Dr. Daniel Paull’s Cash-Based Medical Practice Success

Today on the Practice Profit System, you are going to hear from Dr. Daniel Paul. Now, why do you want to listen in on Dr. Daniel Paul's interview? Because he is not your traditional doctor. This is a guy that went to med school, was in fellowship, and realized that the system sucks. Okay. And he found out about direct care in orthopedics and had a friend of his that was doing it. And he created a company called Easy Orthopedics. He has no office. He has quote unquote no patient list, no EMR, and he's making as much as an orthopedic surgeon would treating patients with house calls. So check out the interview. Enjoy. This is Matthew Gallogly. I am your host. Today, and I have Dr. Daniel Paul, who is located in beautiful, sunny, warm Colorado. Here's why I love Dr. Paul and why I'm really looking forward to today's conversation. Because when you go to his LinkedIn profile, here's what it says: orthopedic surgeon, pioneer of insurance-free and mobile orthopedic care, antagonist of health insurance and large hospital conglomerates. That's a pretty good bio right there. So how long have you been an antagonist? And did you study that in college?

Oh man. Well, first, thanks Matthew for having me on your podcast. No, did I study that in college? No, actually I studied physics. It's kind of a funny story. I didn't set out to sort of do this. It kind of happened by calamity and accident, but it allowed me to sort of get my head to take a few steps back and really get a good look at everything. And like the more that you look at it, it's just a really insane system that a lot of docs just are institutionalized in. It's kind of crazy that we just keep doing what we're doing. So once I sort of had like a realization of that, that's really when I became an antagonist. I mean, because you can't run a cash-based practice, which is what I have, without sort of being an antagonist to that system. That system wants you to work inside it. So I mean, just the very fact of being liberated from it sort of makes you an antagonist of those systems who ultimately want to control and commoditize you as a physician.

Okay, so you went to Miami, University of Miami med school, right?

For med school, yeah.

Right. So you kind of went on the traditional path, right? Like what was the epiphany? When did it kind of come to you that like, wait a minute, this system is kind of jacked?

So, I mean, my personal, so with me, so yeah, I went to University of Miami for medical school and then I went to University of Toledo for my orthopedic surgery residency out in Ohio. And at that point, I was just planning on going into the system and getting a job and just being very much in it. With residency, you're so busy learning and it's very labor intensive. You're not really Looking at anything else. I mean, you get paid, in my opinion, a fairly small salary for what you're doing, especially during the later years when you're really running things in a certain sense. And so you're not like RVUs, insurance, you have to do that if you want to do orthopedic surgery, like you have to do that. So that was what I was doing. And after that, I started a fellowship in hand surgery. And suffice to say, you know, a lot of people go to their fellowships and they're like, oh, such a wonderful year, blah, blah, blah. I learned, I had mentors. I wish that was my experience. It really just wasn't. It was not a positive educational experience. I don't really know how else to say it. But anyways, so I'm halfway through that. It's only a year, optional year, right? I've already finished 4 years of med school, 5 years of residency. I've passed part 1 of my boards. I'm in my fellowship. I'm halfway through and I'm unhappy. And then, so that's one thing. The other thing is I'm looking for a job. Now, my wife is from Colorado, and at this point I've dragged her all over the country. And she's been, you know, we want to go back to Colorado. That's where her family is and it's nice out here and that's where we want to live. And we weren't super picky. Her family's in Colorado Springs, which is an hour south of Denver, and we're willing to live anywhere on the Front Range, you know? And it's like, man, I just can't find a job. Like I can't find one. Or if I do, it's like really, it's abusive at best. Like, hey, take our entire call for our entire practice, or here's a 4-month guarantee for you and then go figure it out on your own, which is really, you And most guarantees are 2 years. You really can't build a practice in 4 months unless you got extremely lucky or you inherited one that already existed. So like that's going on, right? And then, so I interview for a job 'cause I can't find any in Colorado, out in Connecticut. And that, and that's where I grew up. And I remember going there, you know, it was like on a Wednesday, I had to like leave fellowship and drive there and, you know, whatever. And it's just this old senior partner just telling me how much money he made in the '90s. And how bitter he was really about everything. That's the sense that I got because there was a hand surgeon that left.

How much money he made in the '90s.

That's crazy.

Back in the day. Yeah.

And then he was just so mad at this guy that left, you know, it was just, it wasn't a good, like it was kind of a red flag. I'm talking a lot of junk about the guy who previously left. So I talked to a junior attending and I'm going to see if I can do this right, but talk to a junior attending. He's like 2, 3 years in. He's a sports guy, sports trained guy. And I'm like, do you like working here? Right? Simple question. You know, you expect most people to be like, yeah, it's pretty good. That's all right. He was like, it's getting better. It was like this really, like, that's how it sounded. And I was like, oh my God. And like, he didn't have sports cases. He was on call. He was doing his own reductions in the ER, which, if you're an ortho guy, that's not a good sign. It was just, I'm sure he was getting lowballed because that's what they were like floating lowball offers around. So. I was like, oh my God, like, what is this? Like, it was just, it created this sort of existential crisis where I'm like, is this what all the jobs are like? Is this just what, you know, you grind it out for so long through training. It was this realization like, oh, this sort of like existence is forever. Like this does not get any better. And like, I think that's the only way you're sort of able to make it through training is by knowing like, okay, it'll get better when I get out. It'll get better when I get out. And I guess I had this existential crisis where I'm like, oh, I don't think it will. It might even get worse. So it was that combined with this fellowship and I was just like, this is it. I'm like, I gotta do something differently. So I quit my fellowship, which is not normally done, but I did it. I broke my lease. I moved into my in-laws' basement out in Colorado. I have one friend from medical school and he started a cash-based practice doing internal medicine where he was basically, you know, he was doing house calls in South Florida. And I'm like, you know what? This guy's happier than anybody I know in the medical profession and he's doing better financially. I'm like, there's gotta be something here. So that was sort of it. It was really kind of a desperation move. I was in Colorado Springs already. It's not like it's super saturated with orthopods. It's not like I could find a job. You know, I didn't wanna move, so I just had to create my own practice. And taking insurance wasn't an option because it would've led to a very quick death. It would've led to a very quick failure. Because I don't want to hire 5 people per. I mean, that's what I'd have to do, and I'm not going to do it as better as the other larger guys. I'm not going to get good contracts. And it was sort of like, all right, well, I can't go that way. Let me start with cash. And then as I did it more, I'm like, wow, this is so much better than what I used to sort of do or the system I was in. And like, there's a whole subset of people who don't have insurance or who have high deductibles, and you are the most economical option for them and a great fit. That sort of became the beginning of me being an antagonist of those systems is just being outside of them. And then just really seeing how bad it is inside and seeing how doctors— I mean, really, the best word is like, you know, it's like Shawshank Redemption. It's like we're all institutionalized in this terrible system. We can't picture another way of doing it.

Yeah, that's so true. I mean, it's— I see it from the different side of things, right? Like, so obviously, clearly, I'm not a doctor. I got in medicine by accident in 2013, because a guy told me I needed to be in the erectile dysfunction business. And when I got inside the system and my, my first wife at that time was also going to nursing school and she was working in the ER and I'm like, this is jacked. Like, this is totally insane. Why in the world would you do all of this to come out and be treated as poorly as you are? Okay, so let's— I want to talk about your business model in a little bit. And I know you, you have a book and— or you have some other stuff, but we'll, we'll get to that as well. So what I'm curious about is it sounds like your path has been pretty traditional up until a point. How did you start to learn the business side of this? Did you— are you a naturally gifted business guy? Do you come from a business-oriented family? Or are you just figuring this crap out as you go along?

Yeah, probably the latter. I don't know. I didn't have any business training. Certainly don't have an MBA, nor do I really want one. But yeah, it's trial and error, right? I mean, it's just small, like, you know, making decisions on a small scale, like what makes sense and what doesn't. And then learning from the mistakes that I've made and trying not to make any big ones. And over time, I feel like that's given me a pretty good business sense. You know, I also educate myself, you know, by reading mostly with just free books from the library. I mean, you know, digitally, of course, but that is sort of—

Yeah. That's the thing. We should actually go to the library, right? I'm just joking.

I know the library's amazing, by the way, for those who listening. I mean, you get a library card, it's all digital. I mean, you can just get stuff sent to your, right to your Kindle. You don't even have to go anywhere.

I will tell you this, like I've, I've built, you know, when I first started my first entrepreneurial journey, I would live in the library. Everything's free. It's great. There's no— and now we have the internet, but yeah, keep going.

Yeah, it was just trial and error and figuring it out. And you know, when you're limited by certain constraints, it makes, you know, forces creativity to kind of figure out ways around these problems. So I kind of just tackled them one at a time and, you know, move forward. And I feel like over the years now, it's been almost 5 years I've been doing this. I feel like I've got a pretty good business sense now as things have been growing. And I mean, I started off with like nothing, you know, and the model was new. So, you know, it's a really slow start with this sort of thing, but I was able to get past that early stage and just because I had to, I guess.

Why do you think the lack of business knowledge exists in the medical field? What I mean, you've been through the system. I haven't. Why? Why does it exist? Why is there not at least one frickin class?

So, I mean, gotcha. Doctors are terrible at business. I'll get into that in a second, but this is— here's one of the big reasons why, right? So when you go into medicine and you end up working in the hospital, you're gonna see certain system practices that are very obviously bad and inefficient, right? I'll give you an example, personal example. So I was a 3rd-year resident. I was at this hospital. We're doing pediatric surgery and kid needs surgery. You need to get a consent, obviously, right? No one's gonna debate that. You need to get a consent. So you fill out the consent, you fill out the consent by hand, and then there's a box where if another parent's not there, you could check this box and then you call the parent and they can say, I give consent, and someone witnesses it. So both parents consent, right? It's a good process. The problem was is that if there was a second parent, you had to hand copy the first consent even though there was a checkbox on it. So you basically had to do 2 consents and copy 'em out. And so it could easily be one piece of paper. I know this sounds silly 'cause it's just a piece of paper, but I think it's a good explanation of how the, like what I'm gonna get at here. And so you'd be like, hey, this is kind of silly. Why are we doing 2? And it's not like they're like, well, you know, of course you get, this is the way we've always done it. Right. Which as an entrepreneur, you know, it's like, yeah, that's the worst thing someone can say to you.

Yeah.

But also you get in trouble. You get in trouble. I mean, they beat you down. I mean, they report you, you get in trouble for even doing, saying stuff against that. So, I mean, you'll see these essentially immutable hospital system practices. And at first, at least with me, you're like, this is ridiculous. Like, why are we doing it this way? And you get beaten, man. You get beaten into a pulp and you get in trouble enough times for stuff like that, you stop doing it. So what ends up happening is you'd be smushed into this perfectly formed, shaped cog where you realize that to go against the grain is so much, is so painful that you stop doing it. Any creativity idea, any creative idea you have, any ability to take risk in that way, it's gone. So by the time you get outta that system, through medical school and training, which is close to 10 years for a lot of people, you've been formed into a perfectly forged-in-the-fire cog and you don't have the capacity, or it's latent, it's smushed down somewhere in the middle of that cog to basically take risks and be creative. And when you come out, you're just like, you need those 2 things to be successful and make good business decisions. And while some of us may have them, there's certainly, there certainly have been the suppressed. So for me, I was lucky enough when I left in such kind of a calamitous way, I got those things back. And I think that's helped me be successful. But yeah, you have to be able to do that. You need to be able to be creative. You need to be able to take risks. And that essentially is untrained out of us in medical school.

Well, isn't it fascinating? Yeah, to me it's fascinating though, because, well, 2 points on that. One, the entrepreneur life is all about risk and breaking what's not in just asking why, right? That's how you make a living as an entrepreneur. And you're right, it is beaten into you that you should take zero risk, which I think is hilarious because isn't really medicine— if you look at medicine 100 years ago, wasn't it really about risk of let's try something to— like, think of all the advances that have been created by people in the field saying, you know what, this is a crazy-ass way to do this, let's try something different. What are your thoughts on that?

Yeah, I mean, certainly like way back when before we had IRBs, people did all sorts of stuff for better or for worse. And I mean, you know, there's a lot of medical advances as far as— and also like things that probably shouldn't have been done that were made that way. And I think as far as the field advancement of the field, like from a medical standpoint, doctors are still— a lot of people are in research, a lot of people are looking for, you know, that sort of scientific discovery sense is still there on like the educational intellectual side. But on the business side, like none of that's there. So I don't know, it's tough. Like you're encouraged to do research and, you know, find better ways of doing things in that way, but not in really like the business model of delivery. It's kind of like, hey, don't touch that. Like this is sort of the way it is. Like you have to do all these ridiculous things. Like you have to contract with insurance, you have to work with hospital systems. And that's just not true. But I mean, again, somebody's making a lot of money off docs commoditizing us to basically, you know, they take advantage of our wanting to do the right thing and, you know, go the extra mile for people, which most docs will do. And then we get taken advantage of because of that. And, you know, we become commodities to a lot of people to basically make money for them. And so we're very much stuck in these systems.

I'll never forget this. So I was at an event in 2007. So, you know, gosh, what is that, 15 years ago, 18, 16 years ago. Anyway, so I'm at this event And I'm there with a guy who's doctor. I mean, he wasn't—I mean, he wasn't a GP, but he was either OB-GYN or he was—it wasn't like he was just pushing paper. I mean, he was in it every single day. And we were at a conference, and I will never forget this: guy in front of us collapsed right now. He was either having a heart attack or he was whatever. And a bunch of people jumped in, and I'll never forget this. This doctor. friend of mine. I knew him very well. I go, aren't you gonna jump in? He goes, if I jump in and he doesn't make it, I'm gonna get sued. He goes, I'll stand here and I will give direction, but I will not jump in. He said, my hospital will kill me if I do that because we're not in the location. I'm like, are you serious? That was my first revelation of like, this is really screwed up.

He said, who would kill him? His hospital would kill him? Is that what he said?

His hospital would give him a rash of shit if he went in, jumped in and performed CPR. He was— this was at a conference. And he said, he goes, I can give direction and tell people what to do, but they don't want me jumping in. I'm like, wow. Because of all the legal risk and all of that. I was like, that was— I'm sure that's an isolated case. But that was when I had kind of a major epiphany of, wow, the system really needs some work.

Yeah, that means somebody probably told him that. You know what I mean? Yeah. Yeah. That was probably a topic covered During some, something. I mean, there's a Good Samaritan law, you know, you're supposed to be protected for that sort of stuff anyways. So I don't know from a legal standpoint that really holds any water, but that's crazy, man.

Isn't that crazy? All right, so let's go back to the business side of this. How would you change the structure of medical school and residency knowing what you now know? If you were to go back, let's say I put you, I make you the dean of medical school at University of Miami or wherever. What's the matter with you? What would you add? What would you change?

So there's always a discussion of adding business courses and everything to medicine. I mean, but I think that, you know, you're looking at small business, which is very different than big business, which is why I think an MBA and that sort of thing is really not super helpful. Actually, I think it can be the opposite, actually be hurtful in some ways. But I think the question is, how do you let them know? I mean, I think the first thing is letting them know that their direct care and cash-based practices are available. And at least having them rotate with docs who do that and not having them talk to docs who don't do that. Because the problem is in that level is every once in a while I get approached by a med student who has a question about it and they're like, I talked to my faculty, they all said it would not work. I'm like, oh, all of your faculty who are employed by the school who barely work anyways, who have zero experience in direct care space, they're telling you it won't work? You know, they may be very intelligent and good doctors, but they don't know what they're talking about. I mean, you gotta find out from people who are actually doing it. So that would be, that I think would be a good thing in medical school just to open med students' eyes to that. Even just to rotate just a little bit. They don't have to do it a lot just so they can see like, this is another way of doing it. And then I think in residency, in residency you don't have any time for anything really.

Right.

So I think those courses would just, those things would not be useful. I think in residency you more need cautionary tales. I think you just have someone who comes in. Every once in a while, you know, you have these lectures every week and just for one of the lectures every once in a while, cautionary tale, like, hey, I bought too big of a house and too nice of cars and I got signed a non-compete and I got stuck and divorced and miserable. Don't do what I did. Like, okay, residents will remember that. Just stories, you know? Or like, hey, I was in this terrible system. I created this own practice and actually you can do it like this and it works great. Keep it in mind. Be like, okay. And to the point where there's absolutely zero exposure. I mean, as far as business skills itself, I think you kind of have to learn those from mentors or at least on the small scale or following people who have already done it in that way. But yeah, I mean, I think that, 'cause a lot of people wanna put courses in, I just think it would be tough. I mean, these med students are so overloaded with information already. They're just gonna not, they won't listen. You need stories and experiences I think would stick a lot better for the limited time that you have to teach these things.

What are your thoughts on this? Some of the states have moved to capping the number of hours a doctor in residency can work. I know like the state of New York, I think it's down to like 85 hours in a week. Whereas you hear these stories of working 115, 120 hours, 130 hours a week, being up for 3 straight days. What do you think the— is there a negative impact on medicine for those that are working those kind of insane hours?

Well, the workout restriction is pretty much universal across the United States. It stemmed from a case, I think it was in the '80s or '90s, took a while for the legislation to get passed. I think it was Libby Zion where a reporter, their daughter like had a bad adverse effect and died in the hospital. She was like a teenager or something. And, they asked the residents and they're all like, oh, we're just so tired. We're so tired. And, that kind of sparked the change. So, I mean, if you talk to old docs, they'll tell you you're not going to learn anything only working 80 hours a week. I would tell you say that that's wrong. It's a lot of time to be spent. And, there's also the quality of the hours are spent. Are you doing scut work for 60 of those hours? I mean, if you're working 80 versus 110 or extra 30, 40 of those hours just gut paperwork. You know, like you can improve the quality of the education without necessarily improving the quantity. You essentially get 10 years of experience in 5 years by working essentially double full-time. You know, I don't think increasing the work hour limit and having super sleepy docs is really good for anybody. I don't know how much you learn either when you're working that much. You're pretty much in survival mode. You know, but again, medical institutions, this is the way we've always done it. It took a lot to change that. And I think for the better, you know, I don't think we were doing anybody any services by keeping work hours, you know, unrestricted like that. I mean, look, 80 hours, if they're quality 80 hours, that is still a lot.

I mean, that's a lot of hours. Yeah.

You can't make it, you know, you can't process, right? I've hit 80 hours. You know, usually we hit 80 hours, you work in an overnight shift or something, but like, I mean, I've hit it just Monday through Friday before. It's a lot you're doing. You're getting up. Going in really early, working all day, coming back really late, and just eating, using the bathroom, and going to sleep. I don't know. But of course, you'll find these old docs who like, oh, I worked 120 hours. It's this classic mentality like, well, was that a good thing? I mean, do you want that to continue or you want to keep torturing everybody for no reason? I don't know.

Let's talk about Easy Orthopedics. Let's talk about what you're doing today because I think this is a fascinating thing. So, This is, you do mobile orthopedic care. Tell us what EZ Orthopedics is. Let's talk about more about this journey.

Gotcha. So it's a cash-based practice. So I don't contract with any insurance companies at all. And by cash, I just mean that I don't have to interact with an insurance company. So if I see a patient, they can submit to insurance, right? I'm not submitting. I can give them everything they need. Or if it's medical legal work, I don't have to interact. I get paid in advance. Don't have to interact with an insurance company. Personal injury work, I don't have to interact with an insur— I have to interact with a lawyer, but I don't have to interact with an insurance company. You know, so it's really anything where you don't have to. And, and the reason why I say that is because if you do interact with an insurance company, you've already ruined your practice. Like I said, 5 people per, you know, changes the way you code and you bill and it shoots the overhead up to the moon. And then you're all of a sudden running a high volume practice. So by nature, a cash practice, at least the way I run it, is sort of like a low volume, a low overhead practice. Does not mean low revenue. Which some people falsely think.

Or low volume doesn't mean it's probably way higher profit than what you would be doing in the insurance world.

Oh yeah. Right. I mean, per hour, I don't, you know, you work significantly less than you can earn the same or more depending on how busy you can get. But, you know, at your max, you're still working significantly less. I mean, I'm not working at a hospital, so I decide I don't take call. You know, there's a lot of pluses here that sometimes people miss. But yeah. And so the mobile part, when I started, obviously I couldn't afford a lease. And my friend in South Florida had a, that did it mobile. So I said, I'll try that as well. So start off was pretty much 100% house calls and I carried everything around.

Orthopedic house calls? Like, yeah. Is that like what that tub is behind you in that bag? Is that it? You just walk in with that?

Yeah, those are all my supplies. Yeah. So in that bag, I know it's at the corner of the screen there. I've got a little ultrasound. I've got an iPad, all sorts of injection supplies, sutures, wound care. It's all condensed in there. Yeah. So that's so, so cool. I started that way doing house calls. Then after a while I'd see people in the community, other docs, and they'd be like, hey, can you see this person at my office? We're coming in at 9. And I'm like, okay. So I started going to these other people's offices and, and seeing people there. And I'm, and then after a while I had all these offices I was going to, and then they start letting me bring my own patients there. Now some people may say, well, how did you, I get this question, how'd you negotiate the leases and whatnot? And I'm like, I didn't, we don't exchange any money. And I think this is a problem with doctors. We devalue ourselves. So when I am there, I am a value-added service, right? I'm not using their front office staff. I'm not using their EMR. I'm literally only using the room. I bring all my own supplies. I clean up after myself. So I am literally using a room when no one else is using it at these offices. And I'm a value-added. You have an orthopedic surgeon coming into your office. And for a lot of practices, that's a plus that they can say and market. And the people that get it, get it. So It's not like I'm in there all the time. And so they don't charge me and I bounce in and bounce out and I'm a very small footprint. And that's how it works. Now, of course, that won't work with everybody. They have to understand the value add that you give. But let's say for like a chiropractor, you know, they're worried that if they send them out to the ortho practice in town, they might never come back. So for me to be able to see them at their office, it's a big value add.

Oh, that's brilliant. That's brilliant. I mean, we have a number of clients of ours that are chiropractic and they've partnered with a doctor to provide regenerative orthobiologics, right? And they're, you know, their patients are happy because there's a bunch of patients that they can only take so far. So you're not doing any more surgery these days, right? Are you done doing surgery or are you—

No, I still, I still do them. Okay. But they've kind of moved them to like smaller stuff that I can do in a procedure room. So like under local, so like Dupuytren's, carpal tunnel triggers, cyst excisions. So that at the current moment, that's sort of what I'm doing. I've done more invasive stuff before when I used to work at the, had access to the surgery center, but that's always sort of been a work in progress. I still do it. I still have to do labs regularly to keep my skills up. I mean, I have to make sure my cases that I'm doing are relatively straightforward because I'm not operating as much as I'm used to. But no, I still do it, believe it or not. You know, that's been a hard part to build into the practice. And I could certainly be very profitable without doing any of it, but it's something that I feel like I can do and I like to do. So. I still do it.

What is the reaction to the patients when you tell them you do not take insurance? Because the general consensus with most doctors is that if I don't take insurance, nobody's gonna wanna work with me.

You mean, so the reaction of the patient?

Yeah, the reaction of the patient.

Well, a lot of times they're really happy about it because they found me because like I said, they have a high deductible, they don't have insurance, and they do the math and they realize that I'm the most economical option for them. So they're very happy to find someone who has transparent pricing, can get them in quickly. Take care of them and has good communication. So I think it's a great, I mean, most people are pretty happy about it. Yeah. I mean, yeah, you get the calls or like, well, I have A, B, C, and D. Do you take Medicaid? Do you take UnitedHealthcare? And we're like, we don't. They're like, oh, okay. Which is fine. We don't end up seeing those people. But I think as health insurance gets worse and worse, meaning that premiums are really get higher for patients and they cover less and deductibles go up, I think you'll see more people start Thinking about using cash for care, which I think is the way to go for, I mean, that's what I do for most things that they need. You know, again, we're so institutionalized in this country. We think like you just have to have insurance. And on the other side of the coin, you certainly don't. I mean, I don't have it. I use a health share. I use direct primary care to cover my own personal needs. But yeah, I mean, docs think that like if you do cash, like, I don't know, there's, there's some fallacy that like, uh, we're only treating like healthy and wealthy people and we're just Going to super rich people's houses and it's just totally wrong. I mean, you get some people like that, but the majority of people are really getting squeezed by the system and are serviced poorly and you're, you're a real godsend to 'em. So I, I think a lot of docs falsely assume that, and these are also docs who aren't involved. They don't have any knowledge of direct care. They like to think that the way they're doing it is the way they have to be doing it because they're suffering and they don't want to think that there's another way they can do it where they don't have to suffer in the same way. So. You know, you get some pushback from docs as well.

Yeah, I think you get more pushback from docs, quite frankly. Yeah, I've been in this space for 10 years. And, you know, so the latest statistic, and I'm sure the number is going to change, but the statistic at the beginning of this year was the beginning of '23 is that 60% of Americans are in a what the government deems a quality healthcare plan. I'm not sure what the government quantifies as quality, but we'll just leave that definition alone. And the average out-of-pocket deductible for a family of 4 is $10,000. And it's something like, it's something stupid, like only 30% of the people hit that deductible. So, and if you look at what just happened as a business owner, I have all my friends, all my close friends are business owners. They are experiencing an 85%, on average, 85% increase on their fees, their insurance fees, their insurance rates.

It's a scam.

It's a scam. And then on top of it, they're reducing the coverage, right? So they're like, not only have my fees gone up, but they're reducing this and this and this and this. And we've gone in our company, what we're moving to is I'm just— because I have a contract, you know, I have the ability to connect obviously with all kinds of great doctors— is like, look, we'll just provide catastrophic care, whatever that is, right? And we'll give you money to go pay for your HRT and all the good stuff to help you stay in your functional medicine stuff, because it's just— it's such a scam. I mean, how do you— how did we get to this place, Dan? Like, how did we get to this place that it's such a fucking scam?

I mean, gosh, it is such a scam. I mean, you know, you're talking like, all right, so you hear people say this all the time, like, well, I don't know, my insurance paid for it. It's like, who's paying for your insurance, man? It's you and your company. Your company is putting out a lot of dollars and you're putting out a lot of dollars for the premiums to have the benefit of having insurance. Now that money could, if that money went to you, you, everybody would have a giant salary increase. I mean, like thousands of dollars a year, but it's not, it's going to the insurance company. When the premiums go up every year, guess who's not getting a raise? You may be, I mean, you are getting a raise actually. It's just going to the insurance company premiums, not going into your pocket. So every year those premiums go up and the coverage gets worse. I mean, you're talking like $8,000 deductible and you're paying $2,000 a month. I mean, like you have like $20,000 before they pay that first dollar and then you go out of network, they won't even pay that dollar at all. So yeah. How do we get to this place? Well, I think that you have to go back a long way. So in World War II, there was wage freezes, so you couldn't increase someone's wages during wartime. And so what some employers did to attract people were they would start offering health, major medical coverage, meaning that if you had to go to the hospital, they would pay for it. Now, at the time, it was much, much cheaper. There weren't many things that you could do, and it was like, it wasn't the monster that we have today. So it was significantly cheaper. So that's kind of how benefits got tied to working, and it's kind of just kept ballooning. And I think as time has gone on, and I think the Affordable Care Act certainly accelerated this process.

Oh yeah.

These companies, these insurance companies and like hospitals and pharmaceuticals, they figured out they started making a lot of money and they're just kind of leaning into all those things that make them money. So for insurance companies, it's charging more for premiums, closing networks or narrowing networks, denying more things. And like, they're so profitable that they just keep doing that. And as patients, we're so used to the mentality that you have to have health insurance that we're just willing to suffer through it. And even though there's other ways of doing it, I mean, but as this pain point gets reached by many people, including patients and physicians, more people are kind of figuring out like, hey, this is a real raw deal. I'm not doing this. And you're starting to see some change, albeit slowly, because healthcare system, in contrast to, let's say, the tech sector, moves extremely slowly.

Yeah, it's, well, I think it's fascinating is that, so I'm 56 years old, right? So I'm Gen X. But if you look at the generation after me, when I look at— I have some clients now that are in their 30s or early 40s, and they're not even— they're like you. They're not even going into the industrialized insurance mechanization system. Like, it's just— they're like, no way. You can't. You're like, wait a minute, I've got half a million in freaking loans. How the hell am I going to do this? Right?

I mean, it'll— yeah. So for me, a health share is much more economical than an Obamacare plan, right? I mean, Obamacare plan, is so expensive. And unless you have a subsidy, there's a certain select people who do, and it actually is affordable. But, you know, the networks are razor thin, you know, and there's so much deductibles are sky high. Just the health share, just for me and my family being healthy, makes a lot more sense. But yeah, it's wild. I mean, like, if you don't have income, you can get Medicaid. I mean, it's not, it's not, you know, there's just so many problems with that whole system. But if I'm like, you know, I don't, I really am anti-insurance. So obviously not just do I not take it, I also don't carry it personally.

Yeah. So what is your, what's a typical week like for you? So I'm sure I want to go back to this because I'm sure some people are listening. He's like, oh God, how can he be making any money charging $29 for an office visit, driving around and doing it at home? He's going to eat up all his money in gas. Let's talk about work. Let's talk about how many hours you work in a week, right? How many patients you've seen. And while I don't want you to disclose like the actual dollars that you're making, but compared to what you would be making if you were in a Working in the Viking slave ship of hospital groups.

Gotcha. So, I mean, so I'm not charging $29. So when someone books a visit with me, I generally charge $375 just for an hour of my time. And that generally includes one steroid injection. If they need more, then I'll charge more. So that's the cost of one visit, right? For one hour. And then this is not factoring in like any sort of procedures I do, any sort of medical legal work or anything else. This is just pure cash pay patients. And then my overhead, because I don't have an office or any employees, my wife works with me. My biggest expense is malpractice. So I think I haven't calculated it in a while. Last time I calculated my daily cost, it was like $70 or something like that to run my practice.

Wow. What?

But maybe, you know, because think about it, you get rid of an office and you get rid of all the staff. I mean, you don't— what are you paying for? Medical supplies aren't that expensive, at least the ones I need. A lot of it's insurance and junk, which, Anyways, so if you go out and you see 3 people in a day and you charge them about $400, you know, that and $100 of cost of running it, that's $1,000 you made for a pretty small amount of work. You know, and you string that along for, I don't know how many workdays are in the week, but you can easily see that you can do pretty well with a minimal effort. And if you say, instead of seeing 3, you see 6, it changes it. You start adding in procedures, you add medical legal work, you can do pretty well with a minimal amount of work. So, but the problem is getting patients. So it's not like you always have a ton of patients. So I, I'd say in a typical work, you know, I work as much as I have available, right? And I do have days where I'm somewhat busy, nothing compared to what I used to. But with this model, I think you can max out at like 6+ people a day. 6, 7 kind of is probably the most you could do. That's pretty good money right there. But yeah, I mean, I don't know, I'm probably seeing like 10, 12 patients a week, maybe an independent medical evaluation, maybe something else. I'm probably working less than 20 hours. A lot of time with my family. You know, I'm not going into hospitals. I'm not rounding. I'm not taking call.

You're present with the kids. You're present with the wife, right?

Yeah. Oh yeah. That's super important. I mean, for me, I put, you know, a lot of people say they put family first, but then they work all the time. So you really put work first. I really do try to put family first.

I'm expecting to see the kids. I'm kind of disappointed the kids haven't run by. That's usually my favorite part of these interviews.

The other one's upstairs watching Spider-Man with my wife, who I told I was doing this, so she's keeping her out. She's 2.

Spider-Man's pretty good. Maybe we should go up and watch Spider-Man instead.

Yeah, I know. Yeah. I mean, it's some pretty good stuff. Yeah. The cartoon was like little kid versions. But anyways, as a parent, you know, young, caring of young kids, you know, all those sorts of things. Yeah. But anyways, going back. So, I mean, I think, you know, I'm definitely in the ballpark of like orthopedic surgeon salary, but I work a significant amount less. As time goes on and I get busier, I think that I'll probably make more than mostly any other orthopedic surgeon. And, you know, besides the people who have giant practices or royalties or patents and that sort of thing, and working half as much if you can fill the model out, but it takes time. I mean, that's, that's the hard part is getting patients and building it up. Because then certainly in the beginning, you know, I'd have days where I wasn't doing anything. Even now, every, every once in a while I get days like that or days where not a lot's going on. That's just kind of the nature of your own business. But yeah, I mean, a lot of people think that like, oh, he's just probably not doing it, making any money. I mean, if I'm not, that means I'm also not working a lot at all. So even with, I think the per hour work, you make significantly more. You just have a lot less hours.

How do you get patients? How do you go out and get patients? Because that is like, that is the number one issue of questions that I get. How do I get patients?

So yeah, it was hard. I mean, So I have good search engine optimization on my website, so people will find me through the website. But really it's about finding good referral sources in the community. So I have a list of people in the community and how often they refer per time period, per quarter. And then over time you kind of figure out, all right, who actually refers to me? Who actually values what I do and who, who really doesn't? And I've found some excellent referral sources who bounce me people quite regularly because they know the value that I add. If anyone else ends up doing a practice like this, let's just save some time. You would think that it would be direct primary care doctors would be the best referral source, right?

Yeah.

cash pay patients, primary care. Yeah, you're laughing because you know, you know, I know the answer to this. You would think, right? And you would be wrong.

Yes, it would logically, it would make sense logically.

So in the system, those guys refer out all the time, right? Because they're overloaded. There's no time. Referral, referral, referral. When you're out of the system, they don't because their value is basically keeping patients from going out to see anybody. So they don't really tend to refer that much. And also this irks me a little bit, and this isn't true of all family med direct primary care docs. And by the way, I think It's the best care you can get. This is what I use for myself. But they also tend to do a lot of musculoskeletal care, I think very inappropriately, because they're not really trained in it. They only send things to me like when they've tried a bunch of stuff and it's failed, which like maybe it's fair, maybe it's not. But sometimes things they do, I wouldn't do. So they're not a good referral source. Actually, who refers the most for me is chiropractors. They just seem to—

I was just gonna say, they're great.

Yeah, they're all cash pay. They're all cash pay. It's all musculoskeletal. And they understand what I do and they're like, this guy needs a shoulder injection. Dr. Paul, can you come and see him and take care of his shoulder or hip or whatever? And I'm there. So them, and then some physical therapists as well, tend to be my best referral sources. That combined with, you know, electronic website stuff. And then also just being in the community for a while, getting more medical legal work by doing some good reports and things. So it's just a slow, I don't spend money on marketing. So it's, that's another reason my costs are so low. So it's just a slow word of mouth growth, which is the best, but also takes the longest.

The chiropractors, and like, I'm a huge fan of chiropractors, right? One, before this, I was at the chiropractor as a golfer of 50 years and somebody who works out a lot. Yeah, chiropractic is my friend. But on the flip side of it is, and I have probably in my group in Business Mastery Fellowship, I think I have 4 or 5 chiropractors. And it's so funny, they actually are like, well, I don't like to tell anybody that I'm a chiropractor. Because I don't want them to like think ill of me or something like that. I'm like, what are you kidding me? I'm— every single one of my orthopedic surgeons is looking for a chiropractor to bring business because it's the perfect marriage. It's the absolute perfect marriage. And they're great people, right? Like they're, they're forward thinking. They think differently, right?

Yeah. They just, you know, I think with chiropractors, I mean, they have to— they're much better at business than physicians because they have to be. Oh God. Yeah. They just can't go out and get a job. I mean, they have to create their own business. Insurance kind of ices them out. So they end up, a lot of them end up not taking insurance. So a lot of them end up with these really nice cash practices just by necessity. So by necessity, they're all sort of forced into direct care in their own way. A lot of them are, so they end up being much better at business. That's one part. And with chiropractors, it's like lawyers or like doctors, like physicians, anybody else. They run a full spectrum, right? I mean, you've got ones that you really like and are good and ones that you probably wouldn't want to go to. So I think you can't really— same thing with lawyers. I mean, I don't think you can write a whole people off for profession. I mean, you have to meet the individual and judge 'em. Chiropractors run a full spectrum. You have ones that, hey, you got hurt, let's adjust you and do modalities and get you better. And people get better. And the other side of the coin is, well, I'm gonna cure your wife's asthma. And I'm like, eh, I don't think you will. So, I mean, there's a, you know, I'm sure if there's a holistic chiropractor listening, they're really mad right now, but.

Uh, don't worry, I'll hear, I'll hear from them and I'm going to give them your number. So don't worry about it. You'll get the chance to talk to them.

Yeah, yeah, no, I mean, but there's people that like that, you know, who are into holistic care and like, I don't get referrals from holistic providers at all. So like, that's another part of the referral game where knowing like, okay, this person's a holistic provider. I'm never going to get anything from them. So like, I'll, you know, I talked to them, but I'm not going to pursue that. But again, with anything, it's a full spectrum. So I found it to be very good relationships for me and, you know, We respect what each other does. And you know, because I think as a physician, orthopedic surgeon, you're trained to be like, oh, chiropractors, they're doing God knows what. You think that, but especially spine surgeons. But honestly, a lot of people go to them with their musculoskeletal pains and they come out without any musculoskeletal pain. So I mean, that's the same thing I'm doing, just in a different way. I mean, well, then it's also the place.

It's the place where a lot of people start, right? It's not going to be the perfect solution for everybody. I have a couple chiropractors and what they do is They have a lot— like, one of them has been a chiropractor for 20-plus years, so he has whatever, 12,000 patients, 15,000 patients. And now what he does is when they come in, his orthopedic surgeon partner that they own the regenerative practice together, he does an ultrasound scan on where they've been injured, shows them where there's the tear, and then presents a different solution to them. So it's a great, great solution. Now, are you doing any things like regenerative Orthobiologics, PRP, you doing any of that stuff or you keep it clean?

I do a little PRP, yeah.

Okay.

People are requesting it and so far what I've done seems to have pretty good result. I wouldn't call it a regenerative clinic, but I do offer PRP. That's when people are looking for it, I have that, which I'm glad to have, to be honest with you.

So your friends that you went to med school with and were in residency with that have gone into this system, when you check in with them, what do they say? To you? Like, are they surprised this is working? Are they envious this is working? Do they want to know how to do it, or do they just ignore it because they feel like they fucked up and made a bad decision?

So I think that's a very good question. It's a very interesting question, very interesting as well. So there's a difference between my friends in medical school and my friends in residency, right? Yeah. So I'll start with my friends in residency who are very much in the system. I think at first they're like, what is this guy doing? They know I quit my fellowship and they don't really know, they don't think I'm operating that much. And if like, you know, which I'm not, and in the world of orthopedics, a lot of people think that, which is you're not operating, like you're just, that you're not doing anything, right? Which is just not the case. So I think at first they're like, well, I don't know, maybe he's just burnt out or doing something weird. And I think over time they see me keep doing it and that, you know, my revenue keeps rising and they're kind of like, oh, this is, I don't even know if they know what to think about it. I think there is a little bit of like, oh, I might've messed up there, but there's a little bit of kind of like curiosity. Like, he's still doing that? Is he making any money? Is he able to support himself? And I think as like one of 'em started to realize, like, I think he's making a good amount of money, you know? And so I think there's slow realizations there, but family med docs hit the pain point so much earlier. So direct care is more of an established thing. Direct care with orthopedics is very much not. So I think there's that. In med school, I've actually had a good chunk of people approach me, friends who are like, I need to get out of the system. I need to sort of do what you're doing. And so I help them with that, which is crazy because they've only been— I graduated med school in 2013, right? So in practice, like 5 years plus minus. And a lot of them after 4 or 5 years are like, I'm done with this, you know? Yeah, it's really bad.

Yeah, we hear it all the time. It's amazing.

I think my generation of docs, like, you don't have a 30-year shelf life. There's no 35-year shelf life. I mean, you're seeing 5, 10 years, I think, before people are over the profession, which is crazy considering the amount of time you put in. But after all that wearing down through training, I mean, I have one friend, she's a pediatric interventional radiologist, she's on call Q2. You know, another friend was a neonatologist just being worked to the bone. There's an ER doc I went to school with who I'm not super close with, but apparently he has like an aesthetics practice and stopped doing ER. And there's someone who's direct care dermatology. There's that friend from med school. So I mean, there's a good chunk of people that I personally know who Are sort of figuring out other ways to do it or getting out, which is wild. So on that side, that tends to be more med school. This tends to be more like, whoa, you know, because it's different specialties. Like, I need to do what you're doing. Like, let me know how you do it versus residency, more orthopods where they're just like, well, is he still doing that? Is that, is that really working? Is, is he making money? And like, I think it's starting, the tide's starting to turn a little bit and I think it will turn eventually. When, you know, as time moves on, but it's really crazy actually. I mean, docs are burning out fast. I mean, you're not getting end of career burnouts. You're getting like early career burnouts.

Yeah, I could story after story after story. I mean, one of my top clients is a chief of surgery, has overseen 16,000 joint replacement surgeries as a chief of surgery and highly compensated. Walked in one day and they said, hey, we're, uh, your 3-year contract, we're going to cut your fee in half.

Yeah.

And he basically said, fuck you, and went and started his own practice. This was a year ago, and they're doing great. They'll do a couple mil, you know, I mean, in their first year. That's pretty good. And he's never been happier, right? You know, he has the office, right? He has staff. He's decided to go that route. And I think that's what people don't realize is there's so many different— there's not a way to do non-insurance business. Right. It's really about— it's about your personality. Like, I could see as a young father and knowing what I know about your generation of wanting to be involved in their kids' lives, like, this is perfect. You don't need a Maserati. You don't strike me as a Lamborghini kind of guy.

No, no, I've got 2 Subaru Foresters that I bought used. And so yeah, that's— I mean, of course, I could— I mean, how dare you as a doctor not get into debt?

I know.

What are you thinking, Dan? I know. Oh my gosh, you know, I didn't That's another thing. I mean, Doc, I think it's a terrible idea to really, unless you have tons of cash lying around, like if I wanted to, I could buy a Tesla today. I've just got, but I don't want to. I mean, we get out of training, we're like, I've been delayed gratification. I deserve this. It's encouraged. You buy the really nice house, you buy the really nice cars, your kids go to private school. You sign this hospital contract with a non-compete. The contract comes up for renewal and like your friend, the second time around is not so friendly as the first time. And you golden handcuffed your stuff and you're stuck and you're miserable in this job you hate because you bought too much stuff. So for me, the stuff is like in a direct contrast, a direct like countering autonomy. So the nicer stuff that I buy, the less autonomy I have, at least at this point in my life. So I try to, I still buy quality things. I still go on vacation. I still go out to eat. I just don't need the nicest of every single thing, especially the big stuff like houses and cars. You know, I feel like we have a very nice house in a nice area. Do I have the most expensive house? No. You know, same thing with cars.

Are you more involved in your kids' life? Are you more involved in your kids' life and your wife's life than 90% of your neighbors?

Oh my gosh, I'm around all the time. Yeah. I mean, first year of my first daughter, I've got 2 daughters. I was finishing residency. So the first year of my daughter's life, you know, I was still training. I was very busy. And then the first year of my second daughter's life, I was around a lot. I'm like, man, I missed a lot of that first year. So you don't even realize how much you're missing. And I mean, I think the medical profession will just kind of take, take, and take from you. And like, you really have to put your foot down and make some real changes to have it stop taking from you and actually start giving you stuff, you know? Otherwise it'll take everything from you.

Yeah. That's one of the bigger questions I get a lot is I was talking with a doctor the other day and he goes, well, God, I just bought a Tesla and we just got a new house. You want me to start a new practice? And I'm like, I mean, one, you can start it right inside your insurance practice in a heartbeat. But 2, it's like, oy vey, you know?

I mean, yeah, it's frustrating. Bad business, bad money.

Yeah, I know you got to go here in just a minute. Tell me what the future looks like 5 years from now. Where do you see medicine going? What do you— if you had to bet on what's going to be happening, where doctors are going to be and what the industry is going to look like 5 years from now, what do you see?

Sure. So I don't see insurance or hospital conglomerates slowing down. So I think whatever we experience that sort of core of stuff that you hate, just going to be more of that. It's going to be worse. Reimbursements are going to be lower. There's going to be more administration. Patients are going to be more higher volume. Everything that you can think of that you dislike is going to be more of that in the future because these entities are making multiple, you know, they make stupid amounts of money off of it. And so they're not going to stop. They're going to keep pushing in that direction. So more of that increased status quo, but I think you're also going to see more docs sort of defecting out. And you're gonna see direct primary care grow more and you're gonna see direct specialty care start to grow. And actually I created a course to sort of replicate my practice. If you go to insurancefreemedicalpractice.com, it's there. And it gives 35 CME credits and it basically helps you avoid all the mistakes I made when I started. But anyways, I think you're gonna see, you're gonna see more direct care as people kind of defecting out. It's gonna be slow, but that I think is what it's gonna be. It, it's just gonna, keep continuing on. System's going to get worse. More and more people are going to leave. It's going to create an alternative ecosystem and we'll see where that's at.

What do you think? You think there's going to be a tipping point where all of a sudden the doctors, that there's just not enough doctors for the hospital system?

Yeah, possible. It could be like decade or plus before that, because if this alternative system starts really being a much better existence and hospitals can't get anybody, then they'll make it better for doctors. So, you know, it'll in turn increase the quality of life for a lot of these doctors. You know what I mean? So the doctor's like, well, if nobody wants to, they'll try to outlaw the hospital or they'll try to outlaw us or they'll outlaw us.

They'll work with Congress. Yeah.

It's going to be hard, right? Because, yep. Yeah. That's another thing, like legal, like outlawing. I mean, here's the thing, right? Most of the laws are not, they're all reimbursement related, right? So all the regulations are reimbursement related. You have to do A, B, C, D, E, F, G to get paid. But once you remove that, there's not very many laws, like laws, laws telling you what a physician you can or can't do. I can legally, not that I would do this, I would never do this. I can legally be like a derma, do pathology, dermatology. I could legally do cardiothoracic surgery. Now, no malpractice would cover me and I would never do that because I don't know what I'm doing. But there's not, it's not illegal for me to do that. It's not illegal to someone to charge cash unless like you're opted into Medicare. They can try, but again, it's an elusive, how do you stop it? And I think right now it's so small, they don't even care. They're making so much money. It's like a fly on the radar that they could care less. So. By the time they do care, like it's going to be hard to sort of prevent that.

At some point they'll realize that we are their Jimmy Stewart in It's a Wonderful Life to Mr. Potter. And they'll try to figure out a way to eat us. And when I say us, even though I'm not a doctor, I'm, I feel like I'm a champion in this space. But yeah, I mean, you know, at some point we're going to be cutting into their money and they're going to want to try and figure out a way to put us out of business legally. They have a history of doing that. All businesses do.

So yeah, I mean, but it's disruptive technology in a certain sense. So what they'll see is that we're grabbing bottom parts of the market right now and they don't care about that, you know, you take your cash pay and stuff they don't want to do. And as time goes on, we'll sort of move up market and they'll move farther up market being like, well, we still all do the really, we'll do all the expensive stuff until we find the ability to do that too. And then they have nowhere to go. I mean, if they can try what they want to try, but I think it's going to be hard to stop the whole direct care movement, basically saying that people can't pay cash to see a doctor, you know?

Yeah.

And plus besides that, there's other sorts of avenues. You still have personal injury, you still have medical legal work, you still have Things that are not covered by insurance, like regenerative medicine. There's all sorts of ways. And the nice thing about direct care practice is you can brand it to your own personal way of how you want to do things. So, I mean, it'll very much reflect what you want to do and what you don't want to do.

Cool. All right. Hey, tell everybody how they can get in touch with you. I know you're on LinkedIn, by the way. If you are not following Dr. Paul on LinkedIn, you need to. His stuff's awesome. Like it's, I don't, I don't know where you get your mildly, is that from the Northeast where you get your mildly sarcastic sense of humor?

I don't know. Yeah, somewhere along the lines.

Because it's really good. I don't know.

Oh my gosh. Yeah, sometimes I have to give it to people.

My favorite post, I think, of all time was the one where you posted about the EMR and the campus that looked like Harry Potter. That was my favorite, I think.

Oh, you like that?

Yeah, it was great.

You know why I like that so much is because, for those who aren't listening, we're talking about the Epic Medical Campus that's in, I think it's in Rochester, Minnesota. And the United States is considered the wealthiest country in the history of the world. All right. And 20% of the GDP is healthcare, which is just, it's just, it's mind-boggling amounts of money. And you rarely ever—

I never knew that. I never knew that.

You rarely ever get to see like what the wealth actually looks like because it's just in insurance company ledgers and who knows. But this is an example of who actually get to see the wealth that exists in this system. And if you look at a YouTube video of the Epic Medical Campus, you'll see why, because they have all sorts of themed buildings and it looks cool, but it's also extremely disturbing at the same time.

Yeah. And it's built on, you know, hey, you're like your fees that you pay them that you can't, once you get ingrained with an EMR, it's hard to get out. I witnessed it all the time. So yeah. So how do you, so good solution for that?

Oh yeah.

So tell everybody, I love this. And then what's your solution for an EMR? I love this.

So EMRs are expensive because they need to let, they have to buy or rent the CPT codes from the AMA. And that's how the AMA makes most of its money from lending out these CPT codes. And so they're all billing machines. That's why they're so expensive. But if you don't need to do that, you can really go bare bones and be fine. So I have Google Workspace and you can make it HIPAA compliant by signing a business agreement. And then I have templated Word documents, which with my own letterhead and my own logo and everything. So they look like regular notes and I just make Word documents and I save them as PDF and send out the PDFs for orders. Orders work great. And for notes, that's what I have. I mean, and so it's, it's—

What does that run you per month? Just compared to the thousands of dollars. $36 a month. Yeah.

I could do it for less if I wanted, but I have like the really upgraded plan, so I pay a little extra, but it's just me and my wife. She pay per user and, and you get all the Google stuff that comes with it. It's all HIPAA compliant. So yeah, I, I had to give it to someone the other day. Athena was calling me and I was like, you guys gotta stop calling me. You tell them to stop, they don't stop. It's really annoying. No, they don't.

But, um, they call me and I'm not even a doctor. I swear to God, they call me. I'm like, what the hell?

I had to be professionally rude so they would hopefully be like, I don't want to talk to this guy again in 6 months. We'll see what happens when they call me in 6 months again, probably. Yeah. But there's just so many things like that in the cash-based world that I figured out that I think can just save you so much money and time and frustration. So, but yeah, if you want a good— if you want to feel sick and Just watch the YouTube video of the Epic Medical Campus.

Yeah, it's great. And then give them your site again. I think the more we can get the information out to people about how they can have an option outside of the insurance system, the better off medicine is going to be. So what's your site again?

So you got a few things. So the website with the course where if you wanted to replicate my practice and get CME credits is insurancefreemedicalpractice.com. That'll take you to it to buy that course. My website's easyorthopedics.com where you can find out more about me. And then, uh, on LinkedIn, and then I also have a YouTube channel as well. It's more just informational stuff. I did it early enough, so it says youtube.com/@orthopedics. So I was able to get that once they introduced those tags. I was able to grab it real fast. So I'm proud of that. But that's more of just about like, how do I know if I sprained my finger kind of videos?

Well, you mean as opposed to like going to WebMD and thinking that you have cancer?

So yeah, right, right, right. Exactly. Everything's cancer. Yeah. LinkedIn is more of like the content that I post that we're sort of talking about.

Yeah, it's great stuff. Well, Dr. Paul, thank you for taking the time, and I love hearing the journey. I'm glad to hear that there's another one who has figured out how not to be part of the system and create their own system that works for their lives, their family, and their, their spouse. So kudos to you, my brother. Kudos to you.

So, well, thanks, Matthew, for having me on. I appreciate it.

You got it, brother.