Breaking the Rules of Orthopedics: Dr. Marc Pietropaoli’s Blueprint for True Recovery

By the way, if you do that, you might as well have robots, which is coming.

Oh, it's coming.

Yeah. I mean, it's kind of, it's kind of already here, but yeah.

It's just a matter of time, right? I think it'll be like 5 years. They'll figure out a way to replace surgeons. I really do.

For a lot of the things, not everything, but a lot of the things. Yeah.

Well, I mean, think about it. What if they had the robot do the opening and the closing?

I mean, it can definitely do all the cuts. I mean, they do 'em anyway. They do 'em anyway. I mean, some of the robots are designed so that the surgeon has their hands on it just to kind of seem like the surgeon's doing something, but You really— there are robots that do all the cuts without any issues. Doing the opening and closing would be a little more difficult, but not impossible.

Yeah. Well, they'll figure it out. If they can build a pool table with AI, an AI robot, they're gonna figure out a way to sew somebody up. It's just a matter of time. Um, you didn't build your clinic to feel like an employee in your own business. I'm Matthew Cologli, and on Out of the System hosted by Dr. Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels, and builders who who are creating bold, profitable, patient-centered practices and doing it their way. We're sitting here with Dr. Mark Pietropoli, otherwise known as Dr. P. How you been, man?

I've been great.

Yeah? How's Tank?

Tank is—

Tank the dog.

Tank is great. He's been jumping in the lake and keeping cool because it's been warm.

Yeah? And how's the garden? Mark has the best garden ever.

I can send you a picture of it right now.

Yeah?

Yeah, it's great.

So Mark, Mark lives in Skinny Atlas and he's an orthopedic surgeon. We'll talk about his journey of getting out of insurance here in just a little bit. So he has this gorgeous piece of property. What is it, like 7 acres right on the—

8 acres.

8 acres overlooking Lake Skinny Atlas. And he's got the most amazing high-production home garden and he's got the best— you got the best gardener of all time. And that's your father-in-law, right? The Portuguese.

Yeah.

How's he doing?

He is amazing because he's 96, as you know. I just sent you that picture. He's 96, as you know. And like the day after his 96th birthday, he falls and breaks his hip taking a flag down in 70-mile-an-hour wind. And he has a hip replacement in March. And now it is, you know, July, and his garden looks better than mine.

So he's the guy that gets the hip replacement and keeps going.

Oh my God. Amazing.

You know what I mean? Don't you like when you fall and break your hip when you're that age? Isn't it like, okay, we start the timer for 18 months?

Yeah. And he's just keep going. Yeah, it's crazy. He's doing amazing. Yeah. Amazing.

I love the video that you posted, by the way. You gotta follow— what's your Instagram handle or what's your— what is the— do you know?

Is it— Well, yeah, it's @drmarchpetropalli. TikTok is probably better than Instagram, but— and then we have Victory in Motion 1, our YouTube channel, which is really— that is very good. Yeah. So you wanna learn some stuff.

Mark does some great videos. I love the video of like, you had your dad out there, you've got your white coat on, right? Don't you have your—

My father-in-law. Yeah.

Yeah. Your father. I'm sorry. Your father-in-law.

Yeah.

Yeah. He's out there and you like, I forget what it was, but you're talking about like stretching exercises before you work in the garden. So I don't get it.

And then he starts dancing.

And he starts dancing. And then he starts dancing.

He, he's just messing with me. Yeah.

And then I love the one where you had the dog ask the question, you were interviewing the dog about, about what it's been like since their owner.

Yeah. The little, uh, what kind of dog was that?

Since the owner, was it like, it was smaller than a Chihuahua?

I think it is a Chihuahua. Yeah. I think it was.

What's it been like since your own, since your owners had knee, knee, knee, uh, knee repair, not knee replacement?

Yeah.

Yeah. It was great.

Walked the dog and then the dog walked her outta there.

That's just great.

Yeah. That's Eloise, by the way.

That's Eloise.

For all of you who wanna know who that dog is.

Yeah. So you gotta follow Mark cuz he does some great stuff. But I think what's even better is you're insurance-free, right?

That's right.

As of when?

January 1st, 2025. How is it? Thanks to you. Thanks, man.

Well, you— thank you. I appreciate that. And you've also done the work and your team's done the work too.

So a lot of work. Yes. Yes.

How's it going, man? Like, we haven't talked, you know? Yeah, we haven't had a chance to talk in a while. I've just been going through it.

I mean, it's, it's a whole different thing, clearly not relying on insurance, which is great, you know, in by far most ways. Other ways, you know, it's, it's a learning experience for sure. But what's interesting is some things kind of never change. I mean, you said from kind of day one, your, your list, you know, your own list, market to your own list, that's going to always be your best referral source. And, you know, I mean, we've, we've done, we've done a lot of social media, we've done local advertising, radio, we've been on TV, we've tried webinars, we've done all kinds of things, all with some success. But still, the top 3 referral sources are preexisting, existing patients, existing patients referring somebody, and doctor referrals from doctors who know, like, and trust us for 27 years or whatever it's been.

Yeah. So tell everybody your background. You are Syracuse undergrad, Syracuse Med School, graduated top of class in Syracuse Med School.

Yeah, I got lucky.

Got lucky, my ass. You might be the most fricking driven guy around. Fellowed at— in Birmingham for Dr. Andrews.

Dr. Andrews. Yeah.

Yep. And safe to say you're a pretty talented orthopedic surgeon?

I had great training and I'm fortunate. I have— I, you know, I think I have pretty good hands. So, yes, I would say yes.

And how was the insurance business for you? How was that? What was that like? We taught— we met 3 and a half years ago, right? Is it like 3 and a half? Because it was probably right after Trevor.

We started pretty much working In September of 2021 is when we started working together.

Okay.

But we met before that, probably maybe a month or two before that. Yeah. So, you know, what would that be? 3, 4 years ago?

4 years ago. Yeah.

4 years ago.

Isn't that crazy?

Yeah. God. So we started working together in September of 2021.

Yeah.

And well worth it, by the way.

Thank you. Thank you. You know, you, in fact, you're going to be in my new book. So I'm writing a new book called Out of the System. So this interview will serve as part of that. It was the first time I ever realized how badly orthopedic surgeons were getting screwed. Because when you told me that you made $750 for an ACL reconstructive surgery, and that included 30 days of pre-op, 60 days of post-op, and you had to have your PA—

Oh, 90 days of post-op.

90 days of post-op.

Maybe a day, like the pre-op history and physical, but yeah, 90 for 90 full days. Yeah, $900, $700, you know, $1,500 if you're lucky.

And then you told me you got $1,100 for a joint, but you— and I was like, or, or orthopedic surgeon, because you do—

Well, just if you looked at— I just basically looked at what, what were we bringing in on average for each surgery. People think that you're bringing in— I just literally listened to actually Frank Schallenberger, uh, a podcast, and He's non-operative and he's big on ozone, which is amazing, by the way. Yeah, Frank's great. Amazing. But he was saying, oh, you know, the system is geared toward surgeons and wanting to do surgery because they probably get $10,000 for a surgery. I don't know exactly what they get, et cetera, et cetera.

I'll text Frank after this. I'll text him after this. I'll give him shit.

Yeah, well, what it ends up being was, you know, it was like $1,500. I was averaging $1,500 per surgery and that would cover, you know, That would cover my doing the surgery, that would cover 90 days of care afterwards, that would cover the PA and the nurses doing the pre-op, that would cover the billing people doing the billing, that would cover the front office people making the appointments, that would cover, you know, all the over— you know, the overhead. So $1,500 a surgery. Now you know why there's a lot of joint replacement surgeons who have their own surgery center and they do— they try to do 10, 15, 20 in a day, which is ridiculous.

That's nuts.

Yeah.

How long does a joint replacement take on average? I know it can vary.

Well, no, I mean, if you are running one of these, if you're in one of these factory orthopedic surgery practices where they're just doing joint replacements, the surgeon just comes in to basically put the— do the cuts and put the implant in. So do the bone cuts. So really the PA starts with the surgery and also closes them up. The surgeon might be in there, you know, Anywhere between 15 minutes to a half hour at the most. And they're going from room to room to room. So I've gotten, you know, they're— it's not necessarily their fault. They don't know any better. That's the system. And it is more of an assembly line. And you don't truly need the surgeon to do the closing or do some of these other things either. But it's not really great patient care, let's face it. Yeah.

Yeah, it's I'm not sure I want my healthcare. I'm not sure I want it to be treated like I'm building a Model T Ford. You know what I mean?

Pretty much what it is. You know what that is?

It's kind of— it's really sad to me.

By the way, if you do that, you might as well have robots, which is coming.

Oh, it's coming.

Yeah.

I mean, you'd want to tell them it's kind of already here, but yeah. Yeah. It's just a matter of time, right? I think it'll be like 5 years. They'll figure out a way to replace surgeons. I really do.

Like— For a lot of the things, not everything, but a lot of the things. Yeah.

Well, I mean, think about it. What if they had the robot do the opening and the closing?

I mean, it can definitely do all the cuts. I mean, they do them anyway. They do them anyway. I mean, some of the robots are designed so that the surgeon has their hands on it just to kind of make it seem like the surgeon's doing something. But you really— there are robots that do all the cuts without any issues. Doing the opening and closing would be a little more difficult, but not impossible.

Yeah, well, they'll figure it out. If they can build a pool table with AI, yeah, an AI robot, they're going to figure out a way to sew somebody up.

Right.

It's just a matter of time. What is— what's life like now for you? So when I heard you tell me, mate, what you got paid, like, it was one of those moments when I was like, oh my God, I think I have finally found the group of people that we can rescue. Right?

Like, right.

Because from a marketing parlance standpoint, you may or may not be problem aware, but you certainly didn't know that there was a solution aware. Right. So like in the marketing space, it's like problem aware, you know, all that.

Yeah. By the way, stuff I learned which I would have never known from you and all the other great people in our mastermind and just a lot of other people that you get exposed to because of that, because then it's like it keeps going and going and going.

Yeah. But the thing that was fascinating— well, not that— that just really pissed me off. Like, it really just irritated me that we took a class of people that, in my view, are the best and the brightest. I mean, think about what you sacrificed. So when you— by the time you went through med school, residency, fellowship, how old were you when you came back to upstate New York?

Let's see here.

Like mid-30s?

31 or 32.

Okay. And then how old were you when you started your practice?

31 or 32.

Oh, so you started right away?

Yeah.

You didn't, you didn't go work for someone else?

Well, I did. Good point. I was one of those 50% who did leave my practice within 2 years. So I did join a group in Auburn, New York. I was there for a couple of years. The customer service was terrible and I left.

Why did you want to have your own practice?

I didn't. I had no clue. You get— think about it. Zero. Absolutely none. Zero. Zilch. I don't— I probably still in medical school and residency and fellowship, zero business training, none. So I didn't want to. What happened was I wanted to leave the group I was in 'cause I couldn't stand where I was. They weren't— they, that they treated the patient like they were the enemy. And even back, and back then, so that's like 1998, 1999, 2000. And back then insurance sucked just like it still sucks, but it's way worse now.

It sucks worse now.

Yeah, it's worse now since Obamacare. Not to get political, but sorry, that's the truth. And so if you treated, patients really well, you still did pretty darn well, but you still were very busy, like seeing maybe 60 patients in a day. Like, it's crazy. Um, so I wanted to leave that group, and I had another friend who was in a big group in Syracuse, and he wanted to leave. And so he ended up getting out before me, and he didn't have any training, and he, he was out for a year ahead of me because I had to stay. I had a clause in my thing. I had to stay there. Worst year of my life. And so, so I had to stay there. And as we're talking—

And if there's any of the former partners listening to it, deal with it. Yeah, tough, tough shit. Deal with it.

And so he got an office in Syracuse. I was in Skinny Atlas. I was going to— we were going to have another office, 2 offices eventually. He's like, hey, I'm doing pretty well. I don't need another office. I don't want another office. He goes, why don't you just do it on your own? I'm like, oh crap. But that was good because he had done it on his own. And I'm like, all right, if he can do it, I can do it.

Mm-hmm.

Um, and that's— and, and I, then I just got some good consultants, you know, that's a piece of advice. Get good consultants like Matt if you wanna get out of insurance. But I got the insurance consultants. Yep. Karen's Upgoing Associates and some other consultants. Um, and I started planning, uh, pretty quickly. I went— I, I knew I was gonna get electronic medical records, which no other orthopedic surgeon had at the time.

Right.

So I like, I'm like, I'm gonna be the first one. And I started collecting all my patient data and billing data. So like during that year I was still in the other group, which was brilliant. I have to say, um, I don't have to do a ton of brilliant things, but that was brilliant.

Yeah.

And so then I was able to plug it in and start from scratch. But that was, you know, that was starting my own business and that was very, very difficult. It's, I'm going through the same things now. It's, it's starting another business, but it's different, you know? And I have a lot more, at least a lot more experience and a lot less fear than I had back then because I didn't know what I was doing, you know, back then. But we built it up. And I mean, I got to the point, as you know, I mean, I had almost 50 employees. I had physical therapy, MRI, X-ray, ultrasound, physical therapy, strength and conditioning, injury prevention.

Oh, man, you got everything at your place.

Yeah. I didn't have a surgery center, but pretty much everything other than that. And we were getting close to 50 employees. 2011, 2012, doing very, very, very, very well. That's why I was able to luckily afford my house where I live. And then, you know, it started to go downhill. And so by 2019, I was looking at the numbers and seeing, you know, $1,500 for a surgery, $155 average for an office visit.

You know, what did you use to make—

sorry, $20 to $50 for an x-ray or something.

What did you just make on a surgery? Like 2011, do you remember?

Probably. I mean, probably when I was starting out, it might've been close to double that, but it was never great.

Great.

But it was, it definitely had gone down.

Well, and then your costs go up.

But that's the other thing, right? Your costs definitely didn't go up.

No, it's never gone up.

It didn't go up and it went down. So it wasn't, it wasn't great. It did go down some, but the costs went way up. So then, you know, Then you have to see more patients. You have to do more, uh, ancillary. Which then you have to hire more people. Yeah. And ancillaries, you have to do PT and you have to do MRI and X-ray and all these other things that we did. And then your revenue goes up, but your costs go up right parallel with it, whether they stay below it, hopefully, or sometimes they, they're on the other side. And then at the end of the year, you have a loss and your accountants are like, oh, it's great. You had a loss. And I'm like, why is that great?

Why is that a great loss? I, I don't understand that.

And, and, and they're like, well, you don't have to pay any taxes, but It's never good to have a loss. Just anybody out there running a business, I don't think— I think it's just stupid. It's stupid accounting advice. Kind of like there's a lot of stupid medical advice out there.

Well, the whole way you, you keep score in business is how much money you made.

Profit, right?

Right. Profit is— profit's determining whether or not we did a good job or not.

Yeah. And Matt taught me to go into profit first, which is a different accounting method for all of you out there listening. Very, very helpful.

Yeah, it's— it— so kudos to you, by the way, because you will, um, you'll be the first story that I tell in the book. It'll, it'll be that story. You don't worry, you'll get to see it before I send it out to make sure.

I'm writing a book as well. Yeah, what are you writing? So, um, we don't know— I don't know exactly what the title is, but it has to do with knee repair, not knee replacement. So very much story-based, which is the way to go. And so working on that currently.

Are you writing it yourself? You using AI? What are you doing?

I'm using a, uh, publisher Uh, so I, most of it was basically, I did the, I did the longest webinar you could ever imagine, which started with my—

Oh, I can imagine.

Which started with my origin story and, uh, all kinds of stories. But like I said, I was—

How long was it? How long was the webinar?

It was like 3 and a half hours total.

Jesus Christ.

With questions and everything, just to get everything down.

Yeah.

And then I, I, I did take this transcript of that. I put that into ChatGPT to clean it up. Then I got that to the publisher, and then they're like, okay, I like this story, I like that story, I like that. And then I got a professional storytelling gentleman named Michael Haig, and he has worked with Hollywood actors and things like that. So we've gone through each story and tuned it up. And so it's going to be pretty story-based, but I lost a little momentum. I had a lot of momentum going there, but, you know, business— different things happen in business. So you have to, you know— but I am writing one as well. Sorry, I interrupted you.

No, no, no, no, no.

This is— You're writing your book.

Well, no, look, the book to me is like one of the best things you can do, right? Like it's especially for the doctors. But yeah, but my point is you're gonna be like the initial story cuz that was the, that was the moment. That was the moment. So let's talk about this journey to get insurance free. What was that like?

Well, speaking of moments, like I saw you on a Boston BioLife webinar, speaking of webinars. And so, um, I, it was literally 11, 11:30 at night or something. I don't know. It came across an email or something. I click on it. And it's, it's like maybe, maybe it was a short video to start with to kind of draw me in, which it did. And you basically spoke to everything that most of us doctors know, like you're burned out, you're seeing tons of patients. The only way to bring in more revenue is to see more patients, spend less time with them. There's constant pressure on you, especially if you're an employed physician, to, you know, continue to see more and more and more. It's not satisfying. You don't get to really learn what's wrong with the patient. You literally sometimes you're You walk in the room and you already have an idea of what you're going to tell them, and you just tell them. You don't even ask them anything. It's terrible. And so you spoke to all that, and it happened to be that it was late at night and I'm reviewing charts and records. I mean, you see all those patients, 40, 50, 60 patients.

Never mind, you probably got up at 4 o'clock in the morning to do surgery that day.

Yeah, at least 5 AM. And then you get done with work. you go home, maybe spend a little time with your family, you eat, and then you go right back on your computer and you're catching up and you're also getting ready for the next day. And so I watched that. I signed up or watched the webinar and I said, yeah, I knew all these numbers and everything in 2019. I was like, that's when I made the decision. I'm like, I gotta go for, 'cause we were, I was doing PRP, platelet-rich plasma.

Yep.

Since 2008. I was doing stem cells since 2017. I was doing lasers since 2017. So I was doing a lot of, We were doing some weight loss, strength and conditioning, strength training. And so a lot of those— none of that was covered by insurance. So we could see what were we bringing in from non-insurance and what were we bringing in from insurance. And so that also, I already knew that. So when you started talking about you don't have to see more patients, you actually need to see less and you need to start charging what you're worth. And a lot of these things aren't covered anyway, so just get out. And so that's when I became interested. And then you send me your book, or Alejandro sent me the book. I read it 3 times. So your book did help quite a bit. Mm-hmm. Speaking of books. And then we met and I said, I, I'm going for this. 'Cause like, you know, 'cause what happened was 2019, I kind of made my mind up I was gonna do that. 2020, obviously COVID hits, all that stuff.

So, well, because you had to stop doing surgery.

Yeah. So then it kind of, but that also brought things together too, because when I had to stop doing surgery, I was doing PRP, I was doing bone marrow. I was doing the laser, I was doing the, the strength and conditioning, all these different things separately. And I always dreamed of like, hey, what if we put these all together? They would— it would be amazing. And so for the first time in 2020, when we had patients, I was still doing knee replacements at that time.

Mm-hmm.

And so I had patients who were like scheduled for a knee replacement or wanted to be scheduled and we couldn't do surgery. And they're like, when's this? When the OR is going to open up? When the OR is going to open up? My knee is killing me. I mean, he's killing me. I'm like, well, you, I said, I don't know when, but is there anything else we can do? And they tried all the standard crap, you know, cortisone, all those other things.

Cortisone, all that shit.

PT and gel injections and everything. And anti-inflammatories would rip their stomach up. So I said, well, I have all these things. Why don't we, why don't we put 'em together and try to get 'em approved through the insurance companies through emergency use? Because we got, we got telemedicine approved through emergency use.

Right.

And it was like, okay, maybe they're gonna wake up. So we went back and forth with the insurance companies like, we are gonna do PRP and we're gonna do bone marrow stem cells. We're gonna do all these things and prevent these people from needing a knee replacement. And they're like, okay, submit it and, and, you know, go ahead and do it. And then we'll, you know, we'll tell you if we're gonna pay. And we're like, no, like we wanna know ahead of time. They wanna know ahead of time if they're gonna put this money down that's not, you know, not covered. They're gonna wanna know ahead of time. And what happened was we went back and forth. So we finally, we just did the procedures on, on the people and they did amazing. We did the programs.

Mm-hmm.

And so it was like 3 or 4 people. They did amazing. And I remember going in the room because it went back and forth with the insurance company. It was maybe 6 months, 4 to 6 months after we performed the procedure. And I had to go in and tell them after the insurance company said no, no. But they were like, oh, I don't care. I'm doing great. And I never had to have my knee cut on and I stayed. I didn't have to come out of work and all this stuff. And then I had met you and you're like, what are you charging?

But you were charging, what, $700?

Well, for just for PRP. Yeah. Like, so I was, I was definitely underpricing and undervaluing what we were doing. But the point was, It, it worked. And so then I started working with you on really how to really truly run a non-insurance or a cash-based business. And there's a lot more to it than people think. But in the beginning, it's very simple technically. I mean, if anybody is listening, um, well, we hope they are listening. Oh yeah.

They're listening right now. That's the whole intent of doing these things, Mark, is I want somebody to listen. Sorry. Yeah, you're good.

For all you guys listening out there, um, you've tuned into a good one because I was fortunate that I watched that, that webinar. And like I said, it was the best decision I ever made other than like marrying my wife and having kids and all that.

I'm glad you— I'm glad you mentioned— I'm glad putting marrying your wife was in front of mine.

I see. But I seriously mean that it is the best business decision I've ever made by far. And so the point is, in the beginning, he's going to say, you know, Matt or anybody who does this type of stuff, there's not— I don't think there's anybody else, but they will tell you certain things. And it's the opposite. You thought the opposite for your whole life.

It is like it is the opposite. It's like George Costanza.

Just go with it. Whatever he tells you, it may be opposite of what you think, but it's actually— it's true and it works. And I've really learned that even with marketing and stuff, like it's usually the opposite of what you think that's actually true, that actually does work. And so in the beginning, he's going to teach you how to market to your own list and we can get into all that. But I mean, you basically said, hey, We're gonna do an email campaign. You don't have to stop taking insurance right now. You know, you can't do that right now. You can't take—

No.

32. I think I had 32 staff members. You're like, you can't just stop taking insurance with 32 staff members. You have to kind of, um, you have to kind of pave the way. Like, basically I had to start telling my staff, become more transparent, which I thought has really helped. Like, this is what we're getting for a knee replacement. Did you know that? And they would freak out. This is what we're getting for this. This is what we're getting for that. And they were getting really upset with the insurance companies, fairly so. And not that they loved them anyway, but even more so.

Does anybody love the insurance companies?

No. And so—

I'm pretty sure the CEO of the insurance company is hated by their mother.

You get the team on board and then you market to your own list and patients are coming to you anyway because of the insurance. And you just start offering these things and people will go for it. I don't think that, you know, I don't think they're going to— they're going to pay out of pocket for something when they're already paying for insurance. Well, they will, because what they're paying for with insurance sucks. It doesn't work. And you get tons of patients who come to you. And as an orthopedic surgeon, when they fail all that, the only option I used to have was, let's do a knee replacement.

Yeah.

Now I have Knee Repair, Not Knee Replacement because I did trademark that whole program that I developed during COVID And I don't do any knee replacements anymore. Surgeries.

Are you doing any surgery at all?

Yeah, I still do some BEAR surgery, bridge-enhanced ACL restoration repair, where we sew a collagen implant in between the torn ACL. And—

Are you using biologics with that? Are you using Regen?

Because now that we're, now that we're not in the insurance realm, anybody we sign up for that, we do PRP and stem cells as well.

Okay. So you're, are you charging the patient directly for that BEAR surgery?

Yes, because I don't take insurance. But most of those people come from Canada and they have to pay out of pocket anyway.

But that's— That's, you know, that you just blew somebody's mind. You know that, right? Like somebody's right now going, what? What do you mean you did knee surgery and the patient was fine with it? Like, yeah, we have a client, Steven Meyer, who's in Beverly— no, he's in, he's outside of Beverly Hills. So don't think, oh, it's Beverly Hills. He has like a 6-month waiting list. He's been doing cash-based joint replacement for like 10 years. He hasn't had insurance.

Yeah. Because he's like, I got a, I got a 6-month waiting list.

I charge for whatever, 10, 15 grand.

I mean, patients can still submit it to their insurance, although Medicare, if you don't participate with insurance, Medicare, you have to sign a private contract with them. There's a whole bunch of things that I know actually too, at some point that maybe we can—

Yeah. So dive into that. So like, yeah, well, I mean, like, can't you just have them sign an ABN or does it have to go beyond that?

No, with Medicare, they have to sign an actual private contract with you if you don't participate with Medicare, which is fine.

Yeah. No, it's—

yeah, they can't with Medicare. If they do that, they, if they go to someone who doesn't participate and they sign that contract, then they can't submit it to their own insurance. But private payer insurance can. Got it. And, but I mean, the people with, the people who have Medicare, they have worked their whole life, they've beaten their body up, they put all their money away, they've retired, they want to spend that money traveling, they want to spend that money golfing. They want to— Yeah.

And they don't have kids, they don't have kids in college, they don't have soccer.

So they don't, and so they're like, wait a minute, I don't want a knee replacement. I've been, I've been told either suck it up or, or get a knee replacement. You have a third option. Um, and let me hear about it. And, you know, not everybody does it, but let's say 60%, 68% do. That's pretty darn good.

Okay.

So yeah, not 100% of people who hear what we do end up doing it, but it's probably 60, you know, 60, I think our 68%, something like that. Yep. We'll do it.

It's amazing to me. Even I was kind of— I hadn't realized the depth of the anger for the patient. I had no idea 4 years ago, 5 years ago. Now it's like, at first I was probably like, well, yeah, I guess the Medicare patients, Medicare, Medicaid patients will pay, the Ms. And they will. They're like our best clients.

Yeah, they, like I said, they have They have the money, they've retired, they want to enjoy their life. They're like, well, I spent, you know, $30,000 on this cruise and I couldn't enjoy it. Well, that's no fun. Yeah. So if I have to spend $10,000 or $20,000, or even if it's multiple joints, $30,000 or $40,000, they're spending that much on some of these amazing trips. And it's not like these are super people that you think are super rich or whatever.

For the record, tell everybody what Skinny Atlas is like.

I mean, it's a Well, Skinny Atlas is a very overall high-end vacation community. It's beautiful, it's small, it's only like 7,000 people. But outside of that, and Skinny Atlas has its own, it has farmers, has blue collar, but it's definitely a higher-end vacation town. But the surrounding areas are very blue collar. And by the way, I love farmers. Farmers are great. They want to get better. They've always—

Blue collar, no collar, right?

Yeah. Yeah. And so That's what surprised me the most. Again, that's the exact opposite. It's like, you know, people would say, oh, you live in a, you know, you in an affluent area and it's easy for you. Well, no, actually those are the hardest people. Those people don't wanna spend their money. I guess that's my best clients are like in rural markets like you. So the, the best people are your salt of the earth, blue collar people, frankly, like even women a little bit more than men are, are, are better clients because They make the decisions, and when they make a decision, they go for it. You know, guys are— we're kind of a little bit more goofy, and we tend to not follow the directions as well.

Whatever.

Sorry, it's just the truth.

It's the truth.

So, so, you know, I mean, if I had to pick the ideal client, it would probably be female.

A 68-year-old female?

Yeah, for sure. Yeah, for sure.

Yeah. Who worked for 30 years in the school system.

If they said only one type of client, That would be it. That would be it. Yeah.

I would agree with you. So you make this decision, so you start, like, you didn't make the decision right away. You just had to test it. Like, when did you decide? Do you remember the point? Was there a moment when you decided that insurance is stupid? I'm not gonna do this anymore?

Yes. 2019. So I did have—

So it was, okay.

I did have that in my mind and then COVID hit, so that kind of got derailed. And then, you know, I had a mess administratively at my office, which is a, that, Honestly, that cost me probably a year and a half. Right. And you helped me— you and I worked through that for about a year at least. So what bill are we going to—

what invoice is going to show up today?

And not everybody has that big of an administrative mess to start with, but we worked through it and that slowed us down a little bit. But I knew in 2019, and then definitely once I started talking to you, I'm like, yes. And frankly, I thought we would do it You know, we were gonna be, our, our plan was insurance-free by '23.

So missed it by a, missed it by a year.

It took till, yeah, really. I mean, we, we, we technically, we were by September of 2024, which was 3 years after I started working with you. But Medicare had a few little quirks where they wouldn't let us out until January 1st, which was, it was, again, if people are doing this and they wanna know some of those quirks, I'm more than happy to help.

Yeah.

But that, that, that, yeah, technically, officially, officially it was January 1st, 2025.

But that road wasn't easy.

Not at all.

Because so you have a— so everybody understands, you have a pretty big practice. You have rehab, MRI, X-ray, right?

Yeah.

Or PT rehab.

PT rehab, strength and conditioning. We call it VFit, Victory Fitness. Like, I mean, full body fitness, strength and conditioning.

You had 30+ employees.

Weight loss.

Didn't you have— I thought you had like 38, whatever the number was.

I thought it was 32 when we started, but it was 30.

It was a lot. Yeah, it was 30s. So you're making the switch. Talk a little bit more about that. Like, did you let them all go in one day? I mean, obviously I know the answer, but I want people to like, how did you do it?

Well, you told me, which is, again, I didn't believe you, but you're like, oh, you know, looked at our numbers and whatever and you're like, oh, you know, you could do all— you could do a cash-based business with 8, um, 8 employees.

And literally, how many employees do you have now?

8.

8. Yeah.

Um, so, but it, it, yeah, no, I mean, ideally—

Wait, hold on a second. But that 8 also includes, you still have the MRI?

Yeah. And you do the x-ray and the VFit, the PT? Yeah. Okay.

So that includes all of that?

Yes.

Okay. So if it was a pure regen place, it's 5, by the way.

Yeah, I think we still— I mean, honestly, we need to hire an appointment setter and hire a PT, but that's— we can talk about that. But basically it's somewhere around 8 to 10 right now with all those other things, right? If it's just straight, just going to do injections like PRP and bone marrow and things like that, then yeah, you could probably do 5 or less technically.

How much resistance was there on the team?

Well, I mean, I think what happened was I told everybody, well, I had to Get rid of a couple people, as you know.

Yeah.

And then once they were gone, then quickly had you come, maybe within the month. Um, it may even be 3 years ago today that I did— made the move to get rid of that person. And then you came in August. So I gave it a month, but I had a plan. I was like, listen, guys, we're gonna do this.

We smashed it.

I'd already been greasing the skids that, you know, because we already been doing some of these regenerative programs and they were being successful. So like, Number one, talk about how bad insurance is. Number 2, beta test some things. Do, do, do some PRPs and some lasers and some, and some bone marrow and show your staff how amazing these patients do because it freaks them out and they're like, then they get on board because like, it's amazing how well this stuff works, right? So then they get on board, they get excited, then bring an expert on like you, which I would highly recommend. Who Not How. Read the book Who Not How. Actually, don't read that first. Read Read, um, oh yeah, read Who Not How first, then The Gap and the Gain.

Gap and the Gain.

10x is easier than 2x. Those are all Dan Sullivan, Benjamin Hardy books, just for all of you out there. Highly, highly, highly recommend reading them. Huge. But get a Who Not How. Get somebody who knows how to do it, i.e., Matt. Um, and I'm not just saying that because I'm on his, on his, uh, his, um, podcast right now. I'm living proof of it. So I, you know, it's the bottom line. I mean, like I said, best investment business I've ever made. So get your who, not how. You came in in August. We had a, we had a team meeting offsite completely. Like, don't do something in your office. Get offsite, get out, you know, get the expert to come in, get everybody pumped up. And we did. And, you know, and, and everybody was grouped into different groups, like the different things we knew we needed to have to do to get out of insurance. There was like for specific groups of people. And, and, you know, people, some people say they want to do it. Other— we also, you know, our values, we came up with our values and our vision and all that stuff at that meeting because you really, you can't build, you can't, you need a foundation. So get your values, get your vision, get your team, help your, have your team help with that so they have buy-in. Um, get your culture, you know, set. And you have to start with a good foundation. So you still, we started with that right away. We got our, we literally started with our values like the first second, right?

Yeah. And our, and our vision statement and our mission Remember, we spent like the better part of a day.

Most of the day, but it was well worth it. Right.

Made it happen.

So all in, right, was one of our values.

Yep.

Um, right now they're trust, excellence, all in, and resiliency. There was, there was 8 of them, but those are the, those are the 4 that it is now. TARE. And so all in was part of it, and that was one of the first ones people mentioned. So even though people say they're all in, eventually some people aren't all in to, to put, like, some people are just not meant for talking to patients about money or Just any of that stuff. Or if you're a billing person, you're not going to be needed anymore. Right. You know that you're not going to— so some people—

Or they just believe that there's a lot of people in the medical field that just believe that everything should be covered.

Yeah, true.

And they don't, they don't think about—

true.

They don't think about the impact on the economic side of it.

Yeah. So some people left. So that happens. And then we tried like hell, as you know, tried like hell training. And when you came, we trained, we trained and trained and trained and trained. And when you start dropping and, you know, start drop, we dropped. So then we went with the 80/20 rule. We went—

Yeah, we dropped like the worst 20% or something like that.

We took exactly the 80% of insurances that only brought in 20% of our revenue and we dumped them. So that was only 20% of the revenue, but it was 80% of the insurances. And the word starts getting out there a little bit. And so you see a drop in volume. But even though that's—

how is that? How was the drop in volume for you? How nerve-wracking?

Very. It still is difficult. You walk in and there's not like a ton of patients in the office. So it still is— you still get nervous even though, you know, I mean, I'm just being honest. Like there's someone who just literally signed up for a program the other day for multiple body parts and multiple months of, of a program. For $40,000. So think about how many— that's like, that's like, you know, how many surgeries isn't that?

I remember when you sent me the text one day when you were coming back from surgery.

30 surgeries or 25 surgeries. So, but on the other hand, you know, they didn't— some of those people, you know, they just don't want surgery and there's no option for them. Yeah, there's no option. And if they had to pay out of pocket for a knee replacement, it's $30,000 to $60,000, which is crazy as it is. So anyway, some people self-select and then you kept getting on me and I had a great— I also started the Profit First accounting method, which people can read that book. It's a great book as well. Highly recommend it. So I had an accountant and now I start seeing the numbers more. And actually that's where at the stage I'm at right now, really getting more into numbers and learning that part of the business, which you don't learn that in Med school, residency. So yeah, then I just, you know, I was so loyal and, and, and I— loyalty means so much to me, you know, that I did not want to let go of anybody else because everybody else was good.

Because you let a couple of people left.

Yeah, some people left.

And maybe you went down to like 25 or 26, got rid of some— I won't call—

Probably even less than that, but, you know, but, you know, some people left. Um, and, and so then Yeah, you just look at the numbers and you can't, you can't afford to have that high of a payroll. That's just the bottom line. And so, yeah, I mean, I had to literally let, I think, 7 or 8 people go. I didn't fire them. I had to lay them off, you know, just because that's what, that's what the numbers showed.

You want to go into the detail of that conversation?

And then, and then a few people left. So it ended up being like 10, 10 or 11 people All within 2 days before the Christmas party. Yes. But you know, here's, here, all right, here's my—

Come on, we gotta tell the story, Mark. Like, I'm actually—

Well, you, I want you to, you can tell the story, but here's my advice to anybody out there. First of all, like, if you do get advisors who come in, listen to 'em because I didn't listen to you guys. I mean, I'm gonna be quite honest. I mean, you've been telling me this for a long time and I probably could have, I could have handled it better because I think if you just have a conversation with the staff members, that you're going to let go and tell them what the reality is, that might have been better than letting go of 7 people all in the same day, which sucked. It was terrible. It was worse. Yeah, it's one of the worst days of my life. It was really bad because I love all those people. I didn't want to let them go. But, you know, I had no choice.

Yeah. Yeah, we had started. So I was up there, I think, in June, and we were sitting in your office in the back and I think I got out— I think you handed me an envelope and I think I did the math.

I think it was literally a napkin.

A napkin or an envelope.

A napkin.

And I said, okay, so what's your revenue? What's your payroll numbers? And I don't think the payroll number included you. And you were at 48%, if I remember the number correctly.

Something like that.

You were high 40s. That was before you were drawing a salary. And I said, that number's got to be ideally 28%, no more than 33%. That has to include you. And I can't remember exactly. I do remember I said, I don't like— you're like, who do I let go? I'm like, I don't care. Just pick 7 and get rid of them today. Like, I'm sorry. This sucks.

Yeah, that was June, by the way.

That was June. And look, I've had to do this. The most I've ever had to fire in one day, I think, was 10 or 12. It sucks. It's awful. There's no— there's, there's no part of me that enjoys letting people go. Like, you know, But, you know, business is such— business is just like your blood panel. It doesn't lie. The numbers don't lie, right? I mean, if you've got A1C numbers that are whatever, 6 or 7, and your lipid profile blows, like maybe it's time to quit the sodas and the barbecue. Like, you know, it's like quit drinking beer. I mean, the numbers don't lie. So, and you kept saying, no, no, no, we're gonna land this soft. And I pretty much was saying—

We were, I mean, we had, We had months of, you bring, people, you had months of bringing in $350,000, but if your, if your costs are $360,000, right? Right. It doesn't.

And, and you know, it's not sustainable. So like one of the rules in golf is your, your best score and your worst score, there's always gonna be a range of 15 strokes. By the way, it's the same for PGA Tour players. Think about it. They'll shoot 62, Well, 15 shots of their worst score is 78.

Yeah.

Right? Like, or whatever that number is. But yeah, it's 78. So there's, there's always a 15 to 20 shot range, right? Well, if you think about that in your business, you're gonna have months that are 350, you'll have 2 months that are 350, you're gonna have 2 months that are 150, and the rest of the months are gonna be around 250. Like, that's just what the numbers are gonna be. So you can fight that and say, we gotta have more 350 months, which you wanna have. But the reality is, is if I dollar— if I dollar cost average this thing, it's whatever, $275,000 is what it is. And so I'm looking at the numbers going, I knew there was no way you were going to be able to sustain this. Like, I knew your numbers and I knew, like, we were going over P&Ls and I knew your cash position. And I just was like, are you ready to fire? Like, every month would be like, have you decided? Then you were like, I'm going to Portugal. I'll do it after I go to Portugal. I'm like, oh, fuck, I've seen this show. Like, I've seen this before. And then we had a call in December, and you basically said— I'm like, you really need to let people go. And you go, you're right. Okay. And then you were like, when should I do this? I'm like, tomorrow? And you're like, okay. And Carl had been after you to do that too, right?

He knew what needed to be done.

He's your right hand.

Yeah, he knew what needed to be done. Our director of operations, he knew what needed to be done. And frankly, he, he and a couple other staff members really, really handled it well and helped because it wasn't easy for any, any of us. But yeah, they knew what needed to be done. We— so that was— was that a Thursday?

It was like a Wednesday because Thursday—

We had a Wednesday call.

Yep.

So Thursday's when that happened. And then I was operating. I had a full day of like surgery on Friday. Surgeries on Friday. So I knew, but I, we were, that was also when, um, you do need to empower your staff more. So that was, that was the time that I was, that you were going to do an offsite meeting with them through Zoom.

Through Zoom, because I couldn't make it up.

Uh, without me there. So, because it's, it is beneficial to not have you there all the time. Yeah. And so that was going to be the time we did it. Well, that was the time we did it, but it wasn't great for you and for Carl because That was the hardest day.

That was by far one of the top, top 3 hardest days I've ever had in my business. Your team was not happy. And then you, you were supposed to have your Christmas party on that Saturday and you guys canceled it.

Yeah. Yeah. That was, that was tough.

That was a tough one. Did you have a Christmas party this year?

We had a Christmas celebration in the, in the office. It was actually very, very fun.

Cool.

It was more like a frat party. It was fun just amongst the staff. It was, it was good.

Frat party, like beer slides, like beer pong.

Beer pong and stuff like that. Sure. And Adam and I, Adam and I won. Get people drunk.

Adam and I won.

Get people drunk.

You can like put him in the MRI. Is that what you did?

No, everybody got driven home safely by sober spouses or girlfriends or friends.

That's smart. Yeah. So what happened after that? You let all these people go. This was a year ago, right? It was about a year and a half ago. It was December of '23.

'23.

Yeah. Yeah. So what happened after that?

Well, there was a really rough meeting that you guys had, and then, you know, I had to face everybody on that Monday and just be a leader and be like, hey, own, you know, own up to what was— I mean, they kind of knew the people who were there were— who were left were truly, you know, all in. And, you know, a couple had to be level set a little bit because they're just inexperienced. You know, they don't— and, you know, some people had been only working just in general since college or graduating from whatever school.

Right.

For 5 years. You know, like, this is like a huge shock to them. So they learned a lot and grew up a lot that day. And then, yeah, we just we reorganized a little bit. I think we were we were we were concentrating on maybe too many things, so we narrowed our focus a little bit back to our beachhead, which if you read Matt's first book, what is it?

The anatomy of a seven-figure medical practice.

Practice. Yeah, you should read that book before you read his next one. And he talks about a beachhead, and we're both huge World War II buffs. You can anybody knows about D-Day, you'll know about a beachhead. But Our beachhead was— is knee repair, not knee replacement. Even though I'm an orthopedic surgeon, sports medicine specialist, mostly knees and shoulders over the years, and all these other areas, Matt said you had to concentrate on one area. Like, what's your beachhead? And so that was knee repair, not knee replacement. And, um, and you can still do these other things, but you have to have one kind of niche that you, you, you, you, you, you land on the beach with first and you focus all your efforts toward. So. Talking about like, how do we treat the knee? How do we inject a knee? How do we— what are the systems for advertising for, for knee problems? You know, how do we rehab a knee? So all your systems, because we started to get more into doing— getting our systems set up, it's easier to do for one body part than it is to try to do for— let's do a back system and a shoulder system and this and that and the other thing. Get your knee one done.

Mm-hmm.

Get it all done. Get it honed. Get your, you know, get your marketing all for that. And then you can always, you know, you're not going to, quote unquote, kick a shoulder out of bed or kick a hip out of bed. Right.

Right.

But you're going to— you're going to concentrate on knees mostly. And it makes it much easier for training and messaging and all those things. So we started honing in a little bit more on that because we were getting a little—

Yeah.

Probably spread out. Not that we don't want to spread out a little bit more eventually, but right now You know, that's kind of what we're concentrating on mostly.

So how's it going? Like, how is— I mean, I know you're having good, good months and bad months. You're going to have those. But like, how's this now that you're completely out of insurance? What's it like for you?

Number one, it's very liberating. So it's great.

That part. Like, I mean, you feel— do you feel— do you have passion again for medicine?

Yeah.

And were you burned out? Were you burned out?

Yeah, for sure.

Yeah.

Yeah. I mean, I— and I've Just, I mean, being in the journey to get there was super exciting. Super exciting. So once you get there, you know how that is. It's something, it's like, what do we do next? Right? You gotta have your 10x goal. That was a 10x goal.

Yeah.

Like, that's a 10x goal. Getting out of insurance, uh, complete. And by the way, an orthopedic surgeon, single orthopedic surgeon, uh, getting out of insurance after 25, 26 years. That is 10x. That's a 10x goal. Read the book, 10x Is Easier Than 2x. Now you got your 10x goal. Now you gotta go for the next 10x goal. And we've been, we've been struggling with that a, a little bit.

Yeah.

Um, but not, not tremendously. I mean, it, I mean, as I said, our 90-day goal, I mean, we, we kind of got, uh, January to, to March, we had this goal and, uh, we, I think we improved on it. Uh, March to July.

Yeah.

We had another goal. You know, we do these 90-day goals, but what we found was, you know, because we tried to get kind of cute with our marketing and everything, but what you find is, bottom line, it's still your existing list, your existing patients, the existing patients referring other new people, and then doctors who know, like, and trust you, as I said. So it's the 3rd time I've said that, but your existing list is huge. And if you're going to start with Matt, that's how you're going to first start. You're going to start with your existing list. You don't have to be worried and scared. It's really— the first part's actually pretty easy, and then there's, there's ups and downs. So right now I think I'm in a bit of a transition phase, but it's nothing we can't like figure out or get through. Like scaling and really getting our— I think the marketing part and all that, because you don't have insurance anymore to bring patients in. It's not automatic.

Right. But you've got to go through like 100 patients to find somebody who's a good fit, or 60 patients, right? Like, it's a—

No.

So again, I'm just talking about like if it's a general practice, like the old school. I'm not talking today. Today it's like you get 10 leads in and like how many come in and buy?

Yeah. So I mean, I should look at our big board number here, but again, Matt gets you all these different ways to look at your business, like the vital signs. And so, you know, you got your leads and then we classify our leads into avatar leads, our ideal patient versus non-ideal. And then we're constantly trying to, work to get more of the ideal ones versus the non-ideal ones. Um, and, and when I say ideal, meaning the— that age category we talked about, uh, they have been told they need a knee replacement, they don't want one, that type of thing.

Right.

Because that's our, that's our avatar. Not that if someone came in with their hip or a kid— we have a kid who wants to, um, qualify for the Olympics, has bad Achilles tendonitis, and he wants to qualify for the Olympics eventually. He's like 31. I call him a kid. But I mean, the point is, we still— regenerative medicine works for all kinds of different areas, etc. But our avatar is that age category that we just talked about. And so working toward getting more of that type of a person in the door, then we also— we don't just let people come in. We kind of, we kind of did something similar to what the functional medicine doctors learned.

So you're still doing the thing where they come in and they do an evaluation?

Yeah. So another thing that we learned, you know, being in Matt's mastermind Mind Mavericks is, you know, there's, there's a lot of regenerative medicine doctors in there. So some of us are, are, uh, orthopedic surgeons, sports medicine doctors, but you also have your pain management doctors. You also have some other non-operative doctors who are doing regenerative medicine. And then you have the functional medicine. They're doing more like the hormone replacement therapy, the peptides, et cetera. And your goal was always to meld those together, which we— that is another thing that we're working on.

Mm-hmm.

And so I learned from them how they have patients come in because it's—

Yeah, they do like a lab, right?

Well, they order a lab panel and the patient, first of all, they order a lab panel and they pay a certain amount, X, Y, or Z for it. And then the patient's going to come in and review that lab panel. So number one, the patient's going to show up because they want to for the follow-up appointment because they want to know the results. We kind of do the same thing.

We don't— And for the record, the functional people are charging like $2,500 to $3,500. The cheapest is Rob Powers at like $1,200 or something like that.

Yeah. So we basically have the same range to get somebody in. I mean, for— we call it a clarity day or comprehensive diagnostic evaluation. So it's $3,500 and they come in and they spend at least an hour with myself or my PA or my orthopedic PA, Allison or Jordan. And then You know, get a very, a history, look at all their old records, get x-rays, do an ultrasound, do an MRI, especially to look for bone marrow lesions, which cause a lot of pain that people miss. They get a full 1-hour total body fitness evaluation. And a lot of people who have knee pain actually have a problem with their back or a problem with their hip or whatever. The upper body can affect the lower body. So we treat the whole body. The team will get together, we'll talk about what we think the plan should be. We'll even talk about it in front of the patient. Then I'll sit down, or Jordan, my PA, or Allison, our orthopedic PA, will sit down another hour and go over all their goals, all the questions that you provided for us. We go through that list of questions, and we, at the end of it, we want to figure out what their goals are and, you know, how really ready they are to go through a program. And then we give them usually 3 options, you know. Well, they always have the option of doing nothing, and they always have the option of surgery.

Right.

But we give them 3 regenerative options. Programs, like a good, better, best, frankly. And they can choose from those options. So I would rather have someone say no than maybe. And you've taught us that, which is very important.

Maybe it's just, I want to tell you no, I'm just too polite.

And it takes too much time going back and forth. So I'd say, I think it's 68%. And it was 8%. It fluctuates, but it's about 68% of people choose one of those 3 programs and go on.

So of the people that pay the $3,500, 68% are buying?

Yeah, it might even be more than that. We've had months where it was, but I'm going to say—

How hard is it to sell people a $3,500 office visit?

Well, that's the thing. So you have, you have your avatars calling or you have people calling, and then you have that the front office has to know how to have scripts and things like that because you need to know what you're saying. So everybody's saying the same thing, one voice. But that's kind of the semi-hard part. If it's someone completely cold who's never heard of us, right? They're just calling. But that's where doing all the social media comes in, because a lot of people see us on social media or go to our website or hear me on a radio show or a TV show or something like this, a podcast. So all these things, the more you talked about those stages of awareness, you know, the customer journey, all those things, the more educated they are before they make that phone call.

Mm-hmm.

The more likely they are to, you know, sometimes they just call and say, I wanna do it. I don't care. I know, you know, blah, blah, blah. But other times they, like, we had somebody call the other day, talk to Jamie, and she heard us on the radio and Jamie went through the part that we don't accept it currently, accept insurance. And the lady said, okay, this conversation ends and hung up the phone, but at least it didn't waste her time.

But she's not done because she's not gonna get the results that, the results that she wants. So it's just a matter of time.

And some of those people come back. Yeah.

You know, right now somebody is listening to this and they're about ready to veer into a ditch cuz they, they're like, did he really say he charges $3,500 for an office visit?

Yeah, but it's a whole day too. It's like 4 or 5 hours.

That's the thing I want them to get. It's 4 to 5 hours.

Now, exactly.

You have benefits that like other people don't. You've got the open MRI, you've got the PT, you've got all that stuff.

You can do all these things. X-ray, ultrasound.

But even if you're just doing ultrasound.

Yeah. Oh yeah.

Right. And a basic physical exam, you could charge. We have people that'll charge $500 to $1,000 for that.

Yeah. I mean, you can charge whatever you want.

I think it's fascinating that 68% of the people— it doesn't surprise me that 68% of the people convert after the $3,500.

Well, think about it.

Yeah.

If someone's going to pay $3,500, most are going to— most of those people are probably going to be more likely.

And what's the average— what's the average transaction value on that? What's your— what's the average package price?

The average transaction value ranges From probably fifteen to twenty thousand.

Fifteen to twenty thousand.

Yeah.

And this doesn't include no functional medicine yet. We're not doing anything like that.

No, not yet.

Or ozone, which ozone ozone's great. Yeah, ozone's fantastic. Have you met Frank? You know. Yeah, you met Frank.

Yeah, yeah. And yeah, mastermind. Yep.

Yeah, Frank's great.

I'm gonna go to one of his.

You're gonna go to Reno?

I'm gonna.

I'll see you there.

I'm oh cool.

I'm always in Reno.

I'll probably. The next one's in October, I think.

Yeah, I'm—

We're putting plugs out for you, Dr. Shallenberger.

Yeah, Frank Shallenberger is the best. If you want to learn ozone, he's the godfather of ozone.

For sure.

He's a godfather of a lot of things. He's— there's a guy who has taken some serious arrows for 30-plus years, you know, 35 years. I mean, like, basically got ran out of California. Like, they're like, get the hell out of here. That's why he wound up in— I'm like, how do you wind up in Carson City? He's like, well, I was in California and the medical board was basically running me out of town. They were threatening to take my license. He said, screw this. So we went to Nevada because I didn't want to be in Vegas. We came to Reno. Have you been to Reno?

Never.

You're not missing much. But Carson City is great, right? Like, it's whatever, on the other side of the hill or whatever it is. But yeah, Reno's an interesting place without a doubt. Like, you know, it's, it's just an interesting place. We'll go when we're there. We'll have to work to find a good steakhouse.

Let me just do that. Really? Really? Yeah. Geez. Yeah, but well, so that's October.

October. Yeah, yeah, he's fantastic. What did your peers think about this?

Like, oh, I've gotten some— I've read some interesting office notes from a few people, um, that were like, ah, you know, just really just said some terrible things. Now what's interesting—

what do you mean office notes?

Like, like, so, so someone who saw us and then went to this other doctor who does knee replacements or whatever, standard surgery, and said, hey, I saw, you know, Dr. Pratapali's office or Victory in Motion, home of NeuroParent, not NeuroPlace. When I went there and they, they said, you know, that they could do this program with me and it's X amount of dollars out of pocket because insurance doesn't cover it. And then, you know, I read the note, you're like, I can't believe a colleague of mine is doing this type of thing in the medical notes. Who does that?

Because then does the patient come back and you see those medical notes?

Yeah. Yeah.

Are you serious?

So I've seen some of that. Have you got a lot?

Have you got a lot of shit?

Well, not a lot, but I've seen that. And then now, but what is more interesting is recently, um, I think it's because we've been doing, um, radio advertising too, but recently I've been getting referrals from other orthopedic surgeons or their PAs or their nurse practitioners. You know why? Because, I mean, there are patients who just don't want the knee replacement. They don't want any more surgery. And when you're— when a patient's in your office and you have nothing to offer them, you feel terrible. So I think in some ways they're like very getting excited that, hey, there's another option out there. I don't know it yet. I'm not going to probably ever going to learn it. But go see Dr. Petropali, go see his office. And we've had more of that recently, which is really kind of cool, I think.

Yeah. You know, it's— I'm always fascinated by the industry, right? Because If you, you know, orthopedic surgeons are clearly the best of the best. And I'm not just saying that because you are one, right? But like, you made it off Survivor Island. I mean, you know, what are the other tops?

Well, I did a post on that. I think neurosurgeons, uh, neuro—

Well, neurosurgeons will tell you they're the best, by the way. Any neurosurgeons that are listening, we understand.

You remember the end of that post? Like, who, who would you want to hang out with? Uh, orthopedic surgeon or a neurosurgeon? Sorry, neurosurgeons.

As Dr. Roddy McGee says, bone broken, bone fixed. What do you need to know?

All right.

You know, so, you know, we don't even know if the neurosurgeon worked. And, you know—

I do love neurosurgeons.

I do too. Yeah, I just— but, you know, they're— but it's— you're so trained to just do a thing a specific way. It's just become an assembly line. Yeah. I mean, do you— I mean, people that you did fellowship, you did your fellowship with, or like within that group within Birmingham, what's it called? The Blind Squirrel Club? What is it?

Blind Squirrel Society.

Blind Squirrel Society. Like, do you get a lot of shit from those guys and gals?

Well, I'm going to be at the sports medicine meeting in Nashville, uh, on Wednesday, so I will, I will find out and see. But in general, no. But more locally, yes. But I think, I don't know, I just think that's— it's not necessarily their fault. There's a lack of understanding and I probably would've thought it was crazy too, frankly, 5 years ago or 10 years ago, frankly. But they are universally exhausted and burned out and not happy people either. Even the orthopedic surgeons, which is, I mean, are getting less and less happy. They're, I mean, we know primary care has been just—

Oh yeah, just decimated.

Just, yeah, they have no job satisfaction whatsoever. Orthopedics, they, it's better, but it's gone a lot downhill and universally.

How hard has it been from an identity standpoint? I mean, it's in your name, it's in your title. I know you still do some surgery. How hard has it been to give up surgery and that part of your identity?

Well, for me, it's, it's not that hard because I did it for 25 or 26 years. And so I'm—

Or as Schachter says, I realized I was a widget maker.

Yeah.

At the end of the day.

I mean, I'm thankful for that. And I mean, there are— if everything was perfect, And I'm in the OR doing a case and I have the, like, an experienced staff with me in the set, like, like what Dr. Andrews had, had, uh, if I had that every day, it would make it a lot more tolerable. But this turnover in the ORs and the, the, the delays and the wasted time, it's just, it's just not fun. It's just, it's not efficient. It's not fun. Even though the surgical part of it, it is fun. And I do love, I still do love that. And the cool thing about being in the operating room, It's like either, like, if you're in the shower or you're in the bathroom or in the operating room, no one's usually gonna mess with you.

Yeah.

Like, you don't get phone calls, right? It's pretty good.

It's pretty—

it's good. Those are good times.

Those are great visuals. I wasn't even thinking of that. Nobody can mess with me in the shower.

For the most part. I mean, unless you—

Well, if you're in the fraternity house, yeah, then they would do the ice water dump over you.

Yeah.

Oh my God.

For the most part, no one's gonna mess with you.

So what do you think's gonna happen? I mean, you're We're looking at the numbers. There's this massive number of doctors that are 55-plus that are burnt out. There's not enough doctors coming in. We're 125,000 doctors short last time I saw, last statistic I saw. What's going to happen? Would you tell— I know your son's a lawyer, but would you have told your son or would you tell your daughter if they wanted to go to med school, if they wanted to become a doctor, what would you tell them?

I mean, I would tell them like I tell anybody. I mean, I'd still say, you know, whatever you think you want to do, it doesn't matter what it is. Like, don't listen to what everybody says, et cetera. Go for whatever you want to really do. So, because I do have a lot of students come through my office and they're like, well, you know, I'm like, you got good hands. Have you thought about becoming a surgeon? They might be like, well, no, I just want to do the PA thing. It's a couple years. It's only a couple years and I don't have— I won't have as much debt and it's etc. Like, well, why don't you at least try, you know, go, go try? And we could use good— good— we need good doctors, right?

No kidding.

I mean, so I, I still strongly encourage it. I mean, it's people like you, people like myself, people like all the people that we know are slowly changing things and for the better. And I, you know, I don't know if RFK is going to or not. I don't— I haven't really kept that much track on it, but I haven't seen a ton of improvement yet. But I hope that, yeah, things improve.

It's coming slow.

I mean, in my, in my mind, his hands are a little tied. I mean, in my mind, the bottom line is I think what has to happen is, and people may think I'm crazy here, but this is my own thoughts and everybody can have their own thoughts. But I think when you're born, you should have a health savings account immediately.

Yeah.

Okay.

Yeah, absolutely.

And obviously if there's people who can't afford it, et cetera, well, the government's already paying for Medicaid and all these other things, so fine. Fill up that person's health savings account and put a little, put a certain amount in each year. For the people who can afford it, they can put in, they have to put a bare minimum in each year, but then you can put in a lot more. And you can also donate, like maybe there's, you know, you should be able to donate to people to—

That's a cool idea.

You know, donate to people's HSAs, or there should be some maybe regulation of how that's done. A company, whether it's a private company or it's a government company, Or government organization probably wouldn't be best, but they could help fund people's HSAs. But then when people pass away, they could donate that money to their kids or to their grandkids.

Push it down tax-free.

And just, yeah, like, I mean, and you should be able to put in a lot of money tax-free into an HSA, but it can only go towards medicine no matter what. Like, no matter what.

You can go to preventative if you want to do regen.

Right. So, and then you have catastrophic insurance. So you, you're going to need, you're not going to have enough. If you get in a car accident and break every single bone in your body, you are going to need— there's going to need to be catastrophic insurance. But I think there should still be catastrophic that is— that covers major medical expenses up to whatever. And then all the other stuff can be done through the HSA. And maybe that's stuff that should be taught in school and everything too.

Like, what do you think about that?

Doesn't even get taught in school.

So RFK has said You know, they get like one nutrition class. Now he's requiring 2 semesters. What do you think of that?

Well, there you go. I mean, that's— it depends.

I think they're requiring it to keep their accreditation.

I guess it depends on what you're getting taught and who's teaching it too. That's—

well, let's just make sure— let's just hope the food companies aren't in charge of the nutrition classes. Right here, eat these Cheetos. Right.

It's just so bad. So ideally, yeah, that's good. I mean, there should be more practical stuff taught in school. I like all the home ec stuff and all that stuff. I don't think they do any of that anymore. Like, learn how—

like, just in general, like how to balance your checkbook and stuff like that. Like just in general high school.

Or yeah, or how to take a needle and put a button on a, on a shirt or, you know, how to use power tools and regular tools.

I would have missed— I would have failed that class. I'm not very good at power tools, as you know.

We used to do some crazy stuff in shop.

Yeah. Oh, no, I remember. Yeah, I remember. Like, you know, I had woodshop.

Remember that?

Like, you make the lamp and everything like that. that, put on the lathe. Like, that was great.

Yeah, like, I'm surprised more, more of us didn't get killed, but it didn't happen, right?

Yeah, remember that? Like, there was always the one kid, because you were taking the wood blocks, remember, and you had to like put wood glue on it, and then we'd get like all gooey, and then like he'd run his fingers through the hair. Remember that? Then you like stick their head underneath.

But yeah, that was you, wasn't it?

No, that wasn't me. That wasn't me. Like, I remember everybody, every— if you had it first semester, it was great. You had your Christmas gift for your dad. Yeah, all set. You get him that, of course, that checkerboard, like you give him a, like a checkerboard lamp and you can put the lamp in there and they do that whole deal.

It was the best. Still, still a stepping stool that I have that I made. Yeah.

Like, you know, I get, I get worried. I get, I get worried. I had this conversation. I was in Columbus at Anoop's. Anoop had a housewarming party, so he invited me. So I'm like, sure, hell fuck yeah, I'm going to show up. So we were— I was talking about this with somebody, and she is— she's a big fan of functional medicine, but she's like, we have to make it more and more affordable. We have to make it more and more affordable. And I was explaining it to her. I said, look, I agree in concept, but the only way you're going to make it more affordable is if we drop the costs. And the costs are the costs, right? Like when you went through your costing with your bookkeeper, accountant, CPA, You were shocked at how— what your expenses were, right? Like, as it relates to it.

Very much.

Like, you had to really massively increase prices, didn't you?

Yeah. Yeah. I mean, you tell me, but bottom line is figure out— I mean, just a simple way to do it. Figure out what your costs are completely and then charge 30% more. Is that reasonable?

So yeah, your fixed costs can't be more than 30%, but yeah, like you should. And then you got to factor in all your other costs, your fixed costs, your malpractice, your Your rent, your utilities, all of that. And then yeah, you should have 20 to 30% profit margin in there.

Yeah.

I mean, there's—

'Cause how else do you bonus your staff? How else do you invest in other things? I mean, you—

How do you fund retirement? How do you pay off debt?

How do you— How do other, I mean, what's the, what's just the industry standard on, on charging over costs? Like for, it doesn't have to be in the medical business, but is it 20 or 30% over?

Well, it's whatever the, it's whatever the market's gonna pay.

But I mean, what, what is, what's the, what would be, what's the—

I mean, 20 to 30%. I mean, that's kind of average, right? Yeah. 30%, I'd say.

So why would anybody get upset with us for charging what we charge?

Well, so what would you say to people? That's, that's, that's exactly how we figured it out. Right. What would you say to people like, oh, doctors should not be dis— they shouldn't be charging, they shouldn't be making money. They shouldn't be profitable.

Well, then you go outta business and then, and then, and that's why the healthcare system is where it is. That's why you have burned out doctors. That's why you have 7 minutes for the average visit. Are you kidding me? Come on now.

If that's what you, if that's what you still want, when you're over 60 with a swollen prostate, it takes longer to go to the bathroom.

Yeah. Yeah, just, just, yeah, just if you, if that's what you want, crappy healthcare, fast crappy healthcare without a lot of options, then, you know, keep pushing doctors out of it because you're right, not as many are going to med school.

Um, not crappy healthcare that's 4 times more expensive than the rest of the world, right?

Exactly.

It gets a, gets the worst outcome of the industrialized nations. I mean, it's just, it's insane. It's absolutely insane.

Why is that? Because of Big Pharma and insurance companies. Sorry, but it's true.

You don't have to apologize for some truth.

Insurance companies make trillions. Yeah. Okay. Big Pharma makes hundreds of millions or hundreds of billions. Excuse me, hundreds of billions. But insurance companies make trillions on you. Nobody else makes trillions.

UFC.

Big Pharma doesn't. People get pissy about Big Pharma. Insurance companies make trillions. I'm sorry. Yeah, they do. And they'll deny it and this, that, and the other thing. Baloney.

That's because they control the pharmacy benefit managers. They make more money off the pharmacy benefit managers than they do off the insurance.

Totally.

Which is supposed to be illegal, by the way.

Plenty of good podcasts and information and research out there.

Have you listened to Brigham Bueller? Isn't it great how he's just exposed? I met him down in Vegas. He's a great guy. I mean, what has happened in this country, and I think it's hilarious, that people run around talking about, oh, it's Big Pharma, it's Big Pharma. That's like, they're pawns. They're complete and total pawns to the insurance companies. The insurance companies are the—

No, it's insurance first, for sure.

Oh, they're like the 5 Families in the New York Mafia back in the '50s. I'm sure I'll get a letter on that one. I don't care.

Big Pharma's up there, but it's the insurance companies for sure. Yeah.

Big Pharma is like the carpenters union. They're controlled.

Either the insurance companies own pharmacies or some pharmacies own insurance companies. It's just terrible.

Can you imagine if— and you know this is going to happen. At some point, one of the health insurance companies is going to have so much money, they're going to offer to start buying Big Pharma and the pharmacies, and they're going to control every channel. And Congress, Washington will let it through. They won't have an issue with it. They'll be like, oh yeah, that's fine. It's going to be great. We have our own version of Americanized single payer. It's just 5 of them. They control 85% of the market. It's horrible. And doctors are over there. So you think doctors will revolt at some point? You think that it'll reach a point where they're just like, this is ridiculous? Are we there?

Doctors inherently are not like that. We go into— we go— I mean, very empathetic people. We go into medicine. I mean, I truly did go into medicine to help people, and I have a lot of students who come through And I tell this story. When I was interviewing for medical school, I was told by tons of quote-unquote advisors, don't— when they ask you why you want to go to medical school, don't tell them because you want to help people. I'm like, that makes no sense.

That's why I'm there.

That's exactly what I want to do. So—

What were you supposed to tell them?

I don't know. Like, I'm not sure, but don't tell them that. Don't tell them that you want to help people. So, yeah. So I tell all the students, I said, like, You better want to— you better want to help people. That's why you go into it and be proud of that. And I mean, with all these, you know, we're helping people's own body heal itself, which is amazing, and not needing a bunch of drugs and artificial things that have all these side effects. PRP has no side effects. It's your own platelets. We're taking your own platelets. We're like— people say, thank you so much, Doc. I'm like, I didn't do anything. Your body healed itself. I'm just helping your body heal itself.

Yeah.

Like, I didn't do anything. Yeah, I— yes, I did. I learned how to do, you know, all these different ways to harvest it and et cetera. But still, it's when it really comes down to what actually is happening, it's your body healing yourself. So thank yourself. And, you know, I got people who've lost 130 pounds, come off their, their, you know, their, uh, what, their medications. Isn't that great? Uh, yeah. Like they don't need those medications with a lot of— by the way, this is, I'm not telling people to go off their medications on their own. And Matt's not saying that. And obviously listen to your own doctor, but the point—

Yeah, don't, do not take medical advice from me.

The point is that there's a lot of unneeded medications out there, and that I think everybody can agree with.

Well, there's, there is not one. I, I, I can't, I cannot justify in any form of the benefit of somebody being overweight. Like there's, There's none. Like, remember, like a couple years ago, people like, oh, it's fat shaming. Like, you can be as big as you want. I'm like, that's really— that's like saying go ahead and take as much heroin as you want.

I know that's bad.

Isn't that bad?

I agree. You can say it in a way that is a positive way. Like, if we can do this, this, and this, it's going to lead to, you know, lower blood pressure.

Yeah. Better food supplies.

More energy. Like all, you know, better sex drive, everything. You can think of everything, right? It's going to improve all those things.

Yeah.

And so it's just the way it's framed. But some people like to always go negative.

Yeah, no kidding. What do you think? You think there'll ever be changes about the way that they train doctors? Because how many hours were you— when you were in residency, how many hours a week did you work out of 160 hours?

Yeah, definitely 80 to 100. I think they're limited. Is it limited to 80 or less? It's limited.

I think it's 80 or less. But weren't you working more than 100?

Yeah.

Yeah.

At times, for sure.

You think that was a good system?

I— how do I put this? I think that— well, all I know is I wanted to go into orthopedics. I kind of wanted to be— I wanted to be a sports medicine. I knew you had to go into ortho. But as I got into medical school and I saw the differences of the personalities of the doctors, I definitely wanted to do orthopedics because even if it was 3 a.m., they were kind of always joking around and having fun and whatever. Kind of like I saw the Band of Brothers.

Yeah, yeah, yeah.

You know, poster, our favorite movie. Yeah, I mean, just kind of like it was just a band of brothers. So, um, and, and there were some sisters in there too, which we, we had, and they were, they were tough, just tough, fun, hardworking people. Uh, so I think there's— it's like dose, it's like a dosage. You can overdose or you can underdose. Um, and so too much training and not enough sleep, etc., etc., is not good, but too little is not good either. And I don't know as though—

I think 100 hours is too much. 40 hours is probably too little.

Yeah, I think they've got— I think what's happened is, though, sometimes it's like they're counting the clock exactly. And it's like, you know, you're in the middle of a surgery and you have to leave. Like, that's the training.

Oh, really?

Yeah, that's the training. Now someone comes in, and it's been going on for a long time, actually, but someone comes in and relieves the resident. That's why a lot of doctors just have PAs and stuff like that, because they can stay for the whole thing. But like, that to me, that's not— not really good training. So I'm very happy with the training I had. Was it hard? Yeah. But I was like, by the time I was done, super confident.

Yeah.

Super, like nothing fazed me. Like, that's what you want. You don't want a doctor coming. I mean, there's doctors who come out of their residency who don't know how to do surgery. Like what?

Wait, orthopedic surgeons?

Yes. Come on. Absolutely. We had a guy, it's in the name. I'll, I'll even, I'm not gonna say where it was. It was a school in Pennsylvania, a very prominent school. Um, very high-up school, uh, did his, uh, medical school there and did his— no, did his residency there. And he came to, uh, the fellowship with Dr. Andrews in Birmingham, Alabama, and he didn't know how to operate. He said, I came— he goes, I came here to learn how to operate, which he sure as heck learned how to do with Dr. Andrews.

Jesus.

We all did. But like, we knew how to— like, he hardly did any surgeries at all, uh, which is terrible. Like, that's just a joke. And there are places like that that the doctors just— I think even just if you don't even scrub in now and you just watch a case and don't scrub in, I think that counts towards your hours now, which is a joke. You got to be like, you got to be scrubbed in doing stuff.

Yeah. Like, you can't just be scrubbed in. Don't you have to hold the scalpel?

Like Syracuse Upstate Medical University, man, we just— we really learned how to do surgery. So when we went did our fellowship, we didn't need to— we didn't really, um, need to learn how to have good hands. We just had to learn how to use them in smaller poke holes and, you know, all the arthroscopic stuff that Dr. Andrews did. But yeah, some, some— and it's still like that. And point is, the less hours that they're actually engaged in the residency program, the less training they have when they come out. So there's some stat— I, I don't keep track of this stuff that much, but I heard it somewhere— where there's a fair amount of orthopedic surgeons who come out who are not trained.

And that's mind-blowing to me. Yeah, that's absolutely mind-blowing.

So they're, they're learning on the job. I mean, they've seen a lot, but I really don't—

Yeah, there's, there's very few things I want to learn on the job. Maybe my golf instructor, not my orthopedic surgeon doing my knee replacement.

Somebody's probably going to rip me one for that, but it's true.

That's—

you know what, there's some— there's evidence.

It doesn't matter, Mark. Like, you know what, let's— you know, we can't We can't. We got to fix the system. So what does the future hold? What do you got on the horizon for you and for the practice?

Uh, well, I, uh, I do want to, um— what, for me, I think getting even more facile and in-depth with the, the financial part of things and how the whole practice runs. So what we did last 90-day quarter was we mapped out our entire patient journey from literally from, from marketing to just a regular phone call coming into just every type of thing you can imagine. The whole process, the phone calls, everything, it's all, it's all on Visios. So, and then you click on the box and the box has like a written summary. That's so cool. And then it has a Visio and then it has a video. It's not 100% done, but it's, it's 80% done. 80/20. We still got to— I mean, probably even more than that, maybe 90. But that was our 90-day goal. And Carl led the way there and did a great job. And we— so we knew that the business growth was going to slow down a little bit to get that. We got to get that, you know, honed. And so— and, you know, from past people who've come through that, you know very well who have experience what we do and we're trying to make that uniform. And so then this 90 days, I'm going to really learn more about the— I know this is kind of boring, but you need to, you need to learn this stuff.

Yeah.

No, more about the, more about the financial and the reporting and how all these things, all that, all that's done. But then more of the more probably after that is more getting into marrying the functional medicine. Yeah, the regen. So getting more into the hormone replacement therapy, and the ozone fascinates me, so I'm absolutely gonna learn about that.

Oh, ozone's great. Like, so by the way, it's how I discovered I was allergic to heparin.

That's amazing.

All the PRP procedures I've had.

Wow.

I've never had BMAC or adipose. So yeah, I was at Will's getting my first ozone, and I turned— I mean, I'm beet red to begin with. Like, imagine me being even more red. And, like, my whole face was itching, and you can't move, right? 'Cause you're getting— you know, you've got IVs running in and out, right? They're taking it out of one, spinning it, puts it in the other. So you can't scratch your nose, and everything was itching. And he wakes me. He goes— taps me 'cause my eyes were closed. I was trying to meditate and get through it. And he goes, are you allergic to heparin? And I go, not that I know of. And he shows me a mirror. I'm like, I guess I am. Give me a syringe like this big of, like—

Yeah, yeah, yeah.

Right. Of Benadryl or—

A bit. 'Cause you have to— Um, you have to anticoagulate.

Yeah. So I don't know what we'll do next time. Haven't had one since, but yeah, no, it's great.

Well, cool.

Any final thoughts? What would be— what would you tell someone? What would you tell your younger self coming out of residency and fellowship today? If it was today, what would you tell a young orthopedic surgeon coming out today?

Honestly, that you could start out, um, without insurance. You really could. It'd be— I frankly think it would be easier if you had the right mentor. So if you took someone and maybe I helped them and maybe Arianna helped them, they could easily— yeah, um, you could easily start out, uh, without insurance. Uh, I know that sounds crazy, but you absolutely could. And, uh, and I think that's, that's like next level for you, probably some— somewhere down the road, your avatar. But that, that is an avatar.

We're already getting them. Yeah, they're already coming out, going out. Yep. We're getting them. PM&R are coming out going, I don't— I'm not going into the system. What do I do?

Because we— there's that one guy who just—

Eisenberg.

Yeah, yeah. So he, he's only like, what, a year or two into, into practice?

Or he was like a year into practice, not even that. And he's leaving the— he's leaving the big practice in August.

So that— it can be done. It can be done. What I would, what I would recommend to anybody out there is if you're burned out and you're, uh, tired of the same old thing and tired of, uh, especially if you're employed by a hospital or something like that, contact Matt, because like I said, it was the best— is the best investment I ever made, and I'm very happy I made it. And nothing's easy in life. So if there's nothing that's easy in life, but it's way more exciting, way more fulfilling. And, and I have gotten a lot more free time back and to spend with my family and in my garden and all those things.

Grandkids.

Yeah, grandkids. Got another one coming.

So do you really? Geez, man, they're getting after it.

Well, it's Mark and, and, uh, Hannah.

Oh, really? Oh, well, you're gonna have to get me caught up on that then.

Hey, Mark, you're on the podcast.

We're not going to talk about it on the podcast. Don't worry about it, Mark. We're going to save you the embarrassment. So cool. Well, thanks for coming in, brother. It's good to see you. I appreciate it. Yeah, thanks for all the kind words.

Thank you for everything that you've done for me. Seriously.

You're welcome.

I appreciate it.

It's our pleasure. All right. And if they want to find you, by the way, give them your website just in case.

Yeah. www.victoryinmotion.com. Victory in Motion. Home of knee repair, not knee replacement.

Yeah. And he knows how to repair hip too. So there you go.

That's true.

All right. Thanks everyone. Appreciate it, Mark.

Thank you. Yep. Bye-bye.

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