00:40:45.010 --> 00:40:48.429
that. You know, once the robot still has to learn
00:40:48.429 --> 00:40:50.170
how to do the exposure, maybe someday they'll
00:40:50.170 --> 00:40:52.389
learn how to do that. But you may replace the
00:40:52.389 --> 00:40:54.730
surgeon with just a technician who doesn't go
00:40:54.730 --> 00:40:57.130
through a full training, but just kind of monitors
00:40:57.130 --> 00:41:00.780
the robot. I don't think we're there yet. I think
00:41:00.780 --> 00:41:02.800
that's going to take a long time. I think it
00:41:02.800 --> 00:41:04.880
will take time for patients to trust that. So
00:41:04.880 --> 00:41:08.340
if, I think this is a big if, AI is going to
00:41:08.340 --> 00:41:11.320
replace somebody, it's probably going to be the
00:41:11.320 --> 00:41:14.659
so -called cognitive specialties before the surgical
00:41:14.659 --> 00:41:17.199
procedural specialties. But I think we're a long
00:41:17.199 --> 00:41:19.599
way off from both of those things. And I think
00:41:19.599 --> 00:41:23.019
people also overestimate the degree to which
00:41:23.019 --> 00:41:25.619
patients want that. I think there's still a large
00:41:25.619 --> 00:41:29.059
amount of skepticism and distrust. towards AI
00:41:29.059 --> 00:41:31.659
that gets discounted in the circles that we sort
00:41:31.659 --> 00:41:34.280
of run in because there's a lot of interest and
00:41:34.280 --> 00:41:36.059
we kind of end up in this echo chamber, these
00:41:36.059 --> 00:41:39.360
small spheres of. innovators, health tech people,
00:41:39.860 --> 00:41:41.820
entrepreneurs, investors that are really bullish
00:41:41.820 --> 00:41:44.739
on AI and health care. But if you look at the
00:41:44.739 --> 00:41:47.139
studies that come out, you know, patients like
00:41:47.139 --> 00:41:49.219
AI until they figure out it's AI and then they
00:41:49.219 --> 00:41:53.039
don't like it so much. And so I think we're still
00:41:53.039 --> 00:41:56.000
underestimating the degree to which the demand
00:41:56.000 --> 00:41:59.699
on the part of patients is there. There's definitely
00:41:59.699 --> 00:42:01.820
a subset of people that are very frustrated with
00:42:01.820 --> 00:42:04.380
traditional health care and would go to an AI.
00:42:04.840 --> 00:42:06.900
you know, chatbot or whatever in a minute, because
00:42:06.900 --> 00:42:08.639
they're so fed up with the traditional system.
00:42:08.820 --> 00:42:10.679
And I think they, you know, maybe get a little
00:42:10.679 --> 00:42:14.780
bit more attention than the 60, 70, 80 % of other
00:42:14.780 --> 00:42:18.480
people that still want human interaction. Yeah,
00:42:18.480 --> 00:42:22.340
I love talking to AI Gemini, and chat jibbity
00:42:22.340 --> 00:42:25.219
and AI agents as well. They always tell me a
00:42:25.219 --> 00:42:29.380
brilliant time. Yeah. That's the other part,
00:42:29.400 --> 00:42:31.320
right? They're very there and they're they're
00:42:31.320 --> 00:42:33.679
made that way They're made to be affirming and
00:42:33.679 --> 00:42:36.599
they're made to sort of be, you know, not necessarily
00:42:36.599 --> 00:42:39.480
sycophantic Although obviously chat GPT 4o kind
00:42:39.480 --> 00:42:42.219
of tipped over in that direction But yeah, I
00:42:42.219 --> 00:42:44.000
mean the more you talk with it the more the more
00:42:44.000 --> 00:42:47.159
great you become and what's yeah And again, the
00:42:47.159 --> 00:42:48.739
models can be tuned in different ways, but it's
00:42:48.739 --> 00:42:50.920
a little bit You know disturbing that you can
00:42:50.920 --> 00:42:53.059
kind of lead the witness and if you talk to chat
00:42:53.059 --> 00:42:55.219
GPT or Gemini long enough eventually They'll
00:42:55.219 --> 00:42:56.900
start to you know, tell you what you want to
00:42:56.900 --> 00:42:58.489
hear. They'll just base basically echo back to
00:42:58.489 --> 00:43:00.849
you what you're suggesting to them. And that
00:43:00.849 --> 00:43:03.110
can be very dangerous in healthcare. It can lead
00:43:03.110 --> 00:43:05.829
to poor decisions that seem like the right decision.
00:43:06.929 --> 00:43:11.110
Do you think that's good for mental health? Chat
00:43:11.110 --> 00:43:16.710
bots and AI? Yeah. I think it can be, but I think
00:43:16.710 --> 00:43:19.610
it can just like social media. It can be, but
00:43:19.610 --> 00:43:22.550
it can very quickly become not so good for your
00:43:22.550 --> 00:43:24.809
mental health. I mean, there were stories that
00:43:24.809 --> 00:43:27.619
were coming out of the revolt against GPT -5
00:43:27.619 --> 00:43:30.480
and people were very upset that GPT -4 went away
00:43:30.480 --> 00:43:32.960
because they had bonded with it and people were
00:43:32.960 --> 00:43:35.500
so upset they were crying. I think that that's
00:43:35.500 --> 00:43:39.179
probably not the best thing. And so I think like
00:43:39.179 --> 00:43:41.559
any tool that gives you that feedback, it probably
00:43:41.559 --> 00:43:43.780
is giving you the same dopamine hit that social
00:43:43.780 --> 00:43:46.340
media gives you and maybe even worse because
00:43:46.340 --> 00:43:49.019
you can kind of tune it to give you the dopamine
00:43:49.019 --> 00:43:51.579
hits that you want. I think that's dangerous.
00:43:52.820 --> 00:43:56.650
And why is it dangerous? Well, I think it's dangerous
00:43:56.650 --> 00:43:58.429
because you kind of get sucked into that world
00:43:58.429 --> 00:44:00.150
the same way you can get sucked into social media
00:44:00.150 --> 00:44:04.130
and kind of lose track of you know, what is reality
00:44:04.130 --> 00:44:07.570
to lose track of being grounded and start to
00:44:07.570 --> 00:44:10.170
You know believe things that aren't necessarily
00:44:10.170 --> 00:44:13.489
true or get the same thing as you can go down
00:44:13.489 --> 00:44:17.530
a rabbit hole with social media of being fed
00:44:17.530 --> 00:44:19.769
things that seem like they're true but aren't.
00:44:19.949 --> 00:44:23.349
I think there's the risk with AI that it's telling
00:44:23.349 --> 00:44:25.389
you how great you are, and maybe you aren't really
00:44:25.389 --> 00:44:27.869
that great, or maybe there are things that you
00:44:27.869 --> 00:44:31.469
need to fix or be aware of, and it's sort of
00:44:31.469 --> 00:44:33.590
telling you to justify that. No, you're right,
00:44:33.670 --> 00:44:36.630
and everybody else is wrong, and maybe you aren't
00:44:36.630 --> 00:44:41.440
right. Do you and so my listeners will be used
00:44:41.440 --> 00:44:44.159
to this, but let's go a little bit deeper here.
00:44:44.719 --> 00:44:50.179
Do you think ignorance is bliss? And if so, if
00:44:50.179 --> 00:44:52.059
someone tells you you're right, even if you're
00:44:52.059 --> 00:44:54.179
not and gives you constant validation and you
00:44:54.179 --> 00:44:57.980
fall in love with a robot like her, should we
00:44:57.980 --> 00:45:01.099
deny that for you? If that will lead to happiness
00:45:01.099 --> 00:45:05.059
as happiness, the objective. or is objective
00:45:05.059 --> 00:45:07.860
reaching the truth? And if it's the latter, why
00:45:07.860 --> 00:45:12.900
is that? Why isn't happiness? Yeah, I think we
00:45:12.900 --> 00:45:16.199
would love for ignorance to be blessed because
00:45:16.199 --> 00:45:19.780
facing the truth is painful. But I think there
00:45:19.780 --> 00:45:23.539
is, you know, danger in the ignorance is bliss
00:45:23.539 --> 00:45:26.880
because how long can that continue? You know,
00:45:26.880 --> 00:45:29.599
at some point you may have to face the truth
00:45:29.599 --> 00:45:32.539
whether you want to or not. And I think that
00:45:32.539 --> 00:45:36.219
that can be very painful. I think there's very
00:45:36.219 --> 00:45:38.460
much a parallel in medicine. And I think that's
00:45:38.460 --> 00:45:42.320
why it's going to be hard to have AI replace
00:45:42.320 --> 00:45:45.940
humans in health care. Because if the AI, let's
00:45:45.940 --> 00:45:48.900
say somebody comes in. They have knee arthritis.
00:45:49.960 --> 00:45:51.719
And they get an MRI. They have a meniscus tear.
00:45:51.800 --> 00:45:53.599
And their neighbor had a knee scope. And they
00:45:53.599 --> 00:45:55.440
really want a knee scope. And I sit there and
00:45:55.440 --> 00:45:58.440
tell them, look, you're past the point of a knee
00:45:58.440 --> 00:46:02.500
scope. you know, the really it's either knee
00:46:02.500 --> 00:46:05.340
replacement or, you know, not awkward treatment,
00:46:05.380 --> 00:46:06.940
but that patient's adamant that they want a knee
00:46:06.940 --> 00:46:09.639
scope. And I know that that is, you know, low
00:46:09.639 --> 00:46:14.159
value treatment. You know, at what point does
00:46:14.159 --> 00:46:17.139
ignorance, you know, it's not my job to hide
00:46:17.139 --> 00:46:18.980
the truth from them and just say, you know what,
00:46:19.239 --> 00:46:21.590
this person wants that knee scope. I know it's
00:46:21.590 --> 00:46:23.530
not the best option for them. I know they're
00:46:23.530 --> 00:46:25.530
probably going to do worse with that. But ignorance
00:46:25.530 --> 00:46:27.730
is bliss for that patient. If they don't know
00:46:27.730 --> 00:46:30.889
that going into it, no harm, no foul. But eventually,
00:46:30.909 --> 00:46:33.650
they're going to find out afterwards that ignorance
00:46:33.650 --> 00:46:36.949
is not bliss. So yes, it would be a lot easier
00:46:36.949 --> 00:46:39.750
to just go along with it and say, have that surgery.
00:46:39.829 --> 00:46:41.889
Even if I know that surgery is unlikely to help
00:46:41.889 --> 00:46:44.369
you, that's the path of least resistance rather
00:46:44.369 --> 00:46:48.070
than the truth, which is more painful, that less
00:46:48.070 --> 00:46:50.889
invasive surgery, that's not a a painful long
00:46:50.889 --> 00:46:54.050
recovery knee replacement is not gonna help you.
00:46:54.289 --> 00:46:56.949
So I think, you know, ignorance is bliss until
00:46:56.949 --> 00:46:59.590
it isn't. And sometimes you have to face those
00:46:59.590 --> 00:47:02.429
hard truths. And that's, you know, part of medicine.
00:47:02.449 --> 00:47:06.010
And I think it's part of life. Do you think this
00:47:06.010 --> 00:47:10.210
is something founders and non -founders who don't
00:47:10.210 --> 00:47:11.929
have a healthcare background, building in medicine
00:47:11.929 --> 00:47:16.650
get wrong, that they just want to maximize press
00:47:16.650 --> 00:47:19.309
gainy scores or patient satisfaction scores and
00:47:19.309 --> 00:47:22.469
surveys? And they know the way to maximize is
00:47:22.469 --> 00:47:24.690
give the patient what they request, what they
00:47:24.690 --> 00:47:29.269
want, not what they need. dangerous. I think
00:47:29.269 --> 00:47:31.530
there, you know, I get, I don't want to say battles,
00:47:31.690 --> 00:47:34.090
but disagreements sometimes on social media about
00:47:34.090 --> 00:47:37.130
this, of this idea of consumerization in healthcare,
00:47:37.389 --> 00:47:39.889
right? If you're treating the patient as a customer,
00:47:39.889 --> 00:47:43.670
and you take the idea in business that the customer
00:47:43.670 --> 00:47:46.170
is always right, then, you know, the patient
00:47:46.170 --> 00:47:48.670
is going to come in and dictate care. And I don't
00:47:48.670 --> 00:47:50.809
think it should be a paternalistic model. I think
00:47:50.809 --> 00:47:54.590
shared decision making is the right model. It
00:47:54.590 --> 00:47:56.789
shouldn't be me as a doctor telling the patient,
00:47:56.949 --> 00:48:00.059
you know, what the treatment's going to be. But
00:48:00.059 --> 00:48:01.940
I think the flip side of that is a patient dictating
00:48:01.940 --> 00:48:03.659
treatment. Look, if we want a healthcare system,
00:48:03.900 --> 00:48:06.179
if we say we want value -based care, or we say
00:48:06.179 --> 00:48:08.840
we want evidence -based care, or we say we want
00:48:08.840 --> 00:48:11.780
high -value care, you can't slam doctors for
00:48:11.780 --> 00:48:14.079
offering low -value treatments because they get
00:48:14.079 --> 00:48:16.760
paid for it. At the same time, slam doctors for
00:48:16.760 --> 00:48:18.659
gatekeeping care or being paternalistic. You
00:48:18.659 --> 00:48:21.659
have to find that middle ground between the two
00:48:21.659 --> 00:48:23.320
of those things. And I think that is something
00:48:23.320 --> 00:48:25.949
that gets. overlooked. And the most difficult
00:48:25.949 --> 00:48:28.210
conversations I had throughout my career were
00:48:28.210 --> 00:48:30.829
the ones where a person, you know, was really
00:48:30.829 --> 00:48:32.849
adamant that they wanted surgery, which I get,
00:48:32.849 --> 00:48:35.130
you know, paid more to do, right? I mean, I,
00:48:35.269 --> 00:48:37.590
you know, if somebody says I want surgery, and
00:48:37.590 --> 00:48:39.269
I'm just the fee for service, you know, surgeon
00:48:39.269 --> 00:48:41.010
wants to get paid, sure, even if I don't think
00:48:41.010 --> 00:48:43.030
that surgery is indicated, okay, it's very easy,
00:48:43.130 --> 00:48:45.030
you know, sure, I'll sign up for surgery if you
00:48:45.030 --> 00:48:47.340
want surgery. it's not always the right thing
00:48:47.340 --> 00:48:49.300
to do. And those are the difficult conversations
00:48:49.300 --> 00:48:51.860
to, it's incumbent on me to explain the rationale
00:48:51.860 --> 00:48:56.980
of why that is. But at the same time, I, in my
00:48:56.980 --> 00:49:00.619
judgment, am trying to prevent a bad outcome
00:49:00.619 --> 00:49:04.639
and do what in my experience and my judgment,
00:49:05.219 --> 00:49:08.260
or at least explain to the patient what in my
00:49:08.260 --> 00:49:10.800
best judgment is the right course of action.
00:49:10.820 --> 00:49:13.650
And then it becomes, you know, Well, it doesn't
00:49:13.650 --> 00:49:15.389
matter what you want, doctor. If the patient
00:49:15.389 --> 00:49:16.949
wants the surgery, the patient should have the
00:49:16.949 --> 00:49:18.550
surgery. How do we reconcile that? And I think
00:49:18.550 --> 00:49:21.650
that gets overlooked a lot of the time of, well,
00:49:21.670 --> 00:49:23.010
it's just doctor's gatekeeping. You don't want
00:49:23.010 --> 00:49:24.610
me to have this. You don't want me to have that.
00:49:25.429 --> 00:49:28.829
But there is sometimes a reason behind that.
00:49:29.400 --> 00:49:32.219
again, it's incumbent on me to explain that rationale
00:49:32.219 --> 00:49:35.039
and to, you know, engender enough trust in the
00:49:35.039 --> 00:49:37.079
patient that they at least take what I have to
00:49:37.079 --> 00:49:39.579
say to heart, they may not follow it. And that's,
00:49:39.579 --> 00:49:42.139
you know, it's not up to me to be prescriptive
00:49:42.139 --> 00:49:45.320
to them, they should have the autonomy and the
00:49:45.320 --> 00:49:49.159
the agency to make those decisions. But I think,
00:49:49.159 --> 00:49:51.260
you know, at the end of the day, the the customer
00:49:51.260 --> 00:49:54.199
is always right is not the best way to practice
00:49:54.199 --> 00:49:58.559
healthcare. If there's a system where you know,
00:49:58.980 --> 00:50:02.260
we're operating healthcare as a buffet or a McDonald's
00:50:02.260 --> 00:50:05.719
drive -thru and patients get to pick what they
00:50:05.719 --> 00:50:07.940
want. Say they get to pick they want surgery
00:50:07.940 --> 00:50:10.079
and if you're operating in that system you have
00:50:10.079 --> 00:50:13.559
to provide it even though you know it may actually
00:50:13.559 --> 00:50:16.960
lead to net harm for this patient and for this
00:50:16.960 --> 00:50:22.210
situation. If that system exists Should we also
00:50:22.210 --> 00:50:25.610
build a parallel liability legal system which
00:50:25.610 --> 00:50:30.329
allows the patient to assume full liability and
00:50:30.329 --> 00:50:35.630
they can sign off their right to sue? Because
00:50:35.630 --> 00:50:37.550
currently the current system, they can't do that.
00:50:37.789 --> 00:50:41.329
Even if you do what the patient wants, I guess
00:50:41.329 --> 00:50:43.710
you're better judgment. If there's a negative
00:50:43.710 --> 00:50:46.460
outcome, the patient can still sue you. and no
00:50:46.460 --> 00:50:49.159
amount of notes that I told them. So that's not
00:50:49.159 --> 00:50:50.940
going to protect you because you still performed
00:50:50.940 --> 00:50:53.900
the surgery. So how are you going to look at
00:50:53.900 --> 00:50:57.780
the liability framework shifting? And the one
00:50:57.780 --> 00:51:00.679
analogy is if there's an AI pilot flying the
00:51:00.679 --> 00:51:03.099
plane for a cheaper fare, should patients be
00:51:03.099 --> 00:51:05.239
allowed to sign off liability? The answer there,
00:51:05.440 --> 00:51:08.139
I think, is clearly no because the risk is too
00:51:08.139 --> 00:51:11.099
high and there's a big information asymmetry.
00:51:11.599 --> 00:51:13.940
Patients have no idea how to fly a plane unless
00:51:13.940 --> 00:51:17.349
you're a pilot. Just so your patients have no
00:51:17.349 --> 00:51:19.610
idea how to do a joint replacement, unless they're
00:51:19.610 --> 00:51:23.050
an orthopedic surgeon. So I think, like, how
00:51:23.050 --> 00:51:24.949
do you think about liability in this framework?
00:51:27.750 --> 00:51:30.510
Yeah, I mean, I think even in that situation,
00:51:30.630 --> 00:51:34.050
you could probably still argue that the patient
00:51:34.050 --> 00:51:36.050
can inform themselves, and many patients do,
00:51:36.090 --> 00:51:38.289
are very informed. They have more tools now than
00:51:38.289 --> 00:51:41.489
they've ever had to inform themselves. I'd like
00:51:41.489 --> 00:51:46.570
to think that the Whatever 14 years I spent getting
00:51:46.570 --> 00:51:50.050
through training and then the 17 years I spent
00:51:50.050 --> 00:51:53.389
in my career taught me enough experience that
00:51:53.389 --> 00:51:55.710
even all the reading in the world, all the educating
00:51:55.710 --> 00:51:59.369
yourself in the world isn't a substitute for
00:51:59.369 --> 00:52:01.969
having experienced it multiple patients over
00:52:01.969 --> 00:52:08.659
many years. So can a patient ever fully understand
00:52:08.659 --> 00:52:10.639
the risks. I think a lot of them would argue
00:52:10.639 --> 00:52:13.860
yes. And I can see a lot of them rolling their
00:52:13.860 --> 00:52:15.780
eyes at me right now and saying, you know, doctor,
00:52:15.940 --> 00:52:17.900
it's my decision. I can educate myself. You know
00:52:17.900 --> 00:52:20.139
what you're talking about? I don't know. I mean,
00:52:20.179 --> 00:52:22.679
I think if you looked at other, you know, pilots
00:52:22.679 --> 00:52:26.920
flying a plane, you know, any other type of profession
00:52:26.920 --> 00:52:28.760
where it's, you know, you go through a training
00:52:28.760 --> 00:52:32.260
process that's rigorous. I don't think that I
00:52:32.260 --> 00:52:35.739
would never walk onto a plane after researching
00:52:35.739 --> 00:52:37.280
how to fly a plane and think that I could fly
00:52:37.280 --> 00:52:40.840
a plane. I would never go to a fancy restaurant.
00:52:40.960 --> 00:52:43.920
I think I could go in the kitchen and make meals
00:52:43.920 --> 00:52:46.760
for everybody. Not to trivialize it, but I think
00:52:46.760 --> 00:52:51.519
that can you ever really make a fully informed
00:52:51.519 --> 00:52:54.519
enough decision to take on that liability? Is
00:52:54.519 --> 00:52:57.440
that the right thing to do? And I don't think
00:52:57.440 --> 00:53:03.480
it's necessarily the right thing to do. What
00:53:03.480 --> 00:53:06.639
is a common misconception about ortho? You know,
00:53:06.639 --> 00:53:09.500
there's a lot of ortho jokes, right? Like what
00:53:09.500 --> 00:53:12.679
is a stethoscope? And I don't hear the bone and
00:53:12.679 --> 00:53:16.719
things like that. But what's a more serious common
00:53:16.719 --> 00:53:19.260
misconception? And what advice do you have for
00:53:19.260 --> 00:53:22.119
medical students who are thinking about orthopedic
00:53:22.119 --> 00:53:25.760
surgery as a residency? Yeah, I think there's
00:53:25.760 --> 00:53:28.079
a couple misconceptions that I'll go, you know
00:53:28.079 --> 00:53:32.119
more high high level and low level so I think
00:53:32.119 --> 00:53:34.940
the high level misconception You know is that
00:53:34.940 --> 00:53:38.300
sort of Neanderthal orthopedic surgeon? I'm not
00:53:38.300 --> 00:53:40.599
sure I could get an orthopedic surgery his residency
00:53:40.599 --> 00:53:43.139
spot in this day and age because they're so competitive
00:53:43.139 --> 00:53:46.849
and Even back in my day, you kind of had to be
00:53:46.849 --> 00:53:48.869
at the top of your class and do well on the standardized
00:53:48.869 --> 00:53:52.510
testing to get a spot. Now, I think the average
00:53:52.510 --> 00:53:56.230
number of publications for an orthopedic resident
00:53:56.230 --> 00:53:58.510
or somebody, a medical student applying to orthopedics
00:53:58.510 --> 00:54:00.769
is like 10 publications or something ridiculous
00:54:00.769 --> 00:54:04.789
like that. doing research wasn't even on my radar
00:54:04.789 --> 00:54:06.610
screen in medical school. Now you can't get a
00:54:06.610 --> 00:54:08.469
spot unless you've done a lot of research. I
00:54:08.469 --> 00:54:10.389
think there's good things and bad things about
00:54:10.389 --> 00:54:13.010
that. I think it sort of leads to maybe low quality
00:54:13.010 --> 00:54:15.590
research and there's pressure to publish papers.
00:54:15.989 --> 00:54:19.610
But I guess the misconception would be that orthopedic
00:54:19.610 --> 00:54:22.449
surgeons are just kind of Neanderthals that carry
00:54:22.449 --> 00:54:25.869
hammers around. The lower level misconception,
00:54:26.170 --> 00:54:32.460
we get or the misconception of the orthopedics
00:54:32.460 --> 00:54:35.079
is just all about the money. It's all about how
00:54:35.079 --> 00:54:37.920
many procedures can I do? It's all about the
00:54:37.920 --> 00:54:40.360
financial part of it. We are well paid. We are
00:54:40.360 --> 00:54:42.739
typically at the top of the reimbursement list
00:54:42.739 --> 00:54:48.869
here in the US. I would argue it's in part. because
00:54:48.869 --> 00:54:52.070
we are entrepreneurial. We tend to be more fiercely
00:54:52.070 --> 00:54:55.570
independent than some other specialties. We do
00:54:55.570 --> 00:54:57.670
have the ability to take advantage of ancillary
00:54:57.670 --> 00:55:00.789
services like PT and MRI and owning ASCs that
00:55:00.789 --> 00:55:03.610
sort of are complementary to what we do in our
00:55:03.610 --> 00:55:06.429
day to day. I think that we have gotten more
00:55:06.429 --> 00:55:10.530
efficient and changed with the times. The average
00:55:10.530 --> 00:55:13.250
Medicare reimbursement for a total joint now
00:55:13.250 --> 00:55:17.050
is... I think by 2026 is going to be less than
00:55:17.050 --> 00:55:20.090
$1 ,200 to the surgeon for a hip or knee replacement
00:55:20.090 --> 00:55:23.190
from Medicare. And that's when you adjust for
00:55:23.190 --> 00:55:26.670
inflation down over 80 % compared to it was 20
00:55:26.670 --> 00:55:28.650
years ago. And you say, oh, well, you've just
00:55:28.650 --> 00:55:30.409
done more unnecessary surgeries. Well, at the
00:55:30.409 --> 00:55:33.210
same time, we have this. population that's aging,
00:55:33.429 --> 00:55:35.530
we have this demand for joint replacements that's
00:55:35.530 --> 00:55:37.869
going up. As a baby boomers age, we also have
00:55:37.869 --> 00:55:39.670
the second population of younger people that
00:55:39.670 --> 00:55:42.570
are getting arthritis at an earlier age. So there
00:55:42.570 --> 00:55:45.170
really is no need to do unnecessary joint replacements
00:55:45.170 --> 00:55:47.429
at this point. We've just become extremely efficient
00:55:47.429 --> 00:55:50.769
at it. Patients are getting more complex, but
00:55:50.769 --> 00:55:53.309
our outcomes are the same, if not better than
00:55:53.309 --> 00:55:56.570
they were when patients were healthier. So, you
00:55:56.570 --> 00:55:59.539
know. I think people underestimate you say oh
00:55:59.539 --> 00:56:01.599
you just you just do more do more surgeries well
00:56:01.599 --> 00:56:03.239
the surgeries have to be done you don't just
00:56:03.239 --> 00:56:05.179
you know wave your hand it's still you know work
00:56:05.179 --> 00:56:08.820
to get it done um you know so I think that we
00:56:08.820 --> 00:56:12.280
get ding sometimes for you know sort of being
00:56:12.280 --> 00:56:14.559
just you know money focused and doing unnecessary
00:56:14.559 --> 00:56:16.900
surgeries you know that happens for sure I mean
00:56:16.900 --> 00:56:19.159
I'm not here to say that doesn't happen in some
00:56:19.159 --> 00:56:22.219
cases but I don't think it's as as frequent as
00:56:22.219 --> 00:56:29.269
people make it out to be. Last question, what
00:56:29.269 --> 00:56:32.730
advice do you have for 35 year old Ben if you
00:56:32.730 --> 00:56:36.389
can go back in time and talk to him? So let's
00:56:36.389 --> 00:56:39.010
see 35 year old Ben. So, you know, 13 years ago,
00:56:39.110 --> 00:56:43.429
where was I 13 years ago? I was still early on
00:56:43.429 --> 00:56:47.849
in my career. I would say, you know, just give
00:56:47.849 --> 00:56:50.510
yourself more grace. You know, don't be so hard
00:56:50.510 --> 00:56:53.809
on yourself. Don't be. I think perfection should
00:56:53.809 --> 00:56:57.739
always be the goal. I think back then, I didn't
00:56:57.739 --> 00:57:01.079
understand that perfection is a fool's errand
00:57:01.079 --> 00:57:04.820
in health care and as a surgeon to give yourself
00:57:04.820 --> 00:57:08.119
a little bit of grace when you don't reach perfection.
00:57:08.880 --> 00:57:10.699
And, you know, it's always going to eat at you,
00:57:10.719 --> 00:57:13.440
but you can't let it consume you. You have to
00:57:13.440 --> 00:57:15.219
learn from it. You have to learn from your mistakes.
00:57:15.260 --> 00:57:17.599
You have to get better. But you also have to,
00:57:17.599 --> 00:57:20.679
you know, not overlook your your wins and focus
00:57:20.679 --> 00:57:23.780
too much on on the losses. I think there's a
00:57:23.780 --> 00:57:26.639
tendency. particularly in high achieving people
00:57:26.639 --> 00:57:28.900
to over index on the losses and not give yourself
00:57:28.900 --> 00:57:32.760
enough credit for the wins. I'll ask one more
00:57:32.760 --> 00:57:36.179
question. So I'm 39, entering 40 fairly soon
00:57:36.179 --> 00:57:41.659
in January. My 30s have been more or less a blur.
00:57:42.639 --> 00:57:47.559
It feels like I was 29 yesterday, mentally, physically
00:57:47.559 --> 00:57:53.960
less so. What advice do you have for someone?
00:57:55.000 --> 00:57:57.099
And you know, I'm doing four or five different
00:57:57.099 --> 00:57:59.619
things with my career, partly because I don't
00:57:59.619 --> 00:58:03.260
know what to do still. And partly because some
00:58:03.260 --> 00:58:06.280
things bring in money and some things I do for
00:58:06.280 --> 00:58:09.900
enjoyment. What advice do you have for someone
00:58:09.900 --> 00:58:14.699
who's just entering their 40s? I think take time
00:58:14.699 --> 00:58:19.780
to... Slow down and enjoy the journey Because
00:58:19.780 --> 00:58:22.920
you know when you're really young you feel physically,
00:58:22.920 --> 00:58:26.679
you know invulnerable and Then you're also just
00:58:26.679 --> 00:58:30.559
sort of you know Learning your way Through things,
00:58:30.840 --> 00:58:33.099
you know when you're 30s you still feel physically,
00:58:33.099 --> 00:58:35.460
you know, pretty good. You're starting to establish
00:58:35.460 --> 00:58:38.699
yourself You know, but things are still pretty
00:58:38.699 --> 00:58:40.340
fresh and you're not necessarily thinking about
00:58:40.340 --> 00:58:42.360
the long term at that point I think as you get
00:58:42.360 --> 00:58:45.500
into your you know 40s particularly towards later
00:58:45.500 --> 00:58:48.480
on in your 40s, I think you start to think more
00:58:48.480 --> 00:58:53.300
about work -life balance and not go, go, go all
00:58:53.300 --> 00:58:55.679
the time, but appreciate the journey, appreciate
00:58:55.679 --> 00:58:59.320
the... the people around you, your family, you
00:58:59.320 --> 00:59:02.840
know, appreciate the small moments that you can't
00:59:02.840 --> 00:59:05.420
go, go, go all the time because, you know, you
00:59:05.420 --> 00:59:08.519
start to realize that, you know, you're not going
00:59:08.519 --> 00:59:10.260
to be here forever. And then you don't want to
00:59:10.260 --> 00:59:13.320
look back on it and, you know, regret not spending
00:59:13.320 --> 00:59:15.619
more time doing these things. I mean, I'm sure
00:59:15.619 --> 00:59:17.579
you do it for your family the same way that I
00:59:17.579 --> 00:59:20.500
do it for my family. But at the same time, they
00:59:20.500 --> 00:59:22.860
want you there. They appreciate the work that
00:59:22.860 --> 00:59:26.900
you do, but they also want you present. And so
00:59:26.900 --> 00:59:29.199
it's about finding that right balance and then
00:59:29.199 --> 00:59:34.739
realizing that you only have so much time. Awesome.
00:59:35.019 --> 00:59:37.780
Thanks so much for joining us today, Ben. Yeah,
00:59:37.900 --> 00:59:39.280
no problem. Yeah, appreciate it.