Dr. Vince | Top Doc | Dr. Michael Gambacorta

Okay, I'd like to welcome everyone to the show. We got Dr. Michael Gambacorta from Myrtle Beach, beautiful Myrtle Beach. Thank you so much for joining the show. Looks like he's coming from the trunk of his Escalade. That's the first ever I've had that one. That's awesome.

We can do this anywhere, anytime, man.

Yeah, 100%. That's awesome. That's awesome. Well, thanks so much for joining us. I really appreciate it.

Awesome. I'm glad I could be here.

So tell me how— just a little bit of background. How long you been in practice?

Yeah, sure. I've been practicing in North and South Carolina for about 15 years. Are you there now?

Yes. Okay, good.

If I click out, just let me know. I'm sorry if I lost you for a sec.

No worries.

The practice I started in 2004 was outside Raleigh, North Carolina. We did a family practice, you know, back in the early 2000s, that was the thing. We wanted to get volume and grow a practice that was banging fast and moving great. We did that for a while. The model worked great for us. I know we got pretty popular at that time. I think we were seeing nearly 1,000 a week.

Wow.

So, those big volume practices. I came to a couple crossroads in my career then. Where I had a hard time finding good associates to help me out, um, to hold up the volume at least, because volume's a tough game. It's not fun to do for a lot of people, um, and it may not be really successful because of that. Now, I was able to do it and it worked great for me, and I found it to be very successful, but it wasn't a good structure, uh, to teach or to expect others to do. I think that was the issue.

Right.

Uh, so I had about 13 associates over 15 years. I used to hire them full-time and train them, and we opened a few offices with them and moved from there. So, I opened another office out in that area as well, and now I'm in Myrtle Beach with our 3rd clinic where we have done a little bit different model.

Sure, sure. It's interesting because I feel like when we go through school and every— the whole push is volume, right? And so, that's just not always the best thing for everybody, at least in my experience.

For sure. I mean, it's, uh, I think that's what it was. And maybe when we were in school, a little bit different. At the time, you know, there was the Body by God crew, there was the big waiting list practice crew. There was a lot of coaching and marketing directed towards volume. And volume's a great strategy, it really is. But it's kind of a young man's game. I hate to say it that way. And it's kind of a game where, I mean, you're serving the masses, we're servants to the world. My mentors were Reggie Gold and Sid Williams. So I mean, what do you do? You come out and be a volume guy with that. We're full-size charge chiropractors, you know, and that's kind of how it went. There was nothing wrong with it. I love it. I still use similar models and I'm able to do it, which is important, but it's not for everybody. It's definitely not for everybody.

Yeah, and I think, you know, from the philosophy standpoint, it's awesome, right? We want to serve as many people as possible. I think just from a business standpoint, not all doctors are really geared towards it either from a skills perspective or from a mindset perspective.

Oh, for sure. I mean, a lot of doctors have their techniques that work great and they take a lot more time. There's just no way around it. When we start implementing rehabilitation to the office, immediately we're doing 30-minute, 40-minute, hour-long visits. Yes, I'm not doing all the work, but I'm involved.

Sure, 100%.

Yeah, so if you want rehab or structural correction, often that takes a little bit longer. Some systems in offices are designed to have staff do all the work. I understand that, and I've done that myself, but you still have to spend more time with certain patients.

Right, right. So let's talk a little bit about regenerative medicine. You know, got you interested initially?

Well, I mean, this goes all the way back to the beginning of our first practice. I mean, 2004 we opened chiropractic practice. In 2005, we got pregnant with our first child, and that was the year we decided to bank our children's umbilical cord blood. That was what we did back then. We had some friends in the industry of blood banking and cord blood banking particularly. And we were at least aware of this, at least aware of this science at the time. Now, 15 years later, here we are, and we're actually using the cord blood in regenerative medicine procedures, which is kind of cool.

Yeah.

We've always been interested in it. We've always been in it. I mean, I've been paying a blood bank for 15 years to store my children's blood, so I've definitely got a invested interest in cord blood.

Sure, yeah.

That started me on the path. About a year ago, maybe a year and a half ago, we were interested in integrating that into our practice. So that's what brought us to today.

Got it. Now your wife's a chiropractor as well, is that correct?

Yep, that's correct.

Very cool, very cool. So how did you— did you work with the management company to start this, or did you just figure it out on your own, or what was your path to Integrating the office?

I guess years ago we had first integrated into physical therapy medical supervision. That was back in 2008. I think we did our first integration.

Wow.

Then when we opened up in Myrtle Beach, we— I wanted to open that clinic and just be for me. I wanted to just be chiropractic clinic with some rehab, and I worked, you know, part-time in that office as I was managing the other clinics as well. So I kind of ran all the offices, so I couldn't dedicate a full-time job here. So for that reason, I didn't want to integrate at that time. I created a little different model for my chiropractic practice here in Myrtle Beach. It's more of a concierge practice, a little bit of a different model, not a volume-based model. It was a service-based.

Got it.

So it worked better for my lifestyle and for Yeah. And we integrated here with our medical staff. Basically, we just did it one step at a time. I know I don't use a consultant to answer that question. No, I didn't. Not at this time. In 2008, I've worked with a number of consultants from 2004, '05, '06, '07, '08, a number of different companies, different groups. But I, of course, none at the time did regenerative medicine. That's That wasn't there.

Right, right, right.

So the principles of integration were similar or the same. You know, I have my own attorneys, my own staff, my own— I guess you call them consultants, but not chiropractic consultants.

Yeah, sure.

So I just— we just went ahead and did it, and we added the products. I collaborate with a number of regenerative medicine physicians across the East Coast that I know personally, and I visited clinics, I visited biotech companies, Just go and meet the people who run the show and find out why the product is the best or why they want me to use it and try to identify, you know, right from wrong from there. What's working for others sometimes is a good way to start.

Right.

You know, if I can find products that work great for patients and whether they're using them in the NFL or the NBA or they're using them in very successful clinics and the protocols that come with a lot of the The products, I take the manufacturing research labs protocols and we tweak those with clinical protocols that we've either created or revised or learned from others. So that's been the strategy.

Awesome. That's so awesome. So you, um, sounds like you really put in some legwork visiting the labs, uh, meeting the people and really getting a real, you know, obviously a firsthand understanding of the protocols and the products and then Started bringing them in and figuring out, okay, what's going to work for me? And then it sounds like anytime in practice, right, we're always going to put our own little maybe spin on it as we get clinical results back and we adjust accordingly. Does that kind of sound like what your experience was?

Yeah, I mean, we actually test the products on ourselves first, to be honest with you.

Oh really? Very good.

Without a doubt.

Very nice.

We got the One of the first companies that we worked with, I mean, my wife was the brave one first, I promise you that. She's the one that had an ankle injury that was a 3-year repeated injury. Every summer for 3 years—

Oh, wow.

She was in a boot, a walking boot or a cast for 3 years, basically 3 summers. And basically she said, I have had enough of this, I'm ready to try something else, what do I need to do? She was willing to do anything at that point. So we started using a couple of products, injectables in her ankle, and she got some results. Obviously she had done the steroids, she had done the typical medical route. We've been through that. And now she tried one of our products that we use and she endorsed it and was like, all right, this is the best I've felt in a long time.

Wow.

And since last year, November, or it was 2017, November or so, something like that, that's when she, Stopped complaining altogether. I marked it down on my calendar. I was like, I haven't heard at all from her about this, and she seems to be doing better. I know she says she's better, but is this better? I don't know, you know. So we've taken a few trips now, and she's been able to keep up with me, and it's not been an issue. So that's pretty awesome. Uh, we've injected it again this year, and she said it was even better this time.

Wow.

I, I did a few of the products myself. I've had some old sports injuries and chiropractic shoulder problems that we get. Nothing to stop me from practice, but nothing that I want to stop me from practicing.

So could you just go through some of the basics for some of the new doctors out there? So obviously in a regenerative medicine clinic, we may have PRP, which obviously isn't stem cell, but it still could be kind of under that, maybe that umbrella. But I, and I think, you know, docs are pretty familiar with that, but maybe just talk about, you know, adipose, cord blood, like the kind of different options in that regard.

Yeah, sure. There's a, when you talk about stem cells and regenerative medicine, there's, there's 2 different topics. Regenerative medicine is, is kind of a field, it's really broad, kind of just describing anything out there that could help you heal. Let's put it that way. That's that's it. That's a very broad scope. Stem cells, what you're asking is is what type of stem cells are there and what are people using for this? Now, when you look at autologous harvesting, which is the harvesting your adipose, your fat tissue, or your blood, your plasma. He mentioned something called PRP. That's platelet rich plasma. That's the the way you you draw the blood out and you spin it down and you take. What are considered stem cells from the plasma, but that's typically not really good stem cells. Those are those are maybe a really good anti-inflammatory if you reinject it into a joint. But I I hesitate to call that at all stem cell therapy. Unfortunately, I think a lot of people in the market are calling it that, but it's it's really not. It is a form of regenerative medicine. There's no question there. It's going to help people heal. But I do find the limits to that with. The age of the patient. Sometimes when I think a patient is under thirty years old, that can be a very viable option. You can definitely use PRP. When you get a little bit older, all of a sudden their platelets and the anti-inflammatory response that occurs is just diminished. And I can't tell you how many patients I see that have said they tried the PRP and didn't work. And that's the last thing any doctor wants. Now I know every doctor out there tries to help. Their patients that they're not doing anything wrong. They're doing it with the intention to help them. But I think when the age gets too far, it's just less effective. That's typically what happens with PRP. Adipose spin-down, that's when you draw from abdominal fat or fat on the body. Again, depends on the patient. If the patient doesn't have a whole lot, it could be pretty limited to what you can get from it. That's another issue. Other than that, it's not— it is stem cells and Potentially stem cells, somatic stem cells. The age is also variable. I mean, when you get older, it's not super effective, and that's something that that we lose effectiveness. The research in umbilical cord tissue, placental tissue, and umbilical cord blood is coming out fast and furious right now, and people are using this quite a bit. I know they they're using it maybe inappropriately in some places, or maybe they're claiming things. That they shouldn't be. And that's, I think, what the FDA is interested in learning more about, is what is going on with this. So we're fairly very particular about how we describe what we're using.

Sure.

When you're talking about the cord tissue, uh, the umbilical cord blood or the placental tissue or the growth factors from that tissue, those are regenerative medicine products that are on the market, and you have to ask those manufacturers What is your product specifically? Is it a live tissue product? Is it a tissue product, or is it an exosome or a secretome, a secretion from the product? Sometimes they're claiming stem cell therapy is being done, but they're actually using a secretion from the stem cells.

Hmm.

And that's— it's very, very effective from what we've used. It's very effective, but it's not a stem cell. It's the stem cell secretion. So you're getting cytokines, hyaluronic acid may be added to it, the growth factors, the proteins, the structural matrix might be there. All that's there, but it might not have the stem cell itself in the product. So you gotta kind of vet biotechs and find out what they are talking about.

Got it.

One of the things I like to ask them is, do they do a flow cytometry or cytology? Are they looking at the types of cells that are in their product? I know we can argue about this forever and ever. It may not be accurate, they may not have the right equipment, they may not have the right information, but are they even doing it? Let's start with that. Some of these people don't even do it. So if they're not even doing it, I promise you it's not gonna be the right material. They're guessing is what you're getting.

So how— I mean, obviously there's probably labs popping up on a regular basis because this market is 105 groups are out there, yeah. Wow. So, are you seeing that there is some quote unquote shadiness to some of these, or do you feel like by and large they're all really FDA compliant and they're kind of doing everything by the book, or what's been your experience?

Yeah, I mean, I don't think there's any shadiness. I think that's a stretch. I think there's some groups out there that would like to say that. And I don't particularly like to hear that. If you think about a company, business that's spending millions of dollars in research, maybe, maybe tens of millions, maybe hundreds of millions in research, they're not shady. That's not, that's not the point of the business. They're, they're designed to get a product to market. And if they can do that and it helps people, they're happy. Now the FDA is a different story. They have regulations and their regulations are changing and updating every year, every, as we know.

Yeah.

Keep up with that, that's up to them. And I don't know if they can keep up with that. That's going to be, that's going to be where the, you know, the rubber meets the road here. I don't know who's going through this FDA approval.

Yeah.

A number of these companies have FDA numbers, which means they, they are, they have been inspected and audited and they pass. A lot of them don't. So if that's the case, ask them, what's your FDA numbers? You know, what's the process like? You know, how, how are you getting— how are you getting the product? How are you harvesting it? How are you growing it or handling it? And how are you storing it? How are you shipping it? There's so many places where they could go wrong that unfortunately, you know, I think if they're not really clear on that, you should go to another lab.

Yeah, the reason why I asked it like that is because I do feel like there's some people on the other side that are trying to maybe discredit certain aspects of this, and it may not really be that fair, frankly.

Oh, for sure. If you read a lot of the literature that's being put out by a number of organizations in some medical field— now mind you, some of the medical field is really advocating for this, but there are certain groups that are really, really against umbilical cord tissue or umbilical cord blood. That's a tough one, man.

I mean, they're— Why are some clinics going to Mexico and Panama City and that type of thing?

You mean patients are going there? You mean why are patients going there?

Well, what— no, why— yeah, why are the clinics setting up shop down south?

Okay, I think, uh, I think a lot of that has to do with the stringent FDA regulation on how to get Now, I like the FDA. I think that we're very lucky. Ethically, they keep the product being harvested properly. There's a red tape. It's expensive. It puts a barrier to get in the game for these big companies.

You got to have someone watching.

Correct. If that's all we got, then I'm happy we have them. You know what? What if something were not good? But if you're going to Mexico and you're getting stem cell therapy, but they're pulling out embryonic stem cells from blastocysts and they're injecting them in people. If you know anything about that, that could be pretty bad. You know, number one, that's the that's the the cells that create babies, right?

Right.

That's that's like they're creating sperm and egg in a lab, then they're making. Cell masses, and then they're just disseminating it and putting in product. Number one, that's really bad ethically, but number two, all the research out there points to the fact that if you use embryonic stem cells, you're likely to grow a tumor.

Really?

Embryonic stem cells typically, well, they want to grow and become a baby. So when you put them in somebody, they become a teratoma almost every time. They become some sort of weird— tooth or hair tumor or mass. So if you use that, I don't know what they're doing in Mexico, do you? I have no idea. I can't guarantee the product. I couldn't tell you what they're doing. Now also, we know that another thing in this country, about 82, maybe 83% of all the products that are harvested from our hospital systems are rejected by the labs. They're rejected because they fail the test. They don't pass testing. Bacteria, viruses, improper harvesting, dead tissue, poor shipping, whatever. They don't— they make it to the lab, the lab rejects it.

Hmm.

So do they do that in Mexico?

I don't know. I would be concerned. I— if, you know, people are going down there strictly because they're getting some type of price break, there may be a reason for that.

Nowadays you can get stem cells for $2,000. Here in the US. I mean, you can get it cheap if that's the issue. It's not— maybe not the premium product, but you're gonna get a safe product.

Right, right, right, right.

So you have to— you have to spend $2,000 just to fly there and stay in a hotel and get the treatment and come home.

Yeah, I mean, crazy.

Now it's affordable, you know, now we've got something that's actually doable.

So what are the primary products you're using in your clinic typically? Now you're doing just joint, is that correct?

Yeah, pretty much. Yep.

So what are the primary products that you're using?

Well, let's start with this. When you take a look at products, one of the terms that you'll read about is called homologous usage. Most physicians that I've spoken to of any profession, they're not really familiar with that term. In fact, I had a conversation with an orthopedic surgeon last week and he said, don't you mean autologous usage? Didn't understand what that was regarding stem cells. And I said, no, I mean, the ruling on the FDA paperwork is very, very clear when it comes to the usage of these products. And they keep saying the terms homologous usage. Now that means using a product— if you use a product, you have to use it in the manner that it was initially intended to do, if that makes sense. And I'll clarify that. It means if you're using a blood product Cord blood, right? It's full of hematopoietic stem cells, blood stem cells. And in fact, cord blood has less than 1% mesenchymal stem cells, but it has a myriad of stem cells in it. We just don't know how many or what. It's a plethora of different types. But cord blood, if you use blood in a person, you should use it in their blood, not in their joint. Because if it was intended to use for metabolic purposes, it was intended to carry proteins and nutrients and Bring, bring those healing factors through the blood. It's a blood product.

Right, right.

That has to be injected into a blood area like a muscle or inside a vein. That's homologous use. That means that the purpose, the purpose of the initial product is still doing what it's supposed to do in the patient. If you take a blood product and inject it into a joint, that's, that's not homologous. That doesn't make a lot of sense. You're gonna put a bunch of hematopoietic stem cells, stem cells that's supposed to make blood cells, in someone's knee. That's really not where blood cells are normally made, you know, naturally. So homologous use would be not done with that situation.

Got it.

You want to use something that's based in a cord tissue or placental tissue that has the Wharton's jelly, the structural mass of the cord, and Actual tissue that was designed for structural integrity of the cord and of the placenta. That tissue is producing a greater cache of mesenchymal stem cells, the MSC stem cells that we want. That product is what we use inside a joint. So it doesn't matter the manufacturers, if you know what you're looking for and the product they need to make, that's what they need to get. So it's got to be a Structural proteins, scaffolded protein, scaffolded product with structural integrity in the product in order to work the joint.

Interesting.

That's collagen use.

Got it, got it. That's one of the first times I've heard that really explained where it made a lot of sense, you know, and—

I'm not the FDA, but I hope it helped. That's how I interpreted all the— even this year's research. That's what I'm reading. That's all I'm getting from it.

Absolutely. And so I'm just gonna throw this out there, neither of us are lawyers or offering any type of legal or medical advice on this show. So yeah, let's put that out there. So in terms of results, clinical outcomes, what type of— what are you seeing?

Well, I'll give you an example of this week. On March 2nd, this is the maybe one of the first cases that I've seen this extreme. This 73-year-old female had a rheumatic wrist. I mean, rheumatoid arthritis has been there for a long, long time. Yeah, the marbles on her wrist were so large; they looked like big gumballs. My medical staff and I, we assessed her, and we kind of gave her the. Prognosis of, I don't know if it'll help you. It was one of those—

Either way.

It could go either way. And I said, it may not help at all, or it may help you some. Within 2 weeks— this was just like last week I talked to her about— 2 weeks after the March 2nd appointment, she put her hand up like this, and there was zero, not one bump on her wrist. And she said to me— she held her wrist up like this— and she said, I haven't seen my wrist look like that ever. I'm looking at her going, I really need to take pictures of this because I'm not sure I believe what I'm seeing here. Now, my anesthesiologist actually injected the nodules directly in this situation, and we used a mesenchymal product, a structural protein inside the wrist joint, inside a rheumatic wrist. I'm blown away by what happened. That was, that was just fantastic. Now, I don't see that many extreme rheumatic cases, but that was an extreme one. And if the fact that it did anything in 2 weeks' time or less, I was like blown away.

Yeah, yeah, that's, that is wild. Um, is everybody using, um, like kind of going that high level using anesthesiologists, uh, in terms of performing the procedures?

Great question. It sounds like you know what you're doing over there. You're asking some good questions.

I'm just trying to learn from you, Doc.

I think one of the value-add bonuses that I like to do with my practice, I think that when people get treated in my practice, I treat them myself in my chiropractic practice because I I feel like I'm the best equipped for it. You know, as I said before, I've been through tons of different people. They're not bad doctors, they just weren't able to do what I was hoping for. Their level of care I was providing was different.

Hmm.

Now, when we hire nurses or PAs or nurse practitioners or physician's assistants to do work, we do work with them and they will do work for us, and if we hire them, they'll do mid-level work as they Unfortunately, they're called mid-levels. Now they do a lot of entry-level work. They may do consultations, they may help with exams, they may help with the administration of other medical services. But when it comes to regenerative medicine and we're injecting specific areas of the spine or of the articular skeleton, I prefer personally in my office and myself to have someone who's the best at the needlework and who's done tens of thousands of injections.

Yeah.

So I interview physicians. I have some criteria. I look for those that have 25 years of experience or more.

Wow.

And that have at least a board certification or more. So my physician's double board certified. He claims to have stuck more people with needles than anyone in the country. And I almost believe him. I know he, I know he exaggerates. I do believe you, but I don't know if it's true. But anyway, I've seen it work and he's fantastic. That's like chiropractic though. In our profession, we have a bad joke. We say, there are some chiropractors out there that can adjust, and then there are those who can adjust well.

That's pretty much what it is.

I've seen a lot of physicians that get around a needle and they have no idea how to position it or where to go. And when they look to me for advice on how to inject somebody, we're not gonna have a good relationship. It's not that I'm really bad at it, it's just that that is not my job, all right? I have more experience adjusting patients than most people, let's give it that way, and probably more than most chiropractors. It doesn't mean that I'm the best at it, but it means I have the experience in it. It means I know when, and I know more importantly when not to. And that's the physician I need who's like, listen, this does not get injected, or I'm good with that, I've done 10,000 of these. Okay, that's what I want. And in our office, I use currently a double board certified medical anesthesiologist who has, of course, I do my due diligence on backgrounds. I mean, if he's gonna represent my clinic, he's gotta be as clean as me, you know, on every aspect.

Sure.

There are a lot of doctors out there who are looking for work, That's not who I'm looking for.

Got it. Now I'm assuming that you're— not to be kind of blunt about this, but the prices reflect that, right? It's a concierge clinic, you're offering a very high level of care, so—

Reasonable. Yeah, I still try to keep it very reasonable. I mean, price is price. Everybody's got a different impression. You're on the West Coast, I'm on the East Coast. There might be— how much does a house cost in your neighborhood?

$800,000?

Yeah, I mean, if you spend that, you're living on the ocean in Myrtle Beach.

I maybe should get out there.

Yeah, I mean, if you do that, you can have, you can have any house you want in this county, pretty much. There's a, there's a, there's a handful of very, very expensive homes, but for the most part, that's top end. Yeah, spend $250,000 on a house, you have a beautiful family home here in Myrtle Beach.

I'm getting jealous, my friend.

Regarding price, I'm not gonna avoid that.

Oh, I lost you for a second. Okay guys, hang on just for one second. We just lost Dr. Gambacorta for just one moment. I'm Sure. I'm sure he'll be back shortly. All right, so we lost, lost, we lost Dr. Michael. I just texted him to see if we can pull him back in. Technology, what are you going to do? So far though, obviously super powerful. Dr. Michael has one of the better clinics in that area, probably on the East Coast, to be honest with you. Super high level. And, you know, he's done his due diligence. Obviously having double board certified anesthesiologists doing the actual procedures versus a nurse or a PA, etc. There's just going to be a difference in that quality. There's no doubt about it. Not to say that a nurse, you know, can't do a good job, but As with anything, like Dr. Michael was saying, that there is different skill levels associated with it. So we'll just hang tight to see if we don't— can't get him back on. I just had a couple more questions and then was going to let him go. Hey, you're back. Wait, hold on a second. Let me, uh, let's see. Can you hear me okay? Because I can't hear you.

Can you hear me now?

Yep, there you are, perfect.

I don't know, I lost you altogether.

Hey, technology, what are you gonna do?

Dude, that's crazy. All right, well anyway, I was gonna tell you about the price real quick. We'll get right at it.

Yeah, for sure.

Yeah, the, uh, when you look at— you can hear me okay, right? Sorry, there you go.

Yeah, yeah.

When you talk about pricing of the products, I mean, typically the products are gonna cost Very fairly expensive for us, for a provider to purchase.

Yeah.

If you buy one, one product is usually sold in either the milliliter or the 2 milliliter fashion. They're very expensive if you're buying them one at a time. They're thousands of dollars, sometimes $1,000 or $2,000 for one injection just to buy the product. You have to, you have to buy more than one in order to get a better price.

You get a bulk discount.

Well, in a way, a lot of the companies can negotiate if you're gonna spend a lot of money with them. So each office typically contracts with one or maybe 2 companies because they're gonna do most of their purchasing that way. Now, if you're in a position where you can collaborate with other offices in your region, we— like I've done— we will bulk purchase together. And that makes it really good because we can bring the price way down. So we can pass the price savings to our patients and then outcompete anybody in the area. So that's kind of what— now, I'm not racing to the bottom by any means. Don't, don't think that. But unfortunately, there's less than 1% of the market that can spend $10,000 on an injection. And I know we talked about this the other day briefly. I said, you know, you're, you're going to burn out your market of those people. They're not going to be there. But how many people can spend $4,000 to $5,000? You know, when I make it priced less than your air conditioner, you're— every homeowner, when they get— if you're in Myrtle Beach and you get hit in July with a broken air conditioner and you have to spend $7,000 to put one in your house, what are you gonna do?

You're gonna do it.

You have no choice, right? You'll find a way to make it happen. And that price point, that price point seems to work in most of the country because there's, there's a home expense that's under $5,000 or $6,000 that I think we're gonna have to deal with, or a car repair or something that's gonna be significant amount of money. But not out of reach. If it's within 3 months of you getting it, you can figure it out.

Yeah, yeah.

And we found that was very important to find a price point. The only way we can get to that price point though is to really bulk purchase. So we negotiate with our biotechs where we can get a what's called Tier 1, Tier 2, or Tier 3 pricing. So you can purchase at a Tier 3 pricing But just remember, we as a provider, we're now spending somewhere around thirty, maybe fifty thousand dollars a month on products. So you're you're you're invested. You're definitely not getting a break. You're spending a lot of money to get this program running every month. But yeah, you're buying that much product. You then have something to to do with it. You've got to store it. Yeah, if it's very sensitive. material, it has to be shipped properly and stored properly.

And you mean that's not just going in the back office? No.

Yeah, storage is— all right, so that's the other part. That's the other part of story. You need to have a cryogenic freezer, proper maintenance and management, liquid nitrogen delivered every week. This isn't something that you just do on a whim and say, hey, I want to do stem cells in my office. And it's funny because a lot of these— you see a lot of like internet ads going around like Hey, did you want to do stem cells in your office? And everyone's like putting their hand up like, yeah, me, I want to do it. All right, if you do it, you are invested. All right, if you just want to play around with it, okay, go practice some in someone's office. Go learn from someone first and learn how to do it properly. You can do it very badly, but if you do that, unfortunately, it's probably going to ruin it for everybody. This is a system where I don't want to see A whole bunch of chiropractors jumping in on it when only maybe 2 or 3% of them should be.

Right, right.

There's physician relationships that need to be established. There's legal structures that need to be arranged, and every state is different. There's product handling and knowledge needs to be done. You need to go figure that out yourself. The screening process isn't just like your chiropractic exam. You need to have electrodiagnostic certifications and training. I mean, I've trained with some of the greatest medical neurologists I know. I went to Tufts University, did some postdoc training there. I got certified in electrodiagnostics where I learned about EMGs, NCVs, and ultrasounds. I learned how to read them, how to do them, what to do with them, and I performed 30 or 40 of them in my certifications before they send me home with it. You know, they don't just say, hey, here you go, go do your thing, here's a book. There's a lot there, you know. You've got to actually learn. If you learn what you're looking for and you know how to do it, then you can properly execute the process. You know, there's a lot of work. Just because you're a chiropractor doesn't mean you can't— you have to stop learning. You've got to go learn. You got to go pay money and find someone who knows how to do it and get a certificate for the wall and learn how to do it.

Yeah.

Everyone knows in this world, especially in the world today, you don't even need a college degree to be valuable. Everybody knows that. The people out there that are very, very valuable, movers and shakers right now, they're most often undegreed. They're just very good at what they do.

Yeah.

And that's something that, that it goes for a lot of what we're doing. We're learning from the best and we're becoming the best.

So I know you can't put a dollar figure in terms of what someone would need to invest to kind of get up and running, but how about a timeframe? Like, if they were gonna say, hey, I am very interested in this, I feel like I have the resources from a financial standpoint, what type of timeframe do you think from beginning the research to offering that service?

Yeah, I mean, actually, I put together proposals for that exact question. We have a very small consulting company that we've made The only reason I say it's small is because I only take a couple people on at all to consult with this. I don't have time for it, but it is $40,000 to start a program like this. I have it itemized out straight up, every single penny, where you're going to go and how much ad spend and what you need and how much for the legal and how much for the doctor and how to do it. And in 90 days you should be operational.

Wow.

Say 30 days, you could be actually seeing patients if you have the right relationship equity established. It all depends on your medical relationships in your community. Some people already have them established. I mean, I've got some close colleagues and friends of ours that are— they've married to it, they're married into it. You know, they have their brother-in-law as a physician in town who does orthopedics and is interested, and sure enough, they work great together. It was 30 days, they're running. It's simple.

Yeah.

But it's about $40,000. Minimum to invest. I mean, that is like, that is like minimum. That's, that's if you have a very functional, highly operational chiropractic clinic established. You— that's not counting running a very good chiropractic office first.

Yeah. If someone were to learn— if someone were to find out more information about that, Doc, how would they be able to do that? Or do you want it—

Yeah, contact me personally.

Okay, okay.

You can contact my website at MB, Myrtle Beach, mbstemcell.com.

Got it, okay, good. And then now marketing-wise, you're just, you're doing some basically workshops and that type of thing?

Well, in-office lecturing is obviously a great grassroots approach to teach. I've had a lot of my patients obviously become patients, that's what happens, they become medical Yeah. They're interested in the products. I do play educational videos on regenerative medicine. I have a few posters and banners around the office, nothing flashy, but just the general vibe of the clinic. When you run a pretty decent volume clinic and people are there and they're asking about it, you get— I mean, we've had probably 60% of our patients either A, refer in their husband or wife, or B, have them come back for a second injection or treatment. So we get a lot of immediate referral business and/or repeat business, which is kind of cool. It's just because the results were good.

Yeah, yeah, 100%. So, you know, obviously you're super accomplished, you know, with the chiropractic and on the stem cell. Just from a kind of a personal development or mindset perspective, like, How did you approach that? Because it doesn't— not everybody can run a million-dollar practice multiple times. Matter of fact, it's— if there's a hand— I mean, it's like 1% of 1%. So from your, like, how did you approach that? Um, or, or did it come natural to you, or did you, you know, really put in some, some due diligence on how you're going to build yourself, become more valuable so that you can go to that really, really high level?

Yeah, I mean, uh, I appreciate that question. I, I don't think anybody really— maybe very few people really appreciate what you just said. I, I don't know many people that have done that at all. Um, I, I found when I, when I built the first office and outgrew it, and I was in my second year of practice, and I hired my first associate simply because I had— I had— we were seeing $480 a week. I remember when I hired him, I was like, Man, you need to get on here. And if he took over 100 visits, I could see more new patients. That's all I was thinking. Was it— what was I thinking at the time? It's crazy. Like, what? Anyway, but that was, that was what it was like back then. I'm like, I need to see more patients. Like, that was the, that was the idea. Anyway, so when I got to that point and I built the second office, that was 2008. Um, we, we really like— we bought a building and we redesigned it and rebuilt it out and Just the brainchild that it was, you know, I was still seeing that volume and I was gonna double the clinic when I did that. And of course the market crashed right then. And I remember everybody told me, they said, oh, are you crazy? You just bought this big building, you built this Taj Mahal of chiropractic. They used to say it to me and say, and the market's crashed, what are you gonna do? And I was just like, I just, I grew through that whole phase. I had zero dropout, like patients disappeared, some lost their jobs or whatever, but I had no drop-ins. Everything was normal. I don't know if that was normal around the country, but it didn't change chiropractic. So maybe because we treat mostly working class, I have no idea. I really don't know why.

Yeah.

But I had that mindset at the time to just grow, grow, grow. Some personal issues are involved, of course. We get personal goals that need to get involved or else we lose our personal life. So keeping my marriage together, making sure my kids were raised properly, That all became a big conversation. You know, how do we how do we balance our lives? Is what you're asking. How do we get personal growth? Well, you know, there's no shortage of business consulting, chiropractic consulting, marriage counseling, churches, relationships, close friends, weekends away. Whatever whatever was available, I did. Sign me up. I'm in. I I I I got I got everything: the the marriage sherpas, the gurus, the life coach. Every— I can't name another profession out there that I haven't tried. I'm in, just sign me up, I'll take it. I love that stuff. So it helps me, and it helps most people to get to the next step. And what that is, is a way that either it solves problems for us, or it gives us something to do to get our mind off of what we were doing before so we can focus on something more important, which really is our legacy and our families. I think for the most part, that's what it is. That's what our true focus really is. And if we have legacy and family focus, we win. I mean, that's the goal. We know why we're doing what we're doing every day, and we're happy to do it. We're happy to go to work in the morning. We're thrilled to see that patient at 9:30. We're just so happy. We're like, you know, whatever, this guy's gonna do so much better now that he's treating with us.

Yeah.

And we're happy he's here, and we're happy that we're the guy doing it. So that's, I guess, a good mindset to have. You know, some people get burned out Before I got burned out, I repackaged the office and sold it. And that was, that was a huge step for me to learn how to do that, you know, to actually create a business from nothing in a city where you don't know anybody, in a town where I've never met a soul, and just literally darts on a map and show up and say, I own this town now and I'm the community guy and I'm here in every workshop every week and I'm involved in every civic cultural event. And sure enough, you sell it, and you sell a building, you sell the practice and the whole thing, and you walk away, and then you do it again. That's the thing. I think that's hard.

Yeah.

Because there was a point where, you know, there was points where I doubted. I didn't think I could ever sell it. Or, I mean, there was 7 years I managed the clinics from 2 states. I was working in 2 states. I drove 3 hours back and From Friday morning, I had a load of patients till Friday night, and I would come home Friday night and, you know, see my family at 1:00 in the morning and kiss them goodnight. I mean, but for 7 years I did that, you know. It was, uh, it was just the way it was.

Yeah, yeah.

I don't know if there's a— I don't know if there's a solution. I mean, it didn't come easy, that you're saying, but lots of sacrifice.

I think, you know, that the fact that you invested in yourself, you know, in terms of, you know, people that maybe they're farther ahead of you in specific areas of your life and that you were willing to take that on. That's for me, I mean, I know that I've had 5 coaches in my career and I've gotten a lot out of all of them. And I feel like there's a little bit of reticence in the, at least in the chiropractic profession, to Invest in yourself, um, because it's like if someone's 10 steps ahead of you, goodness gracious, it seems to make sense to try to shortcut the path as much as possible.

Yeah, absolutely. Just like in the regenerative medicine practice, the first thing I did was I called my colleague up, my close friend, and I went— I drove out 6 hours to his practice. I stayed with his family for the weekend. We went at 7 in the morning. It wasn't like he was showing me everything. We had a very mutual exchange. As I was helping him with his chiropractic practice, he was introducing me to his regenerative medicine practice. Oh, very cool. Yeah, we collaborated very well for a long weekend, and we spent, you know, 12-hour days in his clinic breaking it down— his nurse, his doctor, his products, his equipment. And then I took basically his year of experience and stood on his shoulders and went further. And now I do that with my clients and colleagues. I say, well, Come over, learn what I'm doing, and jump.

Yeah, yeah, very cool. So any last thoughts here for someone that's thinking about doing this?

Yeah, before you get into it, make sure that you do your due diligence. Go visit, go call, contact someone like me or someone in your area that, that is doing it. If they're willing to help you, then that's how this— this business is a collaboration. Regenerative medicine is a collaboration. It's a full integration and collaboration of medical science. We're dealing with the most successful chiropractic clinics have lots of patients, great charisma, very good marketing skills, very good advertising skills, very good real estate. Typically, they're very, very well positioned in the community. They have networks of social groups and civic groups all over the county. So when you take that, those skills— don't sell those short. Those are skills.

Mm-hmm.

Because I don't know any medical providers that have that. None of them have that. So, so when you look at that and you say, hey, these guys are, these guys are, uh, mixing kind of two worlds, you know, my medical physician is like, like I said, the best at what he does. But he spent 25 years looking through fluoroscopy and ultrasounds and needles and anesthesia. He's been dealing with some of the most difficult cases medically. And his expertise combined with mine, and we have ourselves a very, very nice company that people love and enjoy.

Yeah.

And we can serve the public in a good way. Now, if you don't do your due diligence and your medical provider is not that skilled, Or you're not the chiropractor who has all those things in place, not for you.

100%. Okay. Hey, Michael, I want to thank you so much for coming on. We'll be sharing this with, you know, on different platforms and whatnot. But, you know, you're a busy guy. It's coming up on 8 o'clock in the evening. And so, I just wanted to thank you for your time. I know it's valuable and I know you have a family that you want to get to, but thank you so much. I really, really appreciate it. You got it, buddy.

Thank you. I'll talk to you soon.

Okay, take care, and I'll be following up with you, okay?

Please do.

Take care.

Bye-bye.

Thanks, Doc.

Have a good one. Bye.