Building a wildly successful private practice by constantly pivoting with Dr. George Rogu

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Hi, docs. Welcome to the Entre MD Podcast, where it is all about helping amazing physicians just like you, embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms. I'm your host, Dr. Una.

Well, welcome everybody back to another episode of the Entreprene MD podcast. This is where you come to get inspired and empowered to thrive as a physician entrepreneur. Today, I am super honored to have Dr. Roghu here. He is a very inspiring doc who's been in practice for a while, and he is the epitome of a physician entrepreneur. He has built a practice that, even though it's been around for a while, is very innovative. Keeping up with the times, constantly pivoting. So I'm happy I have him on here to share what he's done over.

The years with you.

So welcome to the show, Dr. Roghu.

Thank you for having me.

My pleasure. All right, so I know you, but I want you to take a moment and introduce yourself to the audience.

My name is George Rogou. I'm a pediatrician in Commack, Long Island, N.Y. i work at RBK Pediatrics and Urgent Care, and I'm also the president of ipcli, which is an independent pediatric collaborative of New York. I've been doing this for quite some time, a little too long, since 1996. Basically. Came into a small private practice of three people and we built it into three practices in an urgent care with 17 physicians.

Nice.

I think we did something right.

I think you did all right. So tell me a little bit more about the practice. I think I remember when you even started the urgent care, and I thought that was, like, the coolest thing ever. Tell us a little more about it.

Well, the urgent care. Tell me about the practice first. We have a tagline that says, we provide primary care when you want it, urgent care when you need it, Services provided by physicians. Now, those statements come from all the problems that we hear about. People complaining about primary care, you need to do it. I'm too busy as a physician. So that's why we have to give it to them when they want it. Urgent care when you need it. Back in the day, when everybody's complaining about all the urgent care stealing the patients. The minute clinic stealing our patients, oh, my God, the sky is falling. We developed our own urgent care services provided by physicians. Well, that's because everybody's complaining that nurse practitioners are taking our jobs. So I have to support physicians and hire physicians. The practice itself has been around since 1962. Like I said, it grew from a solo practice of like, two or three people to a pretty big practice. Now we're doing primary care, urgent care, chronic care, and now this Telemedicine.

Oh, wow. Okay. We're going to talk about telemedicine in a minute. I didn't realize those three taglines had that significance. I've heard them, but I didn't realize that.

That is really good.

So for you, you're like, well, urgent care, they're taking all our patients. I'm just gonna build one and keep my patients correct. Amazing. Now, people may not realize this, but you did this back in the day when nobody really was doing it. When did you set up the urgent care?

We did the urgent care about. We got recertified twice. So every three years, you have to certify. So about six years.

Nice. Really good.

It starts off pretty quiet. Nobody knows. You're just extending the hours a little bit. So what we did, we started it with the physician partners. Everybody took a shift. We had other things we needed to do anyway, so we sat there and people started to walk in. You know, we saw them. And then, of course, we had to get the urgent care certification. We were kind of acting like urgent care. Anyway, got it when we became certified, then it became a big deal.

Nice.

Okay, good. So. So now we live in times which I'm sure you had. You've had this experience over and over again. Where to thrive, you have to pivot and evolve. And you've, you know, literally done this for decades. So talk to us about some of the evolutions, what prompted them, you know, what you did, how you responded to it. So the urgent care is one. What else have you had to do?

Well, the EHR itself is another one. We were early adopters in the ehr. You start if you listen to what happens around you, if you listen to the complaints on Soapbox, for example, you know, the EHR, they're developing the EHRs, people are getting EHRs. We don't want the EHRs. We're not going to take EHRs. Paper is good, you can't fight it. You just can't fight it. So you might as well find a solution that works. You know, back in the day when we started with the EHR, I believe in 2007, we already had a practice management system installed since 1996 that was working like a charm. 96, that's when we started with the. I mean that's when I started practicing, right? So they were, they were doing paper bills back then. So I came to work, they were doing paper bills with like two or three computers in the office, using floppy disk to transfer the data. And they told me, you're a young guy, find us a practice management system. Internet just started back in 96. And so I put in pediatric practice management system. A good company came up, we went live with them and it was great from 96 until 2007. Then we found a pediatric like EHR. I'm not going to get rid of the practice management because it worked fine. So I integrated it. So I was big on the hybrid model. So you got the best of breed from all companies. And he made it work, got a patient portal that was also integrated into the two products, a physician scheduling system that was integrated into the products. It's a little complicated. You got to have some computer knowledge. But as long as it worked and it was fine, everybody was happy. And then I think in 2016 the EHR blew up. They sold it to one of the big box systems. So everything came tumbling down. That was the problem with hybrid systems. When they worked, it was fantastic. Then you had to make this decision on to get an all in one product and we moved on. It was tough. It was tough getting the whole operation, practice management, ehr, every single body in the building, but everybody buckled down, learned how to use it and now was it 2020 and we're doing fine. So you have to change.

So we just have to change And I like what you said. You said, don't fight it. Just find what works.

Find what works, don't fight it, and adapt.

So at the time of this recording, we are in the middle of the COVID 19 pandemic, and people are not going into the offices. Their practices have literally closed their doors. This is another time where you have to adapt, you have to pivot. What have you done in your practice?

That's another problem. Everybody's having this problem.

Yep.

What do you do? There are no patients. They're not coming in the ehr. The emergency rooms are empty. It's a ghost town. So what we did as an organization in order to keep the staff with a paycheck and to continue to do the right thing, we believe that you should still do physicals and, well, baby checks and give the children the vaccines, because we're going to get over this COVID 19 event. But if we don't give the vaccines, we're going to delay, and then next year we're going to deal with measles and whooping cough and hemophiluous influenza, varicella disease. Lots of diseases that young physicians like you may have not seen.

Well, I trained in Nigeria, though, so I've seen them.

Okay.

But yes, the young physicians like me have not seen them, ever.

When I get called in as an expert in varicella disease, that's pretty bad. But, you know, so what we did is we separated our visits. So in the morning, we're doing well visits. In the afternoon, we're doing sick visits. We have the technology. We tell them, sit in your car and we will text you when your room is ready. We clean up every room twice before patients. We have protective gear for our staff to protect them. We have shields, we have masks. We prepared for this. We knew it was coming. It's not a surprise. I don't know why some people, I mean, you're not throwing away the mess. You're not changing them after every patient. You can keep them for a week, they say you can. And then this telemedicine, another thing that has been coming. I've always said it's coming just like the EHR and might as well get involved with it. So I started getting involved, like in the late summer, early fall of 2019. I did it more as a curiosity. I did it for medication renewals of Ritalin and things like that. So people loved it. They love the telemedicine. For medication renewal, they don't have to come into the office.

Yeah.

And like I told you, when we were on the phone. It's embarrassingly fast. And I still do the same thing I did in person. I cannot explain why it's so fast. So now we're expanding it to more of sick visits. I don't personally like it, but it seems to be the future. You know, at least we have the luxury of. We can do the telemedicine visit, and if they're sick, come on down to the offices, check you out.

Yeah, yeah. So let me help my listeners put this in perspective. So you graduated from residency in what year?

It's a secret. 1996.

1996. Okay. So I have a lot of doctors who are like, it's a lot of technology. I don't want to do this. But here you have a doc who graduated in 1996 who embraced telemedicine almost a full year before. Now we're needing to do it. So what would you tell the doctor who's apprehensive about starting off telemedicine, who's resistant to it?

I would tell them you have to get involved. Because if you don't get involved, the person down the street will. The system, you know, the hospital system will. The urgent cares are doing it now. You know, the new things are with urgent cares, they're doing a telemedicine visit with the patient, and they tell them, come on down again. Everybody's poaching your patients. You have to. The telemedicine has to be within the medical home. That's very, very important.

So they should stop fighting, embrace it. And be aware, if you're not doing it, somebody else is going to do it and take your patients.

Did you hear the recurring theme?

Yeah.

Same recurrent theme every time. You know, other business people smarter than the physicians really come on. They're not.

They're not at all.

All these venture capitalists that take over urgent cares and practices and systems and networks, they know. They know how to make things work. You know, the patients are loyal to the physician. There is a relationship there. But that will only go so far, for so long.

So embrace the change that's coming so you can continue to be relevant. I love it. I'll take it from you. You've been doing this since 1996. So now for the doc who's like, okay, I get it. I'm supposed to do telemedicine, but I don't know where to start. What would you tell them?

They want to get involved in telemedicine.

Yeah.

There are so many products out there. There are a dime a dozen at this point, you have to find the one that works for you, the one that is not crazy expensive. If you're a one person office, there are plenty of free products out there. If you're a bigger organization, you really should get a real product that has the HIPAA security, the consent to treat documentation that collects the demographic data for you. So you have to decide what kind of operation you want to deal with. But actually they're popping up this week. So many new platforms are coming up.

Yeah, they're adapting. They absolutely are.

We're in the driver's seat. We still have the patience, you know.

So we just need to change.

We need to change once again.

Okay, that's great. That's really good.

All right.

So I've talked to practice owners over the years and the biggest issue they seem to have is staffing. And we've talked. We were at a conference together. I think that was February. Yeah, February. Beginning of February. And we got to talk a lot about staffing and all that. And it's amazing how over the years you've been able to build a really great team and retain really good people. So what are your strategies for building a great team?

I think the team culture is very important. Most practices are of the old school silo mentality, the me mentality, the my patient list mentality. I don't know where that was developed, but that's how the old practices are. You know, my practice was just like that up until 2016 when we had that big change and we had a mass exodus of physicians back in 2016, 2017, from whatever physician burnout, they wanted to move closer to systems or whatever. I think it had something to do with that, you know, the top down mentality. A lot of the people have changed within the organizations and now we're working as a team. When they come in to work for us, we train them, we embrace them, we show them the ropes. I remember when I started in 1996, Dr. Reichman said to me, Rule number 11, Dr. Roville, your first patient is there. That was onboarding.

Wow.

That was my onboarding.

Okay, okay.

Here's a lot of scope. You know what? I came from Jacoby Medical center in the Bronx. You know, nothing fazed me at that time, so. But now we teach them, we show them the ehr, we help them, we support them, and then they in turn will support you. I think.

I agree. I agree. Okay. All right. So that's the culture that needs to be in there. Now, how about when you're hiring? How do you make sure. You get the right people on your bus.

I have this talent, I think, of smelling personality.

I figured you would say that.

And it's true.

I think everybody has an md. Everybody is smart. The MD part, you know what? That's a given. It's an expected thing. I expect you to be smart. I expect you to be able to see patients. I expect you to do the right thing to make a diagnosis. The being nice part of it, I think that's the hard part. And you can tell when you speak to somebody, are they nice or are they not nice? If you feel you can't go out with them somewhere at a restaurant or on vacation or something, maybe you don't want to see them all day long. There's some consultants on the soap and listservice and stuff that say if you have a partner and you don't think you can go on vacation with them, he's not a good partner. So it makes sense. Even with your doctors, you should be able to sit in a room with them. Oh, another thing that we did to change the culture, we used to have the consultation rooms on each side of the office. So the guys would stay on one side, the girls would stay on the other side, or the partners would stay real. That's how it used to be. And then I think once we moved the administration and the phones and the secretaries out of the building and the billing out of the building to a call center, now we had this big room that was empty. We took over those two consultation rooms, made them into exam rooms, and I threw every single physician into one big room. I know about everybody's kids. I know about. We know about everything now. Everybody became friends. I think that was important.

That's great.

So don't give everybody individual offices. Stick them in a room like Dr. Rogel.

Yeah. Because that becomes another. Create another way to make the silo business.

Great.

So culture and then hire for attitude, not skill, I guess, is kind of what you do.

Expected. Yeah, that's a hit or miss.

Yeah. Okay.

Yeah, really good.

Noted.

Noted. All right.

And so what advice would you give, say, a new resident or someone who's looking to join a practice, transitioning from one practice to another. What should they be looking for in a practice?

Well, you have to look at the people that are interviewing you. If they seem to be nice, they seem to be, you know, the culture, they fit with your personality. You probably want to work there. If they're, like, mean or. I don't know. I don't want to say disrespectful. But they look down to you. It's probably that old culture mentality. Now that I think back when I interviewed in 1996 at his job, that's the kind of a place you don't want to work at. Not now. It's changed, but that's the kind of mentality that there was.

You survived it, but it was a different time. Like you said, it was a different time.

Back in those times, you did what you had to do. We were part of the generation that you got beat up all the time. So we were used to getting beat up. And then we realized getting beat up is not so nice. So we put an end to that. And that's what has to happen in medicine. What else can I tell any residents? Some of the. It saddens me when I hear nobody wants to go into a partnership track. They all want to be an employed physician. They want to come and they want to go. I'm sure there are many partners out there, practices that need partners. You can't expect it to be given to you and it's not going to be given to you just because you have the md. You have to earn it. And I think you have to be a little bit forward thinking. You have to have a vision, you have to get involved in activities within the practice. That's outside of just seeing patients. You have to help the practice to grow a little bit in advance. That's the kind of a person that you need. I don't need another MD. I got plenty of them. There's plenty of MDs. You want forward thinking MDs that will help to advance the practice.

I love that. Well, in entre md, we call that intrapreneurs. People who would come in and even though they're employees, they act like entrepreneurs. They help to, they help the practice to move forward. They help the bottom line. They're coming to work with all of them. So they're like their whole self is at work. So they're thinking about, you know, what do I do to make this practice better? What do I do to make our income better? How can I innovate? How can I take some stuff off my boss's plate? Those are intrapreneurs. Those are the best kind of employees to have.

Correct. You know, I remember when I was like at the beginnings of my career in the practice, I wasn't a partner yet. They came to me and they said, you know what? All the partners are going on vacation, so you are in charge. I was like, wow. I was like honored today. They probably say, I'm not paid for this.

Yeah, yeah, but you're an entrepreneur.

Yeah, I knew it would help. One day I was telling young physicians, the easiest part of my day is when I see the patients. I had to deal with other stuff. Finding face shields for the practice and masks for the practice, setting up a telemedicine thing. And in between, you see the patients, too. It's hard, but it's not impossible.

Yeah.

Okay, well, so now you talked about hard and not impossible.

What.

What would you say to the person who's been thinking of starting a practice?

Starting a practice. The happiest people are the ones that are in private practice. You don't hear of people complaining of physician burnout if they're in private practice. It's only the people that work in the hospitals because they get abused. They get told what to do, not by physicians, but by some MBA suits, you know, and then they take it personally. What is this guy doesn't know anything about medicine yet. He's telling me what to do. You know, it's rewarding. You can make it whatever you want it to be. You can see as much as you want or as little as you want. Nobody will tell you you can start at 10, you can start at 8. You can, you know, you make your own hours. You just adapt your practice to your lifestyle. I remember when I interviewed, she was very good. I was interviewing with a physician partner of the practice. She had twins. Now, today, you wouldn't look at this as a good thing to do, but she had a room with a nanny in her office with her twins, little babies. They stayed in that room. So she was close to her kids. She did her patients, and then she would be with her kids a little bit. And that's a little bit of an extreme thing. And this was 1996.

Yeah.

But at least that showed that she wants to, I guess, to keep it going.

So private practice gives you the flexibility to practice medicine on your own terms, in a way.

Correct.

So even though it's hard, it's still worth chasing.

You would say, I think it's worth it, but it's not going to be given to you. Your MD doesn't guarantee you success. Your MD just kind of gives you a little bit of a jump start, you know, at least if I succeed, I can say I succeeded and it was all in my hands. And if I fail, you know, I failed. I have nobody else to blame. I remember my father always told me, if you do good medicine, the money will follow. If you follow the money you'll never do good medicine. And unfortunately, what's happening today, hospital systems, they're following the money and that's why they're not doing a good medicine in private practice. We all try to provide, you know, good quality medicine and hopefully the money follows too.

So is your dad an md?

My father was a contractor, paper hanger. He wanted to be an md, but.

He'S a very smart guy. He's like, do good medicine and the money will follow. If you follow the money, the medicine, good medicine will never come. That's good.

I like, makes a lot of sense.

I love it. Okay, so tell me what's new? What new and exciting things are on the horizon for your practice? What have you been thinking about innovating because you've had ideas since 1996. I'm sure they're not about to stop.

Well, we have the three practices and the urgent care. One of our offices is old since 1962. It needs a facelift. The parking is horrible. And I was approached by one of the hospital systems to rent. The hospitals are fighting all over the place. It's hospitals, it's land wars that they're doing right.

Well, that's good. That will keep us them away from us.

Correct. Let them fight between each other. So down the street there's this huge, huge medical mall complex, about 300, 400,000 square feet. Half of it is taken over by one system, half of it is taken over by the other system. So the system that we're basically involved with, they want to develop a women's health center. Now what do I have in my waiting room all day long? Women. So they're going to give us, not give us, they're going to rent us space in their medical mall and we're going to build out a beautiful 5,000 square foot office whichever way we want. And then we're supposed to move down there. There's going to be plenty of parking and so forth and so on. And I told them, you know what, you guys should do one better than that. You guys have the pediatric specialty care center in your system. Why don't you rotate one of those specialists into a section next door to us? And then the answer was, well, that's not a good idea because you guys referred to us anyway. I said to them, well, you're correct, but consider it. You're not cannibalizing your referrals, we're subsidizing your referrals. You could use our referrals to you to pay your physicians to come. And then word on the street. We'll get out that now you guys are there, and then you'll get more cases. So we're going to make like a pediatric universe over there, medical universe. We're not selling out to them. We're just renting space. They're giving us, obviously, a good rent. But now with this coronavirus, I guess that's put on hold for a little bit, too.

Just a little bit.

It's a little bit that'll happen next year. Probably pushed it back by a couple of months, so we'll see.

That's really good. Well, thank you so much for coming on. This was really helpful. I think my biggest takeaway is, you know, adapt, adapt, evolve, pivot. Don't fight, change. Roll with it. Ride the wave. That's what came out through the entire conversation. And, you know, I think that's very helpful for the listeners because we see things that come up as challenges are like, oh, my God, what's going on? But from what you're describing, there will always be those things. And the people who would be really successful are the people who are constantly changing, open to it, not fighting it, just going with the punches. So this is really good.

But isn't that what you say in all your podcasts and all your meetings and entre md? It's the same words.

It's the same thing.

It's the same thing.

Change. You're not a tree. Move.

Yeah. Correct.

I love it. Well, thank you so much for coming on. This was a fantastic episode, and I'm looking forward to many more episodes that we'll do together.

Okay. I'll be here for you.

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