Latest / Becker’s Healthcare Podcast / Healthcare’s Supply-Demand Crisis: AI, Concierge Care and the Future of Access with Dr. Sam Patel

Transcript

Healthcare’s Supply-Demand Crisis: AI, Concierge Care and the Future of Access with Dr. Sam Patel · Becker’s Healthcare Podcast

• 0:02
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  - at the Hyatt Regency in Chicago,
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  - Register on our events page at beckershospitalreview.com
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  - upper right.
• 0:58
  - This is Scott Becker with the Beckers HealthCare
• 1:02
  - podcast. I'm thrilled today to be joined by
• 1:04
  - doctor Sam Patel.
• 1:06
  - Doctor Patel is not just a doctor.
• 1:09
  - He's also an MBA,
• 1:12
  - health tech innovator, and a lot more.
• 1:15
  - Doctor Patel, can you take a moment
• 1:18
  - and tell us about you and your background
• 1:20
  - and and what you what you do?
• 1:22
  - Sure. Absolutely. Well, Scott, I appreciate having the
• 1:24
  - opportunity to be on here. And, of course,
• 1:26
  - when it comes to health care, I think
• 1:28
  - we can all agree that it's evolving every
• 1:30
  - single day. And sort of my background has
• 1:32
  - always been in
• 1:33
  - building my own practices over the number of
• 1:35
  - years. I've had the opportunity of building 12
• 1:37
  - medical practices that have kind of branched into
• 1:40
  - regenerative medicine and wellness and all of the
• 1:43
  - greatness that we see with GLP ones and
• 1:45
  - hormones today. And through that journey, we quickly
• 1:48
  - realized that
• 1:49
  - health care deserved more. You know, the typical
• 1:51
  - insurance based conversations need to become more robust.
• 1:54
  - We are now seeing clients and patients that
• 1:56
  - business
• 2:05
  - owners and
• 2:09
  - the
• 2:10
  - business owners and clinic owners to even needing
• 2:12
  - to evolve. And that evolution requires,
• 2:16
  - some proper knowledge on how to run a
• 2:18
  - business, how to run a clinic. It's not
• 2:21
  - the days of the hospital or the days
• 2:23
  - of insurance where you could slide a glass
• 2:26
  - window and slap a clipboard and ask for
• 2:28
  - someone's insurance, and you can have a subpar
• 2:30
  - experience.
• 2:31
  - Today, everyone is dialed into having good patient
• 2:34
  - care,
• 2:34
  - and alongside of that, having a good experience.
• 2:37
  - So my focus now has shifted from being
• 2:39
  - an owner and operator of 12 clinics once
• 2:41
  - upon a time
• 2:42
  - to building a consulting firm and also building
• 2:45
  - a health care tech company
• 2:46
  - that focuses on that very pain point. The
• 2:49
  - pain point of how do we not just
• 2:51
  - give good quality care, help people feel the
• 2:54
  - best versions of themselves and live a long
• 2:56
  - life, but how do we have them enjoy
• 2:59
  - health care with a good patient experience? And
• 3:01
  - that's exactly what I focus on today.
• 3:04
  - And talk about building that. What led you
• 3:07
  - to build this consulting firm?
• 3:09
  - How is it going? Tell us about it.
• 3:13
  - Give us the background on on
• 3:15
  - what you're doing, and and what are you
• 3:17
  - loving about it? Sure. Well, Scott, it actually
• 3:19
  - happened by mistake. I realized that after we
• 3:21
  - were building those clinics, a lot of other
• 3:24
  - colleagues around the nation that I would meet
• 3:26
  - at either speaking events or I would meet
• 3:28
  - on conferences or I would be learning from,
• 3:30
  - they would ask me, hey, Sam. What are
• 3:32
  - you doing that's different that you're having such
• 3:34
  - great reviews or that your clinics are scaling?
• 3:36
  - What is it that you're doing differently? And
• 3:38
  - I said, hey. Listen. We're treating it like
• 3:39
  - a hospitality,
• 3:41
  - industry. We're treating it like a hotel. We're
• 3:42
  - treating it like a five star fine dining
• 3:44
  - establishment.
• 3:45
  - We're giving them way more. And so as
• 3:48
  - advice became more given to other people as
• 3:52
  - we were giving sort of free consulting, let's
• 3:54
  - call it, we realized, wow. Well, it seems
• 3:56
  - like people are honing in on what we're
• 3:58
  - doing. It seems to be that media is
• 4:01
  - picking it up. So why don't we actually
• 4:03
  - do this for a living?
• 4:04
  - So what was a hobby? What was sort
• 4:07
  - of a freelance
• 4:08
  - agency
• 4:09
  - became an actual full renowned business,
• 4:13
  - Chicago based consulting firm
• 4:15
  - that now has become a full time job.
• 4:17
  - It is now something that we realize is
• 4:19
  - not just a hobby. It is very much
• 4:21
  - a need. And so now our mindset has
• 4:24
  - shifted from, of course, the usual seeing patients'
• 4:27
  - clinical care that once upon a time was,
• 4:30
  - now to once upon a time is, which
• 4:32
  - is helping other clinics
• 4:34
  - focus in on good quality care, but the
• 4:36
  - patient experience. We call it the patient life
• 4:38
  - cycle. The patient life cycle is what's every
• 4:40
  - step
• 4:41
  - of the journey that they, of course, encounter
• 4:44
  - from the moments they find you on a
• 4:45
  - website or Google
• 4:47
  - to the moment they call
• 4:48
  - and ask questions, which the receptionist is one
• 4:51
  - of the most critical features of this patient
• 4:53
  - life cycle, to the moment they do a
• 4:55
  - consultation, to the moment they receive treatment, to
• 4:57
  - the moment they come back. That whole life
• 4:59
  - cycle in a nutshell
• 5:00
  - is what we focus on immensely
• 5:02
  - in our consulting firm. So now 3,000 practices
• 5:06
  - later across 15 countries,
• 5:08
  - multispecialty
• 5:09
  - when it comes
• 5:11
  - to internal medicine, to surgeons, to,
• 5:14
  - you know, of course, physical therapist, to chiropractic,
• 5:16
  - to dental. Let's just call it health care.
• 5:19
  - Health care in a nutshell has this life
• 5:21
  - cycle, but very much so has a compromised
• 5:24
  - one because they've always focused on quality care,
• 5:26
  - but not the actual life cycle and the
• 5:28
  - different touch points, which is exactly what our
• 5:30
  - consulting firm now does. So what was a
• 5:32
  - hobby has now become a full time full
• 5:34
  - fledged consulting firm because we realized that all
• 5:37
  - health care arenas
• 5:39
  - are now needing to focus on this very
• 5:41
  - attribute, which is called the patient life cycle.
• 5:45
  - Fantastic. And and we're watching in health care
• 5:47
  - this vast
• 5:49
  - increase in patient visits, in screenings,
• 5:53
  - in just need given 350,000,000
• 5:56
  - people in our country
• 5:57
  - and only about 900,000
• 5:59
  - practicing doctors?
• 6:01
  - How do we solve some of that supply
• 6:04
  - demand imbalance? Any thoughts there?
• 6:06
  - You know, this is a very intriguing question.
• 6:08
  - I think it's a very factual concept that
• 6:10
  - we need to start discussing more out loud
• 6:12
  - as what is the future of health care
• 6:13
  - looking like? And to your point, the volume
• 6:15
  - is increasing. The knowledge is increasing. People are
• 6:17
  - not becoming healthier. In fact, they're becoming more
• 6:20
  - ill. And so the need of just weight
• 6:22
  - loss, the need of
• 6:24
  - pain management, the need of just normal care
• 6:27
  - is combated with not just the high demand,
• 6:31
  - but also the supply. The physicians are burnt
• 6:34
  - out. They're tired. Clinics are over
• 6:36
  - capacitated.
• 6:38
  - And so I think now it's about,
• 6:40
  - you know, as we develop health care, how
• 6:42
  - do we continue to provide good health? But
• 6:45
  - also, we're starting to see a rise of
• 6:46
  - cash based clinics. We're seeing a rise of
• 6:48
  - concierge clinics. People that are kind of going
• 6:51
  - against the grain. We call them the, you
• 6:52
  - know, the black sheep or the unicorns of
• 6:54
  - the industry.
• 6:55
  - They're saying we need to provide health care
• 6:58
  - more intimately.
• 6:59
  - There is a growing rise of people wanting
• 7:01
  - help, but people have mistrust.
• 7:05
  - That's also equally rising because now it's becoming
• 7:08
  - sort of a health kill a health care
• 7:10
  - mill. People are having to see their provider
• 7:12
  - for seven minutes, and then they're on to
• 7:14
  - the next, you know, nurse, and then they're
• 7:16
  - spat outside the door. And it's very
• 7:19
  - unfortunate what we're seeing,
• 7:21
  - but it's a reality. And I think for
• 7:23
  - that reason, this
• 7:24
  - health care experience, the touch points, how we
• 7:27
  - make people feel when they come in to
• 7:29
  - when we talk to them to when we,
• 7:31
  - you know, do retention, this patient life cycle
• 7:33
  - concept,
• 7:34
  - is now the little inches that we can
• 7:36
  - improve on because there's a high level of
• 7:38
  - mistrust. There's a high level of demand.
• 7:41
  - Care is not being provided as it used
• 7:43
  - to be. We have good technology on our
• 7:45
  - side. We have more knowledge on our side,
• 7:47
  - but we don't have the providers to facilitate
• 7:49
  - the demand. And as a result,
• 7:51
  - we are now not focusing on the patient
• 7:53
  - experience. In fact, we're compromising it. So we
• 7:56
  - have this sort of convergence or this crossroad
• 7:59
  - that we're dealing with. People are expecting more.
• 8:02
  - They have more knowledge. They are coming in
• 8:05
  - with preconceived ideas of care, and then we
• 8:07
  - only spend a few minutes with them. So
• 8:09
  - you can see here that we're both going
• 8:11
  - in opposite directions,
• 8:12
  - and this is a problem. And so for
• 8:14
  - that very much reason,
• 8:15
  - it's important that all clinics, all physicians, all
• 8:18
  - health care providers all around the world now
• 8:20
  - have to figure out how do I meet
• 8:22
  - the demand of knowledge that patients come in
• 8:25
  - with? How do I give them a good
• 8:26
  - experience?
• 8:27
  - And I give them what they want with
• 8:29
  - intimacy, but also not burn myself out. And
• 8:31
  - that's sort of the the problem that we're
• 8:33
  - all trying to solve. And that's also why
• 8:35
  - the rise of cash based medicine. What I
• 8:38
  - say by that is concierge clinics direct primary
• 8:40
  - clinic. Let's just call it membership based health
• 8:43
  - care. It's on the rise because people want
• 8:45
  - that providers, clinicians
• 8:47
  - want to do that because it's not gonna
• 8:49
  - burn them out. And now I think if
• 8:51
  - we fast forward five years from now, there's
• 8:52
  - gonna be a big demand for concierge based
• 8:55
  - clinics in the health care arena.
• 8:59
  - Thank you. And let me ask you a
• 9:00
  - question about this. One of the common thoughts
• 9:03
  - is that if we have a,
• 9:06
  - a a nationalized health system,
• 9:09
  - that there won't be the need for this
• 9:10
  - concierge
• 9:11
  - and so forth care.
• 9:14
  - But what I tend to see in these
• 9:15
  - other countries is that
• 9:18
  - wherever they have nationalized health systems, there seems
• 9:21
  - to be a percentage of the population
• 9:23
  - wealthy or politically connected.
• 9:25
  - They're getting care in some sort of private
• 9:27
  - clinic, concierge type service in other ways.
• 9:30
  - Any thoughts on that? What what do you
• 9:32
  - see out there? Sure. So our biggest portfolio
• 9:35
  - outside The United States when it comes to
• 9:37
  - consulting health care practices and is in Canada
• 9:39
  - and then Europe. And so I think based
• 9:41
  - off this question, I can certainly kinda tell
• 9:43
  - you what I see in from a data
• 9:45
  - perspective is that,
• 9:46
  - you know, if we are leaning towards sort
• 9:48
  - of organizing that system, I think, yes, certainly,
• 9:51
  - maybe the
• 9:52
  - access to care perhaps may be improved.
• 9:55
  - Maybe the quality of giving people what they
• 9:58
  - deserve perhaps, but they debatably
• 10:00
  - improves. But I do think it creates a
• 10:03
  - greater divide. I do think that the rise
• 10:06
  - of, hey, people that can afford because they're
• 10:08
  - not gonna wait multiple months to be seen.
• 10:11
  - They're gonna want care today. They have the
• 10:14
  - means, financial means to get it. So the
• 10:16
  - demand for those types of clinics, as I
• 10:18
  - mentioned, concierge or DPC or cash based practice
• 10:21
  - or membership model clinics will rise. Let's use
• 10:23
  - Canada as an example. My biggest portfolio outside
• 10:26
  - The United States is all across Canada.
• 10:28
  - We consult a little over 500 practices there.
• 10:31
  - And the biggest challenge that they face is
• 10:33
  - that to see a specialist,
• 10:34
  - let's just use a physical therapist or let's
• 10:37
  - see, say, a psychiatrist,
• 10:39
  - a huge demand field right now.
• 10:41
  - It takes at least thirteen to upwards of
• 10:44
  - eighteen months to schedule a visit with that
• 10:46
  - specialist.
• 10:47
  - Now a nationalized health care system certainly may
• 10:49
  - be okay. Great. I will deal with that
• 10:50
  - because the government's paying for it. But
• 10:53
  - do you think that a person of, you
• 10:55
  - know, wealth or an individual that has the
• 10:57
  - means will wait? No. They want
• 11:00
  - for them, it's a loss of opportunity.
• 11:02
  - They see I'm my job is being impacted.
• 11:05
  - My family is being impacted. I have the
• 11:06
  - financial means. Is there a clinic that will
• 11:09
  - give me access to care now? What does
• 11:11
  - this ultimately relate to? This means concierge cash
• 11:14
  - based TPC type style practices
• 11:16
  - will have a higher likelihood of success.
• 11:19
  - But that's what I mean by create create
• 11:21
  - a bigger divide because we see it with
• 11:22
  - Canada. We see it with Europe. But we
• 11:25
  - see that it's only gonna create a larger
• 11:27
  - bottleneck, a larger time frame of specialist,
• 11:31
  - are being seen by a specialist. And that's
• 11:33
  - the fear that I have.
• 11:35
  - And that is really how I view it,
• 11:37
  - but there's a sort of common misconception
• 11:40
  - that we have
• 11:41
  - we we all want coverage for all,
• 11:44
  - but coverage for all without supply for all
• 11:48
  - is is quite frankly meaningless. It's a it's
• 11:51
  - a political platitude.
• 11:53
  - What are the most interesting issues you're watching
• 11:55
  - in health care currently, doctor Patel?
• 11:58
  - So I think that,
• 11:59
  - when we see
• 12:01
  - sort of the frustration,
• 12:03
  - you know, we have a growing population of
• 12:05
  - educated people. We have a growing population of
• 12:07
  - individuals
• 12:08
  - having access to information.
• 12:10
  - So as a result, people are now becoming
• 12:12
  - more proactive. That is the good thing that
• 12:14
  - we're seeing in health care. People are actually
• 12:16
  - saying, you know what? I can prevent disease.
• 12:18
  - I can prevent cancer. I can at least
• 12:20
  - slow down the likelihood of developing chronic diseases.
• 12:23
  - Let me go see my provider sooner than
• 12:25
  - later. We are now developing a more proactive
• 12:29
  - society of health care. It's still, of course,
• 12:31
  - growing,
• 12:32
  - but it is moving in that realm. What
• 12:35
  - does this ultimately mean? This ultimately means that
• 12:38
  - we now have to supply that demand because
• 12:40
  - before people were being reacted with their health.
• 12:43
  - They were only seen when they needed to
• 12:44
  - be seen. If something was wrong, then they
• 12:46
  - went to go get it fixed. Now we
• 12:48
  - see it with other companies. I have no
• 12:51
  - affiliation with these companies, but they're good examples
• 12:53
  - for this use case. We have companies such
• 12:55
  - as PerNuvo,
• 12:56
  - Full Body MRI. We have companies like Function
• 12:58
  - Health.
• 12:59
  - Why do these companies have good amount of
• 13:01
  - success? Why are they having traction?
• 13:03
  - Because they supply
• 13:04
  - knowledge. They give people access to information,
• 13:08
  - and, hence, they are growing in the likelihood
• 13:10
  - of how they're growing today. We see that
• 13:12
  - with
• 13:13
  - wearables like aura rings and all the different
• 13:16
  - things that are coming into the horizon. What
• 13:18
  - this tells us is that the demand is
• 13:20
  - only going to increase because the access to
• 13:23
  - information
• 13:24
  - is now increasing. People are wanting to be
• 13:25
  - preventative. People don't wanna go through what their
• 13:27
  - grandparents or their generations ahead of them have
• 13:30
  - gone through, like diabetes, high cholesterol, heart disease,
• 13:33
  - depression. We can start to actually prevent a
• 13:36
  - lot of this.
• 13:37
  - Hence, the demand is extensively high. That is
• 13:40
  - creating a large amount of burden and friction
• 13:43
  - on the health care system.
• 13:45
  - And for that reason,
• 13:46
  - I think as exciting as this is because
• 13:49
  - we see regenerative medicine, preventative medicine, GLP ones,
• 13:52
  - hormones,
• 13:53
  - stem cells, NAD, all this stuff is so
• 13:55
  - popular. It's growing in popularity.
• 13:58
  - But
• 13:59
  - to that degree, the devil's advocacy here is
• 14:02
  - that there are not enough people.
• 14:04
  - And
• 14:05
  - the burden is going to be very much
• 14:07
  - on the health care. I mean, The US
• 14:08
  - health care system is gonna
• 14:10
  - deal with a lot of pressure here. And,
• 14:11
  - of course, now big pharma getting involved. You
• 14:14
  - know, it's it's interesting what we're gonna see
• 14:16
  - in the next three to five years, and
• 14:17
  - I don't I hope that it improves.
• 14:19
  - What I can be helpful for is that
• 14:21
  - people are wanting to address their health.
• 14:24
  - The negative is we don't have enough people
• 14:26
  - to help them do that, which is what's
• 14:27
  - gonna be interesting over the next few years.
• 14:30
  - Thank you. No. I think that's exactly right.
• 14:33
  - And and and and talk about where you're
• 14:35
  - most focused and excited this next six months
• 14:38
  - and going into next year.
• 14:40
  - So my biggest focus is how do we
• 14:42
  - deal with this inevitability?
• 14:44
  - I mean, we can all sit here and
• 14:45
  - talk, and we could talk for days on
• 14:47
  - what's actually happening and sort of the let's
• 14:49
  - just call it the projections of where we
• 14:51
  - see this going. So instead, just like we're
• 14:54
  - treating medicine, which is being more proactive, why
• 14:56
  - don't we be proactive in the patient demand?
• 14:59
  - And that proactiveness
• 15:00
  - could be encouraging people to either
• 15:03
  - go into continuously go into medicine. I mean,
• 15:06
  - the residency
• 15:07
  - rates are changing. The med school acceptance and
• 15:10
  - applications are changing, not for the better. So
• 15:13
  - what do we do to actually have physicians
• 15:15
  - motivated again? And that's sort of what intrigues
• 15:17
  - me the most, and that's what I love
• 15:19
  - what I do with our consulting firm. We
• 15:21
  - figure out how to give the tools
• 15:23
  - for this demand, whether it's how do you
• 15:25
  - hire people? How do we increase the bandwidth
• 15:29
  - of the amount of patient rooms you have?
• 15:31
  - How do we bring in these preventative treatment
• 15:34
  - services like weight loss, like hormones, like regenerative
• 15:37
  - medicine? How do we now have a good
• 15:39
  - balance? We see dentists doing this. They're bringing
• 15:42
  - in wellness services. We see chiropractors bring in
• 15:45
  - wellness services. We see internal medicine that are
• 15:47
  - entirely Medicare or Medicaid clinics traditionally,
• 15:50
  - bringing in regenerative services that are cash based.
• 15:53
  - So I think it's how do we use
• 15:55
  - the amazing providers out there and help them
• 15:59
  - be taught on how to meet this demand
• 16:02
  - and inspire them to develop, or I should
• 16:04
  - say, evolve their clinical setting
• 16:07
  - to accommodate to this proactive mindset.
• 16:10
  - That I feel is happening now. I know
• 16:12
  - that because those are the clients that I
• 16:13
  - deal with every day, and I think that
• 16:15
  - that demand is gonna increase. People are burnt
• 16:17
  - out by the health care system.
• 16:19
  - They're tired. I have internal medicine physicians seeing
• 16:22
  - 60 patients a day, but they love what
• 16:24
  - they do. They love medicine. They don't love
• 16:26
  - the politics behind it. The reimbursement drops,
• 16:28
  - decline, reimbursement rates declining.
• 16:31
  - So they are now the ones that are
• 16:32
  - creating a hybrid model. Hey. I'm gonna continue
• 16:35
  - to do my medicine,
• 16:37
  - but I wanna have a proactive health
• 16:39
  - care adjunct
• 16:40
  - built to my business. I want a department
• 16:42
  - that does wellness, that does preventative, that does
• 16:44
  - pain management.
• 16:45
  - And I think that is gonna be the
• 16:47
  - future of how we balance both. It's not
• 16:49
  - burning out and retiring our physicians.
• 16:51
  - It's giving them the ability to have balance
• 16:54
  - to meet this demand. And that's sort of
• 16:56
  - what excites me because I am able to
• 16:58
  - help them do that, create that business model,
• 17:00
  - do the training behind that. And so I'm
• 17:02
  - excited because I think that the the demand
• 17:04
  - is increasing.
• 17:05
  - It's not about how do we get more
• 17:07
  - doctors trained. It's about how do we help
• 17:09
  - the current doctors
• 17:11
  - love what they do and
• 17:13
  - mold around this inevitable evolution that we're saying
• 17:16
  - rather than resist against it.
• 17:18
  - And let me ask you this question. I
• 17:19
  - think the latest number I saw was that
• 17:21
  - one to 2% of doctors are working concierge
• 17:26
  - and generally in primary care. But in our
• 17:29
  - area of the Greater Chicago area, there's a
• 17:31
  - cardiology practice that charges an access fee. There's
• 17:34
  - a dermatology practice that charges an access fee,
• 17:37
  - sort of concierge light, but but a type
• 17:40
  - of concierge.
• 17:42
  - From primary care doctors' perspective,
• 17:44
  - they've moved from
• 17:46
  - grinding away patients 30 and a 30 a
• 17:48
  - day to whatever
• 17:50
  - to now doing similar things, but having 200
• 17:53
  - patients that pay them a few thousand dollars
• 17:55
  - a year.
• 17:56
  - And this is a complete change in their
• 17:57
  - business model and quite frankly gives them a
• 17:59
  - lot more freedom and flexibility and probably a
• 18:02
  - better way to practice.
• 18:03
  - Are we gonna see is there at some
• 18:06
  - point
• 18:06
  - where you're gonna see an acceleration
• 18:09
  - towards people doing concierge
• 18:11
  - just because
• 18:12
  - it it just seems like an easier, better
• 18:14
  - way to make a living and run a
• 18:16
  - practice as a physician
• 18:18
  - than
• 18:19
  - having to schedule
• 18:20
  - hundreds and hundreds of patients and and seeing
• 18:22
  - hundreds of 100 patients and then having to
• 18:24
  - deal with the insurance companies. I mean, you're
• 18:26
  - still dealing with the insurance companies, but you're
• 18:27
  - getting a base that seems to be better
• 18:30
  - than what you were making from your insurance
• 18:31
  - companies before. So now you're doubling your income.
• 18:33
  - What what is the
• 18:36
  - are we gonna see more and more of
• 18:37
  - it?
• 18:38
  - I do believe so. Because over the last
• 18:40
  - eighteen months, the highest amount of clients that
• 18:43
  - we have coming to us are people that
• 18:44
  - are in current traditional insurance based practice.
• 18:47
  - And they aren't jumping to the deep end,
• 18:50
  - meaning they're not going straight into
• 18:52
  - leaving that world and going into concierge medicine.
• 18:54
  - I kind of kind of call it the
• 18:55
  - hybrid model. The hybrid model is their business
• 18:58
  - or their practice or their clinic has the
• 19:00
  - insurance model. Maybe they hired nurse practitioner, mid
• 19:03
  - level, or someone depending on their state regulation,
• 19:06
  - someone that can run that side and see
• 19:08
  - the high demand patients. And the physician who's
• 19:10
  - tired and burnt out kind of goes between
• 19:13
  - both worlds. They cut their patient load in
• 19:15
  - half on the insurance side, and then they
• 19:16
  - follow their passion on the cash based side
• 19:18
  - or the concierge side. That's what as a
• 19:20
  - hybrid, they're doing both. They have both different
• 19:23
  - practices running at the same time. Maybe it's
• 19:25
  - one different roof or rather one roof and
• 19:27
  - it's different sort of personality or two different
• 19:29
  - business models. But I do think to your
• 19:31
  - point, reimbursement rates are declining. There is nothing
• 19:35
  - to debate around that. We're seeing it year
• 19:36
  - after year, and that is having
• 19:39
  - that means that if someone that's in their
• 19:41
  - mid or maybe their peak of their career,
• 19:43
  - they're in their fifties, they're going into their
• 19:45
  - sixties or doing very well financially,
• 19:48
  - they're having to see
• 19:49
  - 30%
• 19:51
  - more patients just to maintain the same level
• 19:53
  - of financial income, not just financial income for
• 19:56
  - themselves, but operational costs for the business. Billers,
• 19:59
  - nurses,
• 20:00
  - all of the different team members we have
• 20:02
  - to have, all the technology we have to
• 20:04
  - invest in. Those costs are rising.
• 20:07
  - People are demanding more pay. Finding good quality
• 20:10
  - people in today's workforce is near impossible.
• 20:13
  - So that means we have to pay them
• 20:14
  - more. And on top of that, reimbursements are
• 20:16
  - declining. That's a recipe
• 20:18
  - for frustration.
• 20:19
  - So for that reason, there's only so much
• 20:22
  - a clinician or a physician is gonna take
• 20:24
  - to where they then see their colleague down
• 20:26
  - the road or in another city or someone
• 20:27
  - that their respect
• 20:29
  - convert over to the concierge model, and they
• 20:31
  - have their life back. They don't have to
• 20:33
  - deal with the inconsistency
• 20:35
  - or in, unpredictability,
• 20:37
  - which is exactly what is causing this demand.
• 20:40
  - Insurance agents,
• 20:41
  - reimbursements,
• 20:42
  - all of these are unpredictable.
• 20:45
  - And scaling a business with an unpredictable landscape
• 20:48
  - of income
• 20:49
  - is not gonna be
• 20:50
  - anything that's exciting for somebody.
• 20:52
  - Where if it's a membership model and to
• 20:54
  - your point,
• 20:55
  - you have a standard income that's coming in.
• 20:57
  - It's predictable. You have your members.
• 20:59
  - Then that provides stability. And what the aging
• 21:02
  - physician or physician that's getting into the later
• 21:05
  - stages of their career,
• 21:07
  - they want predictability.
• 21:08
  - They want stability.
• 21:10
  - They do not want what's currently happening, which
• 21:12
  - is unpredictability,
• 21:13
  - which is what reimbursements are. So you can
• 21:15
  - kinda see now why this is a recipe
• 21:17
  - for the convergence or rise
• 21:20
  - of concierge style medicine.
• 21:23
  - Thank you. And where do you see artificial
• 21:26
  - intelligence
• 21:27
  - evolving into all this? We're still very much
• 21:30
  - in a person to person business.
• 21:32
  - Where does AI help? Where does that become
• 21:34
  - part of the solution in technology?
• 21:36
  - Yeah. That's a great question. I think AI
• 21:38
  - sort of has two ways of looking at
• 21:41
  - it. There's operational
• 21:42
  - advantages, and then there's clinical advantages.
• 21:45
  - I think the clinical advantages is where a
• 21:47
  - lot of the debate, I should say, or
• 21:50
  - the,
• 21:50
  - you know, a lot of the discussions are
• 21:52
  - around. Should AI be
• 21:54
  - conducting clinical diagnostic care? Should it be creating
• 21:57
  - treatment plans? There's a lot of debate there.
• 22:00
  - So let's focus our attention on the operational
• 22:02
  - side because that one has a lot more,
• 22:05
  - at least, confidence behind it. There's not so
• 22:07
  - much debate. So the efficiency or operation side
• 22:10
  - of it is
• 22:11
  - AI helping with doing a lot of the
• 22:13
  - billing, helping with analyzing notes, or rewriting
• 22:17
  - a note, making it more efficient, doing the
• 22:19
  - dictation
• 22:20
  - because once again saving time. It could even
• 22:23
  - do a lot of the front desk receptionist
• 22:25
  - work, having to answer calls. Some of the
• 22:27
  - things I've heard now with AI agents, it
• 22:30
  - sounds so realistic. You would never know that
• 22:32
  - it's not an actual human booking appointments,
• 22:35
  - following up with patients, checking in on them,
• 22:37
  - doing patient reminders, scheduling reminders, appointment reminders.
• 22:41
  - These
• 22:41
  - efficiencies
• 22:42
  - now don't require us to have to have
• 22:45
  - them doing man doing being done manually by
• 22:47
  - a human. So I think AI in the
• 22:49
  - health care arena will make physicians
• 22:52
  - and businesses and practices and clinics more efficient.
• 22:56
  - It's gonna allow them to be saving hours
• 22:59
  - and hours a day, whereas typically, a lot
• 23:01
  - of that work was manual. On the clinical
• 23:03
  - side, as I mentioned, two sides of this,
• 23:05
  - I think there's a lot to be developed
• 23:07
  - there. We're seeing it with radiology. It's still
• 23:09
  - in the works. We're seeing it with, you
• 23:11
  - know, other countries, like, certain countries in Asia
• 23:14
  - are already vetting this model of seeing, can
• 23:16
  - we have AI doctors? I think we have
• 23:18
  - a ways to come around that. I do
• 23:20
  - think it helps us
• 23:22
  - in many ways. I don't think that the
• 23:24
  - world is ready for an AI doctor. I
• 23:26
  - do think that the world is seeing benefit
• 23:29
  - from AI operations management of clinics, making it
• 23:33
  - more efficient, giving us data, showing us how
• 23:35
  - we can improve our room rates, our room
• 23:38
  - to time ratio.
• 23:39
  - Yes. I think AI is brilliant there, and
• 23:41
  - that's where I do think that is gonna
• 23:43
  - be the success of AI, at least in
• 23:45
  - the immediate future until the world is ready
• 23:48
  - for AI to be involved in health care
• 23:49
  - management, which who knows when that time will
• 23:51
  - come.
• 23:52
  - And then in terms of health care management,
• 23:55
  - it seems that we're likely to be for
• 23:57
  - a very long time
• 23:59
  - in this very combined world of technology
• 24:01
  - and human in the loop. Like, even with
• 24:04
  - radiology where AI is so pervasive,
• 24:08
  - you absolutely have radiologists
• 24:09
  - reviewing
• 24:10
  - screenings, any AI results, and everything else. And
• 24:13
  - maybe it's helping them get there a little
• 24:15
  - quicker, a little bit better, but you still
• 24:17
  - we still have a shortage of radiologists.
• 24:20
  - Do you see this mix of human talent
• 24:22
  - with technology talent
• 24:24
  - being a long term pathway?
• 24:27
  - I I hope so. My fear is that
• 24:30
  - it's creating a lot of, worry amongst these
• 24:33
  - sort of specialty providers. As you mentioned, radiologists,
• 24:36
  - I know a lot of them. And what
• 24:37
  - I've noticed with them is that they're starting
• 24:39
  - to plan for the next five years. And
• 24:40
  - I asked them, I'm like, hey. Why are
• 24:42
  - you building a wellness practice? Or why are
• 24:44
  - you doing, you know,
• 24:46
  - injury,
• 24:47
  - and and and sort of legal work now?
• 24:49
  - It's because they're scared that they're gonna get
• 24:51
  - replaced.
• 24:52
  - Now I think that that's that's the fear
• 24:54
  - I have is, are is there gonna be
• 24:56
  - a beautiful harmony between the two? And then
• 24:58
  - on a global scale, or I should say
• 24:59
  - a more higher upscale, our hospital systems are
• 25:02
  - more corporatized health care systems
• 25:04
  - gonna say, hey. Well, this is cheaper. Because
• 25:07
  - at the end of the day, yes, we
• 25:08
  - wanna provide quality care. But from sort of
• 25:10
  - their standpoint, the corporate level or the health
• 25:12
  - health big big health care system, it's all
• 25:14
  - about dollars.
• 25:16
  - And how do we balance both?
• 25:18
  - And so if it's good enough, then, yeah,
• 25:20
  - my fear is that they'll become obsolete.
• 25:23
  - And I don't know if that's gonna happen
• 25:25
  - soon. I do think that that is the
• 25:26
  - fear. I see that right now. I see
• 25:29
  - that specifically in radiologist worlds.
• 25:31
  - I see that they're fearful of being replaced.
• 25:34
  - Now, yes, the very specialized, like, neuroradiologist
• 25:37
  - or the very specialized yeah. That's gonna take
• 25:39
  - some time. But to your point, I do
• 25:41
  - think that there is a fear of the
• 25:43
  - need of them
• 25:44
  - not being,
• 25:45
  - needed is gonna be there. But, also, I
• 25:47
  - think that's also why AI is on the
• 25:49
  - rise.
• 25:50
  - I think that the health care system's smart.
• 25:52
  - I think the developers of these platforms
• 25:55
  - are seeing that there's not as many specialists
• 25:57
  - coming into the workforce. Not as many people
• 25:59
  - are going into school residency.
• 26:02
  - So they are trying to proactively figure out
• 26:04
  - what to do. And the cheapest and most
• 26:07
  - predictable way is to create an AI that
• 26:09
  - replaces that person.
• 26:10
  - So I think they're gonna Talk about that
• 26:12
  - for a second. Yeah. Because one of the
• 26:13
  - great problems, you've almost got this vicious cycle.
• 26:16
  - We don't have nearly enough specialists.
• 26:19
  - We already saw this in primary care.
• 26:22
  - We're we're almost past the era of everybody
• 26:24
  - having their own primary care physician,
• 26:26
  - and by necessity and and the numbers can't
• 26:29
  - catch up to themselves. We're getting ten, fifteen
• 26:31
  - thousand primary care doctors a year, ten, fifteen
• 26:33
  - thousand are retiring a year. We've got this
• 26:35
  - growing population.
• 26:37
  - And so by necessity, so much of primary
• 26:39
  - care has moved to technologies,
• 26:41
  - nurse practitioners,
• 26:43
  - PAs, and so forth. And not that we
• 26:45
  - don't love our own primary care doctor. I've
• 26:47
  - got one, but I don't know what I'm
• 26:48
  - gonna do when he retires.
• 26:49
  - But by necessity, we've changed the model.
• 26:52
  - Is that what's gonna happen by specialists by
• 26:54
  - necessity, not because it's better health care.
• 26:57
  - I mean, there's obviously parts of it, but
• 26:59
  - we're just gonna be so short specialists. Like,
• 27:01
  - on oncology, there's 27,000
• 27:03
  - oncologists in this country,
• 27:04
  - 2,000,000 dot new diagnosis a year. Every oncologist
• 27:08
  - I talk to is overwhelmed,
• 27:10
  - exhausted, and information overloaded.
• 27:13
  - Is there no way around the fact that
• 27:14
  - we're gonna end up with so much care
• 27:16
  - provided in other ways because there's just not
• 27:17
  - enough doctors? So systems have to find ways
• 27:20
  - around it.
• 27:21
  - I do. I do think that we're gonna
• 27:23
  - see a lot of creative ways. I think,
• 27:25
  - as I mentioned earlier, we're already seeing that
• 27:26
  - now. We see a lot of these private
• 27:28
  - entities, like, with big health care leaders, big
• 27:31
  - doctors with big names,
• 27:32
  - creating other ways of getting labs done, of
• 27:35
  - getting blood work done, precancer screening done, getting
• 27:37
  - a full body MRI done. And I think
• 27:40
  - that that's sort of the next outlet because
• 27:43
  - politically and with big health care systems,
• 27:46
  - we don't know what's gonna happen. We don't
• 27:48
  - know what the agenda is. We don't know
• 27:49
  - where that's heading. We can
• 27:51
  - stereotypically say or traditionally, by history, it shows
• 27:55
  - that it's not going in the right direction.
• 27:57
  - And so based off of that, I mean,
• 27:58
  - yes, the specialties
• 28:00
  - are gonna be more scarce. As you mentioned,
• 28:02
  - we have the highest
• 28:03
  - population of retirees in the health care arena,
• 28:06
  - our baby boomers. We have the biggest population
• 28:09
  - of experts that are retiring right now, and
• 28:11
  - we're not having the influx.
• 28:12
  - So that is gonna be either people going
• 28:15
  - into medical tourism. We see that now. People
• 28:17
  - are going overseas to be seen by a
• 28:19
  - specialist, whether it's to,
• 28:20
  - an adjacent country, whether it's overseas. I see
• 28:22
  - that right now. People are going to get
• 28:24
  - their LASIK surgery over in Europe because not
• 28:27
  - only is it cheaper, they can be seen
• 28:29
  - right away.
• 28:30
  - So I think that
• 28:32
  - we're gonna see a lot of,
• 28:34
  - fatigue and a lot of reliance or dependency
• 28:37
  - on other avenues, whether it's privatized care, whether
• 28:40
  - it's these private equity firms investing immense amounts
• 28:44
  - of money to create private health care, like,
• 28:46
  - systems. You see the Amazons in the world
• 28:49
  - creating one medical or whatever that is. There's
• 28:52
  - a lot of different big, big, big groups
• 28:54
  - that are saying, well, hey. Why don't we
• 28:55
  - just do this ourselves? Telehealth
• 28:58
  - is back on the rise. We saw it
• 29:00
  - be essentially created during COVID, and now it
• 29:03
  - kinda it took a dip after COVID, and
• 29:05
  - now it's back up because once again, it's
• 29:07
  - easy to access. It's cheap. It's super simple.
• 29:09
  - It's convenient, and there's a mid level on
• 29:11
  - the other end that can execute at a
• 29:12
  - high level.
• 29:13
  - So, yes, I do think that the specialty
• 29:16
  - is gonna be an issue. Overseas market is
• 29:19
  - gonna rise. That's why you see The Middle
• 29:20
  - East and Dubai and The UAE
• 29:22
  - putting a lot of infrastructure
• 29:24
  - with specialty cares because they're gonna attract people
• 29:26
  - from The US who have money. And so
• 29:28
  - I do think that we're gonna see a
• 29:29
  - very interesting evolution,
• 29:31
  - and
• 29:32
  - the hospital systems are gonna struggle. I think
• 29:36
  - the hospital it's all we're already seeing that.
• 29:38
  - I mean, we have one neurosurgeon
• 29:40
  - in a 25 mile radius.
• 29:42
  - How is that one neurosurgeon gonna do neurosurgery
• 29:45
  - for a population size of, you know, half
• 29:47
  - a million people? It's not gonna happen. And
• 29:49
  - so disaster. I mean, it's really just asking.
• 29:51
  - We see it in neurology too where there's
• 29:52
  - this Yep.
• 29:53
  - Aging, dementia, Alzheimer's population,
• 29:56
  - and there's just there's one neurologist for 500,000
• 29:58
  - people. We see it in North Minnesota with
• 30:00
  - the dermatologist,
• 30:01
  - one dermatologist
• 30:02
  - in a population with lots of skin cancer
• 30:04
  - for five hundred thousand people. These numbers are
• 30:06
  - just getting daunting, and so we're gonna try
• 30:08
  - our best to use technology which is to
• 30:10
  - build them. It seems like there's zero political
• 30:12
  - will.
• 30:13
  - And, also, the specialty societies are very concerned
• 30:15
  - about increasing the number of residents if not
• 30:17
  - in their specialties
• 30:18
  - if they're needed because they worry about in
• 30:20
  - the long term
• 30:22
  - there being surpluses. But but what you're gonna
• 30:24
  - end up with is
• 30:25
  - all kinds of physicians getting run out of
• 30:27
  - business, so it's just not enough for them
• 30:29
  - for us to rely on them. I mean,
• 30:30
  - it's really sort of a debacle.
• 30:32
  - The the the telehealth thing is fast because
• 30:34
  - I've I've watched this with the GLP one
• 30:36
  - thing. It's only 30,000,000
• 30:38
  - plus people a year on GLP ones now.
• 30:40
  - Most of them are getting them through telehealth.
• 30:42
  - It used to be they're getting through hospitals
• 30:44
  - and health systems, they're getting through doctors' offices.
• 30:46
  - Now that entire stream has moved away from
• 30:49
  - that
• 30:50
  - with great benefit, it's
• 30:52
  - stopped sort of clogging up the hospital systems
• 30:54
  - and the primary care offices,
• 30:57
  - and the prices have gone down significantly. I
• 30:59
  - mean, it's sort of a fascinating evolution.
• 31:01
  - You know, there are more opportunities like that
• 31:03
  - in health care to try and solve the
• 31:06
  - the demand supply imbalance.
• 31:09
  - Yes. I mean, we see GLP ones themselves
• 31:10
  - have evolved over the last three, four years.
• 31:13
  - You know, you had semaglutide, then you had
• 31:14
  - trezepatide, and then you have RETA that's coming
• 31:16
  - out now and getting popularity.
• 31:18
  - So I think the medications and the the
• 31:20
  - technology behind pharma is gonna continue to increase.
• 31:23
  - As a result,
• 31:24
  - people are gonna want it. You know, there's
• 31:26
  - gonna be other things that solve other big
• 31:28
  - chronic problems. Weight, of course, is our number
• 31:30
  - one,
• 31:31
  - consideration, and I think the mental health arena
• 31:34
  - is starting to get a lot of attention.
• 31:35
  - Is there other alternatives? You see ketamine on
• 31:38
  - the rise. You see TMS, transcranial magnetic stimulation,
• 31:41
  - back on the rise. You see these other
• 31:43
  - alternatives
• 31:44
  - because to your to your point, I mean,
• 31:46
  - what is the other traditional way is you
• 31:48
  - get to see a traditional physician, you have
• 31:49
  - to wait months to see a specialist. And
• 31:51
  - by then, whether you qualify with a, you
• 31:53
  - know, CBT or ICD 10 code, then you
• 31:56
  - may get therapy. Whereas now, it's I can
• 31:58
  - access something quickly online virtually have it mailed
• 32:01
  - to my house.
• 32:02
  - I have worries about these things as well.
• 32:04
  - Is that how what's the limitation here? You
• 32:07
  - know, medicine has always been an intimate process.
• 32:10
  - We we do a physical, we see the
• 32:12
  - patient, We have a conversation with them. We
• 32:14
  - we analyze
• 32:15
  - their different data points, whether it's weight, whether
• 32:18
  - it's body composition, muscle composition, whether it's a
• 32:20
  - lab workup, vital signs.
• 32:23
  - And when we kind of turn into this
• 32:24
  - dependent model of online care, although, yes, it
• 32:27
  - gives us better access. It allows people to
• 32:29
  - have better quick care.
• 32:31
  - It's cheaper as we mentioned. It's more affordable.
• 32:34
  - What is the long term ramification that we
• 32:36
  - may see is
• 32:38
  - the side effects.
• 32:39
  - What is is this sort of the style
• 32:41
  - in which new medicine's gonna be? You don't
• 32:43
  - see a human anymore. Is it gonna be
• 32:45
  - robotic now? What about all the physicals and
• 32:47
  - other different things, other traditional when you go
• 32:50
  - back twenty years ago, your physician did a
• 32:52
  - full physical on you. They would check a
• 32:54
  - spot or a skin cancer that could be
• 32:57
  - a concern, and then they would I biopsy
• 32:59
  - it right in the office. They would send
• 33:00
  - it off. You would other you would get
• 33:02
  - other things analyzed. But if I'm a weight
• 33:04
  - loss patient, well, that weight loss patient, most
• 33:07
  - likely, statistically has other things going on, whether
• 33:11
  - it's joint degenerative disease, whether it's back pain,
• 33:14
  - whether it's,
• 33:15
  - hormone deficits.
• 33:16
  - But those conversations are no longer happening through
• 33:19
  - an online telehealth system just to get quick
• 33:21
  - GLP ones. That's my long term fear of
• 33:24
  - the online dependency that we are creating. Is
• 33:27
  - is it gonna turn medicine into a transactional
• 33:30
  - one, which it is? Or is it gonna
• 33:32
  - turn medicine into a more intimate one because
• 33:34
  - they have easy access virtually?
• 33:36
  - I think there's a debate for both realms.
• 33:38
  - And my fear is that it turns into
• 33:40
  - the transactional one, and we start losing medicine
• 33:43
  - as a whole, which is that intimacy that
• 33:45
  - we know from ten, twenty years ago, which
• 33:47
  - is analyzing your entire health, not through a
• 33:49
  - telehealth visit. And many of them are not
• 33:50
  - even telehealth. You're just texting, which is absolutely
• 33:52
  - obscene.
• 33:54
  - So although it's great for access and we
• 33:56
  - see the access with GOP ones,
• 33:58
  - where is the limitation gonna be? Where are
• 34:00
  - we gonna draw the line? And when does
• 34:02
  - it become a problem? And I think that
• 34:05
  - that question will be answered soon enough.
• 34:07
  - No. I think that's right on. I I
• 34:09
  - see it with my parents who are aging.
• 34:12
  - When they do a telehealth visit,
• 34:14
  - so much is lost
• 34:16
  - compared to doing an in person visit. Just
• 34:18
  - so much is lost. There's a really seeing
• 34:20
  - the whole patient or seeing what's going on
• 34:21
  - with the whole patient. You know, one time
• 34:23
  - we had to take my mom to the
• 34:24
  - emergency room to tell her the visit just
• 34:25
  - completely missed what was really going on with
• 34:27
  - my mother and just see so much of
• 34:28
  - that. That's anecdotal, but I think a lot
• 34:30
  - of things translate to lots of other people.
• 34:32
  - And I and I do think the same
• 34:33
  - concern with the GLP ones,
• 34:35
  - a person prescribes,
• 34:36
  - you don't know if you're really any real
• 34:38
  - doctor looking over it or not. Right. And
• 34:40
  - for ninety percent of people, that might be
• 34:42
  - fine.
• 34:43
  - For ten percent of people, they might be
• 34:45
  - avoiding what might be a real issue someplace
• 34:47
  - else. I think there's just a lot of
• 34:49
  - that. Absolutely.
• 34:50
  - The lifestyle modification, I mean, we can do
• 34:52
  - a quick fix or something. But what what
• 34:54
  - if that weight loss is, you know, emotional
• 34:57
  - and consideration? What if it's depression that's causing
• 35:00
  - it? What if it's a thyroid problem? What
• 35:01
  - if it's a there's so many there's a
• 35:03
  - laundry list as we know. And so it's
• 35:05
  - a band aid. Are we influencing this quick
• 35:08
  - fix band aid behavior?
• 35:10
  - And, you know or are we practicing good
• 35:12
  - root cause medicine? Which is why, once again,
• 35:14
  - going back to our earlier point, concierge medicine
• 35:16
  - kind
• 35:17
  - of basically
• 35:18
  - disrupts that concept. It says, hey. No. We're
• 35:20
  - gonna actually talk about your whole body. We're
• 35:22
  - gonna actually go through every ounce of aspect
• 35:26
  - of your blood in terms of the different
• 35:28
  - markers, the different,
• 35:30
  - you know, levels of hormones you have, the
• 35:32
  - different different electrolyte, everything. It's a full panel
• 35:35
  - of blood, and it tells us the whole
• 35:36
  - story, which is not that's why I that's
• 35:38
  - why I mentioned we're gonna see a massive
• 35:40
  - divide, a divide of access to care being
• 35:42
  - very easy, cheap, and affordable,
• 35:45
  - and
• 35:46
  - in many cases,
• 35:47
  - debatably negligent.
• 35:48
  - And then on the other spectrum, you have
• 35:50
  - amazing care, but it costs a lot of
• 35:52
  - money. So there's gonna be a economical,
• 35:55
  - division between, you know, people that have the
• 35:58
  - access financially versus the people who don't.
• 36:00
  - No. I think that's right on.
• 36:03
  - I I I wanna thank you, doctor Patel,
• 36:04
  - for joining us. What a great conversation. What
• 36:06
  - a brilliant mind. Thank you so much for
• 36:08
  - joining us today on the Bechsus Healthcare podcast.
• 36:10
  - A total pleasure to visit with you. Thank
• 36:11
  - you very much. The time. Pleasure meeting you.
• 36:13
  - Thank you. Thank you.