Exploring Dr. Ariana Demers' Regenerative Medicine Journey

Hey everybody, it is Matt Gallogly and I'm here with Dr. Ariana Demirors. And many of you know Dr. Demirors. She is the current president of IOF and she is a well-sought-out speaker and trainer, not to mention an amazing physician, orthopedic surgeon. She actually helped heal this wonderful little elbow with some great PRP. And so, we're here this morning because I need you to hear Dr. Demir's story because I believe that it's actually very similar to what a lot of you are going through. And so, Dr. Demir is going to share with us how she wound up in regenerative medicine. And, I think you're going to be pretty fascinated by this story. So, Dr. Demir, how in the world— take us back 6 years ago. What was going on in your life?

Yeah, so I was a very busy orthopedic surgeon. I had a 2-year-old daughter at home, and me and my husband were trying to figure out how to raise a 2-year-old and both be surgeons. And I was working my normal, quote, normal hours, probably 80 hours a week. As an orthopedic surgeon, I was—

Normal hours, just 80 hours a week, right? And for context, her husband's an OB-GYN, so he gets called in the middle of the night to deliver kids, right? So, yep, really perfect work-life balance situation, right?

Perfect. And so, yeah, I was very productive. I was doing a lot of surgery. I was doing surgery 2 days a week. I was seeing patients 3 days a week, 30, 35 patients a day. And I was like, what am I doing? This is so miserable. I have no idea what I'm doing every day. I don't think I'm helping people. I'm just going to work, knocking out the patients. I'm drowning.

Mm-hmm.

I had really just— I was begging my husband every morning. I'm like, gosh, please don't make me go to work. There's got to be a different way. I don't know what to do. I can't do this anymore. I'm, I'm done. And so I went to work and I was, I was, you know, on the verge of tears. Like, I just was so out of my element and still busy, still being super productive, but not happy. And I'm sure it showed in all of my interactions. I was probably a little short. I was probably a little hard to get along with. I wasn't my best self for sure.

Right.

And I was seeing patients and seeing patients, and I was like, I'm done. I'm done. I walked out at lunch. I had a full afternoon full of patients already scheduled, and I walked out of my clinic with no intentions of coming back. And I didn't know what to do. So I sat in my car, and I was like, I don't know what to do. So I called my friend who's part of the wellness department. department. I said, I need to go on sabbatical. And he said, um, I don't think that's possible because you have to have a diagnosis to not work. And I was like, I don't think that's okay. I don't have a diagnosis. I just, I can't do this pace anymore. I can't, I can't do this. I'm not helping people. I'm not my best self. I don't even like my job. And, and that's unusual because I love orthopedic surgery, and I love my job, and I was just hating going to work every day.

So wait, I want to back up a second. So you— I want to be really— I want everybody to get context to this.

Yeah.

So first and foremost, orthopedic surgeon. We know that's a very rigorous, grueling process to become an orthopedic surgeon, right? It's one of the hardest processes, rotations, whatever the technical phrase of it is. On top of it, On top of it, you— how long, like, when did you know you wanted to be a doctor? At what age? Early on, right?

Yeah, I was probably 10.

Okay, so this has been a lifelong dream, right? And went to a very well-known, pretty well-known, right? Pretty rigorous orthopedic surgery medical school. And then where'd you do your fellowship on orthopedic surgery?

Yeah, so I did my residency at Michigan State and then I did my fellowship in Taos, New Mexico at Taos Orthopedics in sports medicine.

Okay.

So I'm fellowship trained in sports medicine. And yes, it is hard. Only about 7% of orthopedic surgeons are women. And so it's a little bit different field. Definitely not, Attuned to maybe lifestyle, having family, having kids. Basically, the recommendations, like how we live our life, is just keep working harder. Yeah. Yeah.

And so I want to come back to this. I want to come back to that about working harder, because this is why I'm setting this up. So it's not like for And I know people in the medical industry know what orthopedic surgeons go through, but it's not like this was some random thing. Like, you had dedicated your life, and this was 6 years ago, up to 6 years ago, you had dedicated your life to serving your patients, and that's really all you wanted to do. But is it fair to say the system was chewing you up and spitting you out?

Totally. Yeah, absolutely.

Talk more about that.

So honestly, I've kind of had a number of reiterations of my career When I first got to Sonora, which is my first job out of fellowship, I joined a senior orthopedic surgeon in private practice. And I kind of got blindsided because I joined him and I'm like, I feel like maybe you're going to retire. He's like, absolutely not. I am not retiring. And then 4 months into my first job, he says, you know, I'm retiring and I expect you to buy my practice. And I was like, dang, uh, I kind of saw this, but you promised that you were not doing this and you are doing this. So I actually decided to open my own practice to spite him because I wasn't gonna buy his practice. Um, and I had no idea what I was doing. I, I got the, um, Business for Dummies, literally Business for Dummies Yellow Book. And I started like trying to learn something. And I opened my practice, my own practice, a year out of fellowship with really no business experience whatsoever. And I hired a doctor. And then a year later, I hired another doctor and we had 2 PAs and we had all of the big practice things. And it was successful and I was successful and we were doing great. But It was way too much and it was really taking a toll. So I sold my business to the hospital and that was financially a good decision. And unfortunately, what I've come to realize is it was not a good decision for me personally. So I made more money.

Why was it not a good—

Yeah, I had no ability to make the changes that I was used to making. So, you know, in my private practice, I was used to making those decisions. I was like, wow, we need to change this. And it was able— I was able to change it. And, you know, when I was employed by the hospital and they owned my practice, I'd be like, gosh, you know, we need to change this. Like, well, we're gonna have a meeting about considering about maybe having a meeting about changing some things. You know, 9 months down the road, nothing had changed and I was still pulling my hair out. And it was like, you guys, this is, this is A, important for patients, and B, this system doesn't work for the doctors. You're just making me do more work with less time, less resources, and I still get paid the same. Oh, and by the way, I've got to do it faster because we have to see more patients. And so it was It was really unacceptable. And I think that was the perfect storm for me to have less autonomy, less ability to make change, to do what I thought was a good job for my patients, and still having this onslaught of work. I was dying. Plus, I was taking call in the middle of the night, and I had a small child. So it was just not conducive to life.

Yep.

I walked out. The joke is, I talked to my friend. He's like, well, you have to have diagnosis. I was like, well, I can't do that. That's not going to work out. And so I went to Togo's to get a sandwich and I ran into my nurse who was on maternity leave. And that was also part of it is my systems that I had created to survive the system of medicine was partly my nurse and she was on maternity leave. And so all my systems Kind of broke down, and it was unacceptable. I couldn't do all the work and see all the patients and not be able to be in charge of changing things that needed to be changed. So at Togo's, I said— she's like, um, what are you doing here? Don't you have patients? I said, well, funny story, um, I walked out. I quit. I'm not gonna do this anymore.

She was like, okay, that No, you didn't have a plan of what you were gonna do.

Yeah.

You didn't have a plan of what you were gonna do. You just walked out, right?

Yep. Zero plan.

Zero plan.

I don't know, I'm gonna go sell flip-flops on the beach, something else, because, um, this is not working. I, I can't do this. So, um, luckily—

By the way, Ariana, how many, how many doctors do you think identify with that? How many, how many in your field do you think Probably, I would say at least half.

Half of the doctors in the United States at this time probably feel like that, where they don't want to go to work, that they're dying inside, and you don't know what else to do.

And we're talking repetitive, not just like a day, like, I don't want to go to work, right? We're talking about 4, 5, 6 months, 12 months at a time, right? Constant, right? Yeah. Years. Okay.

Terrible. It is soul crushing. Yeah. Um, yeah, still, I like, I still think about it. It's like, oh God, that was awful. Just to think back, it's like how miserable it's like, I, I went to school forever. This was my passion. This is what I wanted to do. And it was awful. And I had no way out. Even when I thought I was going to take a sabbatical, I didn't even know what that meant. But I, I thought that could be a, you know, a viable thing. And then to turn out that I have to have a diagnosis. To take time off? Like, really? And I looked at my contract and true enough, that's— that was my contract. Um, and so I was like, oh my gosh, what am I gonna do? So luckily I—

So yeah, what happened? So, okay, so we leave, we do the mic drop, we're out, we're gonna go sell flip-flops. Yeah.

Yes. So my office staff who I had hired previously and then joined the hospital, they all got together and they were like, oh boy, this is This is bad. And they came up with a plan for me to work. And they said, hey, we have a plan. How does this sound? How about you just work 2 half days in the morning, just patients, 2 half days in the morning. And we know you have some surgeries scheduled for the next 6 weeks, and then don't schedule any more surgeries. Close your practice to new patients. Don't take any new patients. And then let's just see how this goes. I was like, ooh, one day of surgery, 2 half days in the morning. I could do that. Okay, I'll say yes. And so I did that and I was like, this is crazy. I'm going to go broke. Whatever. I don't care. We can at least do this and at least serve my patients and see how this goes. And I did that for 9 months. I had my— my practice was closed. I did not see new patients. I finished out my surgeries. And then I kept waiting for the administration to be like, oh, hey, excuse me, we've noticed that your revenue has dropped. Is everything okay? And nothing happened.

So the hospital never called and said, hey, we're here. You're having a bad time. You're burnt out. We're worried about your mental health. Because, yeah, God forbid you should be treating patients and in surgery if your mental health isn't totally screwed on, right?

I mean, right.

Fascinating.

I mean, yes. So, and people are like, well, that's not safe. And we've been trained to compartmentalize since the time we got to medical school. Um, you know, doctors have been trained to shove aside any personal needs, anything that's going on, and compartmentalize that, shove that aside, and, and focus on the task at hand. And we're really good at that, unfortunately. But ultimately, I think it's been ingrained in us and we care so deeply for our patients that we do shove aside our own needs to be able to care for our patients. And that's kind of been our contract with society is like, you suffer and Then, and take care of patients, and, and then you get to be a doctor. Um, and oh, by the way, we don't think as highly of you anymore because, um, we think that you're in charge of not getting the care because the insurance companies have, uh, you know, not allowed it. And somehow we're supposed to like fix that. Um, but with no autonomy, no ability to make any change whatsoever. So we just put our heads down and like work really hard and hopefully it'll— get better somehow, but it didn't.

All right, so let's— so you do this 9 months. What's going on during this 9 months? You took work during 2 half days, 1 day of surgery. What are you doing in the interim? Because I would imagine that was like kind of strange to have that much time, because when was the last time you ever had that much time? Like never?

Yeah, um, college.

So what'd you do?

I was like—

College.

Yeah, um, so yeah, I was, I was taking care of myself. I was running, I was working out, I was working 40 hours a week, which is amazing. That was so amazing. But I was kind of panicked because I didn't know what to do. I was like, what am I going to do? What am I going to do? That was like my mantra. I'd run every day and be like, what am I going to do? I have no idea. And so I kind of— a light bulb hit and I was like, I need to do orthobiologics. I think that is going to be how I change my patients' lives, that this is going to be the next new thing. And this is what I'm going to do Is I'm going to focus on orthobiologics. And so I started looking and I started trying to get really smart on how to do orthobiologics in a really, really good way and focus on that only and more of a non-operative clinic. And because I was doing a lot of surgery, I was feeling really exposed. And it was really clear to me that nobody cared if I felt exposed or not because no one had checked. to make sure I was actually above water. And so I started looking and I couldn't really figure out how to get smart on orthobiologics. I searched, I looked, and I found some education with the Interventional Orthobiologics Foundation, IOF, and I started to go to the conferences. And my first IOF conference, my brain exploded. I was like, Oh my gosh, oh my gosh, there is this whole other world and whole other way to care for patients and to get really good results without surgery, without invasive procedures, without high risk, and oh yeah, by the way, without downtime. And there's a ton of research. In the orthopedic world, we have been ingrained, it's been ingrained in our head that there's no research, there's no data, there's no evidence that that works at all. It's pixie dust. dust and, you know, magic, uh, you know, that's bullcrap. Uh, we don't do that.

And this is, this is like 5, 6 years ago when basically in the world of orthobiologics it was kind of like— I, I liken it to the Oregon Trail days, right? Like there was, you know, nothing but pioneers. There's a bunch of people out there just kind of trying to find their way through. Like this was real at the beginning, at the real beginning stages of, of orthobiologics, right?

I mean It was in the beginning. There was a lot of very smart people doing lots of really good work and research. It just wasn't in my realm. I did— I was not aware of it. I didn't know it existed. It does exist. It is real. People all over the world are doing amazing research, and this has been a real thing for a bit. It just wasn't in my realm. And so I was like, oh my God, this is the best thing ever. Yes, I'm all in. And that's what I did. And I started a cash practice. I was a little bit nervous, but I did it one day a week. I said, okay, well, we're gonna do this and I'm gonna do it one day a week and see how this goes. I rented one room and I had my nurse who was the one who was on maternity leave, she joined me one day a week. And I didn't even have a lobby. There was a lobby of the building that we were renting. And so I had a receptionist who I had hired. She was just out of high school and she was very smart, but, you know, this was humble beginnings. And so she would make the appointments on her cell phone and she had a little laptop and she would like meet the patient at the door and be like, oh, hello. Hi, how are you? And let's sit here in this lobby and let me get your information and then let me take you back to our treatment room. The one— We only had one. So, you know, she'd bring her back and we'd do the treatments and we do all— we do the interview. And then at the end of their therapy, I take their credit card. I had a little Square reader that I hooked up to my phone, I think, and took their money.

Right now there's a bunch of doctors short circuiting in their brain about all of this. Like, where's the big machine? Where's the massive computer system? Where's the EMR?

Yeah, no, it was the craziest thing. I was like, oh my gosh, this is really like, you come, I take care of you, I see what the problem is, and I take a long time and you pay me for my time and my expertise and we hang out and talk. Like, my appointments were 1 hour long. And so we would just get— I would get to know them, they'd get to know me, they trusted me that like I had Some treatments that sounded really interesting and helpful with low downtime, and potentially they could avoid surgeries. And we did the treatments, and then they paid me the money, and then they got better, and it was really cool. And this is word of mouth, and I did it one day a week, and I did it for a whole year. And then I'm like, I think this might work.

Actually work.

This might be viable. And so I was very busy in the summer. So I actually quit my 40-hour-a-week orthopedic surgery job that was quite lucrative, and I opened up my orthobiologics clinic in 2019, right before pandemic. It was great timing, but it worked out because I had my ability to make changes. When the pandemic hit, I just switched to telehealth online. services. And when, you know, when we were shut down and nobody could have surgery, people were still having orthopedic problems and they could come to my clinic and they could have injection-based therapies and get better and I could help them and hone in on the why and spend time with them when nobody else was. And so it has been so rewarding, so amazing. I love my job. Am I working hard? Of course I am. I'm— I think I— that's kind of still ingrained in me, but I love it. And I have—

There's nothing wrong with working hard, right? There's nothing wrong with working hard, right? It's— but it's, it's doing it, doing it in a way that you can help your patients and have a great life. Like, you know?

Yep.

Um, so what is life— what does life look like now? What is— what does life look like today?

Yeah, so I have my orthobiologics clinic. Um, I don't— I made a decision when I opened that I was not going to take commercial insurance. I didn't believe in their business model, and I didn't believe that they were serving me or my patients. And so I made a conscious decision to not be in network with any of the commercial insurers. And so I don't take commercial insurance to this day. I'm still operating, I still do orthobiologics, but I don't take commercial insurance. And that has been really interesting. People come and see me and they're like, well, I heard you don't take insurance. I'm like, you're right, I don't. You can still come see me. That's a contract between you and your insurer. What you— if you choose to come see me, you can still see if they'll reimburse you, but that's not my purview. I don't want to have insurance companies between me and my patient.

Yeah.

I don't want them to be telling me and my patient what we can and cannot do. to improve their health and their lives. So, that's been really cool. I still take Medicare. It's a work in progress. I have toyed with that, but I think ultimately that is not something that I think is medically— I want to serve those patients. But ultimately, I haven't figured out how to not take insurance, the Medi-Cal, Medicare insurance. So I'm going to keep doing that. It's a horrible business decision, but from a moral perspective, I'm still going to do that. And, you know, those patients are the patients that I can serve with orthobiologics as well. So that's what I do. And I get to take a vacation and I get to make my own schedule and I get to teach and I get to do all of the things that I, um, like to do. I teach ultrasound-guided training. I teach orthobiologics. I, I get to consult with companies on how to make better products.

Mm-hmm.

And this is— this is the life that I think I was meant to live, is really contributing to the medical advancement and at a higher level than my patient level. I'm now able to effect change on a much bigger scale because we're doing things, these exciting new treatments.

Yeah.

We're actually changing the face of medicine and it's just, it's so exciting and so rewarding.

It really is.

Yeah, absolutely.

Yeah, it really is. It's fascinating to me because again, obviously, clearly I'm not a doctor, but being in the medical field since 2014, early 2014, to watch this evolution of the industry. And it's not just the evolution of the industry, but it's the evolution of the thinking of the doctors. You know, if you really think about where doctors were, let's say in the '50s and the '60s and the '70s, uh, some people call that the golden age of being a doctor. The doctors still had control over that patient-doctor relationship, you know?

Yeah.

And, um, and you, what's happened is it's gone. It's completely gone. And the only, in my view, the only way to get that relationship back is to opt out of the insurance system. What do you, what would you say to someone that is really struggling with the concept that, you know, their patients won't be able to afford it or their patients only will come see them if they have insurance? Because that's a pretty common question that we get in this industry. What do you say to doctors when they ask that?

Yeah, so it's really interesting. I didn't know how that was going to go. And, but, you know, obviously I did it anyways. But, and so I didn't know how that was going to go and what I've What I found is, number one, patients are on the short end of the stick from the insurance company. They are paying high premiums and high deductibles. So no matter what the heck they do, they're already on the hook for, you know, $5,000 deductible, $7,500 deductible, $10,000 deductible with insurance. And so they're, they're a little bit more used to paying money than we think they are. First of all.

Yep.

And then second, when they find out how little it actually costs to do medicine outside the insurance company's grasps, it's not expensive. And so I think people are always shocked when I tell them my surgery prices. They're like, that's it? It's like, yeah, that's it. Like, you should raise your prices. I'm like, I probably should. Thank you for that input. Um, but yeah, that's it. And so I think people are surprised, pleasantly surprised, but they're always nervous. Like, well, how much is this going to cost? And that's been something that I've gotten used to, but it was really disconcerting and hard at the beginning to like just spit out my prices. I was like, That's gonna be $1,500. And they're like, oh, okay. But I think some of the industries that have kind of paved the way that people have experience with all the time is the dental industry, where insurance, it doesn't really get you anything. And we're used to paying out of pocket anyways. And there's some higher ticket items that we choose, like veneers or those things. And people are used to paying that. The other one is the vet industry, right? Everyone has very expensive pets. And, you know, we were like—

I have 3 of them.

Yeah.

So it's like, they're very expensive.

You know, you go to the vet, you're like, oh, I need this. And you pay the money and you're like, okay, well, that was, that was the thing. That's, this is what we do is we pay the money for the services. And so I think when we talk, when I talk to people about that, And I'm like, oh, I take CareCredit. You're familiar with, for your dentist or your vet? They're like, oh yeah, we do that all the time. No problem. Same thing. We do that too. It's not an issue. I just wanna help you and for whatever makes sense. But I think that it's scary in theory, but I think until you talk to your patients, Mm-hmm. about money, you won't realize that people are already expecting to pay like $10,000. That's when they come in, they're expecting. And so if it's anything less than $10,000, they're like, okay, interesting.

Well, that's what the average family— so if a family has— 60% of Americans have what the government considers is a quality plan. I don't know what the heck that means, but whatever that is. Right. So they have a, they have a corporate company back, right? Right.

Right.

Something like that. The average family in America, their deductible out-of-pocket expenses for the year is $10,000.

Yeah.

10 grand.

Absolutely.

And, and I will tell you, so I will tell you, my wife has a very great plan. I tell this to my doctors all the time. And about 3 years ago, I had to have a prostate biopsy. Right. So did the MRI, did the bi— you know, and then had to do the biopsy. So I get the MRI done. And so I'm talking to one of my doctors and he has an open MRI machine. I said, how much do you make on an MRI? He said, I get paid $300 from the insurance companies on average. I said, really? I said, do you wanna know what my out-of-pocket expense was for my open MRI and my prostate? And he goes, what's that? I go, $1,300. He's like, what? And I said, I have great coverage. I had— my out-of-pocket expense was $1,300 and you got paid $300. He, his face got so red. We're actually transitioning that business. He has an open MRI machine. He's no longer taking insurance for it, and he's gonna charge $750.

Yeah.

Because that's a better deal for the patient.

Yeah.

Right? We did the research, like, and so my point is, is like, I've had, you know, I've had some heart, like, scans and all, you know what I mean? Just typical stuff that you go, my out-of-pocket, I mean, I'm dropping $3,000, $4,000 a year out of pocket, bare minimum. For just base, you know, for preventative care medical stuff.

Yeah.

So your patient will pay this. They're, they're paying it already, folks.

Yep. Like, absolutely.

Absolutely. And as frustrated as you are as a doctor, the patients are even more frustrated and ticked off. Totally.

Yep.

Like times 10.

They so are. And so they're feeling short, you know, shortchanged and they're getting shortchanged. They really are. When I talk to my patients, cuz I, I talk to my patients, I have the luxury of time. To talk to my patients. And I tell them and I educate them and they're like, when do you think insurance is going to cover orthobiologics? I said, gosh, I hope never because then they're going to dictate who can and cannot have these services. And it's going to be a race to the bottom and our reimbursement for services are going to go down, down, down, just like they have. And the cost of it is going to go up, up, up. And when they have to pay out of pocket and it's more expensive to pay out of pocket with the insurance than it is for cash pay, that is a problem. I had that same experience. I had an MRI and my out-of-pocket expense was more expensive than a cash pay product. And so I should have paid cash, but I thought I had good coverage and I was surprised by this bill. which was my out-of-pocket expense, and that was more expensive. I was like, what in the world? And so I called them and I said, well, you know, this seems really expensive. They're like, well, this is market value. And I live in a very rural environment. And I said, well, what market is that? And because we're, we're the only one. So we were— we're setting our own prices and we're gouging the patient. I mean, by we, Insurance companies and the hospital are setting their own prices and gouging the patient and making more money. Um, and the insurance company is taking a huge cut of that as well. And so the patient is suffering. So I actually, um, recommend cash pay for a majority of what people need because it's actually cheaper. It's less expensive for them to just pay cash.

Yeah.

than to actually go through insurance. In our training, we have been brainwashed and told that we just need to keep working, work harder, keep, uh, your head down, don't make a fuss. And we have been trained to put aside all of our needs and wants. We shouldn't have to go to the bathroom, we shouldn't have to eat lunch, And this is all done in the name of serving the patient. And we have been so brainwashed into serving the patient that we don't take care of ourselves. And, you know, there has been this contract with society where if we just go to school, do a good job, work really hard, learn everything there ever was to know about the human body and about medicine, That we would be rewarded down the line. And this is the, this is the contract with society that we've been sold. And then what happens is when we're out of residency and we've been working hard and we've been putting off all of our dreams, hopes for school, and, you know, we're now in our mid-30s and haven't started living yet because we've been in school. This is this arrival fallacy where you, you're like, if I just do this hard work, I'm gonna be happy. And then you arrive and you're like, wait, it's the same crap. I still can't go to the bathroom. I still can't eat lunch. I still can't have autonomy in my life and make decisions for myself. And I'm getting paid better, but that doesn't seem to make me any happier. This is definitely I think where most doctors start to question, what the heck did I do?

What?

How? How is this okay? And and when is this going to get better? And unfortunately, the answer is it's not. The system has made this so you will continue to work for the system, and there is no. Exit strategy until you die. And oh, by the way, doctors are really good at committing suicide, at killing themselves as a way out. And that is so, so terrible. And yet we feel stuck. I felt stuck. I was told I had to get a diagnosis to not have— not be able to work. And that was in my contract with my hospital, that I had to have— a diagnosis of depression or, you know, some other medical problem and just to not— to take a break. That is not okay. And I think that doctors really need to understand that this contract, not only with society but with their hospital, but more the society, is broken. We are expected to work work for free. We are expected to put aside all of our needs to, quote, serve the patient, understanding that we're humans. We, we do need to take care of ourselves. We need to sleep. We need to eat well. We need to rest. We need to be paid for our time and our expertise and to have a, a livable life. And if We don't have our bare minimum needs met, we're going to continue down this road where we are now, where 50, 60, 70% of doctors are not well. They're burnt out. They, they have this moral injury. They have this apathy because they can't even take care of themselves. They have not been allowed. We've been sold this bill of goods that is Broken. And I think the way to break out of this is to take back your autonomy. We are smart people and we can do this. People tell me all the time, oh, I don't know about business. I don't know anything. I'm like, good Lord, you are a doctor. You are smart. You can read a book. It's not too hard. Insurance companies and the hospitals have led us to believe that we're not smart enough to understand business. And that's just not true. Everybody can have a business. Look at all the small business owners in our— in your city, in your block, in your neighborhood. They're smart people too, and they seem to be doing just fine. And so if you can read a book on cardiology and electrophysiology and all these things, I'm pretty sure you can read a book on how to do a good job in business. This contract with society You know, I get it all the time. They're like, oh, well, you're a doctor, you're rich, you can afford it. And I'm thinking, have you looked at my bank account? I mean, honestly, the only reason that we're still above water is because we work, you know, twice as hard as the next person just to stay above water. And I think that is a fallacy, and that's that social contract where, you know, If we do all the hard work, we will be compensated. And maybe historically that was true, but once insurance companies got into the middle of that and started taking from both sides, from the patient and from the doctor, and our reimbursements have gone down, down, down, down, down, that if I were only to take Medicare as a payer, I would not be able to keep my doors open. I get paid so little from Medicare that I can't actually pay my rent, pay my employees, pay myself a reasonably low salary. When you look at salaries across the board, I can't even pay myself a normal salary if I were only to take Medicare. I cannot take— I can't keep my doors open. I can't pay my medical My medical loans, you know, to go to medical school is a pricey endeavor, and that we have been locked out. You know, everyone's getting their their loans forgiven, and doctors are not. You know, both me and my husband have loans in the in the area of $250,000 worth of loans. How do you repay that? And then also. Live your life, you know, have a normal life, not even like an extravagant life, just a normal life where you can like drive your car and have a house and do those things. So I think it's completely false and I am always blown away. Like, where do you think this money comes from? Because I am not rich. I do not have money. You know, I do not have a jet. I do not have all these things. And so I think the society's contract is broken, and they have expected that— they think we're getting well compensated when I think where that money is going is the insurance companies. You know, I get paid 9% of the fee. The surgeon's fee is 9% of the cost of surgery. 91% does not go to me, even though I have all the risk and all the expertise. I get paid 9%. So for a knee replacement, my pay is $1,500 for a knee replacement, and that includes the preoperative visit, the surgery, and 90 days after surgery are all included in that price. Yeah, I've actually learned that. Unfortunately, I've learned that lesson, you know, relying on the systems of people, not processes, to be able to sustain a really high volume of patients. And so I was relying on people for a lot of things, and when one person goes out or on maternity leave or they are sick of their job and quit, I've invested all this time and effort on this person, and then I'm dead in the water. When this person leaves, I have no ability. And unfortunately, maybe I'm a little bit of a slow learner because I actually The way that that works, I did that again in my other business, in my cash business. I had a scribe, and this was an in-person scribe, and I relied on him quite heavily. And unfortunately, he left and left me high and dry. And literally, I was dead in the water. I was like, oh my gosh, I relied on this person for so many of the processes that they did, I was really, really stuck. And the mother of, you know, necessity is the mother of invention. And so I started to make decisions for my business that I was going to have not the person, but the process. I was that, and this is my first endeavor into AI, where I said, gosh, I need an AI scribe that doesn't get sick, that doesn't leave me, that I can just, turn on and turn off. And so I've had an AI scribe for the last 18 months, uh, maybe 2 years, and it's been really fantastic. And that has really clarified how I build my systems to not rely on any one person. And that has really strengthened my business and given me peace of mind that I'm not relying on one single person to do my business. I have, I have systems systems that any one person can do. And if that one person leaves or is sick or is on maternity leave, all of my other people can do that process and that system. We just plug and play. And so that has been something that I've had to learn the hard way, but I think it is a better opportunity if it's set up for you and say, Okay, this is the system, not the person. So I met Matt at the beginning of this year, and Maverick Profit Systems has helped me to really clarify my business and be able to Have a plan to go forward and really be able to scale my business and not have it rely on me. More of a system that can go and serve my patients without being constrained by the fact that there's only one of me. And so it's been really exciting and to be able to have my employees excited about taking care of the patient, buying in, and feeling really valuable to the company to help our patients. And so we have this one mission to help our patients return to their active lifestyle by any means necessary. And that includes orthobiologics, that includes weight loss, that includes diet and exercise, That includes talking about stress relief and sleep and all of these things that help with health. And Matt has been so instrumental in allowing my business to serve my patients at such a higher level because I am able to charge what I'm worth be paid for my time, have the luxury of time with my patients to really get to know them and know what they need and how I can serve them best. And so that's been so great. And I'm sustainable. I'm not going to be underwater. I can keep my doors open and continue to serve my patients in this really, really deep fashion that actually Is, is embracing health instead of this band-aid, cortisone, medicine, fix it quick, cover up the problem. We're getting to that root cause. We're getting to the reason why we're experiencing poor health, and then we're fixing it. We are super excited about having this new event, this Business of Orthobiologics event, where we are marrying how to get really smart about orthobiologics and how to get really smart about business. And this is a 2-day event where at the end of the 2-day event, you're going to be having actionable steps to start on Monday to be able to dip your toe in the water. You don't have to change your practice, you don't have to change your business, but you're gonna be able to start down that path of freedom, to be able to have plan B. When your contract is not renewed, when you get sick of doing the hamster wheel and doing what you've always done, for what, for why, you now have an ability to go home and say, you know what? This is it. This isn't as scary. I have steps I can take. I know what to do. You know, I have been able to have a cash practice, but it wasn't super easy. It took a lot of like trial and error and like, I don't know what to do. Let me read this Business for Dummies book. It's going to be great. And so what I did is I have a program, it's an online program, and it basically walks you through the steps steps of how to establish a cash practice in very, very simple terms. It doesn't have to be big. It doesn't have to be this huge burgeoning practice. It's a tiny little micro practice that you can then scale up or scale down depending on your situation. And it's like an add-on, a plugin if you will, to what you're already doing. You don't have to reinvent the wheel. And then To add all of Matt's expertise and knowledge on the things that we don't know. We didn't go to business school. And to have a 30-day plan, a 60-day plan, 90-day plan, a roadmap of how to do this very, very easily, very simply, and also how to do a really great job with orthobiologics and get really great results for your patients. This is just— this is why I want everybody who's thought about doing orthobiologics, cash practice, how to do it, we don't know, we have the answers and come join us. This is a live event. This is going to be super exciting.

Well, here's one of the big challenges in the industry. You want to learn a new skill, right? And so you sign up and you go to an event, right? There's tons of events that you can attend. every single year. And there's, there's a lot of great events, right? Um, you go to IOF, you go to TOBI, you go to Ortho Sono, you whatever, right? AAO, you know, AOM, whatever the organization is, right? And they're all fantastic events. And what they do is they teach you all the medical stuff. Like every 12 minutes there's another doctor coming up talking about how they do in their injections and they use this size needle and they, they do this and they do that and they stand on their left leg and they, you know, they only inject with their left thumb or their right, like all this stuff, right? I'm kind of exaggerating. Right? But they talk about all these really cool things that they're doing and what the patient— the patient's getting this result and it's all science-based and you all sit there and you geek out. Your eyes get big as saucers. Oh yeah. Hey, we gotta just— let's do a double spin rate and let's do it during the full moon because it's gonna give us the biggest platelet count, right? Like it's so cool, right? Here's the problem. No one teaches you how to make money. No one shows you how to take that back into your practice on Monday and turn that into cash. Okay? And here's the problem that most doctors have, and I'm gonna suspect— I'm gonna guess that you have, is that you sit there and you say, wow, I don't really wanna talk about money, you know? And so what happens is you, during the breaks, you talk to your other doctors and you say, well, what do you charge for PRP? What do you charge for PRP? And everybody goes, I charge $650 or $750. And, and maybe if you're really smart, you go, well, how did you come up with that price? And the other doctors go, well, you know, it just kind of felt right. So I want to make— I want to, I want to paint this picture for you. You are getting your pricing structure from a bunch, from a bunch of other broke doctors who can't make payroll, right? And this creates a massive problem for you because your guide on how to set your pricing, your guide on how to run your practice, your guide on how to structure the schedule, the guide on how to talk to the patient about the money is just as broke as you are. And so this is like getting weight training from a fat person. This is like, this is like going to a weight loss center where everybody on staff is morbidly obese and they're gonna teach you about weight loss. That's what this is. And so you don't have the right guide. And so at this event, what's gonna happen is you're gonna get the medical science part of it from Ariana for 2 days, okay? Ariana's gonna do 8 1-hour sessions. I'm gonna do 8 1-hour sessions. And what we're gonna do is after Ariana talks, I'm going to show you how to take that information and turn that into cold hard cash. Just like there is a system of process, a system and a process to do orthobiologics, there's a system and a process and a step-by-step process for you to be able to make money. This is how all of my clients, every single one of them, the average client that I work with in the first 90 days adds an average of $65,000 of new cash revenue to their practice. Okay? I'm not talking about marketing Facebook ads. I'm not talking about anything like that. We're talking about you getting paid what you are worth, at least beginning on the journey. Our average client is doing $100,000 a month within 6 months. Our average client within 1 year is leaving insurance and they're averaging $150,000 a month. And that can be you. And the reason why is just like there's a science and a process to doing a regenerative procedure or the biologics procedure, there's a science and a process for making your business work for you and the lifestyle that you want so that you can have the life that you want, your patients can have the results that they want, and you can be a pillar of the community not just in their eyes but a pillar of the community financially as well. And so no one else is doing this, and every person that I talk to, all the manufacturers, all the device manufacturers, everybody that I've talked to, they realize that this is needed. And so we're gonna change the way the industry is done. Our goal is really simple, is to help 100,000 doctors get free worldwide from insurance-based care. It's simple because the insurance companies, this deal isn't getting any better for you. They're gonna continue to screw you. You know why? Because they just look at you as a dumb old doctor. They don't care about you. They can spit you out. There's another round of doctors coming down the path from medical school that they can sell the scam to. So take, take back control and you can be in control of what you want. You have to be in Dallas September 29th and 30th. If you are sick and tired of being treated like crap, if you are sick and tired of being treated like a used tissue that's wadded up and thrown on the side of the road to be blown away in the wind, you want to get back to being a doctor again, get to Dallas. And we're going to teach you the business, we're going to teach you the science, and we're going to get you on the path to freedom.