speaker-0: you Welcome back to Beyond the White Coat. This is a space, again, where we explore the idea that leadership in healthcare doesn't just happen at the bedside. It also happens in boardrooms, in strategy discussions, and in the systems that ultimately shape how care is delivered. Today, I'm thrilled to be joined by someone who embodies that intersection. Joel Tompkins, certified registered nurse anesthetist, CRNA, an operator, and a leader who has spent time not only delivering care clinically, but also helping scale one of the largest anesthesia organizations in the country. He served as president of client services at Northstar Anesthesia and is currently the CEO of Lassie Health. He brings a unique perspective on how healthcare actually functions at scale. Joel is also one of the earliest investors in Doc2Doc and has been incredibly supportive. and influential behind the scenes. Thank you so much, Joel. So, you've had a fascinating journey that bridges clinical practice and executive leadership. How did that evolution happen for you?
speaker-1: Familial roots in healthcare have been there. But the evolution really started for me when I first started in practice in anesthesia with CRNA. ⁓ My wife and we were in Northern Michigan and walking into a multi-hospital system, I started to realize that healthcare is a business. And I think prior to that, ⁓ going from the University of Pittsburgh where I did my anesthesia training to my first job, I always saw things as, I'm taking care of a patient. And that was ⁓ first and foremost. And while that continued to be, always clinical quality for me was table stakes. I started to realize that there's a true business behind that. And ⁓ back in the day before the epic concerner of the world, and I was walking around with a clipboard and actually, you know, hand charting on paper, everyone knew my clipboard. because there was a copious amount of ⁓ pieces of paper behind all of the charts for the day that had notes, lots and lots of notes, staffing models, diagrams that I would sit there and make. And that's when I realized, I'm like, hey, I love taking care of people. I love anesthesia because it's one-on-one care, but I also know that I'm going to do something else. And that was kind of when I first knew that at some point in time, I knew I was going to step out of the operating room and take on a more advanced role in some way, or form.
speaker-0: Absolutely. So one thing that I've seen personally is that the best operators in healthcare are the ones who start asking, why does this system work the way it does? And it's clear that you were doing that. You had that pen and pad. The kids that graduate these days have no idea what that's like to have a paper chart. But you were beginning to organize your thoughts and observe gaps in the system. Beyond the observation, asking the question, what skills helped you make the actual transition to leadership? Because many of our listeners aspire to be in leadership, aspire to kind of get into administration. They always ask, how do I get from here to there?
speaker-1: Yeah, you know, think, you know, one of the key features is, you know, in anesthesia is, know, you've got an induction, you have maintenance, you have emergence and you have post-op care. And in between those fence posts, a lot can happen. And we, as anesthesia clinicians, are unbelievably challenged on a day-to-day basis, especially when things go bad. I took all of that experience, you know, with me when things went bad. as to how I could then evolve and shape kind of my ⁓ leadership style moving forward. When you're used to someone crumping, having, or a surgeon yelling at you, you can take care of anything on the administrative side. So I think those skillsets, especially for anesthesia clinicians, make you uniquely qualified to be able to deal with kind of the outside of the operating room administrative burden that in healthcare in general, can be put on people. It's being able to multitask and being able to ⁓ actually solve problems quickly, which we all learned while we provided anesthesia.
speaker-0: Yeah, it's funny that you're running towards a fire, right? A lot of people throw their hands up. The complexity of healthcare has gotten ⁓ significantly more complicated and much of the chagrin of providers. And there's a cadre of us who choose to go into leadership in an effort to change the system or to have it be more reactive and responsive and proactive to clinical needs of patients. In my world, even at the ASC level, Staffing alignment incentives are constant challenges. At a national level in your case, that complexity multiplies. Tell me a little bit more about what are the operational pressures you're seeing in hospitals that are facing the way, that are challenging the way care is delivered today.
speaker-1: Yeah, I think, you know, downward pressure in healthcare on cost is going to continue. You know, when I first started in my anesthesia career, know, subsidies have been around obviously for from in the anesthesia space for a long time. you know, let's say 50 % of hospitals were subsidizing anesthesia. Now it's probably somewhere close to 100%. And in particular in the ASC space. We went from 0 % subsidies to post COVID. Now we're seeing 60, 70, 80 % of ASCs actually subsidizing anesthesia. That's not going to change. That's going to get more and more difficult. One in $5 in this country are spent on healthcare. So there's ample opportunity for folks who want to get into the administrative space to be able to come and help figure out how to effectively use those dollars. And I think that pressure, you know, while anesthesia subsidies are a small part of a hospital operating budget. If you think about the ASC space, it becomes a large piece of the puzzle. And we, you know, I've always said, you know, we have to be, you know, consultants in not only anesthesia, but also the perioperative space. So as we think about, you know, how, you know, we as the anesthesia providers can actually ⁓ help reduce the cost of healthcare. It's not just when the patient walks in the door and you take them to the recovery room. It's everything from when that patient is actually scheduled for surgery to discharge. And we've done that with ERAS, Imperium Operative Surgical Home, but it doesn't stop with the patient care. It actually continues with, how are ⁓ we providing feedback to the award leadership on ⁓ staffing models? How are we looking at block scheduling? How are we being creative? and we are getting pulled out of the operating room more and more. And at some point in time, we're going to have to say no. We're going to have to say no to the fact that a pacemaker in the cath lab on an ASA3 that has no other comorbidities, we can't go and do that case because it doesn't make sense from a staffing standpoint when we're needed in the operating room where 65 to 70 % of revenue is actually generated in hospital.
speaker-0: You're absolutely right. And I'd love to get your feedback on a question I'm getting a lot from my peers that are surgery center owners in that there's been this incredible challenge to afford anesthesia providers, the cost of anesthesia providers if they're MDs or NEST or, or, or CRNAs or, or A's it's just been through the roof. In so much that we have pain doctors who are dual board certified in anesthesia and pain. leaving the practice of pain medicine to go back to anesthesia because the incentives are so rich. They're making north of 650,000 bucks a year, 12 weeks vacation, and just can't justify being in the OR pushing on needles anymore. What are the economics at play that drives the pay ranges of providers within the space?
speaker-1: Yeah, I think, you know, if we think back to, you know, COVID, that was the driving force for a lot of these things. And, you know, we saw a reduction in volume, obviously, during COVID. And then it took a while for that volume to ramp back up. But we also saw, you know, hospitals losing volume, ASCs that continued in some states, you Florida and others that actually stayed open. The shift of volume out to the ASCs negatively impacted the hospitals. And unfortunately, the vast majority of hospitals, their response to that was, if I was running eight operating rooms pre-COVID, but I have 16 OR physical locations, I better run 16 post-COVID because I have to, you know, it's the build it, they will come strategy. Well, all that did was take a bad situation, you know, where, where, you know, people were getting out of the profession because they were burned out post-COVID. So now, and then, and that created this massive need for providers and then salaries went through the roof. I think we've somewhat stabilized, dependent upon what market you're talking about. Obviously, when you look out in the periphery in the ⁓ urban or suburban areas, it's always going to be more difficult to staff. I live in Ohio. There's lots of small critical access hospitals, community access hospitals that are in the middle of nowhere. that everyone's going to probably get more compensation over course of time. But I think that it's beginning to flatten out. And obviously, this has been cyclical, in particular in anesthesia over the course of time. I do believe there's, I think there's this, ⁓ there's a cap. Like I can't imagine the compensation going higher, both on physician side and CRNA side and AA side as well. It just, there's no dollars to be able to pay for it. And that's the problem. as anesthesia groups continue to get hammered on, Medicare rates that will go down year over year, there's billing legislation that removed the ability for a group to actually threaten to go out of network with a payer, which gave them some leverage to be able to get better rates. The only thing they can do now is kind of go through the IDR process, which is continuing to get more and more scrutiny. So we just, we all have to be better stewards, you know, of our dollars. And I think, you know, like you said, in the ASC space, it is how do we make sure that we are actually providing this consultative approach that just doesn't include the anesthesia side, but we see everything and right as anesthesia providers, we see everything from soup to nuts and we're probably the best suited to be able to run departments, not only just the anesthesia side, but everything. you know, and that's encompassing and that's where I think a lot of opportunities to lie.
speaker-0: I couldn't agree with you more. I think that many of us view anesthesia providers as being the quarterbacks of the perioperative experience, ⁓ to your point, because we've got the experience in all those diverse environments that can help define economies of scale within these health associations. One of the things that I've come to appreciate as well, though, is that clinicians, especially CRNAs, are increasingly not just participants in the system, but they're architects of it. got a strong advocacy ⁓ angle and many are assuming ⁓ roles in leadership. Where do you see the CRNA profession heading over the course of the next decade?
speaker-1: Yeah, think that the, you know, we're seeing that more and more. think, you know, we were kind of behind, you know, where physicians were. Physicians were always seen kind of as administrative leaders. ⁓ And now you're seeing certainly more and more CRNA step up to the plate, ⁓ not only in healthcare administration, but as, you know, state legislators, ⁓ you name it, you know, folks are stepping up to the plate. And that's going to be helpful that, you know, ⁓ time raises all boats. And I think the evolution of CRNAs from being, you know, chief CRNAs and being kind of rank and file to perioperative surgical directors, to VPs of perioperative surgical services, to chief operating officers, to CEOs, I think is going to continue. And that will expand their, you know, folks scope. And over the next 10 years, I think there's going to be more and more people because the folks that are coming in, I think, to anesthesia programs today, at least from what I see, are cognizant of that. Yes, it's awesome to be able to take care of one person at a time in OR3, but at the same time, a lot of people have ambition to be able to step outside of that and say, hey, I'm going to take on this bigger piece of the puzzle, which is the periaphyso surgical director role or VP of surgical services or whatever the case may be in the hospital or ASC.
speaker-0: One of the gaps that we fill at Doc2Doc within our clinician ecosystem is financial literacy. In the medical training programs for MD graduates, there's no curriculum or financial literacy for folks to understand how money works, how to access capital, interest rates, APRs, and even just general debt load management. We're graduating with north of 250,000 student loan debt. On top of that, we have 60 plus thousand in credit card debt and we'll go from making 74,000 bucks a year in residence year fellowship to sometimes north of $300,000 six months later. Is there any kind of financial coursing within ⁓ a CRNA training program? Is that something that you guys are coming out of school with some ⁓ level of acumen on?
speaker-1: No, and it's, I'd say it's a huge, I mean, I can give you, my experience, you know, my first job as a nurse, I made $13.33 an hour. When I graduated from anesthesia school, I made $60 an hour. So I thought I was, you know, the wealthiest guy in, you know, this side of the Mississippi. But the lack of knowledge of all of those things that you just said, you know, I learned along the way of, you know, how to invest dollars. And I think that The financial acumen piece, along with the business acumen of healthcare, is certainly an area that both ⁓ residency programs and nursing and seizure programs need to be able to focus on because you go from making a good living as a staff nurse to making a really good living as a CRNA, but no one is helping you to say, the second that you graduate and take a job with a private group or with a hospital or your independent contractor, You need to focus on your retirement. You need to focus on all of these different pieces and parts. And how are you going to generate the wealth for yourself that you need for you and your family long-term? There's really not, at least to my knowledge, programs aren't doing a good job of that. And I think we have to do that. ⁓ We have to be able to create not only the clinical value, but value for ⁓ students, residents, et cetera, to be able to be successful long-term.
speaker-0: exceptional. think we believe that the mission and vision of the company expands beyond MDs. ⁓ And we've seen enthusiasm ⁓ in the entire allied health ⁓ practitioner space ⁓ for the product that we're offering on both the borrower side, but also on the educational side. And hence content like this that allows folks to kind of see what's possible and achievable ⁓ is incredibly valuable to our listening audience. We're gonna close with a few rapid fire questions just to kind of get your reaction to just quickly in your role as a healthcare leader. What 30 second bits of advice would you give to a new CRNA grad?
speaker-1: Yeah, continue to learn. if you can, you know, while you're in school, hopefully, you know, your program is actually teaching in the business side of anesthesia. You know, I learned, you know, through school of, you know, hard knocks, it was on the job training, which is a great way to learn. But, you know, learn everything that you can about the anesthesia business, ⁓ you know, prior to actually graduation, because it does actually impact your day-to-day life. You need to understand, you know, base units and time. You need to understand, you know, medical direction versus non-medically directing, QI, QZ, QX, you know, all of those things, because it actually does, you know, come into play in your day-to-day life.
speaker-0: As someone who is extraordinarily successful, but who learned the business side in the school of hard knocks, so many people ask, should I do an MBA or not? You did not. What is your thought on schooling? As you said, take as much school as possible. Should an aspiring leader get an MBA or some kind of a leadership degree to buttress their aspirations to go into leadership?
speaker-1: Yeah, I certainly, you know, as you said, I did not. But I can tell you, I have a junior, my son is a junior in college who is a nursing major and has a business minor, and he's going to actually finish that and be dual majored, you know, nursing and business. ⁓ So I would always say to folks, get as much education as you can, know, MBA, you know, whatever is going to be valuable for you as an individual. And certainly, you know, as people aspire to leadership roles, you know, there is this preconceived notion, you know, that a, you know, a hospital executive has to have an MHA or MBA. And so sometimes it's kind of check the box, you know, that you've got to have those kind of degrees to be able to, you know, climb the proverbial ladder.
speaker-0: Congrats on your son. There's no pure compliment than your kids looking at what you do, growing up with you, being a leader within medicine and choosing to go in that same path. Thank you. Is it something that you wanted for your kids? So many of us today say, I would steer my kids outside of healthcare. How do you feel about his choice with where things are in the world today from a healthcare perspective?
speaker-1: You know, ⁓ my wife and I, you know, were worried about his choice, but one of the best things we did is my brother's an emergency medicine physician. We sent him to be with him for a week or two and said, put him through the paces, put him in everything because we want him to see what being in nurse means.
speaker-0: Last question, what excites you most about the future?
speaker-1: I think the best thing about health care is also the worst thing. It gives us an unbelievable opportunity to actually drive not only clinical care, but also figure out how we can positively impact this country as it relates to spending on health care. ⁓ There's been tons of talk about increasing premiums for health insurance, the subsidies that expired. All of those things. But one of the things that we don't focus on in healthcare is end users like ourselves being today, we're mostly users of healthcare and we have to be consumers of healthcare. We cannot just go into things blindly. And I use this analogy a lot, you know, that you walk into a best buy to buy a 65 inch TV and you just pick one off the wall and there's no prices on the wall. And then three, four months later, you get a bill and you go, whoa, I didn't know $6,500. That's how we are today with healthcare. So I think the opportunities are out there for us to be able to be the best stewards of dollars and resources that we possibly can be. In anesthesia, providers and clinicians are in a wonderful spot to be able to do that just because of our knowledge of the perioperative suite in itself.
speaker-0: Thank you. Thank you. Joel, really appreciate you taking the time to share your perspective. I think one of the biggest takeaways from this conversation is that a career in healthcare does not have to be linear. ⁓ It can evolve from clinician to operator to leader shaping the system itself, like you are. We talked about the importance of operational excellence, the expanding role of nurse anesthetist and the growing need for financial literacy and access to capital as well.
speaker-1: Thank
speaker-0: At Doc2Doc, we're excited to continue to support clinicians, not just physicians, but the entire clinician ecosystem of professionals because they're a critical part of the healthcare ecosystem. And ultimately, the future of healthcare will be shaped not just by those providing care, but by those like you willing to lead, innovate, and rethink the system beyond the white coat. Thank you so much for the time, Joel.
speaker-1: Thank you, Zwei.
speaker-1: Familial roots in healthcare have been there. But the evolution really started for me when I first started in practice in anesthesia with CRNA. ⁓ My wife and we were in Northern Michigan and walking into a multi-hospital system, I started to realize that healthcare is a business. And I think prior to that, ⁓ going from the University of Pittsburgh where I did my anesthesia training to my first job, I always saw things as, I'm taking care of a patient. And that was ⁓ first and foremost. And while that continued to be, always clinical quality for me was table stakes. I started to realize that there's a true business behind that. And ⁓ back in the day before the epic concerner of the world, and I was walking around with a clipboard and actually, you know, hand charting on paper, everyone knew my clipboard. because there was a copious amount of ⁓ pieces of paper behind all of the charts for the day that had notes, lots and lots of notes, staffing models, diagrams that I would sit there and make. And that's when I realized, I'm like, hey, I love taking care of people. I love anesthesia because it's one-on-one care, but I also know that I'm going to do something else. And that was kind of when I first knew that at some point in time, I knew I was going to step out of the operating room and take on a more advanced role in some way, or form.
speaker-0: Absolutely. So one thing that I've seen personally is that the best operators in healthcare are the ones who start asking, why does this system work the way it does? And it's clear that you were doing that. You had that pen and pad. The kids that graduate these days have no idea what that's like to have a paper chart. But you were beginning to organize your thoughts and observe gaps in the system. Beyond the observation, asking the question, what skills helped you make the actual transition to leadership? Because many of our listeners aspire to be in leadership, aspire to kind of get into administration. They always ask, how do I get from here to there?
speaker-1: Yeah, you know, think, you know, one of the key features is, you know, in anesthesia is, know, you've got an induction, you have maintenance, you have emergence and you have post-op care. And in between those fence posts, a lot can happen. And we, as anesthesia clinicians, are unbelievably challenged on a day-to-day basis, especially when things go bad. I took all of that experience, you know, with me when things went bad. as to how I could then evolve and shape kind of my ⁓ leadership style moving forward. When you're used to someone crumping, having, or a surgeon yelling at you, you can take care of anything on the administrative side. So I think those skillsets, especially for anesthesia clinicians, make you uniquely qualified to be able to deal with kind of the outside of the operating room administrative burden that in healthcare in general, can be put on people. It's being able to multitask and being able to ⁓ actually solve problems quickly, which we all learned while we provided anesthesia.
speaker-0: Yeah, it's funny that you're running towards a fire, right? A lot of people throw their hands up. The complexity of healthcare has gotten ⁓ significantly more complicated and much of the chagrin of providers. And there's a cadre of us who choose to go into leadership in an effort to change the system or to have it be more reactive and responsive and proactive to clinical needs of patients. In my world, even at the ASC level, Staffing alignment incentives are constant challenges. At a national level in your case, that complexity multiplies. Tell me a little bit more about what are the operational pressures you're seeing in hospitals that are facing the way, that are challenging the way care is delivered today.
speaker-1: Yeah, I think, you know, downward pressure in healthcare on cost is going to continue. You know, when I first started in my anesthesia career, know, subsidies have been around obviously for from in the anesthesia space for a long time. you know, let's say 50 % of hospitals were subsidizing anesthesia. Now it's probably somewhere close to 100%. And in particular in the ASC space. We went from 0 % subsidies to post COVID. Now we're seeing 60, 70, 80 % of ASCs actually subsidizing anesthesia. That's not going to change. That's going to get more and more difficult. One in $5 in this country are spent on healthcare. So there's ample opportunity for folks who want to get into the administrative space to be able to come and help figure out how to effectively use those dollars. And I think that pressure, you know, while anesthesia subsidies are a small part of a hospital operating budget. If you think about the ASC space, it becomes a large piece of the puzzle. And we, you know, I've always said, you know, we have to be, you know, consultants in not only anesthesia, but also the perioperative space. So as we think about, you know, how, you know, we as the anesthesia providers can actually ⁓ help reduce the cost of healthcare. It's not just when the patient walks in the door and you take them to the recovery room. It's everything from when that patient is actually scheduled for surgery to discharge. And we've done that with ERAS, Imperium Operative Surgical Home, but it doesn't stop with the patient care. It actually continues with, how are ⁓ we providing feedback to the award leadership on ⁓ staffing models? How are we looking at block scheduling? How are we being creative? and we are getting pulled out of the operating room more and more. And at some point in time, we're going to have to say no. We're going to have to say no to the fact that a pacemaker in the cath lab on an ASA3 that has no other comorbidities, we can't go and do that case because it doesn't make sense from a staffing standpoint when we're needed in the operating room where 65 to 70 % of revenue is actually generated in hospital.
speaker-0: You're absolutely right. And I'd love to get your feedback on a question I'm getting a lot from my peers that are surgery center owners in that there's been this incredible challenge to afford anesthesia providers, the cost of anesthesia providers if they're MDs or NEST or, or, or CRNAs or, or A's it's just been through the roof. In so much that we have pain doctors who are dual board certified in anesthesia and pain. leaving the practice of pain medicine to go back to anesthesia because the incentives are so rich. They're making north of 650,000 bucks a year, 12 weeks vacation, and just can't justify being in the OR pushing on needles anymore. What are the economics at play that drives the pay ranges of providers within the space?
speaker-1: Yeah, I think, you know, if we think back to, you know, COVID, that was the driving force for a lot of these things. And, you know, we saw a reduction in volume, obviously, during COVID. And then it took a while for that volume to ramp back up. But we also saw, you know, hospitals losing volume, ASCs that continued in some states, you Florida and others that actually stayed open. The shift of volume out to the ASCs negatively impacted the hospitals. And unfortunately, the vast majority of hospitals, their response to that was, if I was running eight operating rooms pre-COVID, but I have 16 OR physical locations, I better run 16 post-COVID because I have to, you know, it's the build it, they will come strategy. Well, all that did was take a bad situation, you know, where, where, you know, people were getting out of the profession because they were burned out post-COVID. So now, and then, and that created this massive need for providers and then salaries went through the roof. I think we've somewhat stabilized, dependent upon what market you're talking about. Obviously, when you look out in the periphery in the ⁓ urban or suburban areas, it's always going to be more difficult to staff. I live in Ohio. There's lots of small critical access hospitals, community access hospitals that are in the middle of nowhere. that everyone's going to probably get more compensation over course of time. But I think that it's beginning to flatten out. And obviously, this has been cyclical, in particular in anesthesia over the course of time. I do believe there's, I think there's this, ⁓ there's a cap. Like I can't imagine the compensation going higher, both on physician side and CRNA side and AA side as well. It just, there's no dollars to be able to pay for it. And that's the problem. as anesthesia groups continue to get hammered on, Medicare rates that will go down year over year, there's billing legislation that removed the ability for a group to actually threaten to go out of network with a payer, which gave them some leverage to be able to get better rates. The only thing they can do now is kind of go through the IDR process, which is continuing to get more and more scrutiny. So we just, we all have to be better stewards, you know, of our dollars. And I think, you know, like you said, in the ASC space, it is how do we make sure that we are actually providing this consultative approach that just doesn't include the anesthesia side, but we see everything and right as anesthesia providers, we see everything from soup to nuts and we're probably the best suited to be able to run departments, not only just the anesthesia side, but everything. you know, and that's encompassing and that's where I think a lot of opportunities to lie.
speaker-0: I couldn't agree with you more. I think that many of us view anesthesia providers as being the quarterbacks of the perioperative experience, ⁓ to your point, because we've got the experience in all those diverse environments that can help define economies of scale within these health associations. One of the things that I've come to appreciate as well, though, is that clinicians, especially CRNAs, are increasingly not just participants in the system, but they're architects of it. got a strong advocacy ⁓ angle and many are assuming ⁓ roles in leadership. Where do you see the CRNA profession heading over the course of the next decade?
speaker-1: Yeah, think that the, you know, we're seeing that more and more. think, you know, we were kind of behind, you know, where physicians were. Physicians were always seen kind of as administrative leaders. ⁓ And now you're seeing certainly more and more CRNA step up to the plate, ⁓ not only in healthcare administration, but as, you know, state legislators, ⁓ you name it, you know, folks are stepping up to the plate. And that's going to be helpful that, you know, ⁓ time raises all boats. And I think the evolution of CRNAs from being, you know, chief CRNAs and being kind of rank and file to perioperative surgical directors, to VPs of perioperative surgical services, to chief operating officers, to CEOs, I think is going to continue. And that will expand their, you know, folks scope. And over the next 10 years, I think there's going to be more and more people because the folks that are coming in, I think, to anesthesia programs today, at least from what I see, are cognizant of that. Yes, it's awesome to be able to take care of one person at a time in OR3, but at the same time, a lot of people have ambition to be able to step outside of that and say, hey, I'm going to take on this bigger piece of the puzzle, which is the periaphyso surgical director role or VP of surgical services or whatever the case may be in the hospital or ASC.
speaker-0: One of the gaps that we fill at Doc2Doc within our clinician ecosystem is financial literacy. In the medical training programs for MD graduates, there's no curriculum or financial literacy for folks to understand how money works, how to access capital, interest rates, APRs, and even just general debt load management. We're graduating with north of 250,000 student loan debt. On top of that, we have 60 plus thousand in credit card debt and we'll go from making 74,000 bucks a year in residence year fellowship to sometimes north of $300,000 six months later. Is there any kind of financial coursing within ⁓ a CRNA training program? Is that something that you guys are coming out of school with some ⁓ level of acumen on?
speaker-1: No, and it's, I'd say it's a huge, I mean, I can give you, my experience, you know, my first job as a nurse, I made $13.33 an hour. When I graduated from anesthesia school, I made $60 an hour. So I thought I was, you know, the wealthiest guy in, you know, this side of the Mississippi. But the lack of knowledge of all of those things that you just said, you know, I learned along the way of, you know, how to invest dollars. And I think that The financial acumen piece, along with the business acumen of healthcare, is certainly an area that both ⁓ residency programs and nursing and seizure programs need to be able to focus on because you go from making a good living as a staff nurse to making a really good living as a CRNA, but no one is helping you to say, the second that you graduate and take a job with a private group or with a hospital or your independent contractor, You need to focus on your retirement. You need to focus on all of these different pieces and parts. And how are you going to generate the wealth for yourself that you need for you and your family long-term? There's really not, at least to my knowledge, programs aren't doing a good job of that. And I think we have to do that. ⁓ We have to be able to create not only the clinical value, but value for ⁓ students, residents, et cetera, to be able to be successful long-term.
speaker-0: exceptional. think we believe that the mission and vision of the company expands beyond MDs. ⁓ And we've seen enthusiasm ⁓ in the entire allied health ⁓ practitioner space ⁓ for the product that we're offering on both the borrower side, but also on the educational side. And hence content like this that allows folks to kind of see what's possible and achievable ⁓ is incredibly valuable to our listening audience. We're gonna close with a few rapid fire questions just to kind of get your reaction to just quickly in your role as a healthcare leader. What 30 second bits of advice would you give to a new CRNA grad?
speaker-1: Yeah, continue to learn. if you can, you know, while you're in school, hopefully, you know, your program is actually teaching in the business side of anesthesia. You know, I learned, you know, through school of, you know, hard knocks, it was on the job training, which is a great way to learn. But, you know, learn everything that you can about the anesthesia business, ⁓ you know, prior to actually graduation, because it does actually impact your day-to-day life. You need to understand, you know, base units and time. You need to understand, you know, medical direction versus non-medically directing, QI, QZ, QX, you know, all of those things, because it actually does, you know, come into play in your day-to-day life.
speaker-0: As someone who is extraordinarily successful, but who learned the business side in the school of hard knocks, so many people ask, should I do an MBA or not? You did not. What is your thought on schooling? As you said, take as much school as possible. Should an aspiring leader get an MBA or some kind of a leadership degree to buttress their aspirations to go into leadership?
speaker-1: Yeah, I certainly, you know, as you said, I did not. But I can tell you, I have a junior, my son is a junior in college who is a nursing major and has a business minor, and he's going to actually finish that and be dual majored, you know, nursing and business. ⁓ So I would always say to folks, get as much education as you can, know, MBA, you know, whatever is going to be valuable for you as an individual. And certainly, you know, as people aspire to leadership roles, you know, there is this preconceived notion, you know, that a, you know, a hospital executive has to have an MHA or MBA. And so sometimes it's kind of check the box, you know, that you've got to have those kind of degrees to be able to, you know, climb the proverbial ladder.
speaker-0: Congrats on your son. There's no pure compliment than your kids looking at what you do, growing up with you, being a leader within medicine and choosing to go in that same path. Thank you. Is it something that you wanted for your kids? So many of us today say, I would steer my kids outside of healthcare. How do you feel about his choice with where things are in the world today from a healthcare perspective?
speaker-1: You know, ⁓ my wife and I, you know, were worried about his choice, but one of the best things we did is my brother's an emergency medicine physician. We sent him to be with him for a week or two and said, put him through the paces, put him in everything because we want him to see what being in nurse means.
speaker-0: Last question, what excites you most about the future?
speaker-1: I think the best thing about health care is also the worst thing. It gives us an unbelievable opportunity to actually drive not only clinical care, but also figure out how we can positively impact this country as it relates to spending on health care. ⁓ There's been tons of talk about increasing premiums for health insurance, the subsidies that expired. All of those things. But one of the things that we don't focus on in healthcare is end users like ourselves being today, we're mostly users of healthcare and we have to be consumers of healthcare. We cannot just go into things blindly. And I use this analogy a lot, you know, that you walk into a best buy to buy a 65 inch TV and you just pick one off the wall and there's no prices on the wall. And then three, four months later, you get a bill and you go, whoa, I didn't know $6,500. That's how we are today with healthcare. So I think the opportunities are out there for us to be able to be the best stewards of dollars and resources that we possibly can be. In anesthesia, providers and clinicians are in a wonderful spot to be able to do that just because of our knowledge of the perioperative suite in itself.
speaker-0: Thank you. Thank you. Joel, really appreciate you taking the time to share your perspective. I think one of the biggest takeaways from this conversation is that a career in healthcare does not have to be linear. ⁓ It can evolve from clinician to operator to leader shaping the system itself, like you are. We talked about the importance of operational excellence, the expanding role of nurse anesthetist and the growing need for financial literacy and access to capital as well.
speaker-1: Thank
speaker-0: At Doc2Doc, we're excited to continue to support clinicians, not just physicians, but the entire clinician ecosystem of professionals because they're a critical part of the healthcare ecosystem. And ultimately, the future of healthcare will be shaped not just by those providing care, but by those like you willing to lead, innovate, and rethink the system beyond the white coat. Thank you so much for the time, Joel.
speaker-1: Thank you, Zwei.
