Episode Transcript
Daniel Wrenne: What's up guys? Hope your day's going well. Today I am talking with Dr. Daniel Paul. Daniel is an orthopedic surgeon that is operating his own practice that he started from scratch out in Colorado Springs. He's a great guy that's really got a great business going. It's called Easy Orthopedics. You'll also see that he speaks with honesty even when it's painfully true, and he's also a great innovator.
And like any great innovator, he's not built to simply go along with the idea that we should do things just because that's the way they've always been done. But what's especially interesting about Daniel is how he's running his business, which is completely different than the traditional system of healthcare.
And he's in turn starting to disrupt the industry, I think, in a good way. And so today we're gonna be talking about why his practice is so unique. He's gonna share how he got it to this point of really running on full steam and how he's become such an innovator and. Built this practice. It's really relatively simple yet.
Is completely blazing a new trail. We discuss how dollars per hour is such an important metric to pay attention to for physicians, especially those of you guys that are having, limited spare time, feel like you don't have any time. And so we also discuss why this new model he's trailblazing is such a better alternative for physicians.
And for patients and how I can help solve some of these burnout issues and, other issues in healthcare. Overall, it was a really great discussion that I enjoyed. I always love talking to people like Daniel that are really not satisfied with the status quo. People that are motivated to do things differently and chart a new course.
We definitely need more guys like him out in the world. Really, trailblazing and charting a new course. It was motivating for me to hear him talk through this, and I think you're gonna enjoy it and be motivated as well. So, uh, without further ado, let's, let's jump into the episode now.
Daniel Wrenne: Daniel, what's up man?
I'm excited to have you, man. I, I, we had a great conversation kind of talking about what we were gonna cover. And, I love what you're doing. First of all, I absolutely love innovators and people that are doing things a little bit differently and people that don't really like, one of my least favorite things is when I hear people say, oh, well we're just doing that, cuz that's the way it's always been done.
That's like one of my least favorite statements. And I know, I could tell from your facial expressions, you don't really. Like that either and the way that you're doing it, I think your practice is fantastic. It's very innovative. what's interesting though about saying it's innovative is actually in some ways, like, kind of like the way I think it maybe used to be done back in the day.
Like it's really simple as well, and not, uh, what I think people would think of is innovative, but it's, it's definitely a different way of doing things and I think it's fantastic. So thanks for coming on, man. Yeah. Thanks
Dr. Daniel Paull: for having me. I appreciate your kind words there. So yeah, it is kind of a throwback, the model to maybe what things were like before.
There was health insurance was really so, so involved. So used to be your doc. You'd have your doc, they would do house calls, I mean, to find someone who remembers house calls. They have to be probably into their eighties by now. And when they were a kid, they remember the doctor coming to their house. You know, the doc would have an office with maybe his wife was the receptionist and like that was pretty much it.
His notes were just notes for himself or maybe he would occasionally send them out, but they were really notes so he knew. Or he or she knew what they were doing last time, so they were literally notes. And you know, I'm not like a reactionary type person. I just think that with healthcare, I mean, what I've done, really what I've done is I've removed all of the parasites.
I got rid of all the parasites. And when I boiled it all down, it's kind of looks similar to what. It used to look like just with a modern twist with technology, of course, you know, I'm not writing paper charts, everything's electronic. I carry an ultrasound around with me, so, you know, I don't really use paper a whole lot.
So, but the core of it's the same, which is basically spending time with the patient. Um mm-hmm. I think when you do that, you can have a much better outcome, you know? Cause right now the system is, is built. There's all these high volume practices. It's built for one problem, one patient, you know, five. Seven, maybe seven minutes of FaceTime.
So God forbid a patient has multiple problems at once, like they're gonna get terrible care. And, and if they're a bad historian, like there's no help. I mean, God help 'em. I mean, if they can't, you know, if they're a poor historian and they have multiple problems, those are the people that get the worst care in our current system.
Daniel Wrenne: Mm-hmm. Yeah. And so if you look at, you guys listen and check out his website, it's, it's, it kind of gives you a glimpse of what we're talking about. It's easy orthopedics.com. And so your website, like your front page transparent pricing, that's a big deal. I mean, I, I don't know that I've ever seen that on a physician's website.
Most of the time nobody knows what's going on there. House calls, you already mentioned that delivering relationship based care, you've kind of hit on that already. Those are like, those are not happening at all. Those are big time. Differentiators. And you're, you know, I guess you can infer this from the website, but in orthopedics and I think a lot of people are like, what Is that possible? Or, you know, and I would love to dig into that and kind of talk about how you've gotten to where you're at with your practice. But maybe we could take, take a step back first, cuz I think, I think it'd be really helpful to talk about kind of like how you got here in the first place.
And how you kind of got to this point of starting this new innovative practice. So maybe like before that, like maybe you could share like a little bit about your training and, and upbringing and kind of how you got to this point of starting this new practice. Gotcha.
Dr. Daniel Paull: short story with me is I come from a family of engineers, like everybody like. Both sides of the family engineers everywhere. Mm-hmm. So that's probably what I would've done had I not had a bad skiing accident where I broke my right arm in both of my legs when I was 14. And so obviously I was pretty messed up from that and I had all this orthopedic surgery and it kind of got me full again.
And I was like, this is pretty cool. I think this is what I want to do. So 14 years old, I made the decision, which isn't uncommon in the world of physicians and sometimes that 14 year old mentality will come back to bite you decades later when you get to the reality of the decision that you made when you were so little.
But anyways, so I do that go to college, go to med school in Miami. University of Miami and then I do residency five year le uh, fortunate enough to get into orthopedic surgery residency, which is pretty hard to do. I was out in Toledo, Ohio, so I spent five years there and then I started a, a fellowship in hand surgery.
So I was just gonna do hand surgery and this is where things kind of went off the rails, so, A couple of things went on. So I'm in the middle of this hand surgery fellowship, which is an optional year that I've decided to do. I don't need to do. I've decided to do it, and it's a year long and I'm like halfway through and I'm looking for a job, and I'm looking for a job in Colorado or in Connecticut, which is where I'm my wife's from and where I'm from, and Where're in Colorado now.
And it's like, man, I just can't find one. You know, or if I find one, the best word for it is abusive. Where like, you know, they want you taking all their call all the time. They're giving you the short end. Of the stick, just continuously. And it kind of created this existential crisis where I was basically like, what am I doing?
Like, what am I doing? I mean, I'm, I, you know, college, medical school residency, you're just grinding, grinding, grinding, grinding your head's down. And then when I, I finally had a second to look up and I'm like, wow, these jobs are pretty terrible. You know, like they're bad. You know, all I was doing was talking to, I remember interviewed for one of this old senior partner was just telling me bitterly how much money he made in the nineties, you know, and then how much money he's offering now is like, you know, where's, it's a big disconnect there.
And you know, the jobs on Colorado were, like I said, abusive at best. And so that was going on. So I was existential crisis of like, you know, what am I doing? I'm, at this point, I've dragged my wife all over the country, you know, for my training and we wanted to go back to Colorado. And it's like, well, I don't know if I'm gonna be able to do that.
With, with my job. So that's going on. And then at the same time, the fellowship to put it lightly or bluntly was not a positive educational experience, so it kind of created this huge negative ball of like motivational, unhappy energy and like I had to do something with it. So I quit my fellowship, like I broke my lease and we just moved out to Colorado.
And I had the idea for the practice from a friend who started something similar in Miami but with internal medicine. And I said, you know, he's the happiest guy. I know that from my medical swim class, and he's doing really well financially. I'm I'm like, there's something here. There's something here.
Mm-hmm. I don't know what it is. No one's done it for orthopedics, but I was at a point where, you know, I'm living in my in-laws basement and it was like, I'm just gonna go for it. So, I mean, A lot of people said like, oh, that's really brave, but it wasn't some sort of calculated, let me sit down and do it.
It was a desperate desperation move. Mm-hmm. Where maybe you don't have the time to really think these things through, you just kind of go for 'em. And that was about four years ago. So it's done pretty nicely over the past four years. You know, the key, the key, there's key components to it. One is I don't take any insurances.
I don't take private insurance, Medicare, Medicaid, tricare, nothing. I treat them all the same. I don't say any of 'em. And cuz if I do take insurances, it'll run me into the same problem that every other practice is having, where you don't control your overhead and you need a, a staff of ratio from approximately five to one.
And your re reimbursements go down after year, a year, and it becomes this high volume, crazy practice that's not even profitable and turns into insolvency that gets bought up by private equity or a hospital. So I knew I didn't wanna do that. And then what I realized is, oh, I get to spend a lot more time with patients and I, I said, no, I'm actually, I think, delivering better care because if they've got five or six problems, I can go through all of 'em.
Mm-hmm. And my overhead is, and I decide to be mobile, which keeps the overhead down. So I see patients in their homes or at various offices. I don't pay for any of this. I'm value added when I'm there. Right? Yeah. Like if a certain providers like, Hey, this guy's got shoulder pain. Can you come see him in my office?
Sure. You know, if they said, but I'm gonna charge you, I'd say, well, I'll see 'em at their house. You know, I always have that default option. so I keep my overhead low, so I don't need to really turn the treadmill up high to really, you know, do well. So that's kind of the journey in
Daniel Wrenne: a nutshell.
Everybody's always like, man, it sounds scary and courage, like you were saying, but when you're, you point out a few things I think are super important. You were living in your, did you say your in-law's basement? Yeah, we moved into the in-law's basement. In-law's basement. I could, I would guesstimate. That means you had a very modest lifestyle.
Dr. Daniel Paull: Which Oh yeah. I mean like, I mean they were, we weren't paying them rent. They were just nice enough to give us like housing and food. I mean, so we would pay our own personal expenses, but they
Daniel Wrenne: were minimal. Yeah. When your lifestyle is very modest, it's way less intense to go cuz that's the biggest startup cost when you're starting a business.
Biggest cost is like yourself most of the time. And so when you have a modest lifestyle, that's huge. And so that reduces a lot of this. Anxiety people have on the front end. You could, you don't, you don't. You can also reduce your lifestyle before you do it. Some people do that as as well. But I think that, I would suspect that that helped you not feel so intimidated going into it, because then you didn't have as big of a nut to crack.
Early on and you could focus in on, because that, that's the other thing I suspect too, in the early days it was, it was Slim Pickens. Oh, yeah. At the very beginning. Right. You weren't just rolling the money right away.
Dr. Daniel Paull: No, no way. I mean, for all I intents and purposes, you're poor. Right. I think that first year I got like the child tax credit or something, you know, like, cuz I wasn't making any money, I mean, I think, oh my gosh.
I mean, times have certainly changed. Yeah. I think I maybe made $500 my first quarter. Yeah. Which, you know, my friends are coming outta fellowship and getting, starting salaries. 500,000, hundred thousand dollars, $400,000. I'm living in a basement. I made $500 my first quarter, but I was really lucky to get that, and it snowballed from there, you know?
Mm-hmm. It was just figuring things out. But no, the modest lifestyle is huge because, It's like a tradeoff between autonomy and not having and stuff. So if you can free yourself from the mindset of I need a lot of stuff, you can have a lot of autonomy. Mm-hmm. And I do consulting now for other docs who, you know, are looking to do sort things similar.
And you know, one complaint that I get, not from the people who actually pay me to consult, but from the people that don't wanna pay me to consult, is that. Well, what am I supposed to do? I've got this house and all these payments and all these, my kids are in private school. I have all these cars, and it's like, well, you golden handcuffed yourself.
You took the golden handcuffs and you cinched them around your wrist and cinched them in together, and now you have no ability to move because your payments are so stupidly high. And it's like, why did you do that to yourself? You know, it doesn't, I mean, you can still have a very nice existence without being decadent and, and needing the nicest of every single thing.
I mean, you can buy your luxuries later when you have more wealth. I mean, but they don't, they buy 'em immediately. And I think that creates a big problem because to, yeah, to go back from that, it's hard. And maybe it's not just them, but it's also their family and their kids are now used to that lifestyle and yeah, it's like the opposite direction.
Daniel Wrenne: It's difficult if you sign a big monster contract, you know, even if it's paying a bajillion dollars and then you got a five year lock in and then you're, you know, you buy the, really nice house and you're doing it for your family. With good intentions. And then the private school, like you're saying, and then all the other stuff comes with it.
And then the productivity stuff starts to kick in after a year. And then you realize, man, you gotta work long hours. You're not even seeing your family. And then they start to, and then you realize you don't have any control. And then you start to feel like burnout, you know, frustration, like, this place sucks, but at that point you got no options.
I mean, that's a. scary place to be in. Unfortunately, I see a ton of people that are in that exact spot.
Dr. Daniel Paull: Oh, I believe it. I mean, they've dug, they've dug them. They've been digging their own grave, one shovel full at a time. And the irony is, is you may be working so hard that your relationships with your spouse deteriorate.
Yeah. And you end up getting divorced and you don't see your family, which is the whole reason that you may have done that stuff. So, I mean, Yeah, it, it, they really trap you. The hospital systems and these large employers, they know they, they want you to buy the large house. They want you to buy the nice cars.
They want you to be stuck and they give you a non-compete too, so they know they can give you a decent contract the first two years. And then when it comes up for renewal, if they want to, they want to, they can really hammer you and you essentially have very
Daniel Wrenne: little recourse. Yeah. I didn't even mention the non-compete.
That's even worse. And then, What happens too. Yeah. I've, a lot of times they have the realtor like waiting for you when you go visit and they're like, oh, let's go to the million dollar house neighborhood. And the hospital has the realtor that they kind of like introduce. I mean it's, I have suspicion that it is an intentionality aspect to that, which is pretty sad, but it does benefit.
The hospital has incentives to kind of lock people down. Oh yeah. And the best way to lock somebody down is to get 'em to buy a big, old, fancy house.
Dr. Daniel Paull: Yeah, they want leverage, right? You've gotta non-compete and you, and you, you need that salary. You are salary addicted. They've got all the leverage in the world.
They say, Hey, you need to travel out an hour to go see patients at this far away clinic we just bought. I don't want it. Well, you have to, okay? Mm-hmm. I mean, I don't, it doesn't jive well with me. I mean, for me, living in the basement, like, what are you gonna do to me? Right. Yeah. I'm already in my in-laws basement.
I'm comfortable there. Not that I wanna stay there forever, you know, like I don't need any money. I, I mean, I don't need a ton of money at that time. And then as we got more money, I mean, right now I'm in my own basement according this, so we moved up in the world. But, you know, we did that once we, the business was stable and we had wealth, and we could sort of buy things.
And even as, even as the wealth increases, I, we still try, I mean, we still buy quality things, but I try to remain frugal. I think frugal is super important. Yeah. You know, some people, I would say the difference between that and being cheap is someone who's frugal will still spend for quality and buy nice things and do things they want to do while someone who's cheap just will try to not spend any money, if at all possible, period.
I, I think frugality it would be a good trait among. A lot of physicians if they could harness that, but like a lot of 'em don't. Yeah. Cuz of all this like, you know, they've been waiting, waiting, waiting, waiting. They finally get there. They're like, I deserve all this really nice stuff. And I guess they do, but you know, they, they're setting a trap for themselves.
Daniel Wrenne: Yeah. And that's a, bad spot to be and it can come and bite you. And, and at that point you don't even want to admit that you're having trouble with work because you're realizing you don't have any options. You have to kind of like, Put on your smile and like, which I think would even compound that further cuz you're like cognitive dissonance.
It's like, you know, you're doing one thing in reality, it's completely a different thing and you're like, who am I? You know, I mean that, that kind of stuff really weighs on people. And it's a tough spot to be in. The good news about, I mean, if you're listening, you're in like that sort of spot. Like, you don't have to like continue.
The best thing to do is to kind of cut the lifestyle, to free up the control to make choices. You, you're not gonna be able to quit the job until you, Free up the lifestyle in that sort of situation. You have to do the lifestyle thing first, and then you'll start to feel those options. I've worked with some people that have like sold the big fancy house, moved in with their parents in the basement and kind of went back the other direction.
It's totally possible and you can get the control back. It's just, it just takes some hard decisions.
Dr. Daniel Paull: Yeah, it's all about leverage. So you've built yourself if you buy all that stuff, right? And like, I, I totally get the reason why someone buys it. You know, it's not a morally corrupt decision, it's just no causes you long-term pain.
I mean, you've essentially a zero leverage position for yourself. So you wanna get leverage back to the point where, you know, the hospital says, we want you to do this, and you can say, I don't want to, and then you say, well, we're gonna let you go. And you say, fine. Yeah. And they realize, oh, oh, wait a second.
We need you. Right. And then you have, you can, you can bargain it leverage, or you can do, you need leverage. You just, you know, and, and I think a lot of that comes from being in training as a resident where you have a zero leverage possession mm-hmm. Pretty much the entire time. Right. Maybe even negative leverage.
I mean, it's really bad. I had only one single time in re residency that I ever had any leverage which was when. I was supposed to sign these documents on time, you know, and I did, but their system went down. So I got 'em all late and it would've created like some sort of warning in the system. I said, look, I'm happy to sign 'em.
I realized your system went down. I just want something in writing saying that it's not my fault. And they're like, oh we spoke to our supervisor and we don't do that. And I'm like, well, then I'm not signing. And they went all the way to my chairman, right. And he's like, oh, he's very smart. He supported me and then they did give it to me.
And that is the only time I ever had any leverage in res because Right. You, you make, you know, cuz then something later happens and they're like, well this is a history for you. And you're like, no, that first time wasn't my fault. And they just do not care. So that way you have it in writing, you can throw
Daniel Wrenne: it out.
Yeah. I mean, leverage is important and having the freedom and So your model, no insurance, right? All cash. are people. Paying for services? Yeah, I think I know they are, but I mean, I think that's a question. So
Dr. Daniel Paull: by cash, how I define it is not interfacing with an insurance company. Mm-hmm. So for me, I can do whatever I want as long as I don't have to interface with an insurance company, meaning I don't have to submit notes to an insurance company.
I don't have that whole revenue cycle management as long as I can stay outta that. Then it works well for me. So like I've, I've paired that with like medical legal work. I also do personal injury work, which means I might not get paid for a year or two or not, or at all. But for me, interfacing with a lawyer is minimal overhead requirement, generates medical legal work.
So that's fine. But the going back though, do people pay for it? Yeah, they do because, you know, there's a lot of people out there who don't have insurance or, or their deductibles very high and I am actually the most economical option for them. Mm-hmm. As compared to going in the system where they don't know what they're gonna pay and they're gonna, you know, they're scared of that.
Mm-hmm. So I think people wrongly assume that a direct care model, it's like, oh, you're just seeing really rich people all the time, and that's really not what it is. They don't, I don't think they under, they have a good understanding of the percentage of population with no insurance or bad insurance who are looking for healthcare.
Mm-hmm. And you really serve that population much better than You know, the end system stuff. So there's, they're out
Daniel Wrenne: there. Yeah. Most of the people, I get to look at everybody's financial stuff in my day job, so I get to see all their insurance numbers and I would say the majority of people have pretty stink and high deductibles on their health insurance.
That's more common than not having insurance. But there's also a, a pretty large, there's people that don't have insurance at all. There's people that have like health sharing which is not technically insurance. That's what I, so there's, there's all kinds of people that are doing That kind of deal.
But maybe you could talk through the economics a little bit. I'd love it if we could kind of just talk like high level, not like details, but like high level, like how is it, how are you able to make it work from a financial standpoint. I know your expenses are pretty low. That's a big deal.
Dr. Daniel Paull: Yeah, so my overhead I haven't calculated in a while when it's at its lowest. It was like $800 a month, including malpractice. And then my wife works with me now, so it's probably more like $2,500 a month. So I think you're looking at 60, 70 bucks a day if the cost of running the business that includes malpractice equipment, Everything Right.
You know, the staff, just me and my wife. So I've cut down an office, I've cut out staff. So I mean, that slashes all your costs, essentially to as slow as you can get 'em in, in, in my opinion. Yeah. And then, you know, if I see one patient, you know, and it's like, you know, I travel to 'em, I'll give 'em a steroid injection or something that's like $400.
So, you know, you can do the math there if you had a few of 'em together. So if you had a few of 'em together, I mean, it's like four. It's really not working a lot. You're really not working a lot and you're doing quite well. Is four a day reasonable? Yeah, four day is reasonable. And I'm not always hitting four a day, sometimes more, sometimes less.
Right? And then I paired it with medical legal work or I'll do personal injury to house. And that's,
Daniel Wrenne: so four a day is like 300 a year minimum. And you're not, and that's net.
Dr. Daniel Paull: Right, and you have to, and, and you also have the tax advantages of, of your home business, so you're not getting destroyed on a w2. So if it mine's an S-Corp, so mm-hmm.
I pay payroll taxes on my small salary, and then I take a monthly distribution, which doesn't go through payroll taxes. So you actually come out a lot more ahead than someone who would get the equivalent amount. Mm-hmm. In salary, you know? Yeah. You also have write-offs that you use for business. Like my personal computer, my wife uses has a phone that we use to answer calls on.
So, you know, there, there's those, those intangible or slight, or I guess, tangible benefits that you get. Yeah. But the, the other question, which I think is important is that how many hours are you working also, right? Yes. So with the numbers we just ran, you're probably working three to four hours a day.
Uh, okay. That's huge. Or four hours a day, let's say five hours a day. So to be safe, yeah, you're talking and we're overestimating here. You work five days a week, 25 hours. Yeah. You know, so, which in a lot of docks probably work triple that or plus minus. So I mean, I think the other side of the coin, what a lot of docs don't consider is how many hours are you working for this money?
Like to me, it's like, well, how much are you making? And then the follow up question is, How much are you working and and they don't really seem to ask that secondary question cuz they all assume we're all busy as all get out, which isn't always the case. Yeah, I spoke to one orthopedic surgeon once and this really annoyed me.
I should have charged him for a consult. I did. I read that because he definitely had the money for it. And anyways, that's lesson that we learned from me. Right. The reason I charge is not to make money, it's just to protect my time. Your time is valuable. He was retired early cuz he made a lot of money doing a business deal and he was looking to get back into, back into the kind of a mix of things and had some questions for me.
But you know, I was telling him like, my revenues, and he is like, well, I think you're really selling yourself short. And it's like, man, you haven't asked the follow-up question. I'm not, how many hours are you working for this? Like, I'm around all the time. That's critical, right? Yeah. And like, I, I, I think that that is always the follow up question, you know?
Yeah. And also my salary isn't static either. I mean, you know, it increases as the years go on and word of mouth spreads and I get busier.
Daniel Wrenne: Yeah, going back to the scenario we were talking about earlier, like going to work and locking into the hospital and buying a nice house. on top of that, if you throw like 70 plus hour a week commitment, that's a disaster.
I mean, that's like, cuz you don't even have the time to like, well dude, you know, see your family. But, but for sure you don't have the time to like look for new options or be creative or think about new things. But, you know, having. A lot of people say that, like, spending time with family or like, I mean, in my experience when I, cuz we ask people what's most important, the most common answer is, is my family.
But I always, one of my favorite quotes is like, don't tell me what's most important. Let's look at your checkbook and your calendar and I'll tell you what's most important. And you can look at, you know, your calendar. If you're working 80 hours a week, that doesn't resemble. That family is most important.
Now I get it that like a lot of times you kind of get into these situations that lock you down. Yeah. But like this kind of road is way more flexible. And you can choose. Plus you're building a, a business too. That's, in my experience, I love doing that. And it's something you can turn into whatever you want.
Like you can make it like, Your own little, it's just you and your spouse practice that's small. Or you could turn it into like a big operation. I believe that this kind of medicine is gonna explode in the future. And there's gonna be demand for once somebody like you starts making good money or gets the word out that you're efficient with your hourly rate people are gonna be like, Hmm, I'm already fried at my job.
I really need to do this. I,
Dr. Daniel Paull: I'm hoping that that happens. I, I think with internal medicine doctors, it's already happened cuz they hit the pain point much earlier or family medicine doctors and direct primary care is like tried and true at this point right now for, at least for my specialty of orthopedics, they still do pretty well financially.
I think that'll change as time goes on, as their reimbursements get slashed down 5% every year. Yeah. Um, so they haven't quite hit that pain point, but I'm hoping more people start, their goal is to build the ecosystem. Of this kind of alternative model, which in my opinion is, is better. I mean, you remove all the things that you hate, right?
You know, dealing with the hospitals and insurance companies, especially insurance companies, I mean, hospitals still provide value. You know, if you're really sick, that's where you have to go. But insurance companies really don't, really don't. I mean, there's so many people who lose money on the insurance every single year.
And, uh, there's better ways to do it. I mean, I use a health share myself, but yeah, that's a whole podcast in itself. Um, So, you know, my goal is to disrupt those sorts of things by essentially removing them from the equation.
Daniel Wrenne: Yeah. So I know you can make it work for the physician. We just kind of talked through the basic math and we're using like kind of a part-time scenario.
but I'm curious, I think it sounds better for the patient particularly because. financially and care wise, but I'm curious to confirm your thoughts on that. Like is, do you feel really strongly about it being a better model for the patients as
Dr. Daniel Paull: well? Yeah, definitely. I mean, certainly in the clinic, yeah.
I do think it is because medicine is a time dependent practice. So if someone just wants to do a good job with you, they need to spend time with you now. Now you can be the best physician in the world, but. If you only have seven minutes with someone, you're gonna be able to only do seven minutes worth of work.
It's like me asking you to paint a wall in 10 minutes, like you can do it. Mm-hmm. Might not be good. So I think that my appointments are booked for a lot longer, like close to an hour. So I get to really spend a lot of time, all questions are answered. They have my cell phone number when they're done, and they can call our tech.
So I think communication is much better and I think any doc practicing in this sort of model will find themselves a much better physician than they were. In the previous model. Mm-hmm. Now, of course there's things like trauma where you need to go to a hospital. I'm not saying that, you know, there's, there's still a role for that, but for just clinical settings and everything, I think that it's better care.
I mean, especially for the person who has multiple problems, especially for the person who's a poor historian, cuz they get particularly back here. Yeah. But I, it doesn't sound, it's actually a very efficient use of time in a way cuz instead of seeing someone for five or six times, I mean, you get, you can make a lot of progress with them in an hour when you just have, you know, that time to spend with them.
Daniel Wrenne: Yeah. I mean, you're, you're cutting out a bunch of like this fat in the system that exists and the patient's paying for that. I mean, the physician and the patient. Collectively, but like the patients paying at the end of the day for a lot of that fat in the form of like, the premiums just keep going up on health insurance.
Yeah. Whether their employer pays it or they pay it, which in the end of the day they pay it because the employer passes it through. But like the patients are paying for it. At the end of the day. Either way you spin it.
Dr. Daniel Paull: right. Yeah, the employers, I mean, it goes up like double digits every year.
And these companies are raking in record profits and it's squeezing these companies. So companies are starting to be like, well, what can we do to not pay these disaster premiums? And some of 'em are going to self-funded, and so like this model works very well for that. Mm-hmm. Like I've been able to do some surgeries for a company that basically pays me to do their surgeries for small surgeries, and for them it saves a lot of money.
so they're, they're happy about that.
Daniel Wrenne: Yeah. So it's like, it's better for the patients, it's better for the physician. And I know, you know, there are lots of exceptions and like you're saying, like there's definitely still a place for hospitals and and, and special specialty in specialization areas.
But like, I'm just really curious like why more people aren't doing it. It seems to be. Like a logical solution. Cuz I talk to people all day long that are really frustrated by their jobs. In fact, regularly people are like, I hate it. Like, you know, like, I despise my work. I hear people say that. Or like, and they're saying, you know, I want to do, I wanna work as hard as I can to get to be financially independent as fast as I can.
So, so that I can retire early or I'm gonna switch. Or I'm gonna do side gigs so that I can get out of this world. But like there's this other avenue out there. In my experience too, I haven't come across yet somebody that's doing this direct pay model where they're frustrated. In fact, they all love it.
They're, they won't, people won't stop talking about it cuz it's, they love it so much. So it just kind of is weird to me that like more people aren't doing it.
Dr. Daniel Paull: Yeah. All right. You see all the miserable doctors in the system and all the happy doctors in the Yeah. I'm
Daniel Wrenne: like, what in the world? And
Dr. Daniel Paull: you're like, there's disconnect here.
Daniel Wrenne: Why? Why are they, I keep, I keep talking about on, on this podcast cuz I'm so baffled by it. I mean, I, I've had like, if you're listening, you're like, man, this is enough Direct care people like, quit it with the direct care. But like, for real, I, I don't, it, it genuinely seems like such a better option and I feel like it really can help with a lot of these problems.
That are coming up, but it's, it's just so slow. Like people are not
Dr. Daniel Paull: adapting it. (Mid Roll) Yeah. So let me see if I can crack this. Not for you, at least in my opinion. So you, you have to look at the mentality of a physician, right? You know, we used to, when you're in medical training, which is a while, and it really, you're in there for a good, you know, if you work in like, like, you know, close to 80 hour weeks, 67 hour weeks for five years straight, you know, at least for me, that's a lot of training.
You are not allowed to be creative at all. So, and I don't even mean like artistic projects. I mean like you see system processes if you attempt to change them or suggest a better way. And it can be the most asinine thing you can think of. You don't even get like, no, you get the, this is the way we've always done it, which I hate, obviously.
Yeah. But more than that, you get to, you get beaten down, you get meetings, you get stomped into the ground. So that happens to you a couple of times. Like it happened to me, like I got in trouble a lot in intern year for that, you know? And then I, once the years I troublemaker. Yeah. I mean, not for patient care but for that stirring things up.
Yeah. You know, for like, basically being like, these systems are really bad. Yeah. And then people like got really mad at me for like saying that, and so I stopped saying it. So basically by the time you come outta training, your creativity to do anything like that is smushed. And then your ability to take risk along with that is as well.
So with any new business, you really need a good risk profile and you need an ability to, to take you need, you need some creativity. And like once I got out of the system, all that came back to me and that's what's led me to be successful, the very things that would cause me to get in trouble. While being in the system are the same things that lead me to be successful out of the system.
So you need, I think they have trouble re harnessing that or finding that again, especially if they're still working in the system. Mm-hmm. And like we talked about, the lifestyle issues that locks 'em into a salary. So with any new business, you know, you're gonna be poor for a while unless you're venture capital backed, which I wouldn't, that's, I don't know, that's not my thing.
But You know, you're poor for a while. And, and I don't know if they're, they're, they're, they're not able to do that. You know, they made a good amount of money for too long, even though they're making less as time goes on. So I think between all those things, they haven't, you know, they have, they're not able to do it.
I mean, so the activation energy, I guess is what I'm saying is extremely high. And I think that's why you saw it in primary care docs, because the pain point for them was so high that they, they, they've managed to now do it. But even still with them, it is still a small percentage of docs that have done direct care.
You know, and some of those docs who are most damaged by the systems are the most ardent defenders of it. You know, they're the first ones to tell you that this will never work. Like this isn't blah, blah, blah. And it's like, meanwhile, they're also the most damaged by the system at the same time. So they're, they're like, maybe they're like defending a system that's abusing them.
Because if they had come to the realization that like, oh, like I could do this other thing that's better and I'm not doing that, it causes some sort of, you know, strife.
Daniel Wrenne: Mm-hmm. Yeah. But I think hearing people talk about it more. I mean, that, that's partly why I, I, I haven't stopped talking about it for a little while.
I think the more you hear stories and examples of people doing it a different way and blazing the trail and, you know, doing it, you know, kind of. Like nobody had done it, how you've done it before you did it. And so that's especially scary for some people. But like as you start to see more people do it and the model becomes more clear and I think it's a little bit less prone and I'm sure that there's gonna be companies like yours will grow and then you're gonna be like, I might want to hire, and I have clients that are doing this now, like, hi, indirect care, indirect primary care.
They're like, I need to hire another physician and I'm gonna hire 'em on a salary. And then there's the risk goes down to where you're not having to like, just straight up jump jump into the unknown. Yeah. I think, I
Dr. Daniel Paull: think you're gonna see that it might happen to me at some point, you know, it would be nice to get somebody who compliments my skillset in the world of orthopedics and, you know, the, they'll be like, I'm, I'm playing a long game here, essentially, is what I'm saying, like mm-hmm.
My practice is paradoxically more stable than most of these big hospital system or large private practice contracts. Doesn't seem like it would be, but I get my revenue from a lot of different sources you know, different. And if one of 'em goes down, it's not a big deal. Meanwhile, if you're working for these companies, I mean, there's so many mergers and acquisitions and there's so much political fighting that.
You may find, I mean, I, I don't think these big system jobs are really stable right now, to be honest with you.
Daniel Wrenne: No, I, I agree. There's so much, there's so many things brewing and in your position. One of the ways I like to look at entrepreneurship, it's like in your position you have to have, I don't know how many patients.
You see, but like, they all have to fire you. Like they all have to stop working with you for it to kind of be a, a big, huge blow up. Versus at the hospital, like one, usually one person can kind of make that call. Oh my God. Yeah. That's
Dr. Daniel Paull: pretty scary. It is super scary. You know, and it can be, you could be a good doctor.
Yeah. And if you're just not productive enough. You know, if you're not the surgeon who's cutting onto every single thing that walks in, they're gonna be not happy with you. But maybe you're a really good doc who still does a lot of surgeries, you're just not as productive as the doc down the hall who's lauded for just doing surgery on anything that has a pulse.
You know? Yeah. So there's a lot of other dynamics. I mean, I could tell you stories too. I mean, it, it, it's, it's, it could, it can be, unless saying know it's, it can be really bad. Mm-hmm.
Daniel Wrenne: Yeah. Would you say you were always an entrepreneur? Like if I was asking you in residency or fellowship or something like, would you have said you were an entrepreneur then?
Dr. Daniel Paull: No, I wouldn't have said I was an entrepreneur. I never had a chance to, you know? Yeah. So like, once I started, you know, for me I'm like, oh my gosh, I love this. This is like a natural rhythm of my life. Like, yeah, feels like the right stride and pace and everything. So I really love entrepreneurship, but I didn't know until I started it.
And not everybody's like that. I get that. But I think for me it's like a, a means to. Have control and autonomy over my life is by also being an entrepreneur and putting work into that. Yeah.
Daniel Wrenne: One of the things I love about entrepreneurship is it seems to align more with, or like you're incentivized kind of to like do self-development.
It's like the things you need to develop to be a good entrepreneur are also good life skills. Like, like failing, you know, screwing, you know, having mistakes like in entrepreneurship mistakes are a positive. Like, it's like learning, failing forward. you know, in the real world. That's kind of how it is too.
I know in, in medicine a lot of times, like it's not looked at. You have to have high expectations and. You know, it's more like perfection is, is the target, but in entrepreneurship there's a lot of skills and you have to develop, you have to, you have to market yourself and be able to sell the services and grow a business and handle the finances.
The financial part is, is one of the biggest things, like you're kind of forced to be thrown into the financial aspects. When you run a business. You kind of have to know baseline financials, like you gotta keep the books. And you gotta, I mean, you can't really hire everything out, right?
Dr. Daniel Paull: No. Yeah. I mean, like for me, I remember at one point I'm like, you know, I've got all these money that people owe me on this piece of paper.
I'm like, maybe I should put it in an Excel spreadsheet. I'm like, oh, there's my accounts receivable. Right, right. That I now had for years. So. That's fine. You know, there's figuring it out for sure. There's making, well, that didn't work. I'm not gonna do that again. And, and with me figuring out how heck do I market myself, there's, you know, I've found out who the good referral sources are and who's not, and you know, yeah.
I make sure I've develop the good relationships and the ones that don't refer, I don't, you know. Yeah. There's a lot of stuff I've had to figure out, but it's been enjoyable. I mean, most of my reading has been sort of like behavioral psychology lately. Right, which I think helps with is the best for small business.
I would kind of advocate against an mba, at least for small business. I don't think that's, if you wanna work in the corporate battle somewhere, or you wanna make really good connections to possibly get a good job in business, then MBA can be helpful. But running small business, I think it can be kind of detrimental because I think everything is focused, focused on human relations and things that, you know, not just boiling everything down to numbers.
So that's, that's my 2 cents about that. But yeah, I, I think failing is okay in entrepreneurship. Yes. But in, you know, then there's the medicine side, like, you don't wanna do that. You are aiming for perfection. You try to do the best possible standard of care job you possibly can every single time.
But with entrepreneurship, you know, it's a little bit more, you know, you, you're exploring there's some level of exploration that you're doing. Yeah.
Daniel Wrenne: You know, one of the best ways to market a business is to be different, like very unique and different, and, Your business is very unique and different. I mean, there, there's nobody.
Now in some ways that's a, that can be a challenge early on because there's not any market awareness for it yet. Or it's lower. So people are like, what? What do you mean? Like, I gotta pay, that's what my health insurance is for. But but differentiation, like, you got that nailed, like you're very Yeah, I guess so.
You know, you got some serious differentiators, which is, is really good. You know, typically for marketing. And that's, that's, that's the thing. Everybody's kind of doing the same thing. It's like, well, that doesn't, that's, that's no different. I
Dr. Daniel Paull: mean, I don't pay for marketing either too, so my marketing budget's zero.
I do networking and then word, word of mouth at this point. So I spent, you know, me taking someone out for lunch to me is like, I guess I, I guess that's marketing dollars in a sense, but mm-hmm. I'm not like, big on advertising. I mean, that's just, you know, that's such
Daniel Wrenne: a black hole of money. Yeah.
The, the other thing, my experience of word of mouth marketing versus like, Referrals, provider referrals, like in a hospital, referrals or whatever, like word of mouth marketing, you tend to get people you get along with or like you're in the same sort of values circle more often because you're typically being referred by somebody that you liked or they liked you and that also they liked themselves.
So, my experience has been that word of mouth. Referrals are far and away the best from a connection standpoint. Not, not necessarily anything else, but just from a like connectivity standpoint, which is really good. Cuz that's one thing that I've heard a lot of physicians say too is they are like, it's very frustrating to work with patients that don't value what I do at all.
Oh yeah.
Dr. Daniel Paull: It happens to me, but extremely rarely. Most of the time if I'm seeing 'em, they have to decide whether I'm gonna be valuable or not. So yeah, generally speaking, I, I don't wanna work with anybody who doesn't value, you know, what I do. But that is extremely frustrating, you know? Cause they're like, well, why am I seeing you?
Because, like, you know, right. Like all these problems. I mean, that's why I'm, you're seeing me But to go back to word of mouth marketing, I think it's the most powerful and it's the least expensive, but it also takes the longest. Yeah, it does. It just takes a really long period of time. But once you get it going and it's solid.
And I mean that's also the problem with these employee jobs. If they boot you outta town with a non-compete, you know, there goes all that goodwill that you've built up over the years among the two. Yeah.
Daniel Wrenne: Yeah. The last thing I wanna talk about as we start to wrap up you have some. Really good advocacy going on on LinkedIn.
If for those of you guys listening, make sure to check out Daniel's LinkedIn profile. He's got all kinds of, I mean, maybe some people get offended, probably like, you know, a small percentage of people sometimes get offended, which I think is a good sign of like, truth coming out cuz it's gonna be offensive.
And a lot of people in our world today are like afraid to offend people. And that's another thing I respect about you is you're like, It doesn't appear afraid about offending people. Go read some of his LinkedIn posts and you'll, you'll kind of get an idea of what I'm talking about. But one of the examples I, I looked at recently was talking about not doing prior authorizations.
Oh yeah. And now that, I mean, and that's people, people are like, what?
Dr. Daniel Paull: Yeah, I mean, so that was interesting. So for me, I don't deal with insurance, but sometimes people have insurance. Like the example was a lady wanted to get an MRI of her neck or I thought she needed an MRI of her neck. You know, she had these symptoms for a while.
She was kind of a reckless for covid staying at home, and we tried some therapy shots, whatever, and. I order it and she wants to use your insurance, which is fine. And then I get a call from some company outta Massachusetts and I'm in Colorado, and they're like, oh, we're just gathering information for your prior authorization.
And I'm like, oh, uh, I, I, I don't, I don't believe in those. And they're like, what do you mean? I'm like, oh, oh, I don't do this. And like it was just silence. No one probably ever said that to her before. And she's like, it's for your patient. And I'm like, I'm sure it is. But I'm like, if the insurance company denies it, that's on the insurance company, not me.
I'm not contracted with any of them. I don't have to do prior authorizations. And I, I called the patient and I said, Hey, I think they're gonna deny your mri. I would call 'em. And she called them and she gave 'em hell and they approved it. Yeah. I'm not saying that strategy will always work. But it worked that time.
But the whole point is that they exist because we say, okay. I'll do 'em, you know, and so, you know, it is just a, it's a att nutritional game, which I think is really stupid. The insurance companies don't want to pay for it, even though they do want to pay for it, which is a whole different story. But, so I posted that on LinkedIn.
It's super, like, I hate prior authorizations more than anyone, but we have to do 'em, you know, and it's like you're the reason that prior authorizations exist because you continue to do them get draw line. And what, what'd you say? You gotta draw the line. Yeah. I mean, at what point? You know, I'm the medical expert.
I'm seeing the patient. I'm not benefiting financially from this mri. It's for clinical diagnosis and reasons. The person's paying their premium. They have a right to get that mri. And who are you? Is the insurance company Tell me to deny it. Based on what? Based on some medical expert that's in the bowels of the building that's never seen the patient.
They've never seen the patient. I mean, it's hard to make you know, medical recommendations, you know, in, in that sort of situation.
Daniel Wrenne: it's almost like health insurance is trying to make health calls. They
Dr. Daniel Paull: do. They make, they, they, they direct medical care and have no liability for it. So if we wanted you to get an MRIs, let's say, you know, something, and they denied it.
And let's say it showed a tumor that was now metastatic, like they have zero liability in that g exact case, zero. So they could have caused a detriment of your health and they aren't liable for it because they say at the end of the day, well, we're not saying you can't do it, we're just saying we're not gonna pay for it.
But in the reality of the situation, it means that it's not gonna get done. So I feel that they should have medical liability if they want to deny care along those ways. Yeah. You get people being like, well, they just wanna make sure that the MRI is appropriate. It's like, how do they know? Are they sending their own doctor there to evaluate the patient?
No. So how can they make that determination? Yeah. The doctor's
Daniel Wrenne: already said it.
Dr. Daniel Paull: Yeah. The medical doctor considered a medical expert, right. Has already said it, and most of the time it's not by well benefiting financially from that, but yet they say no. And then 90% of the time they end up approving these.
So they're just dragging the doctor through like an hour long phone session where it has to be peer to peer, doctor to doctor. And if you've ever done one of these peer-to-peers, you get to it and it's like I'm talking about ankle sy osmosis to a cardiologist who I'm sure is extremely intelligent but has no idea what he's talking about.
And I know that because he said, I have no idea what you're talking about. I'm just gonna approve it. So I mean, that is, you know, train wreck that. So I just avoid all that. It's like I'm not participating in it. I don't do that. We can get you a cash MRI for $500, which may be less than what you pay with a deductible anyways.
Yeah. And then the funny thing is when you order an MRI for cash, it just gets done like same day that the, the, the facility loves to have those. There's nothing to do. They just, patient pays, they get it. They can use an HSA or whatever, and it's, but it's great.
Daniel Wrenne: Yeah. It's, it's, it's somehow, I mean, it amazingly becomes super simple when you eliminate insurance, especially from the mix.
And, and sometimes the hospital can get a little screwy too, but insurance is just a, a trainer. Yeah. Try to figure out your billing. Good luck with that.
Dr. Daniel Paull: Yeah, I mean you can outsource it, but how do you know if they care? The people working
Daniel Wrenne: for you maybe. And then you're paying, it's the cost of paying for people to deal with all the junk.
Like that's added
Dr. Daniel Paull: overhead. It's huge overhead because it's, it's a lot of staff. And then also you need to house this staff, so your office is gonna be bigger. And then also like, uh, the benefits as well, which is, comes back to insurance on the other side. So it's what's driving these practices into insolvency and why they're considering.
Getting bought up by private equity, which you know, In my opinion is probably one of the worst groups that can buy into medicine because they, you know, obviously only care about money, which is what their job is. And I think that sometimes conflicts with good medical care, even though they'll, they'll basically lie to you and say, it doesn't always,
Daniel Wrenne: maybe, I would say
Dr. Daniel Paull: always.
Yeah, always. Yeah. And, and, and funny thing on private equities, they'll say whatever they need to say to get the keys to the castle. Right. And I think as physicians, we don't assume that they would, somebody would be like Dish, honest, but, but, but, but they do, you know, like, They'll make it up if they have to.
Yeah. And uh, I think a lot of physicians are extremely naive.
Daniel Wrenne: Yeah. Yeah. They'll just convince themselves it's true temporarily.
Dr. Daniel Paull: Right. I mean, whether it's lying, whether it's lying or it's bullshitting, who's to say? But you know, it's not truthful, whatever it is. Yeah. In a lot of these cases, I would, I would, I would guess.
Daniel Wrenne: Do you think physician burnout
Dr. Daniel Paull: will increase? Oh yeah. It's gonna accelerate. I mean, because the, the abuses of that system look. The United States is considered the wealthiest country in the history of the world. Alright? History of the world, wealthiest country, and 20%, about 20% of the G d P of dollars spent is on healthcare.
So it's this monstrosity. There's so much money in it, and the entities that are making that money wanna make more money, like health, you know, hospital systems, pharmaceuticals, health insurance companies. And so that will only increase as, you know, they'll just keep leaning in that direction. So all the systemic abuses that physicians face will increase.
As that be just becomes an accelerated process. You know, as they become more, become more, get more and more resources. So yeah, I think it'll increase. I don't think the shelf life of a physician in the system is like 30 plus years anymore. It's probably half of that at this current point in time.
At least in that
Daniel Wrenne: model. Yeah. Something's gonna blow up though. I mean this, this sit, the more painful it gets, it's like ripe for disruption. Yeah, I
Dr. Daniel Paull: mean, in a weird way it's good cuz it'll drive more people into this other sort of model that I think we need to grow and build. You know, eventually if we get enough people and different providers and physicians in it, you know, it can be comparable to the other model.
It's just, just without all the stuff that you hate. But again, it's like one piece at a time.
Daniel Wrenne: Mm-hmm. Yep. Well, Daniel, this has been fun. I, I love a conversa good conversation about entrepreneurship and, and your business. Sounds super cool. And I'm excited to hear it's doing well, I think, I think the more that kind of thing happens, the better.
I mean, that's kind of like a shining light in the train wreck of healthcare and keep up the good word on LinkedIn. Well, I appreciate
Dr. Daniel Paull: you having me on, Daniel. Yeah, I'll try. I just try to just so discord on there, plant seeds of truth to the best of my ability and you know, Oh, you know, people hate on it.
Most people like it, and I'll just keep going until I'm forced to, until it's like forced to stop. Yeah,
Daniel Wrenne: no, keep it up, man.
