E74: Rethinking Canadian Healthcare with Brett Belchetz

This podcast is brought to you by Ginsler Wealth. The information discussed today is meant to be general in nature and not tailored to your specific investing circumstances. This means that you should talk to your regular Ginsler Wealth advisor or your own advisor before acting on any information we discuss today. Nothing in this podcast is intended to be a solicitation, and past performance does not guarantee future returns. This is our second episode discussing how the Canadian healthcare system can be improved. It is therefore best listened to by those with open minds. Today on The Unlimited Podcast, we speak with Dr. Brett Belchets, co-founder and CEO of Maple, one of Canada's leading virtual care platforms. We talk about his time as an ER physician, why he founded Maple, Managing exponential growth and how AI will change healthcare productivity globally. Let's go. Well, welcome everyone. Another episode of the Unlimited Podcast. Pretty quickly on the heels of our last episode with Mara Lederman from Signal One, that was a health or healthcare-oriented episode. And I thought, as I mentioned last time, let's have a theme. Let's get another amazing leader in the Canadian healthcare space to tell us what's going on in that space. And as I said last time, and I'll say, and almost every time, and I'll say it again this time, very special guest today. This is Dr. Brett Belchets. Brett and I go back not as far as Mara. If you listen to that one, I think that was about 35+ years. I think Brett and I go back maybe 30 years to University of Western Ontario. And so very good, dear friend of mine. Brett is the founder and CEO of Maple, and we're gonna hear a lot about Maple and the journey over the past 10 years. And actually, one of Brett's co-founders, Stu Starr, was also a Western colleague of mine. If you listened to my episode with Ronen Harari from Spin Master, we talked about Business 257 at Western, and I told you about the PC Buddy, the special project or the product launch that you had to do as part of that course. Brett's co-founder Stu was one of my partners in PC Buddy. Luckily for Stu, he did not pursue PC Buddy and instead partnered with Brett to co-found Maple, where I think they've had much more success than that Biz 257 project would've generated. So Brett, welcome to the show. Nice to chat with you and appreciate your time.

Thank you. It's great to be here. And, you know, I gotta say it's been great watching You grow this podcast over time and seeing the great talent that you've been attracting and the success you're having. So it's awesome to finally make the invite. And I will say, we've known each other since 1994 now. So yeah, we're at about 32 years. It's a long time.

Yeah, 32. Okay. Well, you've got it precise. And I will say, I didn't mention this at the beginning, and we will give a little background to Brett, but Probably his number one most proud and claim to fame moment is that he is an advisory board member of Gensler Wealth. You know, we're not going to focus the podcast on that, but Brett has been very helpful to me as we've launched this business many years ago. I also should say, just from a full disclosure perspective, that I am a, dare I say, an early investor in Maple. We're supposed to disclose this stuff from a regulatory perspective, The reality is you can't— anyone who's listening can't invest in Maple anyways at this moment, I would imagine. So talking about Maple, it's not investment advice, but there's nothing you can do about it anyways. Okay, so let me give an intro of Brett and then we'll dive in. So Dr. Brett Belchetz is the co-founder and CEO of Maple, which is one of Canada's leading virtual care platforms. Brett earned his medical degree from the University of Toronto, spent time at McKinsey and Company, and later returned to medicine practicing as an emergency room physician in Toronto. And his experience on the front lines of Canada's healthcare system, particularly seeing patients wait hours for relatively straightforward care, which I'm sure Brett will tell us about, ultimately led him to co-found Maple in 2015. I'm going to stop there and let Brett explain, you know, when we get to it, what Maple is and the impact Maple has had. You know, I've given the 2-second or maybe the 30-second overview, but can you give us the background? You know, you can start when you met me because that was probably the kickoff point of all of this. But back from becoming a doctor and ultimately to the founding of Maple, give us a little bit of the story there.

In terms of my background, as you stated, so I finished medical school in the year 2000 and then went to work for McKinsey and did that for a bunch of years, got some training in business and experience in business and learned a lot about, I think, many things that most physicians would not be exposed to, which I think allowed me to have a different lens on many of the challenges that I later saw in the healthcare system. After working for McKinsey, came back, did my residency, and started working as an emergency room physician in the mid-2000s and loved the work. It was great. It was everything I think I had hoped for— challenging, impactful, dealt with things that really made a difference in people's lives. And I would go to work and really feel like I was making a difference. But as we got a little bit further into my career, what I started to become frustrated by was A, the experience that my patients were having trying to access help in this system, and B, the way the system was overall utilizing the resources, the most important resources in the system, such as the hours of physician capacity that existed. So I would routinely go to the hospital and I would do my shift and the waiting room would be full every single time. I mean, there was, there was never a time I walked in the door where That waiting room was empty. It was, it was a, you know, on a good day it was a 2-hour wait and on a bad day it was a 10-hour wait. And as I cycled through the patients on every single shift, what I would see is that at least half the patients had very typical family practice type issues. They, they weren't coming in for what you would typically consider to be emergency room symptoms. So they weren't coming in for the chest pains or the car crashes or all the other wild things that you'll see in the emergency room. And when I would speak to these patients, I think there is this common misconception, and many of my colleagues probably would share this misconception, and many in the community would believe this, that these people are abusing the system, they're going to the emergency room when they shouldn't, and we should somehow stop these people from going there. And that couldn't be further from the truth that I experienced on a day-to-day basis. So what I actually saw was that most of the people who were coming with these kinds of issues, the reason they were there is because they had nowhere else to go. And the stats support this 100%. So if you look at Canada's healthcare system, we have a massive number of people who don't have family doctors. So I think the latest stat is somewhere over 6 million people don't have a family doctor. And even those people who do have family doctors, those people who are fortunate enough to be signed up, Our stats show that we have the longest wait times to get an appointment with a family doctor of almost any country in the developed world. So it's typically, you know, about 7 days or more to get an appointment with your family doctor. And that's just not good enough. So for almost any set of semi-acute symptoms, or even if you just need a really important prescription renewed, that's not good enough. If you miss your prescription pills for a week, things can go really bad. If you have a urinary tract infection and you wait a week for treatment, things can get very significant and serious. So These people were ending up in the ER because really there was just nowhere else for them to be. And so when I was looking at this, there were a couple things that I thought about. One is this is just terrible for these people. It's terrible for them that they have to sit in a waiting room for 8 hours. They have to miss a day of work. They have to potentially pull their kids out of school. They have to secure childcare or all of the social interruptions that occur. They're also getting exposed to the flu in the waiting room. So After that long period of time they're sitting in the waiting room, they get the extra special surprise of not only getting their prescription, but also getting another illness, which is not good for anybody. And so I started to think there really had to be a better experience and better way to provide care. And what really hammered home to me that there was a better way was that none of my friends or family members were having this experience. So if you were my friend or my family member, and you ran out of your prescription, what you did was text me. And I was able to solve all these issues for my friends and family members by text, by FaceTime video. And it was obvious that it worked. They were super happy. You know, I would get the diagnosis right. They would always tell me that it was correct and it was super easy for me to do it. And so it just struck me as incredibly unfair in our system that if you had the right friend or family member, who was a doctor, you got this amazing thing called virtual care. You know, anytime you wanted help, you just texted somebody and got it and your life went on as usual. But for everybody else, there was this horrendous 8 to 10 hour wait in the emergency room, you know, where you walked out with the bonus maybe of the flu. So the idea for Maple really started with, can we equalize the playing field? Can we give everybody in Canada the opportunity to have the same experience as those who have the right friend or family member who's a physician. So that's where the idea came from. And I'll stop there because it's a bit of a long-winded story, but happy to give a lot more detail because there's a whole other side to it about physician capacity utilization, all sorts of stuff like that.

Okay. So no, that's great. So 2 questions. So I think I've heard you talk about on prior podcasts or elsewhere, like maybe an attempt to try to solve this Just, you know, from your then current position as an ER doctor, any insight into that? Obviously you started Maple, so maybe that didn't work, but what did you find in the system when you said, guys, this is wild, can't we do something here?

I did a lot of work from within the system to try to make a difference. So, you know, I sat on hospital committees, you know, we had a transformation effort in my hospital. And, you know, we really looked at all of the issues that we had in terms of how could we improve patient flow in the department, how could we more effectively treat some of the things that were minor issues and get them out of the hospital faster. I even went to a higher level. I remember giving a talk at a Senate subcommittee in Ottawa. And, you know, what I learned is through all of those efforts is that It doesn't matter how much effort you put in. There is so much inertia in our enormous Canadian healthcare system that it is very difficult to introduce new ideas or to make change. And it very quickly became apparent to me that even ideas that everybody recognized were correct, that were the right way to go, were almost impossible to be implemented. It was also impossible to make these things move forward. Either the bureaucracy was in the way, there was a clinicians group that objected, there was a funding barrier that existed. And when I say funding barrier, it's not that there wasn't enough money in the system. I mean, there perpetually isn't enough money in the system, but it's more so that the way that we fund the healthcare system is that sometimes what happens is if you spend $10 out in the community, it'll save you $100 in the hospital. And the problem is the funding bucket goes either to the community or to the hospital. And so the community funding, there isn't that $10 that exists, and they're not willing to take the chance on that $10 of extra spend because they're not the ones who save the $100. And so what ends up happening is you can have the greatest idea ever and it doesn't get funded because the benefit is created somewhere else in the healthcare system than where the money is spent. And so That's just an example. So, you know, I would see these patterns over and over, and eventually after trying very hard within the system for a number of years, I just came to the conclusion that I thought I knew a, or at least I had a really good idea what would be a potential way to solve for many of the issues I had seen and that I could do it very quickly. I could step outside of the healthcare system and do it on my own without any of that bureaucracy administration and, you know, all of the barriers that I've mentioned. And so I took the plunge in 2015 and said, let's just go do it. Let's demonstrate it works. And maybe if we demonstrate that it works, maybe at some point this big colossal healthcare system will follow us. And because of what we've done, they'll make the decisions that need to be made. But me just sitting on committees and brainstorming up ideas just isn't getting us anywhere.

Okay. So then you make the leap and you start Maple. It's very difficult to start a business as an entrepreneur. And you started a business that was gonna be a major change in it to the customer that you were trying to help. Actually a major positive change in my view, but a major change to sort of, you know, the way things are done in the country. What was the early days of Maple like and how did you get it rolling? And what was the initial reaction from a whole variety of parties? Most importantly, maybe the patient, I guess, or the user? So

I'll say the early days were very challenging. We faced resistance, I'd say, almost on every dimension. So when we started it, there were only 3 of us. So it was myself, my 2 co-founders, Stuart Starmer, who you've already spoken about. There was Roxana Zayman, who is our 3rd co-founder, who is still with us as our chief operating officer. And the 3 of us believed in it really strongly and we had very clearly defined roles. Stu was the technology guy, Roxanna was the business person primarily, and I was more the clinical and product lead. And we jumped in with passion, we built our platform, we didn't raise any money initially, at least not for the first bunch of months. And we were convinced that this was a great idea. And I remember Going out to raise up one of our first rounds of investment. This was the stage where we'd taken things about as far as we could take them without any investment coming in. But at some point in time, some of us were going to have to reduce our hours of work that we were working in our other jobs. We needed to have some technology infrastructure stood up. We needed to potentially hire some people. And as a result, we needed some investment. And I remember approaching some of the first investors that came to mind, and I remember being told point blank that this will never work. This will never work for 2 reasons. And when I say that, that I was told this, I wasn't told this once. I was told this many times. So I was told this will never work because A, at that point in time, virtual care in almost all of Canada was completely uninsured by provincial government. So what that meant is that there was no way to get paid under our public health insurance system for the care provided, which meant that if we wanted to do this, the only way that it could launch would be through private payment. And so we were told, never going to work because no Canadian will ever pay for this. Canadians don't pay for healthcare, period, full stop. That's one. 2, we were told doctors aren't going to work on this. There is no doctor that is ever going to sign up to see patients on your platform. A, because they have guaranteed income in the public healthcare system. So this just isn't of interest to them. And B, because it's just not a proven thing and doctors don't like doing unproven things. So they're not going to be interested. So that was all pretty challenging. It, you know, you're looking at a business where you think you've got a great idea, you need funding, but Everybody you speak to who you might want to get a check from fundamentally does not believe in your business model. So there's another element to this which is really challenging, which is that when you stand up a business like this, you know, I think the classic term for it in business is a two-sided marketplace. I don't like to think of us as a two-sided marketplace because I think what we are really much more so is a very comprehensive technology platform that enables much better delivery of healthcare. And we happen to Allow healthcare providers to use our platform and patients to access their care on our platform. But I don't think of us as a two-sided marketplace. But that being said, in the early days, we very much needed both sides. So what I mean by that is that you cannot get healthcare providers to sign up and stay on your platform if you have no patients. You cannot market to patients or get clients if you have no healthcare providers. And this was a 24/7 business. The idea being we would make it like Uber. It functions around the clock. You can see a doctor anytime, day or night, weekends, holidays, et cetera. So we needed pretty good staffing to be able to cover that. And so it was a really big chicken and egg to crack. How do we get doctors on there to cover those kinds of hours when we don't have any patients and no volume for them to see and no way to make any money? And how do we get patients to actually sign up if we don't have any healthcare providers? So we found a bunch of doctors who who were actually very, very enthusiastic about the idea, who actually thought it would work and really signed onto this concept. And with those doctors, what we essentially said is the only way that we will let you invest in this platform is if you guarantee to sign up to cover shifts on the platform in the early days when we have no other providers. And so it kind of worked out. They invested, they agreed to sign up, we had our shifts covered in the early days, and we were able to go out to market and make that promise to patients that we had 24/7 coverage. And there is something formative that I just want to get back to, which I think is really important in your earlier question because I didn't speak to it, but I just want to speak to this as well because it also really helped us to grow and to get more healthcare providers on board, which is that when I was thinking about how we started Maple and how we would staff Maple, one of the problems that I was trying to solve for is the fact that we in our healthcare system, don't properly utilize our healthcare workers that we have in the system. We don't utilize our capacity. So up until we started Maple, the only way you could ever provide work as a healthcare worker, as a doctor, is on a shift. So you would sign up for a shift at your clinic. I would sign up for a shift in the emergency room. And for me as an emergency room doctor, a full-time set of shifts was about 16 to 18 shifts a month. That is as much as anybody who has normal levels of strength can do. Because it is such a tough job that after 16 to 18 shifts, you are burned out. You do not want to go back into the hospital. So for me, I was off 14 or 15 days every single month. And there is no amount of money that our healthcare system could have offered me to get me to go on another shift, either in a hospital or a clinic or elsewhere. The thought of going in now for another 6 to 8 hours and being stuck there and not being able to walk away was just too much for me to handle. But if I go back to my earlier example, if, you know, my friends text me and I just answer, that never bothered me because on my relaxed day off, if a friend texts me and I can answer at my leisure or not respond if I'm busy doing something else, that was actually quite appealing. And so we structured the entire system for doctors to be Uber style, that this wasn't a replacement for your shifts. This wasn't something that was going to take you out of the hospital or out of your clinic. But this was for these doctors that were burned out of their clinic, burned out of their emergency room, couldn't offer an extra day, but yet Many days on a Friday afternoon or a Tuesday afternoon might be free. We offered them a way to Uber-style jump on and see as many patients as they want and walk away whenever they wanted. And so all those people that said, you know, no doctor will ever do this, no doctor will ever staff this. What we found very quickly is that most healthcare providers were just like me. They had a lot of free time and, you know, there's only so many times they could go to the gym or have lunch with friends or do all those other things. And they thought, wouldn't it be great if I could find a way to make a little bit of extra income without that commitment to another shift? And so very quickly we went from this place. Once we got that core group of doctors, we got to a place where we were actually overstaffed. And I know I'm jumping ahead in the story, but what's been amazing about our business is we've been overstaffed ever since the beginning. Ever since then, we have had a waitlist of doctors waiting to join our platform. And that waitlist, even though we have been a very high-growth business, that waitlist of doctors has always grown faster than our core business.

And I suspect that waitlist of doctors hasn't taken away their time in the hospitals or their clinics or where they would've been anyways in the, you know, call it the public system.

Exactly. We're, and we're very purposeful about that. One of the things that we always look for when we're taking people off the waitlist is to understand What kind of work does this healthcare provider do? Why are they coming to Maple? Is this going to potentially take care out of the system, or is it going to achieve what we are looking for it to achieve, which is to add extra capacity to the system by giving them a way to work when they wouldn't have been working otherwise? So we've been extremely purposeful and we've been very successful about it. And that's one of the things I think we're most proud of is that we have been able to, through our system, Add a lot of capacity to the system using the same group of healthcare providers.

Amazing, amazing. So want to jump ahead? I guess the story is you know that was in 2015, 2016. I guess that Maple launched and you grew it for a number of years. Got the doctors on, I assume and hope. You know, good number of consumer or patients if you want to. I don't know what you call. I'll call it patients. And then all of a sudden COVID happened. And what happened to your growing business when COVID entered the picture here?

COVID was transformational. I think it was transformational for society as a whole, but it was very transformational for virtual healthcare. We went from a place where prior to COVID, if you were to look at February of 2020, Across all of Canada, less than 1% of healthcare visits were done virtually. So nobody was really doing it. Now, we'd been growing nicely, but our growth had been measured and we'd had to work for the adoption that we'd gotten. And we were still having a lot of difficulties. I still remember as late as 2019, our doctors seeing patients virtually and sending a prescription to a pharmacy and pharmacies refusing to fill the prescriptions when they heard that the visit occurred online because they said that was online, that's illegal. I'm not filling this prescription. So even though we'd been doing okay and we were growing, there was still just an incredible amount of hesitancy out there in the community to allow this, to believe in it, to adopt it, et cetera. And so there were barriers that we were running into left, right, and center. That all changed with COVID So in the month of April of 2020, we went from under 1% of visits being done virtually to 70, 7-0, 70% of all healthcare visits were done virtually in the month of April 2020. I don't think there's ever been an industry in the history of any industry that has changed that quickly. And that is a radical transformation overnight. So what did that do to our business? So, you know, you're looking at a 70-fold increase in volume that wants to be virtual. You know, we didn't grow 70-fold, but our business did essentially quadruple in the span of about 6 weeks. So that is an incredible, incredible rate of growth. You know, 300%, 400% growth in 6 weeks is very, very, very challenging to manage. And it's one of those things where a lot of business owners would say, wow, that's incredible. What a great opportunity. You must have been so happy about it. And the answer is, you know, be careful what you wish for because yes, it is nice to be in demand and in vogue. And I will also tell you, you know, after COVID, began, never again did a pharmacist refuse to take our prescription because the visit was virtual. I think they all understood now this was real, this was legal. And I think regulations and legislation across the country very quickly adjusted to make it clear virtual was a normal part of healthcare. But meeting that kind of a spike in demand over that short period of time is very, very difficult. So we had very carefully grown our physician pool over time so that Wait times were always low, but we didn't have physicians that were sitting around idly wondering where there was work to be done. And then all of a sudden, you know, our average wait time, which I think prior to COVID was about 2.5 minutes on a 24/7 basis. I remember the first big shutdown day of COVID I think our wait times spiked to something like 4 hours. And, you know, for the community at large, that's, that's kind of normal. 4 hours in the emergency room, 4 hours in a walk-in clinic. But for us, this was catastrophic. You know, we were not okay with it, it being 4 hours. And what was even scarier is it spiked to 4 hours and then just started going up and up and up because the, Visit volume just never stopped. So we really put all hands on deck in every part of our company. You know, we took, we took everybody in the company who was doing anything other than customer support or clinical care. We just took them off of what they were doing. And, you know, our marketing stopped, our sales efforts stopped, our engineering stopped, like everything stopped and everything focused on, A, how do we provide more customer support? Because the inquiries were just rolling in at a pace we'd never seen. B, how do we get anybody who's a doctor mobilized, working more on the platform? And how do we make sure that they're supported? The ones who were sporadically working, whose hospital was now shut down or their clinic was shut down, how do we support them in being able to get more active on the platform very quickly? Even I myself, I'm a physician by background, as I mentioned, I just stopped doing all the business side of the business. I was just literally seeing patients on our app till 4 in the morning every night. during COVID for the first few weeks. And I remember I would finally see the number of patients waiting go down to a low level. I'd go to bed at 4 and I'd be up again at 7 or 8 doing it again. So it was all hands on deck. And the other thing that we were doing is we converted half our team into physician onboarding specialists very quickly because we had this huge waitlist. I think we had about 600 clinicians waiting to join the platform at that point in time. So the directive I gave is let's get everybody in the company quickly trained in how to onboard new doctors. And let's onboard that whole waitlist of doctors as fast as we can. So over the course of 2 weeks, we actually onboarded the entire waitlist and we had all of them working on the platform. And within about a couple of weeks, we actually had that wait time not back to 2.5 minutes, but I think it was down to about 10 or 15 minutes within a couple of weeks. So we mobilized. It was horrendous. It was unenjoyable. We were all doing it from home with complete social isolation at the same time.

Right, yeah.

You didn't even get to get into a room and actually get happy together about your achievement. You had your Zoom party to celebrate. But I would say I am still to this day just so proud of what our team did, the amount of hours and the amount of dedication that went into it. And the fact that while our system maybe buckled a little bit, it didn't break at all. And I think what we saw actually, the other thing that was interesting, there were some other nascent virtual care platforms at the time and their wait times went up to like 28, 32 days when COVID started because they They didn't have this very flexible Uber-style idea of staffing that we had. And so I think it really proved out our model of virtual care as opposed to some of the more traditional appointment-based models that were starting to compete against us at the time.

I guess at that point the government began covering these visits, or what was the government's reaction during that time and what has been the follow-on since COVID's sort of gone away, I should say?

Yeah, it took about 6 weeks for government really to step in and fill the void. So initially government, I think, was very focused in many, many different directions. They were worried about masks and medical supplies and medications and testing and all the other things that they had to worry about. And then I think about 6 weeks in, they finally realized, wait a second, everybody is seeing doctors online and there's no billing codes for this. So Then they started to introduce billing codes, and we saw this happen very rapidly across the country. And what was introduced were billing codes for either video visits or audio visits. So by audio visit, I mean a visit that is done either by telephone or interactive audio through a virtual care platform. They did not introduce billing codes for any other modalities of virtual care, such as, you know, by email or by secure messaging. And what we've seen since that happened was that Some provinces have maintained that coverage. So, you know, for instance, British Columbia has maintained that coverage throughout the years, while other provinces have drastically curtailed that coverage. So for instance, in Ontario, they have radically cut back the degree to which virtual care visits are funded between a doctor and a patient that's not part of their practice, to the point where I would say it is very close to almost being an uninsured service again in Ontario.

Clearly, at least From my perspective, sounds like from yours, the virtual care during COVID was a lifesaver, literally, probably, and proved that it worked, and I assume took significant untold amount of stress off the hospital system. So why would— why after the fact would those codes be taken down when it was a proof of model of a potentially successful way to solve one or two or more issues of our current healthcare system? Why revert? I just, I just don't understand.

Yeah, it's a great question. Um, I think the, the reason for this is actually quite justifiable. As I mentioned, our system was quite thoughtful, so we were all about this idea that we didn't want you to leave your physical practice, that this was supposed to be something you did between shifts to augment your hours. But unfortunately, what happened after the billing codes exploded in 2020 is a lot of less thoughtful ways of doing virtual care emerged. And those types of virtual care operations were not designed to help a doctor provide care between their shifts. What they were designed to do is actually put a doctor on shift and actually replace what they would do in a clinic. And what governments across the country started to see as we got later into the pandemic, and also as they were allowed to open their offices again, is that a lot of providers were not coming back to their offices. A lot of them were saying, why would I go to that clinic for my 8-hour shift when I can just do my 8-hour shift at the cottage or wherever else I choose to be? And so governments had this dilemma, which is they recognized that we need to get the physical healthcare system working again, but we had created such a profound change in the way that healthcare providers was working that unless we started to revise how we pay for healthcare, We would be facing a whole other kind of problem. So I think there were some good thought behind it. I think we can continue. There is opportunity to iterate upon where we're at right now. I do think there are certain areas where we can do a much better job funding virtual care, and there are certain governments in Canada that are doing a much better job. So if I skip ahead, for instance, Maple works in partnership with a number of provincial governments in Canada now. Where we license our platform and our processes and our know-how out to them so that they can run their own virtual care programs to use their own healthcare providers to treat their own patients. And those models typically are totally publicly funded and they work really well because A, they use that Uber-style model that we've spoken about and they make sure that they're not taking people out of the system. And B, those programs are typically based on a limited patient pool. that is eligible. So usually the patient pool for those programs is the pool of people that don't have a family doctor. So these are the people that we know are not just using this as an alternative to a family doctor's visit that they could have had. These are people that the emergency room would have been their alternative to this visit. So there are governments that have done this really well and really thoughtfully, and then there are other places where the funding has just disappeared.

Okay, well, we've talked a lot about What got you to start Maple, some of the challenges you faced, COVID, all this stuff. What I haven't asked you, and maybe just to give our listeners a little bit more of a picture of what Maple is, can you now describe what is Maple delivering? How does it work? What's the scope of care that can be provided? It'd be nice to let listeners get a sense of what we're really talking about here that they can have in the palm of their hands, literally.

Yeah, so Maple, it's an application that you can download on your iPhone or your Android phone, or you can access it via web on your computer or any browser-enabled device. And what the application does is it lets you access visits with doctors and nurse practitioners on a 24/7 basis around the clock throughout the year for a variety of medical issues. And within the application, When you have your visit, you can have your visit by video chat or by audio chat or by secure messaging, depending upon your preferences and your clinical need. But essentially within that visit, you can do everything that you would be able to do in a physical doctor's visit minus the physical touch. And for those who have never done this, I think we very quickly get this response, which is, how can you care for me? How can you diagnose me? How can you get it right? And the reality is that there's very few things that we cannot do. on a virtual visit. So most people, we can get their vitals quite easily. You know, I'd say there's a very significant proportion of people who either know how to check their own heart rate or they have an Apple Watch or some other monitor that allows them to get a heart rate. Apple Watches get your oxygenation. A lot of people have blood pressure monitors. Almost everybody's got a thermometer at home. So we can actually get a full set of vitals quite easily. We can easily on video examine your joints, your skin. We can have high-resolution photos of the back of your throat or, you know, if you have a rash on your skin that needs to be looked at. Most of the diagnosis actually in medicine, to be honest, is based on history taking, it's asking the right questions and understanding the story more so than actually looking at you as well. So I would say about 70% of things that would be diagnosed in a doctor's office, we can very effectively diagnose in a virtual care environment. Now, what we can't do, we can't look inside your ear, can't listen to your lungs. So if there's something that requires listening to your lungs or looking in your ear, you probably might need to be seen in person. But within the application, then everything else related to that visit will be there in the same application. So you can get a digital prescription, which can get sent straight to your pharmacy of your choice directly from the application. We can order laboratory tests. We can make specialist referrals. We can order X-rays. We can also write sick notes. But as I said, almost everything you would do in a physical doctor visit, we can do minus the physical touch. So We are typically resolving somewhere around, I'd say about 90% of the requests that come into the application. And we treat millions of patients every single year. So I think we are the single busiest place of healthcare in all of Canada right now. And the use cases are numerous. So, you know, obviously there's this use case of the person who doesn't have a family doctor, but very often it's the person who does have a family doctor, but You know, 9:00 PM, they realize they're out of their medication that they need to take that night. And, you know, they'll come onto Maple and they'll have a prescription in their hand and delivered to the pharmacy within 30 minutes. When I say prescription in your hand, I mean virtually in your hand, of course, not physically in your hand, but it's at the pharmacy within 30 minutes. It's, you know, the family whose kid wakes up sick in the middle of the night with a fever and, you know, they're trying to figure out, do I need to go to the emergency room or can I manage this at home? We'll have that visit and we'll walk the parents through, you know, how worried to be. The woman who gets recurrent urinary tract infections and has another UTI and knows she has it, we can get her those antibiotics. And again, the family doctor's visit might be 5, 6 days away at best. So those are some of the many use cases. A lot of the time it's somebody who has, say, thyroid disease and they just need to get their regular blood work ordered. We can order that for them. So almost you name it, we're able to do it on the application. And we're able to do it very effectively. And what's also really nice about it is all the records of those visits are stored right there in your application. So after the visit, if you forget what the doctor said to you, it's all there. If you forget what you were prescribed, it's right there. If you forget what your test results were, it's all right there. Everything is stored in one place for you. So it's a really nice place to have record keeping. And we've also set up the system that you can share those records with anyone you choose, including your family doctor, if you want them to see what happened on the Platform because continuity of care is very important to us. And then the other thing I'll say is that we've started to dig into some areas of specialty care as well. So, you know, we have dermatologists on the platform. We have a sleep therapist on the platform. We have a comprehensive ADHD program. So anybody out there, either adult or if you think your child has ADHD, we have a comprehensive virtual ADHD program, which is very, very well loved and effective. We're starting to get in some areas of women's health where we have ongoing programs for that. So Really, our aspiration is to go from where we've been, which is this sort of ad hoc primary care whenever you need it or urgent care whenever you need it model to what we're realizing as well is there's just a deficiency of ongoing care for a number of other conditions. And we're starting to add that as well.

Sounds incredible. Before we move on to just a couple final questions on slightly different topics, last podcast we did with Mara Lederman, She talked about founding her business and going to market with a product and then realizing that they needed to pivot to something quite different. I think in Maple's story, I guess there might have been something similar with sort of how you were going to reach your end consumer and what you initially thought and did versus maybe what's happening now. We always like to share stories of how entrepreneurs and business owners have to think about adapting. Have I got that right? And can you maybe share that?

Yeah, there definitely was a bit of a pivot in our business model, not in the core product and how it met the market's needs. And I think our core product, I think I would say, is just as important to the patients and the consumers that we serve as it ever has been. But in the early days when we started this business, all 3 of us are first-time founders. And being first-time founders, all 3 of us, when we thought about business models, we were very heavily influenced by what were the big flashy names of that time. And so going back to 2015, the famous names out there were all of the consumer digital brands. So it was, you know, the Ubers of the world, the Airbnbs of the world, et cetera. And so when we thought about Maple, that was all we thought about. We thought, let's be, you know, the Uber of medical care. Let's be the Airbnb sort of Airbnb-ish thing of medical care as well. But it was this idea of we like this, concept of a very visible, very flashy consumer branded experience. And that was all we thought about. So we went to market initially purely as a direct-to-market, direct-to-consumer experience. And it went well. I mean, we were growing really nicely, but we didn't even think of any other go-to-markets. And that, I think, is just an example of what happens when you're a first-time founder and you don't even think about, you know, how else you could go to market or what other successes there could be. And then all of a sudden in late 2016 or so, we got approached by a couple of businesses actually asking us what our corporate plans were like. And we didn't have any corporate plans. We'd never even thought of corporate plans or selling through business. And we had this revelation that, wait a second, maybe there's an opportunity to reach a lot more people as a health benefit for employers. 'Cause that's what they were asking for. So we negotiated back and forth with these employers, landed on contracts. We actually very quickly built a whole new part of our system that enabled a third party to sponsor care for a group. We called it our partnership system. And that pivot was actually quite instrumental because if I fast forward to today, the vast majority of our revenue, you know, we still run a very successful and thriving direct-to-consumer business, but the vast majority of our revenue is business-to-business. We do far more in the business-to-business area than we ever have in the consumer area. And it is really interesting to see that given that was just not at all what we were even remotely thinking about back in the day.

Amazing. Yeah, I have access to Maple through, uh, actually through CAA right now, uh, which I guess is one of your big partners. And historically I've had access through one of my previous companies and as a direct user. So I've been through the path with with you guys. But yeah, it's an amazing thing to have for sure. Okay, we're almost out of time. We cannot end the podcast without talking about everyone and my favorite topic on earth these days, which is AI. AI and the future of medicine, let's just say. So, you know, you've got a pretty good vantage point. You've got an amazing vantage point to the health system, to tech, AI. You want to give us a little bit of color from your lens, how AI is going to impact our health system and anything else that you think generally?

So AI is, is this, it, it, you know, it's this huge scary or not scary word depending on who you are and, and, and what your perspective is. But I think when it comes to healthcare, I think AI is a tremendous transformative opportunity. So we're in this point of inflection where, you know, in healthcare we're in a lot of trouble. You know, we all see the stats on Canada's healthcare system, but I'm not even talking about Canada. I'm talking globally. We're in a lot of trouble. Demographics are flipping in almost every single country in the world. So just to give you an example of Canada's demographics, and again, this is not unique, we're not even close to the worst at this, but if you look back around the year 2000, we had about 50% more children in Canada than we did senior citizens. And by the year 2030, we'll have 50% more senior citizens than we do children. So it's already flipped over. We're very close to a complete flip. And not only that, but the number of working-age people we have relative to the number of seniors is also dramatically flipping. So if you go back to about 2010, we had about 4.5 working-age adults for every senior citizen. By 2030, it's now about 2.7 is what we're projecting. So a dramatic reduction in the number of people who are working. Add all that up. What does that mean? It means that as you and I get older, there will not be enough human beings to provide care for us. There will not be enough doctors. There will not be enough nurses. There will not be enough of anything. And that's, as I said, I'm just gonna hammer this home. This is not a Canadian problem. This is a global problem. So I think people have been scratching their head for a number of years as to what is the solution for this. And I'm gonna tell you, AI is the best potential solution we've come across. It is a game changer in terms of healthcare provider productivity. So, you know, we're working extensively in incorporating AI at Maple. And so AI already is lifting a lot of the burden off of our healthcare providers. You cannot see a doctor on Maple without speaking to an AI first that actually takes your whole history from you. And so by the time you're speaking to a doctor now at Maple, all of the hard work has been done. Your whole history has been taken very effectively by an AI. It's already come up with an idea of what the likely set of diagnoses the doctor should think about are. It's already recommended some potential treatments for the doctor to think about. And all the doctor really has to do now is just confirm some of the things that the AI asked about you and make sure that the conversation accurately captured what your story is. But then the doctor really just spends time with you to say, this is what I think is going on and how do we move forward? And so We're in a world now where we've gone from an average medical visit duration that was about 12 to 14 minutes for every single patient encounter before AI. I think we can get it down to 4 minutes or less per patient with AI. We're well on the way towards that. So when you think about that, that's tripling the productivity of a healthcare provider. So this massive scary demographic challenge that I've spoken about, if we all of a sudden could get 3 times as many visits out of our healthcare providers as they're able to do now, all of a sudden that's not so scary. So there's lots more work to be done. We're able to do that within Maple because we control all parts of the ecosystem. We control the provider experience, the patient experience, how it all works together, and the administrative backend. A little more difficult to do that in that broader healthcare system, but certainly not impossible. There's an incredible amount of opportunity. And don't get me started in terms of where I think robotics can go, because I think melding robotics with AI, as the robots get good enough, a lot of the things that health— human healthcare providers are required for right now, such as doing some of the physical examination or the procedural work, that may be able to be automated away as well. And so what I can say, my 30,000-foot view is that AI as it relates to healthcare is not optional. It is an absolutely mandatory thing for us to figure out because without it, we are going to end up in a world where you or I may not have any care available to us at all.

I'm just gonna call Maple. Okay. You know, one of the things, as I sort of alluded to with one of the previous questions, we love to hear from entrepreneurs and sort of some key lessons as we close out here in a minute, maybe just from your journey, or maybe I phrase the question as, you know, if you could roll back the clock, go back in time and it's 2015, the day before you decide you're gonna launch Maple. Like, what would you be telling yourself back then? Which is another way of saying, you know, what lessons might you impart to other folks who are either business owners, runners, want to be an entrepreneur, et cetera? Big sort of takeaways.

Yeah, I think number one, when we went in, we were in this weird inflection point in time where a lot of people were starting businesses and selling them right away. I mean, you were hearing about startups that, you you know, had no profitability and no business model, but had grown some revenue and all of a sudden we're selling for big dollar figures within 2 or 3 years. And I think we being part of that culture thought that was gonna be our journey. And that I think was just a blip in time. I don't think that is the sustainable place for entrepreneurialism to lie. I think the sustainable place is you build a great business that actually has good unit economics. It's scalable, it's gonna be profitable, it's gonna generate cash and all that stuff. And you should be prepared to be there for the long haul. There's very few business people that are launching businesses and selling them in 2 or 3 years anymore. So I think what I would say to myself is don't focus on the flashy investments and the rapid growth they bring. Focus on building a strong business that can have a rapid approach to profitability and positive cash flow and understand that you should be going into this with a viewpoint that you're going to be doing this for a long time and you better really love it. And I would say to anybody else thinking about starting a business, if you don't love actually running that business, if you're just in it to flip it, don't do it.

Okay. Amazing. Good thoughts. Okay. Last question, which we ask everybody, and our listeners have heard me say this many times, but our theme here is Your Wealth Unlimited because we can help families with whatever they need on the financial side. That's our sort of family office service. And on the investing side, we don't make anything ourselves, so we go out and find what we What we believe, a caveat for the regulators, what we believe to be the best investments. So I like to ask our guests, you know, the world is unlimited. You could do anything. You could be doing anything if you weren't, you know, a medical doctor, McKinsey, Medical, Maple, etc. If you could just do anything on earth that you might want to do, maybe different than what you're doing now, what would you be doing?

Right now, I think If I look back at my life, and this is going to be a really boring answer, I mean, but if I look back at my life, I think the last time I took more than about 2 weeks off was when I was 25 years old. So, you know, I've been going now for, you know, almost 30 years without a vacation that was more than 2 weeks. So,

Right.

I think if I could do anything right now, I would actually want to do something that allowed me to get bored because I don't know what it feels like to be bored. I've never been bored in 30 years. So, I would like to just do nothing to the point where boredom creeps in and I remember what that feels like. And then I think I would tell you, this is what I'm energized to do now. But right now, you know, I live in this space where, you know, things have been so full for so long, I can't even, I think, come up with an answer to that question because there isn't the mental space to go there.

Okay. Well, you know what? We're glad that you're not bored. We're glad that you're focused on what you're doing. You really are a trailblazer in the Canadian healthcare system. You've impacted millions and millions of people. lives. I see it, and I hope our listeners appreciate that, and everyone that you're dealing with, and your co-founders and your company, by the way. Credit to everyone over there. You're making a major, major difference in our country, and I thank you for it. And thanks for your support and guidance over the years, and wish you continued success with Maple. Your success is our country's success, and maybe there'll be a doctor to look after me when I'm older. So. There you go.

Thank you for having me. It's been great speaking today.

Okay. All the best. Take care.

The Unlimited Podcast is hosted and produced by Brian Ginsler and is edited and mixed by myself, David McMillan. This podcast is not to be taken as investment advice. If you like what you heard, don't forget to rate the podcast and follow us on social media. Follow us on social media @GinslerWealth. Thanks for listening, and see you next time.