Defining Your Company Culture And What To Do With It

You've been in the industry 12 years.

Uh-huh.

You know, predicting the future is always risky, right? But where do you see— where do you see the industry heading? What do you see if you look out, you squint out on the horizon, say 3 years? Where do you think the industry is heading? Are cell counts going up? You think we're going to see improved results?

Do you—

where—

just from a business standpoint, what are some of the things you see? The reason why I love working with doctors, especially at this high level, is nothing fazes you, right?

Nope.

You've been in the medical space for how long?

So, founded Plymouth Medical 12 years ago now.

Okay.

Yeah.

And what'd you do before that?

I was weirdly, I was in like supply chain, airline supply chain, weirdly. Yeah.

It's an odd trans—

Yeah, it was an odd transition. But, you know, my partner was always in orthopedics. devices, and we just saw an opportunity with sort of the broadening uses of cell therapies across orthopedics, pain management, and we just saw sort of a niche in pre-surgical type of product solutions for our clients.

So tell me, like, what's the business like today? I mean, because you really— you, you were really at the beginning and the cutting edge of this stuff 12 years ago.

Yeah, we were at the beginning of it, but there was a lot of sort of misinformation, a lot less, I would say, very clear doses for the cell therapies that were being leveraged back in the day. So it was actually very difficult to sort of break into cell therapy 12 years ago because it wasn't as well understood as it is today. But we still, you know, at the time did our homework. We kind of kissed a lot of toads and we saw that there was definitely a sort of a correlation between higher cell counts and outcomes. So we always made it sort of our point and our mission to bring quality products to our clients that would enable them to really leverage higher cell doses. Because we found that, you know, looking at the science even back then, it was pretty clear that, you know, smaller blood draws, other systems that are not necessarily therapeutic wouldn't, you know, provide our clients with the outcomes they were looking for.

So, what are your systems that you have that you provide?

Yeah.

What kind of cell counts are you getting? We were talking earlier, like, on the different size vials. What kind of cell counts are you getting?

That's kind of the beauty of our system is that it's whatever cell count that you're looking to achieve, you can get because we have a multitude of different kit sizes, single-spin kits, double-spin kits as well. So, really, from one platform, you could do PRP, bone marrow, A2M, microfragmented adipose tissue. So, Right then and there, you're future-proofing, you know, using one system to be used across multiple tissue types. But, even within those categories of PRP and bone marrow, you can draw 20, 30, 60, 120 mLs of blood as well. So, depending on what dose you're targeting for the indication that you're treating, you have a number of options.

Right.

So, for musculoskeletal, you know, physicians or orthopedics, we do typically recommend our double spin kits because they provide our clients with much higher doses, like 5 billion doses from a 30 mL draw on average if a patient has like normal, normal platelet counts. From a 60 mL draw, you could, you know, easily sort of achieve the 10 billion platelet dose that a lot of the latest studies are kind of pointing to to provide patients with, you know, outcomes to a year. Or more. So, great. Yeah.

And you're really— obviously, you, you, you are— this is a big component of what you talk— you've been talking about this for quite some time, about cell count. Cell count matters.

We've been talking about this ad nauseam for a long time.

So you— and you have— I know a lot of, a lot of you use her system, and you've got the cell counter, right?

Yep.

Why— how do you see your clients utilizing that? Are they testing the cell count on every dose? How do they— How detailed are we getting on that?

Yeah, that's a good question. We have typically, we have 3 types of clients that are leveraging our cell counters. One are like larger institutions, like university-based, you know, health systems that are basically involved in a lot of the clinical studies that are currently underway. We work with the Biologic Association Research Board that is doing a NeoA, multicenter NeoA trial at like Mayo, Cleveland Clinic, Northwell, Cedars-Sinai. So a lot of these larger university systems that are getting into the science. need a cell counter at the point of care to qualify and quantify the cells that are being leveraged. We also work with, you know, groups that actually make their own PRP. So they're avoiding having to, you know, purchase an FDA-cleared kit like our kits, and they're making it themselves. So they're looking for a device like our cell counter to QC at the very least what they're creating manually under their hoods. And then the third type of client is, you know, High-volume orthobiologic specialists that really kind of want to start correlating their injectates to patient-reported outcomes because they feel that, you know, that's where the science needs to go. A lot of the randomized controlled trials are very contrived. They're, you know, they don't have diabetic patients or smokers. And, you know, we're kind of— we've been supporting a lot of these patient-reported outcome registries with our cell count data. In order to, you know, complete the picture of, you know, what is it that the patient needs by indication to get outcomes and for how long those outcomes will last. So, those are the 3 types of clients that are leveraging our cell counters.

Yeah.

How many of you are testing cell count on patients on a consistent basis? You're documenting that on a regular basis? Yeah. You know, I think that's one of the ways that, you know, when we— like, Sam, I'll use you, not to pick on you, but I'm just, I looked right at you and you came to mind. I think that's a lot of things. You know, when you hear people say, well, I'm getting competition and they're down the street, they're getting their PRP for $500 or $700. We all know all PRP is not the same. And so I think in that case, if you can provide that documentation, how are you all— are you providing that documentation, Ariana? Okay.

I think what we have to realize is that, you know, when we started this 12 years ago, there was really no data on dose response. There was no data on dose-response for tendinopathy. There was no data on dose-response for knee OA or for even for, you know, degenerative disc disease. And we were competing with, you know, smaller test tube systems or even, you know, manually processed PRP that our clients were leveraging without really knowing whether there was going to be a clinical outcome. So the use of our cell counters is really sort of help justify the additional blood draws that our system basically demands. And also it helps quality control the PRP in terms of the purity of the PRP. So the total white cell count, the RBCs that are present, final injectate, all of those different cells that we're injecting have an impact on the tissues or the joints that are being injected. So, you know, we need to control that. And we saw that very early on in the game and thought that, you know, the science is only going to progress if we have an idea of what was actually being injected because there's such a heterogeneity of different kits on the market, then it's very difficult to pinpoint what's going to work and what doesn't.

Yeah. So, yeah.

Where do you see— you've been in the industry 12 years. You know, predicting the future is always risky, right? But where do you see the industry heading? What do you see if you look out You squint out on the horizon, say 3 years, where do you think the industry is heading? Are cell counts going up? You think we're going to see improved results?

Do you—

where, just from a business standpoint, what are some of the things you see?

I think, I think what we're seeing right now, like at Plymouth Medical, is a bit of a shift in thinking on dose response because there's more clinical studies that exist on that subject. But I think it's really more of an acceptance, certainly in orthopedics, We used to, I mean, being based in New York City, we used to get pretty much laughed out of orthopedic hospitals 12 years ago that was like, you know what, no, we're good. Like, we're gonna just stick to what we know. But I think now there's definitely a shift in thinking that there are some presurgical options that could be leveraged to give patients a little more relief for a little longer to sort of maybe delay that surgical intervention. So we're definitely seeing a shift in thinking. and how to properly leverage cell therapies, not like the free-for-all that used to exist before.

The wild, wild west?

Well, there's still some component of that.

It's still pretty wild.

Yeah, it's still pretty wild, but we're trying to kind of bring a little legitimacy and gravitas to what we do every day. And I think that kind of— it's a testament to, you know, the 2,100 clients we have around the country to, you know, that I want to do the right thing and move the science forward.

Yeah.

So, yeah.

Do you all have any questions for Joanne? We'll have to pass the— Throwbacks. Throw that to Donnie.

I would love for Joanne to talk about the educational support that she gives to all of us with the Plymouth Medical platform.

Yes, please talk about the educational support.

Yeah, so one of the things that we sort of really pride ourselves in is not just supplying product and having that transaction with our clients, but because there's been a paucity of a lot of, you know, clinical evidence on a lot of what we're doing in cell therapy, we thought to put together almost like a compendium or a database of all things orthobiologics. So there's sort of the concepts Cliff Notes. So we have a database that's available for a client to access where all of the latest clinical evidence that exists on orthobiologics is sort of indexed by level of evidence, the intervention, if there's information on the dose, was there any sort of post-injection rehab protocol. So it's really easy for you to kind of sift through that, the clinical evidence. If you're looking at, you know, PRP or bone marrow for rotator cuff issues, you can really kind of pin that down very quickly. It just renders the information that can be just read as a very simple summary, or you can, if you want to read the whole thing, it's available to you as well. And within that, there's an ability for all of us in our community to interact and have questions, you know, talk about it and upload images of cases that we've seen lately as well that are pertinent for that particular study. Within this database, we also have videos on, you know, shockwave therapy, how to leverage shockwave therapy at the point of care, because a lot of that is Yep. And we also have a lot of checklists for, you know, all the different kits that we have. You know, we're mostly all-female team, so we checklist the hell out of everything. And so everything comes with a checklist. There's, you know, everything that's outlined that is contained in the kit. So for training purposes, it makes it easier to sort of implement based on, you know, a pick list for your MAs to, you know, pick Get your cases ready. So just, we do really spend a lot of time on training and education, not just your staff or the MAs, but also keeping you or keeping our clients sort of at the very cutting edge of what's been, what's coming out, you know?

Yeah.

What other questions do we have for Joanne? I would tell you to go look at her booth, but you'll have to press your face up against the glass to look at her booth, and hopefully you'll get your stuff back.

Fingers crossed.

Fingers crossed.

Yeah, I just want the shockwave back. Yeah.

All right, give Joanne a big hand. Thanks, Joanne. Appreciate it.

Thank you.

You're welcome.

Thank you.

Come on up. We got some work to do. You warm enough?

Yeah.

Okay, good. All right.

I brought the long sleeve today.

Okay, good. Very good. So we're gonna do hot seats, correct? Is that what we're doing? So we're gonna do some hot seats. What is a hot seat? That is where if you have questions about specifically your practice, about how to get unstuck about some of the things that we have covered, we will do a mini consult with you right here in front of everybody else. So the only downside is, is you're going to get a little naked.

No.

Just a smidge, not a skosh.

Just your soul.

Just your soul. Not like physically naked because we're outside. If we're indoors, Whole different ballgame. So who has some, who needs some help in their business? Who would like a little bit of help breaking down and fixing a problem in their business? I know that there's someone out there.

Don't forget, this is $4,000 an hour.

Yep.

Rains, it rains.

Doesn't matter, like if you're starting, if you've been around.

You're gonna save money starting right now. This is gonna be worth it.

You wanna go?

All right, Tom.

I'm up. Come on up. Okay. And Andrew, we have the electrodes plugged into the seat, correct? Okay, good.

It's gonna be electrifying.

Okay, so Tom, using— you got to hold that thing, that baby close. There you go. Tell us in 20 seconds or less who you are, where are you, and what do you do?

I'm Tom Iurima from Santa Cruz, California, Center for Wellness and Integrative Medicine. So the major constraint that I'm facing is coming out of lockdown, I'm rebuilding the team of my front desk, And operations.

Okay.

There's been a significant shift in labor availability geographically to my brick and mortar in the last 6 months that wasn't there.

Santa Clara or Santa Cruz?

Santa Cruz.

Santa Cruz. Okay.

The beach community of Silicon Valley.

Got it.

And so the question is, how do I create the culture among my front desk staff So that I can move from complete fee-for-service à la carte at all times to prepaid packages, to sales of prepaid packages, rather than me just handing them an invoice and saying, this is what the patient's charges were for today. Please schedule them next visit in such and such amount of time.

Got it.

And also the patient not knowing what his next charge is going to be because we're purely à la carte. We may be doing these add-on treatments.

Okay, so let's go back. So the biggest challenge, what I hear, is that you have a staffing issue, correct?

Yes.

You can't find the right type of people to help scale your practice.

I would say I don't even know how to look for the right people. I know that hiring medical people that are used to the conveyor belt convention in medicine has been traditionally a mistake. So I've gone to like hair salons, people that are more in touch with customer service and customer satisfaction.

Okay. Define the culture of your organization. How would you define it?

Poorly.

Okay.

All right.

So we, when we started, we talked about the fact that at Mavericks, and this is not just at Mavericks, we did it at the Carolina Men's Clinic as well, and a couple of other companies that I've owned over the years. Culture first, value second, skill set third. If they fit with the culture, I can teach them the skill set. What normally happens is you look for skill set, right? And when you look for skill set, what you wind up with is you wind up with a bunch of people that are just there for the paycheck. How many football fans do I see are here in the room? Okay. Okay. So let's talk about, let's talk about 2 different organizations. Let's talk about the New England Patriots in their dynasty days. Now they're struggling. You got rid of Tom Brady. That'll happen. Okay. And let's compare them to the team in the same timeframe.

How about the—

Cowboys.

I would say the Washington Redskins because they were historically one of the worst teams in the NFL.

Okay.

You choose to root for them. Okay. What would you say the culture of the New England Patriots was? Do your job. Don't talk to the media. Just do your— if you've watched Dynasty, which I recommend that you all watch Dynasty. If you're building teams, you need to watch Dynasty, which is a breakdown of the whole time of Belichick and Brady and Kraft. Okay? And they're interviewed in there. And Tom— and they talk about it all the time. Do your job. What's the culture of the Alabama Crimson Tide when Nick Saban was running the show? Focus on the process. The score takes care of itself. Don't worry about how many stats you have. Don't worry about what your passing yards are. But write a great paper for kinesiology or really nail that, the geometry test that you have or calculus test or whatever they take. I guess for math classes at the University of Alabama, it'd be like, you know, low-scale math, but that's another topic for another day. That was kind of, well, I'm an LSU fan.

I'm sorry.

Yeah, I know.

Okay.

So if you think about the culture of winning organizations, everything has to start on that. So if you say you have no culture, When you were asking, I think you were asking Arianna's team and saying that you'd been through so many receptionists. How many receptionists in the last 2 years?

47.

Okay. So the challenge you have is you have a culture and the culture is hire fire.

I would say that the culture is blind because the leader doesn't define the culture.

Okay.

Blind, not blonde. You said blind. Yeah, I thought you said blonde there for a second. How many people thought he said blonde? Tony was about ready to freaking WWU your ass. She was gonna dropkick your ass, weren't you? Yeah.

Uh, you almost died.

Yeah, you almost— you, you're lucky I paused there. There were a couple of blondes going— I mean, the team back there were like, oh, we're gonna— badass bitch culture was gonna just drop his ass. Okay.

Okay.

All right. So the culture is blind. So you have to spend the time to define the culture. The culture isn't something that's just defined in one. You don't just like go have a couple of bourbons and say, I've got the culture. Okay? The culture of Mavericks is constantly evolving. It is constantly evolving. And we're constantly refining and defining what it means to be a Maverick. So if you look at our team, if you look at the team that we had at the last BOB compared to this BOB, Toni's nodding her head. Don't nod it too much. It's a vastly different team because we're like, they don't fit in the culture. Nice people, did a good job, didn't fit in the culture. Wasn't about production. It wasn't about any of that. It's produced. Well, sort of, but like they just didn't fit the culture. And so they're no longer there. And so you have to be ruthless about this culture. So then the next thing is, well, I want you to talk about culture because I know you— we've talked a lot about this. And you wouldn't be able to be on the road as much as you are unless you define, unless you had a clearly defined culture.

Absolutely. So, my culture in my organization is that we focus on family first, work second, be impeccable with your word, leverage technology, and taking impeccable care of the patient, The doctor and the workers.

Yep.

If it doesn't— if it— so if it doesn't work for the patient, the doctor, and the staff, it doesn't belong in our clinic. It has to meet all 3 of those needs. That's how I designed my clinic. It has to work for the doctor. We can't work myself to death. It has to work for the staff. They have to come to work every day loving their job. And it has to work for the patient. They have to come here and feel taken care of, heard. They love our clinic because they know they can trust whatever I say, whatever we say is a go because they know that we have their back.

Yep.

That's our culture.

Yeah. You mentioned your values, right? You said family first, right?

Yes.

Work second.

Yes.

Okay. What was the next one?

Take impeccable care of the patient.

Okay.

And your word is impeccable. Don't lie. Don't mince the truth.

Yep.

And leverage technology.

Yep.

So now, right now, when you're getting ready to bring people on, one of the big mistakes that people make is they go, they're interviewing people like, let me tell you about our culture. And they lay all these things out. And what do you think the prospective employee says? Oh yeah, I'm all in on that. Okay. Well, they're not all in on it. They just want the job. What you have to do is one, you've gotta create a culture like that when the organization, like people want, people want to come work for you. So one of my favorite lines from Nick Saban is that mediocre people don't wanna work around high achievers and high achievers don't wanna work with mediocre people. Okay. He has another thing is you can be bad, you can be average, you can be good, you can be excellent, or you can be elite. And you never, ever, ever hire good people. You only hire excellent and elite people because excellent and elite people want to be coached hard. That's a Maverick rule. Mavericks want to be coached hard. The difference that you can tell is like on a football team, you see an excellent and elite player come off the football field, they go right to their position coach and their position coach might be dog cussing them out. Right? But they want to be coached hard, and they're standing there going like this. Okay? A good player goes away from their position coach, and when their position coach confronts them, they get in an argument with their position coach. What's that?

And that's a good player.

That's a good player. Not even a bad. We won't even talk about. And by the way, Atiba has won 22 championships as a football coach. Okay? So with kids that come from very difficult backgrounds, and he's coached a number of players that are in the NFL. Okay, so he really knows this stuff. So you've got to have this concept of, I'm only going to hire excellent elite people, and they exist everywhere. I mean, you found them in Sonora. We always say, but you found them in Sonora, you can do this in Sonora.

If you can do it in Sonora, you can do it dang near anywhere, because I have some of the best gals. I wouldn't trade them for anything. And they are smart, driven, working at the top of their expertise, and then some, always hungry for knowledge, always looking to improve. They're improving on processes that I didn't even know needed improving. Okay, I'll take that. I just am so thankful and grateful that they have as much passion for this business as I do.

Yep.

And it doesn't work if you ain't got passion, right? We had an employee that was not passionate and she didn't work out. She ended letting— she let herself go. She said, I feel like this isn't working out.

Yeah.

Yes. Because they don't want to be exposed. I'm so glad that you said that because I was about ready to fire you.

Yeah, they don't want to be exposed. Did you want to say something? Here, no, throw the, throw the catch box.

As an employee, I think that on top of the culture that we come into knowing that we need to live up to, Dr. Demers loves to teach. And so we all come in so excited to learn from her. We learn from her every single day. And I think that being able to continue bettering ourselves is a huge piece of our culture. But on top of that, knowing that we all have each other's backs, but she will always have our back because she knows we are doing our best job. And so if we have a patient comes in, 'cause we, you know, we all have difficult patients, and if a patient comes in and is complaining or trying to degrade any of us, I will have my girls' back, but Dr. Demers will have our back immediately and we will have her back. And I think that that just makes it such a cohesive office. Knowing that we can all trust each other without a single doubt, it's made we we love being around each other. I'm sure you guys can see that with all of us. But our culture in our office is so so incredibly pure because we trust each other, and it's it's it's taken some time to build that. But I you know I worked for Dr. Demers for two years now, and I I would go to war for this. Like it this is just so incredible what we get to do for people. But because we get to learn from her. And we get to have such an amazing team and finding the people who are passionate and want to keep learning, I think has been the biggest part about building the right team for us.

Yeah.

What'd you say, Kate?

The question was, will I ever accept a guy? Well, we did that. It didn't go well.

So, yeah. We don't, we don't really, you know, we don't have a rule. Like our team is predominantly, well, it's all women right now, right? Like it's not like I'm not going to hire a guy. I just got to find people that fit the culture.

Exactly.

So here's the thing. You've got to define your culture. Okay?

How do you do that, Matt?

So you go— it's a great question. What you do is, I started actually working on thinking about like, what are the things that are important to me? Okay? Now here's— this is gonna— you've probably heard me say this.

Should I tape this, right?

It's being taped.

Okay.

All right. So let me give you an example of this. A lot of people say their business is a family, right? Oh, it's all family. We're a big one, but one big happy family here. That actually doesn't work for me. I don't necessarily come from like a really good family environment. Most of them are alcoholics, you know, just not a really— just leave it at that. It's just, it's just not a really good environment. And I was working with a, with this mentor of mine, and I said, yeah, you know, I want to have it be a family. And he His name is Rob Berkley. You'll hear me talk about him a lot. We call him Yoda. And he looked at me and goes, you don't want a family. You can't stand your own. And I went, oh. He said, you want to build a community. And he said, what you unders— have to understand is that 50% of the people don't like their families. For a lot of them, it means that, oh, this is a big family. We have to accept drunk Uncle Al when he gets really drunk on Thanksgiving and feels me up. And that's just the way drunk Uncle Al is. And oh, we're just one big happy family as he has his hand on my ass. I decided it was not going to be a family. We're going to build a community. Okay. And if you think of communities, one of my favorite movies is Band of Brothers or shows is Band of Brothers. And they're built by this common bond to accomplish this unbelievable task from Normandy all the way to the Eagle's Nest at Berchtesgaden. through World War II of defeating the Nazis. And there are these people that came from all these disparate different places in Manhattan and Wyoming and all of this, and they became lifelong friends. Band of Brothers. So for me, that's what resonated with me. Like, for movies really speak to me. So I want to create this fam— this band of brothers, not a family, a band of brothers and sisters that are going to accomplish an unbelievable, impossible task. And that's where that culture kind of started coming from. And then from there, it kind of evolved, right? So if you were to look at my earlier things, look, I don't care about— I don't care about your religion, your race, your sexual orientation. I don't give a shit about any of that because we love unconditionally at Mavericks. That's one of our rules. We love unconditionally. We realize— Mavericks realize that everybody's dealing with their own shit and we love you in the process. And so these are things that are important to me. My faith is very important to me, that kind of just sense of community. And I just started playing with it. There's not like a formula. Right? You just got to kind of play with it and evolve it. And Atiba wants to say something, so let's hand this off to Atiba.

First off, anybody done the hire and fire a lot? Anyone else? A couple of you. Okay, so 47.

The rest of them are lying.

I know. Okay, 47. It's a heck of a number. But you know what? You're actually fortunate for that.

Yes.

Here's why.

Never did that before.

Well, true. Hopefully never again. But here's why. I want you to take the time. So if anybody else has gone through this, this is what you've got to do. Take the time and think back over the 47. And this is going to take some time, not today, right? And go through them one at a time and start to think, why didn't that person work? There was something about them, maybe 2, 3, 4, 5, 6 things that made them not work. In that moment, you're finding the opposite of what you want.

Yep.

And so if you found the opposite of what you want, how do you find what you do want? Change your perspective and flip it. Now, once you do that, you start to find skills and some traits, and then you start to ask yourself this question, okay, what about me values that? Now you start to build your own values and you get to know what you're looking for. Okay. And that's what you look for in the interview process.

Yeah. So you start to define that. Like, then you define, like, what are you looking for in that employee? When I got divorced, I started creating a list of the type of what I wanted in a woman, my next partner, right? Most people have a list of what they don't want. I suggest you make a list of what you do want and screw what you don't want. And when I got really clear on that list, Katie walked through the door. Go ahead.

This also works If you're feeling burnt out, if you don't like your job, and you're like, gosh, what do I do? I don't know. Well, the first question is, what do I not want to do? What am I hating so much? What am I not willing— why do I hate my job so much? What is it about it? I don't want to take call because I hate it so much. I don't want to do this. I don't want to do this. So what's the opposite? I only work when I set my hours. I don't like to be told what to do. I am the only one who gets to decide what types of patients I see. So it's the same thing.

Yep.

Because it's much easier to have that like, I don't want that reaction than to like dream up what it could be. So you just take that and flip it.

So then you gotta define your values. I recommend that you have 5 values, no more. You need to go to Webster's Dictionary and define and get the clear definition of what it is, because most people don't realize what words mean. Words are powerful, okay? As a copywriter or somebody who writes, who spent— made a lot of money writing marketing materials that would get people to buy, and who spends his life on stage using words to get people to do— take action, and improve their lives, words matter. And so most people have really long, like, value statements. No, we have one word. That's what works for us. And we have a clear definition based on Webster's as to what that means. And then we define what it looks like day in and day out and what it's not. So for example, grit, our number one value, G-R-I-T, we define what it is and we define what it's not. One of the things that it's not is you're not allowed to be a victim. This whole victim mentality that exists in society, that doesn't work in Mavericks. In fact, we have a new person that's coming on board and she was having a situation where her old job wasn't working out. She was working some part-time stuff for us and she was acting a victim. I said, Mavericks don't act like victims. Bam, that changed, right? So you have to be really clear. This is the definition process you have to go through and you got to spend the time to do that. To do that. And then once you have that, you have to abide by that. We manage, we lead, we hire, we fire, we train, we compensate. Everything is based on values. Everything is based on values. And we reward people that live out the value set of Mavericks. That's the thing that we look for. Then after that, people come flocking to your door. You don't have to search for people because guess what? Excellent lead people like Heather and Misty, they're only going to recommend people that are excellent elite and that are going to be— they're going to live and breathe that culture of Mavericks. Ariana?

I was also going to just ask you, um, to maybe clarify. Once he's got this, what does he do with it?

You live it every single day. So you don't just have these values and this culture and then you just stick it on the wall and you forget about it. Every day in your meetings, on our weekly meeting, we have a value of the week and we talk about it. We recognize people that are living out the value that week. We always say, is that like, if we're like, if I had started, I'll tell you what, I'm gonna give you a very recent example. When we were told that there was a gas leak, I went, fuck. Okay.

Right?

And, you know, not exactly ideal. And I kind of went into a very quick pity party, and Atiba came over, put his arm around me, tapped me, and said, it's gonna be all right. Go be a Maverick. That's how that looks. Okay? Right? It's got— you gotta live it every day. You've gotta do it every day. You've gotta encourage people to do that every day. You can't just let it go. That's gonna be your big challenge because You like the bright shiny objectitis. I would actually create a value in your organization, something that has to do with a process, or you talk about how you actually filter new ideas, because that's your Achilles heel. We all have it. I have bright shiny objectitis. I have a process through which I filter everything through. Okay? Right?

And then one thing that I have a question about, but he's like, hire, fire, hire, fire. Now, there is a discussion of a slow to hire, quick to fire. What's your thoughts on that?

I think if you really build your culture, you will attract excellent and elite people to your organization.

Yep.

That you will have a difficult time choosing which one to pick. Again, another example. Okay. So at our events, we have Christine Lane. She's an actor in Hollywood, 28 years old. She met Atiba at an event. We needed somebody to work events. He goes, I think she'd be a good fit. She worked IOF, she worked San Francisco, and she was just in Pensacola. After San Francisco, Misty's going, Christine, you got to come work with us. You're a maverick. We're at dinner. She's like, you got to come work with us. You're a perfect fit. We don't really have a position for her, right? That just kind of happened. And then online, there is a former trauma surgeon. I don't think I told you this. There's a guy who was a trauma surgeon in the military reached out to us and said, I want to work with you. I'm like, okay, yeah, we can help you grow your practice. He goes, no, no, no, no, no, I want to work in your organization. I love everything that you talk about, everything that you guys stand for. We talk about our culture very freely because I want to repel the people that think that they're owed something in life. If you think that society owes you something, you cannot be a Maverick. James, let's hear in the catch box.

Is there something in the interview process because you can see People that come for the interview and maybe they're trained to say everything you want to hear, some scenario that kind of reveals their true self so you don't lose them. I mean, easily wasting time.

And it's the concept of 1,000 plays and a team is going to talk about it, or not that topic, but he'll talk about that topic.

But so yeah, the interview process is it, right? And your culture happens the moment They read a job description. Your job description needs to speak to your culture. The language that you use, it's all about messaging, right? Everything we put out, it's all about messaging. Now, for us, and we have people who come through our interview process and most of them don't make it to an actual interview because they get frustrated. Guess what? You're going to have a conversation back and forth with my staff. Over email at least 20 times before you get invited to an interview. That's part of us. We want to see some things. We define grit a little bit differently, but we want to see that you want this. And then we're asking you questions about your history to learn who you were. Likewise, for us, we're really big into questions. If you're not willing to ask a question, I'm not willing to hire you. So I'm going to ask you a question where information is missing and see how you respond. If you don't come back with a question, guess what? Goodbye. But that's, that's part of who we are. We question everything. We take nothing at face value, right? But we do that through the interview process. And so everybody's interview process is going to be different based on your values. But it starts there. And what ends up happening is by the time they actually get to an interview, They're saying, yo, I knew something was different about y'all. There's just something different about your company. What is it? We say, yeah, it's our values.

Do you ever check background checks?

For certain positions, yes. Yeah. Yes, obviously.

Here's how I check backgrounds. The internet.

Oh, yeah.

I can learn anything I wanna know about somebody by looking at their Facebook page, Instagram posts, TikTok. We've interviewed people and they're like, oh, yeah, I'm into grit. You know, that's, you know, they found out about our value. We don't tell 'em value's grit. Oh yeah, yeah, yeah. And then we look at it and they're like, take from the rich guy. And, you know, they're like at the communist— whatever, not Communist Party, but like, you know, they're— because I can't say that because I'd get in trouble, but you know what I mean? Like, their, their posts are like, you know, burning, like burning down police stations. That's not gonna work, right? We're a non-political organization, okay? We take zero political stances. That is not our mission. Aside from the fact that every politician is corrupt.

Facts.

Okay, that's, that's our political position. We don't trust any of them, okay? And that you all are getting screwed. But we don't talk— look, I don't talk about— I talk a little bit about my faith, about how I have a faith, how I have faith in a creator and faith in God, right? You get to know me, I'll talk a little bit more about it, but I'm not going to sit there and get you to convert. I have clients that are Muslims, Hindus, agnostics, atheists, Christians, non-Christians. I'm married to a Jewish woman. I've got Mormon clients. Like, that's not my place. I— and I don't talk politics. It's all fucking corrupt, okay? They're not interested in you. They're as bad as the insurance companies. That's about the extent of it. Because if I do that, I'm gonna alienate half of you, and you all— we all need this. That's not the role of Mavericks. We would never take a political position on something, okay?

That's true.

And that's— so if somebody's taking a political position and saying companies need to do X, Y, and Z, And I see it on her social media, then we're not going to hire her.

And to further that point, so for us, by the time you get to an interview, we've got about an 8-page dossier that we've built on you.

Yep.

We go that deep into who you are, right? Like, we literally stalk you. So we know if you get an interview with us, you have to work really hard to screw up not getting the job because we're sure by the time we meet you, we want you and you fit. Background check.

Does this help you?

Yes.

Let's give Tom a big round of applause. There you go. For those of you that wonder about systems and support, like hiring your team, you just got a glimpse of it. That's the kind of hard conversations that we have. Okay? This is not mamby pambi stuffy kind of things.

I just, I just, it came to me late in the conversation, but I just had one word of advice for Tom, or maybe not advice, but a thought, something to think about. And that's that if you're not getting the person that you want, you may want to look for somebody that has no experience and train them up the way you want to train them. And that's how I got my first real job, was because my manager was so good, she didn't want anybody who was already in the business because they were leaving that job for a reason, and they were going to have that— whatever that issue was they had, they were going to have it forever. And she didn't want people with problems. So, you know, find somebody fresh that needs a job and teach them how to do it.

All right, anybody else? Was that helpful to you all? Thank you very much, I appreciate it.

Oh, did you want to do a front seat? Oh, you want to come up? I think you need a hot seat.

Wait, what are we going to do here? Question, or you want to come up and do a hot seat? Look, Tom lived. His ass is a little crispy, but he lived.

It's okay.

I was just curious about how you're getting their Facebook information, like their social media information. Like, are you requesting that as part of the process?

Like, no, we just go on and look at it.

You just go on.

Most people, most people don't know how to turn off their public state. They make it all private.

I see. I see.

Okay.

And if they're private, then there's other questions.

Yes. If they are private, then okay.

Okay.

That's probably not going to work at our organization. It's pretty hard to hide your digital footprint.

No, you're good.

You're good. Yeah.

Pay's never been an issue. You want to know why? They're into the mission. They're into the vision.

Okay.

I, you know, pay, I don't, pay is not an issue, right? Because when they buy into the mission and the vision, They have like Misty, Heather, Catherine. I mean, I'm not afraid to say this, but Catherine left a job that she was making a lot more to come work with us. Okay. And it's because I'm very persuasive, right? No, but she's into the mission. We literally had a phone conversation. I found out we connect, we were in our Slack group and she said, make some posts. And I kind of suspected it was her who was looking for a new job. And we talked for like, what, an hour and 20 minutes that first time? I almost made her the offer right then and there because I knew she was a perfect fit. Couldn't afford her, had no idea I was going to pay for her, none of it. I don't worry about how to pay for people when they're the perfect fit, right? Because they're going to pay for themselves very quickly. Okay. All right, Sam, you're gonna come up. Okay, now remember that blessing I gave you a little bit ago that you're a badass motherfucker? It still sticks. Okay.

I got 69 hours to go.

You got 69 hours to go. Okay, so what is it that we can help you with today?

So I have a hybrid anesthesia and pain management practice. I'm interested in going into orthobiologics, but what stuck with me is the beachhead comment that you made. And I have a ketamine practice with about 12 to 15 infusions a month, and I'm thinking perhaps that is the thing where I should be working on growing initially.

Anybody here else— anybody else doing ketamine? Cool. I've always wanted to do ketamine. Yeah, I know, no, I'm going to go somewhere. I'm trying to get Atiba to come with me, which is like pulling teeth out of a— anyway. Okay, so let's talk about the economics of ketamine. All right, so what do you charge for a ketamine infusion?

$500 per infusion.

And how long does it take?

An hour, hour and a half.

Okay, and what are the restrictions around ketamine? Do you need somebody— do you have to be monitored the full time?

I have them— I'm there present during every infusion.

Okay. And do you need licensure for that, or is that something that you can outsource to somebody to monitor them during the infusion?

No, I'm going to be there for—

No, no, no. I'm talking about the state. I'm asking, is that something that you can have somebody else in your company do? Do they have to be licensed as a physician to do that?

I know of a psychiatrist who has a registered nurse, a PACU nurse, come in and do that.

Okay.

But right now I'm not busy enough in a position to—

That's not what I'm asking. Okay, I understand what you're saying. What I'm trying to get to is, I get asked a lot, is ketamine a great business? Well, what, what constitutes a great business model? It has to be something that you can scale that doesn't require you to be there. So if I instantaneously have to be there for it to scale, I'm going to hit a ceiling. Now, you could say the same thing with orthobiologics, but the reality is, is there's more training for orthobiologics and there's more ways to get people trained. And NPs can do it and PAs can do it, right? And there's other doctors that want to do it. So you have a little bit bigger pool. Ketamine is, is a little bit of a challenge. Yes, James, what are you going to say?

I've administered ketamine but in a surgical setting. So my context is, you know, ACLS certified, oxygen emergency equipment, patient has to be on full monitors, airway equipment. Don't take any chances because it is— it You don't know what you're doing, you got— and you got a bad airway, goodbye to your career and to the patient.

Yeah. So the challenge I have with ketamine is that ketamine is challenging to be scalable. Yes, sir.

I've done 20 years of lidocaine and ketamine infusion. Lidocaine is dangerous, ketamine is not. And anyway, I have a nurse there registered and I am next room visiting patient.

So I'm readily available. But I'm doing something else in the meantime. Yeah. So that's the question you have to ask is, can you scale it? Because you might be selling 10 to 12 a week, you said, or 10 to 12 a month.

Yes. But I look at, I look at that, you know, you're $100,000 a month that I'm at $60,000 to $70,000 right now. And you talked about the premium pricing. If I, from people coming in now, I started charging $700 or $4,000 for a series of 6. that I could do an additional 6 infusions a week beyond what I'm doing, adding an additional $25,000 a month, and that would take me to $100,000 a month.

Okay, so what's the end result that the patient's getting from taking ketamine? And by the way, I don't have an issue with ketamine at all. I think it's fantastic. I don't have any— I'm just trying to play a little bit of devil's advocate here, and it's whether or not it's a clean business model. But what's the end result that the patient is getting with ketamine?

Improvement in depression, which I measure with—

Wait, they're going to be more depressed?

Less.

Okay, I'm just joking with you.

So it's— I would say it's 75 to 80% for depression. Unfortunately, a lot of the people I have to screen out that I don't think they're appropriate candidates. Okay. And I send them to a psychiatrist first. I do think that ketamine is hitting this upswing in popularity and attracting a lot of attention, and it's very important to be screening in who you take in because the perception that ketamine clinics are getting too popular right now, and there's been a lot of regulatory blowback. In the last year and a half.

Okay. All right. Where did Atiba go?

But it's also a high— yeah, he's— but it's also a very high margin, low overhead model to do.

What does the ketamine cost you?

It costs $20, $25 per infusion. So it's $475 of profit.

Well, yeah. And then you have to have staff there and all that other fun stuff. Yeah.

That ain't profit.

Yeah, that ain't profit. Okay. All right, so let's kind of break this down. Can you make— what else can I add into the ketamine to create something that is not out in the marketplace? Because right now you're just selling ketamine, right? So now they're going to compete with you on price. So what else, what else can you provide to them that will help them on this journey to deal with their depression or their PTSD and the anxiety?

So I had this conversation with Atiba last evening, and he talked about integrating psychotherapy in and I had another marketing person approach me and one of my patients has a $10 million advertising business that she handles the Comcast account among others. And the 3 of us were on a call together and she thought his idea was good, but his vision of growth is I'm going to double your infusions. And, you know, for what he wanted, it was like 30% of the additional revenue. So I thought that was a little on the high side.

Okay.

So if they're doing ketamine, would they be a candidate for doing ongoing IV therapy? Would there be a benefit to them to continue on to ongoing IV therapy? Just general generic IVs, Meyer cocktail, that kind of stuff?

I haven't looked into that.

Okay, so that's what you've got to do. You got to look into it, right? So like if you're in Colorado, you include mushroom journeys with it, right?

That's what I'm a little—

Georgiana does.

But I'm, I'm a little reluctant to do anything that's Class 1.

No, no, I'm just talking about And we're talking, we're brainstorming now.

Vitamins.

We're talking about vitamins.

Yeah.

Yes, vitamins.

When you're talking about a mental disorder, you gotta look at the gut. You gotta look at nutrition. And so bundling that into a package with the ketamine makes sense. And that's how you scale it.

You just, you warm my heart, Phyllis. That means you've been listening for the last 9 months. It's great. Like, that's what I'm getting to, right? Yes, that's the beauty of the group, by the way, right? Go ahead, James.

What?

Oh, so she said bundle like gut biomes with it, right? If they're dealing with anxiety and depression. So where I was going to go is if you have anxiety and depression, if you have depression, what is it? You probably— are you 20 extra pounds, right? So you're going to help fix the depression with ketamine, but let's get their gut biome fixed. Let's help them lose the 20 pounds. Now, instead of selling ketamine, what I'm doing is you're selling— you're offering to them a journey back to full health. Okay, see, ketamine is an à la carte offer. It's a get injection, feel better for a little bit. I get IV, feel better for a little bit of time. Get IV, feel a little better for a little bit of time. We want to approach everything on that. That's how you create it. You're thinking about one-off. I'm thinking about the whole system. James?

I've only had one patient that I did for ketamine for, and he was on oxy and Norco and everything. And basically came every week after that. He never depended on oxycodone or heroin. He loved the ketamine.

Okay.

But it was charged to insurance. I don't know how, but it was. I got reimbursed. The other thing was about lots of these patients that have pain and PTSD and depression. They've lots of— many times they fall under the chronic pain syndrome. And, um, and I, I've done lots and lots of stellate ganglion blocks. I did one for PTSD, but she was also a pain patient. And I got her hallucinations down from once a week to, from every day to once a week, but I only did one time and I can't charge insurance for it. And she didn't have any pain-related diagnosis, ICD-10 I could use to get reimbursed for the Stellate. And I, so I did it for free, but she got better.

Yeah. So, you know, again, we're looking at things that, this is what I would tell you is you, and this, I think what Ari, you were going to say something, go ahead.

Yeah. So I think this is what everybody struggles is how do you create your package? How do you create your signature solution? Um, and. And one thing that we recommend is just look what you're already doing and not getting paid for. So he's doing salivary ganglion blocks for free. Maybe we should bundle those in. Maybe we should add some physical therapy that we're already sending people to as part of the package. Maybe we're doing gut microbiome and we're going to bring that in. So look around it to what you're already doing, what's facile, what's in your office currently. And instead of doing a pixie choosy, onesie choosy à la carte, that's your package.

Yep.

And what you said is, what outcome are we selling? What outcome? So, if your outcome is to feel better, how do you get people to feel better? All the things. And then, just create that package that addresses every single reason why people don't feel good. Their gut microbiome, they're overweight, they're—

I'm sure their hormone balance is jacked.

Their hormones are out of whack, their adrenals are out of whack, they have chronic pain. If you can create a package to address that, to feel better, then you have something. Then you're not charging $500. That's a $5,000 package. And can you guarantee they're going to feel better?

Heck yeah.

They're gonna feel amazing and they're gonna tell all their friends and be like, oh my God, you have to go see her. I don't know how she did it. I don't know what she did. Was it worth it? 100,000%.

Yep. Does that help you?

Another issue I have is the—

You didn't answer my question. Did it help you?

I am not an expert with the microbiome stuff and that's—

Well, that's okay. No, no. Does that concept help you? I'm gonna help you a lot right now.

Well, including with the—

yes, the idea of a better mess.

Yeah.

Do you understand where we're going with that? You don't need to have all the answers from the treatment protocol right now. Can you find the answers about gut microbiome? You're a smart guy.

I think that the Stella is a more quick next step for me to add Stellas to that.

Do that, but do it in a package. Okay. Go ahead. I'm sorry. You want to ask another question?

So there is this, this, there's, I have scheduling and scripting issues. And I looking, you know, you have the automated chatbot on your thing.

On my site.

Yeah.

And I would like to add that. And, and also working on the automated scripting. That was one of my aha moments hearing you speak that, yes, I, when you were talking about scripting that I want to have that automated chatbot that can answer as many scripted things as possible.

Yeah.

So do I. It's not automated yet. We have the chatbot. The automation is Misty. That's the automation.

Her name's Misty.

Her name's Misty. That's our AI. We haven't— it hasn't moved up the list yet for getting fixed, but yes.

Yeah.

Yeah. So the, the intake, the scripting, the conversion of people who are calling. And I work at a surgery center and they are very keen to try to have cash-paying patients because they do a lot of cases that have a delayed slow pay. Yep. And they're trying to cover their—

So what's the question?

Well, I thought about trying to add stellates in that, you know, for the ketamine infusion, saying, okay, my good, better, best package. Maybe the good is a series of 3, best is— better is a stellate ganglion, a series of 3, and best is 6 ketamine infusions and several stellates.

Yeah, I mean, I think that's great. We know the stellates work very, very well. I mean, John Farrell's doing them down in Baltimore. And they're getting amazing results. They just did a study at AOM with his fellows, and they were doing the whole thing with regards to the results that they're getting. And the results that they're getting with PTSD of stopping it dead in its tracks, anxiety with the stelling, is with the stelly is what you call stelling gangling blocks, is unbelievable. Right?

John Farrell is.

It's it.

He's the family practice guy in DC with seven doctors in network. Yep.

He's doing stellies. He's doing stellies. Right now they're not doing ketamine, but, you know, look, there's, there's a lot of people in this country that have PTSD. I mean, one of the things that we have in our company is it's everybody has some kind of military affiliation. It's not by design. It's just who we attract. We have some, we have some community members that are dealing with some PTSD that we're going to get fixed. We can fix this problem. Go ahead, Donnie, throw the box.

I wanted to bring up PTSD in the military because one of my patients He is— his neighbor ran for the Senate, and he's very tight with the member of Congress, and the member of Congress has been trying to get the VA—

We don't want the government involved in this.

Nope.

No. Nothing has ever gotten better by the government being involved, okay? This is not something we want covered by the VA.

Well, they did send out Stellate in the government with Sean Mulvaney and some others. But I don't know, and maybe some of the others know, I don't know of anyone really packaging ketamine at this point. Do you? I mean, unless it's someone—

Not me.

Not you? Okay. But there's not many.

Nonetheless, there's not many.

And so, you know, in talking about a beachhead and having, you know, narrowing down what you do and focusing on one thing and becoming known for that, which will actually increase your business, that may be the way you go. You know, you come up with your, you know, good, better, best with ketamine plus Stellate or whatever, and, and, and use that in your marketing on your YouTube videos and your Instagram videos and your TikTok if it doesn't get sold back to someone else. And that, that may be one aspect of your business that you become the go-to person in your community for that because you're the one doing that.

Yep. Yes. Thank you, Don. Go ahead, Phyllis.

Yeah, I was going to say I had a conversation with someone at a conference a little over a year ago, and they were talking about some of the clinical data that's coming out about ketamine and how they think that insurance is coming. Very soon. And when that happens, then you need to find another beachhead. So you need to keep that in mind.

Or you say screw it.

Don't rely on just that.

Yeah. Or you say to heck with it and you just make it really, really good and no one wants to leave. So, okay. How many people found these last 2 sessions helpful? Yep. You just got a witness of what it's like to be on Ask Matt Anything. In Business Mastery Fellowship, when we talk about building a community, Of like-minded people. That is what one of our— that's what one of our nightly calls is like. Okay, when you have questions like that or you get stuck, this community helps you get unstuck. And one of the things I pride myself on is I do not have all the answers, but I sure as hell know where to find them. Okay, it's this baby right here. And there's many, many times I'm on calls and I'll text Ariana or Don or someone else in our group of saying, hey, how do you handle this situation? See, that's what you, that's what you're getting in Business Mastery Fellowship. It's not the, just the technical side of things. It's that right there.